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Home My WebLink AboutAgreement A-19-473 with CHC.pdfAgreement No. 19-473 1 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and year 2 first hereinabove wri tten . 3 4 CONTRACTOR 5 6 7 8 9 10 1 1 12 13 14 15 16 17 18 19 20 California Health Collaborative Steven Ram irez , CEO 1680 W . Shaw Ave . Fresno California 93711 Mailing Address : Phone#: 559 -244-4525 Cont act Stephen Ram irez , CEO Email: s rami rez@healthcollaborative.org FOR ACCOUNTING USE ONLY: Fu nd /Subclass ; 000 1/10000 21 ORG : 56201662 22 23 24 25 26 2 7 28 Accoun t: 7295 SMA COUNTY OF FRESNO Nathan Magsig , Chairman of the Board of Supervisors of the County of Fresno ATTEST: Bern ice E. Seide l C lerk of the Board of Supervisors County of Fresno, State of Cal iforn ia -13- Exhibit A California Health Collaborative SOW Page 1 of 14 Retail RETAIL Activity Activity Description Time Frame** Documentation 07011103 Direct Education – 18-59 years of age Provide 25 evidence-based nutrition education sessions in each of the six targeted communities reaching at least 200 annually (Total = 600) to reinforce behavioral economic strategies to reach customer/client population using approved curriculum related to purchasing healthy items and food resource management. Year 1 Q1 Q2 Q3 Q4 x X X X Year 2 Q1 Q2 Q3 Q4 X X X X Year 3 Q1 Q2 Q3 Q4 X X X X Food Behavior Checklist, sign in sheet, data cards, agenda, PEARS *Contributes to Foundational Objective A. Direct Education Reach 07021100 Assessment PRE: Assess environment and client-need of at least 200 retail settings using observational or intercept surveys to identify facilitators and barriers to access to food using approved version of CX3 and Healthy Stores for a Healthy Community Survey. Assess for interior signage and promotion, product placement, and pricing strategies and incentives. POST: Assess environment in relation to {changes made} and/or client impact. Year 1 Q1 Q2 Q3 Q4 x X X X Year 2 Q1 Q2 Q3 Q4 X X X X Year 3 Q1 Q2 Q3 Q4 X X X X Completed assessments, assessment results, PEARS *Contributes to all Foundational Objectives 07031100 Community Engagement (a) Maintain and identify at least 2-5 local influencers {SNAP- Ed population + key stakeholders such as chambers of commerce, youth organizations, store owners, retail coalitions, farmer or farmers market associations and food banks} annually in each of the six targeted communities. Present assessment results and/or educate on the benefits and impact of working in the SHOP domain. Leverage relationships with influencers to generate support for existing work and/or additional work around Year 1 Q1 Q2 Q3 Q4 x X X X Year 2 Q1 Q2 Q3 Q4 X X X X Year 3 Q1 Q2 Q3 Q4 X X X X Agenda, sign in sheet, meetings notes, materials disseminated, PEARS *Contributes to Foundational Objective C. Community Engagement Exhibit A California Health Collaborative SOW Page 2 of 14 Retail improved and/or expanded food access among community members. Engage local influencers consistently throughout planning, implementation, and maintenance of selected interventions. 07041100 Community Engagement (b) Maintain and Identify at least 1 key decision maker {could include city council, policy makers, Agricultural Commissioners} annually in six targeted communities. Present assessment results and/or educate on the benefits and impact of working in the SHOP settings to improve the food environment. Leverage relationships and generate support for existing work and/or additional work around improved and/or expanded HSHC, interior signage and promotion, product placement, and pricing strategies and incentives among leadership, staff, outside funders, etc. Engage decision-makers at each of the participating sites, organizational, and/or community level consistently throughout planning, implementation, and maintenance of selected interventions in SHOP settings. Year 1 Q1 Q2 Q3 Q4 x x x X Year 2 Q1 Q2 Q3 Q4 x x x x Year 3 Q1 Q2 Q3 Q4 x x x x Agenda, sign in sheet, meetings notes, materials disseminated, PEARS *Contributes to Foundational Objective C. Community Engagement 07051100 Community Engagement (c) In partnership with LHD, engage at least 2-5 adult and/or youth champions in conducting assessments and/or present assessment results if applicable from each of the targeted communities annually. Gather community feedback and input on the needs and desires of the community as well as facilitators and barriers related to healthy food and identify potential priority areas. Incorporate local champions and community members’ vision and high priority needs into the project planning Year 1 Q1 Q2 Q3 Q4 x x x x Year 2 Q1 Q2 Q3 Q4 x x x x Year 3 Q1 Q2 Q3 Q4 x x x x Agenda, sign in sheet, materials disseminated, priorities identified, PEARS *Contributes to Foundational Objective C. Community Engagement Exhibit A California Health Collaborative SOW Page 3 of 14 Retail by engaging them through meetings, listening sessions, surveys, etc. 07061100 Community Engagement (d) Meet regularly at least 4-6 times, to share and/or gather data from assessments, community engagement activities, implementation progress, successes, solutions for challenges, and report results with community stakeholders such as FCHIP, Diabetes Collaborative, and Fresno Food Security Network annually. Engage partners with common goals to leverage relationships, support, and funding opportunities. Year 1 Q1 Q2 Q3 Q4 x x x x Year 2 Q1 Q2 Q3 Q4 x x x x Year 3 Q1 Q2 Q3 Q4 x x x x Agenda, sign in sheets, and/or meeting notes, materials disseminated, PEARS *Contributes to Foundational Objective C. Community Engagement 07071100 Coordination and Collaboration: Partnerships & Coalition (a) Establish, cultivate, and maintain relationships with organizations that have an interest in the retail environment such as LHD Tobacco Control, Alcohol Prevention, Sexually Transmitted Diseases Prevention, education institutions, Food banks, LHD Collaborating for Wellness Program RX4 Health (CDC funded), and other community-based organizations to collaborate and support healthy food retail and access interventions across sectors. Year 1 Q1 Q2 Q3 Q4 X x x x Year 2 Q1 Q2 Q3 Q4 x x x x Year 3 Q1 Q2 Q3 Q4 x x x x Agenda, sign-in sheets, and/or meeting notes, PEARS *Contributes to Foundational Objective B. Partnership/Coalition Work and Support 07091100 Indirect Education (Promotion) Promote, support, and reinforce messages consistent with direct education and other activities regarding making healthy food choices. Communicate through various appropriate channels (social media, news releases, newsletters, site-based events, flyers, posters, websites, health fairs, etc.). Coordinate at least 2 state sponsored Fruit and Veggie Fest events at participating stores reaching 150 each Year 1 Q1 Q2 Q3 Q4 x x x x Year 2 Q1 Q2 Q3 Q4 x x x x Year 3 Q1 Q2 Q3 Q4 x x x x Flyers, Materials distributed, pictures, social media posts, press releases, PEARS *Contributes to all Foundational Objectives Exhibit A California Health Collaborative SOW Page 4 of 14 Retail year. Provide healthy food and beverage tastings. Promote messaging of healthy eating, eating healthy on a budget, benefits of consuming more water and less sugary beverages. In partnership with LHD and school wellness subcontractor, conduct at least 10 retail store tours annually to at least 250 SNAP-Ed targeted population (adults or youth) in six targeted communities. As appropriate, provide food tastings to store tour participants. At least 3 qualifying store sites will participate in Rethink Your Drink Day and at least 3 store sites will participate in Healthy Snack Day reaching at least 75 adults or youth annually. Craft and disseminate at least 2 press releases promoting Fruit and Veggie Fests and craft and post 4 social media posts promoting healthy retail, Rethink Your Drink Day, Healthy Snack Day awareness, etc. annually. 07101100 Training and Technical Assistance Provide training and technical assistance to store owners to support product placement, pricing incentives, and/or signage and promotion. Training and technical assistance may include healthy food procurement (how to find healthy food distribution, collective buying, food hubs), site sharing, access points and establishing MOUs. Provide technical assistance around food storage, food safety, and healthy check-out aisles. Engage store owners to become peer-to-peer trainers. Cultivate, recruit, and/or maintain at least 12 qualified stores in year 1, maintain at least 10 and recruit at least 3 Year 1 Q1 Q2 Q3 Q4 x x x x Year 2 Q1 Q2 Q3 Q4 x x x x Year 3 Q1 Q2 Q3 Q4 x x x x Agenda, sign in sheet, materials disseminated, pictures, flyers *Contributes to Foundational Objective C. Community Engagement Exhibit A California Health Collaborative SOW Page 5 of 14 Retail qualified stores in year 2, and maintain at least 13 and recruit at least 3 qualified stores in year 3 for a total of 16 participating stores by 2022. Work with participating stores to support at least one new PSE per year. Continue to cultivate and maintain relationships with existing stores from prior years to cultivate sustainability with existing PSE work such as Healthy Checkout Aisles, interior signage, promotion, product placement, and/or pricing strategies. **Time Frame: Year & Quarter: Year 1 (FFY 2020); Year 2 (FFY 2021); Year 3 (FFY 2022) Qtr. 1 (Oct. 1-Dec. 31); Qtr. 2 (Jan. 1-March 31); Qtr. 3 (Apr. 1-Jun. 30); Qtr. 4 (Jul. 1-Sept.30) Exhibit A California Health Collaborative SOW Page 6 of 14 Healthcare Clinics & Hospitals HEALTHCARE CLINICS & HOSPITALS Activity Activity Description Time Frame** Documentation 14011103 Direct Education 18 – 59 years of age Provide evidence-based nutrition education or/and physical activity sessions in partnership with 1 FQHC and 1 hospital annually for a bi-directional referral process in Fresno County in collaboration with LHD Collaborating for Wellness Program RX4 Health (CDC funded) for a total of 6 sites by 2022. Reach at least 96 unduplicated adults in year one, 144 unduplicated in year two, and 192 unduplicated adults in year three to reach 432 unduplicated adults by 2022. Provide evidence based nutrition education that reinforces healthy eating behavior to FQHC’s and hospital to reach at least 10 adult staff annually. Ensure staff have adequate knowledge of nutrition education and standards as well as community food resources to promote referral. Year 1 Q1 Q2 Q3 Q4 X X X X Year 2 Q1 Q2 Q3 Q4 X X X X Year 3 Q1 Q2 Q3 Q4 X X X X Pre/post assessment of family food practice behavior change, food behavior checklist, agenda, sign in sheet, data cards, materials disseminated, PEARS *Contributes to Foundational Objective A. Direct Education Reach 14021100 Assessment - Nutrition Standards and Places that Serve STANDARDS PRE: Assess readiness, environment, and client-need of health care facilities in relation to nutrition standards- community to identify strategies to implement. POST: Assess environment in relation to nutrition standards-community and/or client impact. At least 3 hospitals: CRMC, Fresno Adventist Hospital, Reedley Saint Agnes – Trinity Hospital, Fresno At least 2 clinic sites: Kerman, Parlier, Sanger SERVE: Year 1 Q1 Q2 Q3 Q4 x X X X Year 2 Q1 Q2 Q3 Q4 X X X X Year 3 Q1 Q2 Q3 Q4 X X X X STANDARDS Assessments completed, summaries of results, PEARS SERVE SMT score card, Environmental Scan, PEARS *Contributes to all Foundational Objectives Exhibit A California Health Collaborative SOW Page 7 of 14 Healthcare Clinics & Hospitals PRE: Assess readiness, environment, and client-need of health care facilities in relation to behavioral economics, places that serve food and beverages / Cafeteria and Food Service in other settings (Healthcare) - Water Access & Appeal to identify strategies in relation to smarter meal time concepts to implement. POST: Assess environment in relation to behavioral economics, places that serve food and beverages / Cafeteria and Food Service in other settings (Healthcare) -Water Access & Appeal and/or client impact. At least 3 hospitals: CRMC, Fresno Adventist Hospital, Reedley Saint Agnes – Trinity Hospital, Fresno At least 2 clinic sites: Kerman, Sanger, Parlier 14031100 Community Engagement (a) - Nutrition Standards and Places that Serve STANDARDS Identify and maintain at least 2 key staff or influencers at each (nutrition education, cafeteria staff, community benefits, and community influencers) FQHC and hospital site for a total of 10 by 2022. Present assessment results and/or educate on the benefits and impact of nutrition standards-community to identify priorities. Leverage relationships with influencers, key site staff, and community influencers to generate support for existing standards and/or additional work around improved and/or expanded nutrition standards in FQHC’s and hospitals. Engage local influencers consistently throughout planning, implementation, and Year 1 Q1 Q2 Q3 Q4 x X X X Year 2 Q1 Q2 Q3 Q4 X X X X Year 3 Q1 Q2 Q3 Q4 X X X X STANDARDS Agenda, meeting notes, materials disseminated, PEARS SERVE Agenda, sign in sheet, materials disseminated such as results and educational materials, PEARS *Contributes to Foundational Objective C. Community Engagement Exhibit A California Health Collaborative SOW Page 8 of 14 Healthcare Clinics & Hospitals maintenance of nutrition standards service improvements. SERVE Identify and maintain at least 2 key staff or influencers at each (nutrition education, cafeteria staff, food service, community benefits, and community influencers) FQHC and hospital site for a total of 10 by 2022. Present assessment results and/or educate on the benefits and impact of behavioral economics, water access and appeal, and smarter meal times concepts to identify priorities. Leverage relationships and generate support for existing work and or additional work around improved and or expanded interest in healthy eating environments among leadership, influencers, key site staff, and community influencers in FQHC’s and hospitals. Engage local influencers consistently throughout planning, implementation, and maintenance of behavioral economics of food and beverage service improvements. 14041100 Community Engagement (b) - Nutrition Standards and Places that Serve STANDARDS Identify and maintain at least 1 key decision maker such as site leadership and staff, food service staff, vendors, administrators, program directors, organizational leads, board of directors, etc. Present assessment results and/or educate on the benefits and impact of nutrition standards. Year 1 Q1 Q2 Q3 Q4 x X X X Year 2 Q1 Q2 Q3 Q4 X X X X Year 3 Q1 Q2 Q3 Q4 X X X X Agenda, sign in sheet, materials disseminated, PEARS *Contributes to Foundational Objective C. Community Engagement Exhibit A California Health Collaborative SOW Page 9 of 14 Healthcare Clinics & Hospitals Leverage relationships and generate support for existing work and/or additional work around improved and/or expanded nutrition standards among leadership, staff, outside funders, etc. Engage decision-makers at the site, organizational, and/or community level consistently throughout planning, implementation, and maintenance of nutrition standards. Promote the importance of healthy site policies that include nutrition standards inclusive of healthy procurement, vending, sales, and marketing. SERVE Identify and maintain at least 1 key decision maker from participating FQHC and hospital such as site leadership and staff, food service staff, community benefits, vendors, administrators, program directors, organizational leads, and board of directors, etc. annually. Present assessment results and/or educate on the benefits and impact of behavioral economics, and water access and appeal and develop an action plan for staff to implement 3-5 smarter meal time concept strategies annually. Leverage relationships and generate support for existing work and/or additional work around improved and/or expanded in healthy eating and beverage environments among leadership, staff, outside funders, etc. Engage decision-makers at the site, organizational, and/or community level consistently throughout planning, implementation, and maintenance of behavioral economics. Exhibit A California Health Collaborative SOW Page 10 of 14 Healthcare Clinics & Hospitals 14051100 Community Engagement (c) Places that Serve SERVE Engage at least 3-5 community members in assessment and/or present assessment results to FQHC’s and hospital food service staff, community benefits, and nutrition staff to identify priorities, and develop an action plan for staff to implement 3-5 smarter mealtime concepts and strategies. Gather community feedback and input on the needs and desires of the community as well as facilitators and barriers related to cafeterias and meal times. Incorporate local champions, community members’ vision, and high priority needs into the project planning by engaging them through meetings, listening sessions, surveys, etc. Year 1 Q1 Q2 Q3 Q4 x x x X Year 2 Q1 Q2 Q3 Q4 x x x x Year 3 Q1 Q2 Q3 Q4 x x x x Agenda, sign in sheet, materials disseminated such as results and educational materials, PEARS *Contributes to Foundational Objective C. Community Engagement 14071100 Coordination and Collaboration: Partnerships & Coalitions (a) Attend at least 4 community collaborative or coalition meetings and report results with community stakeholders such as FCHIP, Regional Partnership for Childhood Obesity Prevention, and Diabetes Collaborative. Engage partners with common goals to leverage relationships, support, and funding opportunities. Year 1 Q1 Q2 Q3 Q4 x x x x Year 2 Q1 Q2 Q3 Q4 x x x x Year 3 Q1 Q2 Q3 Q4 x x x x Agenda, meetings notes, materials disseminated, PEARS *Contributes to Foundational Objective B. Partnership/Coalition Work and Support 14091100 Indirect Education (Promotion) - Nutrition Standards and Places that Serve STANDARDS Promote, support, and reinforce messages consistent with direct education and other activities self-guided learning displays, posters, and educational boards throughout FQHC’s and hospitals’ cafeterias that Year 1 Q1 Q2 Q3 Q4 x x x x Year 2 Q1 Q2 Q3 Q4 x x x x Year 3 Q1 Q2 Q3 Q4 STANDARDS & SERVE Summary of participation, pictures, completed Days of Action surveys, materials disseminated, social media posts, press release, PEARS Exhibit A California Health Collaborative SOW Page 11 of 14 Healthcare Clinics & Hospitals reinforce and encourage healthy food and beverage choices. Participate in Days of Action related to healthy food and beverage choices. At least 1 hospital and 2 FQHC sites will participate in Rethink Your Drink Day and Healthy Snack Day annually reaching at least 50 annually. Communicate and promote through various appropriate channels (social media, newsletters, site-based events, flyers, posters, websites, health fairs, etc.). Craft and disseminate at least 2 press releases and 4 annual social media posts promoting Rethink Your Drink Day, Healthy Snack Day awareness, etc. SERVE Promote, support, and reinforce messages consistent with direct education and other activities self-guided learning displays, posters, and educational boards throughout FQHC’s and Hospitals’ cafeterias that reinforce and encourage healthy food and beverage choices. x x x x *Contributes to all Foundational Objectives 14101100 Training and Technical Assistance - Nutrition Standards and Places that Serve STANDARDS Provide at least two instances of technical training and assistance per FQHC or hospital annually, reaching at least 2 site leadership and staff to support the development and implementation of nutrition standards annually. Provide site-specific templates, examples, and resources for the development of standards as well as on the implementation and maintenance of standards. SERVE Year 1 Q1 Q2 Q3 Q4 x x x x Year 2 Q1 Q2 Q3 Q4 x x x x Year 3 Q1 Q2 Q3 Q4 x x x x STANDARDS & SERVE Agenda, sign in, meeting notes, materials disseminated, PEARS *Contributes to Foundational Objective C. Community Engagement Exhibit A California Health Collaborative SOW Page 12 of 14 Healthcare Clinics & Hospitals Provide at least two instances of training and technical assistance per FQHC or hospital annually, reaching at least 2 site leadership and or staff to support the development and implementation of nutrition standards and smarter meal times concepts annually. **Time Frame Year 1 (FFY 2020); Year 2 (FFY 2021); Year 3 (FFY 2022) Qtr. 1 (Oct. 1-Dec. 31); Qtr. 2 (Jan. 1-March 31); Qtr. 3 (Apr. 1-Jun. 30); Qtr. 4 (Jul. 1-Sept.30) Exhibit A California Health Collaborative SOW Page 13 of 14 Standard Activities STANDARD ACTIVITIES FOR ALL SUBCONTRACTS Activity Description Timeframe** Documentation 5.1 Monthly invoices Due 30 days after the end of each month Monthly invoices with backup documentation including but not limited to: Checklist, Personnel Salaries and Benefits, Summary Spreadsheets, Bi- weekly Time Logs or timesheets, detail for travel, receipts, invoices, recipes 5.2 Enter program activity data into PEARS database. Due Jan. 15, Apr. 15, Jul. 15, Oct. 15 Program activity, demographic and participation data entry single sessions provided into ATF. 5.3 Work with Department to complete the NEOPB Semi- Annual Progress Report Due Apr. 15 and Oct. 15 May include but is not limited to: backup documentation, pictures, evaluation reports, policies, success stories, press releases, challenges and strategies to address them, fiscal reports. 5.4 Submit Quarterly CalFresh Healthy Living Narrative Reports on progress towards meeting subcontractors’ respective activities. Due January 31, April 30, July 31 and October 31 Back up documentation includes CalFresh Healthy Living Narrative Report. Respective back up documentation for activity reporting must be kept on file by activity number and quarter and readily accessible if needed. This includes but not limited to: •Nutrition and physical activity single session classes (sing in sheets, agenda, data cards) •Events (event flyer, pictures) •Trainings/Meetings (agenda, Notes) PSE (Meeting Agendas, e-mails, pictures) 5.5 Work with Department-contracted Evaluator to evaluate and to comply with required and PSE change evaluation activities Ongoing Evaluation Reports, PEARS and Success Stories 5.6 Participate in Department and State periodic in-person trainings and webinars as appropriate. Ongoing PEARS, Department Quarterly CalFresh Healthy Living Narrative Reports 5.7 Participate in CalFresh Healthy Living Program Lead meetings and All Team meetings as scheduled. Ongoing Agenda, meeting notes 5.8 Participate in FCHIP workgroups as appropriate to communicate, cross-promote, facilitate a coordinated approach to enhance the consistency of nutrition Ongoing Agenda, meeting notes Exhibit A California Health Collaborative SOW Page 14 of 14 Standard Activities messaging and integrate activities with contractors and community partners to improve access to healthy foods and physical activity in target communities. 5.9 Work with Department to engage champions in completing scope of work activities as appropriate and to the extent feasible. Ongoing PEARS, E-mail communication, Champion Engagement System, pictures, success story **Time Frame: Year 1 (FFY 2020); Year 2 (FFY 2021); Year 3 (FFY 2022) Qtr. 1 (Oct. 1-Dec. 31); Qtr. 2 (Jan. 1-March 31); Qtr. 3 (Apr. 1-Jun. 30); Qtr. 4 (Jul. 1-Sept.30) FFY 2020 CalFresh Healthy Living Budget EXHIBIT B Sub Staffing C Rev. Date Organization Name:(CDPH) California Dept. of Public Health County/Jurisdiction:Fresno Contracts/Sub-Grant/Agreement:TBD - Healthy Retail & Health Care Budget Adjustment Budget Adjustment Staffing: Salary/Benefits:Budget Adjustment Position #Add Delete Increase Decrease Last Amount Approved Position Title Position Name SNAP-Ed Time Spent: % of SNAP-Ed Time Spent on Mgmt/Admin SNAP-Ed Time Spent: % of SNAP-Ed Time Spent on Direct SNAP- Ed Delivery Annual Salary FTE Total SNAP- Ed Salary Benefit Rate Total SNAP- Ed Benefits SNAP-Ed Admin Costs Total SNAP-Ed Funded Salary and Benefits Budget Justification 1 Program Director TBD 80.00%20.00%$84,872.00 0.25 $21,218.00 30.000%$6,365.40 $22,066.72 $27,583.40 2 Program Coordinator TBD 20.00%80.00%$46,350.00 1 $46,350.00 30.000%$13,905.00 $12,051.00 $60,255.00 3 Program Coordinator TBD 20.00%80.00%$47,740.00 1 $47,740.00 30.000%$14,322.00 $12,412.40 $62,062.00 4 Program Coordinator TBD 20.00%80.00%$48,668.00 0.7 $34,067.60 30.000%$10,220.28 $8,857.58 $44,287.88 5 0 $0.00 30.000%$0.00 $0.00 $0.00 6 $0.00 $0.00 $0.00 $0.00 44 $0.00 $0.00 $0.00 $0.00 45 $0.00 $0.00 $0.00 $0.00 46 $0.00 $0.00 $0.00 $0.00 47 $0.00 $0.00 $0.00 $0.00 48 $0.00 $0.00 $0.00 $0.00 49 $0.00 $0.00 $0.00 $0.00 50 $0.00 $0.00 $0.00 $0.00 51 $0.00 $0.00 $0.00 $0.00 52 $0.00 $0.00 $0.00 $0.00 53 $0.00 $0.00 $0.00 $0.00 54 $0.00 $0.00 $0.00 $0.00 55 $0.00 $0.00 $0.00 $0.00 56 $0.00 $0.00 $0.00 $0.00 57 $0.00 $0.00 $0.00 $0.00 58 $0.00 $0.00 $0.00 $0.00 59 $0.00 $0.00 $0.00 $0.00 60 $0.00 $0.00 $0.00 $0.00 Total Staffing: Salaries/Benefits:2.95 $149,376 $44,813 $55,388 $194,188 • Provide narrative in Budget Justification column for Benefit Rates over 90% Definition and basis for calculations of benefit rate(s): Includes payroll taxes, medical/dental benefits, and retirement as a percentage of salaries. (Describe what is covered in the benefit rate for your agency) FFY 2020 CalFresh Healthy Living Budget EXHIBIT B Sub Travel C Organization Name:(CDPH) California Dept. of Public Health County/Jurisdiction:Fresno Contracts/Sub-Grant/Agreement:TBD - Healthy Retail & Health Care Budget Adjustment Budget Adjustment Travel: In-State Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Position Title/Name Location Description and Justification Trips FTE Days Nights Per Diem Lodging Air Miles ($.58)Reg Fee Other Total Budget Justification 1 All NEOP funded staff-TBD Fresno County and Regional travel Healthy retail and health care strategies' activities, nutrition education, coalition meetings, community partner meetings, Promising Practices Exchange, local/regional meetings, training events and other travel to accomplish IWP activities.300 1 50 $8,700.00 2 TBD - Project Director and 3 Community Coordinators Orange County SNAP-Ed LIA Forum Other=parking, Uber, Lyft, plus 1 extra night for Administrator and Project Coordinator 1 3 2 2 $46.00 $120.00 400 $80.00 $1,468.00 3 TBD - Project Director and 3 Community Coordinators TBD Up to 7 (1 day) trainings (inlcuding CalFresh Healthy Living, spokesperson, Healthy Retail, Health Care, SNAP-Ed 101, nutrition education, ToPs, Leah's Pantry, etc.) Other=Parking and cabs 7 3 2 1 $46.00 $110.00 400 $30.00 $6,496.00 4 TBD-Health Care TBD 1 day training conducted by TBD vendor for Health Care clinic and hospital parters regarding IWP sub strategies and/or other related PSE nutrition and physcial activity PSE strategies identified by healthcare partners. Training costs will include travel, training fee, facility costs, training materials to help build capacity of the healthcare partners. Other = facility costs and training matierals.1 2 1 1 $46.00 $90.00 400 $1,800.00 $2,500.00 $9,104.00 5 $0.00 6 $0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 Total In-State Travel:$25,768 • Lodging costs include taxes. Reimbursement at CalHR rates. • Provide narrative in Description and Justification column describing all expenses for each budget line item Budget Adjustment Budget Adjustment Travel: Out-of-State Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Position Title/Name Location Description and Justification Trips FTE Days Nights Per Diem Lodging Air Miles ($.58)Reg Fee Other Total Budget Justification 1 $0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 Total Out-of-State Travel:$0 • Lodging costs include taxes. Reimbursement at CalHR rates. • Provide narrative in Description and Justification column describing all expenses for each budget line item Total Travel:$25,768 FFY 2020 CalFresh Healthy Living Budget EXHIBIT B Sub BJ C Organization Name:(CDPH) California Dept. of Public Health State-Level Project:Fresno Contracts/Sub-Grant/Agreement:TBD - Healthy Retail & Health Care Budget Adjustment Budget Adjustment Non-Capital Equipment/Supplies:Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Budget Item Description and Justification FTE Cost Per Item # of Items has been intention Total Budget Justification 1 Office Supplies General office supplies- Pens, pencils, paper products, desk supplies, postage, toner and ink, etc.2.95 $25.00 40 $2,950.00 2 Printing Printing of materials and copy duplication for program activities. FTE x $25 x 40 = $2,950 2.95 $25.00 80 $5,900.00 3 $0.00 39 $0.00 40 $0.00 Theft-sensitive equipment/supplies that are less than $5,000 (Computers, printers, projectors, etc.) 1 NA $0.00 25 $0.00 Total Non-Capital Equipment/Supplies:$8,850 • Provide narrative in Description and Justification column describing all expenses for each budget line item Budget Adjustment Budget Adjustment Materials:Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Budget Item Description and Justification Cost per Item # of Items as been intentio as been intention Total Budget Justification 1 Nutrition Education materials NEOP approved healthy retail and health care strategy matierals, curriclums, tool kits, etc $75 x 50 $75.00 100 $7,500.00 2 Food and beverage Demonstrations Produce and supplies (fresh, frozen, canned fruits and vegetables) and other items for use in USDA approved recipes. Paper towels, bowels, plates napkins, utensils, table coverings, cleaning supplies. $2.50 2,003 $5,007.50 3 Small Kitchen Wares Durable kitchen items for taste testing activities, including but not limited to electric skillet $24.99, spa water dispensers $25.99, cooking utensils $19.99, gloves $10.00, hair nets $10.00, storage containers $20.00, small serving cups $25.99, Bowls $15.99, Rolling Wagon $70.00, Foil $5.00, Saran Wrap $5.00, Baggies $5.00 plus tax. $20.00 158 $3,160.00 4 Nutrition Education Demonstration Supplies General Items necessary for retail and health care events such as tables($50), chairs($25), ice chests($30), table cloths ($100), canopy($100). Additionally, materials for two Fruit and Veggie Fest events and two health care focused additional events. Materials include: signage ($225), fliers ($50), food demo items($50), rental of generator($75), radio remote ($200) $50.00 70 $3,500.00 5 Healthcare and Retail PSE projects Meetings with Health Care and Retail partners to support their projects: Approximately 12 project meetings and trainings to support their partner- identified PSE projects at their respective sites. This may include meeting room rental fees to bring together Calfresh Healthy Living staff, community residents, stakeholders and key decision-makers; expert trainers to build capacity of health care and retail community partners and champion communtiy residents to implement identified PSE projects; project-specific materials needed to complete their chosen PSE projects; printing of NEOP-approved PSE materials to increase awareness of the subject matter; co-sponsorships of community PSE- related events (prior approval from state); and other materials promoting the specific PSE in accordance with NEOPB and USDA guidelines. Project goals are determined by SLAQ and health care and retail partners with input and technical assistance from CalFresh Healthy Living staff, and thus project needs may vary.$50.00 106 $5,300.00 FFY 2020 CalFresh Healthy Living Budget EXHIBIT B Sub BJ C 6 CalFresh Healthy Living Branded Team Ware Requesting to purchase CalFresh Healthy Living Team shirts for Fresno County NEOP Team members that are more condusive to working outside and doing physical activity in the community and sometimes staff have multiple outside events in a week. 60 CalFresh Healthy Living Team breathable wicking material polo-like shirts (30 x $35 = $1050 + 250 tax/shipping = $1300). Team members receive 2 CalFresh Healthy Living shirts, aprons, hats to wear at all program events and community events. During upcoming fiscal year, additional items may need to be purchase additional shirts to provide new team members and have some additional ones on hand as new future team members come on board. $1.00 1,300 $1,300.00 7 $0.00 16 $0.00 17 $0.00 18 $0.00 19 $0.00 20 $0.00 Total Materials:$25,768 • Provide narrative in Description and Justification column describing all expenses for each budget line item Budget Adjustment Budget Adjustment Building/Space:Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Location Name/Address Calculation Description FTE Cost per Month # of Month(s) has been intention Total Budget Justification 1 California Health Collaborative-1680 W Shaw Avenue Fresno, California 93711 Office space for NEOP funded staff (FTE X square ft x 12 months 2.95 $266.67 12 $9,440.12 2 Storage space - Pacific Storage 4201 West San Jose Ave. Fresno, CA 93722 Storage space for program and food demonstration supplies 1 $121.50 12 $1,458.00 3 $0.00 9 $0.00 10 $0.00 Total Building/Space:$10,898 • Provide narrative in Calculation Description column describing the calculation for each budget line item Budget Adjustment Budget Adjustment Maintenance:Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Location Name/Address Calculation Description FTE Cost per Month # of Month(s) has been intention Total Budget Justification 1 Communications - California health Collaborative-1680 W Shaw Avenue Fresno, California 93711address Phones, internet, it support 2.95 $155.00 12 $5,487.00 2 $0.00 23 $0.00 24 $0.00 25 $0.00 Total Maintenance:$5,487 • Provide narrative in Calculation Description column describing the calculation for each budget line item FFY 2020 CalFresh Healthy Living Budget EXHIBIT B Sub BJ C Budget Adjustment Budget Adjustment Equipment and Other Capital Expenditures (Items that are $5,000 or more):Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Budget Item Description and Justification FTE Cost per Item # of Item(s)Misc.Total Budget Justification 1 NA $0.00 2 $0.00 3 $0.00 4 $0.00 5 $0.00 6 $0.00 7 $0.00 8 $0.00 9 $0.00 10 $0.00 Total Equipment and Other Capital Expenditures:$0 • Provide narrative in Description and Justification column describing all expenses for each budget line item Budget Adjustment Budget Adjustment Contracts/Sub-Grants/Agreements:Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Organization Name Description of Service(s) This column has been This column has This column has This column has Total Grant Budget Justification Contracts/Sub-Grants/Agreements that are $25,000 or more A NA B Q AA AB Contracts/Sub-Grants/Agreements that are less than $25,000 1 20 Total Contracts/Sub-Grants/Agreements:$0 • Provide narrative in Description of Service(s) column summarizing the work that will be performed for each budget line item Total Direct Costs:$270,959 Budget Adjustment Budget Adjustment Indirect Costs:Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Indirect Cost Rate Calculation Method Total Admin/ Program Dollars This column has been intentionally left blank This column has been intentionally left blank2 This column has b Total Budget Justification 1 15.00%Total Direct Costs x 15%$270,959.00 $40,643.85 Total Indirect Costs:$40,644 • Provide narrative in the Calculation Method column explaining the line items included in the calculation Total Budget:$311,603 FFY 2021 CalFresh Healthy Living Budget EXHIBIT B Sub Staffing C (2) Organization Name:(CDPH) California Dept. of Public Health County/Jurisdiction:Fresno Contracts/Sub-Grant/Agreement:TBD - Healthy Retail & Health Care Budget Adjustment Budget Adjustment Staffing: Salary/Benefits:Budget Adjustment Position #Add Delete Increase Decrease Last Amount Approved Position Title Position Name SNAP-Ed Time Spent: % of SNAP-Ed Time Spent on Mgmt/Admin SNAP-Ed Time Spent: % of SNAP-Ed Time Spent on Direct SNAP- Ed Delivery Annual Salary FTE Total SNAP- Ed Salary Benefit Rate Total SNAP- Ed Benefits SNAP-Ed Admin Costs Total SNAP-Ed Funded Salary and Benefits Budget Justification 1 Program Director TBD 80.00%20.00%$84,872.00 0.25 $21,218.00 30.000%$6,365.40 $22,066.72 $27,583.40 2 Program Coordinator TBD 20.00%80.00%$46,350.00 1 $46,350.00 30.000%$13,905.00 $12,051.00 $60,255.00 3 Program Coordinator TBD 20.00%80.00%$47,740.00 1 $47,740.00 30.000%$14,322.00 $12,412.40 $62,062.00 4 Program Coordinator TBD 20.00%80.00%$48,668.00 0.7 $34,067.60 30.000%$10,220.28 $8,857.58 $44,287.88 5 0 $0.00 30.000%$0.00 $0.00 $0.00 6 $0.00 $0.00 $0.00 $0.00 44 $0.00 $0.00 $0.00 $0.00 45 $0.00 $0.00 $0.00 $0.00 46 $0.00 $0.00 $0.00 $0.00 47 $0.00 $0.00 $0.00 $0.00 48 $0.00 $0.00 $0.00 $0.00 49 $0.00 $0.00 $0.00 $0.00 50 $0.00 $0.00 $0.00 $0.00 51 $0.00 $0.00 $0.00 $0.00 52 $0.00 $0.00 $0.00 $0.00 53 $0.00 $0.00 $0.00 $0.00 54 $0.00 $0.00 $0.00 $0.00 55 $0.00 $0.00 $0.00 $0.00 56 $0.00 $0.00 $0.00 $0.00 57 $0.00 $0.00 $0.00 $0.00 58 $0.00 $0.00 $0.00 $0.00 59 $0.00 $0.00 $0.00 $0.00 60 $0.00 $0.00 $0.00 $0.00 Total Staffing: Salaries/Benefits:2.95 $149,376 $44,813 $55,388 $194,188 • Provide narrative in Budget Justification column for Benefit Rates over 90% Definition and basis for calculations of benefit rate(s): Includes payroll taxes, medical/dental benefits, and retirement as a percentage of salaries. (Describe what is covered in the benefit rate for your agency) FFY 2021 CalFresh Healthy Living Budget EXHIBIT B Sub Travel C (2) Organization Name:(CDPH) California Dept. of Public Health County/Jurisdiction:Fresno Contracts/Sub-Grant/Agreement:TBD - Healthy Retail & Health Care Budget Adjustment Budget Adjustment Travel: In-State Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Position Title/Name Location Description and Justification Trips FTE Days Nights Per Diem Lodging Air Miles ($.58)Reg Fee Other Total Budget Justification 1 All NEOP funded staff-TBD Fresno County and Regional travel Healthy retail and health care strategies' activities, nutrition education, coalition meetings, community partner meetings, Promising Practices Exchange, local/regional meetings, training events and other travel to accomplish IWP activities.300 1 50 $8,700.00 2 TBD - Project Director and 3 Community Coordinators Orange County SNAP-Ed LIA Forum Other=parking, Uber, Lyft, plus 1 extra night for Administrator and Project Coordinator 1 3 2 2 $46.00 $120.00 400 $80.00 $1,468.00 3 TBD - Project Director and 3 Community Coordinators TBD Up to 7 (1 day) trainings (inlcuding CalFresh Healthy Living, spokesperson, Healthy Retail, Health Care, SNAP-Ed 101, nutrition education, ToPs, Leah's Pantry, etc.) Other=Parking and cabs 7 3 2 1 $46.00 $110.00 400 $30.00 $6,496.00 4 TBD-Health Care TBD 1 day training conducted by TBD vendor for Health Care clinic and hospital parters regarding IWP sub strategies and/or other related PSE nutrition and physcial activity PSE strategies identified by healthcare partners. Training costs will include travel, training fee, facility costs, training materials to help build capacity of the healthcare partners. Other = facility costs and training matierals.1 2 1 1 $46.00 $90.00 400 $1,800.00 $2,500.00 $9,104.00 5 $0.00 6 $0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 Total In-State Travel:$25,768 • Lodging costs include taxes. Reimbursement at CalHR rates. • Provide narrative in Description and Justification column describing all expenses for each budget line item Budget Adjustment Budget Adjustment Travel: Out-of-State Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Position Title/Name Location Description and Justification Trips FTE Days Nights Per Diem Lodging Air Miles ($.58)Reg Fee Other Total Budget Justification 1 $0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 Total Out-of-State Travel:$0 • Lodging costs include taxes. Reimbursement at CalHR rates. • Provide narrative in Description and Justification column describing all expenses for each budget line item Total Travel:$25,768 FFY 2021 CalFresh Healthy Living Budget EXHIBIT B Sub BJ C (2) Organization Name:(CDPH) California Dept. of Public Health State-Level Project:Fresno Contracts/Sub-Grant/Agreement:TBD - Healthy Retail & Health Care Budget Adjustment Budget Adjustment Non-Capital Equipment/Supplies:Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Budget Item Description and Justification FTE Cost Per Item # of Items has been intention Total Budget Justification 1 Office Supplies General office supplies- Pens, pencils, paper products, desk supplies, postage, toner and ink, etc.2.95 $25.00 40 $2,950.00 2 Printing Printing of materials and copy duplication for program activities. FTE x $25 x 40 = $2,950 2.95 $25.00 80 $5,900.00 3 $0.00 39 $0.00 40 $0.00 Theft-sensitive equipment/supplies that are less than $5,000 (Computers, printers, projectors, etc.) 1 NA $0.00 25 $0.00 Total Non-Capital Equipment/Supplies:$8,850 • Provide narrative in Description and Justification column describing all expenses for each budget line item Budget Adjustment Budget Adjustment Materials:Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Budget Item Description and Justification Cost per Item # of Items as been intentioas been intention Total Budget Justification 1 Nutrition Education materials NEOP approved healthy retail and health care strategy matierals, curriclums, tool kits, etc $75 x 50 $75.00 100 $7,500.00 2 Food and beverage Demonstrations Produce and supplies (fresh, frozen, canned fruits and vegetables) and other items for use in USDA approved recipes. Paper towels, bowels, plates napkins, utensils, table coverings, cleaning supplies. $2.50 2,003 $5,007.50 3 Small Kitchen Wares Durable kitchen items for taste testing activities, including but not limited to electric skillet $24.99, spa water dispensers $25.99, cooking utensils $19.99, gloves $10.00, hair nets $10.00, storage containers $20.00, small serving cups $25.99, Bowls $15.99, Rolling Wagon $70.00, Foil $5.00, Saran Wrap $5.00, Baggies $5.00 plus tax. $20.00 158 $3,160.00 4 Nutrition Education Demonstration Supplies General Items necessary for retail and health care events such as tables($50), chairs($25), ice chests($30), table cloths ($100), canopy($100). Additionally, materials for two Fruit and Veggie Fest events and two health care focused additional events. Materials include: signage ($225), fliers ($50), food demo items($50), rental of generator($75), radio remote ($200) $50.00 70 $3,500.00 5 Healthcare and Retail PSE projects Meetings with Health Care and Retail partners to support their projects: Approximately 12 project meetings and trainings to support their partner- identified PSE projects at their respective sites. This may include meeting room rental fees to bring together Calfresh Healthy Living staff, community residents, stakeholders and key decision-makers; expert trainers to build capacity of health care and retail community partners and champion communtiy residents to implement identified PSE projects; project-specific materials needed to complete their chosen PSE projects; printing of NEOP-approved PSE materials to increase awareness of the subject matter; co-sponsorships of community PSE- related events (prior approval from state); and other materials promoting the specific PSE in accordance with NEOPB and USDA guidelines. Project goals are determined by SLAQ and health care and retail partners with input and technical assistance from CalFresh Healthy Living staff, and thus project needs may vary.$50.00 106 $5,300.00 FFY 2021 CalFresh Healthy Living Budget EXHIBIT B Sub BJ C (2) 6 CalFresh Healthy Living Branded Team Ware Requesting to purchase CalFresh Healthy Living Team shirts for Fresno County NEOP Team members that are more condusive to working outside and doing physical activity in the community and sometimes staff have multiple outside events in a week. 60 CalFresh Healthy Living Team breathable wicking material polo-like shirts (30 x $35 = $1050 + 250 tax/shipping = $1300). Team members receive 2 CalFresh Healthy Living shirts, aprons, hats to wear at all program events and community events. During upcoming fiscal year, additional items may need to be purchase additional shirts to provide new team members and have some additional ones on hand as new future team members come on board. $1.00 1,300 $1,300.00 7 $0.00 16 $0.00 17 $0.00 18 $0.00 19 $0.00 20 $0.00 Total Materials:$25,768 • Provide narrative in Description and Justification column describing all expenses for each budget line item Budget Adjustment Budget Adjustment Building/Space:Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Location Name/Address Calculation Description FTE Cost per Month # of Month(s) has been intention Total Budget Justification 1 California Health Collaborative-1680 W Shaw Avenue Fresno, California 93711 Office space for NEOP funded staff (FTE X square ft x 12 months 2.95 $266.67 12 $9,440.12 2 Storage space - Pacific Storage 4201 West San Jose Ave. Fresno, CA 93722 Storage space for program and food demonstration supplies 1 $121.50 12 $1,458.00 3 $0.00 9 $0.00 10 $0.00 Total Building/Space:$10,898 • Provide narrative in Calculation Description column describing the calculation for each budget line item Budget Adjustment Budget Adjustment Maintenance:Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Location Name/Address Calculation Description FTE Cost per Month # of Month(s) has been intention Total Budget Justification 1 Communications - California health Collaborative-1680 W Shaw Avenue Fresno, California 93711address Phones, internet, it support 2.95 $155.00 12 $5,487.00 2 $0.00 23 $0.00 24 $0.00 25 $0.00 Total Maintenance:$5,487 • Provide narrative in Calculation Description column describing the calculation for each budget line item FFY 2021 CalFresh Healthy Living Budget EXHIBIT B Sub BJ C (2) Budget Adjustment Budget Adjustment Equipment and Other Capital Expenditures (Items that are $5,000 or more):Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Budget Item Description and Justification FTE Cost per Item # of Item(s)Misc.Total Budget Justification 1 NA $0.00 2 $0.00 3 $0.00 4 $0.00 5 $0.00 6 $0.00 7 $0.00 8 $0.00 9 $0.00 10 $0.00 Total Equipment and Other Capital Expenditures:$0 • Provide narrative in Description and Justification column describing all expenses for each budget line item Budget Adjustment Budget Adjustment Contracts/Sub-Grants/Agreements:Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Organization Name Description of Service(s) This column has been This column has This column has This column has Total Grant Budget Justification Contracts/Sub-Grants/Agreements that are $25,000 or more A NA B Q AA AB Contracts/Sub-Grants/Agreements that are less than $25,000 1 20 Total Contracts/Sub-Grants/Agreements:$0 • Provide narrative in Description of Service(s) column summarizing the work that will be performed for each budget line item Total Direct Costs:$270,959 Budget Adjustment Budget Adjustment Indirect Costs:Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Indirect Cost Rate Calculation Method Total Admin/ Program Dollars This column has been intentionally left blank This column has been intentionally left blank2 This column has b Total Budget Justification 1 15.00%Total Direct Costs x 15%$270,959.00 $40,643.85 Total Indirect Costs:$40,644 • Provide narrative in the Calculation Method column explaining the line items included in the calculation Total Budget:$311,603 FFY 2022 CalFresh Healthy Living Budget EXHIBIT B Sub Staffing C (3) Organization Name:(CDPH) California Dept. of Public Health County/Jurisdiction:Fresno Contracts/Sub-Grant/Agreement:TBD - Healthy Retail & Health Care Budget Adjustment Budget Adjustment Staffing: Salary/Benefits:Budget Adjustment Position #Add Delete Increase Decrease Last Amount Approved Position Title Position Name SNAP-Ed Time Spent: % of SNAP-Ed Time Spent on Mgmt/Admin SNAP-Ed Time Spent: % of SNAP-Ed Time Spent on Direct SNAP- Ed Delivery Annual Salary FTE Total SNAP- Ed Salary Benefit Rate Total SNAP- Ed Benefits SNAP-Ed Admin Costs Total SNAP-Ed Funded Salary and Benefits Budget Justification 1 Program Director TBD 80.00%20.00%$84,872.00 0.25 $21,218.00 30.000%$6,365.40 $22,066.72 $27,583.40 2 Program Coordinator TBD 20.00%80.00%$46,350.00 1 $46,350.00 30.000%$13,905.00 $12,051.00 $60,255.00 3 Program Coordinator TBD 20.00%80.00%$47,740.00 1 $47,740.00 30.000%$14,322.00 $12,412.40 $62,062.00 4 Program Coordinator TBD 20.00%80.00%$48,668.00 0.7 $34,067.60 30.000%$10,220.28 $8,857.58 $44,287.88 5 0 $0.00 30.000%$0.00 $0.00 $0.00 6 $0.00 $0.00 $0.00 $0.00 44 $0.00 $0.00 $0.00 $0.00 45 $0.00 $0.00 $0.00 $0.00 46 $0.00 $0.00 $0.00 $0.00 47 $0.00 $0.00 $0.00 $0.00 48 $0.00 $0.00 $0.00 $0.00 49 $0.00 $0.00 $0.00 $0.00 50 $0.00 $0.00 $0.00 $0.00 51 $0.00 $0.00 $0.00 $0.00 52 $0.00 $0.00 $0.00 $0.00 53 $0.00 $0.00 $0.00 $0.00 54 $0.00 $0.00 $0.00 $0.00 55 $0.00 $0.00 $0.00 $0.00 56 $0.00 $0.00 $0.00 $0.00 57 $0.00 $0.00 $0.00 $0.00 58 $0.00 $0.00 $0.00 $0.00 59 $0.00 $0.00 $0.00 $0.00 60 $0.00 $0.00 $0.00 $0.00 Total Staffing: Salaries/Benefits:2.95 $149,376 $44,813 $55,388 $194,188 • Provide narrative in Budget Justification column for Benefit Rates over 90% Definition and basis for calculations of benefit rate(s): Includes payroll taxes, medical/dental benefits, and retirement as a percentage of salaries. (Describe what is covered in the benefit rate for your agency) FFY 2022 CalFresh Healthy Living Budget EXHIBIT B Sub Travel C (3) Organization Name:(CDPH) California Dept. of Public Health County/Jurisdiction:Fresno Contracts/Sub-Grant/Agreement:TBD - Healthy Retail & Health Care Budget Adjustment Budget Adjustment Travel: In-State Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Position Title/Name Location Description and Justification Trips FTE Days Nights Per Diem Lodging Air Miles ($.58)Reg Fee Other Total Budget Justification 1 All NEOP funded staff-TBD Fresno County and Regional travel Healthy retail and health care strategies' activities, nutrition education, coalition meetings, community partner meetings, Promising Practices Exchange, local/regional meetings, training events and other travel to accomplish IWP activities.300 1 50 $8,700.00 2 TBD - Project Director and 3 Community Coordinators Orange County SNAP-Ed LIA Forum Other=parking, Uber, Lyft, plus 1 extra night for Administrator and Project Coordinator 1 3 2 2 $46.00 $120.00 400 $80.00 $1,468.00 3 TBD - Project Director and 3 Community Coordinators TBD Up to 7 (1 day) trainings (inlcuding CalFresh Healthy Living, spokesperson, Healthy Retail, Health Care, SNAP-Ed 101, nutrition education, ToPs, Leah's Pantry, etc.) Other=Parking and cabs 7 3 2 1 $46.00 $110.00 400 $30.00 $6,496.00 4 TBD-Health Care TBD 1 day training conducted by TBD vendor for Health Care clinic and hospital parters regarding IWP sub strategies and/or other related PSE nutrition and physcial activity PSE strategies identified by healthcare partners. Training costs will include travel, training fee, facility costs, training materials to help build capacity of the healthcare partners. Other = facility costs and training matierals.1 2 1 1 $46.00 $90.00 400 $1,800.00 $2,500.00 $9,104.00 5 $0.00 6 $0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 Total In-State Travel:$25,768 • Lodging costs include taxes. Reimbursement at CalHR rates. • Provide narrative in Description and Justification column describing all expenses for each budget line item Budget Adjustment Budget Adjustment Travel: Out-of-State Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Position Title/Name Location Description and Justification Trips FTE Days Nights Per Diem Lodging Air Miles ($.58)Reg Fee Other Total Budget Justification 1 $0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 ##$0.00 Total Out-of-State Travel:$0 • Lodging costs include taxes. Reimbursement at CalHR rates. • Provide narrative in Description and Justification column describing all expenses for each budget line item Total Travel:$25,768 FFY 2022 CalFresh Healthy Living Budget EXHIBIT B Sub BJ C (3) Organization Name:(CDPH) California Dept. of Public Health State-Level Project:Fresno Contracts/Sub-Grant/Agreement:TBD - Healthy Retail & Health Care Budget Adjustment Budget Adjustment Non-Capital Equipment/Supplies:Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Budget Item Description and Justification FTE Cost Per Item # of Items has been intention Total Budget Justification 1 Office Supplies General office supplies- Pens, pencils, paper products, desk supplies, postage, toner and ink, etc.2.95 $25.00 40 $2,950.00 2 Printing Printing of materials and copy duplication for program activities. FTE x $25 x 40 = $2,950 2.95 $25.00 80 $5,900.00 3 $0.00 39 $0.00 40 $0.00 Theft-sensitive equipment/supplies that are less than $5,000 (Computers, printers, projectors, etc.) 1 NA $0.00 25 $0.00 Total Non-Capital Equipment/Supplies:$8,850 • Provide narrative in Description and Justification column describing all expenses for each budget line item Budget Adjustment Budget Adjustment Materials:Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Budget Item Description and Justification Cost per Item # of Items as been intentioas been intention Total Budget Justification 1 Nutrition Education materials NEOP approved healthy retail and health care strategy matierals, curriclums, tool kits, etc $75 x 50 $75.00 100 $7,500.00 2 Food and beverage Demonstrations Produce and supplies (fresh, frozen, canned fruits and vegetables) and other items for use in USDA approved recipes. Paper towels, bowels, plates napkins, utensils, table coverings, cleaning supplies. $2.50 2,003 $5,007.50 3 Small Kitchen Wares Durable kitchen items for taste testing activities, including but not limited to electric skillet $24.99, spa water dispensers $25.99, cooking utensils $19.99, gloves $10.00, hair nets $10.00, storage containers $20.00, small serving cups $25.99, Bowls $15.99, Rolling Wagon $70.00, Foil $5.00, Saran Wrap $5.00, Baggies $5.00 plus tax. $20.00 158 $3,160.00 4 Nutrition Education Demonstration Supplies General Items necessary for retail and health care events such as tables($50), chairs($25), ice chests($30), table cloths ($100), canopy($100). Additionally, materials for two Fruit and Veggie Fest events and two health care focused additional events. Materials include: signage ($225), fliers ($50), food demo items($50), rental of generator($75), radio remote ($200) $50.00 70 $3,500.00 5 Healthcare and Retail PSE projects Meetings with Health Care and Retail partners to support their projects: Approximately 12 project meetings and trainings to support their partner- identified PSE projects at their respective sites. This may include meeting room rental fees to bring together Calfresh Healthy Living staff, community residents, stakeholders and key decision-makers; expert trainers to build capacity of health care and retail community partners and champion communtiy residents to implement identified PSE projects; project-specific materials needed to complete their chosen PSE projects; printing of NEOP-approved PSE materials to increase awareness of the subject matter; co-sponsorships of community PSE- related events (prior approval from state); and other materials promoting the specific PSE in accordance with NEOPB and USDA guidelines. Project goals are determined by SLAQ and health care and retail partners with input and technical assistance from CalFresh Healthy Living staff, and thus project needs may vary.$50.00 106 $5,300.00 FFY 2022 CalFresh Healthy Living Budget EXHIBIT B Sub BJ C (3) 6 CalFresh Healthy Living Branded Team Ware Requesting to purchase CalFresh Healthy Living Team shirts for Fresno County NEOP Team members that are more condusive to working outside and doing physical activity in the community and sometimes staff have multiple outside events in a week. 60 CalFresh Healthy Living Team breathable wicking material polo-like shirts (30 x $35 = $1050 + 250 tax/shipping = $1300). Team members receive 2 CalFresh Healthy Living shirts, aprons, hats to wear at all program events and community events. During upcoming fiscal year, additional items may need to be purchase additional shirts to provide new team members and have some additional ones on hand as new future team members come on board. $1.00 1,300 $1,300.00 7 $0.00 16 $0.00 17 $0.00 18 $0.00 19 $0.00 20 $0.00 Total Materials:$25,768 • Provide narrative in Description and Justification column describing all expenses for each budget line item Budget Adjustment Budget Adjustment Building/Space:Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Location Name/Address Calculation Description FTE Cost per Month # of Month(s) has been intention Total Budget Justification 1 California Health Collaborative-1680 W Shaw Avenue Fresno, California 93711 Office space for NEOP funded staff (FTE X square ft x 12 months 2.95 $266.67 12 $9,440.12 2 Storage space - Pacific Storage 4201 West San Jose Ave. Fresno, CA 93722 Storage space for program and food demonstration supplies 1 $121.50 12 $1,458.00 3 $0.00 9 $0.00 10 $0.00 Total Building/Space:$10,898 • Provide narrative in Calculation Description column describing the calculation for each budget line item Budget Adjustment Budget Adjustment Maintenance:Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Location Name/Address Calculation Description FTE Cost per Month # of Month(s) has been intention Total Budget Justification 1 Communications - California health Collaborative-1680 W Shaw Avenue Fresno, California 93711address Phones, internet, it support 2.95 $155.00 12 $5,487.00 2 $0.00 23 $0.00 24 $0.00 25 $0.00 Total Maintenance:$5,487 • Provide narrative in Calculation Description column describing the calculation for each budget line item FFY 2022 CalFresh Healthy Living Budget EXHIBIT B Sub BJ C (3) Budget Adjustment Budget Adjustment Equipment and Other Capital Expenditures (Items that are $5,000 or more):Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Budget Item Description and Justification FTE Cost per Item # of Item(s)Misc.Total Budget Justification 1 NA $0.00 2 $0.00 3 $0.00 4 $0.00 5 $0.00 6 $0.00 7 $0.00 8 $0.00 9 $0.00 10 $0.00 Total Equipment and Other Capital Expenditures:$0 • Provide narrative in Description and Justification column describing all expenses for each budget line item Budget Adjustment Budget Adjustment Contracts/Sub-Grants/Agreements:Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Organization Name Description of Service(s) This column has been This column has This column has This column has Total Grant Budget Justification Contracts/Sub-Grants/Agreements that are $25,000 or more A NA B Q AA AB Contracts/Sub-Grants/Agreements that are less than $25,000 1 20 Total Contracts/Sub-Grants/Agreements:$0 • Provide narrative in Description of Service(s) column summarizing the work that will be performed for each budget line item Total Direct Costs:$270,959 Budget Adjustment Budget Adjustment Indirect Costs:Budget Adjustment Item #Add Delete Increase Decrease Last Amount Approved Indirect Cost Rate Calculation Method Total Admin/ Program Dollars This column has been intentionally left blank This column has been intentionally left blank2 This column has b Total Budget Justification 1 15.00%Total Direct Costs x 15%$270,959.00 $40,643.85 Total Indirect Costs:$40,644 • Provide narrative in the Calculation Method column explaining the line items included in the calculation Total Budget:$311,603 STANDARD GRANT CONDITIONS 19-10323 EXHIBIT C EXHIBIT C STANDARD GRANT CONDITIONS 1.APPROVAL: This Grant is of no force or effect until signed by both parties and approved by the Department of General Services, if required. The Grantee may not commence performance until such approval has been obtained 2.AMENDMENT: No amendment or variation of the terms of this Grant shall be valid unless made in writing, signed by the parties, and approved as required. No oral understanding or Agreement not incorporated in the Grant is binding on any of the parties. In no case shall the Department materially alter the scope of the Project set forth in Exhibit A. 3.ASSIGNMENT: This Grant is not assignable by the Grantee, either in whole or in part, without the written consent of the Grant Manager in the form of a written amendment to the Grant. 4.AUDIT: Grantee agrees that the Department, the Bureau of State Audits, or their designated representative shall have the right to review and to copy any records and supporting documentation pertaining to this Grant. Grantee agrees to maintain such records for a possible audit for a minimum of three (3) years after final payment or completion of the project funded with this Grant, unless a longer period of records retention is stipulated. Grantee agrees to allow the auditor(s) access to such records during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Grantee agrees to include a similar right of the State to audit records and interview staff in any subcontract related to the project. 5.CONFLICT OF INTEREST: Grantee certifies that it is in compliance with all applicable state and/or federal conflict of interest laws. 6.INDEMNIFICATION: Grantee agrees to indemnify, defend and save harmless the State, its officers, agents and employees from any and all claims and losses accruing or resulting to any and all contractors, subcontractors, suppliers, laborers, and any other person, firm or corporation furnishing or supplying work services, materials, or supplies in connection with the project, and from any and all claims and losses accruing or resulting to any person, firm or corporation who may be injured or damaged by Grantee in the performance of any activities related to the Project. 7.FISCAL MANAGEMENT SYSTEMS AND ACCOUNTING STANDARDS: Grantee agrees that, at a minimum, its fiscal control and accounting procedures will be sufficient to permit tracing of all grant funds to a level of expenditure adequate to establish that such funds have not been used in violation of any applicable state or federal law, or the provisions of this Grant. Grantee further agrees that it will maintain separate Project accounts in accordance with generally accepted accounting principles. STANDARD GRANT CONDITIONS 19-10323 EXHIBIT C Page 2 of 4 8.GOVERNING LAW: This Grant is governed by and shall be interpreted in accordance with the laws of the State of California. 9.INCOME RESTRICTIONS: Grantee agrees that any refunds, rebates, credits, or other amounts (including any interest thereon) accruing to or received by the Grantee under this Grant shall be paid by the Grantee to the Department, to the extent that they are properly allocable to costs for which the Grantee has been reimbursed by the Department under this Grant. 10.INDEPENDENT CONTRACTOR: Grantee, and its agents and employees of Grantee, in the performance of the Project, shall act in an independent capacity and not as officers, employees or agents of the Department. 11.MEDIA EVENTS: Grantee shall notify the Department's Grant Manager in writing at least twenty (20) working days before any public or media event publicizing the accomplishments and/or results of the Project and provide the opportunity for attendance and participation by Department's representatives. 12.NO THIRD-PARTY RIGHTS: The Department and Grantee do not intend to create any rights or remedies for any third- party as a beneficiary of this Grant or the project. 13.NOTICE: Grantee shall promptly notify the Department's Grant Manager in writing of any events, developments or changes that could affect the completion of the project or the budget approved for this Grant. 14.PROFESSIONALS: Grantee agrees that only licensed professionals will be used to perform services under this Grant where such services are called for. 15.RECORDS: Grantee certifies that it will maintain Project accounts in accordance with generally accepted accounting principles. Grantee further certifies that it will comply with the following conditions for a grant award as set forth in the Request for Applications (Exhibit D) and the Grant Application (Exhibit A). A.Establish an official file for the Project which shall adequately document all significant actions relative to the Project; B.Establish separate accounts which will adequately and accurately depict all amounts received and expended on this Project, including all grant funds received under this Grant; C.Establish separate accounts which will adequately depict all income received which is attributable to the Project, especially including any income attributable to grant funds disbursed under this Grant; D.Establish an accounting system which will adequately depict final total costs of the Project, including both direct and indirect costs; and, E.Establish such accounts and maintain such records as may be necessary for the state to fulfill federal reporting requirements, including any and all reporting requirements under federal tax statutes or regulations. STANDARD GRANT CONDITIONS 19-10323 EXHIBIT C Page 3 of 4 16.RELATED LITIGATION: Under no circumstances may Grantee use funds from any disbursement under this Grant to pay for costs associated with any litigation between the Grantee and the Department. 17.RIGHTS IN DATA: Grantee and the Department agree that all data, plans, drawings, specifications, reports, computer programs, operating manuals, notes, and other written or graphic work submitted under Exhibit A in the performance of the Project funded by this Grant shall be in the public domain. Grantee may disclose, disseminate and use in whole or in part, any final form data and information received, collected, and developed under this Project, subject to appropriate acknowledgment of credit to the Department for financial support. Grantee shall not utilize the materials submitted to the Department (except data)'for any profit making venture or sell or grant rights to a third-party who intends to do so. The Department has the right to use submitted data for all governmental purposes. 18.VENUE: The Department and Grantee agree that any action arising out of this Grant shall be filed and maintained in the Superior Court California. Grantee waives any existing sovereign immunity for the purposes of this Grant, if applicable. 19.STATE-FUNDED RESEARCH GRANTS: A.Grantee shall provide for free public access to any publication of a department-funded invention or department-funded technology. Grantee further agrees to all terms and conditions required by the California Taxpayer Access to Publicly Funded Research Act {Chapter 2.5 (commencing with Section 13989) of Part 4.5 of Division 3 of Title 2 of the Government Code). B. As a condition of receiving the research grant, Grantee agrees to the following terms and conditions which are set forth in Government Code section 13989.6 ("Section 13989.6"): 1)Grantee is responsible for ensuring that any publishing or copyright agreements concerning submitted manuscripts fully comply with Section 13989.6. 2)Grantees shall report to the Department the final disposition of the research grant, including, but not limited to, if it was published, when it was published, where it was published, when the 12-month time period expires, and where the manuscript will be available for open access. 3)For a manuscript that is accepted for publication in a peer-reviewed journal, the Grantee shall ensure that an electronic version of the peer-reviewed manuscript is available to the department and on an appropriate publicly accessible database approved by the Department, including, but not limited to, the University of California's eScholarship Repository at the California Digital Library, PubMed Central, or the California Digital Open Source Library, to be made publicly available not later than 12 months after the official date of publication. Manuscripts submitted to the California Digital Open Source Library shall be exempt from the requirements in subdivision (b) of Section 66408 of the Education Code. Grantee shall make reasonable efforts to comply with this requirement by ensuring that their manuscript is accessible on an approved publicly accessible database, and notifying the Department that the STANDARD GRANT CONDITIONS 19-10323 EXHIBIT C Page 4 of 4 manuscript is available on a department-approved database. If Grantee is unable to ensure that their manuscript is accessible on an approved publicly accessible database, Grantee may comply by providing the manuscript to the Department not later than 12 months after the official date of publication. 4)For publications other than those described in paragraph B.3 above,including meeting abstracts, Grantee shall comply by providing the manuscript to the Department not later than 12 months after the official date of publication. 5)Grantee is authorized to use grant money for publication costs, including fees charged by a publisher for color and page charges, or fees for digital distribution. County of Fresno 19-10323 Exhibit D Federal Terms and Conditions (For Federally Funded Grant Agreements) The use of headings or titles throughout this exhibit is for convenience only and shall not be used to interpret or to govern the meaning of any specific term or condition. This exhibit contains provisions that require strict adherence to various contracting laws and policies. Index of Special Terms and Conditions CDPH (rev. 07/16) Page 1 of 11 1.Federal Funds 2.Federal Equal Employment Opportunity Requirements 3.Debarment and Suspension Certification 4.Covenant Against Contingent Fees 5.Air or Water Pollution Requirements 6.Lobbying Restrictions and Disclosure Certification 7.Additional Restrictions 8.Human Subjects Use Requirments 9.Financial and Compliance Audit Requirements 10.Audit and Record Retention 11.Federal Requirements California Department of Public Health - Federal Terms and Conditions Exhibit D 1.Federal Funds (Applicable 'only to that portion of an agreement funded in part or whole with federal funds.) a.It is mutually understood between the parties that this Grant may have been written before ascertaining the availability of congressional appropriation of funds, for the mutual benefit of both pa,rties, in order to avoid program and fiscal delays which would occur if the Grant were executed after that determination was made. b.This Grant is valid and enforceable only if sufficient funds are made available to the State by the United States Government for the fiscal years covered by the term of this Grant. In addition, this Grant is subject to any additional restrictions, limitations, or conditions enacted by the Congress or any statute enacted by the Congress which may affect the provisions, terms or funding of this Grant in any manner. c.It is mutually agreed that if the Congress does not appropriate sufficient funds for the program, this Grant shall be amended to reflect any reduction in funds. d.CDPH has the option to invalidate or cancel the Grant with 30-days advance written notice or to amend the Grant to reflect any reduction in funds. 2.Federal Equal Opportunity Requirements (Applicable to all federally funded grants entered into by the California Department of Public Health (CDPH) formerly known as California Department of Health Services (CDHS).) a.The Grantee will not discriminate against any employee or applicant for employment because of race, color, religion, sex, national origin, physical or mental handicap, disability, age or status as a disabled veteran or veteran of the Vietnam era. The Grantee will take affirmative action to ensure that qualified applicants are employed, and that employees are treated during employment, without regard to their race, color, religion, sex, national origin, physical or mental handicap, disability, age or status as a disabled veteran or veteran of the Vietnam era. Such action shall include, but not be limited to the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and career development opportunities and selection for training, including apprenticeship. The Grantee agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the Federal Government or CDPH, selling forth the provisions of the Equal Opportunity clause, Section 503 of the Rehabilitation Act of 1973 and the affirmative action clause required by the Vietnam Era Veterans' Readjustment Assistance Act of 1974 (38 U.S.C. 4212). Such notices shall state the Grantee's obligation Linder the law to take affirmative action to employ and advance in employment qualified applicants without discrimination based on their race, color, religion, sex, national origin physical or mental handicap, disability, age or status as a disabled veteran or veteran of the Vietnam era and the rights of applicants and employees. b.The Grantee will, in all solicitations or advancements for employees placed by or on behalf of the Grantee, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin physical or mental handicap, disability, age or status as a disabled veteran or veteran of the Vietnam era. c.The Grantee will send to each labor union or representative of workers with which it has a collective bargaining agreement or other contract or understanding a notice, to be provided by the Federal Government or the State, advising the labor union or workers' representative of the Grantee's commitments under the provisions herein and shall post copies of the notice in conspicuous places available to employees and applicants for employment. d.The Grantee will comply with all provisions of and furnish all information and reports required by Section 503 of the Rehabilitation Act of 1973, as amended, the Vietnam Era Veterans' Readjustment Assistance Act of 1974 (38 U.S.C. 4212) and of the Federal Executive Order No. 11246 as amended, including by Executive Order 11375, 'Amending Executive Order 11246 Relating to Equal Employment Opportunity,' and as supplemented by regulation at 41 CFR part 60, "Office of the Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor," and of the rules, regulations, and relevant orders of the Secretary of Labor. CDPH (rev. 07/16) Page 2 of 11 California Department of Public Health - Federal Terms and Conditions Exhibit D e.The Grantee will furnish all information and reports required by Federal Executive Order No. 11246 as amended, including by Executive Order 11375, 'Amending Executive Order 11246 Relating to Equal Employment Opportunity,' and as supplemented by regulation at 41 CFR part 60, "Office of the Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor," and the Rehabilitation Act of 1973, and by the rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to its books, records, and accounts by the State and its designated representatives and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules, regulations, and orders. f.. In the event of the Grantee's noncompliance with the requirements of the provisions herein or with any federal rules, regulations, or orders which are referenced herein, this Agreement may be cancelled, terminated, or suspended in whole or in part and the Grantee may be declared ineligible for further federal and state contracts in accordance with procedures authorized in Federal Executive Order No. 11246 as amended and such other sanctions may be imposed and remedies invoked as provided in Federal Executive Order No. 11246 as amended, including by Executive Order 11375, 'Amending Executive Order 11246 Relating to Equal Employment Opportunity,' and as supplemented by regulation at 41 CFR part 60, "Office of the Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor," or by rule, regulation, or order of the Secretary of Labor, or as otherwise provided by law. g.The Grantee will include the provisions of Paragraphs a through g in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to Federal Executive Order No. 11246 as amended, including by Executive Order 11375, 'Amending Executive Order 11246 Relating to Equal Employment Opportunity,' and as supplemented by regulation at 41 CFR part 60, "Office of the Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor,'' or Section 503 of the Rehabilitation Act of 1973 or (38 U.S.C. 4212) of the Vietnam Era Veteran's Readjustment Assistance Act, so that such provisions will be binding upon each subGrantee or vendor. The Grantee will take such action with respect to any subcontract or purchase order as the Director of the Office of Federal Contract Compliance Programs or CDPH may direct as a means of enforcing such provisions including sanctions for noncompliance provided, however, that in the event the Grantee becomes involved in, or is threatened with litigation by a subGrantee or vendor as a result of such direction by CDPH, the Grantee may request in writing to CDPH, who, in turn, may request the United States to enter into such litigation to protect the interests of the State and of the United States. 3.Debarment and Suspension Certification a.By signing this Grant, the Grantee agrees to comply with applicable federal suspension and debarment regulations including, but not limited to 7 CFR Part 3017, 45 CFR 76, 40 CFR 32 or 34 CFR 85. b.By signing this Grant, the Grantee certifies to the best of its knowledge and belief, that it and its principals: (1)Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any federal department or agency; (2)Have not within a three-year period preceding this application/proposal/agreement been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (3)Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in Paragraph b(2) herein; and (4)Have not within a three-year period preceding this application/proposal/agreement had one or more public transactions (Federal, State or local) terminated for cause or default. (5)Shall not knowingly enter into any lower tier covered transaction with a person who is proposed for debarment under federal regulations (i.e., 48 CFR part 9, subpart 9.4), debarred, suspended, declared . ineligible, or voluntarily excluded from participation in such transaction, unless authorized by the State. CDPH (rev. 07/16) Page3of11 California Department of Public Health - Federal Terms and Conditions Exhibit D (6)Will include a clause entitled, "Debarment and Suspension Certification" that essentially sets forth the provisions herein, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. c.If the Grantee is unable to certify to any of the statements in this certification, the Grantee shall submit an explanation to the CDPH Program Contract Manager. d.The terms and definitions herein have the meanings set out in the Definitions and Coverage sections of the rules implementing Federal Executive Order 12549. e.If the Grantee knowingly violates this certification, in addition to other remedies available to the Federal Government, the CDPH may terminate this Agreement for cause or default. 4.Covenant Against Contingent Fees The Grantee warrants that no person or selling agency has been employed or retained to solicit/secure this Grant upon an agreement of understanding for a commission, percentage, brokerage, or contingent fee, except bona fide employees or bona fide established commercial or selling agencies retained by the Grantee for the purpose of securing business. For breach or violation of this warranty, CDPH shall have the right to annul this Grant without liability or in its discretion to deduct from the Grant price or consideration, or otherwise recover, the full amount of such commission, percentage, and brokerage or contingent fee. 5.Air or Water Pollution Requirements Any federally funded grant and/or subgrants in excess of $100,000 must comply with the following provisions unless said grant is exempt under 40 CFR 15.5. a.Government Grantees agree to comply with all applicable standards, orders, or requirements issued under section 306 of the Clean Air Act [42 U.S.C. 1857(h)], section 508 of the Clean Water Act (33 U.S.C. 1368), Executive Order 11738, and Environmental Protection Agency regulations (40 CFR part 15). · b.Institutions of higher education, hospitals, nonprofit organizations and commercial businesses agree to comply with all applicable standards, orders, or requirements issued under the Clean Air Act (42 U.S.C. 7401 et seq.), as amended, and the Federal Water Pollution Control Act (33 U.S.C. 1251 et seq.), as amended. 6.Lobbying Restrictions and Disclosure Certification (Applicable to federally funded grants in excess of $100,000 per Section 1352 of the 31, U.S.C.) a.Certification and Disclosure Requirements (1)Each person (or recipient) who requests or receives a grant, subgrant, which is subject to Section 1352 of the 31, U.S.C., and which exceeds $100,000 at any tier, shall file a certification (in the form set forth in Attachment 1, consisting of one page, entitled "Certification Regarding Lobbying") that the recipient has not made, and will not make, any payment prohibited by Paragraph b of this provision. (2)Each recipient shall file a disclosure (in the form set forth in Attachment 2, entitled "Standard Form-LLL 'disclosure of Lobbying Activities"') if such recipient has made or has agreed to make any payment using nonappropriated funds (to include profits from any covered federal action) in connection with a grant or any extension or amendment of that grant, which would be prohibited under Paragraph b of this provision if paid for with appropriated funds. (3)Each recipient shall file a disclosure form at the end of each calendar quarter in which there occurs any event that requires disclosure or that materially affect the accuracy of the information contained in any disclosure form previously filed by such person under Paragraph a(2) herein. An event that materially affects the accuracy of the information reported includes: (a)A cumulative increase of $25,000 or more in the amount paid or expected to be paid for influencing or attempting to influence a covered federal action; CDPH (rev. 07116) Page 4 of 11 California Department of Public Health - Federal Terms and Conditions Exhibit D (b)A change in the person(s) or individuals(s) influencing or attempting to influence a covered federal action; or (c)A change in the officer(s), employee(s), or member(s) contacted for the purpose of influencing or attempiing to influence a covered federal action. (4)Each person (or recipient) who requests or receives from a person referred to in Paragraph a(1) of this provision a grant or subgrant exceeding $100,000 at any tier under a grant shall file a certification, and a disclosure form, if required, to the next tier above. (5)All disclosure forms (but not certifications) shall be forwarded from tier to tier until received by the person referred to in Paragraph a(1) of this provision. That person shall forward all disclosure forms to CDPH Program Contract Manager. b.Prohibition Section 1352 of Title 31, U.S.C., provides in part that no appropriated funds may be expended by the recipient of a federal contract or agreement, grant, loan, or cooperative agreement to pay any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with any of the following covered federal actions: the awarding of any federal contract or agreement, the making of any federal grant, the making of any federal loan, entering Into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract or agreement, grant, loan, or cooperative agreement. 7.Additional Restrictions Grantee shall comply with the restrictions under Division F, Title V, Section 503 of the Consolidated Appropriations Act, 2012 (H.R. 2055), which provides that: "SEC. 503.(a) No part of any appropriation contained in this Act or transferred pursuant to section 4002 of Public Law 111-148 shall be used, other than for normal and recognized executive-legislative relationships, for publicity or propaganda purposes, for the preparation, distribution, or use of any kit, pamphlet, booklet, publication, electronic communication, radio, television, or video presentation designed to support or defeat the enactment of legislation before the Congress or any State or local legislature or legislative body, except in presentation to the Congress or any State or local legislature itself, or designed to support or defeat any proposed or pending regulation, administrative action, or order issued by the executive branch of any State or local government, except in presentation to the executive branch of any State or local government itself. (b)No part of any appropriation contained in this Act or transferred pursuant to section 4002 of Public Law 111-148 shall be used to pay the salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or Executive order proposed or pending before the Congress or any State government, State legislature or local legislature or legislative body, other than for normal and recognized executive-legislative relationships or participation by an agency or officer of a State, local or tribal government in policymaking and administrative processes within the executive branch of that government. (c)The prohibitions in subsections (a) and (b) shall include any activity to advocate or promote any proposed, pending or future Federal, State or local tax increase, or any proposed, pending, or future requirement or restriction on any legal consumer product, including its sale or marketing, including but not limited to the advocacy or promotion of gun control." 8.Human Subjects Use Requirements (Applicable only to federally funded agreements in which performance, directly or through a subcontract/subaward, includes any tests or examination of materials derived from the human body.) CDPH (rev. 07116) Page5of11 California Department of Public Health - Federal Terms and Conditions Exhibit D By signing this Agreement, Contractor agrees that if any performance under this Agreement or any subcontract or subagreement includes any tests or examination of materials derived from the human body for the purpose of providing information, diagnosis, prevention, treatment or assessment of disease, impairment, or health of a human being, all locations at which such examinations are performed shall meet the requirements of 42 U.S.C. Section 263a (CLIA) and the regulations thereunder. 9.Financial and Compliance Audit Requirements By signing this Agreement, the Contractor/Subcontrac tor agrees to abide by all requirements specified in 2 CFR 200, et seq., 2 CFR 400, et seq., and 45 CFR, 75, et seq., as applicable, including but not limited to obtaining an annual audit, and any subsequent federal regulatory additions or revisions. a.The definitions used in this provision are contained in Section 38040 of the Health and Safety Code, which by this reference is made a part hereof. b.Direct service contract means a contract or agreement for services contained in local assistance or subvention programs or both (see Health and Safety [H&S] Code section 38020). Direct service contracts shall not include contracts, agreements, grants, or subventions to other governmental agencies or units of government nor contracts or agreements with regional centers or area agencies on aging (H&S Code section 38030). c.The Contractor, as indicated below, agrees to obtain one of the following audits: (1)If the Contractor is a nonprofit organization (as defined in H&S Code section 38040) and receives $25,000 or more from any State agency under a direct service contract or agreement; the Contractor agrees to obtain an annual single, organization wide, financial and compliance·audit. Said audit shall be conducted according to Generally Accepted Auditing Standards. This audit does not fulfill the audit requirements of Paragraph c(3) below. The audit shall be completed by the 15th day of the fifth month following the end of the Contractor's fiscal year, and/or (2)If the Contractor is a nonprofit organization (as defined in H&S Code section 38040) and receives less than $25.000 per year from any State agency under a direct service contract or agreement, the Contractor agrees to obtain a biennial single, organization wide financial and compliance audit, unless there is evidence of fraud or other violation of state law in connection with this Agreement. This audit does not fulfill the audit requirements of Paragraph c(3) below. The audit shall be completed by the 15th day of the fifth month following the end of the Contractor's fiscal year, and/or (3)If the Contractor is a State or Local Government entity or Nonprofit organization (as defined in 2CFR Part 200) and expends $750,000 or more in Federal awards, the Contractor agrees to obtain an annual single, organization wide, financial and compliance audit according to the requirements specified in 2CFR Part 200. An audit conducted pursuant to this provision will fulfill the audit requirements outlined in Paragraphs c(1) and c(2) above. The audit shall be completed by the end of the ninth month following the end of the audit period. The requirements of this provision apply if: (a)The Contractor is a recipient expending Federal awards received directly from Federal awarding agencies, or (b)The Contractor is a subrecipient expending Federal awards received from a pass-through entity such as the State, County or community based organization. (4)If the Contractor submits to CDPH a report of an audit other than a single audit, the Contractor must also submit a certification indicating the Contractor has not expended $750,000 or more in federal funds for the year covered by the audit report. d.Two copies of the audit report shall be delivered to the CDPH program.funding this Agreement. The audit report must identify ihe Contractor's legal name and the number assigned to this Agreement. The audit report shall be due within 30 days after the completion of the audit. Upon receipt of said audit report, the CDPH Program Contract Manager shall forward the audit report to CDPH's Audits and Investigations Unit if the audit report was submitted under Section 16.c(3), unless the audit report is from a City, County, or Special District within the State of California whereby the report will be retained by the funding program. CDPH (rev. 07/16) Page 6 of 11 California Department of Public Health - Federal Terms and Conditions Exhibit D e.The cost of the audits described herein may be included in the funding for this Agreement up to the proportionate amount this Agreement represents of the Contractor's total revenue. The CDPH program funding this Agreement must provide advance written approval of the specific amount allowed for said audit expenses. f.The State or its authorized designee, including the Bureau of State Audits, is responsible for conducting agreement performance audits which are not financial and compliance audits. Performance audits are defined by Generally Accepted Government Auditing Standards. g.Nothing in this Agreement limits the State's responsibility or authority to enforce State law or regulations, procedures, or reporting requirements arising thereto. h.Nothing in this provision limits the authority of the State to make audits of this Agreement, provided however, that if independent audits arranged for by the Contractor meet Generally Accepted Governmental Auditing Standards, the State shall rely on those audits and any additional audit work and shall build upon the work already done. i.The State may, at its option, direct its own auditors to perform either of the audits described above. The Contractor will be given advance written notification, if the State chooses to exercise its option to perform said audits. j.The Contractor shall include a clause in any agreement the Contractor enters into with the audit firm doing the single organization wide audit to provide access by the State or Federal Government to the working papers of the independent auditor who prepares the single organization wide audit for the Contractor. k.Federal or state auditors shall have "expanded scope auditing" authority to conduct specific program audits during the same period in which a single organization wide audit is being performed, but the audit report has not been issued. The federal or state auditors shall review and have access to the current audit work being conducted and will not apply any testing or review procedures which have not been satisfied by previous audit work that has been completed. The term "expanded scope auditing" is applied and defined in the U.S. General Accounting Office (GAO) issued Standards for Audit of Government Organizations, Programs, Activities and Functions, better known as the "yellow book". 10.Audit and Record Retention (Applicable to agreements in excess of $10,000.) a.The Contractor shall maintain books, records, documents, and other evidence, accounting procedures and practices, sufficient to properly reflect all direct and indirect costs of whatever nature claimed to have been incurred in the performance of this Agreement, including any matching costs and expenses. The foregoing constitutes "records" for the purpose of this provision. b.The Contractor's facility or office or such part thereof as may be engaged in the performance of this Agreement and his/her records shall be subject at all reasonable times to inspection, audit, and reproduction. c.Contractor agrees that CDPH, the Department of General Services, the Bureau of State Audits, or their designated representatives including the Comptroller General of the United States shall have the right to review and to copy any records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to allow the auditor(s) access to such records during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, the Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (GC 8546.7, CCR Title 2, Section 1896). d.The Contractor shall preserve and make available his/her records (1) for a period of three years from the date of final payment under this Agreement, and (2) for such longer period, if any, as is required by applicable statute, by any other provision of this Agreement, or by subparagraphs (1) or (2) below. CDPH (rev. 07/16) Page 7 of 11 California Department of Public Health - Federal Terms and Conditions Exhibit D (1)If this Agreement is completely or partially terminated, the records relating to the work terminated shall be preserved and made available for a period of three years from the date of any resulting final settlement. (2)If any litigation, claim, negotiation, audit, or other action involving the records has been started before the expiration of the three-year period, the records shall be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular three-year period, whichever is later. e.The Contractor shall comply with the above requirements and be aware of the penalties for violations of fraud and for obstruction of investigation as set forth in Public Contract Code§ 10115.10, if applicable. f.The Contractor may, at its discretion, following receipt of final payment under this Agreement, reduce its accounts, books and records related to this Agreement to microfilm, computer disk, CD ROM, or other data storage medium. Upon request by an authorized representative to inspect, audit or obtain copies of said records, the Contractor and/or Subcontractor must supply or make available applicable devices, hardware, and/or software necessary to view, copy and/or print said records. Applicable devices may include, but are not limited to, microfilm readers and microfilm printers, etc. g.The Contractor shall, if applicable, comply with the Single Audit Act and the audit reporting requirements set forth in Title 2 of the Code of Federal Regulations, Part 200 (2CFR Part 200). 11.Federal Requirements Grantor agrees to comply with and shall require all subgranteers, if any, to comply with all applicable Federal requirements including but not limited to the United States Code, the Code of Federal Regulations,. the Funding Opportunity Announcement, the Notice of Award, the funding agreement, and any memoranda or letter regarding the applicable Federal requirements. CDPH (rev. 07/16) Page 8 of 11 California Department of Public Health -Federal Terms and Conditions STATE OF CALIFORNIA CALIFORNIA DEPARTMENT OF PUBLIC HEAL TH CERTIFICATION REGARDING LOBBYING The undersigned certifies , to the best of his or her knowledge and belief, that: Exhibit D Attachment 1 (1 ) No Federal appropriated funds have been paid or will be paid , by or on behalf of the undersigned , to any person for influencing or attempting to influence an officer or emp loyee of an agency , a Member of Congress , an officer or employee of Congress , or an employee of a Member of Congress in connection with the making , awarding or entering into of this Federal contract , Federal grant , or cooperative agreement, and the extens ion , continuation , renewal , amendment , or modification of th is Federal contract, grant , or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency of the United States Government , a Member of Congress , an officer or employee of Congress , or an employee of a Member of Congress in connection with this Federal contract , grant , or cooperative agreement , the undersigned shall complete and submit Standard Form LLL, "Disclosure of Lobbying Activities " in accordance with its instructions . (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (i nclud ing subGrantees , subgrants , and contracts under grants and cooperative agreements ) of $100 ,000 or more , and that all subrecipients shall certify and disclose accord ingly . This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into . Submission of this certification is a prerequisite for making or entering into this transact ion imposed by Section 1352 , Title 31 , U .S .C ., any person who fails to file the required certification shall be subject to a c ivil penalty of not less than $10 ,000 and not more than $100 ,000 for each such failure . County of Fresno Name of Grantee 19-10323 Contract I Grant Number Date After execution by or on behalf of Grantee , please return to : California Department of Public Health Nutrition Education and Obesity Prevention Branch P .O. Box 997377 , MS 7204 Sacramento , CA 95899-7377 Attn : K immy Casjens , Grant Manager Signature of Person Sign ing for Grantee TWe 1 ATTEST: CDPH reserves the right to notifiy the Grantee in writing of an alternate submission address . CDPH (rev. 0 7/16) Page 9 of 11 California Department of Public Health - Federal Terms and Conditions Exhibit D CERTIFICATION REGARDING LOBBYING Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) Attachment 2 Approved by 0MB D348-0046 CDPH (rev. 07/16) Page 10 of 11 1. 2. 3. Report Type: grant bid/offer/application post-award b. Year 4.Name and Address of Reporting Entity: D Subawardee Tier _, if known: and Address of Prime: Con ressional District, If known: 6.Federal DepartmenVAgency 7.Federal Program Name/Description: 8. 1O.a. Name and Address of Lobbying Registrant 9. Award Amount, if known: b. Individuals Performing Services (including address if different from 10a. Signature: Title: Date: Standard Form-LLL (Rev. 7-97) California Department of Public Health - Federal Terms and Conditions Exhibit D INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the Initiation or receipt of a covered Federal action, or a material change to a previous fllfng, pursuant to title 31 U.S.C. section 1352. The fllfng of a form is required for each payment or agreement to make payment to any lobbying entity for Influencing or attempting to Influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress In connection with a covered Federal action. Complete all Items that apply for both the lnltlal filing and material change i"eport. Refer to the implementing guidance published by the Office of Management and Budget for addltronal Information. 1.Identify the type of covered Federal action for which lobbying activity Is and/or has been secured to influence the outcome of_ a covered Federal action. 2.Identify the status of the covered Federal action. 3.Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the Information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last prevlously submitted report by this reporting entity for this covered Federal action. 4.Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, If known. Check the appropri'ate classification of the reporting entity that designates If It Is, or expects to be a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime Is the 1st tier. Subawards Include but are not limited to subcontracts, subgrants and contract awards under grants. 5.If the organization filing the report In item 4 checks "Subawardee," then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known. 6.Enter the name of the Federal agency making the award or Joan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7.Enter the Federal program name or description for the covered Federal action (Item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments. 8.Enter the most appropriate Federal Identifying number available for the Federal action Identified In item 1 (e.g., Request for Proposal (RFP) number; Invitation for ·Bid (IFB) number: grant announcement number: the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., MRFP-DE-90-001." 9.For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified In Item 4 or 5. 10.(a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity Identified in Item 4 to influence the covered Federal action. (b)Enter the full names of the lndlvldual{s) performing services, and include full address if different from 10 {a). Enter Last Name, First Na"me, and Middle Initial (Ml). 11.The certifying official shall sign and date the form, print his/her name, title, and telephone number. CDPH (rev. 07/16) Page 11 of 11 Exhibit E Page 1 of 2 SELF-DEALING TRANSACTION DISCLOSURE FORM In order to conduct business with the County of Fresno (hereinafter referred to as “County”), members of a contractor’s board of directors (hereinafter referred to as “County Contractor”), must disclose any self-dealing transactions that they are a party to while providing goods, performing services, or both for the County. A self-dealing transaction is defined below: “A self-dealing transaction means a transaction to which the corporation is a party and in which one or more of its directors has a material financial interest.” The definition above will be utilized for purposes of completing this disclosure form. INSTRUCTIONS (1)Enter board member’s name, job title (if applicable), and date this disclosure is being made. (2)Enter the board member’s company/agency name and address. (3)Describe in detail the nature of the self-dealing transaction that is being disclosed to the County. At a minimum, include a description of the following: a.The name of the agency/company with which the Corporation has the transaction; and b.The nature of the material financial interest in the Corporation’s transaction that the board member has. (4)Describe in detail why the self-dealing transaction is appropriate based on applicable provisions of the Corporations Code. (5)Form must be signed by the board member that is involved in the self-dealing transaction described in Sections (3) and (4). Exhibit E Page 2 of 2 (1)Company Board Member Information: Name: Date: Job Title: (2)Company/Agency Name and Address: (3)Disclosure (Please describe the nature of the self-dealing transaction you are a party to): (4)Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a): (5)Authorized Signature Signature: Date: