HomeMy WebLinkAboutAgreement A-20-022 with Vendor listed in Exhibit A.pdfAgreement No . 20 -022
1 AGREEMENT
2 THIS AGREEMENT is made and entered into this 7th day of January , 2020 , by and between
3 the COUNTY OF FRESNO , a Political Subdivision of the State of Californ ia , here inafter referred to as
4 "COUNTY", and each Vendor listed in Exhibit A "Contractors List", attached hereto and by th is reference
5 incorporated herein , collectively herein referred to as "CONTRACTOR". Reference in this Agreement to
6 "party" or "parties" shall be understood to refer to the COUNTY and each CONTRACTOR(S), unless
7 otherwise specified .
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W I T N E S S E T H:
WHEREAS, COUNTY is in need of pre-employment psychological screen ing and evaluation
seNices to be conducted by qualified mental health practitioners consistent with California Government
Code Section 1031 (f) and Californ ia Peace Officer Standards and Training (POST) Commission Regulation
1955;and
WHEREAS , COUNTY sought bids for the provision of these psychological screening and
evaluation seNices by issuing Request for Proposal (RFP) No . 20-020 ; and
WHEREAS, each CONTRACTOR submitted a response to RFP No . 20-020 , is qualified
consistent with California Government Code Section 1031 (f) and POST Commission Regulation 1955 and
willing to provide such seNices pursuant to the terms and conditions of this Agreement.
NOW, THEREFORE , in cons ideration of the mutual covenants, terms and conditions herein
contained, the parties hereto agree as follows :
1 . OBLIGATIONS OF THE CONTRACTOR
A CONTRACTOR shall perform all seNices and fulfill all responsibilities as identified
in COUNTY'S Request for Proposal (RFP ) No . 20-020 , dated September 18 , 2019 , and CONTRACTOR 'S
response to said RFP , all incorporated herein by reference and made part of this Agreement. In the event
of any inconsistency among these documents , the inconsistency shall be resolved by giving precedence in
the following order of priority : 1) to this Agreement , including Exhibits "A " and "B", 2) to the RFP , and 3) to
the Response to the RFP. A copy of COUNTY 's RFP No 20-020 , and the three CONTRACTORS '
responses , shall be retained by COUNTY's Human Resources Department , and made available during the
term of this Agreement.
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B. CONTRACTOR shall conduct pre-employment psychological screenings, special
compulsory psychological evaluations and third opinion appeal evaluation services for safety and non-
safety COUNTY positions when requested by the COUNTY as specified in RFP No. 20-020.
CONTRACTOR understands that the COUNTY typically recruits to fill multiple vacancies at one time and
CONTRACTOR agrees to perform as many requested screenings as necessary to meet COUNTY’s needs.
CONTRACTOR agrees to have resources available to accommodate such referrals.
C. CONTRACTOR’s staff performing services under this Agreement shall be
qualified professionals as defined in Government Code Section 1031(f), California POST Commission
Regulation 1955 and shall meet any and all applicable education and training requirements for the
performance of pre-employment psychological screenings and special compulsory evaluations of peace
officers as set forth by Federal, State and Local regulations including California Commission on POST and
will maintain such qualifications during the term of this Agreement.
D. CONTRACTOR shall also perform special services related to screenings and
evaluations conducted for the COUNTY. Special services include, but are not limited to: participating in
case reviews; providing expert testimony in administrative and legal proceedings related to appeals of
screenings and evaluations conducted; consulting with COUNTY regarding such appeals or regarding
COUNTY concerns related to screening and evaluation processes; and rendering an opinion as to whether
a candidate/employee is a qualified individual with a disability as defined by California State law as well as
suggestions to accommodate such individuals. CONTRACTOR shall obtain pre-approval from the
COUNTY before CONTRACTOR provides any special services.
E. CONTRACTOR shall conduct psychological screenings at their place of business.
However, CONTRACTOR agrees to conduct psychological screenings at locations other than
CONTRACTOR’s office, if requested by the COUNTY.
F. CONTRACTOR shall schedule a screening or evaluation appointment within five
(5) working days of CONTRACTOR being notified of COUNTY’s need. The date of each scheduled
appointment shall be within ten (10) working days from the date of original notification. CONTRACTOR
shall notify COUNTY the same day if a candidate/employee cancels or fails to show for a scheduled
appointment. All re-scheduling of candidates, if any, will be done after obtaining approval from the
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COUNTY. CONTRACTOR shall provide final results to the COUNTY within five (5) working days of the
completion of each screening or evaluation.
G. Prior to conducting a screening or evaluation, CONTRACTOR shall obtain the
candidate/employee’s written authorization to release test results, interpretation reports and interview
evaluation summaries to the COUNTY. The written authorization may be required to be in a format pre-
approved by the COUNTY.
H. CONTRACTOR agrees to perform the services covered herein in strict
accordance with all applicable Federal, State, and local statutes, regulations, ordinances, rules and policies
governing the practice of medicine and provision of psychological services.
J. Under this Agreement, each CONTRACTOR only has rights and obligations with
respect to the COUNTY. This Agreement creates no rights or obligations between any
CONTRACTORs; no CONTRACTOR has any right to receive performance under this Agreement from,
or to enforce any part of this Agreement against, any other CONTRACTOR.
K. CONTRACTOR understands there is no guarantee made by COUNTY to any
CONTRACTOR that any services shall be requested by COUNTY from CONTRACTOR. Furthermore,
CONTRACTOR understands this agreement is non-exclusive and shall not prohibit COUNTY from
entering into agreement with other providers of pre-employment psychological screening and evaluation
services.
2. OBLIGATIONS OF THE COUNTY
A. COUNTY’s Department of Human Resources shall provide CONTRACTOR
appropriate notification for scheduling psychological screenings and evaluations including
candidate/employee name and type of examination to be performed.
B. COUNTY shall notify CONTRACTOR if candidates who cancelled or failed to
show for a scheduled appointment shall be re-scheduled.
C. COUNTY shall provide CONTRACTOR pre-approval for special services to be
provided by CONTRACTOR, including preparation and standby, testimony/deposition and portal-to-portal
driving.
3. TERM
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The term of this Agreement shall be for a period of three (3) years, commencing on
the 7th day of January, 2020 through and including the 6th day of January, 2023. This Agreement may be
extended for two (2) additional consecutive twelve (12) month periods upon written approval of both parties
no later than thirty (30) days prior to the first day of the next twelve (12) month extension period. The
Director of Human Resources or his or her designee is authorized to execute such written approval on
behalf of COUNTY based on CONTRACTOR’S satisfactory performance.
4. TERMINATION
A. Non-Allocation of Funds - The terms of this Agreement, and the services to be
provided hereunder, are contingent on the approval of funds by the appropriating government agency.
Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
terminated, at any time by giving the CONTRACTOR thirty (30) days advance written notice.
B. Breach of Contract - The COUNTY may immediately suspend or terminate this
Agreement in whole or in part, where in the determination of the COUNTY there is:
1) An illegal or improper use of funds;
2) A failure to comply with any term of this Agreement;
3) A substantially incorrect or incomplete report submitted to the COUNTY;
4) Improperly performed service.
In no event shall any payment by the COUNTY constitute a waiver by the COUNTY of any
breach of this Agreement or any default which may then exist on the part of the CONTRACTOR. Neither
shall such payment impair or prejudice any remedy available to the COUNTY with respect to the breach or
default. The COUNTY shall have the right to demand of the CONTRACTOR the repayment to the
COUNTY of any funds disbursed to the CONTRACTOR under this Agreement, which in the judgment of
the COUNTY were not expended in accordance with the terms of this Agreement. The CONTRACTOR
shall promptly refund any such funds upon demand.
C. Without Cause - Under circumstances other than those set forth above, this
Agreement may be terminated by COUNTY upon the giving of thirty (30) days advance written notice of an
intention to terminate to CONTRACTOR.
D. Termination of One or More Contractors – In the event that COUNTY terminates
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this Agreement as to one or more CONTRACTORs, this Agreement shall stay in full force and effect as to
the remaining CONTRACTORs. Termination of one or more CONTRACTORs from this Agreement shall
not terminate the Agreement as to the remaining CONTRACTORs.
5. COMPENSATION/INVOICING: COUNTY agrees to pay CONTRACTOR and
CONTRACTOR agrees to receive compensation at the rates identified on each CONTRACTOR’s Exhibit
“B”, attached hereto and by this reference incorporated herein. CONTRACTOR shall submit monthly
invoices to the County of Fresno Department of Human Resources, 2220 Tulare Street, 14th Floor, Fresno,
CA 93721, Attn: Employment Services. CONTRACTOR shall submit invoices in accordance with RFP No.
20-020.
In no event shall services cumulatively performed by all CONTRACTORs under this
Agreement be in excess of One Hundred and Fifty Thousand Dollars and No/100 Dollars ($150,000)
annually for each twelve (12) month period of this Agreement. It is understood that all expenses incidental
to CONTRACTOR'S performance of services under this Agreement shall be borne by CONTRACTOR.
Payments by County shall be in arrears, within forty-five (45) days after receipt and verification of
CONTRACTORS’ invoices by COUNTY, for services provided during the preceding month. If an invoice
submitted by the CONTRACTOR contains discrepancies/inaccuracies, it will not be processed. The
CONTRACTOR will be required to submit a revised and accurate invoice for payment to be processed.
6. INDEPENDENT CONTRACTOR: In performance of the work, duties and obligations
assumed by CONTRACTOR under this Agreement, it is mutually understood and agreed that
CONTRACTOR, including any and all of the CONTRACTOR'S officers, agents, and employees will at all
times be acting and performing as an independent contractor, and shall act in an independent capacity and
not as an officer, agent, servant, employee, joint venturer, partner, or associate of the COUNTY.
Furthermore, COUNTY shall have no right to control or supervise or direct the manner or method by which
CONTRACTOR shall perform its work and function. However, COUNTY shall retain the right to administer
this Agreement so as to verify that CONTRACTOR is performing its obligations in accordance with the
terms and conditions thereof.
CONTRACTOR and COUNTY shall comply with all applicable provisions of law and
the rules and regulations, if any, of governmental authorities having jurisdiction over matters the subject
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thereof.
Because of its status as an independent contractor, CONTRACTOR shall have
absolutely no right to employment rights and benefits available to COUNTY employees. CONTRACTOR
shall be solely liable and responsible for providing to, or on behalf of, its employees all legally-required
employee benefits. In addition, CONTRACTOR shall be solely responsible and save COUNTY harmless
from all matters relating to payment of CONTRACTOR'S employees, including compliance with Social
Security withholding and all other regulations governing such matters. It is acknowledged that during the
term of this Agreement, CONTRACTOR may be providing services to others unrelated to the COUNTY or
to this Agreement.
7. MODIFICATION: Any matters of this Agreement may be modified from time to time
by the written consent of all the parties without, in any way, affecting the remainder.
8. NON-ASSIGNMENT: Neither party shall assign, transfer or sub-contract this
Agreement nor their rights or duties under this Agreement without the prior written consent of the other
party.
9. HOLD HARMLESS: CONTRACTOR agrees to indemnify, save, hold harmless, and
at COUNTY'S request, defend the COUNTY, its officers, agents, and employees from any and all costs and
expenses (including attorney’s fees and costs), damages, liabilities, claims, and losses occurring or
resulting to COUNTY in connection with the performance, or failure to perform, by CONTRACTOR, its
officers, agents, or employees under this Agreement, and from any and all costs and expenses (including
attorney’s fees and costs), damages, liabilities, claims, and losses occurring or resulting to any person, firm,
or corporation who may be injured or damaged by the performance, or failure to perform, of
CONTRACTOR, its officers, agents, or employees under this Agreement.
10. INSURANCE
Without limiting the COUNTY's right to obtain indemnification from CONTRACTOR or
any third parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect, the following
insurance policies or a program of self-insurance, including but not limited to, an insurance pooling
arrangement or Joint Powers Agreement (JPA) throughout the term of the Agreement.
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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 shall be issued on a per occurrence basis. COUNTY may require specific coverages including
completed operations, products liability, contractual liability, Explosion-Collapse-Underground, fire legal
liability or any other liability insurance deemed necessary because of the nature of this contract.
B. Automobile Liability
Comprehensive Automobile Liability Insurance with limits of not less than One
Million Dollars ($1,000,000.00) per accident for bodily injury and for property damages. Coverage should
include any auto used in connection with this Agreement.
C. Professional Liability
If CONTRACTOR employs licensed professional staff, (e.g., Ph.D., R.N.,
L.C.S.W., M.F.C.C.) in providing services, Professional Liability Insurance with limits of not less than One
Million Dollars ($1,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate.
This coverage shall be issued on a per claim basis. Contractor agrees that it shall maintain, at its sole
expense, in full force and effect for a period of three years following the termination of this Agreement, one
or more policies of professional liability insurance with limits of coverage as specified herein.
D. Worker's Compensation
A policy of Worker's Compensation insurance as may be required by the California
Labor Code.
Additional Requirements Relating to Insurance
CONTRACTOR shall obtain endorsements to the Commercial General Liability
insurance naming the County of Fresno, its officers, agents, and employees, individually and collectively, as
additional insured, but only insofar as the operations under this Agreement are concerned. Such coverage
for additional insured shall apply as primary insurance and any other insurance, or self-insurance,
maintained by COUNTY, its officers, agents and employees shall be excess only and not contributing with
insurance provided under CONTRACTOR's policies herein. This insurance shall not be cancelled or
changed without a minimum of thirty (30) days advance written notice given to COUNTY.
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CONTRACTOR hereby waives its right to recover from COUNTY, its officers,
agents, and employees any amounts paid by the policy of worker’s compensation insurance required by
this Agreement. CONTRACTOR is solely responsible to obtain any endorsement to such policy that may be
necessary to accomplish such waiver of subrogation, but CONTRACTOR’s waiver of subrogation under
this paragraph is effective whether or not CONTRACTOR obtains such an endorsement.
Within Thirty (30) days from the date CONTRACTOR signs and executes this
Agreement, CONTRACTOR shall provide certificates of insurance and endorsement as stated above for all
of the foregoing policies, as required herein, to the County of Fresno, (Paul Nerland, Director of Human
Resources, 2220 Tulare Street, 14th Floor, Fresno, CA 93721), stating that such insurance coverage have
been obtained and are in full force; that the County of Fresno, its officers, agents and employees will not be
responsible for any premiums on the policies; that for such worker’s compensation insurance the
CONTRACTOR has waived its right to recover from the COUNTY, its officers, agents, and employees any
amounts paid under the insurance policy and that waiver does not invalidate the insurance policy; that such
Commercial General Liability insurance names the County of Fresno, its officers, agents and employees,
individually and collectively, as additional insured, but only insofar as the operations under this Agreement
are concerned; that such coverage for additional insured shall apply as primary insurance and any other
insurance, or self-insurance, maintained by COUNTY, its officers, agents and employees, shall be excess
only and not contributing with insurance provided under CONTRACTOR's policies herein; and that this
insurance shall not be cancelled or changed without a minimum of thirty (30) days advance, written notice
given to COUNTY.
In the event CONTRACTOR fails to keep in effect at all times insurance coverage as
herein provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate this
Agreement upon the occurrence of such event.
All policies shall be issued by admitted insurers licensed to do business in the State of
California, and such insurance shall be purchased from companies possessing a current A.M. Best, Inc.
rating of A FSC VII or better.
11. NON-DISCRIMINATION: During the performance of this Agreement, CONTRACTOR
shall not unlawfully discriminate against any employee or candidate on the basis of race, ethnicity, gender,
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sexual orientation, religion, color, national origin, ancestry, medical condition, marital status, age or sex
pursuant to all applicable State and Federal statutes and regulations.
12. AUDITS AND INSPECTIONS: The CONTRACTOR shall at any time during business
hours, and as often as the COUNTY may deem necessary, make available to the COUNTY for examination
all of its records and data with respect to the matters covered by this Agreement. The CONTRACTOR
shall, upon request by the COUNTY, permit the COUNTY to audit and inspect all of such records and data
necessary to ensure CONTRACTOR'S compliance with the terms of this Agreement.
If this Agreement exceeds ten thousand dollars ($10,000.00), CONTRACTOR shall be
subject to the examination and audit of the Auditor General for a period of three (3) years after final
payment under contract (Government Code Section 8546.7).
13. NOTICES: The persons and their addresses having authority to give and receive
notices under this Agreement include the following:
COUNTY CONTRACTORS
COUNTY OF FRESNO See Exhibit A
Department of Human Resources
2220 Tulare Street, 14th Floor
Fresno, CA 93721
All notices between the COUNTY and the CONTRACTOR provided for or permitted
under this Agreement must be in writing and delivered either by personal service, by first-class United
States mail, by an overnight commercial courier service, or by telephonic facsimile transmission. A notice
delivered by personal service is effective upon service to the recipient. A noticed delivered by first-class
United States mail is effective three COUNTY business days after deposit in the United States mail,
postage prepaid, addressed to the recipient. A notice delivered by an overnight commercial courier service
is effective one COUNTY business day after deposit with the overnight commercial courier service, deliver
fees prepaid, with deliver instructions given for the next day delivery, addressed to the recipient. A noticed
delivered by telephonic facsimile is effective when transmission to the recipient is completed (but, if such
transmission is completed outside of COUNTY business hours, then such delivery shall be deemed to be
effective at the next beginning of a COUNTY business day), provided that the sender maintains a machine
record of the completed transmission. For all claims arising out of or related to this Agreement, nothing in
this section establishes, waives, or modifies any claims presentation requirements or procedures provided
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by law, including but not limited to the Government Claims Act (Division 3.6 of Title 1 of the Government
Code, beginning with section 810).
14. GOVERNING LAW: Venue for any action arising out of or related to this Agreement
shall only be in Fresno County, California.
The rights and obligations of the parties and all interpretation and performance of this
Agreement shall be governed in all respects by the laws of the State of California.
15. DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the CONTRACTOR is operating as a corporation
(a for-profit or non-profit corporation) or if during the term of the agreement, the CONTRACTOR
changes its status to operate as a corporation.
Members of the CONTRACTOR’s Board of Directors shall disclose any self-dealing
transactions that they are a party to while CONTRACTOR is providing goods or performing services
under this agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR
is a party and in which one or more of its directors has a material financial interest. Members of the
Board of Directors shall disclose any self-dealing transactions that they are a party to by completing and
signing a Self-Dealing Transaction Disclosure Form, attached hereto as Exhibit “C” and incorporated
herein by reference, and submitting it to the COUNTY prior to commencing with the self-dealing
transaction or immediately thereafter.
16. ENTIRE AGREEMENT: This Agreement, including all Exhibits and the COUNTY’s
RFP and the CONTRACTOR’s Response to COUNTY’s RFP, constitutes the entire agreement between
the CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous
Agreement negotiations, proposals, commitments, writings, advertisements, publications, and
understanding of any nature whatsoever unless expressly included in this Agreement.
17. CONFIDENTIALITY:
All services performed by CONTRACTOR under this Agreement shall be in strict conformance
with all applicable Federal, State of California and/or local laws and regulations relating to confidentiality.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and
year first hereinabove written.
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CONTRACTORS
SEE ATTACHED SIGNATURE PAGES
FOR ACCOUNTING USE ONLY: 13 Fund/Subclass: 0001/10000
14 ORG No .: 10100400
Account No .: 7295
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COUNTY OF FRESNO
~
Ernest B~ ~
Chairman of the Board of Supervisors of
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the County of Fresno
ATTEST:
Bernice E. Seidel
Clerk of the Board of Supervisors
County of Fresno , State of California
By:
~ ~£,~
Depu tyt,-f?
EXHIBIT “A”
FRESNO COUNTY DEPARTMENT OF HUMAN RESOURCES
PSYCHOLOGICAL SCREENING SERVICES
LIST OF CONTRACTORS
1. California Forensic Institute
2743 E. Shaw Avenue, Suite 110
Fresno, CA 93710
Attention: Dr. Jana Price-Sharps, Ed.D.
Phone No.: (559) 909-5527
2. Erene Soliman, Psy.D.
5151 N. Palm Suite 500
Fresno, CA 93704
Attention: Dr. Erene Soliman, Psy.D.
Phone No.: (559) 449 -2734
3. Kent M. Kawagoe, Ph.D.
5740 N. Palm Ave, Suite 105
Fresno, CA 93704
Attention: Dr. Kent Kawagoe, Ph.D.
Phone No.: (559) 431-1900
EXHIBIT “B”
CONTRACTOR: CALIFORNIA FORENSIC INSITITUTE
Cost of Services
Year 1 Year 2 Year 3 Year 4 Year 5
Pre-Placement Screening
(at Bidder’s Place of Business)
$380 $380 $380 $380 $380
Pre-Placement Screening
(Conducted Off -Site)
$425 $425 $425 $425 $425
Hourly rate for special
compulsory evaluations and
special services
$150 $150 $150 $150 $150
Third Opinion Appeal
Evaluation
$500/hr $500/hr $500/hr $500/hr $500/hr
Rate per No-Show for
Appointment
No
Charge
No
Charge
No
Charge
No
Charge
No
Charge
Deposition and court
testimony hourly rate
$125 $125 $125 $125 $125
Court preparation and
standby hourly rate
$100 $100 $100 $100 $100
Hourly rate for consultation
services.
No
Charge
(under 2
hours);
$125 (over
2 hours)
No
Charge
(under 2
hours);
$125 (over
2 hours)
No
Charge
(under 2
hours);
$125 (over
2 hours)
No
Charge
(under 2
hours);
$125 (over
2 hours)
No
Charge
(under 2
hours);
$125 (over
2 hours)
Hourly rate for authorized
additional pre-employment
testing (in cases requiring
additional testing or evaluation.)
$125 $125 $125 $125 $125
EXHIBIT “B”
CONTRACTOR: ERENE SOLIMAN, PSY.D.
Cost of Services
Year 1 Year 2 Year 3 Year 4 Year 5
Pre-Placement Screening
(at Bidder’s Place of Business)
$395 $402 $410 $419 $427
Pre-Placement Screening
(Conducted Off -Site)
$495 $502 $510 $519 $527
Hourly rate for special
compulsory evaluations and
special services
$100 $102 $104 $106 $108
Third Opinion Appeal
Evaluation
$395 $402 $410 $419 $427
Rate per No-Show for
Appointment
$125 $127 $130 $132 $135
Deposition and court
testimony hourly rate
$350 $357 $364 $371 $378
Court preparation and
standby hourly rate
$200 $204 $208 $210 $212
Hourly rate for consultation
services.
$100 $102 $104 $106 $108
Hourly rate for authorized
additional pre-employment
testing (in cases requiring
additional testing or evaluation.)
$100 $102 $104 $106 $108
EXHIBIT “B”
CONTRACTOR: KENT M. KAWAGOE, PH.D.
Cost of Services
Year 1 Year 2 Year 3 Year 4 Year 5
Pre-Placement
Screening (at
Bidder’s Place of
Business)
$425 $450 $450 $450 $450
Pre-Placement
Screening
(Conducted Off -Site)
$425 $450 $450 $450 $450
Hourly rate for
special compulsory
evaluations and
special services
$1,500 (up to
8 hours, $200/hr
after)
$1,500 (up to
8 hours, $200/hr
after)
$1,500 (up to
8 hours, $200/hr
after)
$1,500 (up to
8 hours, $200/hr
after)
$1,500 (up to
8 hours, $200/hr
after)
Third Opinion
Appeal Evaluation
$750 $750 $750 $750 $750
Rate per No-Show
for Appointment
$150 $150 $150 $150 $150
Deposition and
court testimony
hourly rate
$300 $300 $300 $300 $300
Court preparation
and standby hourly
rate
$300 $300 $300 $300 $300
Hourly rate for
consultation
services.
No charge
for informal
/ $250 per
hour for
professional
No charge
for informal
/ $250 per
hour for
professional
No charge
for informal
/ $250 per
hour for
professional
No charge
for informal
/ $250 per
hour for
professional
No charge
for informal
/ $250 per
hour for
professional
Hourly rate for
authorized
additional pre-
employment testing
(in cases requiring
additional testing or
evaluation.)
$50 $70 $70 $70 $70
Exhibit C
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as “County”),
members of a contractor’s board of directors (hereinafter referred to as “County Contractor”), must
disclose any self-dealing transactions that they are a party to while providing goods, performing
services, or both for the County. A self-dealing transaction is defined below:
“A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest”
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member’s name, job title (if applicable), and date this disclosure is being made.
(2) Enter the board member’s company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction; and
b. The nature of the material financial interest in the Corporation’s transaction that the
board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Exhibit 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: