HomeMy WebLinkAboutAgreement A-24-574 Amendment No. 4 to Master Agreement.pdf Agreement No. 24-574
1 AMENDMENT NO. 4 TO SERVICE AGREEMENT
2 This Amendment No. 4 to Service Agreement ("Amendment No. 4") is dated
3 November 5, 2024 and is between the County of Fresno, a political subdivision of the State
4 of California ("County"), and each Provider listed in Revised Exhibit A-4, "List of Providers"
5 (collectively referred to as "Provider"). Reference in this Agreement to "party" or "parties" shall
6 be understood to referred to county and each provider, unless otherwise specified.
7 Recitals
8 A. On June 23, 2020, the County and the Contractor entered into Individual/Group Provider
9 Master Agreement, which is County Agreement number 20-236, for specialty mental health
10 services to County's Medi-Cal beneficiaries; and.
11 B. On June 30, 2023, the County and the Provider amended the above service Agreement,
12 which is Agreement number 23-271 to add additional Provider to the Agreement and incorporate
13 a new billing structure due to the implementation of the California Advancing and Innovation
14 Medi-Cal (CaIAIM) initiative by the Department of Health Care Services; and
15 C. On January 9, 2024 the County and Provider amended the above service Agreement,
16 which is Agreement number 24-021 to add additional provider to the Agreement, and
17 D. On May 21, 2024 the County and Provider amended the above service Agreement,
18 which is Agreement number 24-214 (the Agreement and Amendments are collectively referred
19 to as the "Agreement") to increase the maximum budget amount, revise billing rates, remove
20 one provider, and add three providers to the agreement, and
21 E. The County now desire to further amend the Agreement to add the following Providers to
22 the Agreement: (1) Valley Children's Hospital, (2) A Hopeful Encounter, Inc., (3) The Healing
23 Circle: A Marriage & Family Therapy Professional Corporation, (4) Erica McClincy and (5)
24 Eugene Yamamoto, reflected on Revised Exhibit A-4.
25 The parties therefore agree as follows:
26 1. All references to Revised Exhibit A-3 shall be deemed references to Revised Exhibit A-4,
27 effective upon execution. Revised Exhibit A-4 is attached and incorporated by this reference.
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1 2. The parties agree that upon execution of this Amendment No. 4, Agreement No. 24-217,
2 as previously amended, is further revised, updated, and amended to add the following Providers:
3 (1)Valley Children's Hospital, (2)A Hopeful Encounter, (3)The Healing Circle: A Marriage &
4 Family Therapy Professional Corporation, (4) Erica McClincy and (5) Eugene Yamamoto.
5 3. The Provider represent and warrant to the county that:
6 a. The Provider is duly authorized and empowered to sign and perform its obligations
7 under this Amendment.
8 b. The individual signing this Amendment of on behalf of the Provider is duly authorized
9 to do so and his or her signature on this Amendment legally binds the Provider to the
10 terms of this Amendment.
11 4. The parties agree that this Amendment may be executed by electronic signature as
12 provided in this section.
13 a. An "electronic signature" means any symbol or process intended by an individual
14 signing this Amendment to represent their signature, including but not limited to (1) a
15 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
16 electronically scanned and transmitted (for example by PDF document) version of an
17 original handwritten signature.
18 b. Each electronic signature affixed or attached to this Amendment (1) is deemed
19 equivalent to a valid original handwritten signature of the person signing this
20 Amendment for all purposes, including but not limited to evidentiary proof in any
21 administrative or judicial proceeding, and (2) has the same force and effect as the
22 valid original handwritten signature of that person.
23 c. The provisions of this section satisfy the requirements of Civil Code section 1633.5,
24 subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3, Part
25 2, Title 2.5, beginning with section 1633.1).
26 d. Each party using a digital signature represents that it has undertaken and satisfied
27 the requirements of Government Code section 16.5, subdivision (a), paragraphs (1)
28 through (5), and agrees that each other party may rely upon that representation.
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1 e. This Amendment is not conditioned upon the parties conducting the transactions
2 under it by electronic means and either party may sign this Amendment with an
3 original handwritten signature.
4 5. This Amendment may be signed in counterparts, each of which is an original, and all of
5 which together constitute this Amendment.
6 6. The Agreement, as previously amended, and as amended by this Amendment No. 4 is
7 ratified and continued. All provisions of the Agreement as previously amended, and not
8 amended by this Amendment No. 4 remain in full force and effect.
9 7. When both parties have signed this Amendment No. 4, the Agreement, Amendment No.
10 1, Amendment No. 2, Amendment No. 3 and this Amendment No. 4 together constitute the
11 Agreement.
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1 The parties are signing this Amendment No. 4 on the date stated in the introductory
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Providers COUNTY OF FRESNO
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Please See Signature Pages Attached
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6 Nathan Magsig, Chairman of the Board of
Supervisors of the County of Fresno
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Attest:
8 Bernice E. Seidel
Clerk of the Board of Supervisors
9 County of Fresno, State of California
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By: �
11 Deputy v
12 For accounting use only:
13 Org No.: 56302666
Account No.: 7223/0
14 Fund No.: 0001
Subclass No.: 10000
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I This Amendment No. 4 to Agreement No. 20-236 is tieing executers on the date stated in
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Provider(Individual). Enca McChncv
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Title:
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1 This Amendment No. 4 to Agreement No. 20-236 is being executed on the date stated in
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Provider (Individual): Eugene Yamamoto
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By:_4_jzl�
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Title: Z C'sLv' --50LC
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1 This Amendment No. 4 to Agreement No. 20-236 is being executed on the date stated in
2 the introductory clause.
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Provider (Group): A Hopeful Encounter
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5 lyBy:
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Print Name: C]
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8 Title: P F2ES 101F1U
Chairman of the Board, or President, or any Vice President
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10 Date: _� L)
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Print Name:
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Secretary (of Corporation), or any Assistant Secretary,
17 or Chief Financial Officer, or any Assistant Treasurer
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1 This Amendment No. 4 to Agreement No. 20-236 is being executed on the date stated in
2 the introductory clause.
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Provider(Group): The Healing Circle: A Marriage & Family
4 Therapy Professional Corporation
5 Gerardo Madrigal, LMFT Digitally signed by Gerardo Madrigal,LMFT
By:
g Date:2024.09.05 13:02:00-07'00'
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7 Print Name: Gerardo L. Madrigal
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Title: Owner
9 Chairman of the Board,or President, or any Vice President
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Date: 09/05/2024
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By:
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Title:
17 Secretary(of Corporation),or any Assistant Secretary,
or Chief Financial Officer, or any Assistant Treasurer
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Docusign Envelope ID: D12E1 B4D-7719-4D93-914E-59CCE64B3BBB
1 This Amendment No. 4 to Agreement No. 20-236 is being executed on the date stated in
2 the introductory clause.
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Provider(Group): Valley Children's Hospital
4 ocuSigned by:
5 By,E� Y256
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6 Tina Mycroft
Print Name:
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8 Title: SVP and CFO
Chairman of the Board, or President, or any Vice President
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10 Date: 10/9/2024 1 16:14:43 PDT
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Print Name:
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Secretary (of Corporation), or any Assistant Secretary,
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Date:
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Page 1 of 3
Revised Exhibit A-4
Individual Providers
Name Address Email
Amato, Dolores 6777 N. Willow Ave Fresno, CA 93710 dgamato@gmail.com
Cisneros, Karina 5070 N. Sixth Street Suite 105, Fresno, CA karicbm22@gmail.com
93710
Cooke, Johanna V. 5100 N. 6th St Fresno, CA 93710, Ste 151 jcooke.lcsw@gmail.com
Dickey, Judith 501 E. Terrace Ave Fresno CA 93704 jstoryteller1 @icloud.com
Farris, Donald 3740 Circle Dr. Fresno, CA 93704-4765 donfarris1871@gmail.com
Jones, Kimberly M. 5665 S. Chestnut Ave Spc 61 Fresno, CA drkimjones02@gmail.com
93725
La Familia Therapy
Services, Inc. 4229 E. Clinton, Fresno, CA 93703 lafamiliatherapyservices@gmail.com
Lynch, Nasim Nancy 5151 N. Palm Ave#950, Fresno, CA 93704 nancylynch24@hotmail.com
Madrigal, Gerardo 5528 N. Palm Ave Suite#122 Fresno, CA gmadrigal80@gmail.com
93704
McClincy, Erica 1100 W. Shaw Ave Suite 120 Fresno, CA EricaMcClincy.LCSW@gmail.com
93711
Nalls, Kannon E. 739 Meadow Ct., Exeter, CA 93221 drkannonnalls@gmail.com
5588 N. Palm Ave, Fresno CA 93704
1445 Marion St Kin sbur , CA 93631
Quintanilla, Elsa 5588 N. Palm Ave Fresno, CA 93704 quintanillac12@gmail.com
Quintanilla, Juan 5588 N. Palm Ave Fresno, CA 93704 archaicvegan@outlook.com
Randolph, Michelle 438 E. Shaw Ave#140 Fresno, CA 93710 michelleneufer(c�gmail.com
5070 N. 6th Street Suite 105, Fresno, CA 93710
Roltgen, Teresa 2505 W. Shaw Ave Fresno, CA 93711 teriroltgen@gmail.com
Romero, Jorge 373 E. Shaw Ave# 140, Fresno, CA 93710 ajorgeandrom@aol.com
Tucibat, Michael 6777 N. Willow Ave, Suite# 142 Fresno, CA Mike.Tucibat.LMFT@infinitewebs.net
93710
5070 N. Sixth Street Suite 105, Fresno, CA
Vang, Ka Bao 93710 kbadame02@gmail.com
Xiong, Zoua 5588 N. Palm Ave Fresno, CA 93704 zouaxiongmft@gmail.com
Yamamoto, Eugene 5151 N. Palm Ave Suite 500 Fresno, CA 93704 Yamfamily2@gmail.com
Page 2 of 3
Revised Exhibit A-4
Group Providers
Name Address Email
A Hopeful Encounter 3253 E. Shields Ave Fresno, CA 93726 susanxiong(@bhopefulencounter.org
Allay Psychological Services 2900 Fresno St.# 108, Fresno, CA 93721 reshale@allaypsych.com
Bio Behavioral Medical Clinics 1060 W. Sierra Ave, Suite 105, Fresno, CA mmuro@bbmc-inc.com
93711
DN Associates 4460 W. Shaw Ave#595, Fresno, CA 93722 cdonovan@coreconditions.org
Erene Soliman Psychologist INC. 5151 N. Palm Ave#500, Fresno, CA 93704 esoliman@att.net
575 E. Locust Ave STE 101, Fresno, CA
Esperanza Family Counseling 93720 sergiop.esperanzafc@gmail.com
Fresno American Indian Health 1551 E. Shaw Ave.#139, Fresno, CA 93710 bramirez@faihp.org
Project
Fresno New Connections 4411 N. Cedar Ave, Fresno, CA 93726 rmartin@teamfnc.com
Generational Changes, Inc. 2409 Merced St Ste 106 Fresno, CA 93721 gchanges.inc@gmail.com
Healing Hope, Inc. 1913 N. Gateway Blvd#101, Fresno, CA morxpopper@healinghopeinc.org
93727
1322 E. Shaw Ave Suite 410, Fresno, CA
House Psychiatric Clinic, Inc. 93710 staff@houseclinic.org
Impact Behavioral Health and 1616 W. Shaw Ave BLD B2 Fresno CA, impactbhrc@gmail.com
Recovery 93711
Inspire Psychological Services, 5807 E. Beck Ave, Fresno, CA 93727 chengvang2004@gmail.com
Inc.
Integral Community Solutions
Institute 1065 S St Building 1, Fresno, CA 93721 jcgarcia@icsi.solutions
Joint Opportunities 1424 W. California Ave, Fresno, CA 93706 mickievalentine@icloud.com
Marjaree Mason Center 1600 M Street, Fresno, CA 93721 laurae@mmcenter.org
3451 W. Shaw Ave Ste 102, Fresno CA
Omid Counseling Center, Inc. 93711 Omidhopecenter@gmail.com
Poverello House Enrichment 412 F St Fresno, CA 93706 kmurphy@poverellohouse.org
Center
Precision Psychiatric CAO(@_precisionpsvch.com
Services, Inc. 7850 White Lane, Suite E301, Bakersfield,
CA 93309 minty(o-)precisionpsych.com
bodoh@precisionpsych.com
Page 3 of 3
Revised Exhibit A-4
Prodigy Healthcare Inc. 311 E. Merced St., Fowler CA, 93625 harjas@prodigy-hc.com;rodi hc.com
@p gy
JRomero@promesabehavioral.org;
Imcclain@promesabehavioral.org;
Promesa Behavioral Health 7120 N. Marks Ave, Fresno, CA 93711 Iweigant@promesabehavioral.org;
ezuniga@promesabehavioral.org
valeriec@qual ityfamilyservices.org;
4946 E.Yale Ave, Suite 103, Fresno, CA sarah@qualityfamilyservices.org;
Quality Group Homes, Inc. 93727 lisac@qualityfamilyservices.org;
duked@qualityfamilyservices.org
refe rra I @fre s n o rc.o rg;
Resiliency Center of Fresno 3845 N. Clark St Ste 201 Fresno, CA 93726 parrot@fresnorc.org;
rlowrey@fresnorrc.org
roncsteele1 @gmail.com
Ron Steele and Associates Inc 5150 N. 6th St STE 169, Fresno, CA 93710
ajsimmslmft@gmail.com
Simmons&Simmons Wellness 2190 N.Winery Ave Suite 102, Fresno, CA
Center 93703
soymejica@verizon.net
SJET Clinical Services 418 N. 6th Street, Fowler, CA 93625
Gmadriga180(a�gmail.corn
The Healing Circle: A Marriage & 1033 N. Fulton St, Fresno, CA 93728
Family Therapy Professional
Corporation
MDanovsky(cD.valleychildrens.org
Valley Children's Hospital 9300 Valley Children's Place, Madera, CA
93636
mickievalentine@icloud.com
West Side Church of God 1424 W. California Ave, Fresno, CA 93706