HomeMy WebLinkAboutAgreement A-24-538 with North Star Family Center.pdf Agreement No. 24-538
1 SERVICE AGREEMENT
2 This Service Agreement ("Agreement") is dated October 8, 2024 and is between
3 North Star Family Center, a California Non-Profit Corporation whose address is 4969 E Clinton
4 Way, Suite 113, Fresno CA 93727,("Subrecipient"), and the County of Fresno, a political
5 subdivision of the State of California ("County").
6 Recitals
7 A. County, through its Department of Social Services (DSS), is in need of supervised family
8 time services and intensive supervised family time services for children and their parents,
9 siblings, and relatives.
10 B. The County issued Request for Proposal (RFP) No. 24-056 for Supervised Family Time
11 Services where the Subrecipient responded to said RFP and was selected in accordance with the
12 RFP and Subrecipient's submitted response.
13 C. The purpose of this Agreement is to provide children and youth safe, supportive, and
14 consistent Family Time Services to promote the goal of reunification.
15 The parties therefore agree as follows:
16 Article 1
17 Subrecipient's Services
18 1.1 Scope of Services. The Subrecipient shall perform all of the services provided in
19 Exhibit A to this Agreement, titled "Scope of Services," and pursuant to the staffing patterns and
20 program expenses detailed in Exhibit B, titled "Compensation."
21 1.2 Representation. The Subrecipient represents that it is qualified, ready, willing, and
22 able to perform all of the services provided in this Agreement.
23 1.3 Compliance with Laws. The Subrecipient shall, at its own cost, comply with all
24 applicable federal, state, and local laws and regulations in the performance of its obligations
25 under this Agreement, including but not limited to workers compensation, labor, and
26 confidentiality laws and regulations.
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1
1 Article 2
2 County's Responsibilities
3 2.1 The County shall meet all obligations provided in Exhibit A to this Agreement, titled
4 "Scope of Services."
5 Article 3
6 Compensation, Invoices, and Payments
7 3.1 The County agrees to pay, and the Subrecipient agrees to receive, compensation for
8 the performance of its services under this Agreement as described in Exhibit B to this
9 Agreement, titled "Compensation."
10 3.2 The services provided by the Subrecipient under this Agreement are funded in
11 whole or in part by the State of California and/or the United States Federal government. In the
12 event that funding for these services is delayed by the State Controller or the Federal
13 government, the County may defer payment to the Subrecipient. The amount of the deferred
14 payment shall not exceed the amount of funding delayed to the County. The period of time of
15 the deferral by the County shall not exceed the period of time of the State Controller's or
16 Federal government's delay of payment to County plus forty-five (45) days.
17 3.3 To the extent permitted by State and Federal rules and regulations, advanced
18 payment of up to ten percent (10%) of the maximum compensation under this Agreement may
19 be requested of County by Subrecipient. Advance payments shall be limited to implementation
20 costs for new and/or expanded services only. Approval of an advanced payment is at the sole
21 discretion of County's DSS Director or designee. If advanced payment occurs, the amount of
22 the advanced payment shall be deducted in equal installments from claims submitted during the
23 seventh through twelfth months of this Agreement.
24 3.4 Maximum Compensation. The maximum compensation payable to the Subrecipient
25 under this Agreement is four million, nine hundred sixty-four thousand, three hundred fifty-one
26 and no/100, ($4,964,351) during the term of this Agreement. For the period from execution
27 through September 30, 2025, in no event shall compensation paid for services performed under
28 this agreement be in excess of nine hundred eighty-three thousand, four hundred seven and
2
1 no/100 dollars. ($983,407). For the period of October 1, 2025 through September 30, 2026, in
2 no event shall compensation paid for the services performed under this Agreement be in excess
3 of nine hundred sixty-nine thousand, three hundred twenty and no/100 ($969,320). For the
4 period of October 1, 2026 through September 30, 2027, in no event shall compensation for
5 these services performed under this Agreement be in excess of nine hundred eighty-seven
6 thousand, seven hundred seventy-five and no/100 ($987,775). For the optional twelve (12)
7 month extension for the period of October 1, 2027 through September 30, 2028, in no event
8 shall compensation paid for services performed under this Agreement be in excess of one
9 million, seven thousand, three hundred forty-nine and no/100 ($1,007,349). For the optional
10 twelve (12) month extension for the period of October 1, 2028 through September 30, 2029, in
11 no event shall compensation paid for services performed under this Agreement be in excess of
12 one million, sixteen thousand, five hundred one and no/100 ($1,016,500).
13 3.5 The Subrecipient acknowledges that the County is a local government entity, and
14 does so with notice that the County's powers are limited by the California Constitution and by
15 State law, and with notice that the Subrecipient may receive compensation under this
16 Agreement only for services performed according to the terms of this Agreement and while this
17 Agreement is in effect, and subject to the maximum amount payable under this section. The
18 Subrecipient further acknowledges that County employees have no authority to pay the
19 Subrecipient except as expressly provided in this Agreement.
20 3.6 Invoices. The Subrecipient shall submit monthly invoices in attention to Staff Analyst
21 to: )SSlnvoices(a-)fresnocountvca.gov. The Subrecipient shall submit each invoice within 30
22 days following the month in which expenses were incurred and services rendered, and in any
23 case within 60 days after the end of the term or termination of this Agreement. Subrecipient
24 shall submit invoices to the County each month with a detailed general ledger (GL), itemizing
25 costs incurred in the previous month, along with supporting documentation of costs. Failure to
26 submit GL reports and supporting documentation shall be deemed sufficient cause for County to
27 withhold payments until there is compliance, as further described in Section 3.7 herein.
28 Supporting documentation shall include but is not limited to receipts, invoices received, and
3
1 documented administrative / overhead costs. No reimbursement for services shall be made
2 until invoices, reports and outcomes are received, reviewed and approved by County's DSS.
3 Proof of payment may be required for certain funding streams and will be made available by the
4 Subrecipient as requested by the County.
5 3.7 Proof of payment may be required for certain funding streams and will be made
6 available by the Subrecipient as requested by the County.
7 3.8 Payment. The County shall pay each correctly completed and timely submitted
8 invoice within 45 days after receipt. If an invoice is incorrect or otherwise not in proper form or
9 detail, County's DSS Director or designee shall have the right to withhold payment as to only
10 that portion of the invoices that is incorrect or improper, after five (5) days prior written notice or
11 email correspondence to Subrecipient. The County shall remit any payment to the
12 Subrecipient's address specified in the invoice.
13 3.9 Incidental Expenses. The Subrecipient is solely responsible for all of its costs and
14 expenses that are not specified as payable by the County under this Agreement.
15 Article 4
16 Term of Agreement
17 4.1 Term. This Agreement is effective upon execution and terminates on September 30,
18 2027, except as provided in section 4.2, "Extension," or Article 6, "Termination and Suspension,"
19 below.
20 4.2 Extension. The term of this Agreement may be extended for no more than two, one-
21 year periods only upon written approval of both parties at least 30 days before the first day of
22 the next one-year extension period. The County's DSS Director or his or her designee is
23 authorized to sign the written approval on behalf of the County based on the Subrecipient's
24 satisfactory performance. The extension of this Agreement by the County is not a waiver or
25 compromise of any default or breach of this Agreement by the Subrecipient existing at the time
26 of the extension whether or not known to the County.
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4
1 Article 5
2 Notices
3 5.1 Contact Information. The persons and their addresses having authority to give and
4 receive notices provided for or permitted under this Agreement include the following:
5
For the County:
6 Director of Department of Social Services
County of Fresno
7 205 W. Pontiac Way
Clovis, CA 93612
8
For the Subrecipient:
9 Chief Operating Officer
North Star Family Center
10 4969 E Clinton Way, Suite 113
Fresno, CA 93727
11
5.2 Change of Contact Information. Either party may change the information in section
12
5.1 by giving notice as provided in section 5.3.
13
5.3 Method of Delivery. Each notice between the County and the Subrecipient provided
14
for or permitted under this Agreement must be in writing, state that it is a notice provided under
15
this Agreement, and be delivered either by personal service, by first-class United States mail, by
16
an overnight commercial courier service, by telephonic facsimile transmission, or by a Portable
17
Document Format (PDF) document attached to an email.
18
(A) A notice delivered by personal service is effective upon service to the recipient.
19
(B) A notice delivered by first-class United States mail is effective three County
20
business days after deposit in the United States mail, postage prepaid, addressed to the
21
recipient.
22
(C)A notice delivered by an overnight commercial courier service is effective one
23
County business day after deposit with the overnight commercial courier service,
24
delivery fees prepaid, with delivery instructions given for next day delivery, addressed to
25
the recipient.
26
(D)A notice delivered by telephonic facsimile transmission or by PDF document
27
attached to an email is effective when transmission to the recipient is completed (but, if
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such transmission is completed outside of County business hours, then such delivery is
5
1 deemed to be effective at the next beginning of a County business day), provided that
2 the sender maintains a machine record of the completed transmission.
3 5.4 Claims Presentation. For all claims arising from or related to this Agreement,
4 nothing in this Agreement establishes, waives, or modifies any claims presentation
5 requirements or procedures provided by law, including the Government Claims Act (Division 3.6
6 of Title 1 of the Government Code, beginning with section 810).
7 Article 6
8 Termination and Suspension
9 6.1 Termination for Non-Allocation of Funds. The terms of this Agreement are
10 contingent on the approval of funds by the appropriating government agency. If sufficient funds
11 are not allocated, then the County, upon at least 30 days' advance written notice to the
12 Subrecipient, may:
13 (A) Modify the services provided by the Subrecipient under this Agreement; or
14 (B) Terminate this Agreement.
15 6.2 Termination for Breach.
16 (A) Upon determining that a breach (as defined in paragraph (C) below) has
17 occurred, the County may give written notice of the breach to the Subrecipient. The
18 written notice may suspend performance under this Agreement, and must provide at
19 least 30 days for the Subrecipient to cure the breach.
20 (B) If the Subrecipient fails to cure the breach to the County's satisfaction within the
21 time stated in the written notice, the County may terminate this Agreement immediately.
22 (C) For purposes of this section, a breach occurs when, in the determination of the
23 County, the Subrecipient has:
24 (1) Obtained or used funds illegally or improperly;
25 (2) Failed to comply with any part of this Agreement;
26 (3) Submitted a substantially incorrect or incomplete report to the County; or
27 (4) Improperly performed any of its obligations under this Agreement.
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6
1 6.3 Termination without Cause. In circumstances other than those set forth above, the
2 County or Subrecipient may terminate this Agreement by giving at least 30 days advance
3 written notice to the Subrecipient.
4 6.4 No Penalty or Further Obligation. Any termination of this Agreement by the County
5 under this Article 6 is without penalty to or further obligation of the County.
6 6.5 County's Rights upon Termination. Upon termination for breach under this Article
7 6, the County may demand repayment by the Subrecipient of any monies disbursed to the
8 Subrecipient under this Agreement that, in the County's sole judgment, were not expended in
9 compliance with this Agreement. The Subrecipient shall promptly refund all such monies upon
10 demand. This section survives the termination of this Agreement.
11 Article 7
12 Independent Subrecipient
13 7.1 Status. In performing under this Agreement, the Subrecipient, including its officers,
14 agents, employees, and volunteers, is at all times acting and performing as an independent
15 Subrecipient in an independent capacity, and not as an officer, agent, servant, employee, joint
16 venturer, partner, or associate of the County.
17 7.2 Verifying Performance. The County has no right to control, supervise, or direct the
18 manner or method of the Subrecipient's performance under this Agreement, but the County may
19 verify that the Subrecipient is performing according to the terms of this Agreement.
20 7.3 Benefits. Because of its status as an independent Subrecipient, the Subrecipient
21 has no right to employment rights or benefits available to County employees. The Subrecipient
22 is solely responsible for providing to its own employees all employee benefits required by law.
23 The Subrecipient shall save the County harmless from all matters relating to the payment of
24 Subrecipient's employees, including compliance with Social Security withholding and all related
25 regulations.
26 7.4 Services to Others. The parties acknowledge that, during the term of this
27 Agreement, the Subrecipient may provide services to others unrelated to the County.
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7
1 Article 8
2 Indemnity and Defense
3 8.1 Indemnity. The Subrecipient shall indemnify and hold harmless and defend the
4 County (including its officers, agents, employees, and volunteers) against all claims, demands,
5 injuries, damages, costs, expenses (including attorney fees and costs), fines, penalties, and
6 liabilities of any kind to the County, the Subrecipient, or any third party that arise from or relate
7 to the performance or failure to perform by the Subrecipient (or any of its officers, agents,
8 subcontractors, or employees) under this Agreement. The County may conduct or participate in
9 its own defense without affecting the Subrecipient's obligation to indemnify and hold harmless or
10 defend the County.
11 8.2 Survival. This Article 8 survives the termination of this Agreement.
12 Article 9
13 Insurance
14 9.1 The Subrecipient shall comply with all the insurance requirements in Exhibit D to this
15 Agreement.
16 Article 10
17 Inspections, Audits, Record Maintenance, and Public Records
18 10.1 Inspection of Documents. The Subrecipient shall make available to the County,
19 and the County may examine at any time during business hours and as often as the County
20 deems necessary, all of the Subrecipient's records and data with respect to the matters covered
21 by this Agreement, excluding attorney-client privileged communications. The Subrecipient shall,
22 upon request by the County, permit the County to audit and inspect all of such records and data
23 to ensure the Subrecipient's compliance with the terms of this Agreement.
24 10.2 State Audit Requirements. If the compensation to be paid by the County under this
25 Agreement exceeds $10,000, the Subrecipient is subject to the examination and audit of the
26 California State Auditor, as provided in Government Code section 8546.7, for a period of three
27 years after final payment under this Agreement. This section survives the termination of this
28 Agreement.
8
1 10.3 Single Audit Clause. If Subrecipient expends Seven Hundred Fifty Thousand
2 Dollars ($750,000) or more in Federal and Federal flow-through monies annually, Subrecipient
3 agrees to conduct an annual audit in accordance with the requirements of the Single Audit
4 Standards as set forth in Office of Management and Budget (OMB) Title 2 of the Code of
5 Federal Regulations Part 200. Subrecipient shall submit said audit and management letter to
6 County. The audit must include a statement of findings or a statement that there were no
7 findings. If there were negative findings, Subrecipient must include a corrective action signed by
8 an authorized individual. Subrecipient agrees to take action to correct any material non-
9 compliance or weakness found as a result of such audit. Such audit shall be delivered to
10 County's DSS, Administration, for review within nine (9) months of the end of any fiscal year in
11 which funds were expended and/or received for the program. Failure to perform the requisite
12 audit functions as required by this Agreement may result in County performing the necessary
13 audit tasks, or at County's option, contracting with a public accountant to perform said audit, or,
14 may result in the inability of County to enter into future agreements with Subrecipient. All audit
15 costs related to this Agreement are the sole responsibility of Subrecipient.
16 10.4 Program Audit Requirements. A single audit report is not applicable if all
17 Subrecipient's Federal contracts do not exceed the Seven Hundred Fifty Thousand Dollars
18 ($750,000) requirement or Subrecipient's funding is through Drug related Medi-Cal. If a single
19 audit is not applicable, a program audit must be performed and a program audit report with
20 management letter shall be submitted by Subrecipient to County as a minimum requirement to
21 attest to Subrecipient's solvency. Said audit report shall be delivered to County's DSS,
22 Administration, for review no later than nine (9) months after the close of the fiscal year in which
23 the funds supplied through this Agreement are expended. Failure to comply with this Act may
24 result in County performing the necessary audit tasks or contracting with a qualified accountant
25 to perform said audit. All audit costs related to this Agreement are the sole responsibility of
26 Subrecipient who agrees to take corrective action to eliminate any material noncompliance or
27 weakness found as a result of such audit. Audit work performed by County under this paragraph
28
9
1 shall be billed to the Subrecipient at County cost, as determined by County's Auditor-
2 Controller/Treasurer-Tax Collector.
3 10.5 Record Establishment and Maintenance. Subrecipient shall establish and maintain
4 records in accordance with those requirements prescribed by County, with respect to all matters
5 covered by this Agreement. Subrecipient shall retain all fiscal books, account records and client
6 files for services performed under this Agreement for at least five (5) years from date of final
7 payment under this Agreement or until all State and Federal audits are completed for that fiscal
8 year, whichever is later.
9 (A) Cost Documentation. Subrecipient agrees to maintain records to verify costs
10 under this Agreement including a General Ledger, properly executed payrolls, time
11 records, invoices, vouchers, orders, proof of payment, and any other accounting
12 documents pertaining in whole or in part to this Agreement and they shall be clearly
13 identified and readily accessible. The support documentation must indicate the line
14 budget account number to which the cost is charged.
15 (B) Service Documentation. Subrecipient agrees to maintain records to verify
16 services under this Agreement including names and addresses of clients served, if
17 applicable, and the dates of service and a description of services provided on each
18 occasion. These records and any other documents pertaining in whole or in part to this
19 Agreement shall be clearly identified and readily accessible.
20
(C) County shall notify Subrecipient in writing within thirty (30) days of any potential
21
State or Federal audit exception discovered during an examination. Where findings
22
indicate that program requirements are not being met and State or Federal participation
23
in this program may be imperiled in the event that corrections are not accomplished by
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Subrecipient within thirty (30) days of receipt of such notice from County, written
25
notification thereof shall constitute County's intent to terminate this Agreement.
26
10.6 Public Records. The County is not limited in any manner with respect to its public
27
disclosure of this Agreement or any record or data that the Subrecipient may provide to the
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10
1 County. The County's public disclosure of this Agreement or any record or data that the
2 Subrecipient may provide to the County may include but is not limited to the following:
3 (A) The County may voluntarily, or upon request by any member of the public or
4 governmental agency, disclose this Agreement to the public or such governmental
5 agency.
6 (B) The County may voluntarily, or upon request by any member of the public or
7 governmental agency, disclose to the public or such governmental agency any record or
8 data that the Subrecipient may provide to the County, unless such disclosure is
9 prohibited by court order.
10 (C)This Agreement, and any record or data that the Subrecipient may provide to the
11 County, is subject to public disclosure under the Ralph M. Brown Act (California
12 Government Code, Title 5, Division 2, Part 1, Chapter 9, beginning with section 54950).
13 (D)This Agreement, and any record or data that the Subrecipient may provide to the
14 County, is subject to public disclosure as a public record under the California Public
15 Records Act (California Government Code, Title 1, Division 7, Chapter 3.5, beginning
16 with section 6250) ("CPRA").
17 (E) This Agreement, and any record or data that the Subrecipient may provide to the
18 County, is subject to public disclosure as information concerning the conduct of the
19 people's business of the State of California under California Constitution, Article 1,
20 section 3, subdivision (b).
21 (F) Any marking of confidentiality or restricted access upon or otherwise made with
22 respect to any record or data that the Subrecipient may provide to the County shall be
23 disregarded and have no effect on the County's right or duty to disclose to the public or
24 governmental agency any such record or data.
25 (G) Notwithstanding sections A-F above, any information protected by law shall not
26 be subject to public disclosure.
27 10.7 Public Records Act Requests. If the County receives a written or oral request
28 under the CPRA to publicly disclose any record that is in the Subrecipient's possession or
11
1 control, and which the County has a right, under any provision of this Agreement or applicable
2 law, to possess or control, then the County may demand, in writing, that the Subrecipient deliver
3 to the County, for purposes of public disclosure, the requested records that may be in the
4 possession or control of the Subrecipient. Within five business days after the County's demand,
5 the Subrecipient shall (a) deliver to the County all of the requested records that are in the
6 Subrecipient's possession or control, together with a written statement that the Subrecipient,
7 after conducting a diligent search, has produced all requested records that are in the
8 Subrecipient's possession or control, or (b) provide to the County a written statement that the
9 Subrecipient, after conducting a diligent search, does not possess or control any of the
10 requested records. The Subrecipient shall cooperate with the County with respect to any County
11 demand for such records. If the Subrecipient wishes to assert that any specific record or data is
12 exempt from disclosure under the CPRA or other applicable law, it must deliver the record or
13 data to the County and assert the exemption by citation to specific legal authority within the
14 written statement that it provides to the County under this section. The Subrecipient's assertion
15 of any exemption from disclosure is not binding on the County, but the County will give at least
16 10 days' advance written notice to the Subrecipient before disclosing any record subject to the
17 Subrecipient's assertion of exemption from disclosure. The Subrecipient shall indemnify the
18 County for any court-ordered award of costs or attorney's fees under the CPRA that results from
19 the Subrecipient's delay, claim of exemption, failure to produce any such records, or failure to
20 cooperate with the County with respect to any County demand for any such records.
21 Article 11
22 Disclosure of Self-Dealing Transactions and Conflict of Interest
23 11.1 Applicability. This Article 11 applies if the Subrecipient is operating as a
24 corporation, or changes its status to operate as a corporation.
25 11.2 Duty to Disclose. If any member of the Subrecipient's board of directors is party to a
26 self-dealing transaction, he or she shall disclose the transaction by completing and signing a
27 "Self-Dealing Transaction Disclosure Form" (Exhibit C to this Agreement) and submitting it to
28 the County before commencing the transaction or immediately after.
12
1 11.3 Definition. "Self-dealing transaction" means a transaction to which the Subrecipient
2 is a party and in which one or more of its directors, as an individual, has a material financial
3 interest.
4 11.4 Conflict of Interest. No officer, employee or agent of the County who exercises any
5 function or responsibility for planning and carrying out of the services provided under this
6 Agreement shall have any direct or indirect personal financial interest in this Agreement. In
7 addition, no employee of the County shall be employed by the Subrecipient under this
8 Agreement to fulfill any contractual obligations with the County. The Subrecipient shall comply
9 with all Federal, State of California and local conflict of interest laws, statutes and regulations,
10 which shall be applicable to all parties and beneficiaries under this Agreement and any officer,
11 employee or agent of the County.
12 Article 12
13 Confidentiality and Data Security
14
12.1 Conformance with Laws: All services performed by Subrecipient under this
15
Agreement shall be in strict conformance with all applicable Federal, State of California and/or
16
local laws and regulations relating to confidentiality. For the purpose of preventing the potential
17
loss, misappropriation or inadvertent disclosure of County data including sensitive or personal
18
client information; abuse of County resources; and/or disruption to County operations,
19
individuals and/or agencies that enter into a contractual relationship with County for the purpose
20
of providing services under this Agreement must employ adequate data security measures to
21
protect the confidential information provided to Subrecipient by County,
22
including but not limited to the following:
23 (A) Subrecipient-Owned Mobile/Wireless/Handheld Devices may not be connected
24
to County networks via personally owned mobile, wireless or handheld devices, except
25 when authorized by County for telecommuting and then only if virus protection software
26
currency agreements are in place, and if a secure connection is used.
27
(B) Subrecipient-Owned Computers or Computer Peripherals may not be brought
28
into County for use, including and not limited to mobile storage devices, without prior
13
1
authorization from County's Chief Information Officer or their designee. Data must be
2
stored on a secure server approved by County and transferred by means of a VPN
3
(Virtual Private Network) connection, or another type of secure connection of this type if
4
any data is approved to be transferred.
5
(C) County-Owned Computer Equipment— Subrecipient or anyone having an
6
employment relationship with County may not use County computers or computer
7
peripherals on non-County premises without prior authorization from County's Chief
8
Information Officer or their designee.
9
(D) Subrecipient may not store County's private, confidential or sensitive data on any
10
hard-disk drive.
11
(E) Subrecipient is responsible to employ strict controls to ensure the integrity and
12
security of County's confidential information and to prevent unauthorized access to data
13
maintained in computer files, program documentation, data processing systems, data
14
files and data processing equipment which stores or processes County data internally
15
and externally.
16 (F) Confidential client information transmitted to one party by the other by means of
17
electronic transmissions must be encrypted according to Advanced Encryption
18 Standards (AES) of 128 BIT or higher. Additionally, a password or pass phrase must be
19
utilized.
20
(G)Subrecipient is responsible to immediately notify County of any breaches or
21
potential breaches of security related to County's confidential information, data
22
maintained in computer files, program documentation, data processing systems, data
23 files and data processing equipment which stores or processes County data internally or
24 externally.
25 (H) Subrecipient shall require its subcontractors to comply with the provisions of this
26
Data Security section.
27 1H
28 1H
14
1 Article 13
2 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-
3 Lower Tier Covered Transactions.
4 13.1 County and Subrecipient recognize that Subrecipient is a recipient of State or
5 Federal assistance funds under the terms of this Agreement. By signing this Agreement,
6 Subrecipient agrees to comply with applicable Federal suspension and debarment regulations,
7 including but not limited to: 7 CFR 3016.35, 29 CRF 97.35, 45 CFR 92.35, and Executive Order
8 12549. By signing this Agreement, Subrecipient attests to the best of its knowledge and belief,
9 that it and its principals:
10 (A) Are not presently debarred, suspended, proposed for debarment, declared
11 ineligible, or voluntarily excluded from participation in this transaction by any Federal
12 department or agency; and
13 (B) Shall not knowingly enter into any lower tier covered transaction with an entity or
14 person who is debarred, suspended, proposed for debarment, declared ineligible, or
15 voluntarily excluded from participation in this transaction by any Federal department or
16 agency.
17 (C) Subrecipient shall provide immediate written notice to County if at any time
18 during the term of this Agreement Subrecipient learns that the representations it makes
19 above were erroneous when made or have become erroneous by reason of changed
20 circumstances.
21 13.2 Subrecipient shall include a clause titled "Certification Regarding Debarment,
22 Suspension, Ineligibility, and Voluntary Exclusion — Lower Tier Covered Transactions" and
23 similar in nature to this Article Thirteen (13) in all lower tier covered transactions and in all
24 solicitations for lower tier covered transactions.
25 13.3 Subrecipient shall, prior to soliciting or purchasing goods and services in excess of
26 $25,000 funded by this Agreement, review and retain the proposed vendor's suspension and
27 debarment status at https:Hsam.gov/SAM .
28
15
1 13.4 The certification in Article Thirteen (13) of this Agreement is a material representation
2 of fact upon which County relied in entering into this Agreement.
3 Article 14
4 General Terms
5 14.1 Modification. Except as provided in Article 6, "Termination and Suspension," this
6 Agreement may not be modified, and no waiver is effective, except by written consent by both
7 parties. The Subrecipient acknowledges that County employees have no authority to modify this
8 Agreement except as expressly provided in this Agreement.
9 (A) Changes to line items in the Exhibit B, Compensation, in an amount not to
10 exceed 10% of the maximum annual compensation payable to the Subrecipient may be
11 made with the written approval of County's DSS Director or their designee. Said
12 modifications shall not result in any changes to the maximum compensation amount
13 payable to Subrecipient, as stated in this Agreement.
14 (B) Subrecipient agrees that reductions to the maximum compensation set forth
15 under Article Three (3) of this Agreement may be necessitated by a reduction in funding
16 from State or Federal sources. Any such reduction to the maximum compensation may
17 be made with the written approval of County's DSS Director or their designee and
18 Subrecipient. Subrecipient further understands that this Agreement is subject to any
19 restriction, limitations, or enactments of all legislative bodies which affect the provisions,
20 term, or funding of this Agreement in any manner. If the parties do not provide written
21 approval for modification due to reduced funding, this Agreement may be terminated in
22 accordance with Section 6.1 above.
23 14.2 Subrecipient's Name Change. An amendment, assignment, or new agreement is
24 required to change the name of Subrecipient as listed on this Agreement. Upon receipt of legal
25 documentation of the name change, County will process the agreement. Payment of invoices
26 presented with a new name cannot be paid prior to approval of said agreement.
27 14.3 Public Information. Subrecipient shall disclose County as a funding source in all
28 public information and program materials developed in support of contracted services.
16
1 14.4 Non-Assignment. Neither party may assign its rights or delegate its obligations
2 under this Agreement without the prior written consent of the other party. Any transferee,
3 assignee or subcontractor will be subject to all applicable provisions of this Agreement, and all
4 applicable State and Federal regulations. Subrecipient shall be held primarily responsible by
5 County for the performance of any transferee, assignee or subcontractor unless otherwise
6 expressly agreed to in writing by County. The use of subcontractor by Subrecipient shall not
7 entitle Subrecipient to any additional compensation than provided for under this Agreement.
8 14.5 Governing Law. The laws of the State of California govern all matters arising from
9 or related to this Agreement.
10 14.6 Jurisdiction and Venue. This Agreement is signed and performed in Fresno
11 County, California. Subrecipient consents to California jurisdiction for actions arising from or
12 related to this Agreement, and, subject to the Government Claims Act, all such actions must be
13 brought and maintained in Fresno County.
14 14.7 Construction. The final form of this Agreement is the result of the parties' combined
15 efforts. If anything in this Agreement is found by a court of competent jurisdiction to be
16 ambiguous, that ambiguity shall not be resolved by construing the terms of this Agreement
17 against either party.
18 14.8 Days. Unless otherwise specified, "days" means calendar days.
19 14.9 Headings. The headings and section titles in this Agreement are for convenience
20 only and are not part of this Agreement.
21 14.10 Severability. If anything in this Agreement is found by a court of competent
22 jurisdiction to be unlawful or otherwise unenforceable, the balance of this Agreement remains in
23 effect, and the parties shall make best efforts to replace the unlawful or unenforceable part of
24 this Agreement with lawful and enforceable terms intended to accomplish the parties' original
25 intent.
26 14.11 Nondiscrimination. During the performance of this Agreement, the Subrecipient
27 shall not unlawfully discriminate against any employee or applicant for employment, or recipient
28 of services, because of race, religious creed, color, national origin, ancestry, physical disability,
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1 mental disability, medical condition, genetic information, marital status, sex, gender, gender
2 identity, gender expression, age, sexual orientation, military status or veteran status pursuant to
3 all applicable State of California and federal statutes and regulation.
4 (A) Domestic Partners and Gender Identity. For State fund-funded contracts of
5 $100,000 or more, Subrecipient certifies that it complies with Public Contract Code
6 Section 10295.3.
7 (B) Americans with Disabilities Act. Subrecipient shall comply with the Americans
8 with Disabilities Act (ADA) of 1990, which prohibits discrimination on the basis of
9 disability, as well as all applicable regulations and guidelines issued pursuant to the ADA
10 (42 U.S.C. 12101 et seq.).
11 (C) Subrecipient shall include the non-discrimination and compliance provisions of
12 this section in all subcontracts to perform work under this Agreement.
13 14.12 Limited English Proficiency. Subrecipient shall provide interpreting and translation
14 services to persons participating in Subrecipient's services who have limited or no English
15 language proficiency, including services to persons who are deaf or blind. Interpreter and
16 translation services shall be provided as necessary to allow such participants meaningful
17 access to the programs, services and benefits provided by Subrecipient. Interpreter and
18 translation services, including translation of Subrecipient's "vital documents" (those documents
19 that contain information that is critical for accessing Subrecipient's services or are required by
20 law) shall be provided to participants at no cost to the participant. Subrecipient shall ensure that
21 any employees, agents, subcontractors, or partners who interpret or translate for a program
22 participant, or who directly communicate with a program participant in a language other than
23 English, demonstrate proficiency in the participant's language and can effectively communicate
24 any specialized terms and concepts peculiar to Subrecipient's services.
25 14.13 Drug-Free Workplace Requirements. For purposes of this paragraph, Subrecipient
26 will be referred to as the "grantee". By drawing funds against this grant award, the grantee is
27 providing the certification that it is required by regulations implementing the Drug-Free
28 Workplace Act of 1988, 45 CFR Part 76, Subpart F. These regulations require certification by
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1 grantees that they will maintain a drug-free workplace. False certification or violation of the
2 certification shall be grounds for suspension of payments, suspension or termination of grants,
3 or government wide suspension or debarment. Subrecipient shall also comply with the
4 requirements of the Drug-Free Workplace Act of 1990 (California Government Code section
5 8350 et seq.).
6 14.14 Grievances. Subrecipient shall establish procedures for handling client complaints
7 and/or grievances. Such procedures will include provisions for informing clients of their rights to
8 a State Hearing to resolve such issues when appropriate.
9 14.15 Lobbying and Political Activity. None of the funds provided under this Agreement
10 shall be used for publicity, lobbying or propaganda purposes designed to support or defeat
11 legislation pending in the Congress of the United States of America or the Legislature of the
12 State of California. Subrecipient shall not directly or indirectly use any of the funds under this
13 Agreement for any political activity or to further the election or defeat of any candidate for public
14 office.
15 14.16 Clean Air Act and the Federal Water Pollution Control Act. If the compensation
16 to be paid by the County under this Agreement exceeds One Hundred Fifty Thousand and
17 No/100 Dollars ($150,000) of Federal funding, Subrecipient agrees to comply with all applicable
18 standards, orders or regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671 q)
19 and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387). Violations
20 must be reported to the Federal awarding agency and the Regional Office of the Environmental
21 Protection Agency (EPA).
22 14.17 Procurement of Recovered Materials. If compensation to be paid by the County
23 under this Agreement is funded in whole or in part with Federal funding, In the performance of
24 this Agreement, Subrecipient shall comply with section 6002 of the Solid Waste Disposal Act, as
25 amended by the Resource Conservation and Recovery Act. The requirements of Section 6002
26 include procuring only items designated in guidelines of the Environmental Protection Agency
27 (EPA) at 40 CFR part 247 that contain the highest percentage of recovered materials
28 practicable, consistent with maintaining a satisfactory level of competition, where the purchase
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1 price of the item exceeds $10,000 or the value of the quantity acquired during the preceding
2 fiscal year exceeded $10,000; procuring solid waste management services in a manner that
3 maximizes energy and resource recovery; and establishing an affirmative procurement program
4 for procurement of recovered materials identified in the EPA guidelines.
5 14.18 No Waiver. Payment, waiver, or discharge by the County of any liability or obligation
6 of the Subrecipient under this Agreement on any one or more occasions is not a waiver of
7 performance of any continuing or other obligation of the Subrecipient and does not prohibit
8 enforcement by the County of any obligation on any other occasion.
9 14.19 Child Support Compliance Act. If compensation to be paid by the County under
10 this Agreement includes State funding in excess of$100,000, the Subrecipient acknowledges in
11 accordance with Public Contract Code 7110, that:
12 (A) Subrecipient recognizes the importance of child and family support obligations
13 and shall fully comply with all applicable state and federal laws relating to child and
14 family support enforcement, including, but not limited to, disclosure of information and
15 compliance with earnings assignment orders, as provided in Chapter 8 (commencing
16 with section 5200) of Part 5 of Division 9 of the Family Code; and
17 (B) Subrecipient to the best of its knowledge is fully complying with the earnings
18 assignment orders of all employees and is providing the names of all new employees to
19 the New Hire Registry maintained by the California Employment Development
20 Department.
21 14.20 Priority Hiring Considerations. If compensation to be paid by the County under this
22 Agreement includes State funding and services in excess of$200,000, Subrecipient shall give
23 priority consideration in filling vacancies in positions funded by the Agreement to qualified
24 recipients of aid under Welfare and Institutions Code Section 11200, in accordance with Public
25 Contract Code Section 10353.
26 14.21 Entire Agreement. This Agreement, including its exhibits, is the entire agreement
27 between the Subrecipient and the County with respect to the subject matter of this Agreement,
28 and it supersedes all previous negotiations, proposals, commitments, writings, advertisements,
20
1 publications, and understandings of any nature unless those things are expressly included in
2 this Agreement. If there is any inconsistency between the terms of this Agreement without its
3 exhibits and the terms of the exhibits, then the inconsistency will be resolved by giving
4 precedence first to the terms of this Agreement without its exhibits, and then to the terms of the
5 exhibits.
6 14.22 No Third-Party Beneficiaries. This Agreement does not and is not intended to
7 create any rights or obligations for any person or entity except for the parties.
8 14.23 Authorized Signature. The Subrecipient represents and warrants to the County
9 that:
10 (A) The Subrecipient is duly authorized and empowered to sign and perform its
11 obligations under this Agreement.
12 (B) The individual signing this Agreement on behalf of the Subrecipient is duly
13 authorized to do so and his or her signature on this Agreement legally binds the
14 Subrecipient to the terms of this Agreement.
15 14.24 Electronic Signatures. The parties agree that this Agreement may be executed by
16 electronic signature as provided in this section.
17 (A) An "electronic signature" means any symbol or process intended by an individual
18 signing this Agreement to represent their signature, including but not limited to (1) a
19 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
20 electronically scanned and transmitted (for example by PDF document) version of an
21 original handwritten signature.
22 (B) Each electronic signature affixed or attached to this Agreement (1) is deemed
23 equivalent to a valid original handwritten signature of the person signing this Agreement
24 for all purposes, including but not limited to evidentiary proof in any administrative or
25 judicial proceeding, and (2) has the same force and effect as the valid original
26 handwritten signature of that person.
27
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1 (C)The provisions of this section satisfy the requirements of Civil Code section
2 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3,
3 Part 2, Title 2.5, beginning with section 1633.1).
4 (D) Each party using a digital signature represents that it has undertaken and
5 satisfied the requirements of Government Code section 16.5, subdivision (a),
6 paragraphs (1) through (5), and agrees that each other party may rely upon that
7 representation.
8 (E) This Agreement is not conditioned upon the parties conducting the transactions
9 under it by electronic means and either party may sign this Agreement with an original
10 handwritten signature.
11 14.25 Counterparts. This Agreement may be signed in counterparts, each of which is an
12 original, and all of which together constitute this Agreement.
13 [SIGNATURE PAGE FOLL0INS]
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1 The parties are signing this Agreement on the date stated in the introductory clause.
2
North Star Family Center County OF FRESNO
3
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5 ary De e, hief Operating Officer Nathan Magsig , Chairman of the Board of
Supervisors of the County of Fresno
6 4969 E Clinton Way, Suite#113
Fresno, CA 93727 Attest:
7 Bernice E. Siedel
Clerk of the Board of Supervisors
8 County of Fresno, State of California
9 _
By:
10 Deputy
11 For accounting use only:
12 Org No.: 5610 7001
Account No.: 7870
13 Fund No.: 0001
Subclass No.: 10000
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Exhibit A
Page 1 of 22
SCOPE OF SERVICES
Organization: North Star Family Center
Address: 4969 E. Clinton Way, Suite 113, Fresno CA 93727
Services: Supervised Family Time Services
Telephone: 559 226-2273
Contact: Mary Dela Torre, Chief Operating Officer
Contract Period: Upon Extension-September 30, 2027,with two (2) possible one-year extensions
by both parties.
A. Background:
North Star Family Center will provide children and youth safe, supportive, and consistent family
time services that must include two components: supervised family time (SFT) and short-term intensive
supervised family time (ISFT) services for children and their parents, siblings, and relatives.
Supervised family time refers to contact between parents and their children in out-of-home
care while in the presence of a specially trained professional (monitor). The monitor supervises all family
time and addresses issues to strengthen the child-parent relationship.The ISFT program is an enhanced
supervised family time component,facilitated by a Master's level or clinically licensed/unlicensed staff
or supervised intern designed to prevent or repair damage to the child-parent relationship, and/or to
address behavioral, developmental, relational, and/or safety needs. Family time is typically one hour in
duration per session, however, in some cases family time may be extended to two (2) hours.
Frequent family time between children and their families promote the goal of reunification, support
attachment, and enhance the child's sense of well-being and self-esteem. Consistent, reliable family
time also assist parents with parenting skills and aid in the social worker's assessment of the child and
family.The goal in all cases is to safely work toward reunification.The type, frequency and duration of
family time is based upon numerous factors including the age of the child,type of alleged abuse, and an
ongoing assessment of the parent's ability to safely care for and interact with their children.The
continuum of family time services,from the most restrictive to the least restrictive include, ISFT and SFT,
observed and unsupervised.
Family time services shall be provided in a family-friendly, home-like environment, and must be
provided on a daily basis, and incorporate flexible hours of operation including evenings, weekends and
holidays. Family time sites must be readily accessible to public transportation, and located in metro
geographical areas that include the highest CWS family referral rates.These include zip code areas of
93702, 93703, 93705, 93706, 93722, 93726 and 93727.
Exhibit A
Page 2 of 22
TYPE OF SERVICE Minimum Number of Scheduled
Visits
Supervised Family Time (SFT) 240 Hours per Week
800 Referred Families
Intensive Supervised Family Time (ISFT) 40 Hours per Week
100 Referred Families
SFT:
SFT is a lower level family time component. Families referred to SFT generally are lower risk but have
complicating factors that do not allow them to have unsupervised family time.The SFT monitor
documents family interactions and assist families with general needs to accommodate positive and
effective interactions and overall family time. It is expected that families receive SFT for three to six
months, but this time frame could be longer if needed.
ISFT:
ISFT is a higher-level family time component. Families referred to ISFT may include parents with
untreated mental health, situations involving sexual abuse where the non-offending parent is deemed
non-supportive of the child victim, emotional abuse that includes a severe disconnect between parent
and child, severe physical abuse, and families with high conflict or at risk of domestic violence. Given the
nature of these referrals, ISFT requires the presence of a licensed/unlicensed, Master's level, or
student/intern in training for a post-graduate degree under the direct supervision of a license clinician
or mental health professional. Families receive support from the clinician to strengthen parent/child
relationships, provide parental coaching, and provide the opportunity for family time to be positive and
not damaging to the child.
B. location and Hours of Service:
Family Time Services will be provided seven days a week, including holidays at the following location:
• 4969 E. Clinton Way, Suite 113, Fresno CA 93727
Days and hours of service are as follow:
• Monday to Friday, 3:00 p.m.-8:00 p.m.
• Saturday, 9 a.m. -6:00 p.m.
• Sunday, 9 a.m. -6:00 p.m.
Holidays that are excluded from those hours are: Halloween,Thanksgiving Day, and Christmas Day.
Changes to hours or Family Time Service location requires prior DSS approval. Any proposed change in
Subrecipient's location shall require written approval from the County's DSS Director or designees prior
to the commencement by Subrecipient of any formal negotiation or procedure to secure an alternate
location. Should Subrecipient and County mutually agree that a change in location is necessary,
Subrecipient shall use the guidelines in Appendix A.
Exhibit A
Page 3 of 22
C.Target Population
Children/youth and family members involved with CWS and referred only by CWS for family time
services. Services provided by Subrecipient will aim to meet the needs of the diverse and vulnerable
population of high-needs youth from urban and rural areas of Fresno County, considering various
challenges such as:
• Youth with disabilities,
• Adjudicated Youth,
• Youth at High Risk of Juvenile Justice involvement
• LGBTQI+ identity and gender nonconforming youth
• Youth facing immigration challenges.
D. Subrecipient Responsibilities:
1. To make family time services available to children and families referred by DSS comprised of a
minimum of 240 scheduled hours of SFT and 40 hours of ISFT a week.
2. Family time services, defined by one (1)family time monitor and/or coach,the child, or children
in CWS, and their family members who are present for the supervised family time.This may
include parent(s), sibling(s), grandparent(s), or other relatives, as approved by DSS.The duration
of each family time shall be at minimum one hour(60 minutes).
3. Provider shall make an initial contact attempt to the parent/caretaker and foster parents within
24 hours of receipt of family time referral.
4. At DSS' request, participate and/or coordinate an "ice breaker" meeting between the parents
and the child's substitute care provider for the purpose of facilitating greater comfort and
communication between the family and substitute care provider.
5. During family time,the family time monitor shall have constant visual and auditory contact with
the child and family. Every effort shall be made to keep the child safe and supported during the
child's family time with family member(s).The family time monitor shall be present at all times
during family time and will pay close attention to all forms of communication and the child's
behavior during family time. Proposals should address how the provider proposes to handle
large groups and other situations that may warrant more than one staff member at family time.
6. The family time monitor shall also interact with and may direct, as deemed appropriate by the
provider,the parent(s)for the purpose of enhancing their parenting skills.This interaction with
the parents should serve to help the parent(s) become aware of their understanding of child
rearing and other important areas related to parenting.The family time monitor may also
provide instruction on infant care as needed and provide guidance on the day-to-day
responsibilities of parenthood.The following is a sample of the potential parenting topics that
may be provided by the family time monitor:
o Approaches to Raising Children;
o Understanding the Source of a Child's Behavior;
o Helping Children Build Healthy Self-Esteem;
o Communicating Effectively;
o Influencing Your Children Positively;
Exhibit A
Page 4 of 22
o How Children Think;
o Reducing Stress in Your Family; and
o Resolving Family Conflicts
7. The family time provider shall continually engage in efforts to progress families to a less
restrictive level of family time service and meet family time service goals. Efforts shall include
continual communication with DSS Social Worker and DSS Family Time Center staff regarding
families that meet the service goals created by the Social Worker and visiting party and are
ready to transition. Families identified as ready to transition should be pre-approved by DSS
before de-escalation occurs.
8. Providers will keep a record of family time for each case and shall utilize DSS provided Family
Time Narrative forms to submit to DSS Social Worker and Family Time Center staff.
9. The provider shall engage in efforts to minimize the number of cancelled and no-show family
time appointments for parents and care providers. Efforts should include, at a minimum,
contacting all of the family time parties by phone or another mutually agreed upon method, at
least 24 hours prior to the scheduled family time. Provider shall have the capability to send text
notifications in addition to making phone calls.
10. 10.The provider shall notify the assigned DSS Social Worker and Family Time Center staff within
72 hours of receipt of referral of any issues, barriers, or concerns with scheduling to receive
assistance/guidance with resolving and expediting the scheduling process.All cancellations, no-
shows, and minor refusals shall be documented to assist the DSS Social Worker and DSS Family
Time Center staff in identifying trends and providing intervention. Communication regarding
cancellations, no-shows, and minor refusals shall be provided to both the DSS Family Time
Center staff and assigned DSS Social Worker. Communication should include: time of visit,
reason for cancellation, and the number of consecutive cancellations, no-shows, and minor
refusals. Provider will propose additional plans to decrease cancelled and no-show family time
appointments and maximize parent/caretaker participation in family time.
11. The provider shall maintain staffing patterns that promote and meet the various ethnic and
linguistic needs of families served. Bidders should employ a sufficient number of bilingual
employees and employees with sufficient cultural competency skills. Staff must have the
language skills necessary to communicate fully and effectively with referred families, and/or use
interpreter services to meet these needs.
12. The provider shall propose staffing patterns that ensure sufficient staffing and contingency
plans to ensure no visits are cancelled due to staff illness, staff time off, staff shortages, etc.
13. The provider shall immediately discuss with DSS staff any office closure or visitation
cancellations due to a major catastrophe, public health crisis, or other significant emergency,
such as a natural disaster.
14. Forms and written materials are required to be offered in Spanish, Hmong, Lao, or other
language determined by DSS to be a "threshold" level.To meet the threshold level for
translation of documents,five percent or more individuals served speak only that language.
15. The provider must provide interpreter services, as needed. Costs of interpretation services shall
be borne by the provider. Bidders should include in their cost proposal.
Exhibit A
Page 5 of 22
16. The provider shall attend DSS teaming meetings upon the request of DSS. Provider shall have
weekly availability to discuss capacity, scheduling issues, concerns regarding referrals, or
additional needs.
17. The provider shall maintain current and accurate records of all families referred, receiving
services, and discontinued.This includes all referral information, narratives, and all
documentation shared by DSS.
18. The provider shall maintain current and accurate records of scheduled family time and
available capacity.A copy of visits scheduled for the day shall be provided to the DSS Family
Time Center staff daily if changes have been made to the weekly schedule, no later than the day
of services.
19. The provider shall provide a copy and review the DSS provided Supervised Family Time
Guidelines with all parents and care providers. See Appendix B for guidelines.
20. As directed by DSS, provider will have the capability to coordinate/provide virtual visits or a
combination of virtual and in-person visits.
21. As directed by DSS, provider shall discontinue referrals/visitation parties.
22. Provider shall comply with all additional program requirements set forth in Appendix A.
23. Subrecipient will provide annual Civil Rights training to their staff in the first quarter of every
calendar year and will provide relevant proof to DSS by April 1, for each year of the contract.
Additional requirements for ISFT services include:
1.The primary monitor for ISFT will be a licensed/unlicensed clinician or have a MSW or Master's degree
in a related field, or be a student/intern in training for a post-graduate degree under the direct
supervision of a licensed clinician or mental health professional.
2.The ISFT monitor will have a thorough understanding of child development and attachment and
bonding issues for children who have been victims of severe child neglect or abuse and/or parents
with mental health issues.
3.The ISFT monitor must comply and receive required training, as specified in Appendix A, for family
time monitors.
4. Intervention on an as needed basis during family time.These interventions will include, but not be
limited to, addressing parenting skills, assisting parents with child relationships and/or bonding,
identifying techniques to overcome attachment issues, and providing for the safety of the child.
5. ISFT is not therapy and cannot be billed to Medi-Cal or to an insurance company. As ISFT is not
therapy, what takes place during family time is not confidential. Information regarding family time is
captured in the DSS 3rd Party ISV Narrative Form (see Appendix D).This information can be provided
to the Juvenile Court as it may relate to whether it would be in the best interest of the child for ISFT to
continue or whether a less restrictive level of family time is warranted.
6. It is not the intent of ISFT to provide long-term intervention with a family, nor to successfully address
long-term trauma or significant negative family dynamics.
Additional program services and operations for both SIFT and ISFT shall be consistent with the
requirements outlined in Appendix A.
Exhibit A
Page 6 of 22
E. Staff Qualifications and Experience:
Staffing will ensure consistency for each child and family, as well as year-round Family Time Service
coverage.
Staffing will reflect the ethnicity, culture, and language of individuals served including African American,
Hispanic/Latino, and Hmong. Subrecipient is a culturally diverse agency where English, Spanish, and
Hmong are spoken.This includes offering services and program materials in both bilingual and
monolingual formats to cater to families.
All employees will have successfully passed through a thorough background check and will comply with
all legally applicable qualifications and criteria for employment, as well as Family Time Program
requirements for professional providers as described in Appendix A.
ISFT requires the presence of a licensed/unlicensed, Master's level, or student/intern in training for
a post-graduate degree under the direct supervision of a license clinician or mental health professional.
F. Performance Outcomes and Expectations
Goal 1:Support and improve parent-child attachment and interaction
Outcome 1: Families will have access to family time services as expeditiously as possible through agency
contact within 24 hours of received referral.
Indicator: 100%of referred families will be contacted within 24 hours of received referral
Outcome 2: Increase in positive interactions in: communication skills, physical space and intimacy needs,
conflict exploration and resolutions, and understanding child developmental stages.
Indicator: Within three months of their first visit,families will demonstrate a 25% improvement in each
category listed as documented by SFT and ISFT supervisors' evaluations and/or an evidence-based
family engagement assessment.
Goal 2:Timely transition to lower levels of family time and increased likelihood of reunification
Outcome: Parents will be evaluated for their readiness to transition to lower levels of visitation at regular
intervals throughout their participation in family time services where they will demonstrate improved
parent-child interactions.
Indicator: 75%of families that indicate readiness based on SFT and ISFT supervisors' evaluations and/or
an evidence-based family engagement assessment will move to a lower level of visitation.
Goal 3: Cancelation/no show rate will be no more than 10%for both parents and all care providers.
Outcome: Scheduled Supervised family time will be prioritized by parents and care providers through
proactive and friendly agency telephone text/call or email reminder 24 hours prior to scheduled family
time.
Exhibit A
Page 7 of 22
Indicator: 90%of scheduled family time will be completed by parents and caretakers (10%or better no-
show/cancellation rate).
*Please note, percentage indicators are subject to change at the Department's discretion.
Additional Obiectives:
Provide Flexibility:Allow for flexibility in transitioning families from ISFT to SFT or directly
to unsupervised family time on a case-by-case basis.This includes offering in-home
supervised visitations as a transition option for eligible parents.
This transition may include up to two in-home supervised visitation sessions, preceded by a
Collaborative Family Team meeting to discuss expectations, protocols, and safety concerns.This in-
home transition is dependent upon the County Social Worker assessing safety prior to in-home
visitation.
G. Data Collection and Reporting:
DSS will require the collection and reporting of data that includes, but is not limited to:
• Monthly demographic and contract performance outcome information;
• Families referred and engaged in supervised family time services;
• Family time participation data, no show rate and reasons, and client discharge information;
• Individual reports to CWS Social Workers regarding family time. Provider shall use DSS provided
• Family Time Narrative forms. See Appendix C and D for forms;
• Monthly back up supporting information to support submitted invoices;
Other reports and/or information may be required by DSS. North Star regularly monitors progress and
outcomes through activity reports, meetings, examination of client files, and observation. Success will be
measured based on improvements in family interactions,feedback from families and caseworkers, and
reduced instances of setbacks in the reunification process.Administrative staff will call and conduct
satisfaction surveys with families regularly.
H. County Responsibilities:
DSS staff will coordinate and participate in monthly or quarterly meetings with Subrecipient to review
program outcomes and contractual issues.
DSS staff will meet with Subrecipient staff as often as needed to exchange pertinent information, provide
guidance, resolve problems, and work collaboratively to coordinate services.
Exhibit A
Page 8 of 22
APPENDIX A
SUPERVISED FAMILY TIME PROGRAM REQUIREMENTS
Services must be delivered in compliance with Family Code 3200.5 and Court Standards
5.20. Selected portions of the standards identified in Family Code 3200.5 and Court
Standards 5.20 are identified below. However, the vendor and its supervised family time
professional provider(s) shall be responsible for understanding and complying with all
applicable aspects of the Family Code and Court Standards regardless of their inclusion in or
exclusion from this RFP.
For the purposes of clarification, both Family Code 3200.5, and Court Standards 5.20
describe the paid family time monitors as a "Professional Provider" and the term may be used
interchangeably in this Appendix.
Hours of Service
Services must be available between 3:00 p.m. and 8:00 p.m., Monday through Friday and
between 9:00 a.m. and 6:OOp.m., Saturday through Sunday and holidays. The provider may
wish to have no hours of operation during the following holidays: Halloween, Thanksgiving
Day, and Christmas Day. The ability to accommodate afternoon, evening and weekend visits
is required due to children's school and parents'work schedules. All sites should be located
in or readily accessible to public transportation and must include a site in areas of high child
removal rates, that include zip code areas 93702, 93703, 93705, 93706, 93722, 93726 and
93727. DSS is also interested in providing services to families who are located in rural parts
of the County. Bidders who wish to serve a limited number of families located at a site(s) in
cities or rural areas outside the Fresno/Clovis metro areas are encouraged to identify such
site(s) within their proposal.
Professional Provider Qualifications
A"professional provider"who is providing the services hereunder, is any person paid for
providing supervised family time services, or an independent contractor, employee, intern,
or volunteer operating through a supervised family time center or agency. The selected
contractor will ensure each staff providing supervised family time services is fingerprinted
and the fingerprints processed through a LiveScan and Child Abuse Index search process.
The professional provider shall:
• Be 21 years of age or older;
• Have no conviction for driving under the influence (DUI)within the last 5 years;
• Not have been on probation or parole for the last 10 years;
• Have no record of a conviction for child molestation, child abuse, or other crimes
against a person;
• Have proof of automobile insurance if transporting the child;
• Have no civil, criminal, or juvenile restraining orders within the last 10 years;
• Have no current or past court order in which the provider is the person being supervised;
• Be able to speak the language of the party being supervised and of the child, or the
provider must provide a neutral interpreter over the age of 18 who is able to do so;
• Have no conflict of interest with the clients; and
• Agree to adhere to and enforce the Court Order regarding supervised family time
Exhibit A
Page 9 of 22
Ratio of Children to Professional Provider
Staffing should be maintained at a 1:1 ratio: One (1) staff per family time service unit or
group, per one (1) family group per family time room, at any given time. However, at the
discretion of the professional provider, two staff persons may be used for family time that
include greater than six (6) participants (parent(s), children, and other family members).
Other factors to consider for staffing ratios of participants to a professional provider should
be contingent on:
• The degree of risk factors present in each case;
• The nature of supervision required in each case;
• The number and ages of the children to be supervised during family time;
• The number of people visiting the child during family time;
• The duration and location of family time; and
• The experience of the professional provider.
During any family time where staffing is provided at a greater than 1:1 ratio of staff persons
per family group or when more than one family group is in the same family time room,
documentation shall be provided in the case file justifying the use of additional staff.
Delineation of Terms and Conditions
The provider bears the sole responsibility for enforcement of all the terms and conditions of
any supervised family time service provided herein. Unless otherwise ordered by the Court,
the provider should:
• Monitor conditions to assure the safety and welfare of the child;
• Enforce the frequency and duration of family time as ordered by the Court and
County specified;
• Avoid any attempt to take sides with any party;
• Ensure that all contact between the child and the noncustodial party is within the provider's
hearing and sight at all times, and that discussions are audible to the provider; Speak in a
language spoken by the child and the noncustodial party;
• Allow no derogatory comments about the parent, his or her family, caretaker, child, or
child's siblings;
• Allow no discussion of the Court case or possible future outcomes;
• Allow neither the provider nor the child to be used to gather information about the
other party or caretaker or to transmit documents, information, or personal
possessions;
• Allow no spanking, hitting, or threatening the child;
• Allow no family time to occur while the visiting party appears to be under the influence
of alcohol or illegal drugs;
• Allow no emotional, verbal, physical, or sexual abuse; and
• Ensure that the parties follow any additional rules set forth by the provider, Department
of Social Services, or the Court.
Exhibit A
Page 10 of 22
Maintenance and Disclosure of Records
Professional providers will keep a record of family time for each case; these records will be
completed within three (3) days and emailed to DSS within five (5) days of family time.
Provider shall use DSS provided Family Time Narrative forms (See Appendix C and D). Any
critical incident report will be provided no later than 24-hours following the incident.
Supervised family time reports shall be in a form and format as provided by DSS, and shall
include, but not be limited to:
• The date, time, and duration of the contact or family time;
• Who attended family time;
• The professional provider who conducted family time;
• A summary of activities during the family time;
• An account of critical incidents, including physical or verbal altercations and threats;
• Violations of protective or court visitation orders;
• Any failure to comply with the terms and conditions of family time;
• Any incidence of abuse as required by law; and
• Actions taken by the provider, including any interruptions, terminations of family time, and
reasons for these actions. If family time is temporarily suspended or terminated, the
professional provider should state the reasons for the action taken in writing and provide
the written statement to the family time parties, their attorneys, the attorney for the child,
and the County immediately upon suspension or termination or as soon thereafter as
feasible, but in no case later than three (3) days following the action.
• An account of any redirection or attempts at redirection provided by the professional
provider during family time.
Case recordings and supervised family time reports will be limited to facts, observations, and
direct statements made by the parties, not personal conclusions, suggestions, or opinions of
the provider. All contacts by the provider in person, in writing, or by telephone with any party
(County, contractor or family member), the children, the court, attorneys, mental health
professionals, and referring agencies should be documented in the case file. All entries
should be dated and signed by the person recording the entry.
If ordered by the Court, requested by the County under this bid, or requested by either party
or the attorney for either party or the attorney for the child, a report about the supervised
family time will be produced. These reports should include facts, observations, and direct
statements and not opinions or recommendations regarding future family time unless
ordered by the Court. On rare occasions, the Court may subpoena a professional provider
for testimony at a Court proceeding.
Any identifying information about the parties and the child, including addresses, telephone
numbers, places of employment, and schools, is confidential, should not be disclosed, and
should be deleted from documents before releasing them to any Court, attorney, attorney for
the child, party, mediator, evaluator, mental health professional or non-county social worker,
except as required in reporting suspected child abuse.
Legal Responsibilities and Obligations of the Professional Provider
All providers of supervised family time should:
Exhibit A
Page 11 of 22
• Advise the parties before commencement of supervised family time that no confidential
privilege exists;
• Report suspected child abuse to the appropriate agency, as provided by law, and inform
the parties of the provider's obligation to make such reports;
• Suspend or terminate family time under items listed in this section;
• Keep recordings of all actions which have taken place regarding the supervised family time;
• Keep records in a secure area and secured in accordance with Division 19, Confidentiality
of Information;
• Prepare a written contract to be signed by the parties before commencement of the
supervised family time. The contract should inform each party of the terms and
conditions of supervised family time;
• Review custody and visitation orders relevant to the supervised family time;
• Implement an intake and screening procedure; and
• Comply with additional requirements as stated within County request or Court Orders.
Facility Requirements and Preferences
The family time center sites should be a home-like setting with clean, well-lit rooms and
kitchen facilities that are available for families to prepare meals together. The environment
should be child friendly and the family time rooms need to be age appropriate in design and
decoration.
Examples include infant appropriate rooms with carpet on the floor for crawling and other
rooms with age-appropriate activities available for older youth and their families to engage in
together.
Family time sites should offer a level of structure so that families can learn or re-learn how to
interact appropriately. More specifically, at a minimum, all facilities where services are
provided are required to have:
• Family time rooms no smaller than 10' x 10' in size
• Adequate parking
• Handicapped accessibility
• Diapers &wipes
• Protective gloves & masks
• Toys for a variety of age groups
• Digital camera available to take pictures of children and family
• Regular janitorial service (State the frequency of service)
• Regular cleaning of toys (State the frequency and method of cleaning)
County prefers these additional amenities:
• Kitchen and dining facilities
• Child size furniture
• Playground/outside fenced play area
Exhibit A
Page 12 of 22
• Sitting area to have Family Time outside
• Videotape surveillance capability
Capability to hold family time outside helps promote a more family-friendly environment. Outside
family time allows parents to practice parenting skills and provides a space for siblings to
participate in fun activities.
Administrative Requirements
• Participate in regularly scheduled meetings (up to once per month) with County contract
management and program staff to discuss contract, program service and objectives;
• Participate in Team Decision-Making, Child Family Team meetings, and/or case staffings
on a scheduled basis or as required at County specified locations;
• Ensure compliance with all of the Scope of Work requirements;
• Meet or exceed Performance Outcomes;
• Maintain case files for each individual participant;
• Ensure staff meet the Scope of Work training requirements;
• Develop and maintain a written plan of maintenance/cleaning for family time rooms, toys,
and other supplies;
• All family time will be referred to the selected vendor(s) by the County of Fresno,
Department of Social Services, Child Welfare Services Family Time Center staff;
• Within 24 hours of receipt of an approved referral, make contact with the
parent(s)/care provider to coordinate a family time. Contractor will develop a
system/process to ensure parent(s)/care provider family time attendance (i.e. family time
reminders by phone and other means as appropriate);
• Plan and make available appropriate activities for parents and children for each family
time which take into consideration holidays and seasons including cultural, religious and
ethnic differences of the clients who are served (list such planned activities);
• Special life events of a child such as birthdays are important celebratory events.A large
room or an alternate location within the community where supervised family time for
birthdays may occur will be secured/provided for these events;
• Develop a master calendar to reflect family time scheduled time slots and staff utilization,
and provide to County on a monthly basis;
• Maintain current and accurate records of visits scheduled and available capacity.
Provider shall, on a weekly basis, provide a copy of visits scheduled for the day to the
DSS Family Time Center staff;
• Provide a monthly statistical report to Department of Social Services no later than the
10th of each month. The monthly statistical report will address desired outcomes for
supervised family time and utilization of services. County will provide the contract
vendor(s) with the statistical form; and
• Promptly notify the DSS Family Time staff and assigned Social Worker staff upon
Exhibit A
Page 13 of 22
notice of cancellation for all cancelled family time, "no-show" family time, or minor
refusals via the DSS visitation e-mail in-box. Communication regarding cancellations, no-
shows, or minor refusals should include: reason for cancellation,time of scheduled visits,
whether cancellations, no-shows, or minor refusal are consecutive, and providers efforts to
mitigate these cancellations.
Professional Provider Training
Each provider of supervised family time services is required to demonstrate their ability to
provide, during each fiscal year of services, training opportunities for their staff, which will
include:
• The role of a professional provider;
• Observation techniques;
• Child abuse reporting laws;
• Parenting training (to be approved by County);
• Culture Competency and Disproportionally of African-American families in Child Welfare;
• Record-keeping procedures;
• Screening, monitoring, and termination of family time;
• Developmental needs of children;
• Legal responsibilities and obligations of a provider;
• Cultural sensitivity;
• First Aid and certification;
• Conflicts of interest;
• Confidentiality;
• Civil Rights;
• Issues relating to substance abuse, child abuse, sexual abuse, and domestic violence;
• An understanding of terms and conditions of supervised family time; and
• The legal responsibilities and obligations of a provider under the court standards.
Safety and Security Procedures
All providers should make every reasonable effort to assure the safety and welfare of the
child and adults during the family time. Supervised family time centers will establish a
written protocol with the assistance of the local law enforcement agency that describes the
emergency assistance and responses that can be expected from the local law enforcement
agency. In addition, the supervised family time service provider will:
• Establish and state in writing minimum security procedures and inform the parties of
these procedures before the commencement of supervised family time;
• Conduct comprehensive intake and screening to assess the nature and degree of risk
for each case;
• Establish written procedures that must be followed in the event a child is abducted
during supervised family time; and
• Suspend or terminate supervised family time if the provider determines that the risk
Exhibit A
Page 14 of 22
factors present are placing in jeopardy the safety and welfare of the child or provider.
The procedures for intake should include separate interviews with the parties before the first
family time. During the interview, the provider should obtain identifying information and
explain the reasons for temporary suspension or termination of family time under this
standard. If the child is of sufficient age and capacity, the provider should include the child in
part of the intake or orientation process. Any discussion should be presented to the child in a
manner appropriate to the child's developmental stage.
The service provider will obtain during the intake process or will have obtained from the
County:
• Copies of any protective order;
• Current court orders;
• Any Judicial Council form relating to supervised family time orders;
• A report of any written records of allegations of domestic violence or abuse; and
• An account of the child's health needs if the child has a chronic health condition.
Safety Considerations for Sexual Abuse Cases
In cases where there are allegations of sexual abuse, in addition to the requirements of the
safety and security procedures above, the provider should comply with the following terms
and conditions, unless otherwise ordered by the Court:
• Allow no exchanges of gifts, money, or cards;
• Allow no photographing, audio taping, or videotaping of the child;
• Allow no physical contact with the child such as lap sitting, hair combing, stroking,
hand holding, prolonged hugging, wrestling, tickling, horse playing, changing
diapers, or accompanying the child to the bathroom;
• Allow no whispering, passing notes, hand signals, or body signals; and
• Allow no supervised family time in the location where the alleged sexual abuse occurred.
Confidentiality
Communications between parties and providers of supervised family time services are
not protected by any privilege of confidentiality. Professional and therapeutic providers
should, whenever possible, maintain confidentiality regarding the case except when:
• Ordered by the Court;
• Subpoenaed to produce records or testify in Court;
• Requested to provide information about the case by a mediator or evaluator in
conjunction with a Court-Ordered mediation, investigation, or evaluation;
• Required to provide information about the case by Department of Social Services; or
• Requested to provide information about the case by law enforcement.
Court Standards
The Court generally orders supervised family time services. Supervised family time
service providers and all documentation are subject to subpoena at any time. Additionally,
Exhibit A
Page 15 of 22
DSS reserves the right to visit the facility to observe visits and to review any and all
records pertaining to supervised family time services at any time (with or without notice).
The Rules of Court Standard are to be followed and adhered to by all selected vendor of
services.
Conflict of Interest
All providers should maintain neutrality by refusing to discuss the merits of the case or agree
with or support one party over another.Any discussion between a provider and the parties
should be for the purposes of arranging family time and providing for the safety of the
children. In order to avoid a conflict of interest, the provider should not:
• Be financially dependent on the person being supervised;
• Be an employee of the person being supervised;
• Be an employee of or affiliated with any superior court in the county in which the
supervision is ordered unless specified in the employment contract; or
• Be in an intimate relationship with the person being supervised.
Reference Information Cited:
1. California DSS Manual Child Welfare Services Manual
Division 31.
2. California DSS Manual Child Welfare Services Manual
Division, Confidentiality of Information Division 19
3. 2010 California Rules of Court. Standard 5.20. Uniform standards of practice for
providers of supervised visitation.
For more information, please visit 2024 California Rules of Court
Exhibit A
Page 16 of 22
APPENDIX B
Supervised Family Time Guidelines
The DSS Family Time Team strives to create a safe place for children and
parents to spend quality time in a friendly and welcoming environment. The staff
at the Family Time Center are here to help make sure `parenting"time is a
positive experience for everyone involved. We strive to be engaging, courteous,
and helpful. We are family focused, child-centered, and invested in each family's
success!
What you need to know:
• For your safety, security will be screening everyone upon entry to the building. Items,
bags and other containers are subject to inspection.Any drug paraphernalia found may
cause your family time to be terminated. Knives, weapons or any other sharp or
dangerous objects are not to be brought into the building.
• SmokingNaping is not allowed in the building, the visiting rooms and within 20 feet of
entrances to the building.
• When coming to attend your family time, notify the reception staff that you have
arrived. When checking in with reception, please use mother's name on the case for ease
of identification.
• Please understand you may not use any foul or disrespectful language in the lobby while
waiting for your family time and during your family time. We are sure you are aware of
why this is considered an important aspect of successful family time.
• If you are aware of others who would like to also participate in family time with the
child(ren), please direct them to the Social Worker, as only persons pre-approved for
family time are allowed to attend.
• If you are going to be late or cannot attend,please contact Family Time Center at(559)
600-3469, or the Family Time Coordinator at (559) 600-1679. Please remember to notify
the reason for being late or not being to attend(i.e. any illness, transportation issues).
• Only service animals are allowed in the building.
During Family Time:
• Family time should focus on your quality interactions with your child(ren) and
communications regarding the future outcomes of the court case should not be discussed.
If your child(ren) brings up the court case or future activities that cannot be guaranteed,
the family time support staff and yourself should redirect the conversation. If you have
any questions or concerns regarding your case or staff,please reach out to your social
worker prior or after your family time.
• In order to focus your interactions with your child(ren), we encourage limiting the use of
electronic devices during your scheduled family time. This will help to minimize
distractions or interruptions during your time together. When taking photos, DSS staff are
Exhibit A
Page 17 of 22
not allowed to be in the frame of the picture for confidentiality and privacy concerns.
Video recording is allowed for milestones (first steps,birthdays, etc.).
• Any items/gifts brought into the building should be unwrapped or in a gift bag as they
will need to be examined by staff for appropriateness and safety and will be documented
in the visitation narrative and submitted to the Social Worker. Any electronic devices and
large items (bicycles, TVs, riding toys, large toys, etc.)will need to be arranged through
your Social Worker.
• Family Time coaches are here to provide guidance and encouragement to support families
to have positive, engaging interactions while spending time together
• If you have any concerns or questions regarding your Family Time,please inform your
Family Time Coach, that is supervising your family time and they will discuss the matter
with you at an appropriate time outside of your family time. If it is in regards to
something that is out of the realm of the Family Time, and we are not able to help, we
will contact the social worker and advise that you do the same.
• An approved staff member must accompany young children that require assistance using
the restroom.
What to bring to Family Time:
• Your love, affection, and patience are the most important items. Please try to help us
keep your child(ren) comfortable, even during these difficult times.
• Food items and beverages are allowed during the visitations, but the Department of
Social Services appreciates and encourages your assistance with enforcing healthy snacks
and food items. Snack foods/finger foods are encouraged. Beverages should be in
individual containers with reclosable/sealable tops (i.e. screw type lid). No alcohol and
no glass is allowed. Please be mindful to not bring excessive portions/amounts of food.
• Please remember the focus is to be on the quality time spent as a family.
What not to bring to the Family Time:
• Please avoid discussing topics that may upset your child(ren) and may cause the
child(ren) to worry or feel guilty.
• The Family time support staff and/or child(ren) are not to be used to communicate with
the other parent/caregiver.
• We ask that you not bring any nuts or products that contain nuts into the building as this
may cause other individuals to have a severe allergic reaction.
Virtual Family Time
(Used when in person Family Time is unable to be facilitated.)
• Family Time will need to be held in a private area so there will be no distractions or
interruptions during your time together.
• You will need to have your camera on at all times. Filters are not allowed.
• Due to safety concerns, if you are driving or in a moving vehicle during your family time,
it will be terminated.
• We encourage Parents of young children to sing, read a story or practice the alphabet with
their child. Children can still find comfort in seeing and in hearing parent's voices.
Exhibit A
Page 18 of 22
• Please prepare for your family time by thinking of age appropriate subjects to discuss, or
games to play that do not require anything to be brought into the center(i.e. I Spy,Would
You Rather), and help the child feel comfortable while visiting.
At the end of the Family Time:
• You will be expected to assist with making sure that the family time room is cleaned at
the end of your family time. This includes picking up toys, trash, leftover food items, etc.
• Exit promptly in the direction provided by the Family Time Coach. Ending family time is
hard for everyone, it is encouraged to support the transition by acknowledging the
emotion while sharing support for your child as they learn to cope through your reactions
and develop their resiliency.
• If you have any concerns, questions or complaints about your family time, please do not
hesitate to notify your social worker assigned to your case.
• All family time interactions will be narrated and provided to your social worker.
• Please reach out to your Social Worker with any questions or changes to your Family
Time schedule. The Social Worker will advise Family Time Center staff if changes are
needed.
These guidelines are subject to change. Please address
questions to the DSS Family Time Team and/or your
Social Worker.
Date Given:
Case Name:
Visiting Party Name(s):
Visiting Party Signature(s):
Family Time Coach Name(s):
Family Time Coach Signature(s):
Exhibit A
Page 19 of 22
Appendix C
DSS 3rd Party Supervised Family Time Narrative
Form
PLEASE EMAIL THIS FORM TO CWSVisitation(a)fresnocountvca.gov WITHIN 5 BUSINESS DAYS OF THE VISIT
OR PROVIDE A WRITTEN COPY TO THE SOCIAL WORKER
Name of Family Time Monitor: Family Time Schedule:
Title/Relationship: Session Duration:
Case Name: Date of Visit:
Individuals Participating in the Family Time
ADULTS CHILD(REN)
List the name and relationship of all adults List the name and relationship of all children visiting. Note:
visiting. You may have more than one focus child. Focus child(ren)
should be any child with an open DSS case.
Name Relationship Name Relationship
1. Relationship: 1. Relationship:
2. Relationship: 2. Relationship:
3. Relationship: 3. Relationship:
4. Relationship: 4. Relationship:
S. Relationship: 5. Relationship:
6. Relationship: 6. Relationship:
Please list any additional adults or children and their relationship here:
Family Time Description
Provide a brief description regarding the child(ren)'s arrival and greeting with the
parent or relative attending:
Provide a description of the interactions and activities during the family time session
including any interventions provided by the monitor to address areas needing
improvement (if appropriate):
Exhibit A
Page 20 of 22
Provide a brief description regarding the child(ren)'s separation from the parent or
relative at the end of the session:
Other Comments for the Social Worker or Court regarding the session:
Family Time — Scheduled but did not occur
ONLY COMPLETE THIS SECTION IF THE VISIT WAS SCHEDULED BUT DID NOT OCCUR FOR ANY REASON
❑No show—child(ren) ❑No show—parent/relative ❑Canceled by Social
Worker El Canceled by other party—Name of party:
If canceled, please provide a reason for the cancellation:
Exhibit A
Page 21 of 22
Appendix D
DSS 3rd Party ISV Family Time Narrative Form
PLEASE EMAIL THIS FORM TO CWSVisitation(a fresnocountvca.gov WITHIN 5 BUSINESS DAYS OF THE VISIT
OR PROVIDE A WRITTEN COPY TO THE SOCIAL WORKER
Name of Family Time Monitor: Family Time Schedule:
Title/Relationship: Session Duration:
Case Name: Date of Visit:
Individuals Participating in the Family Time
ADULTS CHILD(REN)
List the name and relationship of all adults List the name and relationship of all children visiting. Note:
visiting. You may have more than one focus child. Focus child(ren)
should be any child with an open DSS case.
Name Relationship Name Relationship
1. Relationship: 1. Relationship:
2. Relationship: 2. Relationship:
3. Relationship: 3. Relationship:
4. Relationship: 4. Relationship:
S. Relationship: 5. Relationship:
6. 1 Relationship: 6. 1 Relationship:
Please list any additional adults or children and their relationship here:
Family Time Description
What are the identified short-term goals for this family (SW to identify):
Provide a brief description regarding the child(ren)'s arrival and greeting with the
parent or relative attending:
Provide a description of the interactions and activities during the family time session
including any interventions provided by the monitor to address areas needing
improvement (if appropriate):
Provide a brief description regarding the child(ren)'s separation from the parent or
relative at the end of the session:
Strengths during the session:
Exhibit A
Page 22 of 22
Areas needing improvement during the session:
Other Comments for the Social Worker or Court regarding the session:
Family Time— Scheduled but did not occur
ONLY COMPLETE THIS SECTION IF THE VISIT WAS SCHEDULED BUT DID NOT OCCUR FOR ANY REASON
❑No show—child(ren) ❑No show—parent/relative ❑Canceled by Social
Worker El Canceled by other party—Name of party:
If canceled, please provide a reason for the cancellation:
Exhibit B
Family Time Services
North Star Family Center
Fiscal Year(FY)1:2024-25
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Admin Assistant 1.00 $ 20 $ 38,188.80
1102 Admin Assistant 0.75 28,641.60
1103 Scheduling Assistant 0.75 - 28,641.60
1104 HR/Finance 0.45 40,500.00
1105 Program Director 0.33 29,700.00
1106 Quality Assurance 0.50 39,000.00
1107 -
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 3.78 $ 20 $ 204,672.00
Acct# Program Position FTE Admin Program Total
1116 Program Supervisor/ISFT Supervisor 1.00 $ $ 83,000.00
1117 ISFT Supervisor 1.00 $ 48,796.80
1118 SFT Supervisor 1.00 $ 44,553.60
1119 SFT Supervisor 0.75 $ 33,415.20
1120 SFT Supervisor 0.75 $ 33,415.20
1121 SFT Supervisor 0.75 $ 33,415.20
1122 SFT Supervisor 0.75 $ 33,415.20
1123 SFT Supervisor 0.75 $ 33,415.20
1124 SFT Supervisor 0.75 $ 33,415.20
1125 SFT Supervisor 0.75 $ 33,415.20
1126 -
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 8.25 $ - $ 410,256.80
Admin Program Total
Direct Personnel Salaries Subtotal 12.03 $ 204,672.00 $ 410,256.80 $ 614,928.80
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 8,187.00 $ 16,410 $ 24,597
1202 Worker's Compensation $ 2,968.00 5,949 8,917
1203 Health Insurance $ 5,400.00 16,200 21,600
1204 Other(specify) $ - - -
1205 Other(specify) $
1206 1 Other(specify) $ -
Direct Employee Benefits Subtotal: $ 16,555.00 $ 38,559 $ 55,114
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 ;OASDI $ $ $
1 of 36
1302 FICA/MEDICARE 7,829 15,692 23,521
1303 SUI 6,959 13,949 20,908
1304 Other(specify) - - -
1305 Other(specify)
1306 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 14,788 $ 29,641 $ 44,429
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 236,015.00 $ 478,457 $ 714,472
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
33% 67%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support
2003 Client Transportation&Support
2004 Clothing,Food,&Hygiene
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 5,000.00
3002 Printing/Postage $ 3,600.00
3003 Office,Household&Program Supplies $ 31,800.00
3004 Advertising $ -
3005 Staff Development&Training $ 8,000.00
3006 Staff Mileage $ 1,500.00
3007 Subscriptions&Memberships $ 1,380.00
3008 Vehicle Maintenance $ -
3009 Other(specify) $
3010 Other(specify) $
3011 Other(specify) $
3012 Other(specify) $
DIRECT OPERATING EXPENSES TOTAL: $ 51,280
2 of 36
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 8,000
4002 Rent/Lease Building 96,004
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles -
4005 Security 1,200
4006 Utilities 12,060
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENT TOTAL:1 $ 117,264
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 25,000
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services 3,000
5004 Translation Services 5,000
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 33,000
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ -
Administrative Overhead
6002 Professional Liability Insurance 28,500
6003 Accounting/Bookkeeping 3,000
6004 External Audit 9,200
6005 Insurance(Specify):
6006 Payroll Services 480
6007 Depreciation(Provider-Owned Equipment to be Usedfor Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 41,180
INDIRECT COST RATE 4.37%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ -
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data $ 2,410.00
7003 Furniture&Fixtures $ 23,801.00
7004 Leasehold/Tenant/Building Improvements $ -
7005 Other Assets over$500 with Lifespan of 2 Years+ $
7006 Assets over$5,000/unit(Specify) $
7007 Other(specify) $
7008 Other(specify) $
FIXED ASSETS EXPENSES TOTAL $ 26,211
TOTAL PROGRAM EXPENSES $ 983,407
3 of 36
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 $
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0
8009 Other(Specify) 0
8010 Other(Specify) 0
Estimated Specialty Mental Health Services Billing Totals: 0 $
Estimated%of Clients who are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation(FFP)% 1 0%
MEDI-CAL FFP TOTAL $
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ 983,407
REALIGNMENT TOTAL $ 983,407
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-Capital Facilities&Technology
MHSA TOTAL $
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance
8403 Grants(Specify)
8404 Other(Specify)
8405 Other(Specify)
OTHER REVENUE TOTAL $
TOTAL PROGRAM FUNDING SOURCES: 1 $ 983,407
NET PROGRAM COST: $ -
4 of 36
Family Time Services
North Star Family Center
Fiscal Year(FY)1:2024-25 Budget Narrative
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 714,472
Administrative Positions 204,672
1101 Admin Assistant $ 38,188.80 Full Time$20/hr
1102 Admin Assistant $ 28,641.60 Part Time$18.36/hr
1103 Scheduling Assistant $ 28,641.60 Part Time$18.36/hr
1104 HR/Finance $ 40,500.00 Part Time$43.27/hr
1105 Program Director $ 29,700.00 Part Time$43.27/hr
1106 Quality Assurance $ 39,000.00 Part Time$37.50/hr
1107
1108 -
1109
1110
1111
1112
1113
1114
1115 -
Program Positions 410,256.80
1116 Program Supervisor/ISFT Supervisor $ 83,000.00 Full Time$39.90/hr
1117 ISFT/SFT Supervisor $ 48,796.80 Full Time$26.52/hr
1118 SIFT Supervisor $ 44,553.60 Full Time$21.42/hr
1119 SIFT Supervisor $ 33,415.20 Part Time$21.42/hr
1120 SIFT Supervisor $ 33,415.20 Part Time$21.42/hr
1121 SIFT Supervisor $ 33,415.20 Part Time$21.42/hr
1122 SIFT Supervisor $ 33,415.20 Part Time$21.42/hr
1123 SIFT Supervisor $ 33,415.20 Part Time$21.42/hr
1124 SIFT Supervisor $ 33,415.20 Part Time$21.42/hr
1125 SIFT Supervisor $ 33,415.20 Part Time$21.42/hr
1126 -
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits 55,114.00
1201 Retirement 24,597
1202 Worker's Compensation 8,917
1203 Health Insurance 21,600
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 44,429
1301 OASDI -
1302 FICA/MEDICARE 23,521.00
1303 SUI 20,908.00
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
5 of 36
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2000:DIRECT CLIENT SUPPORT
2001 Child Care
2002 Client Housing Support
2003 Client Transportation&Support
2004 Clothing,Food,&Hygiene
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 51,280
3001 Telecommunications 5,000 $415/month for internet and phone system
3002 Printing/Postage 3,600 Printer paper,ink,postage
3003 Office,Household&Program Supplies 31,800 $4800 replacement for furniture/toys,$325/month sanitation service. Reoccurring
office supplies(pens,pencils,staples/
staplers,etc).Laptops$650 each x 12=$7,800.Additional program supplies include
kitchen items(dish soap,air fryer,toaster,microwave,fridge),TV,video game console,
video games,board games,books,and toys.Also accounting for diapers,wipes,spare
clothes.
3004 Advertising -
3005 Staff Development&Training 8,000 Initial onboarding trainings,CPR/AED Certifications
3006 Staff Mileage 1,500 Cost of staff mileage reimbursement per year for traveling if any home visits are
required
3007 Subscriptions&Memberships 1,380 $115/month includes email,Microsoft,Adobe
3008 Vehicle Maintenance -
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 117,264
4001 Building Maintenance 8,000 Janitorial Service
4002 Rent/Lease Building 96,004 Rent for two units and security deposit @ 4969 E.Clinton Way Suite 113 and 119
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles -
4005 Security 1,200 Cost for security cameras
4006 Utilities 12,060 $1005/month
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 33,000
5001 Consultant(Network&Data Management) 25,000 New server costs and rewiring costs
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services 3,000 Initial onboarding costs,screenings,fingerprints,etc.
5004 Translation Services 5,000 $125/hr
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 41,180
6001 Administrative Overhead -
6002 Professional Liability Insurance 28,500 Worker's compensation based on number of employees and general liability insurance
6003 Accounting/Bookkeeping 3,000 $250/month accountant review
6004 External Audit 9,200 Annual audit based on previous costs
6005 Insurance(Specify): -
6 of 36
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6006 Payroll Services 480 Portion of the monthly cost to use Quickbooks$40/month
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
60013 Other(specify)
7 of 36
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7000:DIRECT FIXED ASSETS 26,211
7001 Computer Equipment&Software -
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 2,410 Emergency cell phones for each room and cost of a printer
7003 Furniture&Fixtures 23,801 Amount to furnish two units. Tables,desks,portable laptop desks,couch,chairs,
dining,etc
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 983,407
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 983,407
BUDGET CHECK: -
8 of 36
Family Time Services
North Star Family Center
Fiscal Year(FY)2:2025-26
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Admin Assistant 1.00 $ $ 39,334.46
1102 Admin Assistant 0.75 $ 29,500.85
1103 Scheduling Assistant 0.75 $ 29,500.85
1104 HR/Finance 0.45 $ 41,715.00
1105 Program Director 0.33 $ 30,591.00
1106 Quality Assurance 0.50 $ 40,170.00
1107 -
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 3.78 $ $ 210,812
Acct# Program Position FTE Admin Program Total
1116 Program Supervisor/ISFT Supervisor 1.00 $ $ 85,490.00
1117 ISFT Supervisor 1.00 $ 50,260.70
1118 SFT Supervisor 1.00 $ 45,890.21
1119 SFT Supervisor 0.75 $ 34,417.66
1120 SFT Supervisor 0.75 $ 34,417.66
1121 SFT Supervisor 0.75 $ 34,417.66
1122 SFT Supervisor 0.75 $ 34,417.66
1123 SFT Supervisor 0.75 $ 34,417.66
1124 SFT Supervisor 0.75 $ 34,417.66
1125 SFT Supervisor 0.75 $ 34,417.66
1126 -
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 8.25 $ $ 422,565
Admin Program Total
Direct Personnel Salaries Subtotal 12.03 $ $ $ 633,377
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 8,435.00 $ 16,905 $ 25,340
1202 Worker's Compensation $ 3,057.00 6,129 $ 9,186
1203 Health Insurance $ 5,563.00 16,689 $ 22,252
1204 Other(specify) - - -
1205 Other(specify)
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ 17,055 $ 39,723 $ 56,778
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 ;OASDI $ - $ - $
9 of 36
1302 FICA/MEDICARE 7,986 16,006 23,992
1303 SUI 7,098 14,228 21,326
1304 Other(specify) - - -
1305 Other(specify)
1306 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 15,084 $ 30,234 $ 45,318
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 32,139 $ 69,957 $ 735,473
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
4% 10%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support
2003 Client Transportation&Support
2004 Clothing,Food,&Hygiene
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 5,151.00
3002 Printing/Postage $ 3,709.00
3003 Office,Household&Program Supplies $ 25,000.00
3004 Advertising $ -
3005 Staff Development&Training $ 8,365.00
3006 Staff Mileage $ 1,700.00
3007 Subscriptions&Memberships $ 1,422.00
3008 Vehicle Maintenance -
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 45,347
10 of 36
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 20,278
4002 Rent/Lease Building 90,516
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles -
4005 Security
4006 Utilities 12,301
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENT TOTAL:1 $ 123,095
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 8,000
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services 5,150
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 13,150
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ -
Administrative Overhead
6002 Professional Liability Insurance 29,360
6003 Accounting/Bookkeeping 4,000
6004 External Audit 9,200
6005 Insurance(Specify):
6006 Payroll Services 495
6007 Depreciation(Provider-Owned Equipment to be Usedfor Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 43,055
INDIRECT COST RATE 4.65%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ -
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data 1,200
7003 Furniture&Fixtures 8,000
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
11 of 36
FIXED ASSETS EXPENSES TOTAL $ 9,200
TOTAL PROGRAM EXPENSES $ 969,320
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 $
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0
8009 Other(Specify) 0
8010 Other(Specify) 0
Estimated Specialty Mental Health Services Billing Totals: 0 $
Estimated%of Clients who are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation(FFP)% 1 0%
MEDI-CAL FFP TOTAL $
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ 969,320
REALIGNMENT TOTAL $ 969,320
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-Capital Facilities&Technology
MHSA TOTAL $
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance
8403 Grants(Specify)
8404 Other(Specify)
8405 Other(Specify)
OTHER REVENUE TOTAL $
TOTAL PROGRAM FUNDING SOURCES: $ 969,320
NET PROGRAM COST: $ -
12 of 36
Family Time Services
North Star Family Center
Fiscal Year(FY)2:2025-26 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 735,473
Administrative Positions 210,812
1101 Admin Assistant 1.00 Full Time$20.60/hr
1102 Admin Assistant 0.75 Part Time$18.91/hr
1103 Scheduling Assistant 0.75 Part Time$18.91/hr
1104 HR/Finance 0.45 Part Time$44.57/hr
1105 Program Director 0.33 Part Time$44.57/hr
1106 Quality Assurance 0.50 Part Time$38.63/hr
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 10
1115 10
Program Positions 422,565
1116 Program Supervisor/ISFT Supervisor 1.00 Full Time$41.10/hr
1117 ISFT Supervisor 1.00 Full Time$27.22/hr
1118 SFT Supervisor 1.00 Full Time$22.06/hr
1119 SFT Supervisor 0.75 Part Time$22.06/hr
1120 SFT Supervisor 0.75 Part Time$22.06/hr
1121 SFT Supervisor 0.75 Part Time$22.06/hr
1122 SFT Supervisor 0.75 Part Time$22.06/hr
1123 SFT Supervisor 0.75 Part Time$22.06/hr
1124 SFT Supervisor 0.75 Part Time$22.06/hr
1125 SFT Supervisor 0.75 Part Time$22.06/hr
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits 56,778
1201 Retirement 25,340 3%increase from previous year due to increase in salaries
1202 Worker's Compensation 9,186 3%increase from previous year due to increase in salaries
1203 Health Insurance 22,252 3%increase from previous year due to increase in salaries
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify)
Direct Payroll Taxes&Expenses: 45,318
1301 OASDI -
1302 FICA/MEDICARE 23,992 3%increase from previous year due to increase in salaries
1303 SUI 21,326 3%increase from previous year due to increase in salaries
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
13 of 36
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2000:DIRECT CLIENT SUPPORT
2001 Child Care
2002 Client Housing Support
2003 Client Transportation&Support
2004 Clothing,Food,&Hygiene
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 45,347
3001 Telecommunications 5,151 $429.25/month for internet and phone system
3002 Printing/Postage 3,709 Printer paper,ink,postage
3003 Office,Household&Program Supplies 25,000 $335/month sanitation service. Reoccurring office supplies(pens,pencils,
staples/staplers,etc).Additional program supplies/replacements include kitchen items
(dish soap,air fryer,toaster,microwave,fridge),TV,video game console,video games,
board games,books,coloring materials,and toys replacements.Also accounting for
diapers,wipes,spare clothes replacements.
3004 Advertising -
3005 Staff Development&Training 8,365 Yearly trainings/developments
3006 Staff Mileage 1,700 Cost of staff mileage reimbursement per year for traveling if any home visits are
required. Increased from previous due to planning on additional referrals
3007 Subscriptions&Memberships 1,422 $118.50/month includes email,Microsoft,Adobe
3008 Vehicle Maintenance -
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 123,095
4001 Building Maintenance 20,278 Includes janitorial services,yearly CAMS,any additional maintainence to the building
to ensure it is presentable for our clients. Paint,carpet,etc.
4002 Rent/Lease Building 90,516 Rent for both units @ 4969 E.Clinton Way Suite 113 and 119
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles
4005 Security -
4006 Utilities 12,301 Utilities for both units @ 4969 E.Clinton Way Suite 113 and 119
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 13,150
5001 Consultant(Network&Data Management) 8,000 Server maintenance
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 5,150 Yearly translations
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 43,055
6001 lAdministrative Overhead
14 of 36
PROGRAM EXPENSE
ACC T# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6002 Professional Liability Insurance 29,360 Includes 3%increase from previous year
6003 Accounting/Bookkeeping 4,000 Includes 3%increase from previous year
6004 External Audit 9,200 Includes 3%increase from previous year
6005 Insurance(Specify): -
6006 Payroll Services 495 Includes 3%increase from previous year
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 9,200
7001 Computer Equipment&Software -
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 1,200 Phone replacements/purchasing of activations for emergency phones
7003 Furniture&Fixtures 8,000 Yearly replacements if damage occurs
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 969,320
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 969,320
BUDGET CHECK: -
15 of 36
Family Time Services
North Star Family Center
Fiscal Year(FY)3:2026-27
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Admin Assistant 1.00 $ $ 40,514.49
1102 Admin Assistant 0.75 $ 30,385.88
1103 Scheduling Assistant 0.75 $ 30,385.88
1104 HR/Finance 0.45 $ 42,966.45
1105 Program Director 0.33 $ 31,508.73
1106 Quality Assurance 0.50 $ 41,375.10
1107 -
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 3.78 $ $ 217,137
Acct# Program Position FTE Admin Program Total
1116 Program Supervisor/ISFT Supervisor 1.00 $ $ 88,054.70
1117 ISFT Supervisor 1.00 $ 51,768.52
1118 SFT Supervisor 1.00 $ 47,266.92
1119 SFT Supervisor 0.75 $ 35,450.19
1120 SFT Supervisor 0.75 $ 35,450.19
1121 SFT Supervisor 0.75 $ 35,450.19
1122 SFT Supervisor 0.75 $ 35,450.19
1123 SFT Supervisor 0.75 $ 35,450.19
1124 SFT Supervisor 0.75 $ 35,450.19
1125 SFT Supervisor 0.75 $ 35,450.19
1126 -
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 8.25 $ $ 435,241
Admin Program Total
Direct Personnel Salaries Subtotal 12.03 $ $ $ 652,378
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 8,688.00 $ 17,412 $ 26,100
1202 Worker's Compensation $ 3,149.00 6,313 9,462
1203 Health Insurance $ 5,730.00 17,190 22,920
1204 Other(specify) - - -
1205 Other(specify)
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ 17,567 $ 40,915 $ 58,482
16 of 36
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $
1302 FICA/MEDICARE 8,226 16,486 24,712
1303 SUI 7,311 14,655 21,966
1304 Other(specify) - - -
1305 Other(specify)
1306 Other(specify)
Direct Payroll Taxes&Expenses Subtotal: $ 15,537 $ 31,141 $ 46,678
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 33,104 $ 72,056 $ 757,538
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
4% 10%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support
2003 Client Transportation&Support
2004 Clothing,Food,&Hygiene
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 5,305.00
3002 Printing/Postage $ 3,820.00
3003 Office,Household&Program Supplies $ 18,175.00
3004 Advertising $ -
3005 Staff Development&Training $ 8,615.00
3006 Staff Mileage $ 1,750.00
3007 Subscriptions&Memberships $ 1,465.00
3008 Vehicle Maintenance -
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 39,130
17 of 36
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 20,600
4002 Rent/Lease Building 93,540
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles -
4005 Security
4006 Utilities 12,795
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENT TOTAL:1 $ 126,935
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 8,000
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services 5,305
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 13,305
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ -
Administrative Overhead
6002 Professional Liability Insurance 30,242
6003 Accounting/Bookkeeping 4,120
6004 External Audit 9,200
6005 Insurance(Specify):
6006 Payroll Services 510
6007 Depreciation(Provider-Owned Equipment to be Usedfor Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 44,072
INDIRECT COST RATE 4.67%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ -
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data 1,235
7003 Furniture&Fixtures 5,560
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+ -
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 6,795
TOTAL PROGRAM EXPENSES $ 987,775
18 of 36
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 $
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0
8009 Other(Specify) 0
8010 Other(Specify) 0
Estimated Specialty Mental Health Services Billing Totals: 0 $
Estimated%of Clients who are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation(FFP)% 1 0%
MEDI-CAL FFP TOTAL $
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ 987,775
REALIGNMENT TOTAL $ 987,775
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-Capital Facilities&Technology
MHSA TOTAL $
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance
8403 Grants(Specify)
8404 Other(Specify)
8405 Other(Specify)
OTHER REVENUE TOTAL $
TOTAL PROGRAM FUNDING SOURCES: 1 $ 987,775
NET PROGRAM COST: $ -
19 of 36
Family Time Services
North Star Family Center
Fiscal Year(FY)3:2026-27 Budget Narrative
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 757,538
Administrative Positions 217,137
1101 Admin Assistant 40,514 Full Time$21.22/hr
1102 Admin Assistant 30,386 Part Time$19.47/hr
1103 Scheduling Assistant 30,386 Part Time$19.47/hr
1104 HR/Finance 42,966 Part Time$45.90/hr
1105 Program Director 31,509 Part Time$45.90/hr
1106 Quality Assurance 41,375 Part Time$39.78/hr
1107 0 -
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 435,241
1116 Program Supervisor/ISFT Supervisor 88,055 Full Time$42.33/hr
1117 ISFT Supervisor 51,769 Full Time$28.03/hr
1118 SIFT Supervisor 47,267 Full Time$22.72/hr
1119 SIFT Supervisor 35,450 Part Time$22.72/hr
1120 SIFT Supervisor 35,450 Part Time$22.72/hr
1121 SIFT Supervisor 35,450 Part Time$22.72/hr
1122 SIFT Supervisor 35,450 Part Time$22.72/hr
1123 SIFT Supervisor 35,450 Part Time$22.72/hr
1124 SIFT Supervisor 35,450 Part Time$22.72/hr
1125 SIFT Supervisor 35,450 Part Time$22.72/hr
1126 0 -
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10
Direct Employee Benefits 58,482
1201 Retirement 26,100 3%increase from previous year due to increase in salaries
1202 Worker's Compensation 9,462 3%increase from previous year due to increase in salaries
1203 Health Insurance 22,920 3%increase from previous year due to increase in salaries
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 46,678
1301 OASDI -
1302 FICA/MEDICARE 24,712 3%increase from previous year due to increase in salaries
1303 SUI 21,966 3%increase from previous year due to increase in salaries
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
20 of 36
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2000:DIRECT CLIENT SUPPORT
2001 Child Care
2002 Client Housing Support
2003 Client Transportation&Support
2004 Clothing,Food,&Hygiene
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 39,130
3001 Telecommunications 5,305 442.08/month phones and internet
3002 Printing/Postage 3,820 Printer paper,ink,postage
3003 Office,Household&Program Supplies 18,175 $345/month sanitation service. Reoccurring office supplies(pens,pencils,
staples/staplers,etc).Additional program supplies/replacements include kitchen items
(dish soap,air fryer,toaster,microwave,fridge),TV,video game console,video games,
board games,books,coloring materials,and toys replacements.Also accounting for
diapers,wipes,spare clothes replacements.
3004 Advertising -
3005 Staff Development&Training 8,615 Yearly trainings/developments
3006 Staff Mileage 1,750 Cost of staff mileage reimbursement per year for traveling if any home visits are
required. Increased from previous due to planning on additional referrals
3007 Subscriptions&Memberships 1,465 $122/month includes email,Microsoft,Adobe
3008 Vehicle Maintenance -
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify) -
4000:DIRECT FACILITIES&EQUIPMENT 126,935
4001 Building Maintenance 20,600 Includes janitorial services,yearly CAMS,any additional maintainence to the building
to ensure it is presentable for our clients. Paint,carpet,etc.
4002 Rent/Lease Building 93,540 Rent for both units @ 4969 E.Clinton Way Suite 113 and 119
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles
4005 Security -
4006 Utilities 12,795 Utilities for both units @ 4969 E.Clinton Way Suite 113 and 119
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify) -
5000:DIRECT SPECIAL EXPENSES 13,305
5001 Consultant(Network&Data Management) 8,000 Server maintenance
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 5,305 Yearly translations
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 44,072
6001 Administrative Overhead -
6002 Professional Liability Insurance 30,242 Includes 3%increase from previous year
6003 Accounting/Bookkeeping 4,120 Includes 3%increase from previous year
6004 External Audit 9,200 Includes 3%increase from previous year
6005 Insurance(Specify): -
21 of 36
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6006 Payroll Services 510 Includes 3%increase from previous year
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 6,795
7001 Computer Equipment&Software -
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 1,235 Phone replacements/purchasing of activations for emergency phones
7003 Furniture&Fixtures 5,560 Yearly replacements if damage occurs
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 987,775
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 987,775
BUDGET CHECK: -
22 of 36
Family Time Services
North Star Family Center
Fiscal Year(FY)4: 2027-28
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Admin Assistant 1.00 $ $ 41,729.42
1102 Admin Assistant 0.75 $ 31,297.46
1103 Scheduling Assistant 0.75 $ 31,297.46
1104 HR/Finance 0.45 $ 44,255.44
1105 Program Director 0.33 $ 32,453.99
1106 Quality Assurance 0.50 $ 42,616.35
1107 -
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 3.78 $ $ 223,650
Acct# Program Position FTE Admin Program Total
1116 Program Supervisor/ISFT Supervisor 1.00 $ $ 90,696.34
1117 ISFT Supervisor 1.00 $ 53,321.58
1118 SFT Supervisor 1.00 $ 48,684.93
1119 SFT Supervisor 0.75 $ 36,513.70
1120 SFT Supervisor 0.75 $ 36,513.70
1121 SFT Supervisor 0.75 $ 36,513.70
1122 SFT Supervisor 0.75 $ 36,513.70
1123 SFT Supervisor 0.75 $ 36,513.70
1124 SFT Supervisor 0.75 $ 36,513.70
1125 SFT Supervisor 0.75 $ 36,513.70
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 8.25 $ $ 448,299
Admin Program Total
Direct Personnel Salaries Subtotal 12.03 $ $ $ 671,949
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 8,949.00 $ 17,934 $ 26,883
1202 Worker's Compensation $ 3,243.00 6,502 9,745
1203 Health Insurance $ 5,901.00 17,706 23,607
1204 Other(specify) - - -
1205 Other(specify)
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ 18,093 $ 42,142 $ 60,235
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 $ $ $
23 of 36
1302 FICA/MEDICARE 8,473 16,981 25,454
1303 SUI 7,530 15,095 22,625
1304 Other(specify) - - -
1305 Other(specify)
1306 Other(specify)
Direct Payroll Taxes&Expenses Subtotal: $ 16,003 $ 32,076 $ 48,079
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 34,096 $ 74,218 $ 780,263
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
4% 10%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support
2003 Client Transportation&Support
2004 Clothing,Food,&Hygiene
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 5,464.00
3002 Printing/Postage $ 3,935.00
3003 Office,Household&Program Supplies $ 13,320.00
3004 Advertising $ -
3005 Staff Development&Training $ 8,873.00
3006 Staff Mileage $ 1,803.00
3007 Subscriptions&Memberships $ 1,509.00
3008 IVehicle Maintenance -
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 34,904
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 17,600
4002 Rent/Lease Building 96,552
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles -
4005 ISecurity
4006 Utilities 13,178
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
24 of 36
I DIRECT FACILITIES/EQUIPMENT TOTAL] $ 127,330 I
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 8,000
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 5,460
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 13,460
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ -
Administrative Overhead
6002 Professional Liability Insurance 31,150
6003 Accounting/Bookkeeping 4,245
6004 External Audit 9,200
6005 Insurance(Specify):
6006 Payroll Services 525
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 45,120
INDIRECT COST RATE 4.69%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data $ 1,272
7003 Furniture&Fixtures 5,000
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify) -
FIXED ASSETS EXPENSES TOTAL $ 6,272
TOTAL PROGRAM EXPENSES $ 1,007,349
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 $
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0
25 of 36
8009 Other(Specify) 0
8010 10ther(Specify) 0
Estimated Specialty Mental Health Services Billing Totals: 0 $
Estimated%of Clients who are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation(FFP)% 1 0%
MEDI-CAL FFP TOTAL $
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ 1,007,349
REALIGNMENT TOTAL $ 1,007,349
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $
8302 PEI-Prevention&Early Intervention
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-Capital Facilities&Technology
MHSA TOTAL $
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance
8403 Grants(Specify)
8404 Other(Specify)
8405 Other(Specify)
OTHER REVENUE TOTAL $
TOTAL PROGRAM FUNDING SOURCES: $ 1,007,349
NET PROGRAM COST: $ -
26 of 36
Family Time Services
North Star Family Center
Fiscal Year(FY)4:2027-28 Budget Narrative
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 780,263
Administrative Positions 223,650
1101 Admin Assistant 41,729 Full Time$21.85/hr
1102 Admin Assistant 31,297 Part Time$20.05/hr
1103 Scheduling Assistant 31,297 Part Time$20.05/hr
1104 HR/Finance 44,255 Part Time$47.27/hr
1105 Program Director 32,454 Part Time$47.27/hr
1106 Quality Assurance 42,616 Part Time$40.97/hr
1107 0 -
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 448,299
1116 Program Supervisor/ISFT Supervisor 90,696 Full Time$43.59/hr
1117 ISFT Supervisor 53,322 Full Time$28.87/hr
1118 SFT Supervisor 48,685 Full Time$23.40/hr
1119 SFT Supervisor 36,514 Part Time$23.40/hr
1120 SFT Supervisor 36,514 Part Time$23.40/hr
1121 SFT Supervisor 36,514 Part Time$23.40/hr
1122 SFT Supervisor 36,514 Part Time$23.40/hr
1123 SFT Supervisor 36,514 Part Time$23.40/hr
1124 SFT Supervisor 36,514 Part Time$23.40/hr
1125 SFT Supervisor 36,514 Part Time$23.40/hr
1126 0 -
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits 60,235
1201 Retirement 26,883 3%increase from previous year due to increase in salaries
1202 Worker's Compensation 9,745 3%increase from previous year due to increase in salaries
1203 Health Insurance 23,607 3%increase from previous year due to increase in salaries
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify)
Direct Payroll Taxes&Expenses: 48,079
1301 OASDI -
1302 FICA/MEDICARE 25,454 3%increase from previous year due to increase in salaries
1303 SUI 22,625 3%increase from previous year due to increase in salaries
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT
2001 Child Care
2002 Client Housing Support
2003 Client Transportation&Support
2004 Clothing,Food,&Hygiene
2005 Education Support
2006 Employment Support
27 of 36
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 34,904
3001 Telecommunications 5,464 455.33/month phones and internet
3002 Printing/Postage 3,935 Printer paper,ink,postage
3003 Office,Household&Program Supplies 13,320 $355/month sanitation service. Reoccurring office supplies(pens,pencils,
staples/staplers,etc).Additional program supplies/replacements include kitchen items
(dish soap,air fryer,toaster,microwave,fridge),TV,video game console,video games,
board games,books,coloring materials,and toys replacements.Also accounting for
diapers,wipes,spare clothes replacements.
3004 Advertising -
3005 Staff Development&Training 8,873 Yearly trainings/developments
3006 Staff Mileage 1,803 Cost of staff mileage reimbursement per year for traveling if any home visits are
required. Increased from previous due to planning on additional referrals
3007 Subscriptions&Memberships 1,509 $126/month includes email,Microsoft,Adobe
3008 Vehicle Maintenance -
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 127,330
4001 Building Maintenance 17,600 Includes janitorial services,yearly CAMS,any additional maintainence to the building
to ensure it is presentable for our clients. Paint,carpet,etc.
4002 Rent/Lease Building 96,552 Rent for both units @ 4969 E.Clinton Way Suite 113 and 119
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles
4005 Security -
4006 Utilities 13,178 Utilities for both units @ 4969 E.Clinton Way Suite 113 and 119
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 13,460
5001 Consultant(Network&Data Management) 8,000 Server maintenance
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services -
5004 Translation Services 5,460 Yearly translations
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 45,120
6001 Administrative Overhead -
6002 Professional Liability Insurance 31,150 Includes 3%increase from previous year
6003 Accounting/Bookkeeping 4,245 Includes 3%increase from previous year
6004 External Audit 9,200 Includes 3%increase from previous year
6005 Insurance(Specify): -
6006 Payroll Services 525 Includes 3%increase from previous year
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify) -
28 of 36
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 6,272
7001 Computer Equipment&Software -
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 1,272 Phone replacements/purchasing of activations for emergency phones
7003 Furniture&Fixtures 5,000 Yearly replacements if damage occurs
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,007,349
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 1,007,349
BUDGET CHECK: -
29 of 36
Family Time Services
North Star Family Center
Fiscal Year(FY)5:2028-29
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Admin Assistant 1.00 $ $ 42,981.30
1102 Admin Assistant 0.75 $ 32,236.38
1103 Scheduling Assistant 0.75 $ 32,236.38
1104 HR/Finance 0.45 $ 45,583.10
1105 Program Director 0.33 $ 33,427.61
1106 Quality Assurance 0.50 $ 43,894.84
1107 -
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 3.78 $ $ 230,360
Acct# Program Position FTE Admin Program Total
1116 Program Supervisor/ISFT Supervisor 1.00 $ $ 93,417.23
1117 ISFT Supervisor 1.00 $ 54,921.23
1118 SFT Supervisor 1.00 $ 50,145.48
1119 SFT Supervisor 0.75 $ 37,609.11
1120 SFT Supervisor 0.75 $ 37,609.11
1121 SFT Supervisor 0.75 $ 37,609.11
1122 SFT Supervisor 0.75 $ 37,609.11
1123 SFT Supervisor 0.75 $ 37,609.11
1124 SFT Supervisor 0.75 $ 37,609.11
1125 SFT Supervisor 0.75 $ 37,609.11
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 8.25 $ $ 461,748
Admin Program Total
Direct Personnel Salaries Subtotal 12.03 $ $ $ 692,107
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 9,217.00 $ 18,472 $ 27,689
1202 Worker's Compensation $ 3,340.00 6,697 10,037
1203 Health Insurance $ 6,078.00 18,237 24,315
1204 Other(specify) - - -
1205 Other(specify)
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ 18,635 $ 43,406 $ 62,041
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ $ $
30 of 36
1302 FICA/MEDICARE 8,727 17,490 26,217
1303 SUI 7,756 15,548 23,304
1304 Other(specify) - - -
1305 Other(specify)
1306 Other(specify)
Direct Payroll Taxes&Expenses Subtotal: $ 16,483 $ 33,038 $ 49,521
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 35,118 $ 76,444 $ 803,669
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
4% 10%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support
2003 Client Transportation&Support
2004 Clothing,Food,&Hygiene
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 5,628.00
3002 Printing/Postage $ 2,500.00
3003 Office,Household&Program Supplies $ 8,000.00
3004 Advertising $ -
3005 Staff Development&Training $ 9,000.00
3006 Staff Mileage $ 1,803.00
3007 Subscriptions&Memberships $ 1,554.00
3008 IVehicle Maintenance -
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 28,485
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 13,000
4002 Rent/Lease Building 99,564
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles
4005 ISecurity -
4006 Utilities 13,561
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
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I DIRECT FACILITIES/EQUIPMENT TOTAL] $ 126,125 I
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 2,500
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 5,624
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 8,124
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ -
Administrative Overhead
6002 Professional Liability Insurance 32,085
6003 Accounting/Bookkeeping 4,372
6004 External Audit 9,200
6005 Insurance(Specify):
6006 Payroll Services 540
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 46,197
INDIRECT COST RATE 4.76%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ -
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data $ 1,400
7003 Furniture&Fixtures 2,500
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify) -
FIXED ASSETS EXPENSES TOTAL $ 3,900
TOTAL PROGRAM EXPENSES $ 1,016,500
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 $
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0
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8009 Other(Specify) 0
8010 10ther(Specify) 0
Estimated Specialty Mental Health Services Billing Totals: 0 $
Estimated%of Clients who are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation(FFP)% 1 0%
MEDI-CAL FFP TOTAL $
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ 1,016,500
REALIGNMENT TOTAL $ 1,016,500
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $
8302 PEI-Prevention&Early Intervention
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-Capital Facilities&Technology
MHSA TOTAL $
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance
8403 Grants(Specify)
8404 Other(Specify)
8405 Other(Specify)
OTHER REVENUE TOTAL $
TOTAL PROGRAM FUNDING SOURCES: $ 1,016,500
NET PROGRAM COST: $ -
33 of 36
Family Time Services
North Star Family Center
Fiscal Year(FY)5:2028-29 Budget Narrative
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 803,669
Administrative Positions 230,360
1101 Admin Assistant 42,981 Full Time$22.50/hr
1102 Admin Assistant 32,236 Part Time$20.65/hr
1103 Scheduling Assistant 32,236 Part Time$20.65/hr
1104 HR/Finance 45,583 Part Time$48.68/hr
1105 Program Director 33,428 Part Time$48.68/hr
1106 Quality Assurance 43,895 Part Time$42.19/hr
1107 0 -
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 10
Program Positions 461,748
1116 Program Supervisor/ISFT Supervisor 93,417 Full Time$44.89/hr
1117 ISFT Supervisor 54,921 Full Time$29.73/hr
1118 SFT Supervisor 50,145 Full Time$24.10/hr
1119 SFT Supervisor 37,609 Part Time$24.10/hr
1120 SFT Supervisor 37,609 Part Time$24.10/hr
1121 SFT Supervisor 37,609 Part Time$24.10/hr
1122 SFT Supervisor 37,609 Part Time$24.10/hr
1123 SFT Supervisor 37,609 Part Time$24.10/hr
1124 SFT Supervisor 37,609 Part Time$24.10/hr
1125 SFT Supervisor 37,609 Part Time$24.10/hr
1126 0
1127 0
1128 0 -
1129 0
1130 0
1131 0
1132 0
1133 10
1134 10
Direct Employee Benefits 62,041
1201 Retirement 27,689 3%increase from previous year due to increase in salaries
1202 Worker's Compensation 10,037 3%increase from previous year due to increase in salaries
1203 Health Insurance 24,315 3%increase from previous year due to increase in salaries
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 49,521
1301 OASDI -
1302 FICA/MEDICARE 26,217 3%increase from previous year due to increase in salaries
1303 SUI 23,304 3%increase from previous year due to increase in salaries
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT
2001 Child Care
2002 Client Housing Support
2003 Client Transportation&Support
2004 Clothing,Food,&Hygiene
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
34 of 36
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 28,485
3001 Telecommunications 5,628 455.33/month phones and internet
3002 Printing/Postage 2,500 Printer paper,ink,postage. Lowered due to final year of contract
3003 Office,Household&Program Supplies 8,000 $365/month sanitation service. Reoccurring office supplies(pens,pencils,
staples/staplers,etc).Additional program supplies/replacements include kitchen
items(dish soap,air fryer,toaster,microwave,fridge),TV,video game console,video
games,board games,books,coloring materials,and toys replacements.Also
accounting for diapers,wipes,spare clothes replacements. Lower than previous years
due to final year of contract. Cannot roll to next year if there are extra supplies
3004 Advertising -
3005 Staff Development&Training 9,000 Yearly trainings/developments
3006 Staff Mileage 1,803 Cost of staff mileage reimbursement per year for traveling if any home visits are
required. Increased from previous due to planning on additional referrals
3007 Subscriptions&Memberships 1,554 $129.50/month includes email,Microsoft,Adobe
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify) -
4000:DIRECT FACILITIES&EQUIPMENT 126,125
4001 Building Maintenance 13,000 Includes janitorial services,yearly CAMS,any additional maintainence to the building
to ensure it is presentable for our clients. Paint,carpet,etc. Smaller budget,
assuming there will be left over supplies from previous years
4002 Rent/Lease Building 99,564 Rent for both units @ 4969 E.Clinton Way Suite 113 and 119
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles
4005 Security -
4006 Utilities 13,561 Utilities for both units @ 4969 E.Clinton Way Suite 113 and 119
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 8,124
5001 Consultant(Network&Data Management) 2,500 Server maintenance
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services -
5004 Translation Services 5,624 Yearly translations
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 46,197
6001 Administrative Overhead -
6002 Professional Liability Insurance 32,085 Includes 3%increase from previous year
6003 Accounting/Bookkeeping 4,372 Includes 3%increase from previous year
6004 External Audit 9,200 Includes 3%increase from previous year
6005 Insurance(Specify): -
6006 Payroll Services 540 Includes 3%increase from previous year
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6 113 I Other(specify)
7000:DIRECT FIXED ASSETS 3,900
7001 1 Computer Equipment&Software
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7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 1,400 Phone replacements/purchasing of activations for emergency phones
7003 Furniture&Fixtures 2,500 Yearly replacements if damage occurs. Some items won't be replaced if not needed
for current year
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7 008 I Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 1 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,016,500
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 1,016,500
BUDGET CHECK: -
36 of 36
Exhibit C
Self-Dealing Transaction Disclosure Form
In order to conduct business with the County of Fresno ("County"), members of a
Subrecipient's board of directors ("County Subrecipient"), 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 used 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.
The form must be signed by the board member that is involved in the self-dealing
transaction described in Sections (3) and (4).
C-1
Exhibit C
(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:
C-2
Exhibit D
Insurance Requirements
1. Required Policies
Without limiting the County's right to obtain indemnification from the Subrecipient or any third
parties, Subrecipient, at its sole expense, shall maintain in full force and effect the following
insurance policies throughout the term of this Agreement.
(A) Commercial General Liability. Commercial general liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence and an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
Coverage must include products, completed operations, property damage, bodily injury,
personal injury, and advertising injury. The Subrecipient shall obtain an endorsement to
this policy naming the County of Fresno, its officers, agents, employees, and volunteers,
individually and collectively, as additional insureds, but only insofar as the operations
under this Agreement are concerned. Such coverage for additional insureds will apply as
primary insurance and any other insurance, or self-insurance, maintained by the County
is excess only and not contributing with insurance provided under the Subrecipient's
policy.
(B) Automobile Liability. Automobile liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for property damages.
Coverage must include any auto used in connection with this Agreement.
(C)Workers Compensation. Workers compensation insurance as required by the laws of
the State of California with statutory limits.
(D) Employer's Liability. Employer's liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for disease.
(E) Professional Liability. Professional liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence and an annual aggregate of Three Million
Dollars ($3,000,000). If this is a claims-made policy, then (1)the retroactive date must
be prior to the date on which services began under this Agreement; (2)the Subrecipient
shall maintain the policy and provide to the County annual evidence of insurance for not
less than five years after completion of services under this Agreement; and (3) if the
policy is canceled or not renewed, and not replaced with another claims-made policy
with a retroactive date prior to the date on which services begin under this Agreement,
then the Subrecipient shall purchase extended reporting coverage on its claims-made
policy for a minimum of five years after completion of services under this Agreement.
(F) Molestation Liability. Sexual abuse/ molestation liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence, with an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
(G)Cyber Liability. Cyber liability insurance with limits of not less than Two Million Dollars
($2,000,000) per occurrence. Coverage must include claims involving Cyber Risks. The
cyber liability policy must be endorsed to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property (including but not limited to
information or data) that is in the care, custody, or control of the Subrecipient.
D-1
Exhibit D
Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security
Breach, which may include Disclosure of Personal Information to an Unauthorized Third
Party; (ii) data breach; (iii) breach of any of the Subrecipient's obligations under [identify
the Article, section, or exhibit containing data security obligations] of this Agreement; (iv)
system failure; (v) data recovery; (vi) failure to timely disclose data breach or Security
Breach; (vii)failure to comply with privacy policy; (viii) payment card liabilities and costs;
(ix) infringement of intellectual property, including but not limited to infringement of
copyright, trademark, and trade dress; (x) invasion of privacy, including release of
private information; (xi) information theft; (xii) damage to or destruction or alteration of
electronic information; (xiii) cyber extortion; (xiv) extortion related to the Subrecipient's
obligations under this Agreement regarding electronic information, including Personal
Information; (xv) fraudulent instruction; (xvi) funds transfer fraud; (xvii) telephone fraud;
(xviii) network security; (xix) data breach response costs, including Security Breach
response costs; (xx) regulatory fines and penalties related to the Subrecipient's
obligations under this Agreement regarding electronic information, including Personal
Information; and (xxi) credit monitoring expenses.
2. Additional Requirements
(A) Verification of Coverage. Within 30 days after the Subrecipient signs this Agreement,
and at any time during the term of this Agreement as requested by the County's Risk
Manager or the County Administrative Office, the Subrecipient shall deliver, or cause its
broker or producer to deliver, to the DSSContractinsurance(aD-fresnocountyca.gov,
Attention: Contract Analyst.
(i) Each insurance certificate must state that: (1) the insurance coverage has been
obtained and is in full force; (2) the County, its officers, agents, employees, and
volunteers are not responsible for any premiums on the policy; and (3) the
Subrecipient has waived its right to recover from the County, its officers, agents,
employees, and volunteers any amounts paid under any insurance policy
required by this Agreement and that waiver does not invalidate the insurance
policy.
(ii) The commercial general liability insurance certificate must also state, and include
an endorsement, that the County of Fresno, its officers, agents, employees, and
volunteers, individually and collectively, are additional insureds insofar as the
operations under this Agreement are concerned. The commercial general liability
insurance certificate must also state that the coverage shall apply as primary
insurance and any other insurance, or self-insurance, maintained by the County
shall be excess only and not contributing with insurance provided under the
Subrecipient's policy.
(iii) The automobile liability insurance certificate must state that the policy covers any
auto used in connection with this Agreement.
D-2
Exhibit D
(iv) The professional liability insurance certificate, if it is a claims-made policy, must
also state the retroactive date of the policy, which must be prior to the date on
which services began under this Agreement.
(v) The cyber liability insurance certificate must also state that it is endorsed, and
include an endorsement, to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property (including but not limited
to information or data) that is in the care, custody, or control of the Subrecipient.
(B) Acceptability of Insurers. All insurance policies required under this Agreement must be
issued by admitted insurers licensed to do business in the State of California and
possessing at all times during the term of this Agreement an A.M. Best, Inc. rating of no
less than A: VI I.
(C) Notice of Cancellation or Change. For each insurance policy required under this
Agreement, the Subrecipient shall provide to the County, or ensure that the policy
requires the insurer to provide to the County, written notice of any cancellation or change
in the policy as required in this paragraph. For cancellation of the policy for nonpayment
of premium, the Subrecipient shall, or shall cause the insurer to, provide written notice to
the County not less than 10 days in advance of cancellation. For cancellation of the
policy for any other reason, and for any other change to the policy, the Subrecipient
shall, or shall cause the insurer to, provide written notice to the County not less than 30
days in advance of cancellation or change. The County in its sole discretion may
determine that the failure of the Subrecipient or its insurer to timely provide a written
notice required by this paragraph is a breach of this Agreement.
(D) County's Entitlement to Greater Coverage. If the Subrecipient has or obtains
insurance with broader coverage, higher limits, or both, than what is required under this
Agreement, then the County requires and is entitled to the broader coverage, higher
limits, or both. To that end, the Subrecipient shall deliver, or cause its broker or producer
to deliver, to the County's Risk Manager certificates of insurance and endorsements for
all of the coverages that have such broader coverage, higher limits, or both, as required
under this Agreement.
(E) Waiver of Subrogation. The Subrecipient waives any right to recover from the County,
its officers, agents, employees, and volunteers any amounts paid under the policy of
worker's compensation insurance required by this Agreement. The Subrecipient is solely
responsible to obtain any policy endorsement that may be necessary to accomplish that
waiver, but the Subrecipient's waiver of subrogation under this paragraph is effective
whether or not the Subrecipient obtains such an endorsement.
(F) County's Remedy for Subrecipient's Failure to Maintain. If the Subrecipient fails to
keep in effect at all times any insurance coverage required under this Agreement, the
County may, in addition to any other remedies it may have, suspend or terminate this
Agreement upon the occurrence of that failure, or purchase such insurance coverage,
and charge the cost of that coverage to the Subrecipient. The County may offset such
charges against any amounts owed by the County to the Subrecipient under this
Agreement.
D-3
Exhibit D
(G)Subcontractors. The Subrecipient shall require and verify that all subcontractors used
by the Subrecipient to provide services under this Agreement maintain insurance
meeting all insurance requirements provided in this Agreement. This paragraph does not
authorize the Subrecipient to provide services under this Agreement using
subcontractors.
D-4