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Home My WebLink About32182ACCEPTANCE OF AWARD County of Fresno, Department of Public Health Funding Period: July 1, 2015 through June 30,2016 Base Award: $308,674 Food, Shelter, Incentives and Enablers Allotment: $18,662 Agreement No. 15-407 I hereby accept this award. By accepting this award, I agree to the requirements as described in the Standards and Procedures Manual for FY 2015-2016 and any other conditions stipulated by the California Department of Public Health, Tuberculosis Control Branch. Deborah A. Poochigian Print Name ATTEST: BERNICE E. SEIDEL, Clerk Board of Supervisors By ~.j :;.\c. ; c~ ~ ( · De uty Chairman, Board of Supervisors Title State of Calffomia-Heallh and Human Services Agency California Department of PubHc Health Contracts and Purchasing Services Section Darfur Contracting Act Pursuant to Public Contract Code (PCC) sections 10475-10481, the Darfur Contracting Act's intent is to preclude State agencies from contracting with scrutinized companies that do business in the African nation of Sudan. A scrutinized company is a company doing specified types of business in Sudan as defined in PCC section 10476. Scrutinized companies are ineligible to, and cannot, contract with a State agency for goods or services (PCC section 10477(a)) unless obtaining permission from the Department of General Services according to the criteria set forth in PCC section 10477(b). Therefore, to be eligible to contract with the California Department of Public Health, please initial one of the following three paragraphs and complete the certification below: 1. 2. 3. DAP Initials Initials Initials CERTIFICATION We do not currently have, or we have not had within the previous three years, business activities or other operations outside of the United States. OR We are a scrutinized company as defined in Public Contract Code section 10476, but we have received written permission from the Department of General Services (DGS) to submit a bid or proposal pursuant to Public Contract Code section 10477(b) or submit a contracUpurchase order. A copy of the written permission from DGS is included with our bid, proposal or contracUpurchase order. OR We currently have, or we have had within the previous three years, business activities or other operations outside of the United States, but we certify below that we are not a scrutinized company as defined in Public Contract Code section 10476. I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind this company to the clause listed above. This certification is made under the laws of the State of California. Company Name (Printed) County of Fresno CDPH 9067 (4/09) Board of Su ervisors Federa/10 Number 94-6000-512 ATIEST: BERNICE E. SEIDEL~Cier1< Board of Supervisors By =-t,/)C,· < OAetl D :>q{y Executed in the County and State of Fresno, CA California Department of Public Health Tuberculosis Control Branch Contractor Certification Clauses 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) County of Fresno Deborah A. Poochigian, Cha~rman, Board of.Supervisors Date xecuted Executed in the County of Fresno NTRACTOR ·CERTIFJCATION CLAUSES Federa/10 Number 94-6000-512 ATTEST: BERNICE E. SEIDEL, Clerk Board of Supervisors By :i.. "" 'C~ ; c ~ofp~y- 1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with the nondiscrimination program requirements. (Gov. Code §12990 (a-t) and CCR, Title 2, Section 8103) (Not applicable to public entities.) 2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-free workplace by taking the following actions: a. Publish a statement notifying employees that unlawful manufacture, distribution, dispensation, possession or use of a controlled substance is prohibited and specifying actions to be taken against employees for violations. b. Establish a Drug-Free Awareness Program to inform employees about: 1) the dangers of drug abuse in the workplace; 2) the person's or organization's policy of maintaining a drug-free workplace; 3) any available counseling, rehabilitation and employee assistance programs; and, 4) penalties that may be imposed upon employees for drug abuse violations. c. Every employee who works on the proposed Agreement will: 1) receive a copy of the company's drug-free workplace policy statement; and, Adapted from DGS form CCC-307 (0312812007) Page 1 of4 February 2014 V91!1V!I!!GI f<I!CIL191\IIII!CIIfl VI I UUJI\,e I !C9!UI I UU'OH • .UIU~tO) \(VI UIUI U!911\.olf STATE OF CALIFORNIA CALIFORNIA DEPARTMENT OF PUBLIC HEALTH CERTIFICATION REGARDING LOBBYING The undersigned certifies, to the best of his or her knowledge and belief, that: Attachment 1 (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the making, awarding or entering into of this Federal contract, Federal grant, or cooperative agreement, and the extension, continuation, renewal, amendment, or modification of this Federal contract, grant, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency of the United States Government, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, or cooperative agreement, the undersigned shall complete and submit Standard Form LLL, "Disclosure of Lobbying Activities" in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontractors, subgrants, and contracts under grants and cooperative agreements) of $100,000 or more, and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S.C., any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. County of Fresno Name of Contrador Date After execution by or on behalf of Contractor, please return to: California Department of Public Health Tuberculosis Control Branch 850 Marina Bay Parkway, Building P, Second Floor Richmond, CA 94804-8403 Deborah A. Poochigian Printed Name of Person Signing for Con Chairman, Board of Supervisors Tille ATIEST: BERNICE E. SEIDEL, Cieri< Board of Supervisors d\~~~puty CDPH reserves the right to notifiy the contractor in writing of an alternate submission address. Adapted from CDPH Exhibit D(F) (10114) Page 24 of26 03-2015