HomeMy WebLinkAbout31989AGREEMENT NO . 13-712-1
;;TATE OF CALIFORNIA
STANDARD AGREEMENT AMENDMENT
SlD 2 13A (Ro• 6/03 )
(g) Check here if additional pages are added : .1 Page(s)
Reg ist rat ion Number: e p ! .? 2 (..,. '} <-;0
State Agency's Name
California Department of Public Health
Contractor's Name
County of Fresno
2. The term of this
Agreement is:
3. The maximum amount of this
July1,2013 through June 30, 2016
$ 512 ,950
Also known as CDPH or the State
(Also referred to as Contractor)
---·---~wee_~:.~-~!!er _~his amendment is : Five Hundred Twelve Thou.s~nd . Nine H~~~red Fifty D~~~~-------·-··------------
4 . The parties mutually agree to this amendment as follows . All actions noted below are by this reference made a part
of the Agreement and incorporated herein :
I. Purpose of amendment: This amendment decreases the funding level in the amount of ($53,975) for year 2
of this agreement, due to a revised state allocation formula that reflects the annual federal Housing
Opportunities for Persons with AIDS grant award to California for FY 2014-15 and unspent dollars from prior
year allocations . In addition, the Scope of Work has been revised to reflect changes to the Performance Goals
for Year 2 .
11. Certain changes made in this amendment are shown as : Text additions are displayed in bold and underline.
Text deletions are displayed as strike through text (i .e .. StAke).
All other terms and cond itions shall remain the same .
IN WITNESS WHEREOF, this A reement has been executed b the parties hereto.
CONTRACTOR
Contractor's Name (If other than an individual. state whether a corporation. partnership. etc.}
County of Fresno
By(Aut .
.!6
Date Signed (Do not type)
Deborah ervisors
Address
1221 Fulton Mall, 6th Floor, Contracts Section , Fresno . CA 93721
STATE OF CALIFORNIA
Agency Name
California Department of Public Health
Murillo , Chief, Contracts Management Unit
1616 Capitol Avenue , Suite 74 .317, MS 1802, P.O. Box 997377.
Sacramento , CA 95899-7377
ATTEST :
BERNICE E. SEIDEL. Clerk
Board of Supervisors
By ~~(}~:> ~s~cw
Deputy
(Continued on next page)
CALIFORNIA
Department of Gcmeral Services
Use Only
I2SJ Exempt per:OOA Budget Act 201~
STD 213 Continued County of Fresno
Contract Number: 13-20417 A01
Page 2 of 2
Ill. Exhibit A-Scope of Work, Provis ion G-Data Collection and Reporting Requirements ,
Paragraph 1.c.1) Performance Goals, Year 2 is amended to read as follows :
c . The cumulative reports shall contain the following minimum data set:
1) Performance Goals
HOPWA Program Activity Estimated Number of
Households Assisted
For each Fiscal Year
(July 1 -June 30)
Year1 Year2 Year3
STRMU 60 0050 60
TBRA 0 0 0
Facility-Based HousinQ-Hotel/Motel 15 ~5 15
Facility-Based Housing -Transitional
Facility-Based Housing -Permanent 0 0 0
Housing Placement Assistance (e.g 15 ~10 15
Security Deposits)
HousinQ Information Services 95 ~65 95
Supportive Services 70 70 70
IV. Exhibit B-Budget Detail and Payment Provisions, Provision 4 (Amounts Payable) is amended to
read as follows :
4. Amounts Payable
A. The amounts payable under this Agreement shall not exceed :
1) $188,975 for the budget period of 07/01/2013 through 06/30/2014.
2) $188 ,975 $135,000 for the budget period of 07/01/2014 through 06/30/2015.
3) $188 ,975 for the budget period of 07/01/2015 through 06/30/2016 .
V. Exhibit B-Attachment II, Budget (Year 2) is hereby replaced in its entirety with Exhibit B,
Attachment II, Budget (Year 2) A01.
"All references to Exhibit B, Attachment II, Budget (Year 2), in any exhibit incorporated into this
agreement shall hereinafter be deemed to read Exhibit B, Attachment II, Budget (Year 2) A01 .
County of Fresno
Contract Number: 13-20417 A01
Exhibit B -Attachment II
Housing Opportunities for Persons with AIDS
Budget (Year 2)
Ju ly 1, 2014 to June 30, 2015
Orig inal Amendment 1
Budget
A PERSONNEL $80 ,137 ($13,320)
OPERATING EXPENSES $4 ,687 ($2,087)
CAPITAL EXPENDITURES $0 iQ
D. OTHER COSTS $102,426 ($38,076)
E. INDIRECT COSTS $1 ,725 ($492)
Up to 15% of Personnel)
TOTALS $188 ,975 ($53,975)
Page 1 of 1
Total
$66,817
$2,600
iQ
$64,350
$1,233
$135,000
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CCC-307
CERTIFICATION
I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly
authorized to legally bind the prospective Contractor to the clause(s) listed below. This
certification is made under the laws of the State of California.
Contractor/Bidder Firm Name (Print ed) Federal ID Number
..
County of Fresno 94-6000-512
By (~[ure 1M , ,
1-1 l.tlA IL . ·-
Printed Name and Title of Person ~'gning
Deborah A. Poochigian, Chairman, Board of Supervisors
Date Executed Executed in the County of
::r~IH\'lt.l..l l.3 :J-_0\5 Fresno
'J
CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with
the nondiscrimination program requirements. (Gov. Code §12990 (a-f) and CCR, Title 2,
Section 81 03) (Not applicable to public entities .)
2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the
requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-free
workplace by taking the following actions:
a. Publish a statement notifying employees that unlawful manufacture, distribution,
dispensation, possession or use of a controlled substance is prohibited and specifying
actions to be taken against employees for violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
1) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free workplace;
3) any available counseling, rehabilitation and employee assistance programs; and,
4) penalties that may be imposed upon employees for drug abuse violations.
c. Every employee who works on the proposed Agreement will:
1) receive a copy ofthe company's drug-free workplace policy statement; and,
2) agree to abide by the terms of the company's statement as a condition of employment
on the Agreement.
Failure to comply with these requirements may result in suspension of payments under
the Agreement or termination of the Agreement or both and Contractor may be ineligible
for award of any future State agreements if the department determines that any of the
following has occurred: the Contractor has made false certification, or violated the
certification by failing to carry out the requirements as noted above. (Gov. Code §8350 et
seq .)
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor certifies
that no more than one (1) final unappealable finding of contempt of court by a Federal
court has been issued against Contractor within the immediately preceding two-year
period b<;cause of Contractor's failure to comply with an order of a Federal court, which
orders Contractor to comply with an order of the National Labor Relations Board. (Pub .
Contract Code §I 0296) (Not applicable to public entities .)
4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE-PRO BONO
REQUIREMENT: Contractor hereby certifies that contractor will comply with the
requirements of Section 6072 of the Business and Professions Code, effective January 1,
2003.
Contractor agrees to make a good faith effort to provide a minimum number of hours of
pro bono legal services during each year of the contract equal to the lessor of30
multiplied by the number of full time attorneys in the firm's offices in the State, with the
number of hours prorated on an actual day basis for any contract period ofless than a full
year or 1 0% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state contract for
legal services, and may be taken into account when determining the award of future
contracts with the State for legal services.
5. EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an
expatriate corporation or subsidiary of an expatriate corporation within the meaning of
Public Contract Code Section I 0286 and 1 0286.1, and is eligible to contract with the
State ofCalifornia.
6. SWEATFREE CODE OF CONDUCT:
a. All Contractors contracting for the procurement or laundering of apparel, garments or
corresponding accessories, or the procurement of equipment, materials, or supplies, other
than procurement related to a public works contract, declare under penalty of perjury that
no apparel, garments or corresponding accessories, equipment, materials, or supplies
furnished to the state pursuant to the contract have been laundered or produced in whole
or in part by sweatshop labor, forced labor, convict labor, indentured labor under penal
sanction, abusive forms of child labor or ex ploitation of children in sweatshop labor, or
with the benefit of sweatshop labor, forced labor, convict labor, indentured labor under
penal sanction, abusive forms of child labor or exploitation of children in sweatshop
labor. The contractor further declares under penalty of perjury that they adhere to the
Sweatfree Code of Conduct as set forth on the California Department of Industrial
Relations website located at www .dir.ca.gov , and Public Contract Code Section 6108.
b . The contractor agrees to cooperate fully in providing reasonable access to the
contractor's records, documents, agents or employees, or premises if reasonably required
by authorized officials of the contracting agency , the Department oflndustrial Relations,
or the Department of Justice to determine the contractor's compliance with the
requirements under paragraph (a).
7. DOMESTIC PARTNERS: For contracts over $100,000 executed or amended after
January 1, 2007, the contractor certifies that contractor is in compliance with Public
Contract Code section 10295.3.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1. CONFLICT OF INTEREST: Contractor needs to be aware of the following provisions
regarding current or former state employees. If Contractor has any questions on the
status of any person rendering services or involved with the Agreement, the awarding
agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code § 1041 0):
1). No officer or employee shall engage in any employment, activity or enterprise from
which the officer or employee receives compensation or has a financial interest and
which is sponsored or funded by any state agency, unless the employment, activity or
enterprise is required as a condition of regular state employment.
2). No officer or employee shall contract on his or her own behalf as an independent
contractor with any state agency to provide goods or services.
Former State Employees (Pub. Contract Code § 10411 ):
1). For the two-year period from the date he or she left state employment, no former state
officer or employee may enter into a contract in which he or she engaged in any ofthe
negotiations, transactions, planning, arrangements or any part of the decision-making
process relevant to the contract while employed in any capacity by any state agency.
2). For the twelve-month period from the date he or she left state employment, no former
state officer or employee may enter into a contract with any state agency if he or she was
employed by that state agency in a policy-making position in the same general subject
area as the proposed contract within the 12-month period prior to his or her leaving state
service.
If Contractor violates any provisions of above paragraphs, such action by Contractor shall
render this Agreement void. (Pub. Contract Code § 1 0420)
Members ofboards and commissions are exempt from this section if they do not receive
payment other than payment of each meeting of the board or commission, payment for
preparatory time and payment for per diem. (Pub. Contract Code §10430 (e))
2. LABOR CODE/WORKERS ' COMPENSATION: Contractor needs to be aware of the
provisions which require every employer to be insured against liability for Worker 's
Compensation or to undertake self-insurance in accordance with the provisions, and
Contractor affirms to comply with such provisions before commencing the performance
of the work of this Agreement. (Labor Code Section 3 700)
3. AMERJCANS WITH DISABILITIES ACT: Contractor assures the State that it
complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits
discrimination on the basis of disability, as well as all applicable regulations and
guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE: An amendment is required to change the
Contractor's name as listed on this Agreement. Upon receipt of legal documentation of
the name change the State will process the amendment. Payment of invoices presented
with a new name cannot be paid prior to approval of said amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the contracting
agencies will be verifYing that the contractor is currently qualified to do business in
California in order to ensure that all obligations due to the state are fulfilled .
b. "Doing business" is defined in R&TC Section 2310 I as actively engaging in any
transaction for the purpose of financial or pecuniary gain or profit. Although there are
some statUtory exceptions to taxation, rarely will a corporate contractor performing
within the state not be subject to the franchise tax.
c . Both domestic and foreign corporations (those incorporated outside of California) must
be in good standing in order to be qualified to do business in California. Agencies will
determine whether a corporation is in good standing by calling the Office of the Secretary
of State .
6. RESOLUTION: A county, city, district, or other local public body must provide the
State with a copy of a resolution, order, motion, or ordinance of the local governing body
which by law has authority to enter into an agreement, authorizing execution of the
agreement.
7. AIR OR WATER POLLUTION VIOLATION : Under the State laws, the Contractor
shall not be : (1) in violation of any order or resolution not subject to review promulgated
by the State Air Resources Board or an air pollution control district; (2) subject to cease
and desist order not subject to review issued pursuant to Section 13301 ofthe Water
Code for violation of waste discharge requirements or discharge prohibitions; or (3)
finally determined to be in violation of provisions of federal law relating to air or water
pollution.
8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all
contractors that are not another state agency or other governmental entity.
3tate of Cal ifornia-California Department of Public Health
PAYEE DATA RECORD
:Required when receiving payment from the State of California in lieu of IRS W-9)
3TD . 204 (Rev. S/06)_CDPH N/A
INSTRUCTIONS : Complete all information on this form. Sign , date, and return to the State agency (department/office) address shown at
[!] the bottom of this page . Prompt return of this fully completed form will prevent delays when processing payments . Information provided
in this form will be used by State agencies to prepare Information Returns (1099). See reverse side for more information and Privacy
Statement.
NOTE : Governmental entities , federal, state, and local (including school districts), are not required to submit this form .
rn PAYEE'S LEGAL BUSINESS NAME (Type or Print)
SOLE PROPRIETOR-ENTER NAME AS SHOWN ON SSN (Last, First, M.l .) E-MAIL ADDRESS
MAILING ADDRESS BUSINESS ADDRESS
CITY, STATE, ZIP CODE CITY, STATE, ZIP CODE
m ENTER FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN): ru -I I I I I I I I NOTE:
Payment will not
be processed
PAYEE without an ENTITY CORPORATION: accompanying TYPE 0 PARTNERSHIP 0 MEDICAL (e.g ., dentistry, psychotherapy, chiropractic, etc.) taxpayer 1.0.
0 LEGAL (e .g ., attorney services)
number.
CHECK 0 EST ATE OR TRUST 0 EXEMPT (nonprofit) ONE BOX
ONLY 0 ALLOTHERS
0 INDIVIDUAL OR SOLE PROPRIETOR WJ-W-1 I I I I ENTER SOCIAL SECURITY NUMBER:
(SSN required by authority of California Revenue and Tax Code Section 18646)
@] 0 California resident-qualified to do business in California or maintains a permanent place of business in California.
PAYEE 0 California nonresident (see reverse side)-Payments to nonresidents for services may be subject to State income tax
RESIDENCY withholding.
TYPE 0 No services performed in California.
0 Copy of Franchise Tax Board waiver of State withholding attached .
[]] I hereby certify under penalty of perjury that the information provided on this document is true and correct.
Should my residency status change, I will promptly notify the State agency below.
AUTHORIZED PAYEE REPRESENTATIVE'S NAME (Type or Print) TITLE
SIGNATURE DATE l TELEPHONE
( )
~ Please return completed form to:
Department/Office: California Department of Public Health
Unit/Section:
Mailing Address :
City/State/ZIP:
Telephone: ( ) FAX: ( )
E-Mail Address:
Sla te of Cali fornia-California Department of Pu bli c Health
PAYEE DATA RECORD
STD. 204 (Rev. 5/0S)_CDPH (Page 2)
1 Requirement to Complete Payee Data Record, STD . 204
A completed Payee Data Record, STD . 204, is required for payments to all non -governmental entities and will be kept on file at each
State agency . Since each State agency with which you do business must have a separate STD . 204 on file, it is possible for a
payee to receive this form from various State agencies .
Payees who do not wish to complete the STD . 204 may elect to not do business with the State . If the payee does not complete the
STD. 204 and the required payee data is not otherwise provided, payment may be reduced for federal backup withholding and
nonresident State income tax withholding. Amounts reported on Information Returns (1099) are in accordance with the Internal
Revenue Code and the California Revenue and Taxation Code. ·
2 Enter the payee's legal business name . Sole proprietorships must also include the owner's full name. An individual must list his/her
full name . The mailing address should be the address at which the payee chooses to receive correspondence . Do not enter
payment address or lock box information here.
3 Check the box that corresponds to the payee business type . Check only one box. Corporations must check the box that identifies
the type of corporation. The State of California requires that all parties entering into business transactions that may lead to
payment(s) from the State provide their Taxpayer Identification Number (TIN). The TIN is required by the California Revenue and
Taxation Code Section 18646 to facilitate tax compliance enforcement activities and the preparation of Form 1099 and other
information returns as required by the Internal Revenue Code Section 6109(a).
4
The TIN for individuals and sole proprietorships is the Social Security Number (SSN). Only partnerships, estates, trusts, and
corporations will enter their Federal Employer Identification Number (FEIN).
Are you a California resident or nonresident?
A corporation will be defined as a "resident" if it has a permanent place of business in California or is qualified through the Secretary
of State to do business in California .
A partnership is considered a resident partnership if it has a permanent place of business in California . An estate is a resident if the
decedent was a California resident at time of death . A trust is a resident if at least one trustee is a California resident.
For individuals and sole proprietors, the term "resident" includes every individual who is in California for other than a temporary or
transitory purpose and any individual domiciled in California who is absent for a temporary or transitory purpose . Generally, an
individual who comes to California for a purpose that will extend over a long or indefinite period will be considered a resident.
However, an individual who comes to perform a particular contract of short duration will be considered a nonresident.
Payments to all nonresidents may be subject to withholding. Nonresident payees performing services in California or receiving rent ,
lease , or royalty payments from property (real or personal) located in California will have 7% of their total payments withheld for
State income taxes . However, no withholding is required if total payments to the payee are $1 ,500 or less for the calendar year.
For information on Nonresident Withholding, contact the Franchise Tax Board at the numbers listed below:
Withholding Services and Compliance Section: 1-888-792-4900 E-mail address : wscs .gen@ftb .ca .gov
For hearing impaired with TDD, call: 1-800-822-6268 Website: www.ftb .ca .gov
5 Provide the name, title, signature , and telephone number of the individual completing this form. Provide the date the form was
completed.
6 This section must be completed by the State agency requesting the STD. 204 .
Privacy Statement
Section 7(b} of the Privacy Act of 1974 (Public Law 93-579) requ ires that any federal, State , or local governmental agency, which requests
an individual to disclose their social security account number, shall inform that individual whether that disclosure is mandatory or voluntary,
by which statutory or other authority such number is solicited , and what uses will be made of it.
It is mandatory to furnish the information requested . Federal law requires that payment for which the requested information is not provided
is subject to federal backup withholding and State law imposes noncompliance penalties of up to $20,000 .
You have the right to access records containing your personal information, such as your SSN . To exercise that right, please contact the
business services unit or the accounts payable unit of the State agency(ies) with which you transact that business.
All questions should be referred to the requesting State agency listed on the bottom front of this form .
State of California-Health and Human Services Agency
Darfur Contracting Act
California Department of Public Health
Contracts and Purchasing Services Section
Pursuant to Public Contract Code (PCC) sections 10475-10481 , the Darfur Contracting Act's intent is to
preclude State agencies from contracting with scrutinized companies that do business in the African nation of
Sudan . A scrutinized company is a company doing specified types of business in Sudan as defined in PCC
section 10476. Scrutinized companies are ineligible to , and cannot , contract with a State agency for goods or
services (PCC section 10477(a)) unless obtaining permission from the Department of General Services
according to the criteria set forth in PCC section 10477(b).
Therefore, to be eligible to contract with the California Department of Public Health , please initial one of the
following three paragraphs and comp lete the certification below:
1.
2 .
3 .
DAP
Initials
Initials
Initials
CERTIFICATION
We do not currently have , or we have not had within the previous
three years, business activities or other operations outside of the United States .
OR
We are a scrutinized company as defined in Public Contract Code
section 10476, but we have received written permission from the Department of General
Services (DGS) to submit a bid or proposal pursuant to Public Contract Code section
1 0477(b) or submit a contract/purchase order. A copy of the written permission from
DGS is included with our bid , proposal or contract/purchase order.
OR
We currently have, or we have had within the previous three years,
business activities or other operations outside of the United States,
but we certify below that we are not a scrutinized company
as defined in Public Contract Code section 10476.
I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind this
company to the clause listed above . This certification is made under the laws of the State of California.
Company Name (Printed) Federa/10 Number
County of Fresno 94-6000-512
By (Autho~eQ. ~
Printed Name and Title of Person SigningQ
Deborah A. Poochigian, Chairman, Board of Supervisors
Date Executed Executed in the County and State of
:r().Jn~k 1~, ~oiS Fresno, CA
CDPH 906 7 (4 /09)
ATTEST:
BERNICE E . SEIDEL , Clerk
Board of Superviso rs
By ~ (QAsbbyl
Deputy
AGREEMENT BETWEEN THE COUNTY OF FRESNO AND THE STATE OF CALIFORNIA
No.: California Department of Public Health
Office of AIDS: Housing Opportunities
for Persons With AIDS (#13-20417, A01)
APPROVED AS TO LEGAL FORM:
DANIEL C. CEDERBORG,
COUNTY COUNSEL
APPROVED AS TO ACCOUNTING FORM:
VICKI CROW, C.P.A., AUDITOR-CONTROLLER/
TREASURER -TAX COLLECTOR
Term: July 1, 2013 -June 30, 2016
REVIEWED AND RECOMMENDED FOR APPROVAL:
ByDavi/£a~
Director
Department of Public Health
Fund/Subclass:
Organization #:
Revenue:
ks
0001/10000
56201630
4380