HomeMy WebLinkAboutA-16-691 CLFA Consumer Family Advocacy Svcs.pdfBoard Agenda Item 26
DATE:December 13, 2016
TO:Board of Supervisors
SUBMITTED BY:Department of Behavioral Health
SUBJECT:Agreement for Consumer/Family Advocacy Services
RECOMMENDED ACTION(S):
Approve and authorize the Chairman to execute an Agreement with Centro La Familia Advocacy
Services for consumer/family advocacy services and coordination of supportive collaborations,
effective January 1, 2017, not to exceed four and one-half consecutive years, which includes a two and
one-half-year base contract and two optional one-year extensions, total not to exceed $511,056.
Approval of the recommended action will allow the Department of Behavioral Health to provide culturally
sensitive consumer/family advocacy services through Centro La Familia Advocacy Services (CLFAS) for
persons experiencing first onset serious mental illness or serious emotional disturbance in the County. CLFAS
was selected following a Request for Proposals (RFP) for consumer/family advocacy services. The
recommended Agreement will be financed with Mental Health Services Act (MHSA) Prevention and Early
Intervention (PEI) funds, with no increase in Net County Cost.
ALTERNATIVE ACTION:
Non-approval would leave underserved and unserved target populations without advocacy, outreach and
education services needed to empower them, improve their well-being, and help them navigate the mental
health system of care. These populations have been documented in mental health studies and through US
Census analysis to have low levels of access and/or use of mental health services. Many individuals will not
seek mental health services through traditional methods and need education, guidance, and service linkages
provided by consumer/family advocacy services resulting in a possible escalation of a consumer’s mental illness
symptoms and referrals to hospital emergency departments.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. Services are fully funded by
MHSA PEI funds. The FY 2016-17 cost is $56,784 (January 1, 2017-June 30, 2017); $113,568 annual maximum
cost for FYs 2017-18 through 2020-21; and $511,056 for the term. Sufficient appropriations and estimated
revenues are included in the Department Org 5630 FY 2016-17 Adopted Budget and will be included in future
budget requests for the contract term. Total expenditures will be determined by actual services provided.
The recommended administrative costs for FY 2016-17 are at 8.1% as compared to the total budget, and at
6.3% as compared to the total budget for remaining fiscal years 2017-18, 2018-19, 2019-20, and 2020-21. The
recommended employee benefits costs for each FY are at 29.4% as compared to the total salaries. The
benefits calculation includes the full amount of employee health and retirement costs, life insurance, payroll
taxes, State disability and unemployment insurance. Based on similar contract services, the percentages are
both reasonable and necessary for the administration of the program.
Page 1 County of Fresno File Number: 16-1482
File Number: 16-1482
DISCUSSION:
Under the provisions of MHSA, county mental health departments receive funding to provide services to
underserved and unserved populations who may be experiencing a first break in mental illness. These
populations include, but are not limited to, rural and suburban communities of all ages and ethnicities such as
Latinos, African American, and Southeast Asians. Mental health PEI consumer/family advocacy services were
initiated through the consumer/stakeholder process and approved by the State Department of Health Care
Services (DHCS) as part of the MHSA Three-Year Plan. Funding provides services that include community
based:
·outreach;
·suicide prevention, mental wellness and anti-stigma education; and,
·system navigation services; and, linkages to services.
Services are delivered in the community clients and their families frequent, such as in their homes, places of
worship, community center and schools. Services embody:
·community collaboration;
·cultural and linguistic competency;
·individual/family driven values;
·a wellness/recovery focus;
·integrated services; and,
·performance outcomes based.
The program is instrumental in helping clients and their families navigate mental health systems of care to
access services they may not be aware of, are unable to access, or are reluctant to seek out. Through these
services, the clients shall learn to depend less on costlier crisis services such as emergency departments, and
minimize or avoid more severe outcomes such as substance abuse, hospitalization or incarcerations.
Prevention involves reducing risk factors or stressors, building protective factors and skills as well as increasing
support. Prevention also promotes positive cognitive, social and emotional development and encourages a
state of well-being that allows the individual to function well in challenging circumstances. Early intervention is
directed toward individuals and families for whom a short-duration (up to one year), relatively low-intensity
intervention is appropriate to measurably improve a mental health problem or concern very early in its
manifestation, thereby avoiding the need for more extensive mental health treatment or services; or prevent a
serious mental illness or serious emotional disturbance from escalating.
Consumer/Family Advocacy services are available for consumers and their families experiencing a first break of
mental illness or early onset of a crisis. Advocates:
·provide mental illness and recovery education to the family and community;
·assist the family and consumer in navigating the mental health systems of care available in the
community;
·help build resiliency and de-escalation techniques in the family in an effort to prevent future mental
health crisis that requires involuntary psychiatric assessment; and,
·coordinate and collaborate with other community providers, including the County, to ensure
staff/providers and community members are aware of, and able to access appropriate and available
services.
On August 31, 2016, RFP No. 17-013 was released by the Department and County Purchasing seeking a
provider(s) for consumer/family advocacy services effective January 1, 2017. The RFP closed on October 5,
2016 and resulted in one response. The bid was reviewed by an evaluation committee comprised of five
Department members: Senior/Fiscal Staff Analyst; Clinical Supervisor, Older Adult Services; Clinical Supervisor,
Children and Family Services; Community Mental Health Specialist; and a Utilization Review Specialist. The
Page 2 County of Fresno File Number: 16-1482
File Number: 16-1482
evaluation committee determined the response met the requirements for services sought and unanimously
recommend agreement award to Centro La Familia Advocacy Services.
Centro La Familia Advocacy Services is currently providing, and has provided consumer/family advocacy
services under contract with the County since July 1, 2011, with satisfactory performance outcomes. Outcomes
reported for FY 2015-16 include 2,106 individuals served at a cost of $52.71 per client, with 88% of the clients
reporting high satisfaction with services provided. Services were provided in suburban and rural areas of Fresno
County, including, but not limited to, Mendota, Riverdale, Sanger and Kerman.
Upon approval by your Board, the agreement would be effective January 1, 2017 through June 30, 2019, with
an option for two additional one year terms dependent upon satisfactory performance outcomes and available
funding. The agreement differs from the standard agreement of five years (three-year base with two optional
one-year extensions) due to services beginning mid-fiscal year (January 1, 2017) and the desire to align the
contract term with the end of the fiscal year. The previous RFP (952-5411) issued on February 4, 2016 for
services effective July 1, 2016 did not result in a recommended award. On May 24, 2016, Amendment I to
Agreement No. 11-338 was approved to extend the agreement through December 31, 2016 to ensure there was
no break in service while another RFP (17-013) process was completed.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was made aware of the recommended Agreement during the November 23, 2016
meeting.
REFERENCE MATERIAL:
BAI# 39, May 24, 2016
BAI# 42, May 24, 2011
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with Centro La Familia Advocacy Services
CAO ANALYST:
Sonia De La Rosa
Page 3 County of Fresno File Number: 16-1482
12345678910111213141516171819202122232425262728AGREEMENTTHISAGREEMENTismadeandenteredintothisdayof,2016,byandbetweentheCOUNTYOFFRESNO,aPoliticalSubdivisionoftheStateofCalifornia,hereinafterreferredtoas“COUNTY,”andCENTROLAFAMILIAADVOCACYSERVICES,whoseaddressis302FresnoStreet,Fresno,California,hereinafterreferredtoas“CONTRACTOR.”WITNESSETH:WHEREAS,COUNTY,throughitsDepartmentofBehavioralHealth(DBH),PreventionandEarlyIntervention(PEI)componentoftheMentalHealthServicesAct(MHSA),andthroughinputfromthecommunitystakeholderprocess,recognizestheneedtoprovideConsumer/FamilyAdvocacyservices,asspecifiedinthisAgreementandaspartofFresnoCounty’sapprovedStatePEIPlan,tohelpreducestigmaanddiscriminationagainstmentalillnessbytheprovisionofConsumer/FamilyAdvocacyservicesandcoordinationofsupportivecollaborations,includingsupport,education,andempowermenttoclientsandtheirfamilies;andWHEREAS,CONTRACTORisqualifiedandwillingtoprovidesaidservicespursuanttothetermsandconditionsofthisAgreement.NOW,THEREFORE,inconsiderationoftheirmutualcovenantsandconditions,thepartiesheretoagreeasfollows:1.SERVICESA.CONTRACTORshallperformallservicesandfulfillallresponsibilitiesasidentifiedinCOUNTY’SRequestforProposal(RFP)No.17-013datedAugust31,2016,AddendumNo.One(1)toCOUNTY’SRFPNo.17-013datedSeptember19,2016(hereinaftercollectivelyreferredtoasCOUNTY’SRevisedRFPNo.17-013),andCONTRACTOR’SresponsetoRevisedRFPNo.17-013datedOctober5,2016,allincorporatedhereinbyreferenceandmadepartofthisAgreement.Intheeventofanyinconsistencyamongthesedocuments,theinconsistencyshallberesolvedbygivingprecedenceinthefollowingorder:1)tothisAgreement,includingallexhibitsandallamendmentsthereto,2)totheRevisedRFPNo.13-013,and3)toCONTRACTOR’SresponsetotheRevisedRFPNo.13-013.AcopyofCOUNTY’SRevisedRFPNo.17-013andCONTRACTOR’SIII-1-COUNTYOFFRESNOFresno.CA
12345678910111213141516171819202122232425262728responsetheretoshallberetainedandmadeavailableduringthetermofthisAgreementbyCOUNTY’SDepartmentofBehavioralHealth(DBH)ContractsDivision.B.CONTRACTORshallperformallservicesandfulfillallresponsibilitiesassetforthinExhibitA“ScopeofWork”attachedheretoandincorporatedhereinbythisreference.2.TERMThistermofthisAgreementshallbecomeeffectiveonthefirstdayofJanuary,2017,throughandincludingthe30thdayofJune,2019.ThisAgreementmaybeextendedfortwo(2)additionalconsecutivetwelve(12)monthperiodsuponwrittenapprovalofbothpartiesnolaterthanthirty(30)dayspriortothefirstdayofthenexttwelve(12)monthextensionperiod.TheDirectororhisorherdesigneeisauthorizedtoexecutesuchwrittenapprovalonbehalfofCOUNTYbasedonCONTRACTOR’Ssatisfactoryperformance.3.TERMINATIONA.Non-AllocationofFunds-ThetermsofthisAgreement,andtheservicestobeprovidedhereunder,arecontingentupontheapprovaloffundsbytheappropriatinggovernmentagency.Shouldsufficientfundsnotbeallocated,theservicesprovidedmaybemodifiedorthisAgreementterminatedatanytimebygivingCONTRACTORthirty(30)daysadvancewrittennotice.B.BreachofContract-COUNTYmayimmediatelysuspendorterminatethisAgreementinwholeorinpart,whereinthedeterminationofCOUNTYthereis:1)Anillegalorimproperuseoffunds;2)AfailuretocomplywithanytermofthisAgreement;3)AsubstantiallyincorrectorincompletereportsubmittedtoCOUNTY;4)Improperlyperformedservice.InnoeventshallanypaymentbyCOUNTYconstituteawaiverbyCOUNTYofanybreachofthisAgreementoranydefaultwhichmayothenexistonthepartofCONTRACTOR.NeithershallsuchpaymentimpairorprejudiceanyremedyavailabletoCOUNTYwithrespecttothebreachordefault.COUNTYshallhavetherighttodemandofCONTRACTORrepaymenttoCOUNTYofanyfundsdisbursedtoCONTRACTORunderthisAgreement,whichinthejudgmentofCOUNTYwerenotexpendedinaccordancewiththetermsofthisAgreement.CONTRACTORshall-2-COUNTYOFFRESNOFresno.CA
12345678910111213141516171819202122232425262728promptlyrefundanysuchfundsupondemandoratCOUNTY’Soption;suchrepaymentshallbedeductedfromfuturepaymentsowingtoCONTRACTORunderthisAgreement.C.WithoutCause-Undercircumstancesotherthanthosesetforthabove,thisAgreementmaybeterminatedbyCONTRACTOR,COUNTYorCOUNTY’SDBHDirectorordesignee,uponthegivingofsixty(60)daysadvancewrittennoticeofintentiontoterminate.4.COMPENSATIONA.ThemaximumcontractamountunderthisAgreementfortheinitialsix-monthterm(January1,2017throughJune30,2017),shallnotexceedFifty-SixThousandSevenHundredEighty-FourandNo/100Dollars($56,784.00)assetforthintheBudget,attachedheretoasExhibitCandincorporatedhereinbyreference.ThemaximumcontractamountunderthisAgreementforeachtwelve-monthterm(July1,2017throughJune30,2018;July1,2018throughJune30,2019)andeachtwelve-monthextendedterm(July1,2019throughJune30,2020;andJuly1,2020throughJune30,2021)shallnotexceedOneHundredThirteenThousandFiveHundredSixty-EightandNo/100Dollars($113,568.00)assetforthintheExhibitC.B.InnoeventshallthemaximumcompensationamountunderthisAgreementforalltermscombined(January1,2017throughJune30,2021)exceedFiveHundredElevenThousandFifty-SixandNo/100Dollars($511,056.00).C.ItisunderstoodthatallexpensesincidentaltoCONTRACTOR’SperformanceofservicesunderthisAgreementshallbebornebyCONTRACTOR.IfCONTRACTORshouldfailtocomplywithanyprovisionofthisAgreement,COUNTYshallberelievedofitsobligationforfurthercompensation.D.PaymentsshallbemadebyCOUNTYtoCONTRACTORinarrears,forservicesprovidedduringtheprecedingmonth,withinforty-five(45)daysafterthedateofreceiptandapprovalbyCOUNTYofthemonthlyinvoicingasdescribedinSectionFive(5)herein.PaymentsshallbemadeafterreceiptandverificationofactualexpendituresincurredbyCONTRACTORformonthlyprogramcosts,asidentifiedinExhibitC,intheperformanceofthisAgreementinaccordancewithExhibitA,andshallbedocumentedtoCOUNTYonamonthlybasisbythetenth(10th)ofthemonthfollowingthemonthofsaidexpenditures.-3-COUNTYOFFRESNOFresno,CA
12345678910111213141516171819202122232425262728E.COUNTYshallnotbeobligatedtomakeanypaymentsunderthisAgreementiftherequestforpaymentisreceivedbyCOUNTYmorethansixty(60)daysafterthisAgreementhasterminatedorexpired.F.Allfinalinvoicesand/oranyfinalbudgetmodificationrequestsshallbesubmittedbyCONTRACTORwithinsixty(60)daysfollowingthefinalmonthofservicesforwhichpaymentisclaimed.NoactionshallbetakenbyCOUNTYoninvoicessubmittedbeyondthesixty(60)daycloseoutperiod.AnycompensationwhichisnotexpendedbyCONTRACTORpursuanttothetermsandconditionsofthisAgreementshallautomaticallyreverttoCOUNTY.G.TheservicesprovidedbyCONTRACTORunderthisAgreementarefundedinwholeorinpartbytheStateofCalifornia.IntheeventthatfundingfortheseservicesisdelayedbytheStateController,COUNTYmaydeferpaymentstoCONTRACTOR.TheamountofthedeferredpaymentshallnotexceedtheamountoffundingdelayedbytheStateControllertoCOUNTY.TheperiodoftimeofthedeferralbyCOUNTYshallnotexceedtheperiodoftimeoftheStateController’sdelayofpaymenttoCOUNTYplusforty-five(45)days.5.INVOICINGA.CONTRACTORshallprovideinvoicesasdescribedbelowtoCOUNTYbythetenth(10th)dayofeachmonthforthepriormonth’sexpenditures,toDBHInvoices@co.fresno.ca.us.InvoicesandreportsshallbeinsuchdetailasacceptabletoCOUNTY’SDBH,asdescribedinSectionFive(5)andinSectionTwelve(12)oftheAgreement.Additionally,invoicesandsupportingdocumentationmaybemailedto3133NorthMillbrook,Fresno,CA93703,Attention:Consumer/FamilyAdvocacyContractAnalyst.Noreimbursementforservicesshallbemadeuntiltheinvoiceandreportisreceived,verifiedandapprovedbyCOUNTY’SDBH.B.AtthediscretionofCOUNTY’SDBHDirector,ordesignee,ifaninvoiceisincorrectorisotherwisenotinproperformorsubstance,COUNTY’SDBHDirector,ordesignee,shallhavetherighttowithholdpaymentastoonlythatportionoftheinvoicethatisincorrectorimproperafterfive(5)dayspriornoticetoCONTRACTOR.CONTRACTORagreestocontinuetoprovideservicesforaperiodofninety(90)daysafternotificationofanincorrectorimproperinvoice.Ifaftertheninety(90)dayperiod,theinvoice(s)isstillnotcorrectedtoCOUNTYDBH’ssatisfaction,-4-COUNTYOFFRESNOFresno.CA
12345678910111213141516171819202122232425262728COUNTY’SDBHDirector,ordesignee,mayelecttoterminatethisAgreement,pursuanttotheterminationprovisionsstatedinSectionThree(3)ofthisAgreement.Inaddition,forinvoicesreceivedninety(90)daysaftertheexpirationofeachtermofthisAgreementorterminationofthisAgreement,atthediscretionofCOUNTY’SDBHDirector,ordesignee,COUNTY’SDBHshallhavetherighttodenypaymentofanyadditionalinvoicesreceived.C.CONTRACTORshallprovideamonthlyactivityreportwitheachinvoice,furtherdescribedinSectionTwelve(12).InadditioneachmonthlyinvoicewillbeintheformatasidentifiedinExhibitC,showingeachbudgetlineitem,expensesincurred,andthebalanceremainingforeachbudgetlineitemforallservicesanditemsasidentifiedinExhibitC.D.CONTRACTORshallsubmitmonthlystaffingreportsthatidentifyalldirectserviceandsupportstaff,applicablelicensure/certifications,andfulltimehoursworkedtobeusedasatrackingtooltodetermineifCONTRACTOR’SprogramisstaffedaccordingtotheservicesprovidedunderthisAgreement.E.CONTRACTORmustattendCOUNTYDBH’sBusinessOfficetrainingonequipmentreportingforassets,intangibleandsensitiveminorassets.6.INDEPENDENTCONTRACTORInperformanceofthework,duties,andobligationsassumedbyCONTRACTORunderthisAgreement,itismutuallyunderstoodandagreedthatCONTRACTOR,includinganyandallofCONTRACTOR’Sofficers,agents,andemployeeswillatalltimesbeactingandperformingasindependentcontractor,andshallactinanindependentcapacityandnotasanofficer,agent,servant,employee,jointventure,partner,orassociateofCOUNTY.Furthermore,COUNTYshallhavenorighttocontrolorsuperviseordirectthemannerormethodbywhichCONTRACTORshallperformitsworkandfunction.However,COUNTYshallretaintherighttoadministerthisAgreementsoastoverifythatCONTRACTORisperformingtheirobligationsinaccordancewiththetermsandconditionsthereof.CONTRACTORandCOUNTYshallcomplywithallapplicableprovisionsoflawandtherulesandregulations,ifany,ofgovernmentalauthoritieshavingjurisdictionovermatterswhicharedirectlyorindirectlythesubjectofthisAgreement.Becauseofitsstatusasanindependentcontractor,CONTRACTORshallhave-5-COUNTYOFFRESNOFresno.CA
12345678910111213141516171819202122232425262728absolutelynorighttoemploymentrightsandbenefitsavailabletoCOUNTYemployees.CONTRACTORshallbesolelyliableandresponsibleforprovidingto,oronbehalfof,itsemployeesalllegally-requiredemployeebenefits.Inaddition,CONTRACTORshallbesolelyresponsibleandsaveCOUNTYharmlessfromallmattersrelatingtopaymentofCONTRACTOR’semployees,includingcompliancewithSocialSecurity,withholding,andallotherregulationsgoverningsuchmatters.ItisacknowledgedthatduringthetermofthisAgreement,CONTRACTORmaybeprovidingservicestoothersunrelatedtoCOUNTYortothisAgreement.7.MODIFICATIONAnymattersofthisAgreementmaybemodifiedfromtimetotimebythewrittenconsentofallthepartieswithout,inanyway,affectingtheremainder.Notwithstandingtheabove,changestoservicesasneededtoaccommodatechangesinthelawrelatingtomentalhealthandsubstanceusedisordertreatment,assetforthinExhibitA,maybemadewiththesignedwrittenapprovalofCOUNTY’SDBHDirectorordesigneeandCONTRACTORthroughanamendmentapprovedbyCountyCounselandAuditor.Changestolineitemsinthebudget,attachedheretoasExhibitC,asappropriate,thatdonotexceed10%ofCONTRACTOR’SprogramtotalmaximumcompensationpayabletoCONTRACTOR,maybemadewiththewrittenapprovalofCOUNTY’SDBHDirectorordesigneeandCONTRACTOR.Changestothelineitemsinthebudgetthatexceed10%ofthemaximumcompensationpayabletotheCONTRACTORmaybemadewiththesignedwrittenapprovalofCOUNTY’SDBHDirector,orhisorherdesigneethroughanamendmentapprovedbyCountyCounselandAuditor.SaidbudgetlineitemchangesshallnotresultinanychangetotheindividualCONTRACTOR’SprogrammaximumcompensationamountpayabletoCONTRACTOR,asstatedherein.8.NON-ASSIGNMENTNeitherpartyshallassign,transferorsubcontractthisAgreementnortheirrightsordutiesunderthisAgreementwithoutthepriorwrittenconsentoftheotherparty.9.HOLD-HARMLESSCONTRACTORagreestoindemnify,save,holdharmless,andatCOUNTY'Srequest,defendCOUNTY,itsofficers,agentsandemployeesfromanyandallcostsandexpenses,including-6-COUNTYOFFRESNOFresno.CA
12345678910111213141516171819202122232425262728attorneyfeesandcourtcosts,damages,liabilities,claimsandlossesoccurringorresultingtoCOUNTYinconnectionwiththeperformance,orfailuretoperform,byCONTRACTOR,itsofficers,agentsoremployeesunderthisAgreement,andfromanyandallcostsandexpenses,includingattorneyfeesandcourtcosts,damages,liabilities,claimsandlossesoccurringorresultingtoanyperson,firmorcorporationwhomaybeinjuredordamagedbytheperformance,orfailuretoperform,ofCONTRACTOR,theirofficers,agentsoremployeesunderthisAgreement.CONTRACTORagreestoindemnifyCOUNTYforFederal,StateofCaliforniaand/orlocalauditexceptionsresultingfromnoncompliancehereinonthepartofCONTRACTOR.10.INSURANCEWithoutlimitingCOUNTY'SrighttoobtainindemnificationfromCONTRACTORoranythirdparties,CONTRACTOR,atitssoleexpense,shallmaintaininfullforceandeffectthefollowinginsurancepoliciesthroughoutthetermofthisAgreement:A.CommercialGeneralLiabilityCommercialGeneralLiabilityInsurancewithlimitsofnotlessthanOneMillionDollars($1,000,000)peroccurrenceandanannualaggregateofTwoMillionDollars($2,000,000).Thispolicyshallbeissuedonaperoccurrencebasis.COUNTYmayrequirespecificcoverageincludingcompletedoperations,productliability,contractualliability,Explosion,Collapse,andUnderground(XCU),firelegalliabilityoranyotherliabilityinsurancedeemednecessarybecauseofthenatureoftheAgreement.B.AutomobileLiabilityComprehensiveAutomobileLiabilityInsurancewithlimitsforbodilyinjuryofnotlessthanTwoHundredFiftyThousandDollars($250,000)perperson,FiveHundredThousandDollars($500,000)peraccidentandforpropertydamagesofnotlessthanFiftyThousandDollars($50,000),orsuchcoveragewithacombinedsinglelimitofFiveHundredThousandDollars($500,000).Coverageshouldincludeownedandnon-ownedvehiclesusedinconnectionwiththisAgreement.C.ProfessionalLiabilityIfCONTRACTORemployslicensedprofessionalstaff(e.g.Ph.D.,R.N.,L.C.S.W.,L.M.F.T.)inprovidingservices,ProfessionalLiabilityInsurancewithlimitsofnotlessthanOneMillionDollars($1,000,000)peroccurrence,ThreeMillionDollars($3,000,000)annualaggregate.IllCOUNTYOFFRESNOFresno.CA
12345678910111213141516171819202122232425262728D.RealandPropertyInsuranceCONTRACTORshallmaintainapolicyofinsuranceforallriskpersonalpropertycoveragewhichshallbeendorsednamingtheCountyofFresnoasanadditionallosspayee.ThepersonalpropertycoverageshallbeinanamountthatwillcoverthetotalofCOUNTYpurchaseandownedproperty,ataminimum,asdiscussedinSectionNineteen(19)ofthisAgreement.E.AllRiskPropertyInsuranceCONTRACTORwillprovidepropertycoverageforthefullreplacementvalueoftheCOUNTY’SpersonalpropertyinpossessionofCONTRACTORand/orusedintheexecutionofthisAgreement.COUNTYwillbeidentifiedonanappropriatecertificateofinsuranceasthecertificateholderandwillbenamedasanAdditionalLossPayeeonthePropertyInsurancePolicy.F.Worker'sCompensationApolicyofWorker'sCompensationInsuranceasmayberequiredbytheCaliforniaLaborCode.G.ChildAbuse/MolestationandSocialServicesCoverageCONTRACTORshallhaveeitherseparatepoliciesorumbrellapolicywithendorsementscoveringChildAbuse/MolestationandSocialServicesLiabilitycoverageorhaveaspecificendorsementontheirGeneralCommercialliabilitypolicycoveringChildAbuse/MolestationandSocialServicesLiability.Thepolicylimitsforthesepoliciesshallbe$1,000,000peroccurrencewitha$2,000,000annualaggregate.Thepoliciesaretobeonaperoccurrencebasis.CONTRACTORshallobtainendorsementstotheCommercialGeneralLiabilityinsurancenamingtheCountyofFresno,itsofficers,agents,andemployees,individuallyandcollectively,asadditionalinsured,butonlyinsofarastheoperationsunderthisAgreementareconcerned.Suchcoverageforadditionalinsuredshallapplyasprimaryinsuranceandanyotherinsurance,orself-insurance,maintainedbyCOUNTY,itsofficers,agentsandemployeesshallbeexcessonlyandnotcontributingwithinsuranceprovidedunderCONTRACTOR’Spoliciesherein.Thisinsuranceshallnotbecancelledorchangedwithoutaminimumofthirty(30)daysadvancewrittennoticegiventoCOUNTY.Withinthirty(30)daysfromthedateCONTRACTORsignsthisAgreement,CONTRACTORshallprovidecertificatesofinsuranceandendorsementsasstatedaboveforallofthe-8-COUNTYOFFRESNOFresno,CA
12345678910111213141516171819202122232425262728foregoingpolicies,asrequiredherein,totheCountyofFresno,DepartmentofBehavioralHealth,3133N.Millbrook,Fresno,CA93703,Attention:ContractAnalyst,statingthatsuchinsurancecoverageshavebeenobtainedandareinfullforce;thattheCountyofFresno,itsofficers,agentsandemployeeswillnotberesponsibleforanypremiumsonthepolicies;thatsuchCommercialGeneralLiabilityinsurancenamestheCountyofFresno,itsofficers,agentsandemployees,individuallyandcollectively,asadditionalinsured,butonlyinsofarastheoperationsunderthisAgreementareconcerned;thatsuchcoverageforadditionalinsuredshallapplyasprimaryinsuranceandanyotherinsurance,orself-insurance,maintainedbyCOUNTY,itsofficers,agentsandemployees,shallbeexcessonlyandnotcontributingwithinsuranceprovidedunderCONTRACTOR’Spoliciesherein;andthatthisinsuranceshallnotbecancelledorchangedwithoutaminimumofthirty(30)daysadvance,writtennoticegiventoCOUNTY.IntheeventCONTRACTORfailstokeepineffectatalltimesinsurancecoverageashereinprovided,COUNTYmay,inadditiontootherremediesitmayhave,suspendorterminatethisAgreementupontheoccurrenceofsuchevent.AllpoliciesshallbewithadmittedinsurerslicensedtodobusinessintheStateofCalifornia.InsurancepurchasedshallbefromcompaniespossessingacurrentA.M.Best,Inc.ratingofAFSCVIIorbetter.11.LICENSES/CERTIFICATESThroughouteachtermofthisAgreement,CONTRACTORandCONTRACTOR’Sstaffshallmaintainallnecessarylicenses,permits,approvals,certificates,waiversandexemptionsnecessaryfortheprovisionoftheserviceshereunderandrequiredbythelawsandregulationsoftheUnitedStatesofAmerica,StateofCalifornia,theCountyofFresno,andanyotherapplicablegovernmentalagencies.CONTRACTORshallnotifyCOUNTYimmediatelyinwritingofitsinabilitytoobtainormaintainsuchlicenses,permits,approvals,certificates,waiversandexemptionsirrespectiveofthependencyofanyappealrelatedthereto.Additionally,CONTRACTORandCONTRACTOR’Sstaffshallcomplywithallapplicablelaws,rulesorregulations,asmaynowexistorbehereafterchanged.Ill-9-COUNTYOFFRESNOFresno,CA
1234567891011121314151617181920212223242526272812.REPORTSA.ActivityReportsCONTRACTORshallsubmittoCOUNTY’SDBHbythe10thofeachmonthallmonthlyactivityandbudgetreportsfortheprecedingmonth.B.AdditionalReportsInaddition,CONTRACTORshallalsofurnishtoCOUNTYsuchstatements,records,reports,data,andotherinformationasCOUNTYmayrequestpertainingtomatterscoveredbythisAgreement.IntheeventthatCONTRACTORfailstoprovidesuchreportsorotherinformationrequiredhereunder,itshallbedeemedsufficientcauseforCOUNTYtowithholdmonthlypaymentsuntilthereiscompliance.Inaddition,CONTRACTORshallprovidewrittennotificationandexplanationtoCOUNTYwithinfive(5)daysofanyfundsreceivedfromanothersourcetoconductthesameservicescoveredbythisAgreement.13.MONITORINGCONTRACTORagreestoextendtoCOUNTY’Sstaff,COUNTY’SDBHDirectorandtheStateDepartmentofMentalHealth,ortheirdesignees,therighttoreviewandmonitorrecords,programsorprocedures,atanytime,inregardtoclients,aswellastheoveralloperationofCONTRACTOR’Sprograms,inordertoensurecompliancewiththetermsandconditionsofthisAgreement.14.REFERENCESTOLAWSANDRULESIntheeventanylaw,regulation,orpolicyreferredtointhisAgreementisamendedduringthetermthereof,thepartiesheretoagreetocomplywiththeamendedprovisionasoftheeffectivedateofsuchamendment.15.COMPLIANCEWITHSTATEREQUIREMENTSCONTRACTORrecognizesthatCOUNTYoperatesitsmentalhealthprogramsunderanagreementwiththeStateofCaliforniaDepartmentofMentalHealth,andthatundersaidagreementtheStateimposescertainrequirementsonCOUNTYanditssubcontractors.CONTRACTORshalladheretoallStaterequirements,includingthoseidentifiedinExhibitD“StateMentalHealthRequirements”,attachedheretoandbythisreferenceincorporatedherein.-10-COUNTYOFFRESNOFresno,CA
1234567891011121314151617181920212223242526272816.CONFIDENTIALITYAllservicesperformedbyCONTRACTORunderthisAgreementshallbeinstrictconformancewithallapplicableFederal,StateofCaliforniaand/orlocallawsandregulationsrelatingtoconfidentiality,includingallHealthInsurancePortabilityAccountingAct(HIPAA)regulations.17.HEALTHINSURANCEPORTABILITYANDACCOUNTABILITYACTCOUNTYandCONTRACTOReachconsiderandrepresentthemselvesascoveredentitiesasdefinedbytheU.S.HealthInsurancePortabilityandAccountabilityActof1996,PublicLaw104-191(HIPAA)andagreetouseanddiscloseProtectedHealthInformation(PHI)asrequiredbylaw.COUNTYandCONTRACTORacknowledgethattheexchangeofPHIbetweenthemisonlyfortreatment,payment,andhealthcareoperations.COUNTYandCONTRACTORintendtoprotecttheprivacyandprovideforthesecurityofPHIpursuanttotheAgreementincompliancewithHIPAA,theHealthInformationTechnologyforEconomicandClinicalHealthAct,PublicLaw111-005(HITECH),andregulationspromulgatedthereunderbytheU.S.DepartmentofHealthandHumanServices(HIPAARegulations)andotherapplicablelaws.AspartoftheHIPAARegulations,thePrivacyRuleandtheSecurityRulerequireCONTRACTORtoenterintoacontractcontainingspecificrequirementspriortothedisclosureofPHI,assetforthin,butnotlimitedto,Title45,Sections164.314(a),164.502(e)and164.504(e)oftheCodeofFederalRegulations.18.DATASECURITYForthepurposeofpreventingthepotentialloss,misappropriationorinadvertentaccess,viewing,useordisclosureofCOUNTYdataincludingsensitiveorpersonalclientinformation;abuseofCOUNTYresources;and/ordisruptiontoCOUNTYoperations,individualsand/oragenciesthatenterintoacontractualrelationshipwithCOUNTYforthepurposeofprovidingservicesunderthisAgreementmustemployadequatedatasecuritymeasurestoprotecttheconfidentialinformationprovidedtoCONTRACTORbytheCOUNTY,includingbutnotlimitedtothefollowing:A.CONTRACTOR-OwnedMobile.Wireless,orHandheldDevicesCONTRACTORmaynotconnecttoCOUNTYnetworksviapersonally-owned-n-COUNTYOFFRESNOFresno.CA
12345678910111213141516171819202122232425262728mobile,wirelessorhandhelddevices,unlessthefollowingconditionsaremet:1)CONTRACTORhasreceivedauthorizationbyCOUNTYfortelecommutingpurposes;2)Currentvirusprotectionsoftwareisinplace;3)Mobiledevicehastheremotewipefeatureenabled/and4)Asecureconnectionisused.B.CONTRACTOR-OwnedComputersorComputerPeripheralsCONTRACTORmaynotbringCONTRACTOR-ownedcomputersorcomputerperipheralsintotheCOUNTYforusewithoutpriorauthorizationfromtheCOUNTY’SChiefInformationOfficer,and/ordesignee(s),includingbutnotlimitedtomobilestoragedevices.Ifdataisapprovedtobetransferred,datamustbestoredonasecureserverapprovedbytheCOUNTYandtransferredbymeansofaVirtualPrivateNetwork(VPN)connection,oranothertypeofsecureconnection.Saiddatamustbeencrypted.C.COUNTY-OwnedComputerEquipmentCONTRACTORmaynotuseCOUNTYcomputersorcomputerperipheralsonnon-COUNTYpremiseswithoutpriorauthorizationfromtheCOUNTY’SChiefInformationOfficer,and/ordesignee(s).D.CONTRACTORmaynotstoreCOUNTY’Sprivate,confidentialorsensitivedataonanyhard-diskdrive,portablestoragedevice,orremotestorageinstallationunlessencrypted.E.CONTRACTORshallberesponsibletoemploystrictcontrolstoensuretheintegrityandsecurityofCOUNTY’Sconfidentialinformationandtopreventunauthorizedaccess,viewing,useordisclosureofdatamaintainedincomputerfiles,programdocumentation,dataprocessingsystems,datafilesanddataprocessingequipmentwhichstoresorprocessesCOUNTYdatainternallyandexternally.F.ConfidentialclientinformationtransmittedtoonepartybytheotherbymeansofelectronictransmissionsmustbeencryptedaccordingtoAdvancedEncryptionStandards(AES)of128BITorhigher.Additionally,apasswordorpassphrasemustbeutilized.G.CONTRACTORisresponsibletoimmediatelynotifyCOUNTYofany-12-COUNTYOFFRESNOFresno.CA
12345678910111213141516171819202122232425262728violations,breachesorpotentialbreachesofsecurityrelatedtoCOUNTY’Sconfidentialinformation,datamaintainedincomputerfiles,programdocumentation,dataprocessingsystems,datafilesanddataprocessingequipmentwhichstoresorprocessesCOUNTYdatainternallyorexternally.H.COUNTYshallprovideoversighttoCONTRACTOR’SresponsetoallincidentsarisingfromapossiblebreachofsecurityrelatedtoCOUNTY’SconfidentialclientinformationprovidedtoCONTRACTOR.CONTRACTORwillberesponsibletoissueanynotificationtoaffectedindividualsasrequiredbylaworasdeemednecessarybyCOUNTYinitssolediscretion.CONTRACTORwillberesponsibleforallcostsincurredasaresultofprovidingtherequirednotification.19.PROPERTYOFCOUNTYA.COUNTYandCONTRACTORrecognizethatfixedassetsaretangibleandintangiblepropertyobtainedorcontrolledunderCOUNTY’SMentalHealthPlanforuseinoperationalcapacityandwillbenefitCOUNTYforaperiodmorethanoneyear.Depreciationofthequalifieditemswillbeonastraight-linebasis.ForCOUNTYpurposes,fixedassetsmustfulfillthreequalifications:1)Assetmusthavelifespanofoveroneyear.2)Theassetisnotarepairpart3)TheassetmustbevaluedatorgreaterthanthecapitalizationthresholdsfortheassettypeAssettypeThreshold•land$0•buildingsandimprovements$100,000•infrastructure$100,000•tangible$5,000oequipmentovehicles•intangibleasset$100,000oInternallygeneratedsoftwareoPurchasedsoftwareoEasementsoPatents•capitalleaseequipment$5,000-13-COUNTYOFFRESNOFresno,CA
12345678910111213141516171819202122232425262728QualifiedfixedassetequipmentistobereportedandapprovedbyCOUNTY.IfitisapprovedandidentifiedasanassetitwillbetaggedwithaCOUNTYprogramnumber.A“FixedAssetLog”,attachedheretoasExhibitEandbythisreferenceincorporatedherein,willbemaintainedbyCOUNTY’SAssetManagementSystemandinventoriedannuallyuntiltheassetisfullydepreciated.DuringthetermsofthisAgreement,CONTRACTOR’SfixedassetsmaybeinventoriedincomparisontoCOUNTY’SDBHAssetInventorySystem.B.CertainpurchaseslessthanFiveThousandandNo/100Dollars($5,000.00)withoveroneyearlifespan,andaremobileandhighriskoftheftorlossaresensitiveassets.Suchsensitiveitemsarenotlimitedtocomputers,copiers,televisions,camerasandothersensitiveitemsasdeterminedbyCOUNTY’SDBHDirectorordesignee.CONTRACTORmaintainsatrackingsystemontheitemsthatarenotrequiredtobecapitalizedordepreciated.Theitemsaresubjecttoannualinventoryforcompliance.C.AssetsshallberetainedbyCOUNTY,asCOUNTYproperty,intheeventthisAgreementisterminatedoruponexpirationofthisAgreement.CONTRACTORagreestoparticipateinanannualinventoryofallCOUNTYfixedandinventoriedassets.UponterminationorexpirationofthisAgreementCONTRACTORshallbephysicallypresentwhenfixedandinventoriedassetsarereturnedtoCOUNTYpossession.CONTRACTORisresponsibleforreturningtoCOUNTYallCOUNTYownedundepreciatedfixedandinventoriedassets,orthemonetaryvalueofsaidassetsifunabletoproducetheassetsattheexpirationorterminationofthisAgreement.CONTRACTORfurtheragreestothefollowing:1)Tomaintainallitemsofequipmentingoodworkingorderandcondition,normalwearandtearisexpected;2)TolabelallitemsofequipmentwithCOUNTYassignedprogramnumber,toperformperiodicinventoriesasrequiredbyCOUNTYandtomaintainaninventorylistshowingwhereandhowtheequipmentisbeingused,inaccordancewithproceduresdevelopedbyCOUNTY.AllsuchlistsshallbesubmittedtoCOUNTYwithinten(10)daysofanyrequesttherefore;and-14-COUNTYOFFRESNOFresno.CA
123456789101112131415161718192021222324252627283)ToreportinwritingtoCOUNTYimmediatelyafterdiscovery,thelostortheftofanyitemsofequipment.Forstolenitems,thelocallawenforcementagencymustbecontactedandacopyofthepolicereportsubmittedtoCOUNTY.D.ThepurchaseofanyequipmentbyCONTRACTORwithfundsprovidedhereundershallrequirethepriorwrittenapprovalofCOUNTY’SDBH,shallfulfilltheprovisionsofthisAgreementasappropriate,andmustbedirectlyrelatedtoCONTRACTOR’SservicesoractivityunderthetermsofthisAgreement.COUNTY’SDBHmayrefusereimbursementforanycostsresultingfromequipmentpurchased,whichareincurredbyCONTRACTOR,ifpriorwrittenapprovalhasnotbeenobtainedfromCOUNTY.E.CONTRACTORmustobtainpriorwrittenapprovalfromCOUNTY’SDBHwheneverthereisanymodificationorchangeintheuseofanypropertyacquiredorimproved,inwholeorinpart,usingfundsunderthisAgreement.Ifanyrealorpersonalpropertyacquiredorimprovedwithsaidfundsidentifiedhereinissoldand/orisutilizedbyCONTRACTORforausewhichdoesnotqualifyunderthisAgreement,CONTRACTORshallreimburseCOUNTYinanamountequaltothecurrentfairmarketvalueoftheproperty,lessanyportionthereofattributabletoexpendituresoffundsnotprovidedunderthisAgreement.Theserequirementsshallcontinueineffectforthelifeoftheproperty.IntheeventthisAgreementexpires,orterminates,therequirementsforthisSectionshallremainineffectforactivitiesorpropertyfundedwithsaidfunds,unlessactionistakenbytheStategovernmenttorelieveCOUNTYoftheseobligations20.NON-DISCRIMINATIONDuringtheperformanceofthisAgreement,CONTRACTORshallnotunlawfullydiscriminateagainstanyemployeeorapplicantforemployment,orrecipientofservices,becauseofrace,religiouscreed,color,nationalorigin,ancestry,physicaldisability,mentaldisability,medicalcondition,geneticinformation,maritalstatus,sex,gender,genderidentity,genderexpression,age,sexualorientation,ormilitaryorveteranstatus,pursuanttoallapplicableStateandFederalstatutesandregulations.///-15-COUNTYOFFRESNOFresno.CA
1234567891011121314151617181920212223242526272821.CULTURALCOMPETENCYAsrelatedtoCulturalandLinguisticCompetence,CONTRACTORshallcomplywith:A.Title6oftheCivilRightsActof1964(42U.S.C.Section2000d,and45C.F.R.Part80)andExecutiveOrder12250of1979whichprohibitsrecipientsoffederalfinancialassistancefromdiscriminatingagainstpersonsbasedonrace,color,nationalorigin,sex,disabilityorreligion.ThisisinterpretedtomeanthatalimitedEnglishproficient(LEP)individualisentitledtoequalaccessandparticipationinfederallyfundedprogramsthroughtheprovisionofcomprehensiveandqualitybilingualservices.B.PoliciesandproceduresforensuringaccessandappropriateuseoftrainedinterpretersandmaterialtranslationservicesforallLEPconsumers,including,butnotlimitedto,assessingtheculturalandlinguisticneedsofitsconsumers,trainingofstaffonthepoliciesandprocedures,andmonitoringitslanguageassistanceprogram.TheCONTRACTOR’Sproceduresmustincludeensuringcomplianceofanysub-contractedproviderswiththeserequirements.C.CONTRACTORshallnotuseminorsasinterpreters.D.CONTRACTORshallprovideandpayforinterpretingandtranslationservicestopersonsparticipatinginCONTRACTOR’SserviceswhohavelimitedornoEnglishlanguageproficiency,includingservicestopersonswhoaredeaforblind.Interpreterandtranslationservicesshallbeprovidedasnecessarytoallowsuchparticipantsmeaningfulaccesstotheprograms,servicesandbenefitsprovidedbyCONTRACTOR.Interpreterandtranslationservices,includingtranslationofCONTRACTOR’S“vitaldocuments”(thosedocumentsthatcontaininformationthatiscriticalforaccessingCONTRACTOR’Sservicesorarerequiredbylaw)shallbeprovidedtoparticipantsatnocosttotheparticipant.CONTRACTORshallensurethatanyemployees,agents,subcontractors,orpartnerswhointerpretortranslateforaprogramparticipant,orwhodirectlycommunicatewithaprogramparticipantinalanguageotherthanEnglish,demonstrateproficiencyintheparticipant'slanguageandcaneffectivelycommunicateanyspecializedtermsandconceptspeculiartoCONTRACTOR’Sservices.E.IncompliancewiththeStatemandatedCulturallyandLinguisticallyAppropriateServicesstandardsaspublishedbytheOfficeofMinorityHealth,CONTRACTORmustsubmittoCOUNTYforapproval,within60daysfromdateofcontractexecution,CONTRACTOR’Splanto-16-COUNTYOFFRESNOFresno,CA
12345678910111213141516171819202122232425262728addressallfifteennationalculturalcompetencystandardsassetforthinthe“NationalStandardsonCulturallyandLinguisticallyAppropriateServices(CLAS)”(http://minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdf).COUNTY’Sannualon-sitereviewofCONTRACTORshallincludecollectionofdocumentationtoensureallnationalstandardsareimplemented.Asthenationalcompetencystandardsareupdated,CONTRACTOR’Splanmustbeupdatedaccordingly.22.TAXEQUITYANDFISCALRESPONSIBILITYACTTotheextentnecessarytopreventdisallowanceofreimbursementundersection1861(v)(1)(I)oftheSocialSecurityAct,(42U.S.C.§1395x,subd.(v)(l)[I]),untiltheexpirationoffour(4)yearsafterthefurnishingofservicesunderthisAgreement,CONTRACTORshallmakeavailable,uponwrittenrequesttotheSecretaryoftheUnitedStatesDepartmentofHealthandHumanServices,oruponrequesttotheComptrollerGeneraloftheUnitedStatesGeneralAccountingOffice,oranyoftheirdulyauthorizedrepresentatives,acopyofthisAgreementandsuchbooks,documents,andrecordsasarenecessarytocertifythenatureandextentofthecostsoftheseservicesprovidedbyCONTRACTORunderthisAgreement.CONTRACTORfurtheragreesthatintheeventCONTRACTORcarriesoutanyofitsdutiesunderthisAgreementthroughasubcontract,withavalueorcostofTenThousandandNo/100Dollars($10,000.00)ormoreoveratwelve(12)monthperiod,witharelatedorganization,suchAgreementshallcontainaclausetotheeffectthatuntiltheexpirationoffour(4)yearsafterthefurnishingofsuchservicespursuanttosuchsubcontract,therelatedorganizationsshallmakeavailable,uponwrittenrequesttotheSecretaryoftheUnitedStatesDepartmentofHealthandHumanServices,oruponrequesttotheComptrollerGeneraloftheUnitedStatesGeneralAccountingOffice,oranyoftheirdulyauthorizedrepresentatives,acopyofsuchsubcontractandsuchbooks,documents,andrecordsofsuchorganizationasarenecessarytoverifythenatureandextentofsuchcosts.23.SINGLEAUDITCLAUSEA.IfCONTRACTORexpendsSevenHundredFiftyThousandDollars($750,000.00)ormoreinFederalandFederalflow-throughmonies,CONTRACTORagreestoconductanannualauditinaccordancewiththerequirementsoftheSingleAuditStandardsassetforth-17-COUNTYOFFRESNOFresno.CA
12345678910111213141516171819202122232425262728inOfficeofManagementandBudget(OMB)CircularA-133.CONTRACTORshallsubmitsaidauditandmanagementlettertoCOUNTY.Theauditmustincludeastatementoffindingsorastatementthattherewerenofindings.Iftherewerenegativefindings,CONTRACTORmustincludeacorrectiveactionplansignedbyanauthorizedindividual.CONTRACTORagreestotakeactiontocorrectanymaterialnon-complianceorweaknessfoundasaresultofsuchaudit.SuchauditshallbedeliveredtoCOUNTY’SDBHBusinessOfficeforreviewwithinnine(9)monthsoftheendofanyfiscalyearinwhichfundswereexpendedand/orreceivedfortheprogram.FailuretoperformtherequisiteauditfunctionsasrequiredbythisAgreementmayresultinCOUNTYperformingthenecessaryaudittasks,oratCOUNTY’Soption,contractingwithapublicaccountanttoperformsaidaudit,or,mayresultintheinabilityofCOUNTYtoenterintofutureagreementswithCONTRACTOR.AllauditcostsrelatedtothisAgreementarethesoleresponsibilityofCONTRACTOR.B.AsingleauditreportisnotapplicableifCONTRACTOR’SFederalcontractsdonotexceedtheSevenHundredFiftyThousandDollars($750,000.00)requirementorCONTRACTOR’SonlyfundingisthroughDrugrelatedMedi-Cal.Ifasingleauditisnotapplicable,aprogramauditmustbeperformedandaprogramauditreportwithmanagementlettershallbesubmittedbyCONTRACTORtoCOUNTYasaminimumrequirementtoattesttoCONTRACTOR’Ssolvency.SaidauditreportshallbedeliveredtoCOUNTY’SDBHBusinessOfficeforreview,nolaterthannine(9)monthsafterthecloseofthefiscalyearinwhichthefundssuppliedthroughthisAgreementareexpended.FailuretocomplywiththisActmayresultinCOUNTYperformingthenecessaryaudittasksorcontractingwithaqualifiedaccountanttoperformsaidaudit.AllauditcostsrelatedtothisAgreementarethesoleresponsibilityofCONTRACTORwhoagreestotakecorrectiveactiontoeliminateanymaterialnoncomplianceorweaknessfoundasaresultofsuchaudit.AuditworkperformedbyCOUNTYunderthissectionshallbebilledtotheCONTRACTORatCOUNTY’Scost,asdeterminedbyCOUNTY’SAuditor-Controller/Treasurer-TaxCollector.C.CONTRACTORshallmakeavailableallrecordsandaccountsforinspectionbyCOUNTY,theStateofCalifornia,ifapplicable,theComptrollerGeneraloftheUnitedStates,theFederalGrantorAgency,oranyoftheirdulyauthorizedrepresentatives,atallreasonabletimesfora-18-COUNTYOFFRESNOFresno,CA
12345678910111213141516171819202122232425262728periodofatleastthree(3)yearsfollowingfinalpaymentunderthisAgreementortheclosureofallotherpendingmatters,whicheverislater.24.COMPLIANCECONTRACTORagreestocomplywiththeCOUNTY’SContractorCodeofConductandEthicsandtheCOUNTY’SCompliancePrograminaccordancewithExhibitF,attachedheretoandincorporatedhereinbyreference.Withinthirty(30)daysofenteringintothisAgreementwiththeCOUNTY,CONTRACTORshallhaveallofCONTRACTOR’Semployees,agentsandsubcontractorsprovidingservicesunderthisAgreementcertifyinwriting,thatheorshehasreceived,read,understood,andshallabidebytheContractorCodeofConductandEthics.CONTRACTORshallensurethatwithinthirty(30)daysofhire,allnewemployees,agentsandsubcontractorsprovidingservicesunderthisAgreementshallcertifyinwritingthatheorshehasreceived,read,understood,andshallabidebytheContractorCodeofConductandEthics.CONTRACTORunderstandsthatthepromotionofandadherencetotheCodeofConductisanelementinevaluatingtheperformanceofCONTRACTORanditsemployees,agentsandsubcontractors.Withinthirty(30)daysofenteringintothisAgreement,andannuallythereafter,allemployees,agentsandsubcontractorsprovidingservicesunderthisAgreementshallcompletegeneralcompliancetrainingandappropriateemployees,agentsandsubcontractorsshallcompletedocumentationandbillingorbilling/reimbursementtraining.Allnewemployees,agentsandsubcontractorsshallattendtheappropriatetrainingwithin30daysofhire.Eachindividualwhoisrequiredtoattendtrainingshallcertifyinwritingthatheorshehasreceivedtherequiredtraining.Thecertificationshallspecifythetypeoftrainingreceivedandthedatereceived.ThecertificationshallbeprovidedtotheCOUNTY’SComplianceOfficerat3133N.MillbrookAve,Fresno,California93703.CONTRACTORagreestoreimburseCOUNTYfortheentirecostofanypenaltyimposeduponCOUNTYbytheFederalGovernmentasaresultofCONTRACTOR’SviolationofthetermsofthisAgreement.25.ASSURANCESInenteringintothisAgreement,CONTRACTORcertifiesthatitisnotcurrentlyexcluded,suspended,debarred,orotherwiseineligibletoparticipateintheFederalHealthCare-19-COUNTYOFFRESNOFresno.CA
12345678910111213141516171819202122232425262728Programs:thatithasnotbeenconvictedofacriminaloffenserelatedtotheprovisionofhealthcareitemsorservices;norhasitbeenreinstatedtoparticipationintheFederalHealthCareProgramsafteraperiodofexclusion,suspension,debarment,orineligibility.IfCOUNTYlearns,subsequenttoenteringintoacontract,thatCONTRACTORisineligibleonthesegrounds,COUNTYwillremoveCONTRACTORfromresponsibilityfor,orinvolvementwith,COUNTY’SbusinessoperationsrelatedtotheFederalHealthCareProgramsandshallremovesuchCONTRACTORfromanypositioninwhichCONTRACTOR’Scompensation,ortheitemsorservicesrendered,orderedorprescribedbyCONTRACTORmaybepaidinwholeorpart,directlyorindirectly,byFederalHealthCareProgramsorotherwisewithFederalFundsatleastuntilsuchtimeasCONTRACTORisreinstatedintoparticipationintheFederalHealthCarePrograms.A.IfCOUNTYhasnoticethatCONTRACTORhasbeenchargedwithacriminaloffenserelatedtoanyFederalHealthCareProgram,orisproposedforexclusionduringthetermofanycontract,CONTRACTORandCOUNTYshalltakeallappropriateactionstoensuretheaccuracyofanyclaimssubmittedtoanyFederalHealthCareProgram.Atitsdiscretiongivensuchcircumstances,COUNTYmayrequestthatCONTRACTORceaseprovidingservicesuntilresolutionofthechargesortheproposedexclusion.B.CONTRACTORagreesthatallpotentialnewemployeesofCONTRACTORorsubcontractorsofCONTRACTORwho,ineachcase,areexpectedtoperformprofessionalservicesunderthisAgreement,willbequeriedastowhether(1)theyarenoworeverhavebeenexcluded,suspended,debarred,orotherwiseineligibletoparticipateintheFederalHealthCarePrograms;(2)theyhavebeenconvictedofacriminaloffenserelatedtotheprovisionofhealthcareitemsorservices;andor(3)theyhavebeenreinstatedtoparticipationintheFederalHealthCareProgramsafteraperiodofexclusion,suspension,debarment,orineligibility.1)IntheeventthepotentialemployeeorsubcontractorinformsCONTRACTORthatheorsheisexcluded,suspended,debarredorotherwiseineligible,orhasbeenconvictedofacriminaloffenserelatingtotheprovisionofhealthcareservices,andCONTRACTORhiresorengagessuchpotentialemployeeorsubcontractor,CONTRACTORwillensurethatsaidIII-20-COUNTYOFFRESNOFresno.CA
12345678910111213141516171819202122232425262728employeeorsubcontractordoesnowork,eitherdirectlyorindirectlyrelatingtoservicesprovidedtoCOUNTY.2)Notwithstandingtheabove,COUNTYatitsdiscretionmayterminatethisAgreementinaccordancewithSectionThree(3)ofthisAgreement,orrequireadequateassurance(asdefinedbyCOUNTY)thatnoexcluded,suspendedorotherwiseineligibleemployeeorsubcontractorofCONTRACTORwillperformwork,eitherdirectlyorindirectly,relatingtoservicesprovidedtoCOUNTY.SuchdemandforadequateassuranceshallbeeffectiveuponatimeframetobedeterminedbyCOUNTYtoprotecttheinterestsofCOUNTYconsumers.C.CONTRACTORshallverify(byaskingtheapplicableemployeesandsubcontractors)thatallcurrentemployeesandexistingsubcontractorswho,ineachcase,areexpectedtoperformprofessionalservicesunderthisAgreement(1)arenotcurrentlyexcluded,suspended,debarred,orotherwiseineligibletoparticipateintheFederalHealthCarePrograms;(2)havenotbeenconvictedofacriminaloffenserelatedtotheprovisionofhealthcareitemsorservices;and(3)havenotbeenreinstatedtoparticipationintheFederalHealthCareProgramafteraperiodofexclusion,suspension,debarment,orineligibility.IntheeventanyexistingemployeeorsubcontractorinformsCONTRACTORthatheorsheisexcluded,suspended,debarredorotherwiseineligibletoparticipateintheFederalHealthCarePrograms,orhasbeenconvictedofacriminaloffenserelatingtotheprovisionofhealthcareservices,CONTRACTORwillensurethatsaidemployeeorsubcontractordoesnowork,eitherdirectorindirect,relatingtoservicesprovidedtoCOUNTY.1)CONTRACTORagreestonotifyCOUNTYimmediatelyduringthetermofthisAgreementwheneverCONTRACTORlearnsthatanemployeeorsubcontractorwho,ineachcase,isprovidingprofessionalservicesunderthisAgreementisexcluded,suspended,debarredorotherwiseineligibletoparticipateintheFederalHealthCarePrograms,orisconvictedofacriminaloffenserelatingtotheprovisionofhealthcareservices.2)Notwithstandingtheabove,COUNTYatitsdiscretionmayterminatethisAgreementinaccordancewithSection3ofthisAgreement,orrequireadequateassurance(asdefinedbyCOUNTY)thatnoexcluded,suspendedorotherwiseineligibleemployeeorsubcontractorofCONTRACTORwillperformwork,eitherdirectlyorindirectly,relatingtoservicesprovidedto-21-COUNTYOFFRESNOFresno,CA
12345678910111213141516171819202122232425262728COUNTY.SuchdemandforadequateassuranceshallbeeffectiveuponatimeframetobedeterminedbyCOUNTYtoprotecttheinterestsofCOUNTYconsumers.D.CONTRACTORagreestocooperatefullywithanyreasonablerequestsforinformationfromCOUNTYwhichmaybenecessarytocompleteanyinternalorexternalauditsrelatingtoCONTRACTOR’ScompliancewiththeprovisionsofthisSection.E.CONTRACTORagreestoreimburseCOUNTYfortheentirecostofanypenaltyimposeduponCOUNTYbytheFederalGovernmentasaresultofCONTRACTOR’SviolationofCONTRACTOR’SobligationsasdescribedinthisSection.26.PUBLICITYPROHIBITIONNoneofthefunds,materials,propertyorservicesprovideddirectlyorindirectlyunderthisAgreementshallbeusedforCONTRACTOR’Sadvertising,fundraising,orpublicity(i.e.,purchasingoftickets/tables,silentauctiondonations,etc.)forthepurposeofself-promotion.Notwithstandingtheabove,publicityoftheservicesdescribedinSectionOne(1)ofthisAgreementshallbeallowedasnecessarytoraisepublicawarenessabouttheavailabilityofsuchspecificserviceswhenapprovedinadvancebyCOUNTY’SDBHDirectorordesigneeandatacosttobeprovidedinExhibitCforsuchitemsaswritten/printedmaterials,theuseofmedia(i.e.,radio,television,newspapers)andanyotherrelatedexpense(s).27.COMPLAINTSCONTRACTORshalllogcomplaintsandthedispositionofallcomplaintsfromaclientoraclient’sfamily.CONTRACTORshallprovideacopyofthedetailedcomplaintlogentriesconcerningCOUNTY-sponsoredclientstoCOUNTYatmonthlyintervalsbythetenth(10th)dayofthefollowingmonth,inaformatthatismutuallyagreedupon.Inaddition,CONTRACTORshallprovidedetailsandattachdocumentationofeachcomplaintwiththelog.CONTRACTORshallpostsignsinformingclientsoftheirrighttofileacomplaintorgrievance.CONTRACTORshallnotifyCOUNTYofallincidentsreportabletoStatelicensingbodiesthataffectCOUNTYclientswithintwenty-four(24)hoursofreceiptofacomplaint.Withinten(10)daysaftereachincidentorcomplaintaffectingCOUNTY-sponsoredclients,CONTRACTORshallprovideCOUNTYwithinformationrelevanttothecomplaint,-22-COUNTYOFFRESNOFresno.CA
12345678910111213141516171819202122232425262728investigativedetailsofthecomplaint,thecomplaintandCONTRACTOR'Sdispositionof,orcorrectiveactiontakentoresolvethecomplaint.Inaddition,CONTRACTORshallinformeveryclientoftheirrightsassetforthinExhibitG“MHSAGuidelines-GrievanceandIncidentReporting”,attachedheretoandbythisreferenceincorporatedherein.28.DISCLOSUREOFOWNERSHIPAND/ORCONTROLINTERESTINFORMATIONThisprovisionisonlyapplicableifCONTRACTORisadisclosingentity,fiscalagent,ormanagedcareentityasdefinedinCodeofFederalRegulations(C.F.R),Title42§455.101455.104,and455.106(a)(1),(2).InaccordancewithC.F.R.,Title42§§455.101,455.104,455.105and455.106(a)(1),(2),thefollowinginformationmustbedisclosedbyCONTRACTORbycompletingExhibitH,“DisclosureofOwnershipandControlInterestStatement”,attachedheretoandbythisreferenceincorporatedhereinandmadepartofthisAgreement.CONTRACTORshallsubmitthisformtotheDepartmentofBehavioralHealthwithinthirty(30)daysoftheeffectivedateofthisAgreement.Additionally,CONTRACTORshallreportanychangestothisinformationwithinthirtyfive(35)daysofoccurrencebycompletingExhibitH.SubmissionsshallbescannedpdfcopiesandaretobesentviaemailtoDBHAdministration@co.fresno.ca.usattention:ContractsAdministration.29.DISCLOSURE-CRIMINALHISTORYANDCIVILACTIONSCONTRACTORisrequiredtodiscloseifanyofthefollowingconditionsapplytothem,theirowners,officers,corporatemanagersandpartners(hereinaftercollectivelyreferredtoas“CONTRACTOR”):A.Withinthethree-yearperiodprecedingtheAgreementaward,theyhavebeenconvictedof,orhadaciviljudgmentrenderedagainstthemfor:1)Fraudoracriminaloffenseinconnectionwithobtaining,attemptingtoobtain,orperformingapublic(federal,state,orlocal)transactionorcontractunderapublictransaction;2)Violationofafederalorstateantitruststatute;III-23-COUNTYOFFRESNOFresno.CA
123456789101112131415161718192021222324252627283)Embezzlement,theft,forgery,bribery,falsification,ordestructionofrecords;or4)Falsestatementsorreceiptofstolenproperty.B.Withinathree-yearperiodprecedingtheirAgreementaward,theyhavehadapublictransaction(federal,state,orlocal)terminatedforcauseordefault.DisclosureoftheaboveinformationwillnotautomaticallyeliminateCONTRACTORfromfurtherbusinessconsideration.Theinformationwillbeconsideredaspartofthedeterminationofwhethertocontinueand/orrenewtheContractandanyadditionalinformationorexplanationthataCONTRACTORelectstosubmitwiththedisclosedinformationwillbeconsidered.IfitislaterdeterminedthattheCONTRACTORfailedtodiscloserequiredinformation,anycontractawardedtosuchCONTRACTORmaybeimmediatelyvoidedandterminatedformaterialfailuretocomplywiththetermsandconditionsoftheaward.CONTRACTORmustsigna“CertificationRegardingDebarment,Suspension,andOtherResponsibilityMatters-PrimaryCoveredTransactions”intheformsetforthinExhibitI,attachedheretoandbythisreferenceincorporatedhereinandmadepartofthisAgreement.Additionally,CONTRACTORmustimmediatelyadvisetheCOUNTYinwritingif,duringthetermofthisAgreement:(1)CONTRACTORbecomessuspended,debarred,excludedorineligibleforparticipationinfederalorstatefundedprogramsorfromreceivingFederalfundsaslistedintheexcludedparties’listsystem(http://www.epls.govhor(2)anyoftheabovelistedconditionsbecomeapplicabletoCONTRACTOR.CONTRACTORshallindemnify,defendandholdtheCOUNTYharmlessforanylossordamageresultingfromaconviction,debarment,exclusion,ineligibilityorothermatterlistedinthesignedCertificationRegardingDebarment,Suspension,andOtherResponsibilityMatters.30.DISCLOSUREOFSELF-DEALINGTRANSACTIONSThisprovisionisonlyapplicableiftheCONTRACTORisoperatingasacorporation(afor-profitornon-profitcorporation)orifduringthetermofthisAgreement,theCONTRACTORchangesitsstatustooperateasacorporation.MembersoftheCONTRACTOR’SBoardofDirectorsshalldiscloseanyself-dealing-24-COUNTYOFFRESNOFresno.CA
12345678910111213141516171819202122232425262728transactionsthattheyareapartytowhileCONTRACTORisprovidinggoodsorperformingservicesunderthisAgreement.Aself-dealingtransactionshallmeanatransactiontowhichtheCONTRACTORisapartyandinwhichoneormoreofitsdirectorshasamaterialfinancialinterest.MembersoftheBoardofDirectorsshalldiscloseanyself-dealingtransactionsthattheyareapartytobycompletingandsigningaSelf-DealingTransactionDisclosureForm,attachedheretoasExhibitJandincorporatedhereinbyreferenceandmadepartofthisAgreement,andsubmittingittotheCOUNTYpriortocommencingwiththeself-dealingtransactionorimmediatelythereafter.31.AUDITSANDINSPECTIONSTheCONTRACTORshallatanytimeduringbusinesshours,andasoftenastheCOUNTYmaydeemnecessary,makeavailabletotheCOUNTYforexaminationallofitsrecordsanddatawithrespecttothematterscoveredbythisAgreement.TheCONTRACTORshall,uponrequestbytheCOUNTY,permittheCOUNTYtoauditandinspectallsuchrecordsanddatanecessarytoensureCONTRACTOR(S)’scompliancewiththetermsofthisAgreement.IfthisAgreementexceedsTenThousandandNo/100Dollars($10,000.00),CONTRACTORshallbesubjecttotheexaminationandauditoftheStateAuditorGeneralforaperiodofthree(3)yearsafterfinalpaymentundercontract(CaliforniaGovernmentCodesection8546.7).32.NOTICESThepersonshavingauthoritytogiveandreceivenoticesunderthisAgreementandtheiraddressesincludethefollowing:COUNTYCONTRACTORDirector,FresnoCountyDirectorDepartmentofBehavioralHealthCentroLaFamiliaAdvocacyServices3133N.MillbrookAve.302FresnoStreet,Suite102Fresno,CA93703FresnoCA93706AnyandallnoticesbetweenCOUNTYandCONTRACTORprovidedfororpermittedunderthisAgreementorbylawshallbeinwritingandshallbedeemeddulyservedwhenpersonallydeliveredtooneoftheparties,orinlieuofsuchpersonalservice,whendepositedintheUnitedStatesMail,postageprepaid,addressedtosuchparty.-25-COUNTYOFFRESNOFresno.CA
1234567891011121314151617181920212223242526272833.GOVERNINGLAWThepartiesagreethatforthepurposeofvenue,performanceunderthisAgreementisinFresnoCounty,California.TherightsandobligationsofthepartiesandallinterpretationandperformanceofthisAgreementshallbegovernedinallrespectsbythelawsoftheStateofCalifornia.34.ENTIREAGREEMENTThisAgreement,includingallExhibits,COUNTY’SRevisedRFPNo.17-013andCONTRACTOR’SResponseconstitutestheentireagreementbetweenCONTRACTORandCOUNTYwithrespecttothesubjectmatterhereofandsupersedesallpreviousagreementnegotiations,proposals,commitments,writings,advertisements,publications,andunderstandingsofanynaturewhatsoeverunlessexpresslyincludedinthisAgreement.IllIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII-26-COUNTYOFFRESNOFresno.CA
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IN WITNESS WHEREOF, the parties here to have executed this Agreement as of the day and
year first hereinabove written.
4 ATTEST:
5 CONTRACTOR
6 CENTRO LA FAMILIA ADVOCACY SERVICES COUNTY OF FRESNO
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By:Jt~
PrintName::M UbJS
Titl•= ~ e~uur :;man oiB08fd,Of President
Or any Vice President
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17 By_...,.~~~L~dVl../Jfl:&JM:.q~o~---
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21 Title: Q ;lef-fi.u.i\v ~J. (){f,CRr
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Secretary of Corporation, or
Any Assistant Secretary, or
ChiefFinancial Officer, or
Any Assistant Treasurer
27 Mailing Address:
302 Fresno Street, Suite 102
28 Fresno, CA 93706
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Date: ___.1-~..d""'---...:...;I 3=-----'-\ -=lo""-----
BERNICE E. SEIDEL, Clerk
Board of Supervisors
Date: I {)__. .. I .3 ...... lln
PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
COUNTY OF FRESNO
12345678910111213141516171819202122232425262728APPROVEDASTOLEGALFORM:DANIELCEDERBORG,COUNTYCOUNSELBy:r~Y.APPROVEDASTOACCOUNTINGFORM:VICKICROW,C.P.A.,AUDITOR-CONTROLLER/TREASURER-TAXCOLLECTORByREVIEWEDANDRECOMMENDEDFORAPPROVAL:By:DawanUtecht,DirectorDepartmentofBehavioralHealthFund/Subclass0001/10000Organization:56304710Account/Program:7294/0-28-COUNTYOFFRESNOFresno.CA
ExhibitAPage1of7MentalHealthServicesActConsumer/FamilyAdvocacyServicesScopeofWorkContractor:CentroLaFamiliaAdvocacyServices(CLFAS)302FresnoSt.,Suite102,Fresno,CA93706ContractPeriod:January1,2017throughJune30,2019,withprovisionoftwo(2)twelve-monthrenewalperiodsthereafterContractBudget:$56,784.00firstsix-monthterm;$113,568annuallythereafterTargetPopulation:Unservedandunderservedchildren/youth,transitionalageyouth,adults,andolderadultsandtheirfamiliesresidinginruralandmetropolitanareasofFresnoCountywhomaybeexperiencingafirstbreakinmentalillnessorexperiencingearlyonsetofacrisisConsumer/FamilyAdvocacyProgramProvidedinaccordancewiththeMentalHealthServicesAct(MHSA)guidelinesandprinciples,theConsumer/FamilyAdvocacyprogramincludestheprovisionofcommunity-basedbehavioralhealthsupportandstigmareductioneducationservices.Inaddition,outreachandtrainingshallbeprovidedtoeducateclients,families,andthecommunityon:mentalhealth,wellnessandrecovery;availablesupportandtreatmentresources;andanti-stigmaandsuicideprevention.Programgoalsandobjectivesincludeeducatingandprovidingsupportsandservicesearlyinthemanifestationofmentalillnesstoaddressandalleviatethesymptomsofmentalillnessbeforetheyworsenandtriggerinvolvementwithlawenforcement,involuntaryholds/services,oradmissiontoemergencydepartmentsand/orthecriminaljusticesystem.Inaddition,theprogramshallfacilitateandimprovetherelationships,servicelinkages,andmentalhealthservicesbetweenclients/familiesandCountyofFresno,aswellasothercommunityproviders.Consumer/FamilyAdvocateConsumer/FamilyAdvocatestaffshallserveasclient/familyadvocatesfullydevotedtotheneedsofclients/familiesinthecommunity.Staffshallprovidecommunity-basedresponsesandadvocacyeffortsinplaceswheretheunserved/underservedmayfrequent,suchasinthehome,communitycenters,andothergatheringplacesthroughoutFresnoCounty.TheContractorshalldevelopacommunityidentity,presenceandeffectiveengagementstrategiesthatshallenablethestafftoeducate,advocate,trainandrespondtothebehavioralhealthneeds(mentalhealthandsubstanceusedisorders)ofculturallydiverseindividuals,familiesandgroups.TheContractormayserveasacommunityrepresentativeinpolicymeetingsandcommittees(QualityImprovement,CulturalDiversity,etc.),andinothercommunitystakeholdersettings,suchascommissions,boards,andotherprovideragenciesstaffmeetings.TheConsumer/FamilyAdvocatesshallworktodevelopandimprovepreventionandearlyinterventionstrategieswithclientsandfamiliesofclientswhomaybeexperiencingafirstbreakinmentalillnessorexperiencingearlyonsetofacrisis.
ExhibitAPage2of7Advocatesshallprovidementalhealthandwellnessandrecoveryeducationtothefamily;assistthefamilyandclientindevelopingpositiveinteractionskillsandcommunicationtechniques;andhelpbuildresiliencyinthefamilyinanefforttopreventfuturementalhealthcrisis.TheContractorshallprovide:•Family/clientengagement,referrals,linkagesandwarmhandoffs,supportservices,crisisservices,andfollow-upservicestoensureneedsareaddressed;•ClearandcomprehensivecommunicationofservicesprovidedtothecommunityandspecificallytotheDepartmentofBehavioralHealthanditscontractedprovidersthroughdeliberateandregularcontacts,in-servicetrainings,meetings,etc.;•Ongoingandthoroughcomplaint/concerncomponent,includingreviewandanalysisofqualityimprovementgoals/objectivessoughtandachieved,protocolsforprocessingcomplaints,appropriateresponsiveness,follow-up,etc.;•Familyadvocatetrainingandfamilypeereducationonmentalhealthandwellness,availablecommunityservicesandresources,anti-stigmaandsuicideprevention;•Resourcephonenumberforfamily/clients/providerstocallforadvocacyandsupportneedsandservices,includingprotocolsforprocessingcallsandcoordinatingservices;•Community/client/familyeducationforallagegroups,includingbutnotlimitedto:mentalhealthandwellness,stigmareduction,MentalHealthFirstAidandsuicideprevention;•CommunityresourcecollaborationandcoordinationinruralandmetropolitanareasandcitiesofFresnoCounty;•OutreachandcommunityliaisonservicescoordinatedtoensuresupportservicesinruralandmetropolitanareasandcitiesofFresnoCounty;•CollaborationandcoordinationwithFresnoCountyandothercommunityserviceproviderstoenhanceandexpandawarenessof,andaccessandlinkagestoavailablecommunityresourcesandservices;and•Outreach,educationandin-servicepresentationstoothercommunityprovidersregardingavailableservices,andfeedbackonthoseservices.ReportingTheContractorshallprovidereportsasrequestedbytheCounty,including,butmaynotbelimitedto:
ExhibitAPage3of7•OutcomePerformanceMeasures-datacollectionandreporting,includingclient/familyfeedbackonservices,providers,policiesandprocedures.Datacollectionincludes,butisnotlimitedto:agegroup,race,ethnicity,primarylanguage,numbersserved(uniqueandrepeat),genderatbirth,currentgenderidentity,sexualorientation,disability,Veteran’sstatus,anddurationoftimeuntreated.OutcomesmustbemeasurableandclearlyidentifythePEIprogramtype,individualservices,familyservices,liaisonactivitiesandoutcomesofcontactsandservices.TheContractorshallutilizeacomputerizedtrackingsystemtocollect,trackandmaintainperformancemeasuresandotherrelevantclientdataasrequiredbyMHSAPEIregulationseffectiveOctober6,2015(http://mhsoac.ca.gov/sites/default/files/documents/2016-03/PEIFinalAdoptedOct2015.pdf).Indicators(anddatasource)aretobereportedtotheDBHAnalystonamonthlybasis.SeeProgramOutcomesbelow.•Clientandfamilymembercomplaint/concernreviewprocess.Thiscomplaintreviewprocesswouldincludethereviewofconcernsrelatedtoclientandstakeholderidentifiedissuessuchasaccessto,andsatisfactionwithCountymentalhealthservicesandcontractedservices.Thecomplaint/concernreviewprocessshallinvolvecontinuedandactiveparticipationonFresnoCounty’sQualityImprovementCouncil(QIC).Saidcomplaint/concernreviewprocessshallincludecreatingclient/familymembercalllogs,reportingmechanismstotheDBH,qualityimprovementrecommendationsandadditionalsummaries/reportsasneededtoDBHdesignee(s).Informationalmaterialrelevanttoclient/familymemberneedsandperspectiveshallbeprovidedtoclients/familymembers.•MonthlystaffingreportsidentifyingallstaffbyclassificationandFTE.•FixedAssetLog(ExhibitE)shallbesubmitteduponacquisitionoffixedasset(s)andresubmittedeachmonththereisanadditionordeletionofafixedasset,oruponrequestbyCounty.•MonthlyexpenseandrevenueinvoiceandrelativeGeneralLedgerasdescribedinSectionFive(5)ofthisAgreementandinalignmentwiththeBudget-ExhibitC.ProgramOutcomesContractorshallmeetorexceedtheexpectationsfordatacollectionandreportingofprogramoutcomesasidentifiedbelowandinthisContract.ScopeofWorkComponentSnapshotComponentmmOutcomeIMeasurementToolFamily/ClientActasliaisonbetweenIncreasefamily/clientlevelofCasemanagement,Engagementfamily/clientsconnectingthemfunctioning,confidenceandreferrallog,NeedstoappropriatementalhealthcopingskillsandreduceStressorSurvey,servicesthatincludeslinkage,stigma/discriminationofmentalFamilyDevelopmentcrisisintervention,supporthealth.Matrix,Outcomeservices,referralsandwarm-Comparisonhandoffs.Conductfollow-upsTrackingSheet.
ExhibitAPage4of7IComponent1Activity|toensureneedsweremet.CommunicationofServicesProvideeducationandinformationtocommunitymembers,schools,clinics,community-basedorganizations,churches,DepartmentofBehavioralHealthanditscontractedproviders.Complaint/ConcernsMonitorcomplaint/concemsregardingaccesstoandsatisfactionwithmentalhealthservicesusingestablishedprocess.FamilyAdvocateTrainingandFamilyPeerEducationConsumerFamilyAdvocatesshallparticipateinFamilyAdvocacyTrainingfocusingonholistic,culturallysensitivementalhealthservicedelivery.Actasliaisonsforfamily/clientsconnectingthemtoCountyprofessionalstaffandothermentalhealthservices.ResourcePhoneNumberFamily/clientshaveaccessto;CLFA,DepartmentofBehavioralHealth,andothermentalhealthservices.Community/client/familyeducationProvidecommunityoutreachandpublicspeakingtoincreasepublicawarenessontheimpactofmentalillness.CommunityResourceCollaborationandCoordinationiCollaborateandcoordinateresourcesinurbanandruralcommunitiesinFresno1County.OutreachandcommunityLiaisonServicesPresentationsandhealthfairsinruralcommunitiesandinFresno;presentationsonmedia;casemanagementofindividualsandwarmhandoff!linkagetoservices.OutcomeAllindividualsandorganizationsreachedshallhaveknowledgeandunderstandingofmentalhealthissuestominimizestigma/discrimination,demystifymythsandbecomeawareofavailableresources/servicestoseekandreceiveassistance.Family/clientshallbeprovidedasecureandconfidentialprocesstovoicetheirconcernsandissuesandreceiveresolutionstotheircomplaints.Family/clientsshallreceiveeffective,culturallysensitivementalhealthservices.Stabilizesituationbylinkingfamily/clientstoappropriateresourcesandensurefamily/clientprogress.Family/clientsutilizeCLFAtoconnectwithmentalhealthservices.Alllinkagesshallbetrackedandensurewarmhandoffmade.Consumersandfamilymembersshallincreaseawarenessofmentalhealthissuestominimizestigma/discrimination,andincreasefamilialsupportandcopingskillsthroughoutreachandpresentations.Demonstrateincreasedknowledgeofavailableresourcesandaccesstothoseresourcesincludingcommunitygroups/programs,governmententitlements,self-helpprograms,andvocationaltrainingresourcestoinstillself-relianceandconfidence.ResidentsofunderservedcommunitiesinFresnoandsurroundingruralareasshallincreaseunderstandingofmentalhealthissues.Individualsandfamiliesshallbelinkedwithservices.MeasurementToolSign-insheets,Pre/PostEvaluationsComplaintReviewFormSign-InSheetswithtopic,Referrallog.Casemanagement,referrallog.Sign-insheets,Pre/PostEvaluationSign-insheetsCasemanagement,referrallog.
ExhibitAPage5of7CollaborationandContinuetoparticipateinCoordinationtocommunitymeetings,EnhanceServicescollaboratives,andplanninggroupsinFresnoCounty.|i:CommunityagenciescoordinateLogofcollaborativeservicestoidentifyandaddressmeetingsandeventsgapsandduplicationofservices;agenciesprovidemoreeffectivereferralstoneededservices.DataCollectionshallbecompletedintheprogramusingthefollowingtools,asreferencedabove:TrackingSheets1)Sign-insheets—totrackindividualsreached;2)CallLog—totrackcallsreceivedandoutcomes;3)ReferralLog—totrackreferralsmadeandoutcomes;4)EventLog—totrackthenumberofpresentations,outreachevents,trainings,mediaevents,calls,andwalk-inappointments;5)Pre/PostEvaluation—totrackoutcomesforpresentations.Informationshallbecomparedandassessedforfamily/clientsatisfaction.ClientMeasurementsClientimpactoutcomesshallbemeasuredusingTheNeedsSurveyandTheFamilyDevelopmentMatrix.TheNeedsSurvey:Thepurposeofthesurveyistoidentifythestressorsaclientisfacingandassistthemwithresources/servicestoaddresstheissues.TheNeedssurveyshallbeusedtodetermineappropriateservicestobeprovidedclientsbyCLFAorbyreferral.TheNeeds(Stressors)Surveyshallbeusedtoassesstheneedsofclientsrelatedto:•Basic(food,clothing,shelter)•Physical&mental•Needsrelatedtochildren•Other(immigration,employment)TheFamilyDevelopmentMatrix(FDM):TheCLFA-tailoredstrengthsbasedFamilyDevelopmentMatrix(FDM)toolwith13indicatorsisusedtoassistclientswithproblemsolving,goaldevelopment,andtostimulatedecision-makingandaction.Theindicatorsaredomesticviolence,riskofabuse,thehealthandsafetyofthehome,immigration,emotionalwell-being,purposeforlife,accesstotransportation,knowledgeofcommunityresources,familycommunicationskills,parentingskills,childdevelopment,literacy,andaccesstohealthcare.Basedonresponses,areasaredefinedas“incrisis,”“atrisk,”“stable,”or“self-sufficient.”Uponcompletion,aFamilyEmpowermentplanisjointlydevelopedwiththeclient,ifshe/heiswilling.PleaseseeattachedCLFAFDMAssessmentFormandFamilyEmpowermentPlan.DemographicInformationandReportingInformationonfamily/clientsservedshallbetrackedthroughCLFAIntakeForm,ClientDemographicandCaseActivityReport,andOutcomeComparison.TheseformsshallbeusedtocompilemonthlyreportsfortheDepartmentofBehavioralHealthandshallbeupdatedweeklybystaff.
ExhibitAPage6of71)CLFAIntakewhichtracksdemographicinformation,directservice,andconsenttohelptheclient.Demographicsare:clientname,address,zipcode,dateofbirth,new/existingclient,ethnicity,language,levelofeducation,gender,agebracket,#inhousehold,maritalstatus,legalstatus,referralsource,servicesprovided,highrisk,referrals,casestatus.2)ClientDemographicandCaseActivityReporttracksclientname,address,zipcode,dateofbirth,new/existingclient,ethnicity,language,levelofeducation,gender,agebracket,#inhousehold,maritalstatus,legalstatus,referralsource,servicesprovided,highrisk,referrals,casestatus(sampleincludedinReportssection).3)OutcomeComparison(utilizedforreportstothecounty)includesdate,clientname,staff,eventtype,initialneedsassessment,secondneedsassessment,followup/exitassessment,familydevelopmentmatrixoutcomes,referrals,supportgroupparticipantandnotes.Assessmentsareconductedeverythreemonths,andwhenaclientleavestheprogram.ThetablebelowsummarizesthecomponentsoftheCentroLaFamiliaAdvocacy,Inc.,annualgoals.MeasureableObjectivesDescriptionYear1Year2Year3Year4Year5Family/ClientEngagementCLFA:CLFA:CLFA:CLFA:CLFA:(maintainunduplicatedclient5053565962base).FIRMFIRM:FIRM:FIRM:FIRM:2526283032SupportGroupFacilitationCLFA:CLFA:CLFA:CLFA:CLFA:•CLFASupportGroup910111213•FIRMSupportGroupFIRMFIRMFIRMFIRMFIRM910111213OutreachEventsSmallwithCLFA:CLFA::CLFA:CLFA:CLFA:attendanceof500orless2425262728•NumberofEventsFIRM:FIRM:FIRM:FIRM:FIRM:•NumberReached12131415161,2251,2901,3541,4221,493OutreachEventsLargewithCLFA:CLFA:CLFA:CLFA:CLFA:attendanceof500ormore12233•NumberofEventsFIRM:FIRM:FIRM:FIRM:FIRM:•NumberReached11223450475500525550EducationPresentationsMonthlyCLFA:CLFA:CLFA:CLFA:CLFA:•CLFA2amonth2425262728•FIRM1amonthFIRM:FIRM:FIRM:FIRM:FIRM:1213141516MediaOutreach-TelevisionorCLFA::CLFA:CLFA:CLFA:CLFA:RadioInterviews10,00010,50010,52510,55010,600•CLFA1PerQuarterFIRM:FIRM:FIRM:FIRM:FIRM:•FIRM1PerQuarter10,00010,50010,52510,55010,600Referralsforinfoaboutmental4550556065
ExhibitAPage7of7DescriptionYear1Year2Year3Year4Year5healthFollow-upcontactmadeforcritical/at-riskFDMorNeedsStressors40%45%50%55%60%Follow-upcontactmadeforallothercases40%45%50%55%60%Percentof“WarmHandoffs”(includesinpersonanddirectinvolvementwithcallingforappointments)40%45%50%55%60%
OutcomesMeasurementsExhibitBService/ActivityOutcomeIndicator/Short-TermOutcomesDataSourceCentroLaFamilia:ConsumerAdvocacy;FamilyAdvocateTrainingandPeertoPeerEducationIncreasefamilysupportandawareness.Increaseawarenessofrelapseprevention.FamilyAdvocacytrainingtobecompletedonaquarterlybasis.ThoseengagedinPeertoPeerwillselfreport.inc/decinrelapse.Traininglogssubmittedmonthly.PeertoPeerrecordsCentroLaFamilia:ConsumerAdvocacy:Family/ConsumerReferralReceive,log,andprovideadvocacyservicesasinitiatedbycallstooffice.Family/Consumersupporttoassistinthenavigationofsystemandtoengagecrisis/treatmentservicesasneededtoalleviatecrisisescalation.Monthlycalllogs/withdispositionsubmitted.CentroLaFamiliaConsumerAdvocacy:SupportGroupFacilitationIncreaseconsumerandfamilymembersconfidence,functioningandcopingskills.consumersandfamilymembersexpresspositivechangetogroupleadersObservationandfeedbackfromparticipantsCentroLaFamiliaFamilyAdvocacy:Presentationstotargetpopulationsonvariousmentalhealthdisorders,targetinghomeless,aged,GLBTQ&Oandparentsofschoolagechildren.Educateandincreasepublicawarenessofimpactofmentalillnesstofamilymembersandconsumerstominimizestigma.Targetpopulationincludesunservedandunderservedinruralareasandnon-Englishspeaking.Pre/postevaluationofparticipants.75%ofparticipantswillincreaseawarenessandknowledgeofmentalhealth(ex.QuestionsfromMentalHealthOpinionsQuiz)Monthlyreportofoutreachactivitiestoincludetargetpopulationandgoalsachieved.MentalHealthFirstAidTrainingandparticipantsingroup.
ExhibitCMentalHealthServicesAct-PreventionandEarlyInterventionCENTROLAFAMILIAADVOCACYSERVICES,INC.(CLFAS)CONSUMER/FAMILYADVOCACYSERVICESFY2016-17(January1,2017throughJune30,2017)BudgetCategories-TotalProposedBudgetLineItemDescription(Mustbeitemized)FTE%Admin.DirectTotalPERSONNELSALARIES:0001ConsumerFamilyAdvocate($15/hrx37.5/hrwk)1.0014,625$14,6250002ConsumerFamilyAdvocate($12/hrx18.75/hrwk)0.505,850$5,8500003ExecutiveDirector(7500/mox.05)0.0282,2500$2,250SALARYTOTAL2,25020,475$22,725PAYROLLTAXES:00300$00031OASDI&Medicare1721,567$1,7390032S.U.I.50434$484PAYROLLTAXTOTAL2222,001$2,223EMPLOYEEBENEFITS:0040WorkersCompensation(1.02interimrate)29278$3070041HealthInsurance(medicalvision,life,dental)(7.5%)4113,738$4,149EMPLOYEEBENEFITSTOTAL4404,016$4,456SALARY&BENEFITSGRANDTOTAL26,492$29,404FACILITIES/EQUIPMENTEXPENSES:1050Rent/LeaseBuilding$2,0821051Utilities$1131052BuildingMaintenance/Janitorial$63FACILITY/EQUIPMENTTOTAL$2,258OPERATINGEXPENSES:1060Telephone$3631061Postage$591062Printing/Reproduction$1131063OfficeSupplies&Equipment$7481064StaffMileage/vehiclemaintenance$1,050OPERATINGEXPENSESTOTAL$2,333FINANCIALSERVICESEXPENSES:1070Accounting/Bookkeeping$3751071ExternalAudit$2631072LiabilityInsurance$1631073Other-AdministrativeOverhead$2,704FINANCIALSERVICESTOTAL$3,505SPECIALEXPENSES(Consultant/Etc)1080ConsultantTraining&DevelopmentforMHServices$2,9411081Subcontract-FIRM$16,343SPECIALEXPENSES(Consultant/Etc)$19,284TOTALPROGRAMEXPENSES$56,784REVENUE5100MHSAPEIFunds$56,784REVENUETOTAL$56,784TOTALPROGRAMREVENUE$56,784
ExhibitCMentalHealthServicesAct-PreventionandEarlyInterventionCENTROLAFAMILIAADVOCACYSERVICES,INC.(CLFAS)CONSUMER/FAMILYADVOCACYSERVICESFY2017-18BudgetCategories-LineItemDescription(Mustbeitemized)FTE%Admin.TotalProposedBudgetDirectTotalPERSONNELSALARIES:0001ConsumerFamilyAdvocate($15/hrx37.5/hrwk)1.0029,250$29,2500002ConsumerFamilyAdvocate($12/hrx18.75/hrwk)0.5011,700$11,7000003ExecutiveDirector(7500/mox.05)0.054,5000$4,500SALARYTOTAL4,50040,950$45,450PAYROLLTAXES:00300$00031OASDI&Medicare3443,133$3,4770032S.U.I.100868$968PAYROLLTAXTOTAL4444,001$4,445EMPLOYEEBENEFITS:0040WorkersCompensation(1.02interimrate)60550$6100041HealthInsurance(medicalvision,life,dental)(7.5%)8227,478$8,300EMPLOYEEBENEFITSTOTAL8828,028$8,910SALARY&BENEFITSGRANDTOTAL52,979$58,805FACILITIES/EQUIPMENTEXPENSES:1050Rent/LeaseBuilding$4,1631051Utilities$2251052BuildingMaintenance/Janitorial$125FACILITY/EQUIPMENTTOTAL$4,513OPERATINGEXPENSES:1060Telephone$7251061Postage$1171062Printing/Reproduction$2251063OfficeSupplies&Equipment$1,5071064StaffMileage/vehiclemaintenance$3,500OPERATINGEXPENSESTOTAL$6,074FINANCIALSERVICESEXPENSES:1070Accounting/Bookkeeping$7501071ExternalAudit$5251072LiabilityInsurance$3251073Other-AdministrativeOverhead$4,008FINANCIALSERVICESTOTAL$5,608SPECIALEXPENSES(Consultant/Etc)1080ConsultantTraining&DevelopmentforMHServices$5,8831081Subcontract-FIRM$32,685SPECIALEXPENSES(Consultant/Etc)$38,568TOTALPROGRAMEXPENSES$113,568REVENUE5100MHSAPEIFunds$113,568REVENUETOTAL$113,568TOTALPROGRAMREVENUE$113,568
ExhibitCMentalHealthServicesAct-PreventionandEarlyInterventionCENTROLAFAMILIAADVOCACYSERVICES,INC.(CLFAS)CONSUMER/FAMILYADVOCACYSERVICESFY2018-19BudgetCategories-LineItemDescription(Mustbeitemized)FTE%Admin.TotalProposedBudgetDirectTotalPERSONNELSALARIES:0001ConsumerFamilyAdvocate($15.45/hrx37.5/hrwk)1.0030,128$30,1280002ConsumerFamilyAdvocate($12.36/hrx18.75/hrwk)0.5012,051$12,0510003ExecutiveDirector(7725/mox.05)0.054,6350$4,635SALARYTOTAL4,63542,179$46,814PAYROLLTAXES:00300$00031OASDI&Medicare3543,227$3,5810032S.U.I.100868$968PAYROLLTAXTOTAL4544,095$4,549EMPLOYEEBENEFITS:0040WorkersCompensation(1.02interimrate)63569$6320041HealthInsurance(medicalvision,life,dental)(7.5%)8227,478$8,300EMPLOYEEBENEFITSTOTAL8858,047$8,932SALARY&BENEFITSGRANDTOTAL54,321$60,295FACILITIES/EQUIPMENTEXPENSES:1050Rent/LeaseBuilding$4,1631051Utilities$2251052BuildingMaintenance/Janitorial$125FACILITY/EQUIPMENTTOTAL$4,513OPERATINGEXPENSES:1060Telephone$7251061Postage$1171062Printing/Reproduction$2251063OfficeSupplies&Equipment$1,5071064StaffMileage/vehiclemaintenance$3,500OPERATINGEXPENSESTOTAL$6,074FINANCIALSERVICESEXPENSES:1070Accounting/Bookkeeping$7501071ExternalAudit$5251072LiabilityInsurance$3251073Other-AdministrativeOverhead$2,518FINANCIALSERVICESTOTALH$4,118SPECIALEXPENSES(Consultant/Etc)1080ConsultantTraining&DevelopmentforMHServices$5,8831081Subcontract-FIRM$32,685SPECIALEXPENSES(Consultant/Etc)$38,568TOTALPROGRAMEXPENSES$113,568REVENUE5100MHSAPEIFunds$113,568REVENUETOTAL$113,568TOTALPROGRAMREVENUE$113,568
ExhibitCMentalHealthServicesAct-PreventionandEarlyInterventionCENTROLAFAMILIAADVOCACYSERVICES,INC.(CLFAS)CONSUMER/FAMILYADVOCACYSERVICESFY2019-20BudgetCategories-TotalProposedBudgetLineitemDescription(Mustbeitemized)FTE%Admin.DirectTotalPERSONNELSALARIES:0001ConsumerFamilyAdvocate($15.91/hrx37.5/hrwk)1.0031,031$31,0310002ConsumerFamilyAdvocate($12.36/hrx18.75/hrwk)0.5012,413$12,4130003ExecutiveDirector(7957/mox.05)0.0284,7740$4,774SALARYTOTAL4,77443,444$48,218PAYROLLTAXES:00300$00031OASDI&Medicare3653,323$3,6880032S.U.I.100868$968PAYROLLTAXTOTAL4654,191$4,656EMPLOYEEBENEFITS:0040WorkersCompensation(1.02interimrate)64587$6510041HealthInsurance(medicalvision,life,dental)(7.5%)8227,478$8,300EMPLOYEEBENEFITSTOTAL8868,065$8,951SALARY&BENEFITSGRANDTOTAL55,700$61,825FACILITIES/EQUIPMENTEXPENSES:1050Rent/LeaseBuilding$4,1631051Utilities$2251052BuildingMaintenance/Janitorial$125FACILITY/EQUIPMENTTOTAL$4,513OPERATINGEXPENSES:1060Telephone$7251061Postage$1171062Printing/Reproduction$2251063OfficeSupplies&Equipment$1,5081064StaffMileage/vehiclemaintenance$3,500OPERATINGEXPENSESTOTAL$6,075FINANCIALSERVICESEXPENSES:1070Accounting/Bookkeeping$7501071ExternalAudit$5251072LiabilityInsurance$3251073Other-AdministrativeOverhead$987FINANCIALSERVICESTOTALH$2,587SPECIALEXPENSES(Consultant/Etc)1080ConsultantTraining&DevelopmentforMHServices$5,8831081Subcontract-FIRM$32,685SPECIALEXPENSES(Consultant/Etc)$38,568TOTALPROGRAMEXPENSES$113,568REVENUE5100MHSAPEIFunds$113,568REVENUETOTAL$113,568TOTALPROGRAMREVENUE$113,568
ExhibitCMentalHealthServicesAct-PreventionandEarlyInterventionCENTROLAFAMILIAADVOCACYSERVICES,INC.(CLFAS)CONSUMER/FAMILYADVOCACYSERVICESFY2020-21BudgetCategories-LineItemDescription(Mustbeitemized)FTE%TotalProposedBudgetAdmin.DirectTotalPERSONNELSALARIES:0001ConsumerFamilyAdvocate($15.91/hrx37.5/hrwk)1.000002ConsumerFamilyAdvocate($12.36/hrx18.75/hrwk)0.500003ExecutiveDirector(7957/mox.05)0.0284,77431,03112,4130$31,031$12,413$4,774SALARYTOTAL4,77443,444$48,218PAYROLLTAXES:00300031OASDI&Medicare0032S.U.I.36510003,323868$0$3,688$968PAYROLLTAXTOTAL4654,191$4,656EMPLOYEEBENEFITS:0040WorkersCompensation(1.02interimrate)0041HealthInsurance(medicalvision,life,dental)(7.5%)648225877,478$651$8,300EMPLOYEEBENEFITSTOTAL8868,065$8,951SALARY&BENEFITSGRANDTOTAL55,700$61,825FACILITIES/EQUIPMENTEXPENSES:1050Rent/LeaseBuilding1051Utilities1052BuildingMaintenance/Janitorial$4,163$225$125FACILITY/EQUIPMENTTOTAL$4,513OPERATINGEXPENSES:1060Telephone1061Postage1062Printing/Reproduction1063OfficeSupplies&Equipment1064StaffMileage/vehiclemaintenance$725$117$225$1,508$3,500OPERATINGEXPENSESTOTAL$6,075FINANCIALSERVICESEXPENSES:1070Accounting/Bookkeeping$7501071ExternalAudit$5251072LiabilityInsurance$3251073Other-AdministrativeOverhead$987FINANCIALSERVICESTOTAL|$2,587SPECIALEXPENSES(Consultant/Etc)1080ConsultantTraining&DevelopmentforMHServices$5,8831081Subcontract-FIRM$32,685SPECIALEXPENSES(Consultant/Etc)$38,568TOTALPROGRAMEXPENSESREVENUE$113,5685100MHSAPEIFunds$113,568REVENUETOTAL$113,568TOTALPROGRAMREVENUE$113,568
ExhibitDPage1of2STATEMENTALHEALTHREQUIREMENTS1.CONTROLREQUIREMENTSTheCOUNTYanditssubcontractorsshallprovideservicesinaccordancewithallapplicableFederalandStatestatutesandregulations.2.PROFESSIONALLICENSUREAll(professionallevel)personsemployedbytheCOUNTYMentalHealthProgram(directlyorthroughcontract)providingShort-Doyle/Medi-CalserviceshavemetapplicableprofessionallicensurerequirementspursuanttoBusinessandProfessionsandWelfareandInstitutionsCodes.3.CONFIDENTIALITYCONTRACTORshallconformtoandCOUNTYshallmonitorcompliancewithallStateofCaliforniaandFederalstatutesandregulationsregardingconfidentiality,includingbutnotlimitedtoconfidentialityofinformationrequirementsat42,CodeofFederalRegulationssections2.1etseq;CaliforniaWelfareandInstitutionsCode,sections14100.2,11977,11812,5328;Division10.5and10.6oftheCaliforniaHealthandSafetyCode;Title22,CaliforniaCodeofRegulations,section51009;andDivision1,Part2.6,Chapters1-7oftheCaliforniaCivilCode.4.NON-DISCRIMINATIONA.EligibilityforServicesCONTRACTORshallprepareandmakeavailabletoCOUNTYandtothepublicalleligibilityrequirementstoparticipateintheprogramplansetforthintheAgreement.Nopersonshall,becauseofethnicgroupidentification,age,gender,color,disability,medicalcondition,nationalorigin,race,ancestry,maritalstatus,religion,religiouscreed,politicalbelieforsexualpreferencebeexcludedfromparticipation,bedeniedbenefitsof,orbesubjecttodiscriminationunderanyprogramoractivityreceivingFederalorStateofCaliforniaassistance.B.EmploymentOpportunityCONTRACTORshallcomplywithCOUNTYpolicy,andtheEqualEmploymentOpportunityCommissionguidelines,whichforbidsdiscriminationagainstanypersononthegroundsofrace,color,nationalorigin,sex,religion,age,disabilitystatus,orsexualpreferenceinemploymentpractices.Suchpracticesincluderetirement,recruitmentadvertising,hiring,layoff,termination,upgrading,demotion,transfer,
ExhibitDPage2of2ratesofpayorotherformsofcompensation,useoffacilities,andothertermsandconditionsofemployment.C.SuspensionofCompensationIfanallegationofdiscriminationoccurs,COUNTYmaywithholdallfurtherfunds,untilCONTRACTORcanshowclearandconvincingevidencetothesatisfactionofCOUNTYthatfundsprovidedunderthisAgreementwerenotusedinconnectionwiththeallegeddiscrimination.D.NepotismExceptbyconsentofCOUNTY’SDepartmentofBehavioralHealthDirector,ordesignee,nopersonshallbeemployedbyCONTRACTORwhoisrelatedbybloodormarriageto,orwhoisamemberoftheBoardofDirectorsoranofficerofCONTRACTOR.5.PATIENTS'RIGHTSCONTRACTORshallcomplywithapplicablelawsandregulations,includingbutnotlimitedto,laws,regulations,andStatepoliciesrelatingtopatients'rights
ExhibitEPage1of2Vendor:Contract#ContactPersonContact#FixedAssetandSensitiveItemTrackingSfliilPIItemMake/BrandModelSerial#|CopierLUiJD|DVDPlayerXUJDatePrepared:CanonSony27CRTDV22309YHJY65RPXC4356A12345678f910f111213141516171819202122j"2324r25DateReceived:d)w</><XULE0)>‘5<uOTDateRequested(IfFixedAsset)DateApproved(IfFixedAssset)!PurchaseDateLocationConditionFresnoCountyInventoryNumberCostx3/27/20084/1/20084/10/2008xn/an/a4/1/2008HeritageHeritageNewNew$6,500.00$450.00Ii1tf
EXHIBIT-EPage2of2FIXEDASSETANDSENSITIVEITEMTRACKINGFieldNumberFieldDescriptionInstructionorCommentsRequiredorConditionalHeaderVendorIndicatethelegalnameoftheagencycontractedtoprovideservices.RequiredHeaderProgramIndicatethetitleoftheprojectasdescribedinthecontractwiththeCounty.RequiredHeaderContract#IndicatetheassignedCountycontractnumber.Ifnotknown,Countystaffcanprovide.RequiredHeaderContactPersonIndicatethefirstandlastnameoftheprimaryagencycontactforthecontract.RequiredHeaderContactitIndicatethemostappropriatetelephonenumberoftheprimaryagencycontactforthecontract.RequiredHeaderDatePreparedIndicatethemostcurrentdatethatthetrackingformwascompletedbythevendor.RequiredaItemIdentifytheitembyprovidingacommonlyrecognizeddescriptionoftheitem.RequiredbMake/BrandIdentifythecompanythatmanufacturedtheitem.RequiredcModelIdentifythemodelnumberfortheitem,ifapplicable.ConditionaldSerialtfIdentifytheserialnumberfortheitem,ifapplicable.ConditionaleFixedAssetMarktheboxwithan"X"ifthecostoftheitemis$5,000ormoretoindicatethattheitemisafixedasset.ConditionalfSensitiveItemMarktheboxwithan"X"iftheitemmeetsthecriteriaofasensitiveitemasdefinedbytheCounty.ConditionalgDateRequestedIndicatethedatethattheagencysubmittedarequesttotheCountytopurchasetheitem.RequiredhDateApprovedIndicatethedatethattheCountyapprovedtherequesttopurchasetheitem.RequirediPurchaseDateIndicatethedatetheagencypurchasedtheitem.RequiredjLocationIndicatethephysicallocationoftheitemRequiredkConditionIndicatethegeneralconditionoftheitem(New,Good,Worn,Bad).Required1FresnoCountyInventoryNumberIndicatetheFR#providedbytheCountyfortheitem.ConditionalmCostIndicatethetotalpurchasepriceoftheitemincludingsalestaxandothercosts,suchasshipping.Required
ExhibitFPage1of3FRESNOCOUNTYMENTALHEALTHCOMPLIANCEPROGRAMCONTRACTORCODEOFCONDUCTANDETHICSFresnoCountyisfirmlycommittedtofullcompliancewithallapplicablelaws,regulations,rulesandguidelinesthatapplytotheprovisionandpaymentofmentalhealthservices.Mentalhealthcontractorsandthemannerinwhichtheyconductthemselvesareavitalpartofthiscommitment.FresnoCountyhasestablishedthisContractorCodeofConductandEthicswithwhichcontractoranditsemployeesandsubcontractorsshallcomply.ContractorshallrequireitsemployeesandsubcontractorstoattendacompliancetrainingthatwillbeprovidedbyFresnoCounty.Aftercompletionofthistraining,eachcontractor,contractor’semployeeandsubcontractormustsigntheContractorAcknowledgmentandAgreementformandreturnthisformtotheComplianceofficerordesignee.Contractoranditsemployeesandsubcontractorshall:1.Complywithallapplicablelaws,regulations,rulesorguidelineswhenprovidingandbillingformentalhealthservices.2.Conductthemselveshonestly,fairly,courteouslyandwithahighdegreeofintegrityintheirprofessionaldealingrelatedtotheircontractwiththeCountyandavoidanyconductthatcouldreasonablybeexpectedtoreflectadverselyupontheintegrityoftheCounty.3.TreatCountyemployees,consumers,andothermentalhealthcontractorsfairlyandwithrespect.4.NOTengageinanyactivityinviolationoftheCounty’sComplianceProgram,norengageinanyotherconductwhichviolatesanyapplicablelaw,regulation,ruleorguideline5.Takeprecautionstoensurethatclaimsarepreparedandsubmittedaccurately,timelyandareconsistentwithallapplicablelaws,regulations,rulesorguidelines.6.Ensurethatnofalse,fraudulent,inaccurateorfictitiousclaimsforpaymentorreimbursementofanykindaresubmitted.7.Billonlyforeligibleservicesactuallyrenderedandfullydocumented.Usebillingcodesthataccuratelydescribetheservicesprovided.
ExhibitFPage2of38.Actpromptlytoinvestigateandcorrectproblemsiferrorsinclaimsorbillingarediscovered.9.PromptlyreporttotheComplianceOfficeranysuspectedviolation(s)ofthisCodeofConductandEthicsbyCountyemployeesorothermentalhealthcontractors,orreportanyactivitythattheybelievemayviolatethestandardsoftheComplianceProgram,oranyotherapplicablelaw,regulation,ruleorguideline.FresnoCountyprohibitsretaliationagainstanypersonmakingareport.AnypersonengaginginanyformofretaliationwillbesubjecttodisciplinaryorotherappropriateactionbytheCounty.Contractormayreportanonymously.10.ConsultwiththeComplianceOfficerifyouhaveanyquestionsorareuncertainofanyComplianceProgramstandardoranyotherapplicablelaw,regulation,ruleorguideline.11.ImmediatelynotifytheComplianceOfficeriftheybecomeormaybecomeanIneligiblepersonandthereforeexcludedfromparticipationintheFederalHealthCarePrograms.
FresnoCountyMentalHealthComplianceProgramExhibitFPage3of3ContractorAcknowledgmentandAgreementIherebyacknowledgethatIhavereceived,readandunderstandtheContractorCodeofConductandEthics.IherbyacknowledgethatIhavereceivedtrainingandinformationontheFresnoCountyMentalHealthComplianceProgramandunderstandthecontentsthereof.IfurtheragreetoabidebytheContractorCodeofConductandEthics,andallComplianceProgramrequirementsastheyapplytomyresponsibilitiesasamentalhealthcontractorforFresnoCounty.IunderstandandacceptmyresponsibilitiesunderthisAgreement.IfurtherunderstandthatanyviolationoftheContractorCodeofConductandEthicsortheComplianceProgramisaviolationofCountypolicyandmayalsobeaviolationofapplicablelaws,regulations,rulesorguidelines.IfurtherunderstandthatviolationoftheContractorCodeofConductandEthicsortheComplianceProgrammayresultinterminationofmyagreementwithFresnoCounty.IfurtherunderstandthatFresnoCountywillreportmetotheappropriateFederalorStateagency.ForIndividualProvidersName(print):Discipline:PsychiatristPsychologistLCSWLMFTSignature:Date:ForGrouporOrganizationalProvidersGroup/Org.Name(print):EmployeeName(print):Discipline:PsychiatristPsychologistLCSWLMFTI|Other:JobTitle(ifdifferentfromDiscipline):Signature:Date://
ExhibitGPage1of4MHSAGUIDELINESGRIEVANCESANDINCIDENTREPORTINGGrievancesFresnoCountyMHSAGuidelines(MHSAG)providesbeneficiarieswithagrievanceandappealprocessandanexpeditedappealprocesstoresolvegrievancesanddisputesattheearliestandthelowestpossiblelevel.Title9oftheCaliforniaCodeofRegulationsrequiresthattheMHSGanditsfee-for-serviceprovidersgiveverbalandwritteninformationtoMedi-Calbeneficiariesregardingthefollowing:•Howtoaccessspecialtymentalhealthservices•Howtofileagrievanceaboutservices•HowtofileforaStateFairHearingTheMHSGhasdevelopedaConsumerGuide,abeneficiaryrightsposter,agrievanceform,anappealform,andRequestforChangeofProviderForm.AllofthesebeneficiarymaterialsmustbepostedinprominentlocationswhereMedi-Calbeneficiariesreceiveoutpatientspecialtymentalhealthservices,includingthewaitingroomsofproviders’officesofservice.Pleasenotethatallfee-for-serviceprovidersandcontractagenciesarerequiredtogivetheirclientscopiesofallcurrentbeneficiaryinformationannuallyatthetimetheirtreatmentplansareupdatedandatintake.Beneficiarieshavetherighttousethegrievanceand/orappealprocesswithoutanypenalty,changeinmentalhealthservices,oranyformofretaliation.AllMedi-Calbeneficiariescanfileanappealorstatehearing.Grievancesandappealsformsandselfaddressedenvelopesmustbeavailableforbeneficiariestopickupatallprovidersiteswithouthavingtomakeaverbalorwrittenrequest.Formscanbesenttothefollowingaddress:FresnoCountyMentalHealthPlanP.O.Box712Fresno,CA93712(800)654-3937(formoreinformation)(559)488-3055(TTY)ProviderProblemResolutionandAppealsProcessTheMHSGusesasimple,informalprocedureinidentifyingandresolvingproviderconcernsandproblemsregardingpaymentauthorizationissues,othercomplaintsandconcerns.Informalproviderproblemresolutionprocess-theprovidermayfirstspeaktoaProviderRelationsSpecialist(PRS)regardinghisorhercomplaintorconcern.ThePRSwillattempttosettlethecomplaintorconcernwiththeprovider.Iftheattemptisunsuccessfulandtheproviderchoosestoforegotheinformalgrievanceprocess,theproviderwillbeadvisedtofileawrittencomplainttotheMHSGaddress(listedabove).Formalproviderappealprocess-theproviderhastherighttoaccesstheproviderappealprocessatanytimebefore,during,oraftertheproviderproblemresolutionprocesshas
ExhibitGPage2of4begun,whenthecomplaintconcernsadeniedormodifiedrequestforMHSGpaymentauthorization,ortheprocessorpaymentofaprovider'sclaimtotheMHSG.Paymentauthorizationissues-theprovidermayappealadeniedormodifiedrequestforpaymentauthorizationoradisputewiththeMHSGregardingtheprocessingorpaymentofaprovider’sclaimtotheMHSG.ThewrittenappealmustbesubmittedtotheMHSGwithin90calendardaysofthedateofthereceiptofthenon-approvalofpayment.TheMHSGshallhave60calendardaysfromitsreceiptoftheappealtoinformtheproviderinwritingofthedecision,includingastatementofthereasonsforthedecisionthataddresseseachissueraisedbytheprovider,andanyactionrequiredbytheprovidertoimplementthedecision.Iftheappealconcernsadenialormodificationofpaymentauthorizationrequest,theMHSGutilizesaManagedCarestaffwhowasnotinvolvedintheinitialdenialormodificationdecisiontodeterminetheappealdecision.IftheManagedCarestaffreversestheappealeddecision,theproviderwillbeaskedtosubmitarevisedrequestforpaymentwithin30calendardaysofreceiptofthedecisionOthercomplaints-ifthereareotherissuesorcomplaints,whicharenotrelatedtopaymentauthorizationissues,providersareencouragedtosendaletterofcomplainttotheMHSG.TheproviderwillreceiveawrittenresponsefromtheMHSGwithin60calendardaysofreceiptofthecomplaint.ThedecisionrenderedbuytheMHSGisfinal.
ExhibitGPage3of4PROTOCOLFORCOMPLETIONOFINCIDENTREPORT•TheIncidentReportmustbecompletedforallincidentsinvolvingclients.Thestaffpersonwhobecomesawareoftheincidentcompletesthisform,andthesupervisorco-signsit.•Whenmorethanoneclientisinvolvedinanincident,aseparateformmustbecompletedforeachclient.Wheretheformsshouldbesent-within24hoursfromthetimeoftheincident•IncidentReportshouldbesentto:•DBHProgramSupervisor
ExhibitGPage4of4INCIDENTREPORTWORKSHEETWhendidthishappen?(date/time)Wheredidthishappen?Name/DMH#1.Backgroundinformationoftheincident:2.Methodofinvestigation:(chartreview,face-to-faceinterview,etc.)Whowasaffected?(Ifotherthanconsumer)Listkeypeopleinvolved,(witnesses,visitors,physicians,employees)3.Preliminaryfindings:Howdidithappen?Sequenceofevents.Bespecific.Ifattachmentsareneededwritecommentsonan81/2sheetofpaperandattachtoworksheet.Outcomeseverity:Nonexistent||||inconsequential||||consequential||||deathjnotapplicable|unknown[Q4.Response:a)correctiveaction,b)PlanofAction,c)otherCompletedby(printname)Completedby(signature)DatecompletedReviewedbySupervisor(printname)SupervisorSignatureDate
ExhibitHPage1of2DISCLOSUREOFOWNERSHIPANDCONTROLINTERESTSTATEMENTI.IdentifyingInformationNa/Wofentity/SHJesKJ^number,street)CI^ftflGiyHbffliijrabntoer(EIN)()II.Answerthefollowingquestionsbychecking“Yes”or“No.”Ifanyofthequestionsareanswered“Yes,"listnamesandaddressesofindividualsorcorporationsunder“Remarks”onpage2.Identifyeachitemnumbertobecontinued.YESNOA.Arethereanyindividualsororganizationshavingadirectorindirectownershiporcontrolinterestoffivepercentormoreintheinstitution,organizations,oragencythathavebeenconvictedofacriminaloffenserelatedtotheinvolvementofsuchpersonsororganizationsinanyoftheprogramsestablishedbyTitlesXVI11,XIX,orXX?B.Arethereanydirectors,officers,agents,ormanagingemployeesoftheinstitution,agency,ororganizationwhohaveeverbeenconvictedofacriminaloffenserelatedtotheirinvolvementinsuchprogramsestablishedbyTitlesXVIII,XIX,orXX?aaC.Arethereanyindividualscurrentlyemployedbytheinstitution,agency,ororganizationinamanagerial,accounting,auditing,orsimilarcapacitywhowereemployedbytheinstitution’s,organization’s,oragency’sfiscalintermediaryorcarrierwithintheprevious12months?(TitleXVIIIprovidersonly)OoIII.A.Listnames,addressesforindividuals,ortheEINfororganizationshavingdirectorindirectownershiporacontrollinginterestintheentity.(Seeinstructionsfordefinitionofownershipandcontrollinginterest.)Listanyadditionalnamesandaddressesunder“Remarks”onpage2.Ifmorethanoneindividualisreportedandanyofthesepersonsarerelatedtoeachother,thismustbereportedunder“Remarks.”EINN/W0BRESSHypeofentity:SoleproprietorshipPartnershipCorporationUnincorporatedAssociationsOther(specify)Of.thedisclosingentityisacorporation,listnames,addressesofthedirectors,andElNsforcorporationsunder“Remarks.”[AreanyownersofthedisclosingentityalsoownersofotherMedicare/Medicaidfacilities?(Example:soleproprietor,partnership,ormembersofBoardofDirectors)Ifyes,listnames,addressesoPndidduals,andprovidernumbersPROVIDERNIMMERESS
ExhibitHPage2of2YESNOIV.A.Hastherebeenachangeinownershiporcontrolwithinthelastyear?aIfyes,givedate.B.Doyouanticipateanychangeofownershiporcontrolwithintheyear?Ifyes,when?C.Doyouanticipatefilingforbankruptcywithintheyear?Ifyes,when?V.Isthefacilityoperatedbyamanagementcompanyorleasedinwholeorpartbyanotherorganization?Ifyes,givedateofchangeinoperations.VI.HastherebeenachangeinAdministrator,DirectorofNursing,orMedicalDirectorwithinthelastyear?VII.A.Isthisfacilitychainaffiliated?(Ifyes,listname,addressofcorporation,andEIN.)NameEINAddress(number,name)CityStateZIPcodeB.IftheanswertoquestionVILA,isNO,wasthefacilityeveraffiliatedwithachain?(Ifyes,listname,addressofcorporation,andEIN.)NameEINAddress(number,name)CityStateZIPcodeWhoeverknowinglyandwillfullymakesorcausestobemadeafalsestatementorrepresentationofthisstatement,maybeprosecutedunderapplicablefederalorstatelaws.Inaddition,knowinglyandwillfullyfailingtofullyandaccuratelydisclosetheinformationrequestedmayresultindenialofarequesttoparticipateorwheretheentityalreadyparticipates,aterminationofitsagreementorcontractwiththeagency,asappropriate.Nameofauthorizedrepresentative(typed)TitleSignatureDateRemarks
ExhibitIPage1of2CERTIFICATIONREGARDINGDEBARMENT,SUSPENSION,ANDOTHERRESPONSIBILITYMATTERS--PRIMARYCOVEREDTRANSACTIONSINSTRUCTIONSFORCERTIFICATION1.Bysigningandsubmittingthisproposal,theprospectiveprimaryparticipantisprovidingthecertificationsetoutbelow.2.Theinabilityofapersontoprovidethecertificationrequiredbelowwillnotnecessarilyresultindenialofparticipationinthiscoveredtransaction.Theprospectiveparticipantshallsubmitanexplanationofwhyitcannotprovidethecertificationsetoutbelow.Thecertificationorexplanationwillbeconsideredinconnectionwiththedepartmentoragency'sdeterminationwhethertoenterintothistransaction.However,failureoftheprospectiveprimaryparticipanttofurnishacertificationoranexplanationshalldisqualifysuchpersonfromparticipationinthistransaction.3.Thecertificationinthisclauseisamaterialrepresentationoffactuponwhichreliancewasplacedwhenthedepartmentoragencydeterminedtoenterintothistransaction.Ifitislaterdeterminedthattheprospectiveprimaryparticipantknowinglyrenderedanerroneouscertification,inadditiontootherremediesavailabletotheFederalGovernment,thedepartmentoragencymayterminatethistransactionforcauseordefault.4.Theprospectiveprimaryparticipantshallprovideimmediatewrittennoticetothedepartmentoragencytowhichthisproposalissubmittedifatanytimetheprospectiveprimaryparticipantlearnsthatitscertificationwaserroneouswhensubmittedorhasbecomeerroneousbyreasonofchangedcircumstances.5.Thetermscoveredtransaction,debarred,suspended,ineligible,participant,person,primarycoveredtransaction,principal,proposal,andvoluntarilyexcluded,asusedinthisclause,havethemeaningssetoutintheDefinitionsandCoveragesectionsoftherulesimplementingExecutiveOrder12549.Youmaycontactthedepartmentoragencytowhichthisproposalisbeingsubmittedforassistanceinobtainingacopyofthoseregulations.6.Nothingcontainedintheforegoingshallbeconstruedtorequireestablishmentofasystemofrecordsinordertorenderingoodfaiththecertificationrequiredbythisclause.Theknowledgeandinformationofaparticipantisnotrequiredtoexceedthatwhichisnormallypossessedbyaprudentpersonintheordinarycourseofbusinessdealings.
ExhibitIPage2of2CERTIFICATION(1)Theprospectiveprimaryparticipantcertifiestothebestofitsknowledgeandbelief,thatit,itsowners,officers,corporatemanagersandpartners:(a)Arenotpresentlydebarred,suspended,proposedfordebarment,declaredineligible,orvoluntarilyexcludedbyanyFederaldepartmentoragency;(b)Havenotwithinathree-yearperiodprecedingthisproposalbeenconvictedoforhadaciviljudgmentrenderedagainstthemforcommissionoffraudoracriminaloffenseinconnectionwithobtaining,attemptingtoobtain,orperformingapublic(Federal,Stateorlocal)transactionorcontractunderapublictransaction;violationofFederalorStateantitruststatutesorcommissionofembezzlement,theft,forgery,bribery,falsificationordestructionofrecords,makingfalsestatements,orreceivingstolenproperty;(c)Havenotwithinathree-yearperiodprecedingthisapplication/proposalhadoneormorepublictransactions(Federal,Stateorlocal)terminatedforcauseordefault.(2)Wheretheprospectiveprimaryparticipantisunabletocertifytoanyofthestatementsinthiscertification,suchprospectiveparticipantshallattachanexplanationtothisproposal.Signature:Date:(PrintedName&Title)(NameofAgencyorCompany)”
ExhibitJPage1of2SELF-DEALINGTRANSACTIONDISCLOSUREFORMInordertoconductbusinesswiththeCountyofFresno(hereinafterreferredtoas"County"),membersofacontractor'sboardofdirectors(hereinafterreferredtoas"CountyContractor"),mustdiscloseanyself-dealingtransactionsthattheyareapartytowhileprovidinggoods,performingservices,orbothfortheCounty.Aself-dealingtransactionisdefinedbelow:"Aself-dealingtransactionmeansatransactiontowhichthecorporationisapartyandinwhichoneormoreofitsdirectorshasamaterialfinancialinterest"Thedefinitionabovewillbeutilizedforpurposesofcompletingthisdisclosureform.INSTRUCTIONS(1)Enterboardmember'sname,jobtitle(ifapplicable),anddatethisdisclosureisbeingmade.(2)Entertheboardmember'scompany/agencynameandaddress.(3)Describeindetailthenatureoftheself-dealingtransactionthatisbeingdisclosedtotheCounty.Ataminimum,includeadescriptionofthefollowing:a.Thenameoftheagency/companywithwhichthecorporationhasthetransaction;andb.ThenatureofthematerialfinancialinterestintheCorporation'stransactionthattheboardmemberhas.(4)Describeindetailwhytheself-dealingtransactionisappropriatebasedonapplicableprovisionsoftheCorporationsCode.(5)Formmustbesignedbytheboardmemberthatisinvolvedintheself-dealingtransactiondescribedinSections(3)and(4).
ExhibitJPage2of2(1)CompanyBoardMemberInformation:Name:Date:JobTitle:(2)Company/AgencyNameandAddress:(3)Disclosure(Pleasedescribethenatureoftheself-dealingtransactionyouareapartyto)(4)Explainwhythisself-dealingtransactionisconsistentwiththerequirementsofCorporationsCode5233(a)(5)AuthorizedSignatureSignature:Date: