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Agreement No. 15-323
AGREEMENT
THIS AGREEMENT is made and entered into this~~ _day of_. _ _ -~' 2015,
by and between the COUNTY OF FRESNO, a Political Subdivision of the State of California,
hereinafter referred to as "COUNTY", and CALIFORNIA STATE UNIVERSITY-FRESNO
FOUNDATION, a Private Non-Profit Organization whose address is 4910 N. Chestnut Ave., Fresno,
California, 93726-1852, hereinafter referred to as "CONTRACTOR".
W I T N E S S E T H:
WHEREAS, COUNTY, through its Department ofPub1ic Health, was awarded funding from
the Centers for Disease Control and Prevention for a Partnerships to Improve Community Health
(PICH) Grant (Federal Award Identification Number U58DP005567) to partner with various local
agencies for the purpose of community infrastructure to address local health disparities; and
WHEREAS, COUNTY, requires expertise in research, and program evaluation with a special
focus on health equity and system change efforts; and
WHEARAS, COUNTY, will require assistance with all required reporting on PICH evaluation
actions and findings, performance, outcomes and implementation of PICH policy and program
activities, design of appropriate outcome evaluation methodologies, protocols and survey instruments.
WHEREAS, CONTRACTOR, through its Central Valley Health Policy Institute, has the
expertise in research, program evaluation and collaboration with community partners in the area of
health equity/disparity projects; and
WHEREAS, CONTRACTOR, has the facilities and personnel skilled in the provision of such
services; and
WHEREAS, CONTRACTOR, is qualified and is willing to provide such services, pursuant to
the terms and conditions of this Agreement.
NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties
hereto agree as follows:
1. CONTRACTOR RESPONSIBILITIES
2 7 CONTRACTOR shall perform all services and fulfill all responsibilities identified in
2 8 Exhibit A, attached hereto and by this reference incorporated herein.
- 1 -COUN1Y OF FRESNO
Fresno, Cr\
1 2. TERM
2 This Agreement shall become effective on the 14th day of July, 2015 and shall terminate
3 on the 29th day of September, 2017.
4 This Agreement shall automatically be extended for one (1) additional twelve (12)
5 month period upon the same terms and conditions herein set forth, unless written notice of nonrenewal
6 is given by either CONTRACTOR or COUNTY or COUNTY's DPH Director, or designee, not later
7 than sixty (60) days prior to the close of the current Agreement term.
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3. TERMINATION
A. Non-Allocation of Funds -The terms ofthis Agreement, and the services to be
1 0 provided thereunder, are contingent on the approval of funds by the appropriating government agency.
11 Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
12 terminated at any time by giving CONTRACTOR thirty (30) days advance written notice.
13 B. Breach of Contract -COUNTY may immediately suspend or terminate this
14 Agreement in whole or in part, where in the determination of COUNTY there is:
15 1) An illegal or improper use of funds;
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2)
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4)
A failure to comply with any term of this Agreement;
A substantially incorrect or incomplete report submitted to COUNTY;
Improperly performed service.
19 In no event shall any payment by COUNTY constitute a waiver by COUNTY of any
20 breach ofthis Agreement or any default which may then exist on the part of CONTRACTOR. Neither
21 shall such payment impair or prejudice any remedy available to COUNTY with respect to the breach
22 or default. COUNTY shall have the right to demand of CONTRACTOR the repayment to COUNTY
2 3 of any funds disbursed to CONTRACTOR under this Agreement, which in the judgment of COUNTY
24 were not expended in accordance with the terms ofthis Agreement. CONTRACTOR shall promptly
25 refund any such funds upon demand or, at COUNTY's option, such repayment shall be deducted from
2 6 future payments owing to CONTRACTOR under this Agreement.
27 C. Without Cause -Under circumstances other than those set forth above, this
2 8 Agreement may be terminated by COUNTY or CONTRACTOR upon the giving of thirty (30) days
- 2 -COUN1Y OF FRESNO
Fresno, CA
1 advance written notice of an intention to terminate to the other.
2 4. COMPENSATION
3 COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
4 compensation quarterly in accordance with the rates as identified in CONTRACTOR's Itemized
5 Budget and Budget Narrative, hereinafter referred to as Exhibit B, attached hereto and incorporated
6 herein by this reference. In no event shall actual services performed under this Agreement be in
7 excess of Five Hundred and Thirty-Two Thousand, Five Hundred and Eighty-Eight and No/1 00
8 Dollars ($532,588) during the entire term of this Agreement. It is understood that all expenses
9 incidental to CONTRACTOR's performance of actual services under this Agreement shall be borne by
10 CONTRACTOR.
11 Payments by COUNTY shall be in arrears, for services provided during the preceding
12 month, within forty-five (45) days after receipt and verification of CONTRACTOR's invoices by
13 COUNTY's Department of Public Health. If CONTRACTOR should fail to comply with any
14 provision ofthis Agreement, COUNTY shall be relieved ofits obligation for further compensation.
15 5. INVOICING
16 CONTRACTOR shall invoice COUNTY quarterly, in duplicate, addressed to the
17 County of Fresno, Department of Public Health, Office of Policy, Planning and Communication, P.O.
18 Box. 11867, Fresno, CA 93775, Attention: PICH Coordinator.
19 CONTRACTOR shall include the following information on invoices submitted: contract
2 0 number, invoice number, date, remittance details, expenditure start and end dates and transaction
21 analysis showing all itemized expenditures for the billing period.
2 2 CONTRACTOR shall submit copies of activity records with the quarterly invoice, in
2 3 accordance with the requirements set forth in Paragraph 14 of this Agreement.
24 6. INDEPENDENT CONTRACTOR
2 5 In performance of the work, duties, and obligations assumed by CONTRACTOR under
2 6 this Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of
2 7 CONTRACTOR's officers, agents, and employees will at all times be acting and performing as an
2 8 independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
- 3 -COUN1Y OF FRESNO
Fresno, CA
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employee, joint venturer, partner, or associate ofthe 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 which are directly or indirectly the subject of this Agreement.
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
17 Any matters ofthis Agreement may be modified from time to time by the written
18 consent of all the parties without, in any way, affecting the remainder.
19 8. NON-ASSIGNMENT
2 0 Neither party shall assign, transfer or subcontract this Agreement nor their rights or
21 duties under this Agreement without the prior written consent of the other party.
22 9. HOLD-HARMLESS
23 To the extent ofCONTRACTOR's fault, CONTRACTOR agrees to indemnify, save,
2 4 hold harmless, and at COUNTY's request, defend the COUNTY, its officers, agents and employees
2 5 from any and all costs and expenses, including attorney fees and court costs, damages, liabilities,
2 6 claims and losses occurring or resulting to COUNTY in connection with the performance, or failure to
2 7 perform, by CONTRACTOR, its officers, agents or employees under this Agreement, and from any
2 8 and all costs and expenses, including attorney fees and court costs, damages, liabilities, claims and
-4 -COUNTY OF FRESNO
Fresno, CA
1 losses occurring or resulting to any person, firm or corporation who may be injured or damaged by the
2 performance, or failure to perform, of CONTRACTOR, its officers, agents or employees under this
3 Agreement.
4 10. INSURANCE
5 Without limiting the COUNTY's right to obtain indemnification from CONTRACTOR
6 or any third parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect the
7 following insurance policies throughout the term of this Agreement:
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A.
B.
C.
D.
Commercial General Liability
Commercial General Liability Insurance with limits of not less than One Million
Dollars ($1 ,000,000) per occurrence and an annual aggregate of Two Million
Dollars ($2,000,000). This policy shall be issued on a per occurrence basis.
COUNTY may require specific coverage including completed operations,
product liability, contractual liability, Explosion, Collapse, and Underground
(XCU), fire legal liability or any other liability insurance deemed necessary
because of the nature of the Agreement.
Automobile Liability
Comprehensive Automobile Liability Insurance with limits for bodily injury of
not less than Two Hundred Fifty Thousand Dollars ($250,000) per person, Five
Hundred Thousand Dollars ($500,000) per accident and for property damages of
not less than Fifty Thousand Dollars ($50,000), or such coverage with a
combined single limit of Five Hundred Thousand Dollars ($500,000). Coverage
should include owned and non-owned vehicles used in connection with this
Agreement.
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) per occurrence, Three
Million Dollars ($3,000,000) annual aggregate.
Worker's Compensation
A policy of Worker's Compensation Insurance as may be required by the
California Labor Code.
2 7 CONTRACTOR shall obtain endorsements to the Commercial General Liability
2 8 insurance naming the County of Fresno, its officers, agents, and employees, individually and
- 5 -COUN1Y OF FRESNO
Fresno,CA
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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 the COUNTY, its officers, agents and employees shall be
excess only and not contributing with insurance provided under the 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.
Within thirty (30) days from the date CONTRACTOR executes this Agreement,
CONTRACTOR shall provide certificates of insurance and endorsements as stated above for all of the
foregoing policies, as required herein, to the County of Fresno, Department of Public Health, P.O. Box
11867, Fresno, California, 93775, Attention: Contracts Section-61h Floor, 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 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 the COUNTY, its officers, agents and employees, shall be
excess only and not contributing with insurance provided under the 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 with admitted insurers licensed to do business in the State of
California. Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating
of A FSC VII or better.
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- 6 -COUNlY OF FRESNO
Fresno, CA
1 11. CONFIDENTIALITY
2 All services performed by CONTRACTOR under this Agreement shall be in strict
3 conformance with all applicable Federal, State of California and/or local laws and regulations relating
4 to confidentiality.
5 12. DATA SECURITY
6 For the purpose of preventing the potential loss, misappropriation or inadvertent access,
7 viewing, use or disclosure of COUNTY data including sensitive or personal client information; abuse
8 of COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies that
9 enter into a contractual relationship with the COUNTY for the purpose of providing services under
10 this Agreement must employ adequate data security measures to protect the confidential information
11 provided to CONTRACTOR by the COUNTY, including but not limited to the following:
12 A. CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
13 CONTRACTOR may not connect to COUNTY networks via personally-owned
14 mobile, wireless or handheld devices, unless the following conditions are met:
15 1) CONTRACTOR has received authorization by COUNTY for
16 telecommuting purposes;
Current virus protection software is in place; 17
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2)
3)
4)
Mobile device has the remote wipe feature enabled; and
A secure connection is used.
B. CONTRACTOR-Owned Computers or Computer Peripherals
21 CONTRACTOR may not bring CONTRACTOR-owned computers or computer
2 2 peripherals into the COUNTY for use without prior authorization from the COUNTY's Chief
2 3 Information Officer, and/or designee(s), including but not limited to mobile storage devices. If data is
2 4 approved to be transferred, data must be stored on a secure server approved by the COUNTY and
2 5 transferred by means of a Virtual Private Network (VPN) connection, or another type of secure
2 6 connection. Said data must be encrypted.
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C. COUNTY -Owned Computer Equipment
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Fresno, CA
1 CONTRACTOR or anyone having an employment relationship with the
2 COUNTY, may not use COUNTY computers or computer peripherals on non-COUNTY premises
3 without prior authorization from the COUNTY's Chieflnformation Officer, and/or designee(s).
4 D. CONTRACTOR may not store COUNTY's private, confidential or sensitive
5 data on any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
6 E. CONTRACTOR shall be responsible to employ strict controls to ensure the
7 integrity and security of COUNTY's confidential information and to prevent unauthorized access,
8 viewing, use or disclosure of data maintained in computer files, program documentation, data
9 processing systems, data files and data processing equipment which stores or processes COUNTY
10 data internally and externally.
11 F. Confidential client information transmitted to one party by the other by means of
12 electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of
13 128 BIT or higher. Additionally, a password or pass phrase must be utilized.
14 G. CONTRACTOR is responsible to immediately notify COUNTY of any
15 violations, breaches or potential breaches of security related to COUNTY's confidential information,
16 data maintained in computer files, program documentation, data processing systems, data files and
17 data processing equipment which stores or processes COUNTY data internally or externally.
18 H. COUNTY shall provide oversight to CONTRACTOR's response to all incidents
19 arising from a possible breach of security related to COUNTY's confidential client information
2 0 provided to CONTRACTOR. CONTRACTOR will be responsible to issue any notification to
21 affected individuals as required by law or as deemed necessary by COUNTY in its sole discretion.
22 CONTRACTOR will be responsible for all costs incurred as a result of providing the required
2 3 notification.
24 13. NON-DISCRIMINATION
2 5 During the performance of this Agreement, CONTRACTOR shall not unlawfully
2 6 discriminate against any employee or applicant for employment, or recipient of services, because of
2 7 race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical
2 8 condition, genetic information, marital status, sex, gender, gender identity, gender expression, age,
-8 -COUNTY OF FRESNO
Fresno, CA
1 sexual orientation, or military or veteran status pursuant to all applicable State of California and
2 Federal statutes and regulations.
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14. RECORDS
A. Program Activity Records -CONTRACTOR shall maintain accurate records and
program documentation of all completed activities throughout the Agreement term, i.e. meeting dates,
attendance logs, meeting minutes, invoices and back up documentations, completed summaries, data
collected, evaluation tools, summary reports and primary and secondary data collected and all
information pertaining to each meeting.
B. Financial Records-CONTRACTOR shall maintain accurate accounting records
of its costs and operating expenses throughout the Agreement term.
CONTRACTOR shall submit copies of program activity records with the quarterly
invoice. All records shall be retained through the end of the Agreement term. All records shall be
considered the property of COUNTY and shall be retained by the COUNTY at the termination of this
Agreement.
15. REPORTS
17 CONTRACTOR shall submit to COUNTY's Department ofPublic Health PICH Project
18 Coordinator, or designee, a detailed summary of all program activities completed quarterly. In
19 addition, CONTRACTOR shall also furnish to COUNTY such statements, records, reports, data, and
2 o other information as COUNTY may request pertaining to matters covered by this Agreement. In the
21 event that CONTRACTOR fails to provide such reports or other information required hereunder, it
22 shall be deemed sufficient cause for COUNTY to withhold quarterly payments until there is
2 3 compliance.
24 16. COMPLIANCE WITH FEDERAL REGULATIONS
2 5 CONTRACTOR recognizes that COUNTY operates its PICH Program with the use of
2 6 Federal funds, and that the use of these funds imposes certain requirements on the COUNTY and its
2 7 subcontractors. CONTRACTOR shall adhere to all applicable Federal requirements, including those
2 8 identified in Exhibit C, attached hereto and by this reference incorporated herein.
-9 -COUN1Y OF FRESNO
Fresno, CA
17. REFERENCES TO LAWS AND RULES 1
2
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In the event any law, regulation, or policy referred to in this Agreement is amended
during the term thereof, the parties hereto agree to comply with the amended provision as of the
effective date of such amendment.
5 18. DISCLOSURE OF SELF-DEALING TRANSACTIONS
6 This provision is only applicable if the CONTRACTOR is operating as a corporation (a
7 for-profit or non-profit corporation) or if during the term ofthis agreement, the CONTRACTOR
8 changes its status to operate as a corporation.
9 Members of the CONTRACTOR's Board of Directors shall disclose any self-dealing
10 transactions that they are a party to while CONTRACTOR is providing goods or performing services
11 under this agreement. A self-dealing transaction shall mean a transaction to which the
12 CONTRACTOR is a party and in which one or more of its directors has a material financial interest.
13 Members of the Board of Directors shall disclose any self-dealing transactions that they are a party to
14 by completing and signing a Self-Dealing Transaction Disclosure Form, attached hereto as Exhibit D
15 and incorporated herein by reference, and submitting it to the COUNTY prior to commencing with the
16 self-dealing transaction or immediately thereafter.
17 19. AUDITS AND INSPECTIONS
18 CONTRACTOR shall at any time during business hours, and as often as the COUNTY
19 may deem necessary, make available to the COUNTY for examination all of its records and data with
2 0 respect to the matters covered by this Agreement. CONTRACTOR shall, upon request by the
21 COUNTY, permit the COUNTY to audit and inspect all such records and data necessary to ensure
22 CONTRACTOR's compliance with the terms ofthis Agreement.
23 Ifthis Agreement exceeds Ten Thousand and NollOO Dollars ($10,000.00),
24 CONTRACTOR shall be subject to the examination and audit ofthe State Auditor for a period of
25 three (3) years after final payment under contract (Government Code Section 8546.7).
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Fresno, CA
20. NOTICES
The persons and their addresses having authority to give and receive notices under this
Agreement include the following:
COUNTY CONTRACTOR
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Director, County of Fresno
Department of Public Health
P.O. Box 11867
California State University, Fresno Foundation
4910 N. Chestnut Ave.
Fresno, CA 93 726-1852
7 Fresno, CA 93775
8 Any and all notices between the COUNTY and the CONTRACTOR provided for or
9 permitted under this Agreement or by law shall be in writing and shall be deemed duly served when
1 0 personally delivered to one of the parties, or in lieu of such personal service, when deposited in the
11 United States Mail, postage prepaid, addressed to such party.
12 21. GOVERNING LAW
13 The parties agree, that for the purposes of venue, performance under this Agreement is
14 to be in Fresno County, California.
15 The rights and obligations of the parties and all interpretation and performance ofthis
16 Agreement shall be governed in all respects by the laws of the State of California.
17 22. SEVERABILITY
18 The provisions of this Agreement are severable. The invalidity or unenforceability of
19 any one provision in the Agreement shall not affect the other provisions.
20 23. ENTIRE AGREEMENT
21 This Agreement, including all Exhibits, constitutes the entire agreement between the
2 2 CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous
2 3 Agreement negotiations, proposals, commitments, writings, advertisements, publications, and
2 4 understanding of any nature whatsoever unless expressly included in this Agreement.
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Fresno, CA
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and
year first hereinabove written.
CONTRACTOR:
CALIFORNIA STATE UNIVERSITY,
FRESNO FOUNDATION
COUNTY OF FRESNO:
7 By -----?-e_-~_.·z..~~-c-=-9-~_,-..::...L.~--·~__:__· • __
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Print Name:: Keith Kompsi
Title:Director, Foundation Financial Services
Date: __ e_:_-_-_/_.::._~ _-_/_j __
Print Name: Deborah S. Adishian-Astone
Title: Executive Director
Date: tQ \\\\10\0
Mailing Address:
California State University, Fresno
Office or Research and Sponsored Programs
4910 N. Chestnut Ave.
Fresno, CA 93 726-1852
Phone#: (559) 278-0964
Contact: Doug Carey, Grants Administrator
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Date:
BERNICE E. SEIDEL, Clerk
Board of Supervisors
sy ~u~ ~ ,'JJ~
Date: 'j \ I~ I Wts
PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
COUNTY OF FRESNO
Fresno, Cr\
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APPROVED AS TO LEGAL FORM:
DANIEL C. CEDERBORG, COUNTY COUNSEL
4 By-4~~~--~4>~~~~~~--
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6 AP OVED AS TO ACCO G FORM:
VICKI CROW, C.P.A., AUDITOR-CONTROLLER/
7 TREASURER-TAX COLLECTOR
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REVIEWED AND RECOMMENDED FOR APPROVAL:
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rna
Director
Department of Public Health
Fund/Subclass:
21 Organization:
0001/10000
56201668
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2 3 Account#: 7295
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/RB
-13 -COUNTY Of FRESNO
Fresno, CA
Partners in Community Health {PICH) Evaluator Scope of Work
Scope of Work Period: July 14, 2015-September 29, 2018
Year 1 (Y1): July 2015-September 2016
Year 2 (Y2): October 2016-September 2017
Year 3 (Y3): October 2017-September 2018
Administrative
Activity Activity Name Description
5.1.1 Administrative Meet monthly with Fresno
Meetings County Department of Public
Health (FCDPH) and Lead
Contractor. Include
subcontractors quarterly.
5.1.2 Training Attend training sessions,
conferences, and webinars on
specific content areas.
5.1.3 Evaluation Plan Work collaboratively with FCDPH
Development and CDC to develop the
and Updates Evaluation Plan. Update as
needed.
5.1.4 Collaboration Work collaboratively with the
Lead Contractor in the
implementation of the Evaluation
Plan including meetings with
subcontractors and community
partners for planning and training
and direction of data collection
activities by staff and volunteers.
5.1.5 Success Stories Collaborate in the development
and refinement of success stories
that can be used for reports and
public communication/media
purposes.
5.1.6 Progress Submit progress bi-annual
Reports reports following guidelines from
FCDPH and CDC. Collaborate with
FCDPH in the development of
report deliverables. Submit
electronic documentation of
delivera bles.
5.1.7 Invoicing Submit quarterly Invoices to DPH
by the 5th of each third month.
Backup documentation includes
timesheets, expenditure detail
and copies of respective receipts.
Responsible
Party
FCDPH &
Evaluator &
Lead
Contractor
Evaluator
FCDPH &
Evaluator
Evaluator &
Lead
Contractor
FCDPH &
Evaluator &
Lead
Contractor
Evaluator
Evaluator
Exhibit A
Deliverables
Meeting
agendas, sign-
in sheets
Copies of
training
agendas
Evaluation Plan
and Plan
Updates
Meeting
agendas, sign-
in sheets
Copy of
communication
submitted to
DPH
Semi-annual
progress report
with
supporting
documents
Quarterly
invoices,
backup
documentation
1
Exhibit A
Storefront Advertising Strategy
Overview Tab
• Plan Purpose: This voluntary evaluation seeks to determine the extent to which the Fresno
County Department of Public Health has reduced the amount of storefront and outdoor
advertising for alcohol and tobacco at Fresno County tobacco retail locations. This observational
study will examine the percentage and types of storefront windows covered in signs with
alcohol and tobacco advertising at two points in time. The goal is to highlight the successes and
challenges of this type of intervention.
• Single intervention or strategy: This plan will examine a single intervention which aims to
promote healthier behaviors at the population level by improving access to smoke-free and /or
tobacco-free environments.
Intervention Description Tab
• Name: Storefront Advertising
• Description: We will work with community members, retailers, and decision-makers to reduce
the appeal of tobacco by increasing the number of jurisdictions with practices that reduce
storefront window and outdoor advertising.
• Start/End Date: July 14, 2015-September 2018: During this time period activities include
targeting jurisdictions, workgroups will be held, educational presentations for community
members and retailers, and provide technical assistance.
• PPO/AO: PPO 01-Increase the number of people with improved access to smoke-free and/or
tobacco-free environments from 0 to 176,539 by September 2018.
• Innovative: N/A
• Health Disparities: Tobacco retail stores are more densely distributed in low-income and
minority communities; therefore, the intervention will focus on communities with the highest
proportion of poverty, minorities and tobacco retailers.
Questions Tab
• Question 1: In communities that have made changes to their ordinances for storefront
advertising, has the level of storefront or outdoor tobacco product advertising been reduced
compared to pre-ordinance baseline?
• Question 2: In communities that have made changes to their ordinances for storefront
advertising, has the proportion of stores with no storefront or outdoor tobacco product
advertising been increased compared to pre-ordinance baseline?
• Question 3: Prior to changes in community ordinances for storefront advertising, what
proportion of residents, resident smokers, and store owners support policy change to reduce
storefront and outdoor advertising of tobacco products?
Evaluation Design Tab
Data will be collected retrospectively from a previous implementation of the survey questionnaire by
the Tobacco Prevention Program. This data was collected prior to year one of the current grant and will
be used as the baseline comparison group. A follow-up observation will be administered in year 3 of the
grant in each jurisdiction that has adopted a policy to restrict storefront advertising.
Instruments Tab
Overview
• Healthy Stores for a Healthy Community Public Opinion Survey
• This survey will be administered November-December 2015 and April-May
2018
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Exhibit A
• This instrument has been implemented in previous work by the Public Health
Department.
• Storefront Advertising
o Healthy Stores for a Healthy Community Marketing Surveillance Manual
Indicators
• Stanford prevention research center
• California Tobacco Control Program (2013).
• These guidelines have been used in the past by trained observers from
the Fresno County Public Health Department.
• Inter-rater reliability checks will be conducted
• Healthy Stores for a Healthy Community Public Opinion Survey
o Indicators include
• Perception of tobacco retailers
• Demographic Information
• Smoking status in the last 30 days
• Storefront Advertising
o C7. What percent of the windows and clear doors are covered by signs?
• This section will guide observers' judgments on the percentage of storefront
advertising.
o N17. Products advertised on building/sidewalks
• This section will guide observers on building/sidewalk advertising.
Sampling Plan
• A total of 400 public opinion surveys will be administered with 200 being gathered at each point
in time.
• Participants will be gathered at community events, swap meets, etc. in the targeted
communities.
• A power analysis will be conducted.
• Minority and low-income communities will be targeted for this study.
• Incentives will not be used for this study.
• Participant recruitment will occur at local community events, swap meets, etc. within the
targeted communities.
Data Collection Plan
• Retrospective data collection will be used to acquire baseline comparison groups in the targeted
communities.
o These data were collected by the Tobacco Prevention Program (TPP) in Fresno County
prior to the commencement of the current study.
o The same methods of data collection will be administered in year 3 in order to collect
data on storefront advertisement.
• A public opinion survey will be administered in the targeted communities at local community
events and/or swap meets.
o This survey will provide information on demographic characteristics, perception of the
effects of advertising, and smoking status within the last 30 days.
• CVHPI will work in conjunction with the Fresno County Public Health Department to train
observers to administer the instruments in the targeted communities.
3
Exhibit A
• Fresno County Public Health Department has trained observers and implemented these data
collection methods in the past.
• The Public Opinion Survey will be administered at two different points in time November-
December 2015 and April-May 2017.
• The storefront observation will be completed in year 3, June-July 2018, after the intervention
has taken place.
Data Analysis Plan Tab
• Public Opinion Survey Data Analysis Plan
o Descriptive statistics will be provided for demographic variables such as age,
race/ethnicity, and gender as well as for questions on perception of shopping safety,
storefront advertisement, and smoking status in the last 30 days.
o Independent samples t-tests will be conducted to measure differences in perception of
shopping safety, storefront advertisement, and smoking status in the last 30 days.
• Storefront Advertisement Observation
o The sites which have a baseline observation (from previous study) will be used assessed
in year 3 of the current grant to measure any differences in the percentage of storefront
advertisement.
Dissemination Tab
• Frequencies and descriptive statistics will be generated from observations.
• Wicoxon's Rank-Sum Test will be used to measure statistical differences
between baseline and follow-up measures.
• All descriptive and inferential findings will be written and shared primarily with the community
as well as conferences, a variety of academic settings, and potentially through a peer-reviewed
journal. CVHPI will work in conjunction with FCDPH for all dissemination purposes.
Evaluation Work Plan Tab
• Public Opinion Survey Data Analysis Plan
o An Institutional review board (IRB) will formally designate approval of Public Opinion
Survey by September 2016
• This is a three week process
o The survey has already been developed
o This survey will be administered September-December 15
• Once data is collected, CVHPI will analyze these data and generate a report with
preliminary findings (n = 200)
o This survey will be administered during a second time period April-May 18
• CVHPI will analyze these data in comparison to the baseline and generate a final
report on this analysis
• Storefront Advertising
o Data collection has already commenced through the Tobacco Prevention Program in
Fresno County (prior to year one of this grant)
• This data will be shared by the Fresno County Public Health Department and
analyzed for preliminary findings by Feb 16
o A follow-up observation will be completed in year 3 Jul18
• This data will be analyzed in comparison to the baseline observation completed
prior to year one
• Final analysis will be completed Oct 18 and reports will be prepared for
dissemination
4
Exhibit A
Farm to School Strategy
Overview Tab
• Plan Purpose: The purpose of this voluntary assessment is to evaluate if Fresno County has met
the CAP goal to increase the number of people with access to healthy food and beverage
options. This voluntary evaluation will examine the proportion of locally grown fruits and
vegetable billed to the school by distributors. CVHPI will contact schools within the targeted
jurisdiction and collect invoices that are broken out by source. CVHPI will analyze the
effectiveness of the intervention by measuring the proportion of locally procured fruit and
vegetables made available to K -12 students. The final evaluation will highlight the successes
and challenges of the Farm to School intervention.
• Single intervention or strategy: This plan will evaluate a single intervention which aims to
improve access to healthy food and beverage options.
Intervention Description Tab
• Name: Farm to School
• Description: Review of local school district invoices from local distributors to measure if local
distributors are including on invoices where produce is grown and stored.
• Start/End Date: The first intervention will occur on Jul15. The end date is approximately Sept
18
• PPO/AO: PPO 02
• Innovative: This intervention is not classified as "innovative." The main goal of this intervention
is to improve access to locally grown fruits and vegetables to the people of Fresno County by
improving vendor storage and transferring of locally grown foods. A similar model has been
implemented by Ventura County in a Farm to School program implementation and will be used
as a reference in the current intervention (See, http:/ /healthyventuracounty.org/healthy-
schools/farm-to-schoolj).
• Health Disparities: The intervention focuses on a population with a history of poverty where
73% of the students received free or reduced price meals in the past academic year. For many
Fresno County students, school-based breakfast, lunch and afterschool snack programs provide
a significant portion of the recommended dietary intake for most nutrients.
Questions Tab
• Question 1: In the targeted school districts, which schools have invoices from food distributors
broken out by source?
• Question 2: In the targeted school districts, what proportion of the invoice is locally grown food?
Evaluation Design Tab
The proposed evaluation will use a cross-sectional design with repeated measurement in order to
estimate the number of people with improved access to healthy, locally grown food options. All Schools
within the jurisdiction will be called and asked for invoices from food distributors. Each school will be
contacted twice a year to make sure that they can produce invoices that are broken out by source. After
the intervention has been implemented, in year 3 CVHPI will contact a subset of schools in the targeted
jurisdiction. Schools that can provide invoices with information on the source will be followed-up in the
final portion of the analysis. A month's worth of invoices will be evaluated in order to show that at least
30% of their served food is locally procured.
Instruments Tab
5
Exhibit A
Here you will list each of your evaluation instruments and/or data sources. Instruments may include
surveys, interview/focus group guides, observation tools, and/or data abstraction tools. Data sources
may include sales records, administrative records, and/or electronic medical records. Click 'Add' to
create a new instrument or data source; this will open a new screen with sub-tabs.
Overview
• All schools in the jurisdiction will be contacted and asked if they can provide invoices from the
distributor with information on the source of food. These schools will be contacted twice a year
for three years. In year three, a subset of schools will be sampled from the targeted area and
will be followed-up for the entirety of the month. The schools will be
o United States Department of Agriculture Food and Nutrition Service
• http://www.fns.usda.gov/farmtoschool/procuring-local-foodsprovides extensive
guidelines on tool/instrument development
• An evaluation can be made by tracking farm origins on distributor invoices
• Define 'Local': a boundary must be established
Indicators
• The quantity of billed locally grown fruits and vegetables will be added and examined as a
percent of the total quantity of food purchased.
o This percentage will be used to estimate the number of sites that serve at least 30% of
their fruits and vegetables from local sources
o This percentage will be used to estimate the number of students with increased access
to locally grown fruits and vegetables
Sampling Plan
• 20% (approximately 40 schools) of schools in the targeted community will be contacted via
phone to inquire about food source invoices.
• Demographic information will not be acquired at this time.
• Grade levels range from K-12
• There are no specific sub-populations of interest; although, the targeted communities tend to
be composed of minority and low-income groups.
• Incentives will not be used to recruit schools
Data Collection Plan
• Data collection will primarily be done by records transfer/review.
• Distributor invoices will be gathered from a subset of school sites
• Trained staff from CVHPI will call and gather invoices from school sites
• Schools will be contacted twice a year for the three year period of the grant
• Schools will be contacted until 20% of all schools have been identified to be able to provide
invoices of food source
• Invoices from this subset of schools (20%) will be collected in the last quarter of year 3 of this
grant
Data Analysis Plan Tab
• The quantity of locally grown fruit and vegetables will be treated as a ratio variable
• Descriptive analysis will be conducted to produce frequencies, means, and standard deviations
of sources and quantity of fruits and vegetables
• The quantity of invoiced products will be converted to a percentage of the whole in order to
identify if the site has met the goal of providing 30% of food from local farmers
• The number of sites that meet this requirement will be used to infer how many of the
uninvestigated sites met this criterion and to estimate how many students receive locally
procured fruits and vegetables
6
Exhibit A
Dissemination Tab
• All descriptive and inferential findings will be written and shared primarily with the community
as well as conferences, a variety of academic settings, and potentially through a peer-reviewed
journal. CVHPI will work in conjunction with FCDPH for all dissemination purposes.
Evaluation Work Plan Tab
Timeline:
• Protocols and indicators will be finalized by Apr 2016
• An Institutional review board {IRB) will formally designate approval of this study by May 2016
o This is a three week process
• Development of an agreement with schools for data collection to begin in May 16
• The first observation (calls) will begin in the Spring semester of 16
o This observation will occur prior to the intervention
o Each school will be contacted twice in each FY
o Baseline observations will be completed by July 16
• Interim findings from the first observation will be shared with partners at FCDPH which will
include the number of schools that can provide invoices by source
• The second observation (calls) will be conducted beginning in March-April18
o The same method of observation will be implemented as discussed above
o This observation will be completed by April 2018
• A subset of schools will be followed-up with in August 18 for a month where final invoices will
be collected
o Analysis and findings will be completed and shared with FCDPH and all other partners
• Dissemination of findings will occur in partnership with FCDPH
7
Exhibit A
Physical Activity Strategy
Overview Tab
• Plan Purpose: The purpose of this actual use assessment is to evaluate if Fresno County has met
the CAP goal of increasing the number of people with improved access to physical activity
opportunities. Actual use will be measured by the number of persons the population affected by
the intervention. CVHPI will randomly select 20% of the new physical activity meetings/sessions
bi-annually beginning in Year 2 and observers will count the number of participants and their
level of physical activity at these physical activity/events. In year 3, a subset of events will be
observed on multiple occasions in each round to estimate the rate of consistent use. Structured
observation of new joint use sites will also be conducted. These data will be used along with
programmatic reporting from the new on-line hub to project the total number of
participants/week.
• Single intervention or strategy: This study evaluates actual use associated with a single
intervention to increase the number and accessibility of physical activity opportunities with the
goal of 30,000 Fresno residents participating in these activities by Year 3.
Intervention Description Tab
• Name: Improved access to physical activity opportunities
• Description: The Fresno County Department of Public Health (the Department) will increase the
number of people with improved access to PA opportunities through identification of additional
existing resources and increase the number of physical activity opportunities in targeted Fresno
County community settings. Joint use agreements, purchasing equipment, training and
certification physical activity providers, and the implementation of walking groups will augment
currently available physical activity opportunities. An online referral hub will facilitate an up-to-
date directory of physical activity opportunities throughout the county and increased utilization
of the low/no cost services. Increased physical activity will positively impact obesity and chronic
illness.
• Start/End Date: The intervention will run from July 2015-September, 2018
• PPO/AO: PP0-03 Increase the number of people with improved access to physical activity
opportunities from 0 to 271,325 by September 2018.
• Innovative: This intervention is not classified as "innovative." There is strong evidence that
community-wide physical activity interventions promote regular engagement in physical activity
and support population health. See Record, N. et al (2015) "Community-wide cardiovascular
disease prevention programs and health outcomes in a rural county, 1970-2010. JAMA." 2015
Jan 13;313 (2):147-5. ). There is strong evidence that joint use initiatives are associated with
increased physical activity. See Active Living Research (2012). Promoting Physical Activity
through the Shared Use of School and Community Recreational Resources.
www.activelivingresearch.org.) A recent Cochrane Review found varied effectiveness findings,
walking programs appear to produce consistent improvements in exercise levels. See Baker et al
(2105)" Community wide interventions for increasing physical activity." Cochrane Database Syst
Rev. 2011 Apr 13;(4 There is considerable debate about how to measure whether or not
community-wide physical activity programming is associated with actual increases in activity. In
order to strengthen our measurement of actual use, we will derive a measure of activity based
on the CDC/NCHS physical activity indicators, such as "Percent of adults who engage in aerobic
physical activity of at least moderate intensity for at least 150 minutes/week, or 75
minutes/week of vigorous intensity, or an equivalent
combination."(http:ljwww.healthindicators.gov/lndicators/Aerobic-physical-activity-meeting-
guidelines-adults-percent 1319/Profile). These indicators are generally based on self-report of
weekly activity. In this study, we will measure whether or not participants in new and/or hub-
8
Exhibit A
listed programs participate in at least one quarter of this weekly level (37 minutes of moderate
exercise, 19 minutes of intense exercise).
• Health Disparities: The intervention addresses both the general population and a number of
specific sub-populations, including: Immigrants/Non-native English speakers, Low SES/income,
Uninsured/ underinsured, Geography-Urban, Race/ Ethnicity-Hispanic, Race/Ethnicity-Black
or African American, Race/Ethnicity-Asian.
Questions Tab
• Question 1: How many people participate in new and/or hub-listed physical activity
events/meetings in Fresno?
• Question 2: How many participants remain moderately or more active for at least one quarter of
the weekly standard at the new and/or hub-listed physical activity events/meeting in Fresno?
• Question 3: What are the demographic characteristics of participants in new and/or hub-listed
physical activity events/meetings?
• Question 4: Among participants in new and/or hub-listed physical activity events/meetings that
meet on repeated basis, how many people are repeat users?
• Question 5: At new joint use sites, what is the number of participants and the average level of
activity?
Evaluation Design Tab
The proposed actual use study will use a cross-sectional design with repeated measurement in order to
estimate the number of people participating in physical activity events/meetings. The study will
randomly sample at least 20% of the events/meetings listed by the newly-formed hub and then will use
observation to assess actual use at 4 points in time to assess the growth in program participation. The
observation data will be combined with information from the hub on programming available in the
month of the observation to project overall program participation. With the goal of developing strong
projections of actual use for the whole program by sub-populations, observations will also include very
basic demographic data on participants. In addition, because actual use of physical activity opportunities
may be understood as regular use, a subset of physical activity meetings/events that are offered on a
regular basis (weekly, bi-weekly) will be observed on at least two additional occasions to estimate the
proportion of users who are repeat participants. The proposed study will not seek to collect individual
data on the level of participation or energy expenditure associated with each session, nor will it include
individual surveying of participants to assess their physical activity beyond the scheduled activities.
Instruments Tab
Overview
• The primary measure of use of new and/or hub-listed physical activity will be derived from
counting the number of participants at the sampled meeting/events approximately 15
minutes after the scheduled starting time.
• The SOP ARC (System for Observing Play and Recreation in Communities) will be adapted
and modified to measure community activity at joint use sites. Validity has been established
in previous work (McKenzie et al., 1991; Rowe, Schuldheism, & van der Mars, 1997) through
heart rate monitoring and reliability checks for the adapted version will be conducted by
CVHPI. The primary use for this instrument is to establish comparable measures across many
evaluations in the areas of park activity, accessibility, usability, supervision, and
organization.
• Very basic demographic information (gender, age-range, language spoken) will be collected
for each participant using a simplified tally sheet, completed by observers.
9
Exhibit A
• For sampled physical activity events/meetings with scheduled recurring sessions, the
primary measure will be the number of persons observed at one or two out of 2 subsequent
sessions.
• At the CDC/CTG Active Living Research conference in 2014, a number of tools for structured
observation of physical activity were reviewed and compared. These discussions indicate
that most tools reach beyond actual use in their focus and are targeted to specific
populations (children, teens, school settings). We will seek input from multiple sources on
whether or not to adapt one of these existing tools or explore development of a new
approach. (See, for example, McKenzie T. & Lounsbery M. (2014) Systematic Observation of
Physical Activity and Its Contexts-2014. http://activelivinqresearch.org/svstematic-
observation-physical-activitv-and-its-contexts-2014
Indicators
• Number of persons participating new and/or hub-listed physical activity events/meetings.
• Number of persons engaging in moderate or intense physical exercise for one quarter of
weekly standard. Moderate and intense physical activity will be based on the CDC/NCHC
indicators. (http://www.healthindicators.gov/lndicators/Search?Query=physical+activity.)
We will adapt the number of minutes and activity types based on specific recommendations
for children, teens, adults, and older adults.
• Number of persons participating in at least 2 sessions of a recurring event/meeting.
• Level of activity (SOP ARC) in structured setting. This will be recorded as an ordinal measure.
Sampling Plan
• The new physical activity hub will develop a comprehensive list of new and ongoing
activities, including new walking groups, including their target users, dates, and locations.
• For Years 2 and 3, in the last week of February and June, a sample of events/meetings will
be selected. In each observation period, a 20% random sample or at least 10
events/observation period, random sample of the hub-listed events/meetings will be
selected.
• For both periods, observers will count the number of participants who remain active for at
least one quarter of the weekly CDC/NCHC standard (moderate for 37, intense for 19
minutes or as adapted based on participant groups other than adults).
• In both Year 3 observation periods, all meetings/events with recurring sessions selected for
the 20% random sample will be identified, and will be observed on two additional meetings.
• It is expected that this sampling will yield 30-40 events/meetings for observation in the two
Year 2 observations, and 40-50 events in Year 3, with about~ of these events associated
with recurring sessions.
• The study will be observational. There will be no individual consent process, except as part
of the individual participation agreements for each event on the hub. There will be no
incentives for participants. All event/meeting leaders will be notified in advance that there
may be evaluation observers present.
• Joint use sites will be evaluated depending on the number of sites that are made available
Data Collection Plan
• The proposed study is observational in approach. A web-based data entry form will be used
by observers to record basic descriptive information about events, count participants,
record activity types and durations, and record the number of persons engaging in each
activity. The same observer will return to two subsequent sessions of recurring events, and
count participants and count the number of participants who were also present at the prior
session.
10
Exhibit A
• Structured observation will be conducted by CVHPI research assistants who have 2-years or
more of experience in structured observation projects. These research assistants are MPH
graduates and students at Fresno State.
• The structured observation form will be adapted or developed based on existing tools as
indicated above. The participating research assistants will help in the development of the
web-based reporting system. We will conduct structured observation training to review the
categories of observation and the procedure. In a pilot study, the participating observers
and key research scientists will conduct observations of at least 5 events together, inter-rate
reliability will be assessed, and any remaining differences in coding resolved through
discussion.
• The structured observations will be conducted on events sampled in two one-week
periods/year (February and June). The sampled events will be observed 1 time or 3 times
(for recurring events) over the subsequent 3 week period. The same observer will return to
recurring events for all observations.
Data Analysis Plan Tab
For each of the five questions, our approach will be the same. The structured observations will produce
counts (ratio-level measures) of participants and these will be combined with secondary data to project
county-wide level actual use. All analyses are intended to provide simple counts of participants,
participants who attend recurring sessions, participants who engage in at least X of the weekly exercise
standard, and the number of participants by age category, gender, languages spoken, and event type.
We will utilize data from the newly formed hub to project the number of county-wide participants for
Year 2 and Year 3. The hub data will include characteristics of new and/or ongoing events in terms of
these same categories of intended user groups, sponsoring organizations/neighborhood, event type,
number of sessions. Using these data we will examine any bias in the sampling and correct for this in
development of projected use. We would appreciate technical assistance on how to develop actual use
estimates using analytic methods most consistent with other programs nationally addressing physical
activity actual use.
Dissemination Tab
We believe that our proposed measurement of both the number of participants, whether or not they
are regular users of recurring events, and whether or not they engage in at least one quarter of the
CDC/NCHS recommended weekly activity level in the context of a county-wide initiative will provide
important input in ongoing discussions of community wide physical activity programming and
population health. We intend to develop at least two reports based on the project, including a year 2
summary of program rationale, formation and early findings and in Year 3 on overall utilization
experiences. These reports will be submitted for conferences and peer-reviewed journals. We will assist
Fresno DPH in making public presentations and in preparing reports for funders and policy makers.
Evaluation Work Plan Tab
Timeline
• Finalize protocol and instruments for pilot study/Submit/receive IRB July-October 15
• Conduct pilot study/Revise, submit/receive IRB approval for full study October 15-January 16
• Conduct sampling of hub-listed events/conduct structured observation March 16, July 16,
October 16, March, 17, July 17, October 17, March 18, July 18.
• Complete Year 2 analysis and reporting August 17
• Dissemination Activities August-September 17
• Complete Year 3 analysis and reporting August 18
• Dissemination Activities August-September 18
11
Exhibit A
Rx for Health Strategy
Overview Tab
• Plan Purpose: The purpose of this outcome evaluation plan is to evaluate if Fresno County has
met the CAP goal of increasing the number of people with improved access for chronic disease
prevention, risk reduction, or management through clinical and community linkages as well as to
improve patient health outcomes over time. This innovative intervention will extend the actual
use data collection process by monitoring patient health outcomes on indicators such as
smoking, chronic disease self-management, physical activity, and diet. CVHPI will randomly
select clinical sites to participate in an experimental and control group. The experimental group
will be treated as closely as possible to the control group on all measures with the exception of
providing the patients with referrals to a physical activity program. This longitudinal design will
allow measurement of health outcomes over time and will provide insight on the effectiveness
of the intervention.
• Single intervention or strategy: The evaluation plan will examine a single intervention which
aims at increasing the number of people to 363,214 with opportunities for chronic disease
prevention, risk reduction or management through clinical and community linkages.
Intervention Description Tab
• Name: Prescription for Health.
• Description: The "Prescription for Health" referral system will use local resources to integrate
and promote lifestyle interventions in Federally Qualified Health Centers and rural health clinics.
Referrals will result in increased opportunities for free and low-cost physical activity, tobacco
cessation, and Chronic Disease Self-Management workshops. The Prescription for Health system
will include training and support for clinicians, changes to electronic medical records to track
referrals, and relationships with communities to track referral outcomes.
• Start/End Date: Start date is estimated to be July 15-September 18.
• PPO/AO:
• PPO 04 will increase the number of people with improved opportunities for chronic disease
prevention, risk reduction or management through clinical and community linkages from 0 to
65,000 by September 2018.
• AO 01 will increase the number of Lifestyle Intervention Programs that are covered by health
insurance companies from 0 to 5 by September 2015.
• AO 02 will increase the number of Primary Health Clinics that have adopted a Prescription for
Health Referral System from 0 to 5 by September 2015.
• Innovative: This intervention is innovative because, to our knowledge, there are no consensus
recommendations for program design and no structured evaluations of the model in similar
populations. This evaluation will provide insight on how well the program has reached the
population in consideration, as well as the health outcome of the studied individuals.
• Health Disparities: The population in Fresno County ranks among the worst in the nation when it
comes to accessing parks, primary care physicians, and literature on chronic disease
management. All of which contribute to one's ability to manage chronic conditions.
Questions Tab
• Question 1: What is the effect of Rx for Health prescription for lifestyle modification
programming on chronically ill patients at participating clinics on relevant behavioral changes
such as increases in the amount of time and intensity of physical activity or smoking cessation
compared to similar chronically ill adults served by nonparticipating clinics?
• Question 2: What is the effect of Rx for Health prescription for lifestyle modification
programming on chronically ill patients at participating clinics on changes in attitudes and
12
Exhibit A
behavioral intention for positive relevant behavioral changes such as increases in the amount of
time and intensity of physical activity or smoking cessation compared to similar chronically ill
adults served by nonparticipating clinics?
Evaluation Design Tab
The proposed outcome assessment will be a longitudinal study design where a control and an
experimental group will be monitored for the duration of the implementation. Six local clinics will be
randomly selected to administer a screening tool to identify patients who qualify for this study:
chronically ill adults with potentially modifiable related behaviors (smoking, obesity, inactivity). Half of
the clinics will be randomly assigned into the control and the other half into the experimental group. A
cohort of 50 individuals will receive initial screening and informed consent from each site. Referred and
consented patients will complete a home-visit interview, beginning with more detailed informed
consent. The interview will examine potentially modifiable risk behaviors and their frequency/intensity
as well as attitudes and behavioral intentions concerning relevant behavior change (stages of change
assessment). Six months after the initial clinical screening and research referral a researcher will
administer a follow-up survey. Although not all individuals in the experimental group will be referred to
lifestyle intervention programs, consent must be attained for all individuals even those that are not
referred.
Instruments Tab
Overview
• A screening tool will be administered by the clinics which will help in identifying qualified
patients
• After participants have been screened, a researcher will administer an informed consent
and a survey to all participants in the evaluation.
• The survey will include questions of demography, adherence to prescription for health, and
the current state of physical activity and health
• A follow-up observation will be administered to the same individual six months after the
baseline measurement
Indicators
• Number of people who get referred to physical activity program
• Number of people referred to physical activity program that is covered by insurance
• Number of people wo discuss physical health and activity with doctor
• Level of physical activity
• Minutes of physical activity in a week
• Adherence to "prescription for health"
o Participation in referral program
o Physical activity increase
• What type of chronic conditions do you currently have
o Diabetes
o Hypertension
o Asthma
o Other
• Chronic disease self-management
• Do you smoke
• Diet
Sampling Plan
• 350 individuals will be sampled for this study
13
Exhibit A
• All individuals will have a chronic condition present at the initiation of this study
• Six clinics will be randomly selected for study inclusion
• Three clinics will be randomly assigned to the control group and three clinics to the
experimental group
• Each clinic will administer the screening tool to 50 individuals that are randomly selected to
participate in this study
• A grand total of 300 individuals will participate in this study
o This sampling strategy accounts for potential refusals and attrition
• A total of 150 individuals will participate in the referred experimental group and another
150 in the control group
Data Collection Plan
• The screening tool administered by the clinics will be used to collect baseline data on the
number of individuals who qualify and the number actually referred to lifestyle modification
programs.
• A researcher will administer a survey to each participant with more detailed questions than
the screening tool
• The survey will provide baseline data on detailed indicators of physical health and activity
• This survey will be administered as a six month follow-up to collect potential change
• The researcher will be trained prior to administering the informed consent and survey by a
mock experimental exercise to ensure accurate data collection
• The following is a list of references for inclusion in instrument development: A list of tools
CVHPI will adopt for this study
o Screening Tool:
• Rapid Assessment of Physical Activity (RAPA)
• A tool developed by the Health Promotion Research Center at the
University of Washington
• http://depts.washington.edu/hprc/rapa
• This tool will be adopted and administered by the clinics as a screening
tool
• General Practice Physical Activity Questionnaire (GPPAQ)
• This questionnaire will be adopted by the clinics as a screening tool in
conjunction with RAPA
• http://www.patient.co.uk/doctor/general-practice-physical-activity-
guestionnaire-gppaq
• Treating Tobacco Use and Dependence
• The Agency for Healthcare Research and Quality (AHRQ) provides
recommended guidelines for screening tobacco use
• Obesity will be indicated by Body Mass Index (BMI) from clinic records
o Survey
• International Physical Activity Questionnaire
• This survey will be administered by researchers as recommending by
the CDC
• https://sites.google.com/site/theipag/scoring-protocol
• This survey will be modified with the following questions
o Did the patient receive a PA prescription?
o Did the patient follow-up/enroll in recommended program?
o How often has the patient participated in the program?
• In the case that individuals are referred to smoking and/or overweight
programs this survey would be supplemented with the smoking status,
14
Exhibit A
obesity, and diet quality items from the National Health and Nutrition
Examination Survey (NHANES)
o http://www.cdc.gov/nchs/nhanes/nhanes questionnaires.htm
o The focus will be on the Diet and Behavior and Nutrition (DBQ)
and Smoking and Tobacco use (SMQ)
Data Analysis Plan Tab
The initial screening administered by the clinics will serve as the baseline on indicators of smoking,
chronic disease self-management, physical activity, and diet. These indicators will vary from ordinal to
ratio-level measures and will be monitored for change over time throughout the study. In addition,
CVHPI will administer a survey on health and physical activity at six months after the screening. This
survey will include in-depth indicators for program referral, program follow-up/participation, physical
activity, and health. Both the screening tool and follow-up survey are designed to provide basic counts
of events as well as scaled measures smoking, chronic disease self-management, physical activity, and
diet. Descriptive analysis will be conducted by demographic characteristics as well as health categories.
An intent-to-treat analysis will be primary. Repeated measures will be used to conduct inferential
analysis for the entire population. Tests of tool validity and reliability will be conducted prior to any
analysis.
Dissemination Tab
Due to the innovative approach of this evaluation, it is a priority to disseminate the valuable information
gathered from this assessment. We intend to develop preliminary analysis and a report describing the
initial findings of the screening tool as well as a final analysis and final report that extend in detail the
findings and implications of this study. All descriptive and inferential findings will be written and shared
primarily with the community as well as conferences, a variety of academic settings, and potentially
through a peer-reviewed journal. CVHPI will work in conjunction with FCDPH for all dissemination
purposes.
Evaluation Work Plan Tab
Timeline:
• Protocols and indicators will be finalized by January 16
• An Institutional review board (IRB) will formally designate approval of this study by March 2016
o This is a three week process
• CVHPI has established working relationships with many of the local clinics in the region and
anticipate 4-6 weeks to develop agreements for data collection
o This process will be completed by March 2016
• Clinics and researchers will be trained on how to administer screening and survey tools
developed for the study before the start of year 2
• The screening tool will be administered by the clinics in year 2 (July 16-October 16)
o A 4 month period of patient accrual will be implemented by the clinics
o At the end of patient accrual data will be analyzed and all partners will receive interim
results for the screened population
• A follow-up survey will be administered by a researcher 6 months after the individual's
screening
• Final analysis and reports will begin once all participant's data have been collected
(approximately July 17-October 17)
o Analysis and reports will be shared with all partners
• Dissemination of findings will occur in partnership with FCDPH
15
Exhibit A
GLOSSARY
Actual Use: The number of people who use an environment or system that has been enhanced to
support improved health as intended.
Descriptive analyses: A statistical technique that summarizes or describes a set of data.
Health Disparities: Differences in health outcomes and their determinants among segments of the
population as defined by social, demographic, environmental, or geographic category.
Indicator: A tangible, measurable attribute that is the focus of the evaluation. Example: number of
servings of fruits and vegetables consumed per meal. The indicator should be easily identified from a
survey, observation, or other instrument you plan to use.
Inferential analyses: A statistical method that uses data drawn from a sample to make inferences about
a population.
Innovative Intervention: Interventions that lack evidence of their effectiveness in peer-reviewed
literature or evidence-based interventions that are implemented in new sub-populations or settings.
Instrument: A tool for collecting or observing data.
Interval: Level of measurement where the values are categorically discrete and distance between
attributes has meaning.
Intervention: An effort to improve policies, systems, or environments to promote healthier behaviors at
the population level. Examples include-improving food procurement guidelines; increasing voluntary
adoption of smoke-free housing policies.
Population-wide: The intended geographic area in which the awardee was funded to work.
Nominal: Level of measurement where the numerical values label the attribute uniquely. No ordering of
the cases is implied.
Ordinal: Level of measurement where the attributes have a natural rank order. Distances between
attributes do not have any meaning.
Ratio: Level of measurement where the values are categorically discrete, and distance between
attributes has meaning and a natural zero point.
Strategy: Broad approach to changing health behaviors. Strategies may include multiple interventions
that aim to achieve similar outcomes. Examples include-improving access to healthy foods and
beverages; improving access to smoke free environments.
16
ITEMIZED BUDGET
Proposal Due: Start Date : l Title : CVHPI PICH
iA . Personnel Waaes
S~: %ofAY ,#WTU or
Position on Effort OR Year 1 Year2 Year3 Total
ll.!:!l!@! I smr mos Last Name Basis of Salary Number ~ Summer Request Request Req...t Grant Request
r:.tP mnnth ~
•::t•flill ......
caOitman J PI IAcaaemrc Year Kerease $136 ,644 7% 2 .1 $9 ,565 ::::;~ $10,148 $29 .565
1 ...... •-•~r Faculty Salaries $9,565 $10,148 $29,565
Cal Yr
Pos ition on Salary %Time # Grant OR hrly OR# hrs
rate
""""011.-1 $75 ,000 45% $33 ,750 $34,763 $35 ,805 $104 ,318 -1 !Director Ct:fl\liC:IIIlll
Lessard 1 ~~~0~~~~ $54 ,204 40% $21 ,682 $22 ,332 $23,002 $67 ,016
Alcala 1 A~=~~~--n $37,441 25% $9,360 $9,641 $9,930 $28,932
Comm.
Conley 1 Specialist Y1 and Y3 15%, Y2 20% $33 ,925 15% $5 ,089 $6 ,989 $5 ,399 $17,476
t:Sauesleros 1 ~::i:~~~~ Y1 and Y3 25%, Y2 15% $32 ,000 25% $8 ,000 $4 ,944 $8,487 $21 ,431
ITBN 1
~~t::>t:OI.-1
IY1 and Y3 25%, Y2 15% $32 ,000 25% $8,000 $4,944 $8,487 $21 ,431 -·;·· .. ·· $85,881 $83.612 591:111 mo.803
Hrty Rate Hrslwk Wkslyr Stipend
Ami
Grad 1 1 INUtrmon HOUrlY Kale (Smr} $ 15 I 10 I 35 $5 ,250 $5 ,2 ~50 ss~iso $15}50
r Student lalaries $5.250 $5.2 !50 SU50 $15.750
!Subtotal ALL Personnel $100,696 714 $96," $101,101 $301,111
rB.Fiiilii8Beneflts (3.48% increase i n Workers Comp) r-,;,,;.;.,.; Rate
~ PI 42% $4,017 $4 ,1-38 $.4.262 $12.417
IBenQiman 35% $11 ,813 $12,167 $12.532 $36 .511
I Lessard 35% F~589 $7,816 $8.051 $23 ,455
I Alcala 35% $3 ,276 $3 .374 $3.476 $10 .126 ICOnlev 35% $1,781 $2.446 $1 .890 $6 .117
35o/~ $2 .800 $1 730 $2 .971 $7 .501
ITBN 35% $2 ,800 $1 730 $2.971 $7 .501
IAII ::>tuaems taxes 7 .65% $402 &402 $40 205
ISubtotafl'ringe ........... .., S34.4n s: Btu S3~ Ul 12 ~. IJI-2'2
ITOTAL SALARY AND FRINGE BENEFITS $135,173 $1 32.518 ~ S< 10.751
Cost !'ler #round
D. Travel item tri!'l m il es
!Local Travel $ 0 .57 $750 $750 $750 s2,2so I
rc:.;.~o.•-•~' Travel _$750 J $750 T $750 1 $2.250 I
IF . Other Direct Suooort '" f'~l~ .. l~•lnn
Meeting and office supplies $5 ,238 $5,648 $5 ,666 $16,552
1(1) Materials and Suoolies and communication costs
(6) Equipment or Facility Office space and meetin g $500x12monthsX 1 FTE $6 ,000 $6 ,000 $6 ,000 $18 ,000 1Rentai/User Fees room rental
~Other $11.238 $11.648 111:666 $34 ,662 I
Total Direct Costs $147_._1U I S144.916T 5155.476 $447.553
MTDC $147,161 I $144:9161 $155.476 C,AA' '.r:.r:~
Rate : : IJ. Indirect Costs 19.0% MTDC $27,961 : $27,634 ~ $29.640 $86.036 I IK. Total "ivl'v<>vu Costs $175,121 S1I2,45o I $185,017 ltl:'t1 I:JID
Budget Narrative California State University, Fresno Foundation Central Valley Health Policy Institute Personnel Justification Exhibit 8 Project Director The Project Director, John Capitman, PhD, will assume responsibilities for coordination of all program activities, maintaining communication with all members of the team and will provide direct supervision for project personnel. This position is budgeted at 10% for a total of$13,664 in Year 1 and $42,235 for the 3 year project. Research Director The Research Director, Marlene Bengiamin, PhD, will utilize expertise in research, data and qualitative analysis. She will also be responsible for developing assigned reports, etc. This position is budgeted at 32% for a project total of $24,000 in Year 1 and $74,182 for the 3 year project. Project Coordinator Project Coordinator, Lauren Lessard, ABD, will be responsible for supervising research assistants and students interns. She will also be responsible for report completions. This position is budgeted at 50% for a project total of $25,000 in Year 1 and $77.272 for the 3 year project. Communications Specialist The Communications Specialist, Amanda Conley, will1) develop and maintain relationships with organizations to coordinate and maintain a tracking system for engagement communications, 2) develop, design, and coordinate the launch and maintain updated relevant content online and in person communication. The Communications Specialist will arrange meetings with all partners, facilitate communications and procurement of supplies and services as well as record-keeping and clerical tasks. This position is budgeted at 36% for a project total of$12.213 for Year 1 and $37,749 for the 3 year project. Research Analyst The Data Analyst Emanuel Alcala will provide quantitative analysis for all data collected for Farm to school, health retail, and RX for health components of the project. This position is budgeted at 20% for a project total of$7,488 for Year 1 and $23,145 for the 3 year project. Research Assistants There will be 3 part-time graduate research assistants with public health and nutrition backgrounds. They will assist with primary data collection, securing of secondary data, preparing Page 1 of2
Benefits Non-Personnel Operating Costs Meetings/Supplies & Communications Meeting Travel Direct Cost Indirect Costs @ I9% Page 2 of2 data for analysis, preparing tables and figures based on analyses. The projected total costs for Year I for these staff will be $I1.970 and $29,I90 for the 3 year project. Fringe benefits are calculated individually based on costs and total $44,390 for Year I and $136,607 for the 3 year project. Exhibit 8 Communication costs include actual costs for telephone and teleconference utilization. Project supplies including, paper, ink, office supplies, and required software will be purchased centrally at discounted rates available through California State University, Project estimated cost for these items is $3,975 for Year I and $II ,870 for the 3 year project Costs for this line include meeting space and/or room rentals are budgeted at $6,000 annually. Local travel, including mileage reimbursement and parking costs for the project meetings is budgeted for a project total of$750 annually Total direct costs for personnel, travel and other direct support are $I49,450 for Year I and $452,500 for the 3 year project. Indirect costs are the "overhead" costs of administering the grant. They include setting up of the account, paying bills, and other accounting services necessary to conducting an audit upon completion of the grant/contract. Indirect costs are calculated at 19% or $28,396 for Year I and $85,975 for the 3 year project.
Department of Health and Human Services
Centers for Disease Control-Federal Regulations
Funding Opportunity Announcement {FOA) Restrictions
Exhibit C
Page 1
estnctions !Mat must be considered whtle planning the pmgratr,s and v/riting :he budget are:
• Awardees may not use f'Jnds for research.
• Awardees may not use f:.mds for c:l nical care.
• Awmdees may use fu'lds ont1 fo• reasonable program pu·pcses, mcJuding parsoncel,
travel, supp! es. and services
• Generally. awardees may not Jse turds to purchase furniture or equipmer:t Any such
proposed spending must be clearly identified In the Oudget.
• Reimbursement of pra·award costs is not allowed.
• Other than for r~ormal anrJ recognized executive-legislative relationships, no funds ~.ay
oe used for: pl.blicity or propaganda purposes, for the preparation, distribution, or use of
any rr,ateria. designed to support or defeat the enactment of legislation oerore any
!egtslatlve bOdy the salary or expenses or any grant or contract recopient. or agent acting
for SJCI" recipient related to any activ;ty designed to influence the enactment of
legislation, appropriattons, regu.ation, administrative action. or f::xecutive order proposed
01 pending before any legislative body
• See Addtttonal Requirftment (AR) 12 for detailed guidar:cc en t'n.s p-ohtb:tion and
additional gwida'lce on lobbying for CDC awardees.
• The direct and primary recip.er.t tn a cooperative agreement pmgram m<..:st perform a
substantial role tn carrying out proJeCt outcomes and not rr·erely serve as a condu•t for an
award to another oa or rovider who il'l tneli ible.
Indirect Costs: lndtrect costs are not approved for tt11s award, because an approved.
current lndir~ct Cost Rate Agreement has noi been establ.shed. The costs identified as Indirect
Costs have been moved to Direct Costs, Other category. To have indirect CClSls approved for this
go <lnt. submit an approved md1mct cnst rate agreen'!eN or Ccst Alocation Plan and detajls of
base to the grants maragement specialist no later than October 30, 2014
Cost Limitations as Stated In the Consolidated Appropriations Act, 2014, (Items A through
G)
A Cap on Salaries {D1v H. Ttt~e II. Sec 203) None of the funds appropriated in this title shan be
used to pay the salary o' an indiv1dua1, trrough a grant or other-extramural mechantsrn. at a rate
1n exce~s of Executive Leve~ lL
Note The salary rate limitation does not restrict the salary that an organization may pay an
individual working under an HHS co·1tract or order; it merely limits lhe portion of that salary that
may be pald with Federal funds.
A Gun Control Prohibition (D111 H. Title II, Se<; 217): None of tl"le funds made available In this
title may be used, in whole or In part. to advocate or promote gun control.
C Proper Use of Appropriations· Pt.bUcrty and Propaganda (LOBBYING) FY2012 (Div. H, Tille
v. Sec 503)'
• 503(a) No part of any appropnation coota 1ned in this Act or t·ansferred pursuant to
section 4002 of Public Law 111-148 shall be u~;eo, other than for normal and recognized
executive~legislative (elahonships, for publicity or propaganda purposes. for the
preparatton, distributor~, or use of any kit, pamphlet, booklet, oubli:::ation, electrontc
commwnicatton. radio, television, or video presentation des.gned to st~pport or defeat the
•
•
en~ctmeN of legislation before the Congress or any State or local legislature or
legislative b~dy, excep! in presentation of the Congress cr any State or local ·egislature
1tself, or des1gned to support or defeat any proposed or pending regulation, administrative
action, or order issued b:y the executive branch of any State or local govenment Itself.
503 (b): No part of any appropriation contained '"this Act or transferred pursuant to
section 4002 of Public law 111-148 shal. be used to pay the salary or experses of any
grant or con~ract recipient, or agent acting for such recipient, related to any activity
des1~~ed to tnflue.nce the enactment of legislation, appropriations, regulaUon,
adm•mstratrve action, or Executive order prooosed or pending before the Congress or
any State government, Sta:e legislature or local ;egislature or legislative body, other than
normal and recognized execuhve legislative relationships or participation by an agency or
officer of an State, !ocal or tribal sovernment n pollcymakirg and adm nlstratlve
processes Within tne executive branch of that government.
503(c): The prohibitions In subsections (a) and (b) shall include any activity to advocate
or promote arry proposed, pending or !uture Federal, State or local ~x Increase, or any
proposed, pending, or future requirement or restriction on any legal consumer product
including Its sale of marketing, including but not limited to tho advocacy or promotior of
gun control.
For additlonallnformatron. see Additional Requirement 12 at
httpfl)h'ww.<;dc.govlod.'pqotfJ!:ldirg!gran1s.laddjtiQ!'.1i!LJ:S!.9.Shtsn and Anti Lobbying Restrictions for
CDC Grantees at http·t~·£~govlod.lpgolfyQdi..nglgrants1Anti-
.h9\;lbyino Restrictions fQr_QDC Grantees July 2Q12.pdf.
D. Needie Excharge (Div. H. Trtle V, Sec. 52:2): Notvvithstandlng ary other provision of this Act,
no funds appropriated in this Act shall be used to cany out any program of distributing sterile
needles or syringes for the hypodel':'nlc Injection of any Illegal drug.
E. Restricts dealings with corporations with recent felonies (Div. E, nue VI, Sec. 623}: None or
the funds made available by this Act may be used to e'lter ir.to a contract, memorandum of
understanding, or cooperative agreement with. make a grant to, or provide a loan or loon
guarantee to any corporat\o!'l that was convicted (or hadar. officer or agent of such corporation
acting on behalf of tne corporation convicted) of a felony criminal violation under an>' Federal or
State law wlthln the preceding 24 months. where the awarding agency is aware of the conviction,
unless the agency has considered suspension or debarment of the corporation, or such officer or
agen~ and made a deletmi'lation that this further action is not necessary to protect the Interests
of the Govemment
F Restrrcts dealings with corporations with unpaid federal tax liability (Div. E, Title VI Sec. 622,
Div. H, Title V, Sec. 518): None of the funds made available by this Act may be used to enter into
a contract, memorandum of understanding, or cooperative agreement with, make a grant to, or
provide a loan or loan guarantee to. any corporation that any unpaid Federal tax 1iabll\ty that has
been assessed, for which all judicial and adm.Jnistrative remedies have been exhausted or have
lapsed, and that is not belng paic il" a timely manner pursuant to an agreement wi1h the authority
responsible for collecting the tax liability, where the awarding agency is aware o' the unpa[d tax
liability, unless the agency has considered suspension o· debarment of the co~poration and rrade
a determination that this further action is not necessary to protect the interests of the
Government
G. Blocking access to po!nograpt:y (Div. H, Title V. Sec. 528): (a) None of !he funds made
availab:e in this Act may be used to mahtain or es~ablish a computer networ!< unless such
network blocks the viewing, downloadmg, and exchanging of pornography· (b) Nothing in
subsection (a) shall limit the use of funds necessary for any Federal, State, tribal. or local law
enforcement agency or any other entity carrying out criminal Investigations, prosecution, or
adjudication activities.
Rent or Space Costs: Grantees are responsiole for ensuring that all costs included in this
proposal to establh;h billlng or ~nal indirect cost rates are allowable In accordance wilh the
requirements of the Federal award(s) to which they apply, Including 2 CFR Part 20(1, Uniform
Administrative Requirements. Cost Principles, and Audit Requirements for Federal Awards: 2
CFR Part 225, Cost Principles for State, Lo\'..al. and lnd.an Tribal Governments (OMS Circular A·
87); and 2 CFR Part 230, Cost Principles for Non-Profit Organizations (OMB Cirou!ar A-122}. The
grantee a! so has a respons:blllty to ensure sub-recipients expend funds in compliance with
Exhibit C
Page 2
applicable fecerallaws and regu'ations. Furthermore, ills the responsibility of the grantee to
e~sure rent 1s a legitimate di:ect cost line tem, which the g~an:ee has S'Jpported in current and/or
pnor proJects ard these same costs have been treated as mdirect costs that have not been
claimed as d;rect costs. If rent is claimed as d;rect cost, the grantee must provide a narrative
;usti~ication, which describes their prescribed policy to include the effective date to the assigned
Grants Management Spec.Jalist (GMS) identified in the CDC Contacts for tt1is award.
Trafficking In Persons: This award is St..;bject to the requirements of the Trafficking VIctims
Protection Act of 2000, as amended {22 U.S.C. Part 7104(g)). For the full text of the award terms
and conditions, see,
!l.itJ:t:llwww.c~c.gov/odiQgo/!undmg/grants/A~Derm and C.Q.n.Qi!ion for Traf.nckiQg in Per§o
n~~hJ.m
Cancel Year: 31 U.S. C. Part 1552{a) Procedure for Appropriation Accounts Available for Definite
Periods states the following, On September 30tt• of the otr fiscal year after the period of availabl\ity
for obligation of a fixed appropriation account ends, the account shall be dosed and any
remaining balances (whether obligated or unob~igated) in the accou"lt snail be canceled and
thereafter shall not be available for obligation or expenditure for any purpose. An example is
provided below:
Fiscal Year (FY} 2014 funds wi!l expire Septerrber 30, 2017. All FY 2014 funds should be drawn
down and reported to Payment Management Services (PMS) prior to September 30, 2C 17. After
thts date, corrections or cash requests will not be permitted.
REPORTING REQUIREMENTS
Annual Federal Financial Report (FFR, SF-425): The Annual Federal Financial Report (FFR)
SF-425 is required and must be submitted through eRA Commons no later than 90 days
after the end of the calendar quarter In which the budget period ends. The FFR for this
budget period Is due to the GMSIGMO by December 29, 2015. Reporting timeframe Is
September 30, 2014 through September 29, 2015.
The FFR showd orty Include those funds authorzed and disbursed durin·g the timeframe covered
by the report. The final FFR must indicate the exact balance of unobligated funds and may not
rafted any unliquidated obligations. There must be no discrepancies be:ween the final FFR
expenditure data and !he Payment Management System's (PMS~ cash transaction data. Al~
Federal reporting In PMS is U'lchanged.
Failure to submit the required information in a timely manner may adversely affect the futu•e
funding of th1S project. If ttle :nformation cannot 'oe provided by the due date, the grantee is
requ;red to contact !he Grants Officer liste\1 in t~e conla.cts section of this notice before the due
date.
FFR {SF-425) instructions for CDC Grantees are available at
http://griiJot§,nih.go~l§'forms.btm. For further intormaton, contact Grantslnfo@nih.gov.
Additional resources concerning the eFSR/Ff:~ system, includl'1g a User Guide and an on-line
demonstration, can be found on the eRA Commons Support Page:
l'\_ttp:f/www.cdc.gol£/Odlpgolfundjngtgra:'tsle@(l1.i~Jfi-'S"ltm,
Performance Reporting: The Annual Pe:formance Report Is due no later than 120 days prior to
the er.d of the budget period, May 29,2015, and serves as the contirlUJrtg application. This report
should nclude the information specified In the FOA.
Audit Requirement: Domestic Organizations: An orgar.ization that expends $500,0()0 or more In
a fiscal year in Federal awards shall have a single or prog"am-specrtic audit conducted tor that
year in accordance with the provisions of OMB Ci:-cular A-133. Tne audit period is an
organization's fiscal year. The audit mJst be comp1eted along wtth a data collection form (SF·
SAC), and the reporting package shall be submitted wi~hin the earlier of 30 days after receiot of
the audi~or's report(s), or nine (9) months after the end o( the audit period. The audit report must
be sent to:
Federal Audit Clearing House Internet Data Entry System
Exhibit C
Page 3
El~~.tronic SubmissiQQ:
https://harvester.cersus.gov/faf!:i!Jesl{$(0vkw1za;;lvzl:bna'1ocs.i~~1Q.}Xe~~9~
AND
Procure':'ent & Grants Office .. Risk Management & CoMpliance Activity
Electromc Cooy tq: J:GO.Audlt.Re§olytjon@cdc gQ·~·
After receipt of the audit report, the National External Audit Review Cer:ter wlli provide audit
reso!Jtlon mstructions. CDC will resolve l'i:1dings by issu1ng Final Determ:na:ion Letters.
Au a it requirements for Subrecipieru: The g:-antee must ensure that the s~.tbreciplents receiving
CDC funds also mee~ these requirements. The grantee must also ensure to take appropriate
correc~ive action within six months after receip! of the subreciplent audit report in instances of
non-compliance with appHcable Federal law and regulat:ons {2 CFR 200 Subpart F and HHS
Grants Polley Statement). The grantee may conslder whether subrecipie'1t audits necessitate
adJUstme1t of tlje grantee's own accountbg records. If a subrecipient is not required to have a
program-specific aUdit, the grantee is still required to perform adequate monitor'ng of subrecipient
activities. The grantee shall require each subrecipient to permit the independent auditor access to
the subrecipienfs records and finandal statements. The grantee mast include this requirement In
all s•Jbrecipient contracts.
Note: The standards set fort'"! in :2 CFR Part 200 Subpart F wil' apply !o CJU<:hts of fiscal years
beginn1ng on or after December 26, 201t..
Federal Funding Accountability and Transparency Act (FFATA): FFATA applies to new
awards that have been made and noncompeting continuations that were issued as new
awards on or after October 1, 2010. In accordance with 2 CFR Chapter 1, Part 170
Reporting Sub·Award And Executive Compensation Information, Prime Awardees awarded
a foderal grant art~ required to file a FFATA sub-eward report by the end of the month
following the month in which the prime awardeo awards any sub-grant equal to or greater
rhan $25,000.
Pursuant to A< 33 (see Section_.205(h} and Section_.205(i)), a grant sub-award includes the
provision of any commodlbes (food and non-food) to the sub-redpient w~ere the SJb·reciplent is
required to abide by terms ard conditions regarding the use or "uture administraton of those
goods. If the sub-awardee merely consumes or utilizes the goods, the commodfties are not in
and of themselves considered sub-awa;ds.
2 CFR Part 170: http~//www .e'Cfr .gov/c:g1-bir/tt'j>;;t·
idx?S;D=62cQc§j 1004c0ada2~.;o6552e0a(.tlfQctl&node"'2: 1.1.1 .1.4&ra.'~=div5# too
FFATA: www.fsrs gov.
Report!ng of F'rst-Tier Sub-awards
Applicability: Unless you are exempt (gross ·ncome from all sources reported in rast tax return rs
under $300,000), you must report each action tl'at obligates $25,000 or mo:e ir. Federal funds
that does not include Reco110ry funds (as defined in section 1512(a){2) of the American Recovery
and Reinvestment Act of 2009, Pub. L. 111·5~ for a sub-award to an entity.
Reporting: Report each obligating actio'l of this award term to http:llwww.fsrs.gov. For sub-award
information. repcrt no later than the end of the month following the month in which the obligation
was made. (For example. if the obligation was made on November 7, 2010, the obligation must
be reported by no later than December 31. 2010). You must report the Information about each
obligating action that the submission instructions pcsted at M~m~~speclfy.
~~ Compem!S~tiqp or ReciQieot Executives You must report total compensation for each of your
f<ve most highly compensated execurives for the preceding completed fiscal year, if:
• The total Federal funding authorized to date l.nder tris award is $25,000 cr more;
• In the preceding fiscal year, yo'J recelved-
o 80 percent or more of your annual gross revenues from Federal procurerr,ent
contracts (and subcontracts) and Federal fina1cial assis:an:::e subject lo the
Transparency Act, as defined at 2 CFR Part 170 320 (and sub-awards); and
Exhibit C
Page 4
o S25,COO,COO or more in annual gross revenues •rom Federal procuremen~
contracts (ana subcontracts) and Fede'al financial assistance subjec: to the
Transparency Act, as deflr.ed at 2 CFR Part 1 "/0.32.0 (and sub-awards); and
o The public does not have access to mforma:ion about the compensation of the
execu~ives through periodic reports f11ed t.nder section 13(a} or 15(d) of the
Securrtles Exc'lange Act of 1834 ( 15 U.S.C. Part 78m(a), 78o(d)} or section 6104
of the Internal Revenue Code of 1985. (To determine if the public has access to
the compensat:on information, see the U.S. Security and Exchange Commission
total compensation filln·~s at "ttp:/1\w.w sec .. ggyJ@!".&~{!I~e.x~ompJJJIJ)).
Report executive total compensation as part of your "Elgistration profite at htJ;;:IIw\•M. sam.aov.
Reports should ba made at the end cf the month fotlowing the month In which this award is made
and annually thereafter.
Total Compensation Qf ~Yb:-L'itgment Executives: Unless you are exempt (gross Income from all
sources reported In last tax return is under $300,000), for each first~tler sub-recipient u1der this
award, you must report the names and total compersation of each of the sub-recip'ent's five most
highly compensated executives for the su1>-reclp1ent's preceding completed fiscal year, if:
• In the sub-recipient's preceding fiscal year, tne sub-recipient recelved-
c 80 percent or more of its a:1nua1 grass revenues from Federal procurement
contracts {and suocontracts) ano Federal financial assistance subject to the
Transparency Act, as defined at 2 CrR Part 170 320 (and 5ub-awards): a~d
c $25,000,000 or more ln annual gross revenues from Federal p~ocurement
contracts (and subcontracts). ano Federal f.nancial assistance subject to the
Transparency Act (and sub-awards); and
o The public does not have acceSl> to info-mation about the compensation of the
executive5 through periodic reports filed under sect~on 13(a) or 15(d) of the
Sec'Jrities Exchange Act of 1934 ps U.S.C. Part 78m(a). 78o(d)) or section 6104
of the Internal Revenue Code of 1 f186. (To determine if ttle public has access to
the compensation lnforma~lon, see the U.S. Secur.ty and Exchange Commission
total ccmpensatior filings at htp://wvi"N.soc.gov/answers/execomp. htm).
You must report sub-recipient executtve total compersation to the grantee by the end of the
month following the month d\Jring which you make the sub-award. For example, if a sub-award is
ob\igateo on any date during the month of October of a given year (ie , between October 1st and
31st), you must report any requirec co.'l1pensalion information or the sub-recipient by November
30th of that year.
Definitions:
• Entity means all of the following, as defined In 2 CFR Part 25 (Appendix A,
Paragraph(C)(3)):
o Govemmental organizatio'l, whic:t', is a State, locat government, or Indian tribe;
o Foreign public entity;
o Domestic or foreign non-proftt organization;
c Domestic or foreign for-profit organization;
o Federal agency, but cnly as a SJb-recipient under an aw-ard or sub-uward to a
non-Federal entity.
• Executive means off:cers, managing partners, or any otrer employees In management
positions.
• Suo-award: a legal instrument to provide support to au eligible sub-recipient for the
performance of any portion of the substantive pro:ect or program 'or which the grantee
received this award. The term does not include the grantees procurement of property and
services needed to carry out the project or program (for further explanation, see Sec .
. 210 of the attachment to OMB Circular A·133, Audits of States, Local Governments,
and Non-Profit Organizations}. A sub-award may be prOVide<! through any legal
agreement, Including an agreement that the grantee 0( a sub-recipient considers a
contlract.
Sub-recipient means an entity that ~ece\ves a sub,award from you (the grantee) under
this award; and IS accountable to the grantee for the use of the Federal \mds provided by
the sub-award.
• Total compensation means the cash and non-cash dollar value earned by the exeCtJtive
during the grantee's or sub-recipient's preceding fiscal year and Includes the following
{for more information see 17 CFR Part 229.402(c)(2)}:
Exhibit C
Page 5
o Salary and conus
o Awards of stock, stock options, and stock appreciation rlghts. Use the dollar
amount re~gnlzed for financial statement ~eportlng purposes wi;h respect to the
fiscal year In accordance with the Statement of Financial Accounting standards
No. ~23 (Revised 2004) (FAS 123R), Shared Based Payments.
o Earnings fO( services under non-equity incentive plans. This does not include
group life. heaJtr,, hospitalizatior~ or medical reimbursemerlt plans ~hat do not
discrim'nate In favor of executiVes, and are available generally to all salaried
employees.
o Change in pension value. This is the change in presert va\ue of defined benefit
and actuarial ptJnsiol'l plans.
'' Above-narket earnings on deferred compensation whic'1 is not tax-qJalified.
:::: Other compensation, if the aggregate value of afl such other compensatior. (e.g.
severance. terninatJon payments, value of life insurar.ce paid on behalf of the
employee, perquisites or proper:y) for the executive exceeds $10,000.
@ENERAL REQUIREMENTS
Travel Cost In accordance with HHS Grants Policy Staterrent, travel costs are only allowable
where sue!'! !ravel will provide direct benefit to the project or pmgram. There must be a direct
benef;t imparted on behalf of the traveler as rt applies to the approved activit es of the NoA. To
prevent disallowarce of cost, the 9rartee Is responsible for ensurirg that only allowable travel
reimbursements are applied in accordance with their organization's es:Sbllshed travel policies
and procedures. Grantees approved policies must meet the req•Jirements of 2 CFR Parts 200,
225 and 230, as applicable and 45 CFR Parts 74 and 92, as applicable.
J
Food and Meals: Costs associated with food cr meals are allowable when consistent with OMB
C1rculars and guida'lce. HHS Federal regulations, Program Regulations, HHS poUcies and
guida~. In addition, costs must be proposed in accordance with grantee approved polfcies and
a determination of reasonableness has been performed by the grantees. Grantee a;Jprov!W
pcllcies must meet the requirements of 2 CFR Parts 200, 225 a,d 230, as applicable and 45 CFR
Parts 74 and 92, as app4icable.
Prior Approval: All requests, which require prior approval, must bear :he signature of an
au:horized official of \he business off'~ee o1 the grantee organization as we! I as the principal
investigator or program or project director named on this NoA The grantee must submit these
req:..~ests by May 29.2015 or no later than 120 days prior to this budget period's end date Any
requests received t..'lat rel\ect only one signature wilt be returned to the grantee unprocessed.
Additionally. any requests Involving funding issues must inc!ude an ltemlzed budget and a
narrative justification of the request.
'l he following types of requests requlre prior approval.
• Use of unobligated funds from prior budget period (Carryover)
• Lift ~.mdlng restriction, withholding, or disa:lowance
• RedirectiOn of funds
• Change in scope
• Implement a new activity or enter into a sub-award that is not specified in the most
recently approved budget
• Apply for supplemental funds
• Response to the ObJectiveJTechnical Review Statement
• Change in key persornel
• Extensions
• Conferences or meetings that exceed cost thresllold
Templates for prior approval requests can be found at
h!:!o:INM'W.cQc.gDvlodlpgoifuodingigraot~J:,g.rS!nteegu;cam;.~.s"trn
Correspondene~>: ALL correspondence (includmg emails and faxes) regarding this award must
be dated, ideot:fle:d yvil!) the AWARD)~JUMBER. and include a point of contact (name, phone, fax,
and email). All correspondence should be addressed to the Grants Management Specialist listed
below and submitted with an original plus two copies.
Exhibit C
Page 6
Michelle Ranger, Grants Management Specialist
Centers for Disease Control,
PGO, Chrome and Birth Defects Services Branch
2920 Brandywine Road, Mail Stop E-09
3'11 Floor. Room 3605
Atlanta, GA 30341-4146
Telephone: a10l488-iQ§i
trnail: vk/8@Cdc.gov
Key Personnel: In accordance with 2 CFR Parts 200.308 and 215.25(c)(2) & (3), CDC grantees
must obtain prior approval from CDC fo· (1) change in the project director/principal investigator
business official, authori.zed orga()lZational representative or o:her key persons specified In the
FOA, application or award document: and {2) the disengagement from the project for more than
three months, or a 25 percent reduction in time devoted to the project. by the approved orcject
director or principal Investigator.
Inventions: Acceptance of grant funds obligates grantees to comply w;th the standard patent
rights clause in 37 CFR Part 401.14.
Publications~ Publicatiors, journal a1icles, etc. prodJced under a CDC grant support project
mt:st bear an acknowledgment and disclamer, as appropriate, for example:
rhis pubrtcatior. UOlJrnal article. etc.) Vtcis supported by the Grant or Cooperative Agreement
Number, U58DP005567, funded by ~he Centers for Disease Control and Preventinn. lis contents
are solely the responsibility of the authors and do not necessar'ly represent the offlc1alviews of
the Centers for Disease Control and Prevention or the DepartMent o• Health and Human
Services.
Acknowledgment Of Federal Support: When Issuing statemerts, press releases, reques:s ~r
proposals, bid solicitations and other documents describing projects o~ programs fuMed in wrole
or in part with Federal mor1ey, an award~Nts re-ceiving Federal f:..nds, including and not limited to
State and local governments and grantees of Federal research grants, sheli clearly state:
• percentage of the total costs of tl'.e program or project which will be financed wilh Federal
money
dollar amount of Federal funds for the project or program, and
• percentage and dollar amount of the total costs of the project or ~rogram that will be
financed by nor.-govemmentBI sources.
Copyrlght Interests Provision: This provision is intended to ensure that the public has access
to 1he results and accomplishments of publtc health activities funded by CDC. Pursuant to
apphcable grant regulations and CDC's Public Access Policy, Recipient agrees to s•Jbm;t into the
National Institutes ot Health (NlH) Manuscript S•J'orrission (NIHMS) system an electronic version
of !he final, peeHevievved manusc'ipt of any s•Jch work developed under this award upor,
acceptance tor p~bllcatlon, to be made pt.:blicty available no la~er than 12 months after the official
date or oubllcat1on. Also at the time of submission, Recipient andior :he Recipiert's submitting
aJt>,or must specify the date the final manuscript will be publicly a~cesslble through PubMed
Central {PMC). Recipient and/or Recipient's submitting author must also pest the manuscript
through PMC within twelve (12) months of the publisher's official date of final publication;
however tl'le aut-,or is strongry e'1co~.:raged to ma'<e the subject manuscript available as soon as
possible, The recipient !r.ust obtain prior approval rrom the CDC for any excep~ion to this
provision.
The author's final, peeNeviewed manuscript is defined as the final version accepted tor journal
publication, and Includes a~t modifications from tile publishing peer review process, al"'d all
graphics and supplemental material associated wil.h the article. Recipient and its submitting
authors worl'ling under this award are responsible for ensuring that any pLbhshing or copyright
agreements concerning submi~ted articles reserve adequate right to fully comply with this
provision and the lk:ense reserveo by CDC. The manuscript will be hosted in both PMC and the
CDC Stacks inst:tutlonal repository system. In progress reports for this award, reclplem must
identify publications subject to the CDC Public Access Polley by using the applicable NlHMS
identifiCation number for uo to three (3} mo'lths after the oJblication data and the PubMed Central
Identification number (PMCID} thereafter.
Exhibit C
Page 7
Disclaimer for .conference/Meeting/Seminar Materials: Disc:aimers for conferences/meetings,
etc. and/or publications: l~a conference/meeting/seminar Is funded by a grant, cooperative
agreeme,t, suo-grant and1or a contract the grantee must mclude the following statement on
conference materials, including orcmotional materials, agenda, and internet sites:
Fund;ng for this conference was made possible (in pa1) by the Centers for Disease Control and
Prevention. The views expressed in written conference materials or p;.~bllcations and by speakers
and moderat~rs do not necessarily reflect the official policies of the Department of Health and
Human Servtces, nor does the mention of trade names, commercial practices, or organizations
·mply endorseme'lt by the U.S. Government
Logo Use for Conference and Oth&r Materials: Neither the Department of Health and Human
Services {HHS) nor the CDC logo may be displayed If such display would cau~ confusion as to
the funding source or give false appearance of Government el"\dorsement Use of the HHS name
or logo is governed oy U S.C Part 1320b-10, which prohibits mis:.Jse of the HHS name and
ernbtem in written communication. A non-federal entity is unauthorizec to use the HHS name or
logo governoo by U.S.C. Part 1320b-10 TI1e aporopriale use of the HHS logo Is subject to review
and approval of the HHS Office of the Assistant Secretary for Public Affairs (OASPA). Moreover,
the HHS Office cr the l11spector General has authority to impose civil monetary penalties for
violations (42 CFR Part 1003}. Accordingly, neither the HHS nor the CDC logo can be used by
the grantee without the express, written consent of either the CDC Project Officer or the CDC
Grants Management Officer. It is the respor.slbility of the grantee to request consent for use of
the logo in sufficient detail to ensure a com:olete depiction and disciosure of all uses of the
Government logos, ln au cases for utilization of Govemment logos, the grantee IT'Ust ensure
written consent is received from t~e Project Officer and/or the Grants Management Officer.
Equipment and Products: To the greatest extent practicable, all equipment and products
purchased with CDC funds should be American-made. CDC defines equipment es tangible non-
expendable personal property (including exernpt property) charged direcrly to an award having a
useful life of more than one year AND an acquisition cost of $5,000 or more per unit. However,
consistent with grantee policy, a lm'Jer threshold :r.ay be established. Please provide the
Information to the Grants Management Officer to establish a lower equipment threshold to reflect
your organlzatlon's policy.
The grantee may use its own property management standards and procedures, provided It
observes provisions of in applicable grant regulations and Ol'v1B circulars.
Federal fnfonnatfon Security Management Act {FISMA): All InforMation systems, electronic or
hard copy, that contain federal data must be pro~ected from urauthorized access. This standard
also applies to information associated with CDC grants. Congress and the OMB have instituted
laws, policies and d rectives that govem the creation and imp!ementa:ion offederallnformation
security practices that pertain specifically to grants and contracts. The current regulations are
pursuant to the Federal Information Security Management Act (FISMA), nue Ill of the E-
Government Act of 2002, PL 107-347.
FISMA apprtes to CDC grantees ony when grantees collect, store, process, transmit or use
informatio., on behalf of HHS or any of its component organizations. In all other cases, FISMA is
rot applk::able to recipients of grarts, including cooperative agreements. Under FISMA, the
grantee retains the original data and intellectual property and is responsible for tho security of
these data. subJect to all applicable laws protecting security, privacy, and research. lf.'When
i'lformation collected by a grantee is provided to HHS, responsibility for ttle protection of tre HHS
copy of the information is transferred to HHS and it becomes the agency's responsibility to protect
that information and any derivative copies as required by FlSMA. For the tuil text of the
requirements under Federal Information Security Management Act (F!SMA), Title Ill of theE·
Gove~nmentAct of 2002 Pub. L. No. 107-347, please review the following website:
http~ //flwebgate. a~Xes~ .f!PQ.JlOV /cgi·
bln/cetdoc.cgi?dbname .. 107 cong nublic Jaws6.docid=t_gubl347 107.pdJ
Pilot Program for Enhancement of Contra~tor Employee Whlstleblower Protections:
Grantees are hereby given notice that the 48 CFR section 3.908, implementing section 828,
entitled ~Pilot Program for Enhancement of Contractor Employee Whistleblower Protections,• of
the National Defense Authorization Acl (NDM) for Fiscal Year (FY} 2013 (Pub. L. 112-239,
enacted Ja1uary 2, 2013), applies to this award.
Exhibit C
Page 8
Federal Acquisition Regulations
As promulgated in the Federal Register, the relevant portions of 48 CFR section 3. 908 read as
follows (note t1at use of the term ·contract," •contractor,·· "subcontract" or "subcontractor" for the
purpose of this term and condition, sholJid be read as ''grant,•· •grant*," "subgran~," or
·subgrantee·):
3.906 Pilot program for enhanceme;,t of contractor employee whistleblower protections.
3.908-1 Scope of section.
{a) This section inptemen:s 41 U.S.C. 4712.
{b) This section does not apply to-
{1) DoD, NASA. and the Coast Guard; O'
(2) Any element of the intelligence community, as defined in section 3(4) of the National Security
Act of 1947 (50 U.RC. 3003(4}}. This section does not apply :o any disclosure made by an
employee of a contractor or subcortractor of an element of the intelligence community if such
discJosure-
(i} Relates to an achvity of an element of the intelligence community; or
{ii} Was discovered during contract or subcontract services provided to an element of the
inteEigence community.
3.908-2 Definitions.
As used in this sectlon-
"Abuse of authority" means an arb;trary and capricious exercise of authority that is Inconsistent
with the mission of the executive agency concerned or lhe successful performance ot a contract
of sucn agency.
"Inspector General" means an Inspector General appointed under the Inspector General Act of
1978 and any Inspector General that receves fundil'1g from, or has oversight over cor.tracts
awarded for, or on behalf of, the executive agency concerned.
3.908-3 Policy.
(a) Contractors and subco~tractors are prohlbitad from discharg1rg, demoting, or otherwise
discriminating against an employee as a reprisal for disclosing, to any of the entities listed at
paragraph (b} of this subsection, information tha: the employee reasonably believes ts evidence
of gross mismanagement of a Federal contract a gross waste of Federal funds, an abuse of
authority relating to a Federal contract, a subttsntiaf and specific danger to public health or
safety, or a violation of taw, rule, or regulation related to a Federal contract (Including tr.e
competition for or negotiation of a contract). A reprisal is prohibitea even If it is undertaken at the
request of an executive branch official, unless the request takes the form of a non-discretionary
directive and is w1thin the authority of the executive branch official Making the request
(b) Entities to whom disclosure may be made.
(1) A Member of Congress or a representative of a committee of Congress.
{2) An Inspector General.
(3) The Government Acccu1tabHity Office.
(4) A Federal employee responsib~ for contract oversight or management at the relevant agency.
(5) An authorized official of the Department of Justice or other law enforcement agency.
(6) A court or grand jury.
(7) A management officla! or other employee of the contractor or subcontractor who has lhe
responsibility to investigate, discover. or address misconduct
(c) An employee who initiates or provides evidence of contractor or subcontractor m;scorduct in
any judicial or administrative proceeding relating to waste, fraud, or abuse on a Federal contract
shall be deemed to have made a disclosure.
3.908-9 Contract clause
Contractor Employee Whist1eblower R;ghts and K.equireme1t to lnform Employees of
Whistleblower Rights (Sept. 2013)
{a) This contrac: and employees working on this con:ract will be subjecl to the whistle blower
rights and remedies in the pilot program on Contractor employee wtlistleblower protect1ons
Exhibit C
Page 9
Exhibit C
Page 10
established at 4JJULC. __ 1L12 b)• sect on 828 c(t'le National Defense Authorization Act for Fiscal
Year 2013 (Pub. L. 112-239) ana FAR ~.iJQ§.
(b) The Contractor shall inform its employees in wrltmg. m the predominant language o• the
workforce, of employoo whistleblcwer rights and protections under 1.1J,L~J~ .. 1lli. as descnbed
1n section l.!tQ.a CJf the Federal AcqLJisition Regulation.
(c) T'le Contra:::or shall msert t11e substa.'lce ot this clause, includi•1g th s paragraph (c) 1n all
subccntracts over the sir.piifed acqUJs 'Jon threshold
Exhibit 0
SELF-DEAUNG 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 D
(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: I Date: I