HomeMy WebLinkAboutAgreement A-20-237 with Department of Rehabilitation.pdfSCOID: 5160-31422 Agreement No . 20-237
STATE OF CALIFORNIA-DEPARTMENT OF GENERAL SERVICES r--------------.-------------~
STANDARD AGREEMENT AGREEMENT NUMBER
31422
PURCHASING AUTHORITY NUMBER (If Applicable )
STD 213 (Rev. 03 /2019)
1. This Agreement is entered into between the Contracting Agency and the Contractor named below:
CONT RACTING AGENCY NAME
Department of Rehabilitation
CONTRACTOR NAME
County of Fresno Department of Behavioral Health
2. The term of this Agreement is :
START DATE
July 1, 2020
THROUGH END DATE
June 30, 2023
3. The ma ximum amount of this Agreement is :
$0 .00
4 . The parties agree to comply with the terms and conditions of the following exhibits, which are by this reference made a part of the Agreement.
Exhibits Title
Exhibit A Scope of Work
Exhibit A.1 Contractor's Program Scope of Work
Exhibit B Budget Detail and Payment Provisions
+ -Exhibit B.1 Contractor's Program Budget(s) and Narrative(s) -
+ -Exhibit C* General Terms and Conditions GTC 04/2017 (Dated 04/2017) -
+ -Exhibit D Special Terms and Conditions (Attached hereto as part of this agreement) -
+ -Exh i bit E Additional Provisions -Federally Funded Agreements -
+ -Exhibit F Additional Provisions -Cooperative/Case Services -
+ -Exhibit G Additional Provisions -Contract Monitoring and Reporting -
Items shown with an asterisk /*), are hereby incorporated by reference and made part of this agreement as if attached hereto .
These documents can be viewed at https.j/www.dgs .ca.gov/OLS/Resources
IN WITNESS WHEREOF, THIS AGREEMENT HAS BEEN EXECUTED BY THE PARTIES HERETO.
CONTRACTOR
CONTR ACTOR NAME (if other than an individual, state whether a corporation, partnership, etc.)
County of Fresno Department of Behavioral Health
CONTRACTOR BUSINESS ADDRESS
PO Box 712
CITY
Fresno
TITLE
I
STATE
CA
1
7
4
2
3
3
1
Pages
I
ZIP
93718
PRINTED NAME OF PERSON SIGNING
Ernest Buddy Mendes Chairman of the Board of Supervisors
CONTRACTOR AUTHORIZED SIG NATURE
ATTEST:
BERNICE E. SEIDEL
Clerk of the Board of Supervisors
County of Fresno, State of California
By ~,A,$°=6'\~~o:f) Deputy
DATE SIGNED
Page 1 of 2
STATE OF CALIFORNIA
CALIFORNIA CIVIL RIGHTS LAWS ATTACHMENT
DGS OLS 04 (Rev. 01 /17 )
DEPARTMENT OF GENERAL SERVI CES
OFF ICE OF LEGAL SERVI CES
Pursuant to Public Contract Code section 2010, a person that submits a bid or proposal to , or
otherwise proposes to enter into or renew a contract with , a state agency with respect to any
contract in the amount of $100,000 or above shall certify, under penalty of perjury, at the time
the bid or proposal is submitted or the contract is renewed, all of the following:
1. CALIFORNIA CIVIL RIGHTS LAWS: For contracts executed or renewed after
January 1, 2017 , the contractor certifies compliance with the Unruh Civil Rights Act (Section
51 of the Civil Code) and the Fair Employment and Housing Act (Section 12960 of the
Government Code); and
2. EMPLOYER DISCRIMINATORY POLICIES: For contracts executed or renewed after
January 1 , 2017, if a Contractor has an internal policy against a sovereign nation or
peoples recognized by the United States government, the Contractor certifies that such
policies are not used in violation of the Unruh Civil Rights Act (Section 51 of the Civil Code)
or the Fair Employment and Housing Act (Section 12960 of the Government Code).
CERTIFICATION
I, the official named below, certify under penalty of perjury under the laws of the State of
California that the foregoing is true and correct.
Proposer/Bidder Firm Name (Printed) Federal ID Number
County of Fresno
By (Authorized Signature)
Ernest Buddy Mendes , Chairman of the Board of Supervisors of the County of Fresno
Executed in the County of
Fresno
Date Executed
L9 -:).3 -~ J-.0
ATTEST :
BERNICE E. SE IDEL
Clerk of the Board of Supervisors
County of Fresno , State of Californ ia
By SiMShu\~Slpof> Deputy
Executed in the State of
CA
1
Exhibit A
EXHIBIT A
(Standard Agreement - Subvention)
1. PURPOSE
Subvention: VR Third Party Cooperative/Case Service Agreements: Mental Health
2. AUTHORITY
Legislation: Rehabilitation Act of 1973, as amended, Title I, Parts A and B, Sec. 100-111; 29
U.S.C. 720-731.
Regulations: 34 CFR 361.3
Catalog of Federal Domestic Assistance Number (CFDA) 84.126A
3. CONTRACT REPRESENTATIVES
Direct all inquiries during the term of this Agreement to the Contract Administrators listed
herein:
Department of Rehabilitation
Levi Van Fossen
DOR Contract Administrator
2550 Mariposa Mall, Room 2000
Fresno, California 93721
(559) 444-2410 office
(559) 444-2595 fax
Levi.VanFossen@dor.ca.gov
Contractor
County of Fresno Dept. of Behavioral Health
Dawan Utecht, Director
1925 E. Dakota Avenue
Fresno, CA 93728
(559) 600-6899 office
(559) 600-7711 fax
dutecht@fresnocountyca.gov
4. DESCRIPTION OF SERVICES/DELIVERABLES
See attached program description - EXHIBIT A.1
1
Exhibit A.1
EXHIBIT A.1
(Standard Agreement - Subvention)
COOPERATIVE CONTRACT
FRESNO COUNTY DBH
SCOPE OF WORK
I. INTRODUCTION
This Cooperative Contract is designed to serve the mutual participants of San Joaquin
District’s Department of Rehabilitation (DOR) through DOR’s Fresno office and Fresno
County’s Vocational and Education Services Program (VES) through Dreamcatchers
Empowerment Network, Fresno County’s Department of Behavioral Health (DBH) The
intent of these services is to prepare VES participants with severe and chronic mental illness
to obtain and retain competitive employment as part of their treatment plans. Staff and
resources are combined to provide vocational rehabilitation services through this
cooperative program.
Dreamcatchers will focus on providing vocational supports to DBH clients expressing
interest in employment. DBH Case Managers or Clinicians will refer clients to the VES Case
Manager, who with the assistance of a Program Assistant will help clients to prepare the
DOR application packet to be provided to DOR’s Senior Vocational Rehabilitation Counselor
(SVRC) who are located in the Fresno office. DOR’s SVRC will then meet with the potential
VES clients, either in the Fresno office or at the VES site, to review the application and
authorize or decline service for the potential client. The VES Case Manager will serve as
the point of contact between Fresno County DBH staff and the DOR SVRC.
The VES Case Manager will insure that each client’s DOR application packet includes:
DR260 (Consent to Release and Obtain Information); DR222 (Vocational Rehabilitation
Services Application); DR222A (Supplemental Personal Information); DR222B (Employment
Record); DR216 (Health Questionnaire); DR233 (Statement of Financial Status); copies of
the client’s diagnosis and treatment plan, vocational assessments conducted by DBH and
proof of income. Copies of the client’s Social Security Card and Driver’s License or other ID
will be kept on file at BHS.
During the 2020-2021 fiscal year, there shall be a total of 155 unduplicated VES participants
who will receive services through this contract.
As a result of services provided in this contract in fiscal year 2020 -2021, it is expected that
DOR will:
Open 70 new cases,
Develop 49 new Individualized Plans for Employment (IPE)
Close 33 cases successfully.
During the 2021-2022 fiscal year, there shall be a total of 155 unduplicated VES participants
who will receive services through this contract.
As a result of services provided in this contract in fiscal year 2021-2022, it is expected that
DOR will:
Open 70 new cases,
2
Exhibit A.1
Develop 49 new Individualized Plans for Employment (IPE)
Close 33 cases successfully.
During the 2022-2023 fiscal year, there shall be a total of 155 unduplicated VES participants
who will receive services through this contract.
As a result of services provided in this contract in fiscal year 2022 -2023, it is expected that
DOR will:
Open 70 new cases,
Develop 49 new Individualized Plans for Employment (IPE)
Close 33 cases successfully.
II. SERVICES TO BE PROVIDED
Dreamcatchers staff will provide the following vocational services to persons with severe
and persistent mental health illness. The intent of these services is to prepare VES
participants to obtain and retain competitive employment as part of their mental health
treatment plan.
A. Assessment Services
A.1 Vocational Assessment (VA)
VA Definition: as authorized by DOR’s Senior Vocational Rehabilitation
Counselor (SVRC), allows Dreamcatchers’ Vocational Services Case
Manager (VSCM) and/or Community Service Liaison to assess basic
consumer information including education and vocational levels, abilities,
and interests. Assessment materials/questionnaires are developed by
Dreamcatchers and are not standardized tests. Assessments will also
utilize collateral information. VA will result in vocational service planning
and determining scope of services to be provided.
VA Activities: assessing basic consumer information including education,
vocational levels, abilities, interests. Assessment are limited in scope and
short in duration.
VA ISP: Includes areas to be addressed, proposed assessment activities,
proposed measurable outcomes, timeline for completion, and persons
responsible.
Vocational Assessment Service Goals/Numbers to be Served:
During the fiscal year 2020/2021, the Vocational Assessment goals
will be as follows:
35 DOR/DBH clients will complete the Vocational Assessment service
During the fiscal year 2021/2022, the Vocational Assessment goals
will be as follows:
35 DOR/DBH clients will complete the Vocational Assessment service
During the fiscal year 2022/2023, the Vocational Assessment goals
will be as follows:
35 DOR/DBH clients will complete the Vocational Assessment service
3
Exhibit A.1
B. Training Services
B.1 Personal, Vocational, Social Adjustment (PVSA)
PVSA Definition: as authorized by DOR’s Senior Vocational Rehabilitation
Counselor (SVRC), allows Dreamcatchers’ Vocational Services Case
Manager (VSCM) and/or Community Service Liaison (CSL) to assist
consumers in developing or re-establishing skills, attitudes, personal
characteristics, interpersonal skills, work behaviors, and functional
capacities to achieve and maintain positive employment outcomes. This
service is authorized to address one or more barriers preventing
successful completion of an IPE. Training is time-limited (1-4 months),
individualized (one-on-one), and provided in the environment where the
identified appropriate behavior is needed occurs.
PVSA Activities: training that targets the elimination or reduction of
identified barriers to employment and may include but are not limited
to issues such as: appropriate interactions in the workplace;
grooming and hygiene as related to work; mobility training for use of
public transportation; work habits and attitudes such as attendance,
punctuality, phoning in if ill, returning promptly from breaks and lunch;
personal budgeting, banking and bill payment.
PVSA ISP: Includes areas to be addressed, proposed training activities,
proposed measurable outcomes, timeline for completion, person
responsible.
Personal, Vocational, Social Adjustment Service Goals/Numbers to be Served:
During the fiscal year 2020/2021, the PVSA goals will be as follows:
60 DOR/DBH clients will be referred to receive PVSA services
During the fiscal year 2021/2022, the PVSA goals will be as follows:
60 DOR/DBH clients will be referred to receive PVSA services
During the fiscal year 2022/2023, the PVSA goals will be as follows:
60 DOR/DBH clients will be referred to receive PVSA services
C. Job Related Services--Employment Services (ES)
Employment Services Definition: as authorized by DOR’s allows Dreamcatchers’
Vocational Services Case Manager (VSCM) and/or Community Services Liaison to
assist BHVP consumers with preparing for, obtaining and retaining employment. A
continuum of Employment Services provides guidance, direction and activities to
enhance the consumer’s employability. The four components of Employment
Services are: Intake; Employment Preparation, Job Development, and Employment
Retention.
C.1 ES Intake
ES Intake Activities: assess appropriateness of job choice; review the
Individualized Plan for Employment (IPE); review job choice in relation to local job
market and job availability; analyze collateral information, work experience and
performance; determination if consumer will benefit from services; development of
an Individualized Service Plan (ISP)
ES ISP: includes employment goals and objectives, employment components to
4
Exhibit A.1
be addressed, proposed activities, measurable activities, timeline for completion,
persons responsible.
C.2 Employment Preparation
Employment Preparation Activities: interviewing techniques; resume
development; application preparation; appropriate work behaviors and
work ethics; relevant work practices; appropriate grooming and hygiene;
reviewing impact of employment on the consumer; benefits planning;
identifying support services needed such as transportation, childcare, etc.
Employment Preparation Goals/Numbers to be Served:
During the fiscal year 2020/2021, the ES Intake goals will be as follows:
100 DOR/DBH clients will receive Employment Preparation services
During the fiscal year 2021/2022, the ES Intake goals will be as follows:
100 DOR/DBH clients will receive Employment Preparation services
During the fiscal year 2022/2023, the ES Intake goals will be as follows:
100 DOR/DBH clients will receive Employment Preparation services
C.3 Job Development
Job Development Activities: identification of specific job openings
appropriate to the consumer as indicated in the IPE and ISP; contact
employers to identify job openings, obtain information detailing
qualifications and work site requirements for specific job opportunities to
ensure consumer readiness and success for the job; job site consultation
to identify and modify behaviors; negotiate job carving, work site analysis
or other job accommodations; assisting in job interviewing process;
assisting in coordinating transportation needs; providing job club tools to
assist in job search.
Job Placement Activities: job destination training; job orientation
assistance; information on conditions of employment such as job duties
and descriptions, performance expectations, name of immediate
supervisor, responsibilities of the employer, wage payment process,
benefits, company policies and procedures, including conflict resolution
procedures and health and safety practices, probation and performance
evaluation practices; union status as appropriate.
C.4 Retention
Retention Activities: A minimum of two contacts per month for the first 90
days after consumer acceptance of employment consistent with IPE goals.
Phone or personal contact on or off the job with the consumer to determine
satisfaction with the employment; and phone or personal contact with the
employer to determine satisfaction with the employee; assistance with
necessary minimal supports to sustain employment. Intensive supports
require SVRC authorization.
5
Exhibit A.1
Job Development and Retention Goals/Numbers to be Served:
During the fiscal year 2020/2021, the Job Development and
Retention goals will be as follows:
90 DOR/DBH clients will receive Job Development services
49 DOR/DBH clients will be placed in competitive employment consistent with
their IPE goal.
33 DOR/DBH clients will remain in unsubsidized integrated and competitive
employment for 90 days or longer, in accordance with their Individualized Plan
for Employment, resulting in a successful case closure.
During the fiscal year 2021/2022, the Job Development and
Retention goals will be as follows:
90 DOR/DBH clients will receive Job Development services
49 DOR/DBH clients will be placed in competitive employment consistent with
their IPE goal.
33 DOR/DBH clients will remain in unsubsidized integrated and competitive
employment for 90 days or longer, in accordance with their Individualized Plan
for Employment, resulting in a successful case closure.
During the fiscal year 2022/2023, the Job Development and
Retention goals will be as follows:
90 DOR/DBH clients will receive Job Development services
49 DOR/DBH clients will be placed in competitive employment consistent with
their IPE goal.
33 DOR/DBH clients will remain in unsubsidized integrated and competitive
employment for 90 days or longer, in accordance with their Individualized Plan
for Employment, resulting in a successful case closure.
D. Short-Term Supports Services (STS)
STS Definition: as authorized by DOR’s Senior Vocational Rehabilitation
Counselor (SVRC), allows Dreamcatcher’s Vocational Services Case Manager
(VSCM) to provide time-limited, proactive, individualized service to the
consumer’s employment related needs in learning job duties, adjusting to the
work environment and developing natural supports within the employment
setting as outlined in a consumer’s Individual Service Plan (ISP). This service
is provided to consumers placed in a Competitive Integrated Employment
setting (CIE) which includes Work Experience placements, On-the-Job
Trainings (OJTs), or other job placements. STS is completed within 90 days,
unless additional support is needed to stabilize in the employment setting.
STS Activities: includes proactive contact with the consumer and trainer, site
supervisor or employer in order to identify and resolve employment issues;
proactive and on-going assessment of the consumer’s needs for auxiliary
goods and services (i.e. reasonable accommodations, work clothing,
equipment); regular contact with DOR staff to provide feedback on identified
needs, issues/challenges, or progress towards employment retention;
additional activities on or off the job as needed to stabilize employment (i.e.
developing appropriate work place behaviors, providing travel training,
training in employment tasks, consulting the supervisor on strategies and
6
Exhibit A.1
accommodations).
STS ISP: includes areas to be addressed, proposed activities, proposed
outcomes and methods to track progress, timeline for completion, persons
responsible.
Short-Term Supports (STS) Service Goals/Numbers to be Served:
During the fiscal year 2020/2021, the Short-Term Supports goals will be as follows:
40 DOR/DBH participants will receive Short-Term Supports
During the fiscal year 2021/2022, the Short-Term Supports goals will be as follows:
40 DOR/DBH participants will receive Short-Term Supports
During the fiscal year 2022/2023, the Short-Term Supports goals will be as follows:
40 DOR/DBH participants will receive Short-Term Supports
E. CONTRACT ADMINISTRATOR
Department of Rehabilitation Fresno County
Levi Van Fossen Dawan Utecht
DOR Contract Administrator Director of the Department of Behavioral Health
2550 Mariposa Mall, Room 2000 1925 E. Dakota Avenue
Fresno, California 93721 Fresno, CA 93728
(559)444-2410 office (559)600-6899 office
(559)444-2595 fax (559)600-7711 fax
Levi.VanFossen@dor.ca.gov dutecht@fresnocountyca.gov
F. LINKAGES TO OTHER COMMUNITY AGENCIES
The VES Cooperative Program has ongoing working relationships with the following
agencies to increase opportunities for VES participants and avoid duplication of services:
California State University, Fresno
Reedley College
Fresno City College
Employment Development Department
Independent Living Center
Central Valley Regional Center
California Community Colleges
Social Security Administration
Department of Motor Vehicles
CalWORKs
Fresno County Career Services “One Stops”
Any adult supportive services agencies
Local business/employer community
7
Exhibit A.1
G. IN-SERVICE TRAINING
Twice a year or more frequently as needed, in-service trainings will be conducted to cross-
train in each agency’s mission, services, procedures, and professional approaches. The
cooperative program partners may also jointly request specific trainings from the
DOR/DHCS statewide cooperative unit.
1
Exhibit B
EXHIBIT B
(Standard Agreement - Subvention)
BUDGET DETAIL AND PAYMENT PROVISIONS
1. INVOICING AND PAYMENT
A. Service Budget Payment of Expenditure
1. This is a cost reimbursement Agreement for subvention services. For services
satisfactorily completed, and upon receipt and approval of the invoices, the Department
of Rehabilitation (DOR) agrees to reimburse the Contractor for actual expenditures
incurred subject to the approved Scope of Work, Service Budget, Budget Narrative, and
applicable regulations as attached or referenced hereto and made a part of this
Agreement.
2. All expenses shall be reviewed and approved by the DOR Contract Administrator before
payment can be made to the Contractor.
3. The Service Budget must set forth in detail the reimbursable items, unit rates and
extended total amounts for each line item. The Contractor's Service Budget shall include
items directly related to this Agreement to include a Budget Narrative that fully explains
why and how the costs are necessary to the Agreement.
B. Submission of Invoice(s)
1. Monthly invoices must be completed using the DR 801B Service Invoice form (DR801B)
and shall provide an actual line-item detail of expenditure(s) that supports the approved
Service Budget and Budget Narrative. The DR801B shall include the Agreement Number
and be submitted in duplicate not more frequently than monthly in arrears to the DOR
Contract Administrator or designee (listed in Exhibit A).
2. An original DR801B must be submitted and signed by authorized personnel as listed on
the Signature Authorization (DR 325) form.
3. Supporting documentation must be available upon request at any time by DOR staff, or
other State and Federal representatives.
4. Federal and State funds are time limited, therefore, invoices (service and certified match)
must be submitted as soon as possible, but no later than 60 days after the service
month. Final submission of all fiscal year-end invoices is due no later than November
1st, to allow for payment and draw down prior to the close out of Federal/State funds.
5. If budgetary funds revert due to failure to submit timely invoices or failure to submit a
properly prepared invoice, related Federal and State funds will no longer be available for
use which will require the contractor to submit a claim through the Victims Compensation
and Government Claims Board, where approval to pay is not guaranteed.
6. The DOR is committed to issue payments as quickly as possible following the receipt of
an accurate and complete invoice of allowable costs as approved by the DOR Contract
Administrator.
2
Exhibit B
C. Appropriate Expenditures
Budgets must not contain line items that are or will be reimbursed/paid by another source of
funding during the period covered by this Agreement. Unexpended funds for a fiscal year
shall not be carried over to another fiscal year. Agreement expenditures reimbursed by DOR
must be reported as federal funds in the contractor’s accounting records and on the
Schedule of Federal Awards under the CFDA # listed for this Agreement and prepared for
the Title 2 Code of Federal Regulations, Part 200 (2 CFR 200) Single Audit.
D. Invoice Claim Adjustments
1. Surplus funds from a given line item, within a fiscal year budget may be used to defray
allowable costs under the approved budget line items contained within the same fiscal
year. A claim adjustment is required on the Service Invoice (DOR 801B) with an
attached brief narrative explaining each line item impacted and may not exceed up to a
cumulative amount of ten percent (10%) of the total annual co ntract Service Budget for
all budget years as long, as there is neither an increase nor decrease of the total annual
contract Service Budget. A formal amendment is required if it does not meet the above
criteria.
2. Staff line item salary ranges and percentage of time are projected estimates and are
subject to change based on actual salary and chargeable time costs. Claim adjustments
are allowable as long as the annualized total line item costs do not exceed what is
allowed in Item 1 above.
E. Budget Contract Amendments
A contract amendment between both parties is required for any budget changes not covered
in Section D above. This includes any major category or detailed line item description
changes to the approved Service Budget and Budget Narrative as outlined below:
Adding and deleting a major category budget or detailed line item.
Line item adjustments that exceed a cumulative amount of 10%.
Decrease/increase to the total annual budget award or the total Agreement award for
all budget years.
Any word for word changes to the written budget narrative or budget cost detail.
(Note: ALL changes must be made in bold.)
F. Travel Reimbursements
If travel is reimbursable, the Contractor agrees that all travel expenses and per diem rates
paid to its employees under this Agreement shall be reimbursed at actual costs not to
exceed the California Department of Human Resources (CalHR) designated rates for
excluded employees. Go to CalHR website at
http://www.calhr.ca.gov/employees/pages/travel-reimbursements.aspx. No travel outside
the State of California except for bordering California states shall be reimbursed without
prior documented written authorization from DOR.
Upon request from the DOR, Contractor will provide sufficient documentation to support
travel expenditures such as travel claims, mileage logs, and receipts for lodging,
transportation, and meal costs.
3
Exhibit B
2. BUDGET CONTINGENCY CLAUSE
A. It is mutually agreed that if the Budget Act of the current year and/or any subsequent years
covered under this Agreement does not appropriate sufficient funds for the program, this
Agreement shall be of no further force and effect. In this event, the State shall have no
liability to pay any funds whatsoever to Contractor or to furnish any other considerations
under this Agreement and Contractor shall not be obligated to perform any provisions of this
Agreement.
B. If funding for any fiscal year is reduced or deleted by the Budget Act for purposes of this
program, the State shall have the option to either cancel this Agreement with no liability
occurring to the State, or offer an Agreement amendment to Contractor to reflect the
reduced amount.
3. BUDGET CONTINGENCY CLAUSE FOR FEDERALLY FUNDED AGREEMENTS
A. It is mutually understood between the parties that this Agreement may have been written for
the mutual benefit of both parties before ascertaining the availability of congressional
appropriation of funds to avoid program and fiscal delays that would occur if the Agreement
were executed after that determination was made.
B. This Agreement is valid and enforceable only if sufficient funds are made available to the
State by the United States Government for the current year and/or any subsequent year for
the purpose of this program. In addition, this Agreement is subject to any additional
restrictions, limitations, or conditions enacted by Congress or to any statute enacted by
Congress that may affect the provisions, terms, or funding of this Agreement in any manner.
C. The parties mutually agree that if Congress does not appropriate sufficient funds for the
program, this Agreement shall be amended to reflect any reduction in funds.
4. PROMPT PAYMENT CLAUSE
Payment will be made in accordance with, and within the time specified in, Government Cod e
Chapter 4.5, commencing with section 927.
5. PRINCIPLES AND STANDARDS FOR DETERMINING ALLOWABLE COSTS, INCLUDING
REQUIREMENTS FOR DOCUMENTING PERSONNEL ACTIVITY CHARGEABLE TO THE
AGREEMENT
Agreements awarded by the Department shall be subject to actual costs for servi ces rendered
under this Agreement. Allowable costs under this Agreement must meet the following general
criteria:
Be generally recognized and necessary for the operation of the Contractor's organization .
Be reasonable for the performance of the Agreement, including acceptable sound business
practices.
Be subject to the terms and conditions of the Agreement and approved DOR budgeted line
items.
Not be used for general expenses required to carry out other res ponsibilities of the
Contractor.
Be properly documented and supported.
4
Exhibit B
Documenting and supporting the distribution of all costs, including the allocation of time
chargeable to the Agreement, is required. The Contractor agrees to comply with the 2 CFR 200
cost principles regarding documentation for the support of personnel activity chargeable to the
Agreement.
6. ACCOUNTING SYSTEM REQUIREMENTS
A. Contractor must maintain an appropriate fund accounting system that accurately
accumulates and segregates reasonable, allocable, and allowable costs in compliance with
state and federal regulations, and generally accepted accounting principles. The
Contractor’s financial management system shall provide:
Accurate, current, and complete disclosure of the financial results of each federally
sponsored project.
Records that identify adequately the source and application of funds for federally
sponsored activities.
Written procedures for determining the reasonableness, allocable, and allowable
costs in accordance with the provisions of the applicable federal cost principles and
the terms and conditions of the Agreement.
Accurate fund accounting records that track the revenues received from
funders/sources and the expenditures paid to vendors for goods and services, and
that are supported by adequate source documentation.
B. Contractor shall submit to State such reports, accounts, and records as deemed necessary
by the State to discharge its obligation under State and Federal laws and regulations
1
Exhibit B.1
FY July 1
2020 to
June 30
2021
FY July 1
2021 to
June 30
2022
FY July 1
2022 to
June 30
2023
ITEM
FTE
EXPENDITURE TOTAL TOTAL TOTAL
Rehabilitation Team Unit
FTE Counselor
Units 1.60 1.60 1.60
1 FTE = $110,377 $176,603 $176,603 $176,603
137,932 137,932 137,932
SUBTOTAL $314,535 $314,535 $314,535
Case Service Contract(s):
$594,961 $594,961 $594,961
TOTAL DOR PROGRAM COST $909,496 $909,496 $909,496
Fresno County DBH
DOR Program Budget
July 1, 2020 - June 30, 2023
Case Services
(Individual Consumer Expenses)
Dreamcatchers Empowerment Network
2
Exhibit B.1
FY July 1
2020 to
June 30
2021
FY July 1
2021 to
June 30
2022
FY July 1
2022 to
June 30
2023
TOTALS TOTALS TOTALS
DOR PROGRAM COSTS
(From DOR Program Budget)
(From Service Budget)
TOTAL FEDERAL COSTS
Certified Match (If applicable)
Total Federal Share
Cash Match (If applicable)
Total Federal Share
TOTAL STATE MATCH
0 -0 0 -0 0 -0
$193,723
21.3%
$715,775
78.7%
$193,723
21.3%
$715,775
78.7%
$193,723
21.3%
$715,775
78.7%
$0
0%
0%
$0
0%
$0
Total Served Range
Fresno County DBH
Program Budget and Match Summary
TOTAL PAYMENT BY DOR TO CONTRACTOR
$909,496 $909,496 $909,496
$0 $0
Cooperative agency certified match expenditure and cash match expenditure must be from non-federal funds and
cannot be used to draw down other federal funds. The cash match expenditure must equal at least 21.3% of the
designated share and the certified match expenditure must equal at least 25% of the designated share.
DOR Split
$0
$909,496 $909,496 $909,496
0%
$178,943.66
$193,723 $193,723 $193,723
$0
0%
0%
Service Budget
DOR Split
$178,943.66
Service Budget
DOR Split
$178,943.66
Service Budget
Total Served Range
$0
Total Served Range
$0
Amount To Split
$357,887.33
Amount To Split
$357,887.33 $357,887.33
Amount To Split
1
Exhibit C
EXHIBIT C
GENERAL TERMS AND CONDITIONS (GTC 4/2017)
PLEASE NOTE: The General Terms and Conditions will be included in the Agreement by
reference, you can view them at the Department of General Services, Office of Legal Services
website at : https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services-
Resources-List-Folder/Standard-Contract-Language. Go to Resources, click on the Standard
Contract Language section to expand, then click on GTC 4/2017.
1
Exhibit D
EXHIBIT D
(Standard Agreement - Subvention)
SPECIAL TERMS AND CONDITIONS
1. NOTIFICATION & COMPLIANCE
All notices required by either party shall be in writing and sent by email, mail, or personally
delivered to the appropriate address. Mailing addresses may be changed by written notice.
Contractor agrees to comply with all laws, regulations, ordinances, and policies of any
governmental unit having jurisdiction over the rehabilitation program with regards to
construction, medicine, health, safety, wages, hours, working conditions, workers’
compensation, licensing and all other activities requiring compliance. Contractor shall accept
financial responsibilities in the event of non-compliance.
2. DISPUTES
If Contractor believes that there is a dispute or grievance between Contractor and the State
arising out of or relating to this Agreement, Contractor shall first discuss and attempt to resolve
the issue informally with the DOR Contract Administrator. If the issue cannot be resolved at this
level, Contractor shall follow the following procedures:
A. If the issue cannot be resolved informally with the DOR Contract Administrator, Contractor
shall submit, in writing, a grievance report together with any evide nce to the DOR Contract
Administrator’s Supervisor. The grievance report must state the issues in the dispute, the
legal authority, or other basis for the Contractor’s position and the remedy sought. Within
ten (10) working days of receipt of the written grievance report from the Contractor the DOR
Supervisor shall make a determination on the problem and shall respond in writing to the
Contractor indicating the decision and reasons, therefore. Should the Contractor disagree
with the Supervisor’s decision, Contractor may appeal to the next level following the
procedure in “Disputes”, paragraph B listed below.
B. Contractor’s letter of appeal must be submitted within ten (10) working days of the receipt of
the Contract Administrator’s Supervisor’s written decision. Contractor must submit a letter
of appeal to the Department's Contract Officer explaining the disagreement with the
Contract Administrator’s supervisor’s decision. The letter must include, as an attachment,
copies of the Contractor’s original grievance report, evidence originally submitted, and
response from Supervisor. The Contracting Officer shall, within twenty (20) working days of
receipt of Contractor’s letter of appeal, review the issues raised and shall render a written
decision to the Contractor. The decision of the Director or designee shall be final.
3. RIGHT TO TERMINATE
A. Either party reserves the right to terminate this Agreement subject to 30 days written notice.
B. However, the Agreement can be immediately terminated for cause. The term “for cause”
shall mean that the Contractor fails to meet the terms, conditions, and/or responsibilities of
the Agreement. In this instance, the Agreement termination shall be effective as of the date
indicated on the State’s notification to the Contractor.
2
Exhibit D
4. TRAINING SEMINARS, WORKSHOPS OR CONFERENCES
If said Contractor provides training seminars, workshops, or conferences, Contractor must
obtain prior DOR approval for the location, costs, dates, agenda, instructors, instructional
materials, and attendees at any reimbursable training seminar, workshop, or conference
pursuant to this Agreement and of any reimbursable publicity or educational materials to be
made available for distribution. The Contractor shall acknowledge the support of the State
whenever publicizing the work under this Agreement in any media. The provision does not
apply to necessary staff meetings or training sessions held for the staff of the Contractor to
conduct routine business matters.
5. INSURANCE REQUIREMENTS
General Provisions Applying to All Policies
A. Coverage Term – Coverage needs to be in force for the complete term of the contract. If
insurance expires during the term of the contract, a new certificate must be received by the
State at least ten (10) days prior to the expiration of this insurance. Any new insurance must
still comply with the original terms of the contract.
B. Policy Cancellation or Termination & Notice of Non-Renewal – Contractor is responsible
to notify the State within five business days before the effective date of any cancellation,
non-renewal, or material change that affects required insurance coverage. In the event
Contractor fails to keep in effect the specified insurance coverage, the State may, in addition
to any other remedies it may have, terminate this Contract upon the occurrence of such
event, subject to the provisions of this Contract.
C. Deductible – Contractor is responsible for any deductible or self -insured retention contained
within their insurance program.
D. Insurance Carrier Required Rating – All insurance companies must carry a rating
acceptable to the Office of Risk and Insurance Management. If the Contractor is self -insured
for a portion or all of its insurance, review of financial information including a letter of credit
may be required.
E. Endorsements – Any required endorsements requested by the State must be physically
attached to all requested certificates of insurance and not substituted by referring to such
coverage on the certificate of insurance.
F. Inadequate Insurance – Inadequate or lack of insurance does not negate the contractor
obligations under the contract.
G. Satisfying an SIR - All insurance required by this contract must allow the State to pay
and/or act as the contractor’s agent in satisfying any self -insured retention (SIR). The choice
to pay and/or act as the contractor’s agent in satisfying any SIR is at the State’s discretion.
H. Available Coverages/Limits - All coverage and limits available to the contractor shall also
be available and applicable to the State.
I. Subcontractors - In the case of Contractor utilization of subcontractors to complete the
contracted scope of work, contractor shall include all subcontractors as insured under
Contractor and insurance or supply evidence of insurance to The State equal to policies,
coverages and limits required of Contractor.
i. Commercial General Liability – Contractor shall maintain general liability on an
occurrence form with limits not less than $1,000,000 per occurrence for bodily injury and
3
Exhibit D
property damage liability combined with a $2,000,000 annual policy aggregate. The
policy shall include coverage for liabilities arising out of premises, operations,
independent contractors, products, completed operations, personal & advertising injury,
and liability assumed under an insured Agreement. This insurance shall apply separately
to each insured against whom claim is made or suit is brought subject to the Contractor’s
limit of liability. The policy must include:
The State of California, its officers, agents, and employees as additional insured, but
only with respect to work performed under the Agreement.
Endorsements must be physically attached to all requested certificates of
insurance and not substituted by referring to such coverage on the certificate of
insurance. The endorsement must be acceptable to the DGS Office of Risk and
Insurance Management.
ii. Automobile Liability (If Applicable) – For DOR consumers being provided transportation
under said Agreement, the Contractor shall maintain motor vehicle liability with limits not
less than $1,000,000 combined single limit per accident. Such insurance shall cover
liability arising out of a motor vehicle including owned, hired and non-owned motor
vehicles to include the following additional insurance coverage below:
For public schools and for-profit organizations: Automobile Liability insurance must
include Any-Auto, Hired-Autos, Non-Owned Autos, and any other auto used in
performing services under the Agreement. For seating capacity up to 7 people
(includes driver), the Contractor’s certificate of insurance shall state a limit of liability of
not less than $1,000,000 per occurrence for bodily injury and property damage liability
combined. For seating capacity for 8 –15 people (includes driver) the certificate of
insurance shall state a limit of liability of not less than $1,500,000 per occurrence for
bodily injury and property damage liability combined. For seating capacity for 16
passengers or more the certificate of insurance shall state a limit of liability of not less
than $5,000,000 per occurrence for bodily injury and property damage liability combined.
For non-profit organizations: Automobile Liability insurance must include Any-Auto,
Hired-Autos, Non-Owned Autos, and any other auto used in performing services under
the Agreement. For seating capacity of up to 15 people (includes driver) the certificate
of insurance shall state a limit of liability of not less than $1,000,000 per occurrence for
bodily injury and property damage liability combined. For seating capacity for 16
passengers or more the certificate of insurance shall state a limit of liability of not less
than $5,000,000 per occurrence for bodily injury and property damage liability combined.
The same additional insured designation and endorsement required for general
liability is to be provided for this coverage.
iii. Workers Compensation and Employers Liability – Contractor shall maintain statutory
worker’s compensation and employer’s liability coverage for all its employees who will be
engaged in the performance of the Agreement. Employer’s liability limits of $1,000,000
are required.
The workers’ compensation policy shall contain a waiver of subrogation in favor of
the State. The waiver of subrogation endorsement shall be provided.
4
Exhibit D
iv. Self-insurance - Contractor shall supply the consent letter of self -insurance or the
Certificate of Consent to Self-Insure. The Waiver of Subrogation is not required.
6. CONFLICT OF INTEREST
A. Contractor certifies that it’s employees and the officers of its governing body shall avoid any
actual or potential conflicts of interest and that no officer or employee who exercises any
functions or responsibilities in connection with this Agreement shall have any personal
financial interest or benefit which either directly or indirectly arises from this Agreement.
B. Contractor shall establish safeguards to prohibit its employees or its officers from using their
positions for a purpose which could result in private gain or which gives the appearance of
being motivated for private gain for themselves or others, particularly those with whom t hey
have family, business, or other ties.
7. CONFIDENTIALITY
A. Contractor agrees to comply with the provisions applicable to consumer information as set
forth in 34 Code of Federal Regulations, Section 361.38 and Title 9, California Code of
Regulations, Section 7140 et seq., and personal information as set forth in the Information
Practices Act of 1977 (California Civil Code Section 1798 et seq.).
B. Contractor agrees that any personal information, as defined by the Information Practices Act
of 1977 (California Civil Code Section 1798 et seq.) and this Agreement, obtained in the
performance of this Agreement is classified as confidential and shall not be subject to
disclosure to any source except as required by this contract or otherwise authorized by
DOR.
C. Contractor agrees to remove all confidential, sensitive, or personal information from any
reports, publications, or other materials created during the performance of this contract prior
to being released to the scientific and academic community, or other individuals or entities.
The removal method(s) must be reasonable and appropriate to ensure that any confidential,
sensitive, or personal information cannot be recovered, accessed, used or disclosed, which
would result in a security breach or an information security incident.
D. Subject to the applicable requirements of the regulations cited above, Contractor agrees to
report any security breach or information security incident involving confidential, sensitive, or
personal information (e.g., consumer information) obtained in the performance of this
contract to the DOR’s Contract Administrator and the DOR’s Information Security Officer.
The DOR’s Information Security Officer can be contacted via e-mail at iso@dor.ca.gov.
E. Security breaches or information security incidents that shall be reported include, but are not
limited to:
1. Inappropriate use or unauthorized disclosure of confidential, sensitive, or personal
information (e.g., consumer information) obtained in the performance of this contract by
the Contractor or the Contractor’s assignees. Disclosure methods include, but are not
limited to, electronic, paper, and verbal.
5
Exhibit D
2. Unauthorized access to confidential, sensitive, or personal information (e.g., consumer
information) obtained in the performance of this contract. Information can be held in
medium that includes, but is not limited to, electronic and paper.
3. Loss or theft of information technology (IT) equipment, electronic devices/media, paper
media, or data containing confidential, sensitive, or personal information (e.g., consumer
information) obtained in the performance of this contract. IT equipment and e lectronic
devices/media include, but are not limited to, computers (e.g., laptops, desktops,
tablets), smartphones, cell phones, CDs, DVDs, USB flash drives, servers, printers,
peripherals, assistive technology devices (e.g., notetakers, videophones), and copiers.
Data can be held in medium that includes, but is not limited to, electronic and paper.
F. Contractor agrees to provide annual security and privacy training for all individuals who have
access to confidential, sensitive, or personal information (e.g., consumer information)
obtained in the performance of this contract.
G. Contractor agrees to obtain and maintain acknowledgements from all individuals to evidence
their understanding of the consequences of violating California privacy laws and the
contractor’s information privacy and security policies.
H. For contractors that do not have a security program that includes annual security and
privacy training, a self-training manual is available on the DOR website in the “Requirements
for Becoming a Service Provider” section under “Annual Security and Privacy Training for
VR Service Providers.” The self -training manual is named “Protecting Privacy in State
Government” and can be downloaded at the following link:
https://www.dor.ca.gov/Home/SecurityandPrivacy.
I. Additional training and awareness tools are available at the California Information Security
Office (CISO) website and the California Department of Justice – Privacy Enforcement and
Protection website. These state entities created the self -training manual, “Protecting
Privacy in State Government” that DOR revised to meet its business needs.
8. AUDIT AND REVIEW REQUIREMENTS
A. General Audit and Review Requirements
1. The State shall have the right to conduct inspections, reviews, and/or audits of the
Contractor to determine whether the services provided, and the expenditures invoiced by
the Contractor were in compliance with this Agreement and other applicable federal or
state statutes and regulations.
2. Contractor agrees that Department of Rehabilitation, State Controller's Office,
Department of General Services, Bureau of State Audits, Federal Department of
Education Auditors, or their designated representatives shall h ave the right to review and
to copy any records and supporting documentation pertaining to the performance of the
Agreement, including but not limited to, accounting records, consumer service records,
records and evaluations of individuals referred to the program, and other supporting
documentation that may be relevant to the audit or investigation.
3. The Contractor shall submit to the State such reports, accounts, and records deemed
necessary by the State to discharge its obligation under State and Federal laws and
regulations, including the applicable OMB cost principles and administrative
requirements.
6
Exhibit D
4. Contractor agrees to allow the auditors access to such records during normal business
hours and to allow interviews of any employees who might reasonably ha ve information
related to such records.
5. Contractor agrees to maintain such records for possible audit for a minimum of five (5)
years after final payment or until resolution of all issues which may arise as a result of
any litigation, claim, negotiation, audit, or any other action involving the records prior to
expiration of the five (5) year period, whichever is later.
B. Annual Federal Audit (For Agreements that received Federal Funds $750,000 and above):
1. In addition to the General Audit and Review R equirements above, the Contractor agrees
to provide an annual audit as required by the federal “Single Audit Act” of 1994, as
amended. This audit shall be made in accordance with 2 CFR 200.
9. COMPETITIVE BIDDING AND PROCUREMENTS
A. Contractor shall comply with applicable laws and regulations regarding securing competitive
bids and undertaking negotiations in Contractor's Agreements with other entities for
acquisition of goods and services with funds provided by the State or Federal under this
Agreement. A minimum of two competitive quotations is required for any purchase order or
subcontract for services over $2,500, and should be submitted to the DOR contract
administrator or adequate justification provided for the absence of bidding.
B. Contractors must maintain a copy of the narrative description of the procurement systems
guidelines, rules or regulations that will be used to make purchases under this Agreement.
The State reserves the right to request a copy of these documents and to inspect the
purchasing practices of the Contractor at any time.
C. The Contractor should seek prior approval for any purchase or subcontract exceeding
$2,500 per unit or more for commodities, supplies, and services related to this Agreement.
The Contractor must provide in its request for approval all particulars necessary, as
specified by DOR, for evaluating the necessity or desirability of incurring such costs.
D. For all purchases made, subject to this Agreement, the Contractor must maintain copies of
all paid vendor invoices, documents, bids and other information used in vendor selection, for
inspection or audit.
10. USE OF SUBCONTRACTOR(S)
If the Contractor desires to accomplish part of the services through the use of one (1) or more
subcontractors, the following conditions must be met:
A. The Contractor shall submit any subcontracts to the State for approval prior to starting any
of the work;
B. The Agreement between the primary Contractor and the subcontractor must be in writing;
C. The subcontract must include specific language which establishes the rights of the auditors
of the State to examine the records of the subcontractor relative to the services and
materials provided under the Agreement; and
D. Upon termination of any subcontract, the State shall be notif ied immediately, in writing.
7
Exhibit D
E. Contractor shall assure that all subcontractor administrative fees are reasonable considering
the services being provided, and they may only pay overhead charges on the first $25,000
for each subcontract.
Further, any subcontract in excess of $100,000 entered into as a result of this Agreement shall
contain all applicable provisions stipulated in this Agreement.
11. POTENTIAL SUBCONTRACTORS
Nothing contained in this Agreement or otherwise, shall create any contractual relation between
the State and any subcontractors, and no subcontract shall relieve the Contractor of his
responsibilities and obligations hereunder. The Contractor agrees to be as fully responsible to
the State for the acts and omissions of its subcontractors and of persons either directly or
indirectly employed by any of them as it is for the acts and omissions of persons directly
employed by the contractor. The Contractor's obligation to pay its subcontractors is an
independent obligation from the State's obligation to make payments to the Contractor. As a
result, the State shall have no obligation to pay or to enforce the payment of any moneys to any
subcontractor. Contractor shall not subcontract any services under this Agreement without
prior approval of the State.
12. CONTRACT AMENDMENTS
In the event that additional program services must be performed which was wholly
unanticipated and is not specified in the written Scope of Work, but is, in the opinion of both
parties necessary to the successful accomplishment of the general scope of work outlined, an
amendment to the Agreement is required.
13. SOFTWARE
Contractor certifies that it has appropriate systems and controls in place to ensure that state
funds will not be used in the performance of this contract for the acquisition, operation or
maintenance of computer software in violation of copyright laws.
14. THEFT SENSITIVE ITEMS
DOR is requiring nonexpendable electronic items purchased to be listed under a separate line
item titled “Theft Sensitive Items”. Contractor shall maintain an inventory record for each
nonexpendable item purchased or built with funds provided under the terms of the contract.
The inventory record of each item shall include the date acquired, total cost, serial number,
model identification and any other information or description necessary to identify said item. A
copy of the inventory record must be submitted annually to the State Contract Administrator.
The following items, regardless of cost must be inventoried:
1. Computers/printers
2. Laptops/tablets
3. Copiers/fax
4. Smart phones/cell phones
5. Other electronic items required to provide contract services
Upon termination of the agreement, DOR may request equipment be returned to DOR or
authorize the continued use of equipment for work to be performed under a different
agreement.
8
Exhibit D
DOR reserves title to equipment purchased under this agreement that are not fully consumed
during the life of the agreement.
15. ATTRIBUTION
The Contractor agrees to acknowledge the sponsorship of DOR with respect to any public
statement, press release, news item, or publication related to a program funded all or in part
with funds from DOR. Contractor further agrees to identify the role of DOR with respect to any
individual highlighted or publicized by or through Contractor, when such individual is a DOR
consumer.
16. UNRUH CIVIL RIGHTS ACT AND THE FAIR EMPLOYMENT & HOUSING ACT
Pursuant to Public Contract Code section 2010, if a bidder or proposer executes or renews a
contract over $100,000 on or after January 1, 2017, the bidder or proposer hereby certifies
compliance with the following:
The contractor certifies compliance with the Unruh Civil Rights Act (Section 51 of the Civil
Code) and the Fair Employment and Housing Act (Section 12960 of the Government Code);
and
If the contractor has an internal policy against a sovereign nation or peoples recognized by the
United States government, the Contractor certifies that such policies are not used in violation of
the Unruh Civil Rights Act (Section 51 of the Civil Code) or the Fair Employment and Housing
Act (Section 12960 of the Government Code).
1
Exhibit E
EXHIBIT E
(Standard Agreement - Subvention)
ADDITIONAL PROVISIONS – Federally Funded Agreements
1. FEDERAL REQUIREMENTS
The Federal Office of Management and Budget (OMB) has established unif orm administrative
requirements and cost principles for determining allowable costs chargeable to Federal awards.
The Contractor agrees to abide by the Title 2 Code of Federal Regulations, Part 200 (2 CFR
200), except where the Agreement is more restrictive. The federal regulations are available for
review on the Internet at www.ecfr.gov under Title 2-Grants and Agreements.
2. FEDERAL FUNDING INTELLECTUAL PROPERTY
A. In any Agreement funded in whole or in part by the federal government, DOR may acquire
and maintain the Intellectual Property rights, title and ownership, which results directly and
indirectly from the Agreement. However, the federal government shall have non-exclusive,
non-transferable, irrevocable, paid-up license throughout the world to use, duplicate, or
dispose of such Intellectual Property throughout the world in any manner for governmental
purposes and to have and permit others to do so.
B. Evaluation of Discovery or Invention: If any discovery or invention arises as a result of
funded work, the Contractor must refer the discovery or invention to the DOR. The
Rehabilitation Services Administration (RSA) and its representatives have the sole and
exclusive power to determine whether or not and where a patent should be filed and the
disposition of all rights, including title and license rights, which may result. RSA’s
determination of these issues shall be considered final. In addition, the DOR and RSA
shall acquire at least an irrevocable, non-exclusive, and royalty-free license to utilize for
government purposes of any of these inventions. By signing this Agreement, the Contractor
agrees that determinations of rights to inventions made in the course of or under the
Agreement shall be made by RSA or its authorized representative.
C. Copyrights and Patents: The Federal awarding agency and/or the DOR reserves a royalty-
free, nonexclusive, and irrevocable license to reproduce, publish or otherwise use, and to
authorize others to use, for Federal Government purposes:
1. The copyright in any work developed under a grant, subgrant, or Agreement under a
grant or subgrant; and
2. Any rights of copyright to which a grantee, subgrantee or a contractor purchases
ownership with grant support.
3. DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION
Federal and State agencies shall not award assistance to applicants that are deba rred or
suspended, or otherwise excluded from or ineligible for participation in Federal assistance
programs under Executive Order 12549. By signing this Agreement, Contractor certifies that
neither it nor its principals or subcontractors are presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from participation in this transaction by
any Federal department of agency.
2
Exhibit E
4. PROHIBITION ON TAX DELINQUENCY
Any Agreement that a state agency enters into after July 1, 2012, is void if the contract is
between a state agency and a contractor, or subcontractor, whose name appears on either list
of the 500 largest tax delinquencies pursuant to Section 7063 or 19195 of the Revenue and
Taxation Code. In accordance with Public Contract Code Section 10295.4, agencies are
required to cancel Agreements with entities that appear on either list.
(Franchise Tax Board) https://www.ftb.ca.gov/about-ftb/newsroom/top-500-past-due-
balances/index.html
(Department of Tax and Fee Administration) https://www.cdtfa.ca.gov/taxes-and-
fees/top500.htm
5. THE FOLLOWING PROVISIONS ARE SUBJECT TO THIS AGREEMENT
A. Equal Employment Opportunity--All Agreements require compliance with E.O. 11246--Equal
Employment Opportunity, as amended by E.O. 1137--Amending Executive Order 11246
Relating to Equal Employment Opportunity, and as supplemented by regulations at 41 CFR
Chapter 60 Office of Federal Contract Compliance Programs, Equal Employment
Opportunity, Department of Labor, Part 60-1 Obligations of Contractors and Subcontractors,
Subpart A. Preliminary Matters; Equal Opportunity Clause; Compliance Reports.
B. Clean Air Act (42 U.S.C. 7401 et seq.) and the Federal Water Pollution Control Act (33
U.S.C. 1251 et seq.), as amended--Agreements of amounts in excess of $100,000 shall
require the Contractor to agree to comply with all applicable standards, orders, or
regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401 et seq.) and the Federal
Water Pollution Control Act as amended (33 U.S.C. 1251 et seq.). Violations shall be
reported to ED and the Regional Office of the Environmental Protection Agency (EPA).
C. Byrd Anti-Lobbying Amendment (31 U.S.C. 1352)--By signing this Agreement, the
Contractor who is awarded an Agreement of $100,000 or more certifies that it will not and
has not used Federal appropriated funds to pay any person or organization for influencing or
attempting to influence an officer or employee of any agency, a member of Congress, officer
or employee of Congress, or an employee of a member of Congress in connection with
obtaining any Federal contract, grant, or any other award covered by 31 U.S.C. 1352.
Contractor shall also disclose any lobbying with non-Federal funds that takes place in
connection with obtaining any Federal award.
D. All contractors shall comply with the following statutes and regulations:
1. Subject: Discrimination on the basis of race, color, or national origin.
Statute: Title VI of the Civil Rights Act of 1964 (45 U.S.C. 2000 through 2000d-4).
Regulation: 34 CFR part 100.
2. Subject: Discrimination on the basis of sex
Statute: Title IX of the Education Amendments of 1972 (20 U.S.C. 1681-1683).
Regulations: 34 CFR part 106.
3. Subject: Discrimination on the basis of handicap.
Statute: Section 504 of the Rehabilitation Act of 1973 (29U.S.C. 794).
Regulation: 34 CFR part 104handicap.
4. Subject: Discrimination on the basis of age.
Statute: The Age Discrimination Act (42 U.S.C. 6101 et seq.).
Regulation: 34 CFR part 110
3
Exhibit E
6. RETURN OF INAPPROPRIATE USE OF FUNDS
By signing this Agreement, Contractor shall certify that in the event of funds used
inappropriately, funds must be returned to DOR.
7. AMERICANS WITH DISABILITIES ACT (ADA)
By signing this Agreement, Contractor/Grantee agrees to comply with the Americans with
Disabilities Act (ADA) of 1990, which prohibits discrimination on the basis of disability, as well
as, all applicable regulations and guidelines issued pursuant to the ADA (42 U.S.C. 12101 et
seq.). In compliance with the Rehabilitation Act of 1973, 29 U.S.C. §794 et seq. and
Government Code, Section 11135 et seq.; Section 504 imposes affirmative disability-related
responsibilities on recipients of federal financial assistance as well as federal programs and
activities and prohibits disability-based discrimination; and Section 508, requires electronic and
information technology be accessible to people with disabilities.
1
Exhibit F
EXHIBIT F
(Standard Agreement - Subvention)
ADDITIONAL PROVISIONS - COOPERATIVE/CASE SERVICES
1. MATCH REQUIREMENTS
Contractor shall submit the certified expenditure invoice on a timely basis (i.e. same time as
submission of service budget invoice) for proper DOR processing. To ensure sufficient match is
available to leverage federal funding, the contractor is required to submit 100% of their
obligated certified/cash match to meet their full budgeted amount by the end of each fiscal year.
Refer to the Contract Handbook for Case Services and Cooperative Program Agreements for
more information regarding certified/cash match requirements.
For Agreements that include CERTIFIED EXPENDITURE MATCH:
A. Contractor shall certify to the State, on a monthly basis as specified in Exhibit B & G, the
Contractor’s allowable costs to provide the cooperative program services identified in the
Scope of Work, in accordance with the Cooperative Agency Certified Expenditure Budget
Summary and Narrative, and applicable Federal regulations. All such expe nditures shall be
under the administrative supervision of the State and no portion of the certified expenditures
shall come from Federal funds. The State shall not be obligated to pay the Contractor for
any contributions made by the Contractor in accordance with the Cooperative Agency
Certified Expenditure Budget Summary.
B. The total Cooperative Agency certified expenditure share will be matched to Federal funds
at no less than 25%, as indicated on the DOR Program Budget Summary. If the value of the
certified expenditures by the Contractor is below 25% of the actual total program cost, the
Service Budget may be reduced after review by the DOR Contract Administrator. The State
will not pay the Contractor for actual costs claimed on the Service Invoice (DOR 801B) until
the certified expenditure summary for the same period has been submitted.
C. Contractor contributions, including any excess of the amount specified in the “Cooperative
Agency Certified Expenditure Budget Summary”, will be used by the State to obtain Federal
funds under Section 110 of the Rehabilitation Act of 1973, as amended. Federal funds
obtained in excess of the “Total Program Cost” as identified on the “DOR Program Budget
Summary” shall accrue to the State.
For Agreements that include CASH MATCH:
A. Each fiscal year Contractor will pay to State, no less than quarterly and in advance, upon
receipt of an invoice from the State, all those cash matching funds which are identified within
the Program Budget Summary for that fiscal year. The State shall not be obligated to pay
the Contractor for any contributions made by the Contractor in accordance with the
approved budget, it being understood that all matching funds obtained by the State from the
Contractor shall be exclusive funds of the State and no portion of the cash match shall come
from Federal funds.
B. The total Cooperative Agency cash share will be matched to Federal funds at no less than
21.3% as indicated on the “DOR Program Budget Summary."
2
Exhibit F
2. INDIRECT COSTS
Indirect costs are allowable expenses incurred by an organization which support the activities of
a program or contract, but are not directly assigned to the specific program or contract and are
allocated to the program or contract using a method in compliance with 2 CFR 200. The
allocation method must be fully explained in the contract budget narrative and must be
supported by actual costs incurred and paid by the organization. The allocation of indirect costs
cannot be based on an arbitrary fixed rate and there is a 15% cap on the service budget. There
is no cap on the certified match, however, indirect costs over 40% require a copy of the rate
approval document from the cognizant federal agency or state department designee (e.g.
California Department of Education {CDE} or established through an independent audit).
3. CONTRACT HANDBOOK
Contractor acknowledges and agrees with the policies requirements and conditions of the
Department of Rehabilitation’s Contract Handbook and its additional policy requirements and
conditions for Case Services/Cooperative Program Agreements as applicable for the Fiscal
Year(s) covered under this Agreement. Match requirements are applicable to Cooperative
Programs Agreements only.
4. DOR'S CONTRACT MONITORING
The DOR Contract Administrator will monitor and document the contractor’s performance to
ensure compliance with all Agreement provisions. The DOR Contractor Administrator will:
A. Maintain documentation on all Agreement activities, including the performance of the
Agreement services, invoice reviews and approvals, monitoring activities, and other
Agreement administration activities.
B. Monitor the Agreement to ensure services were performed according to the quality, quantity,
objectives, timeframes and manner specified in the Agreement, and that the Contractor
prepares and maintains adequate documentation to support the services pr ovided,
expenditures reimbursements, and/or any applicable match requirements.
C. Review and approve invoices for payment to substantiate expenditures for the work
performed, including verification that costs invoiced for the provision of services to DOR
applicants/consumers during the Agreement period are based on reasonable costs, and that
the invoices are current, correct, and timely.
D. Ensure that all Service Invoices (DR801B) and Certified Expenditure Summaries, if
applicable, are received no later than November 1st, to allow for payment and draw down
prior to the close out of Federal/State funds.
E. Verify that the contractor has fulfilled all requirements of the Agreement before approving
the final invoice.
F. Ensure there are sufficient funds to pay for all services rendered as required by the
Agreement.
G. Ensure, by the end of the second quarter, that the projected certified expenditure match will
be sufficient to support the budgets as outlined in this Agreement. If not, contact the
3
Exhibit F
appropriate Collaborative Services Program Specialist. (Cooperative Program Agreements
only)
H. Identify low usage levels and consider partial disencumbrance of Agreement funds.
I. Periodically review personnel activity reports for staff funded by the Agreement to ensure
that the Contractor is preparing and maintaining personnel activity reports in compliance
with the applicable OMB cost principle.
J. Verify that all Agreement staff are providing services in accordance to their duties specified
in the Agreement, including ensuring that:
Personnel duty statements or a copy of the Agreement Budget Narrative/Agreement
Duty Statement has been provided to each staff person to communicate the specific
duties to be performed under the Agreement.
Verify that job duties, as provided by the Agreement staff, match Agreement duty
statements and service descriptions.
Ensure that the contractor has submitted to DOR appropriate documentation that
supports the services provided to DOR applicants/consumers, including monthly (or
otherwise specified) progress reports, consumer listings, utilization/service reports,
and/or other agreed-upon documentation.
Verify that Contract staff provide services only to authorized DOR consumers.
1
Exhibit G
EXHIBIT G
(Standard Agreement - Subvention)
ADDITIONAL PROVISIONS-CONTRACTOR'S MONITORING & TRANSPORTATION
I. 8CONTRACT MONITORING AND REPORTING
The Contract Administrator/Program Manager shall monitor the contract by:
Meeting with DOR Contract Administrator and program staff to discuss contract progress at
Quarterly Meetings
Reconcile client list and staff individual DOR/DBH clients cases with DOR staff and program
staff monthly
Reporting the current and cumulative achievement of contract service goals and outcomes
as part of the Quarterly Meetings or more often as directed by the DOR Contract
Administrator
Submit cash match upon receipt of invoice from DOR
II. Transportation
The Contractor will not provide transportation to DOR/DBH clients
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FOR ACCOUNTING USE ONLY:
Fund: 0001
Subclass: 10000
Org: 56304533
Account: 7295
CCC 04/2017
CERTIFICATION
I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly
authorized to legally bind the prospective Contractor to the clause(s) listed below. This
certification is made under the laws of the State of California.
Contractor/Bidder Firm Name (Printed) Fede ral ID N umber
By (Authorized Signature)
S--;r.A~ 1 1~ ~
Printed N ame and Title of'Ferson Signing
Ernest Buddy Mendes, Chairman of the Board of Supervisors
Date Executed Executed in the County of
u -d-3 -;;..o J-0 Fresno
CONTRACTOR CERTIFICATION CLAUSES
I . STATEMENT OF COMPLIANCE: Contractor has , unless exempted , complied with
the nondiscrimination program requirements. (Gov. Code §12990 (a-f) and CCR, Title 2 ,
Section 11102) (Not applicable to public entities .)
2. DRUG-FREE WORKPLACE REQUIREMENTS : Contractor will comply with the
requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-free
workplace by taking the following actions :
a. Publish a statement notifying employees that unlawful manufacture, distribution ,
dispensation , possession or use of a controlled substance is prohibited and specifying
actions to be taken against employees for violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
I) the dangers of drug abuse in the workplace ;
2) the person's or organization's policy of maintaining a drug-free workplace ;
3) any available counseling, rehabilitation and employee assistance programs ; and ,
4) penalties that may be imposed upon employees for drug abuse violations.
c. Every employee who works on the proposed Agreement will :
I) receive a copy of the company's drug-free workplace policy statement; and ,
2) agree to abide by the terms of the company's statement as a condition of employment
on the Agreement.
Failure to comply with these requirements may result in suspension of payments under
the Agreement or termination of the Agreement or both and Contractor may be ineligible
for award of any future State agreements if the department determines that any of the
following has occurred: the Contractor has made false certification, or violated the
I
certification by failing to carry out the requirements as noted above. (Gov. Code §8350 et
seq.)
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor certifies
that no more than one (1) final unappealable finding of contempt of court by a Federal
court has been issued against Contractor within the immediately preceding two-year
period because of Contractor's failure to comply with an order of a Federal court, which
orders Contractor to comply with an order of the National Labor Relations Board. (Pub.
Contract Code §10296) (Not applicable to public entities.)
4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO
REQUIREMENT: Contractor hereby certifies that Contractor will comply with the
requirements of Section 6072 of the Business and Professions Code, effective January 1,
2003.
Contractor agrees to make a good faith effort to provide a minimum number of hours of
pro bono legal services during each year of the contract equal to the lessor of 30
multiplied by the number of full time attorneys in the firm’s offices in the State, with the
number of hours prorated on an actual day basis for any contract period of less than a full
year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state contract for
legal services, and may be taken into account when determining the award of future
contracts with the State for legal services.
5. EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an
expatriate corporation or subsidiary of an expatriate corporation within the meaning of
Public Contract Code Section 10286 and 10286.1, and is eligible to contract with the
State of California.
6. SWEATFREE CODE OF CONDUCT:
a. All Contractors contracting for the procurement or laundering of apparel, garments or
corresponding accessories, or the procurement of equipment, materials, or supplies, other
than procurement related to a public works contract, declare under penalty of perjury that
no apparel, garments or corresponding accessories, equipment, materials, or supplies
furnished to the state pursuant to the contract have been laundered or produced in whole
or in part by sweatshop labor, forced labor, convict labor, indentured labor under penal
sanction, abusive forms of child labor or exploitation of children in sweatshop labor, or
with the benefit of sweatshop labor, forced labor, convict labor, indentured labor under
penal sanction, abusive forms of child labor or exploitation of children in sweatshop
labor. The contractor further declares under penalty of perjury that they adhere to the
Sweatfree Code of Conduct as set forth on the California Department of Industrial
Relations website located at www.dir.ca.gov, and Public Contract Code Section 6108.
b. The contractor agrees to cooperate fully in providing reasonable access to the
contractor’s records, documents, agents or employees, or premises if reasonably required
by authorized officials of the contracting agency, the Department of Industrial Relations,
or the Department of Justice to determine the contractor’s compliance with the
requirements under paragraph (a).
7. DOMESTIC PARTNERS: For contracts of $100,000 or more, Contractor certifies
that Contractor is in compliance with Public Contract Code section 10295.3.
8. GENDER IDENTITY: For contracts of $100,000 or more, Contractor certifies that
Contractor is in compliance with Public Contract Code section 10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1. CONFLICT OF INTEREST: Contractor needs to be aware of the following provisions
regarding current or former state employees. If Contractor has any questions on the
status of any person rendering services or involved with the Agreement, the awarding
agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code §10410):
1). No officer or employee shall engage in any employment, activity or enterprise from
which the officer or employee receives compensation or has a financial interest and
which is sponsored or funded by any state agency, unless the employment, activity or
enterprise is required as a condition of regular state employment.
2). No officer or employee shall contract on his or her own behalf as an independent
contractor with any state agency to provide goods or services.
Former State Employees (Pub. Contract Code §10411):
1). For the two-year period from the date he or she left state employment, no former state
officer or employee may enter into a contract in which he or she engaged in any of the
negotiations, transactions, planning, arrangements or any part of the decision-making
process relevant to the contract while employed in any capacity by any state agency.
2). For the twelve-month period from the date he or she left state employment, no former
state officer or employee may enter into a contract with any state agency if he or she was
employed by that state agency in a policy-making position in the same general subject
area as the proposed contract within the 12-month period prior to his or her leaving state
service.
If Contractor violates any provisions of above paragraphs, such action by Contractor shall
render this Agreement void. (Pub. Contract Code §10420)
Members of boards and commissions are exempt from this section if they do not receive
payment other than payment of each meeting of the board or commission, payment for
preparatory time and payment for per diem. (Pub. Contract Code §10430 (e))
2. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware of the
provisions which require every employer to be insured against liability for Worker's
Compensation or to undertake self-insurance in accordance with the provisions, and
Contractor affirms to comply with such provisions before commencing the performance
of the work of this Agreement. (Labor Code Section 3700)
3. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it
complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits
discrimination on the basis of disability, as well as all applicable regulations and
guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE: An amendment is required to change the
Contractor's name as listed on this Agreement. Upon receipt of legal documentation of
the name change the State will process the amendment. Payment of invoices presented
with a new name cannot be paid prior to approval of said amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the contracting
agencies will be verifying that the contractor is currently qualified to do business in
California in order to ensure that all obligations due to the state are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging in any
transaction for the purpose of financial or pecuniary gain or profit. Although there are
some statutory exceptions to taxation, rarely will a corporate contractor performing
within the state not be subject to the franchise tax.
c. Both domestic and foreign corporations (those incorporated outside of California) must
be in good standing in order to be qualified to do business in California. Agencies will
determine whether a corporation is in good standing by calling the Office of the Secretary
of State.
6. RESOLUTION: A county, city, district, or other local public body must provide the
State with a copy of a resolution, order, motion, or ordinance of the local governing body
which by law has authority to enter into an agreement, authorizing execution of the
agreement.
7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the Contractor
shall not be: (1) in violation of any order or resolution not subject to review promulgated
by the State Air Resources Board or an air pollution control district; (2) subject to cease
and desist order not subject to review issued pursuant to Section 13301 of the Water
Code for violation of waste discharge requirements or discharge prohibitions; or (3)
finally determined to be in violation of provisions of federal law relating to air or water
pollution.
8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all
contractors that are not another state agency or other governmental entity.