HomeMy WebLinkAboutAgreement A-19-256-1 with Poverello House.pdfAgreement No . 19-256-1
1 AMENDMENT I TO AGREEMENT No . 19-256
2 THIS AMENDMENT I TO AGREEMENT (hereinafter "Amendment") is made and
3 entered into this 15th day of December, 2020 , by and between the COUNTY OF FRESNO , a
4 Political Subdivision of the State of Cal iforn ia , Fresno , California , here inafter referred to as
5 "COUNTY", and Poverello House , a Ca lifornia Non-Profit Corporation , whose address is 412
6 F Street, Fresno, CA 93706 , hereinafter referred to as "SUBRECIP IENT".
7 WITN ESSETH :
s WHEREAS , COUNTY is the Administrative Entity for Homeless Emergency Aid
9 Program (HEAP) grant funds awarded to the Fresno Madera Continuum of Care (FMCoC) by
10 the California Bus iness Consumer Services and Housing (BCSH) Agency , as authorized by
11 SB 850 (Chapter 48, Statutes of 2018); and
12 WHEREAS , as a result the FMCoC has a need for triage and emergency shelter
13 services throughout the Counties of Fresno and Madera and , therefore , the COUNTY , as the
14 Administrative Entity for the FMCoC , and SUBRICIPIENT entered into Agreement No . 19-
15 256 , dated the 4th of June 2019 , for SUBRECIPIENT to prov ide such services ; and
16 WHEREAS, COUNTY is the Administrative Ent ity for the Homeless Housing ,
1 7 Assistance and Prevention (HHAP) grant funds awarded to the FMCoC , by the Cal ifornia
18 Business Consumer Services and Hous ing (BCSH) Agency , as authorized by AB 101 ; and
19 WHEREAS , COUNTY, for itself, was awarded HHAP grant funds by the BCSH Agency ;
20 and
21 WHEREAS , COUNTY , as the Administrat ive Entity for FMCoC and for itself, and the
22 SUBRECIPIENT des ire to amend Agreement No . 19-256 to provide that SUBRECIPIENT
2 3 shall also provide services f unded by the HHAP grant funds awarded to FMCoC and the
24 COUNTY.
2 5 NOW THEREFORE , in cons ideration of the mutua l covenants , terms , and condit ions
2 6 herein contained , the parties hereto agree as follows :
2 7 1. That the existing County Agreement No . 19-256, Page one (1 ), line eighteen
2 s (18), beginning with the number "1" and end ing on page two (2), line twenty-eight (28) with
-1 -COUNTY OF FRESNO
Fresno, CA
COUNTY OF FRESNO
Fresno, CA
- 2 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
1
2
3
the word “DSS”, be deleted and the following inserted into its place:
“1. OBLIGATIONS
A. SUBRECIPIENT shall perform all services and fulfill all responsibilities to
provide triage emergency shelter as identified in COUNTY’s Request for Proposal (RFP) No.
19-053, dated February 12, 2019, and Addendum No. One (1) to COUNTY’s RFP No. 19-
053, dated February 27, 2019, collectively hereinafter referred to as COUNTY’s Revised RFP
No. 19-053 and SUBRECIPIENT’s response to said Revised RFP, all incorporated herein by
reference and made part of this Agreement.
B. SUBRECIPIENT shall perform all services set forth in Revised Exhibit A,
Summary of Services, attached hereto and by this reference incorporated herein.
C. SUBRECIPIENT shall provide services pursuant to the staffing pattern and
program expenses detailed in Revised Exhibit B, Budget, attached hereto and by this
reference incorporated herein.
D. SUBRECIPIENT shall maintain membership in the FMCoC and participate in
Coordinated Entry throughout the term of this Agreement, as described in Revised Exhibit A.
If, for any reason, this status is not maintained, the COUNTY may terminate this Agreement
pursuant to Section Three (3) of this Agreement.
E. COUNTY, as the Administrative Entity for HEAP funds awarded to FMCoC,
has entered into an agreement with the State of California for HEAP funding (Agreement No.
18-HEAP-0027), a copy of which is attached hereto as Exhibit C and is incorporated herein
by this reference. Services provided by SUBRECIPIENT under this Agreement shall be
funded in part with HEAP funding and, therefore, SUBRECIPIENT shall be aware of, agree
to, and comply with all State requirements governing the use of HEAP funds; and all
conditions in Exhibit C. Failure to comply with these requirements and conditions may result
in termination of this Agreement pursuant to Section Three (3) of this Agreement.
F. COUNTY has entered into an agreement, for HHAP grant funds awarded to
COUNTY, with the State of California for HHAP funding (Agreement No. 20-HHAP-00096), a
copy of which is attached hereto as Exhibit D and is incorporated herein by this reference.
COUNTY OF FRESNO
Fresno, CA
- 3 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
1
2
3
Services provided by SUBRECIPIENT under this Agreement shall be funded in part with
HHAP funding allocated to the COUNTY and, therefore, SUBRECIPIENT shall be aware of,
agree to, and comply with all State requirements governing the use of HHAP funds; and all
conditions in Exhibit D. Failure to comply with these requirements and conditions may result
in termination of this Agreement pursua nt to Section Three (3) of this Agreement.
G. COUNTY, as the Administrative Entity for HHAP grant funds awarded to
FMCoC, has entered into an agreement with the State of California for HHAP funding
(Agreement No. 20-HHAP-00097), a copy of which is attached hereto as Exhibit E and is
incorporated herein by this reference. Services provided by SUBRECIPIENT under this
Agreement shall be funded with HHAP funding and, therefore, SUBRECIPIENT shall be
aware of, agree to, and comply with all State requirements governing the use of HHAP funds;
and all conditions in Exhibit E. Failure to comply with these requirements and conditions may
result in termination of this Agreement pursuant to Section Three (3) of this Agreement.
H. In the event of any inconsistency among the documents described in
Paragraphs One (1) A, B, C, D, E, F and G hereinabove, the inconsistency shall be resolved
by giving precedence in the following order of priority: 1) to this Agreement, including all
Exhibits attached hereto, 2) to COUNTY’s Revised RFP No. 19-053, and 3) to the
SUBRECIPIENT’s response to the Revised RFP. A copy of COUNTY’s Revised RFP 19-053
and SUBRECIPIENT’s response shall be retained and made available during the term of this
Agreement by COUNTY’s Department of Social Services, hereinafter referred to as
COUNTY’s DSS.”
2. That the existing County Agreement No. 19-256, Page three (3), beginning on
line one (1) with the number “2” and ending on page three (3), line two (2) with the word “May
31, 2021”, be deleted and the following inserted into its place:
“2. TERM
This Agreement shall be effective on the 4th day of June 2019, through and
including March 31, 2022.”
3. That the existing County Agreement No. 19-256 Page three (3), Section four (4)
COUNTY OF FRESNO
Fresno, CA
- 4 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
1
2
3
beginning with Line twenty-four (24), with the number “4” and ending on Page four (4), Line
twenty-one (21) with the word “Agreement,” be deleted and the following inserted in its place:
“4. COMPENSATION
For actual services provided pursuant to the terms of this Agreement, COUNTY
agrees to pay SUBRECIPIENT and SUBRECIPIENT agrees to receive compensation in
accordance with Revised Exhibit B, Budget Summary. Mandated travel shall be reimbursed
based on actual expenditures and mileage reimbursement shall be at SUBRECIPIENT’s
adopted rate per mile, not to exceed the IRS published rate.
In no event shall the cumulative total of this Agreement exceed Nine Hundred
Five Thousand, Six Hundred Fifty-Eight and No/100 Dollars ($905,658). For the period of
June 04, 2019 through March 31, 2021, in no event shall the services performed under this
Agreement exceed Five Hundred Thirty-Six Thousand Five Hundred Ninety-Three and
No/100 Dollars ($536,593). For the period of June 01, 2021 through March 31, 2022, in no
event shall actual services performed under this Agreement be in excess of Three Hundred
Sixty-Nine Thousand Sixty-Five and No/100 Dollars ($369,065). Payments by COUNTY shall
be in arrears, for services provided during the preceding month, within forty-five (45) days
after receipt, verification and approval of SUBRECIPIENT’s invoices by COUNTY.
It is understood that all expenses incidental to SUBRECIPIENT’S performance
of services under this Agreement shall be borne by SUBRECIPIENT. If SUBRECIPIENT
should fail to comply with any provisions of the Agreement, COUNTY shall be relieved of its
obligation for further compensation. Any compensation which is not expended by
SUBRECIPIENT pursuant to the terms and conditions of this Agreement shall automatically
revert to COUNTY. The services provided by the SUBRECIPIENT under this Agreement are
funded in whole or in part by the State of California. In the event that funding for these
services is delayed by the State Controller, COUNTY may defer payment to SUBRECIPIENT.
The amount of the deferred payment shall not exceed the amount of funding delayed by the
COUNTY OF FRESNO
Fresno, CA
- 5 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
1
2
3
State Controller to the COUNTY. The period of time of the deferral by COUNTY shall not
exceed the period of time of the State Controller’s delay of payment to COUNTY plus forty-
five (45) days”
4. That all references in existing COUNTY Agreement No. 19-256 to Exhibit A shall
be changed to read “Revised Exhibit A,” which is attached hereto and incorporated herein by
this reference.
5. That all references in existing COUNTY Agreement No. 19-256 to Exhibit B shall
be changed to read “Revised Exhibit B,” which is attached hereto and incorporated herein by
this reference.
6. That all references in existing COUNTY Agreement No. 19-256 to Exhibit D
(Self-Dealing Transaction Disclosure Form) shall be changed to read “Exhibit F,” which is
attached hereto and incorporated herein by this reference.
COUNTY and SUBRECIPIENT agree that this Amendment is sufficient to amend
Agreement No. 19-256 and, that upon execution of this Amendment, the original Agreement
and this Amendment, shall together be considered the Agreement.
The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
covenants, conditions and promises contained in this Agreement not amended herein shall
remain in full force and effect. This Amendment shall be effective November 1, 2020.
///
///
///
///
///
///
///
///
///
///
1 IN WITNESS WHEREOF , t he parties hereto have executed th is Amendment as of the
2 day and year first hereinabove w ritten.
3 ATTEST:
4 CONTRACTOR:
5
6
7
8
9
10
11
12
13
14
1 5
16
17
18
19
20
21
Mailing Address:
412 F Street , Fresno, CA 93760
Phone No.: (559) 498-6988
Contact: Chief Program Office r
FOR ACCOUNTING USE ONLY:
Fund/Subclass : 0001/10000
Organization : 56107114
Account/Program: 7870
2 2 DEN:SGV
23
24
25
26
27
28
COUNTY OF FRESNO
-6 -
ATTE ST:
Berni ce E. Sei de l,
Cl e rk of the Boa rd of Superviso rs
County of Fres no, State of Ca lifornia
COUNT Y OF FRESNO
Fresno, Ci\
Revised Exhibit A
Page 1 of 5
SUMMARY OF SERVICES
ORGANIZATION: Poverello House
ADDRESS: 412 F Street, Fresno, CA 93706
SERVICE ADDRESS: 412 F Street, Fresno, CA 93706
TELEPHONE: (559) 498-6988
CONTACT: Sara Mirhadi, Chief Programs Officer
EMAIL: mirhadi@poverellohouse.org
CONTRACT: Triage Center Emergency Shelter Services
CONTRACT TERM: June 4, 2019 through May 31, 2021
June 1, 2021 through March 31, 2022
SUMMARY OF SERVICES
Poverello House shall provide Triage Center Emergency Shelter services, including 24-hour
emergency shelter that offers low-barrier access to dormitory or private accommodations with
on-site, housing-focused services including Diversion pre-screening, case management,
housing search and placement, connection to community resources, and stabilization of health
issues. Poverello House will provide ten (10) emergency shelter beds for homeless women in
metro Fresno. The Triage Center is intended to provide a safe, supportive environment where
residents will be provided with wraparound services to attain permanent housing by rebuilding
their support network and addressing the issues that led to the episode of homelessness.
Poverello House shall provide supplemental navigation staff to augment program services and
capacity in support of the Multi-Agency Access Program (MAP) Point services at the main MAP
site located at 412 F Street, Fresno, CA 93706. MAP Point Navigation services provided by
Poverello House will be provided in alignment with the existing MAP Point program, and will
include client screenings to determine needs, assistance in obtaining documents, linking clients
to appropriate services based on the initial screening, collaborating with other service providers
to monitor client success, maintaining agency relationships, employing evidence based
practices in screening and serving clients, and utilizing the standardized MAP Point Community
Screening Tool.
Poverello House shall provide case management services to homeless individuals and families
residing at the temporary emergency shelters established to respond to the COVID-19
pandemic in order to connect them with permanent housing and other community resources.
Services will include assisting homeless clients in obtaining documents needed for housing;
locating and obtaining an appropriate permanent housing placement; helping clients access
necessary social, health care, and employment services; and aid them in overcoming obstacles
to achieve housing stability. At minimum, services will be provided at the following COVID-19
emergency shelter locations:
Revised Exhibit A
Page 2 of 5
2445 W. Whitesbridge Ave., Fresno, CA 93706
2550 W. Clinton Ave., Fresno, CA 93705
412 F Street, Fresno, CA 93706
STAFFING
3.0 FTE Case Managers: Poverello House will provide a minimum of three full-time Case
Manager positions. Case managers will be responsible for creating a supportive service and
housing plan for every client, linking clients to supportive services, and implementing the
established housing plan. Case manager will also assist clients in collecting basic
documentation such as birth certificates, identification cards and social security cards. At least
one Case Manager position will be dedicated to serving Triage Center emergency shelter
participants. Two Case Manager positions will be dedicated to serving the homeless population
residing at COVID-19 emergency shelters. If there is an insufficient population at the COVID-19
emergency shelters to sustain a full caseload, the target population may be expanded to other
households experiencing homelessness, at the discretion of the County, under documented
circumstances.
3.55 FTE Intake Specialists: Poverello House will provide a minimum of 2.55 full-time equivalent
Intake Specialist positions. Intake Specialists will prescreen all those presenting at the Triage
Center. During the initial screening process the intake specialist will practice diversion. Once
diversion is exhausted or inappropriate, the intake specialist will link the client to the Triage
Center emergency shelter services. If shelter is unavailable at the Poverello House Triage
Center, the client will be linked to available shelter elsewhere. Intake specialists will also
address emergency needs such as mental health or medical needs.
1.0 FTE MAP Point Navigator: Poverello House will provide a minimum of one full-time MAP
Point Navigator position. The Navigator will administer the Community Screening Tool and/or
VI-SPDAT to the client and facilitate linkages to indicated services and faith-based supports.
The Navigator will work collaboratively with other service components and programs in the MAP
system. The Navigator will be knowledgeable of cultural sensitivity/competency and well versed
in community resources. The Navigator will be responsible for case management to ensure
proper linkages occur. Navigators are required to have a bachelor’s degree in a related field.
0.24 FTE Triage Center Manager: The Triage Center Manager is responsible for the overall
operation of the Triage Center. The Triage Center Manager will directly supervise case
managers and intake specialists, create schedules, and provide additional coverage if
necessary. The Triage Center Manager will set goals for the Triage Center program and staff
and will ensure that those goals are met.
0.1 FTE Chief Programs Officer: The Chief Programs Officer will provide programmatic and
financial oversight for all Triage Center services.
TARGET POPULATION
The target population of Triage Center Emergency Shelter services is women that are
experiencing homelessness or are at imminent risk of homelessness in Fresno and Madera
Counties.
Revised Exhibit A
Page 3 of 5
TRIAGE CENTER EMERGENCY SHELTER SERVICES
1. Emergency Shelter: Operate 10 emergency shelter beds for women experiencing
homelessness in Fresno and Madera Counties. Basic shelter services provided will
include meals. The maximum length of stay will be 90 days, subject to exceptions for
documented situations.
2. Case Management: Provide intensive case management services that focus on helping
participants develop a housing plan and overcome barriers to attaining permanent
housing. Participants that have been connected to a permanent housing intervention
may be referred to a Bridge Housing program while the permanent housing unit
becomes available. Once a participant has been placed in a Bridge Housing program or
has exited to a Rapid Rehousing program with case management services,
responsibility for navigation and case management for the participant will be assumed by
the new program. If placed in a Bridge Housing program with no case management, the
participant should be connected with Navigation services or other housing support
services.
3. Housing Search and Placement: Provide services and activities necessary to assist
program participants in locating, obtaining, and retaining safe permanent housing.
4. Diversion Pre-Screening: Assess all people who present for homeless services at the
Triage Center for potential Diversion services and if deemed eligible, refer immediately
to a Diversion program.
5. Stabilizing Heath Intervention: Provide services for stabilization of participant health
issues, including substance use and mental health disorders. Guests will have access to
on-site medical, dental, and mental health services.
MAP POINT NAVIGATION SERVICES
1. Navigation: Services will include the Community Screening Tool and/or VI-SPDAT to the
client, assistance in obtaining housing documents, linkages to mainstream services and
community resources. Navigation services will be provided at the main MAP site at
Poverello House.
COVID-19 HOMELESS RESPONSE SERVICES
1. Case Management: Provide individualized client support by helping clients develop a
housing plan and overcome any barriers faced in the housing process, based on their
specific situation and needs. Services will also include assisting clients in securing all
documents and services needed to obtain housing, such as identification,
disability/income verification, and any other documentation needed.
2. Housing Search and Placement: Provide services and activities necessary to assist
program participants in locating, obtaining, and retaining safe permanent housing.
CONTRACTOR RESPONSIBILITIES
• Poverello House shall provide annual Civil Rights training to their staff in the beginning
of every calendar year and will provide relevant proof to the County of Fresno by April 1.
Revised Exhibit A
Page 4 of 5
• All services provided must be in compliance or otherwise aligned with the core
components of Housing First, pursuant to California Welfare and Institutions Code
section 8255, subdivision (b).
• Adhere to a low-barrier shelter policy. Shelter beds must be open to all who desire the
service regardless of sexual orientation or marital status. Guests must be allowed to
enter shelter with their partners, possessions, and pets.
• Allow for 24-hour guest access and not exclude people because of intoxication or mental
illness.
• Register all guests and require their agreement to services provided by the Triage
Center.
• Accept self-referrals, FMCoC CES referrals and, where appropriate, law enforcement
referrals.
• The Triage Center will be a Coordinated Entry assessment site, that conducts homeless
services pre-screening using the Vulnerability Index – Service Prioritization Decision
Assistance Tool (VI-SPDAT).
• The Triage Center will be a Coordinated Entry Access Site that conducts homeless
services pre-screenings and will complete the Data Collection Form when a household
presents with a housing crisis and is open to services, to help determine if the household
can be diverted from entering the homeless response system by utilizing mainstream
resources. The Triage Center Access site will make referrals to mainstream services and
assist in navigating services to the extent possible.
• In the event the number of referrals exceeds the number of available beds, Poverello
House will prioritize referrals by length of homelessness, acuity of needs, and other
factors, as reflected on the FMCoC By-Name list.
• The Triage Center must be staffed 24 hours a day, 7 days a week.
• Provide on-site office space for Diversion program staff.
• Enter guest information into the Homeless Management Information System (HMIS) in
compliance with HUD data collection, management, and reporting standards. Client
HMIS data must be made available for the California Business, Consumer Services and
Housing Agency statewide data system or warehouse.
• Adhere to a “Good Neighbor” policy, whereby Poverello House will secure and maintain
the perimeter of the Triage Center facility, keeping clear of any nuisances and code
violations.
• Comply with all shelter and housing habitability standards as identified in 24 CFR
576.403
PERFORMANCE OUTCOMES
Poverello House shall provide complete and accurate monthly activity reports to the County of
Fresno, in a report format approved by the County by the 10th of each month.
Poverello House shall meet the following outcomes:
• A minimum of 100% bed utilization as measured by HMIS.
• Provide Triage Center emergency shelter services to a minimum of 182 unique and
duplicated participants for the initial 24-month contract term.
• Provide Triage Center emergency shelter services to a minimum of 68 unique and
duplicated participants for the final 9-month contract term.
Revised Exhibit A
Page 5 of 5
• Provide homeless services assessment and Diversion pre-screening to a minimum of
724 individuals presenting at the Triage Center annually.
• 90% of individuals presenting at the Triage Center will be linked to community supportive
services.
• 10% of individuals presenting at the Triage Center will be successfully diverted to
appropriate permanent housing, avoiding entering into shelter.
• A minimum of 89% of participants will be connected to a safe exit from the program,
meaning one of the following destinations: rental with or without subsidy, permanent
shared-living arrangement with family or friends, Bridge Housing or other emergency
housing programs, drug treatment facility, or psychiatric treatment facility.
• 35% of participants will transition to permanent housing.
• 50% of participants will transition to Bridge Housing.
• 75% of participants will attain a safe exit from the program within 90 days.
Revised Exhibit B
Page 1 of 2
BUDGET SUMMARY
ORGANIZATION: Poverello House
SERVICES: Triage Center Emergency Shelter Program
CONTRACT TERM: June 4, 2019 to May 31, 2021
CONTRACT AMOUNT: $536,593
Budget Categories Amount
Personnel
Salaries
0.10 FTE Chief Programs Officer
0.24 FTE Triage Manager
3 FTE Case Managers
1 FTE MAP Point Navigator
3.55 FTE Intake Specialists
Payroll Taxes
Benefits
Subtotal $415,422
Services & Supplies
Client Meals
Client Personal Supplies
Shelter Furniture
Insurance
Communication
Office Expenses
Equipment
IT Services
Travel Costs
Program Supplies
Fiscal & Audits
Training
Subtotal $73,688
Facility Costs
Rent
Utilities
Maintenance
Security
Landscaping
Minor Facility Improvements
Subtotal $15,262
Indirect Costs
Indirect Costs
Subtotal $32,221
Total $536,593
Revised Exhibit B
Page 2 of 2
BUDGET SUMMARY
ORGANIZATION: Poverello House
SERVICES: Triage Center Emergency Shelter Program
CONTRACT TERM: June 1, 2021 to March 31, 2022
CONTRACT AMOUNT: $369,065
Budget Categories Amount
Personnel
Salaries
0.10 FTE Chief Programs Officer
0.24 FTE Triage Manager
3 FTE Case Managers
1 FTE MAP Point Navigator
3.55 FTE Intake Specialists
Payroll Taxes
Benefits
Subtotal $285,480
Services & Supplies
Client Meals
Client Personal Supplies
Shelter Furniture
Insurance
Communication
Office Expenses
Equipment
IT Services
Travel Costs
Program Supplies
Fiscal & Audits
Training
Subtotal $43,858
Facility Costs
Rent
Utilities
Maintenance
Security
Landscaping
Minor Facility Improvements
Subtotal $13,102
Indirect Costs
Indirect Costs
Subtotal $26,625
Total $369,065
Exhibit D
Page 1 of 25
Exhibit D
Page 2 of 25
Exhibit D
Page 3 of 25
Exhibit D
Page 4 of 25
Exhibit D
Page 5 of 25
Exhibit D
Page 6 of 25
Exhibit D
Page 7 of 25
Exhibit D
Page 8 of 25
Exhibit D
Page 9 of 25
Exhibit D
Page 10 of 25
Exhibit D
Page 11 of 25
Exhibit D
Page 12 of 25
Exhibit D
Page 13 of 25
Exhibit D
Page 14 of 25
Exhibit D
Page 15 of 25
Exhibit D
Page 16 of 25
Exhibit D
Page 17 of 25
Exhibit D
Page 18 of 25
Exhibit D
Page 19 of 25
Exhibit D
Page 20 of 25
Exhibit D
Page 21 of 25
Exhibit D
Page 22 of 25
Exhibit D
Page 23 of 25
Exhibit D
Page 24 of 25
Exhibit D
Page 25 of 25
Exhibit E
Page 1 of 25
Exhibit E
Page 2 of 25
Exhibit E
Page 3 of 25
Exhibit E
Page 4 of 25
Exhibit E
Page 5 of 25
Exhibit E
Page 6 of 25
Exhibit E
Page 7 of 25
Exhibit E
Page 8 of 25
Exhibit E
Page 9 of 25
Exhibit E
Page 10 of 25
Exhibit E
Page 11 of 25
Exhibit E
Page 12 of 25
Exhibit E
Page 13 of 25
Exhibit E
Page 14 of 25
Exhibit E
Page 15 of 25
Exhibit E
Page 16 of 25
Exhibit E
Page 17 of 25
Exhibit E
Page 18 of 25
Exhibit E
Page 19 of 25
Exhibit E
Page 20 of 25
Exhibit E
Page 21 of 25
Exhibit E
Page 22 of 25
Exhibit E
Page 23 of 25
Exhibit E
Page 24 of 25
Exhibit E
Page 25 of 25
Exhibit F
Page 1 of 2
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as “County”),
members of a contractor’s board of directors (hereinafter referred to as “County Contractor”),
must disclose any self-dealing transactions that they are a party to while providing goods,
performing services, or both for the County. A self-dealing transaction is defined below:
“A self-dealing transaction means a transaction to which the corporation is a party and in
which one or more of its directors has a material financial interest”
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member’s name, job title (if applicable), and date this disclosure is being
made.
(2) Enter the board member’s company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to
the County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the
transaction; and
b. The nature of the material financial interest in the Corporation’s transaction that
the board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing
transaction described in Sections (3) and (4).
Exhibit F
Page 2 of 2
(1) Company Board Member Information:
Name:Date:
Job
Title:
(2) Company/Agency Name and Address:
(3) Disclosure (Please describe the nature of the self-dealing transaction you are a party to):
(4) Explain why this self-dealing transaction is consistent with the requirements of Corporations
Code 5233 (a):
(5) Authorized Signature
Signature:Date: