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HomeMy WebLinkAbout32517DocuSign Envelope 10: 6E8B7286-A017-4A53-A59E-5944FF5B9E5D .... ::: .. ,:::_:~;;::.r~::-~·i•-'·~ The 1000 North Alameda Street los Angeles CA 90012 213.928.8800 FAX 213.928.8801 800.449.4149 California Endowment February 2, 2016 Supervisor Ernest Buddy Mendes Chainnan, Board of Supervisors Fresno County Public Defender 2220 Tulare Street, Suite 300 Fresno, CA 93 721 Re: 20162616, Connecting Formerly Incarcerated Individuals to Health Resources: To support outreach, education and other assistance to connect fonnerly incarcerated individuals to health, social services, legal and other programs to improve health and well-being in Fresno County. All correspondence should include the grant ID number. Dear Supervisor Mendes: On behalf of The California Endowment and Program Manager Will Ing, I am pleased to infonn you that The Endowment has awarded Fresno County Public Defender $25,000.00 for the above-referenced grant. Grant funds are restricted and must be used according to the tenns and conditions outlined below. Your acceptance ofEndowment funding is your acceptance of these terms and conditions: 1. Use of Funds. Grantee must spend the grant funds only for the purposes described above. 2. Prohibited Uses. Grantee shall not use any portion of the funds granted in a manner inconsistent with Section 50l(c)(3) ofthe Internal Revenue Code, including: a. carrying on propaganda or otherwise attempting to influence legislation, b. influencing the outcome of any specific public election, c. carrying on, directly or indirectly, any voter registration drive, d. inducing or encouraging violations of law or public policy, or e. causing any private inurement or improper private benefit to occur. 3. Payment of Funds to Related Parties ofThe Endowment. No part of these grant funds shall be paid to any director, officer, or employee (or their family members) ofThe Endowment for any purpose. 4. Terrorist Activity. The grantee agrees that it will use the grant funds in compliance V'JWW .t:~l1m\low.u rg DocuSign Envelope 10: 6E8B7286-A017-4A53-A59E-5944FF5B9E5D The California Endown1ent with all applicable anti-terrorist financing and asset control laws, regulations, rules, and executive orders, including, but not limited to the USA Patriot Act of2001 and Executive Order 13224. 5. No Agency. Grantee is solely responsible for all activities supported by the grant funds, the content of any product created with the grant funds, and the manner in which any such product may be disseminated. This Agreement shall not create any agency relationship, partnership, or joint venture between the parties, and Grantee shall make no such representation to anyone. 6. Indemnification. Grantee irrevocably and unconditionally agrees, to the fullest extent permitted by law, to defend, indemnify, and hold harmless The Endowment, its officers, directors, employees, and agents, from and against any and all claims, liabilities, losses, and expenses (including reasonable attorneys' fees) directly, indirectly, wholly, or partially arising from or in connection with any act or omission of Grantee, its employees, or agents, in applying for or accepting the grant, in expending or applying the grant funds, or in carrying out any project or program to be supported by the grant, except to the extent that such claims, liabilities, losses, or expenses arise from or in connection with any act or omission ofThe Endowment, its officers, directors, employees, or agents. Please complete the attached Payment Form so that we may credit your organization's bank account directly within two weeks of your accepting this grant award letter. Ifyou have any questions please contact me at 213-928-8631 or mpincus@calendow.org. Thank you for your efforts to improve individual and community health in California. Regards, ~DocuSigned by:/'!. f7fglrc * {·w,c.MtY 0' 2A 1600FDAB9446D ... Marc J. Pincus Received and accepted by: ATTEST: BERNICE E. SEIDEL, Clerk Board of Supervisors By ci c.!.. ·tJ= Deputy DocuSign Envelope ID: 6E8B7286-A017-4A53-A59E-5944FF5B9E5D , The California Endowtnent Payment Form The California Endowment issues electronic payments via an ACH credit directly to your bank account. In order to process your payment, please enter your Bank Name, ACH Bank Routing Number and Bank Account Number in the fields below. Please note that fees of $0.10-$0.20 cents may be imposed by your bank for each ACH transaction. Please refer to your bank representative for details. If you prefer not to receive payment electronically, please enter "N/A" in the fields, and The Endowment will issue a paper check that will be mailed via US post. Grantee Organization Name Fresno County Public Defender Project Title and File Number Connecting Formerly Incarcerated Individuals Health Resources (201626161 Grantee Organization Address 2220 Tulare Street, Suite 300 Fresno, CA 93721 Payee Organization Name Fresno County Public Defender Bank Name N/A ACH Bank Routing Number N/A Bank Account Number N/A Confirm Bank Account Number N/A Name of Authorized Person Providing Banking Information N/A Title of Authorized Person Providing Banking Information N/A Phone Number for Authorized Person Providing Banking Information N/A Contact email address (we will send an email confirmation once the N/A ACH is processed) By signing this form, I confirm that the above bank information is accurate and that I authorize The California Endowment to issue an ACH credit to the above named account: to Grant Acceptance Letter from The California Endowment for Connecting Formerly Incarcerated Individuals to Health Resources funds to conduct community outreach, education and provide legal assistance, effective January 15, 2016 through January 14, 2017. Reviewed and Recommended for Approval Approved as to Legal Form: JaneT. Smith, County Counsel Date: C)-.]-/{~ Approved as to Accounting Form: Vicki Crow, Auditor-Controller-Treasurer/Tax Collector Date: _______ _ DocuSign Envelope 10: 6E8B7286-A017-4A53-A59E-5944FF5B9E5D The California Endown1ent I further acknowledge that The California Endowment cannot be held liable for lost funds due to incorrect bank information provided. A funds transfer from The California Endowment's bank to a submitted incorrect bank account will require any future distributions to be in paper check form only. Signed by: Title: SUPERVISOR ATTEST: BERNICE E. SEIDEL, Clerk Board of Supervisors syd~ Deputy Certificate Of Completion Envelope ld: 6E8B7286A017 4A53A59E5944FF5B9E5D Subject: 20162616, Grant from The California Endowment to Fresno County Public Defender Source Envelope: Document Pages: 4 Certificate Pages: 5 AutoNav: Enabled Envelopeld Stamping: Enabled Signatures: 3 Initials: 2 Time Zone: (UTC-08:00) Pacific Time (US & Canada) Record Tracking Status: Original 2/23/2016 7:14:24 AM Signer Events Marc J. Pincus mpincus@calendow.org Grants Analyst The California Endowment Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered ID: Dolores Estrada destrada@calendow.org Director, Grant Operations The California Endowment Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered ID: Ernest Buddy Mendes district4@co.fresno.ca.us SUPERVISOR Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 3/2/2016 3:03:24 PM ID: ad033d68-8300-4df5-af74-9739ff6beb11 In Person Signer Events Editor Delivery Events Agent Delivery Events Intermediary Delivery Events Certified Delivery Events Carbon Copy Events Holder: Marc Pincus mpincus@calendow .org Signature ~OocuSign~ by: 7P..· }.C * ew¥: \>:>· ¥. C) . 2A 1600FDAB94460 .. Using IP Address: 64.60.230.130 Using IP Address: 64.60.230.130 Using IP Address: 64.171.224.83 Signature Status Status Status Status Status Docu~. iii UCURCI> Status: Completed Envelope Originator: Marc Pincus 1 000 N Alameda St Los Angeles, CA 90012 mpincus@calendow.org IP Address: 64.60.230.130 Location: DocuSign Timestamp Sent: 2/23/2016 7:30:13 AM Viewed: 2/23/2016 7:30:18 AM Signed: 2/23/2016 7:30:24 AM Sent: 2/23/2016 7:30:25 AM Viewed: 2/24/2016 8:57:03 AM Signed: 2/24/2016 8:57:18 AM Sent: 2/24/2016 8:57:19 AM Viewed: 3/2/2016 3:03:24 PM Signed: 3/2/2016 3:07:57 PM Timestamp Timestamp Timestamp Timestamp Timestamp Timestamp ATTEST: BERNICE E. SEIDEL, Clerk Boardpervisors By~~ Deputy Carbon Copy Events Electronic Approvals eapprovals@calendow .org The California Endowment Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 3/5/2012 10:45:26 AM ID: a 140b8cb-882d-4d5f-b94d-fd95b51 f9f42 TCE Grant Reports tcegrantreports@calendow .org Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 3/6/2014 11:30:39 AM ID: 5ffd3a07 -009e-4507 -9716-d78a999b2f93 Elizabeth Diaz ediaz@co.fresno.ca.us Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 2/1/2016 4:44:14 PM ID: da69a81 e-3129-4acc-91 ba-be8d6ff2f9d9 Douglas Feinberg DFeinberg@co.fresno.ca.us Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered ID: Cheri Yau cyau@co.fresno.ca.us Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered ID: Willing wing@calendow .org Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 2/1/2016 10:44:42 AM ID: bb642f90-12f3-4340-a2a5-3e5df01 063e6 Notary Events Envelope Summary Events Envelope Sent Certified Delivered Signing Complete Completed Status COPIED COPIED COPIED COPIED COPIED COPIED Status Hashed/Encrypted Security Checked Security Checked Security Checked Electronic Record and Signature Disclosure Timestamp Sent: 3/2/2016 3:07:58 PM Sent: 3/2/2016 3:07:59 PM Sent: 3/2/2016 3:08:01 PM Sent: 3/2/2016 3:08:03 PM Sent: 3/2/2016 3:08:04 PM Sent: 3/2/2016 3:08:06 PM Timestamp Timestamps 3/2/2016 3:08:06 PM 3/2/2016 3:08:06 PM 3/2/2016 3:08:06 PM 3/2/2016 3:08:06 PM Electronic Record and Signature Disclosure created on: 11/17/2011 4:46:19 PM Parties agreed to: Ernest Buddy Mendes, Electronic Approvals, TCE Grant Reports, Elizabeth Diaz, Will lng ELECTRONIC CONSENT Acknowledging your access and consent to receive materials electronically To confirm to us that you can access this information electronically, which will be similar to other electronic notices and disclosures that we will provide to you, please verify that you were able to read this electronic disclosure and that you also were able to print on paper or electronically save this page for your future reference and access or that you were able to e-mail this consent to an address where you will be able to print on paper or save it for your future reference and access. Further, if you consent to receiving notices and disclosures in electronic format on the terms and conditions described below, please let us know by clicking the 'I agree' button below. By checking the 'I agree' box, I confirm that: • I can access and read this ELECTRONIC CONSENT; and • I can print on paper the disclosure or save or send the disclosure to a place where I can print it, for future reference and access; and • Until or unless I notify The California Endowment as described above, I consent to receive through electronic means notices, disclosures, authorizations, acknowledgements, and other documents made available to me by The California Endowment during the course of my relationship with you. ELECTRONIC CONSENT DISCLOSURE From time to time, The California Endowment (we, us or Organization) may be required by law to provide to you certain written notices or disclosures. Described below are the terms and conditions for providing to you such notices and disclosures electronically through the DocuSign, Inc. (DocuSign) electronic signing system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to these terms and conditions, please confirm your agreement by clicking the 'I agree' button. Getting paper copies At any time, you may request from us a paper copy of any record provided or made available electronically to you by us. You will have the ability to download and print documents we send to you through the DocuSign system during and immediately after signing session and, if you elect to create a DocuSign signer account, you may access them for a limited period of time (usually 30 days) after such documents are first sent to you. You may request delivery of such paper copies from us by following the procedure described below. Withdrawing your consent If you decide to receive notices and disclosures from us electronically, you may at any time change your mind and tell us that thereafter you want to receive required notices and disclosures only in paper format. How you must inform us of your decision to receive future notices and disclosure in paper format and withdraw your consent to receive notices and disclosures electronically is described below. Consequences of changing your mind If you elect to receive required notices and disclosures only in paper format, it will slow the speed at which we can complete certain steps in transactions with you. To indicate to us that you are changing your mind, you must withdraw your consent using the DocuSign 'Withdraw Consent' form on the signing page of a DocuSign envelope instead of signing it. This will indicate to us that you have withdrawn your consent to receive notices and disclosures electronically from us and you will no longer be able to use the DocuSign system to receive notices and consents electronically from us or to sign documents electronically from us. How to contact The California Endowment You may contact us to let us know of your changes as to how we may contact you electronically, to request paper copies of certain information from us, and to withdraw your prior consent to receive notices and disclosures electronically as follows: To contact us, please email or call your Endowment representative directly. To advise The California Endowment of your new e-mail address To let us know of a change in your e-mail address where we should send notices and disclosures electronically to you, you must send an email message to your Endowment representative and in the body of such request you must state: your previous e-mail address, your new e-mail address. We do not require any other information from you to change your email address. In addition, you must notify DocuSign, Inc. to arrange for your new email address to be reflected in your DocuSign account by following the process for changing e-mail in the DocuSign system. To request paper copies from The California Endowment To request delivery from us of paper copies of the notices and disclosures previously provided by us to you electronically, you must send us an e-mail your Endowment representative and in the body of such request you must state your e-mail address, full name and title, legal name of organization, US Postal address, and telephone number. To withdraw your consent with The California Endowment To inform us that you no longer want to receive future notices and disclosures in electronic format you may: i. decline to sign a document from within your DocuSign session, and on the subsequent page, select the check-box indicating you wish to withdraw your consent or you may; ii. send an e-mail to your Endowment representative and in the body of such request you must state your e-mail, full name and title, legal name of organization, US Postal Address, and telephone number. We do not need any other information from you to withdraw consent. The consequences of your withdrawing consent for online documents will be that transactions may take a longer time to process. R . d h d eqUire ar ware an d ftw so are Operating Systems: WindowsA® 2000, WindowsA® XP, Windows VistaA®; Mac OSA® X Browsers: Final release versions of Internet ExplorerA® 6.0 or above (Windows only); Mozilla Firefox 2.0 or above (Windows and Mac); Safari8.,,¢ 3.0 or above (Mac onlv) PDF Reader: AcrobatA® or similar software may be required to view and print PDF files Screen Resolution: 800 x 600 minimum Enabled Security Settings: Allow per session cookies **These minimum requirements are subject to change. If these requirements change, you will be asked to re-accept the disclosure. Pre-release (e.g. beta) versions of operating systems and browsers are not supported.