HomeMy WebLinkAbout15312 i
Agreement No. 07-201
STANDARD AGREEMENT EDD CUSTOMER CODE: E00314
4 PROJECT/ACTIVITY CODE: 661-090
AGREEMENT NUMBER
M660730
1. This Agreement is entered into between the Agency and the State of California Contractor named below
AGENCY'S NAME
County of Fresno
CONTRACTOR'S NAME
Employment Development Department
2 The term of this July 1, 2005 through June 30, 2008
Agreement is:
3 The maximum amount $6,691.70
of this Agreement is: Six Thousand Six Hundred Ninety-one Dollars and Seventy Cents
4. The parties agree to comply with the terms and conditions of the following exhibits which are by this reference made
a part of the Agreement:
Exhibit A Scope of Work 2 Pages
Attachment A-1 Specifications 2 Pages
Exhibit B Budget Detail and Payment Provisions 2 Pages
Exhibit C General Terms and Conditions 1 Page
Exhibit D Protection of Confidentiality 2 Pages
Attachment D-1 Confidentiality Agreement 1 Page
Attachment D-2 Indemnity Agreement 1 Page
IN WITNESS WHEREOF this Acireement has been executed by-the parties hereto.
CONTRACTOR California Department of General
Services Use Only
CONTRACTOR'S NAME(if other than an individual,state whether a corporation,partnership,etc.)
Employment Development Department
BY(Authorized Signature) DATE SIGNED(Do not type)
.4?�
PRINTED NAME AND TITLE OF PERSON SIGNING
SHERI S. HUBER, Chief, Office of Procurement, Contracting and Admin.
ADDRESS
P.O. Box 826880, MIC 62-C
Sacramento, CA 94280-0001
AGENCY
AGENCY NAME
County of Fresno
BY(Authorzed tore DATE SI le� C�—'J'0-z I J� /r f D of ot,�v
- I
PRINTED NAME AND TITLE OF PERSON SIGNING
BOB WATERSTON, Chairman, Fresno County Board of Supervisors
ADDRESS
Exempt per:
2281 Tulare Street ❑
Fresno CA 93721
r ,
ATTEST
2ER.NICE E . sEIDEL, Clerk
Board of Supervisors
BY �—19 e ,uty
�
J
County of Fresno
Auditor-Controller/Treasurer-Tax Collector
EDD Agreement No. M660730
Customer Code: E00314
Page 1 of 2
EXHIBIT A
(Standard Agreement)
This Agreement is entered into by and between the Employment Development Department, hereinafter
referred to as EDD, and the County of Fresno, Auditor-Controller/Treasurer-Tax Collector, hereinafter
referred to as the Requester. It sets forth the terms and conditions for the release and use of EDD's
confidential information.
SCOPE OF WORK
I. Purpose
The Requester agrees to use the confidential information provided by EDD under this Agreement for the
purpose of seeking reimbursement for medical assistance services, collecting traffic fines and fees, and
probation fines and fees which are directed by state mandate or court order as a result of a violation of
law.
II. Legal Authority
The EDD shall make this information available to the Requester pursuant to Sections 1095(h), 1095(n)(1)
and 1095(n)(2) of the California Unemployment Insurance Code (CUIC).
The Requester shall request and use the information in accordance with the Welfare and Institutions
Code, Division 9 (commencing with Section 10000), specifically including Part 5 of Division 9
(commencing with Section 17000). and Part 6 of Division 9 (commencing with Section 18510).
Ill. Contract Representatives
1. The EDD contacts are:
CONTRACT NEGOTIATIONS TECHNICAL ASSISTANCE
Stephanie Barnes or designee Robert Mortensen or designee
Employment Development Department Employment Development Department
Information Security Office, MIC 33 Enterprise and Tax Systems Division, MIC 79-5
P.O. Box 826880 P.O. Box 826880
Sacramento, CA 94280-0001 Sacramento, CA 94280-0001
Tel: (916) 654-8261 Tel: (916) 654-7979
FAX: (916) 654-8272 rmortensen(cDedd.ca.gov
Sbarnes2 a@edd.ca.gov
FISCAL CONFIDENTIALITY & DATA SECURITY
Angela Yu or designee Information Security Office
Employment Development Department Employment Development Department
Accounts Receivable Unit, MIC 70 Information Security Office, MIC 33
P.O. Box 826880 P.O. Box 826880
Sacramento, CA 94280-0001 Sacramento, CA 94280-0001
Tel: (916) 653-4227 Tel: (916) 654-6231
ayu0C@edd.ca.Qov 1nfoSec cDedd.ca.Qov
County of Fresno
Auditor-Controller/Treasurer-Tax Collector
EDD Agreement No. M660730
Customer Code: E00314
Page 2 of 2
EXHIBIT A
(Standard Agreement)
2. The Requester's contacts are:
CONTRACT NEGOTIATIONS TECHNICAL ASSISTANCE
Vicki Crow, C.P.A. Bobby Sanders, IT Analyst
Auditor-Controller/Treasurer-Tax Collector Auditor-Controller/Treasurer-Tax Collector
County of Fresno County of Fresno
2281 Tulare Street, Room 101 P.O. Box 226
P.O. Box 226 Fresno, CA 93708-0226
Fresno, CA 93708-0226 Tel: (559),442-5270
Tel: (559) 488-3815 FAX: (559) 488-3493
FAX: (559) 488-3493
FISCAL CONFIDENTIALITY & DATA SECURITY
Kimberly Lamanuzzi, Chief Accountant Bobby Sanders, IT Analyst
Revenue Reimbursements Division Aud itor-Control I e r/Trea su rer-Tax Collector
Auditor-Controller/Treasurer-Tax Collector County of Fresno
County of Fresno P.O. Box 226
P.O. Box 226 Fresno, CA 93708-0226
Fresno, CA 93708-0226 Tel: (559) 442-5270
Tel: (559) 488-2894 FAX: (559) 488-3493
FAX: (559) 488-2977
County of Fresno
Auditor-Controller/Treasurer-Tax Collector
EDD Agreement No. M660730
Customer Code: E00314
Attachment A-1
Page 1 of 2
SPECIFICATIONS
I. RESPONSIBILITIES
1. The EDD's Responsibilities
a. The EDD shall prepare and forward to the Requester, on IBM cartridge tape, the following EDD
abstracts for those individuals whose Social Security Numbers (SSNs) have been forwarded to
EDD by the Requester under the assigned Customer Code E00314:
(1) Wage and Claim Abstract (DE 507);
(2) Employer Address (DE 4989);
(3) Client Address;
(4) Current Unemployment Insurance Claim History (up to 2 years); and
(5) Current Disability Insurance Claim History (up to 2 years).
2. The Requester agrees to:
a. Forward to EDD approximately 4,000 SSNs per quarter via cartridge tape. The tapes shall be
mailed or delivered to:
Employment Development Department
Information Technology Branch
Application Operation
800 Capitol Mall
Sacramento, CA 95814
Attn: Abstract Technical, MIC 58-2
b. Only request the abstract(s) authorized in this Agreement on a quarterly basis, during the period
specified herein.
c. Use the specified data only for the purpose of seeking reimbursement for medical assistance
services, collecting traffic fines and fees, and probation fines and fees which are directed by
state mandate or court order as a result of a violation of law.
d. Mail tapes to the Requester's staff person responsible for the security, confidentiality and
dissemination of EDD's confidential information to other Requester staff:
Name and Title: Bobby Sanders, IT Analyst
Agency Name: Auditor-Controller/Treasurer-Tax Collector
County of Fresno
Mailing Address: P.O. Box 226
Fresno CA 93708-0226
e. Request only the EDD information specifically authorized under this Agreement.
County of Fresno
Aud'stor-ControilerfTreasurer-Tax Collector
EDD Agreement No. M660730
Customer Code: E00314
Attachment A-1
Page 2 of 2
f. Submit only the names and Social Security Numbers of individuals as specified in this
Agreement.
g. Use the specified abstract information only for the purposes specified in this Agreement.
h. Comply with the Unemployment Insurance Code on any matters pertaining to the access, use
and/or release of data under this Agreement. Failure to comply with this provision shall be
deemed a breach of this Agreement and shall be grounds for cancellation of this Agreement.
i. Not release EDD's confidential information to any entity, which is a private collection agency.
j. Cooperate with EDD's authority to monitor this Agreement in accordance with Exhibit D.
It. ACCURACY ASSESSMENT
Individual employers and claimants report the information in EDD's files_ Since EDD is not the originator
of the information disclosed, EDD cannot guarantee the accuracy of the information.
III. TERMINATION
This Agreement may be terminated by either party by giving written notice 30 days prior to the effective
date of termination.
County of Fresno
Auditor-Controller/Treasurer-Tax Collector
EDD Agreement No. M660730
Customer Code: E00314
Page 1 of 2
EXHIBIT B
(Standard Agreement)
I. BUDGET DETAIL AND PAYMENT PROVISIONS
a. The maximum amount of this Agreement shall not exceed Six Thousand Six Hundred
Ninety-one Dollars and Seventy Cents ($6,691.70).
b. In consideration of the performance and completion of the foregoing in a satisfactory manner,
and upon receipt of a detailed invoice, in triplicate, quarterly in arrears, the Requester shall
reimburse EDD the total amount due, based on the following product rate structure:
Requested Products Rate Structure
The rate structure consists of:
• $15.00 (fifteen dollars) set-up charge for each tape submitted; and
$5.00 (five dollar) charge per quarter for archive wage material searched.
• The following rate chart will apply:
If the cumulative Then the cost for Then the cost for Archive
number of requested Current Data per Data per requested products
products per quarter requested shall be:
is: products shall be:
:................_.................................................... ............................................................... .. .......�l. .D.�........ ...... W Cie.....
1 - 250 $.50101 $1.00202 $1.00202
.................................................................................... ------...............:...............-.......-----------.....................:.........................----......I.............;
251 - 2,000 .12621 .25242 .25242
:..................._.........._........._........................................•--..................................:._........................................_...
;
2,001 - 10,000 .02163 .04326 € .04326
------------......................................................................:..................................•--•-•------..................----a
... .................................................
10,001 - 250,000 .00510 .0102 .0102
.............- :..........._..--.............-...........................-.....;..----...... - _........................_........_._... -...
_...........
_..:
250,001 - 1 Million 00146 .00146 .00146
:.................... •--......................................----------------...............;...........................................................;...................
More than 1 Million .00121 .00121 .00021
c. Each Social Security Number (SSN) submitted may generate up to 4 products, depending
on the types of information requested. The Requester shall be charged for the total number
of products requested. The maximum amount of this Agreement has been computed, based
on an estimated 4,000 SSNs per quarter, accordingly:
EDD�ABSTRACT . FORMULA- COST
Wage and Claim Abstract DE 507 1 product 4,000 x .02163 x 4Q x 3 yrs. S1,038.34
Employer Address DE 4989 1 product 4,000 x .02163 x 4Q x 3 yrs. $1,038.34
Client Address 1 product 4,000 x .02163 x 4Q x 3 yrs. $1,038.34 i
UI Claim History�Cyrre_ nt-UP to 2 ears 1 product 4,000 x .02163 x 4Q x 3 yrs. $1,038.34
DI Claim History (Current-Up to 2 ears 1 product 4,000 x .02163 x 40 x 3 yrs. S1,038.34
Administrative Costs S1,500.00
CONTRACT TOTAL $6,691.79
(Total for 3-year contract)
County of Fresno
Auditor-Controller/Treasurer-Tax Collector
EDD Agreement No. M660730
Customer Code: E00314
Page 2 of 2
EXHIBIT B
(Standard Agreement)
Administrative Costs for Contracting
The administrative costs for contracting include the costs for development, processing and
maintenance of a contract that averages $1,500 per contract. The Requester will be charged
an administrative cost of$125.00 for a three-year contract.
d. These costs are computed in accordance with Sections 8752 and 8752.1 of the State
Administrative Manual. Nothing herein contained shall preclude advance payments,
pursuant to Article 1, Chapter 3, Part 1, Division 3, Title 2 of the Government Cade of
the State of California.
e. The EDD invoices will reference the EDD Agreement No. M660730 and EDD Customer
Code: E00314; and shall be submitted for payment to:
Kimberly Lamanuzzi, Chief Accountant
Revenue Reimbursements Division
Auditor-Controller/Treasurer-Tax Collector
County of Fresno
P.O. Box 226
Fresno, CA 93708-0226
f. The Requester payment must reference the EDD Invoice Number, EDD Agreement No.
M660730 and the Customer Code: E00314; and be submitted to:
Employment Development Department
Accounting Section, MIC 70
P.O. Box 826217
Sacramento, CA 94230-6217
County of Fresno
Auditor-ControlleNTreasurer-Tax Collector
EDD Agreement No. M660730
Customer Code: E00314
Page 1 of 1
EXHIBIT C
(Standard Agreement)
GENERAL TERMS AND CONDITIONS
1. APPROVAL: This Agreement is of no force or effect until signed by both parties and approved by the
Department of General Services, if required. Requester may not commence performance until such
approval has been obtained.
2. AMENDMENT: No amendment or variation of the terms of this Agreement shall be valid unless made
in writing, signed by the parties and approved as required. No oral understanding or Agreement not
incorporated in the Agreement is binding on any of the parties.
3. ASSIGNMENT: This Agreement is not assignable by the Requester, either in whole or in part, without the
consent of the State in the form of a formal written amendment.
4. TIMELINESS: Time is of the essence in this Agreement.
5. GOVERNING LAW: This contract is governed by and shall be interpreted in accordance with the laws of
the State of California.
6. UNENFORCEABLE PROVISION: In the event that any provision of this Agreement is unenforceable or
held to be unenforceable, then the parties agree that all other provisions of this Agreement have force and
effect and shall not be affected thereby.
7. AMERICANS WITH DISABILITIES ACT: Requester assures the State that it complies with the Americans
with Disabilities Act (ADA) of 1990, which prohibits discrimination on the basis of disability, as well as all
applicable regulations and guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
S. RESOLUTION: A county, city, district, or other local public body must provide the State with a copy of a
resolution, order, motion, or ordinance of the local governing body which by law has authority to enter into
an agreement, authorizing execution of the agreement.
9. INDEMNIFICATION: Requester agrees to indemnify, defend and save harmless the State, its officers,
agents and employees from any and all claims and losses accruing or resulting to any and all contractors,
subcontractors, and any other person, firm or corporation furnishing or supplying work services, materials,
or supplies in connection with the performance of this Agreement, and from any damage to persons or
property arising out of or resulting from acts or omissions of the indemnifying party.
10. DISPUTES, ARBITRATION: In the event of a dispute between EDD and the Requestor over any part of
this Agreement, the dispute may be submitted to nonbinding arbitration upon the consent of both EDD
and the Requestor. An election for arbitration pursuant to this provision shall not preclude either party
from pursuing any remedy for relief otherwise available.
11. TERMINATION: This Agreement may be terminated by EDD by giving written notice 30 days prior to the
effective date of such termination.
County of Fresno
Auditor-Controller/Treasurer-Tax Collector
EDD Agreement No. M660730
Customer Code: E00314
Page 1 of 2
EXHIBIT D
(Standard Agreement)
PROTECTION OF CONFIDENTIALITY
Information maintained by EDD is classified confidential or sensitive. Confidential information is information that identifies
an individual or an employing unit. Sensitive information may be financial or operational information that requires the
maintenance of its integrity and assurance of its accuracy and completeness. Confidential and sensitive information are
not open to the public and require special precautions to protect it from loss and unauthorized use, disclosure, modification
or destruction. The confidential information obtained under this Agreement remains the property of EDD. The Requester
agrees to the following security and confidentiality requirements:
I. ADMINISTRATIVE SAFEGUARDS
a. Adopt policies and procedures to ensure that information obtained from EDD is used solely as provided for in this
Agreement.
b. Warrant by execution of this Agreement, that no person or selling agency has been employed or retained to solicit
or secure this Agreement upon agreement or understanding for a commission, percentage, brokerage or contingent
fee. For breach or violation of this warranty, EDD shall, in addition to other remedies provided by law, have the right
to annul this Agreement without liability.
c. Warrant and certify that in the performance of this Agreement, the Requester will comply with all applicable
statutes, rules and/or regulations. Agree to indemnify EDD against any loss, cost, damage or liability resulting
from Requester violations of this provision; including but not limited to, confidentiality requirements outlined in
the California Unemployment Insurance Code, §1094 and the California Civil Code, §1798 et, seq.
d. Protect EDD's information against unauthorized access, at all times, in all forms of media. The information
obtained under this Agreement will be used exclusively under provisions set forth in this Agreement and provided
by the California Unemployment Insurance Code.
e. Keep all EDD confidential information completely confidential. Make this information available to authorized staff
on a "need-to-know" basis and only for the purposes authorized under this Agreement. "Need-to-know"refers to
those authorized employees who need information to perform their official duties in connection with the uses of
the information authorized by this Agreement.
f. Notify EDD immediately upon discovery that there may have been a breach in security which has or may have
resulted in compromise to the confidential information. For purposes of this section, immediately is defined within
two hours of discovery. The Notification must describe the incident in detail and identify responsible staff(name,
title and contact information).
g. Assign security and confidentiality responsibilities for EDD's information to the person named below and in Exhibit A
of this Agreement. Immediately notify EDD in writing of any designee changes.
AGENCY EMPLOYEE NAME CONTACT INFORMATION
County of Fresno, Bobby Sanders i (559)442-5270
Auditor-Controller/Treasurer-Tax Collector ,
11. USAGE, DUPLICATION, AND REDISCLOSURE SAFEGUARDS
a. Use the confidential information only for purposes specifically authorized under this Agreement. Pursuant to
California Unemployment Insurance Code, §1094(b), use of EDD's confidential information as evidence in any
legal court proceeding, for taxation, or enforcement purposes is prohibited. Pursuant to California Unemplovment
Insurance Code, §1095(t), use of EDD's confidential information by private collection agencies is strictly prohibited.
b. Use and/or extraction of EDD information for any purpose outside the purposes stated in this Agreement is strictly
prohibited.The information obtained under this Agreement shall not be reproduced, published, sold or released in
original or any other form. Making paper or electronic copies of the information provided by EDD for use within or
outside the Requester's office is strictly prohibited.
a ,
County of Fresno
Auditor-Controller/Treasurer-Tax Collector
EDD Agreement No. M660730
Customer Code: E00314
Page 2 of 2
EXHIBIT D
(Standard Agreement)
c. Disclosures of any individually identifiable EDD information to any person outside the Requester's own staff is
strictly prohibited. Except as authorized or required by law, the Requester shall not reveal or divulge to any
person or entity any of the confidential information provided by EDD during the term of this Agreement.
Ill. PHYSICAL SAFEGUARDS
a. Store EDD information in a place physically secure from access by unauthorized persons. Information in electronic
format, such as magnetic tapes or discs, shall be stored and processed in such a way that unauthorized persons
cannot retrieve the information by means of computer, remote terminal or other means.
b. Secure and maintain any computer systems (hardware and software applications)that will be used in the performance
of this Agreement. This includes ensuring that ail security patches, upgrades, and anti-virus updates are applied
as appropriate to secure data that may used, transmitted or stored on such systems in the performance of this
Agreement.
c. Avoid saving EDD's data to a computer hard drive or any other shared information system. If the data is saved to
a local server it should be encrypted, and must be stored in a separate directory from other data maintained by
the Requester. Access to this directory must be restricted to staff authorized to access the EDD data. If recorded
on magnetic media with other data, it should be protected and secured as if it were in its entirety EDD data. However,
such commingling of data resources should be avoided, if practicable. At no time will EDD confidential data be placed
on an individual PC or Laptop.
d. Maintain a record of ail authorized users and authorization level of access granted to EDD's data, based on job
function.
e. Direct all personnel permitted to use EDD's data to avoid leaving the data displayed on their computer screens
where unauthorized users may view it. Users should retrieve computer printouts as soon as they are generated
so that the EDD data is not left unattended in printers where unauthorized users may access them.
f. Destroy all individually identifiable EDD information when its use ends utilizing an approved method of confidential
destruction, which includes electronic deletion (following Department of Defense specifications), shredding, burning,
certified or witnessed destruction.
IV, MANAGEMENT SAFEGUARDS
a. Instruct all employees with access to the information furnished by EDD regarding the:
• Confidential nature of the information; and
• Sanctions against unauthorized use or disclosures found in the California Penal Code, §502, California
Unemployment Insurance Code, §1094 and §2111, and the California Civil Code, §1798.53.
b. Obtain a signed Confidentiality Agreement(Attachment D-1) and an Indemnity Agreement(Attachment D-2)from
each employee assigned to work with EDD's confidential information data, attesting to being made aware of the
confidential nature of the information and of the penalties for unauthorized use or disclosure thereof.
c. Provide copies of the signed Confidentiality and Indemnity Agreements to the EDD-Information Security Office
prior to receipt of any data. Provide the Confidentiality and Indemnity Agreements of all existing staff, and for
all new personnel assigned to work with the information provided by EDD during the term of this Agreement.
d. Make copies of the completed forms available to EDD staff on request and during on-site reviews. The completed
Confidentiality and Indemnity Agreements are hereby made a part of this Agreement.
e. Permit EDD to make on-site inspections to ensure that the terms of this Agreement are being met.
County of Fresno
Auditor-Controller/Treasurer-Tax Collector
EDD Agreement No. M660730
Customer Code: E00314
Attachment D-1
Page 1 of 1
�1 Employment
Development
EDD Department Confidentiality Agreement
State of California
Information resources maintained by the State of California Employment Development Department(EDD) and provided to your agency may be
confidential or sensitive. Confidential and sensitive information are not open to the public and require special precautions to protect it from wrongful
access, use, disclosure,modification and destruction. The EDD strictly enforces information security. If you violate these provisions, you may be
subject to administrative,civil and/or criminal action.
County of Fresno,
An employee of Auditor-Controller/Treasurer-Tax Collector
PRINT YOUR NAME PRINT YOUR EMPLOYER'S NAME
hereby acknowledge that the confidential and/or sensitive records of the Employment Development Department are subject to strict confidentiality requirements
imposed by state and federal law include the Unemployment Insurance Code,Sections 1094 and 2111,the Civil Code,Section 1798 et seq.,the Penal Code,Section
502 and Code of Federal Regulations,Title 28,Part 603.
1 acknowledge that my supervisor and/or the contract's Confidentiality and Data Security Monitor reviewed with me the confidentiality and security policies
INITIAL and administrative processes of my organization and EDD.
I acknowledge responsibility for knowing the classification of the EDD information I worts with and agree to refer questions about the classification of the
1NMAL EDD information(public,sensitive,confidential)to the person the contract assigns responsibility for the security and confidentiality of EDD's data.
I acknowledge responsibility for knowing the privacy,confidentiality and data security laws that appfy to the EDD information I have been granted access to
INITIAL by my employer.including California Unemployment Insurance Code,Sections 1094 and 2111,California Government Code,Section 15619,California
Civil Code,Sections 1798.53 and Penal Code,Section 502.
1 acknowledge that wmrgful access,use,modification or disclosure of confidential information may be punishable as a crime and/or result in disciplinary
INITIAL and/or civil action taken against me—including but not limited to: reprimand,suspension without pay,salary reduction,demotion or dismissal--and/or
fines and penalties resulting from criminal Prosecution or civil lawsuits,and/or termination of contract.
I acknowledge that wrongful access,inspection,use or disclosure of confidential information for personal gain,curiosity or any nonbusiness related reason
INITIAL is a crime under state and federal laws.
I acknowledge that wrongful access,use,modification or disclosure of confidential information is grounds for immediate termination of my organization's
INITIAL contract with EDD.
i agree to protect the following types of EDD confidential and sensitive information:
INITIAL Wage Information; a Applicant Information;
• Employer Information; . Proprietary Information;and
• Claimant information; • Operational Information(instructional manuals).
• Tax Payer Information;
I hereby agree to protect ETD's information on either paper or electronic form by:
N171AL . Accessing or using EDD supplied information only as specified in the contract for the performance of the specific work I am assigned;
• Never accessing information for curiosity.or personal reasons;
• Never showing or discussing sensitive or confidential information to or with anyone who does not have the'need-to-know;'
• Placing sensitive orconfidential information only in approved locations;and
• Never removing sensitive or confidential information from the work site without authorization.
"I certify that I have read and initialed the confidentiality statements printed above."
Print F-A Name(Last,=first, MI) Signature
County of Fresno
Print Name of Governmental Agency Date Signed
Check the appropriate box:
Employment Development Department ❑ Employee ❑ Student
Print Name of Contractor and/or Suocontractor ❑ Subcontractor ❑ Voiunteer
❑ Other
(Explain)
County of Fresno
Auditor-Controller/Treasurer-Tax Collector
EDD Agreement No. M660730
Customer Code: E00314
Attachment D-2
Page 1 of 1
�1 Employment
Develment
EDD Department Indemnity Agreement
S t a t e o f C a l i f o r n i a
In consideration of access to EDD information which is personal, sensitive, or confidential,
County of Fresno
(Enter Requesting Agency/Entity Name)
agrees to indemnify EDD against any and all liability costs, damages, attorney fees and other expenses
EDD may incur by reason of or as a result of any unauthorized use of the personal, sensitive, or confidential
information or any vioiation of the"Confidentiality Agreement"by:
(Enter name of staff person authorized to access EDD's information)
This obligation shall be continuous and may not be changed or modified unless agreed to in writing.
In addition, 1 understand that the following penalties may be incurred for any such misuse of EDD
information:
1. Any individual who has access to returns, reports, or documents maintained by EDD who fails to
protect the confidential information from being published or open to the public may be punished
by imprisonment in the county jail for up to one year or a fine of$20,000.00 or both.
(Unemployment Insurance Code 2111)
2. Any person who intentionally discloses information, not otherwise public, which they knew or should
have known was obtained from personal information maintained by a state agency, shall be subject
to civil action for invasion of privacy by the individual to whom the information pertains.
(Civil Code 1798,53)
3, Any unauthorized access to EDD computer data, computer systems, or unauthorized use of EDD
data is punishable by a fine or imprisonment in the county jail or both. (Penal Code 502)
"I certify that I have read and understand the Indemnity Agreement printed above."
Pnnt Full Name(Last,First,MI) Signature
Employment Development Department
Position and Title Print Name of Contractor ana?or Subcontractor
County of Fresno
Print Name of Governmental Agency Date Signed
Check the appropriate box:
❑ Employee ❑ Subcontractor ❑ Student ❑ Volunteer ❑ Other
(Explain)
EDD Contract No. M660730
Page 1 of 2
CERTIFICATION REGARDING
DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION
LOWER TIER COVERED TRANSACTION
This certification is required by the regulations implementing Executive Order 12549,
Debarment and Suspension, 29 CFR Part 98, Section 98.510, Participants'
responsibilities. The regulations were published as Part V11 of the May 26, 1988,
Federal Register (Pages 19160-19211).
(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS
WHICH ARE AN INTEGRAL PART OF THE CERTIFICATION,)
1. The prospective recipient of Federal assistance funds certifies, by submission of
this proposal, that neither it nor its principals are presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any Federal department or agency.
2. Where the prospective recipient of Federal assistance funds is unable to certify
to any of the statements in this certification, such prospective participant shall
attach an explanation to this proposal.
Name and Title of Authorized Representative
Signature Date
r �
v
EDO Contract No. M660730
Page 2 of 2
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective recipient of Federal assistance funds is
providing the certification as set out below.
2. The certification in this clause is material representation of fact upon which reliance was placed when
this transaction was entered into. If it is later determined that the prospective recipient of Federal
assistance funds knowingly rendered an erroneous certification, in addition to other remedies available
to the Federal Government, the Department of Labor(DOL) may pursue available remedies, including
suspension and/or debarment.
3. The prospective recipient of Federal assistance funds shall provide immediate written notice to the
person to whom this proposal is submitted if at any time the prospective recipient of Federal assistance
funds learns that its certification was erroneous when submitted or has become erroneous by reason of
changed circumstances.
4. The terms "covered transaction," "debarred," "suspended," "ineligible,""lower tier covered transaction,"
"participant," "person," "primary covered transaction," principal," "proposal," and "voluntarily excluded,"
as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules
implementing Executive Order 12549. You may contact the person to whom this proposal is submitted
for assistance in obtaining a copy of those regulations.
5. The prospective recipient of Federal assistance funds agrees by submitting this proposal that, should
the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered
transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from
participation in this covered transaction, unless authorized by the DOL.
6. The prospective recipient of Federal assistance funds further agrees by submitting this proposal that it
will include the clause titled, "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary
Exclusion--Lower Tier Covered Transactions," without modification, in all lower tier covered transactions
and in all solicitations for lower tier covered transactions.
7. A participant in a covered transaction may rely upon a certification of a prospective participant in a
lower tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from
the covered transaction, unless it knows that the certification is erroneous. A participant may decide the
method and frequency by which it determines the eligibility of its principals. Each participant may, but is
not required to, check the List of Parties Excluded From Procurement or Nonprocurement Programs.
8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in
order to render in good faith the certification required by this clause. The knowledge and information of
a participant is not required to exceed that which is normally possessed by a prudent person in the
ordinary course of business dealings.
9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered
transaction knowingly enters into a lower tier covered transaction with a person who is suspended,
debarred, ineligible, or voluntary excluded from participation in this transaction, in addition to other
remedies available to the Federal Government, the DOL may pursue available remedies, including
suspension and/or debarment.
Agreement with the State of California Employment Development Department, (EDD).
EXECUTED AND EFFECTIVE as of the date executed first above set forth.
ATTEST:
Clerk, Board of Supervisors COUN Y OF FRES.NO
By - 'Id, BY (2:W���
Chairman, Board of Supervisors
411IN
Approved as to Legal Form:
D nnis A. Marshall, County Counsel
Approved as to Accounting Form:
Vicki Crow, C.P.A.
Auditor- ontroller/Treasurer-Tax Collector
By ,
Reviewed and Recommended for Approval:
Vicki Crow, C.P.A.
Auditor Controller/Tr asurer-Tax Collector
By �---
FOR ACCOUNTING USE ONLY
Fund/Subclass 0001/10000
Org No. 0410/1100
llll
llll
llll
Illl
Illl
llll .
llll
llll
GAauditor�ADMWIMBOARD ITEMSW19L.doc