HomeMy WebLinkAboutP-20-249 Amend 1 - Pacific Forensic Psychology Associates.pdfCounty of Fresno
INTERNAL SERVICES DEPARTM ENT
ROBERT BASH, DIRECTOR - CIO
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AMENDMENT NUMBER ONE (1)
Agreement Number: P -20-249
December 1,8,2020
Pacific Forensic Psychology Associates
DBA Sharper Future
911 E. Shields Ave
Fresno, CA 93704
Contract Number P-20-249 covering employability-related mental health assessment services for
General Relief applicants and recipients is amended as follows:
The contract with your company expires December 31,2020. The County of Fresno desires to extend
this contract for an additional six (6) months effective January 1 ,2021 through June 30, 2021 . Prices will
be firm for the contract period. Amendment provisions shall remain in full force and effect with any
contract renewals.
Maximum: ln no event shall services performed and/or fees paid under this Agreement be in excess of
One Hundred Twenty Thousand Four Hundred Fifty Dollars ($120,450.00).
Please acknowledge your acceptance by returning all pages of this letter to my office via email or USPS.
lf you have any questions, please contact Bryan Hernandez, Purchasing Analyst, at (559) 600-71 10 or
email bhernandez@fresnocountvca. gov.
FOR THE COUNTY OF FRESNO
Gary E. Cornuelle
Purchasing Manager
333 W. Pontiac Way
Clovis, CA 93612
GEC:BH
G:\PUBLIC\CONTRACTS & EXTRACTS\2020 CONTRACTS\20.249 GR MENTAL HEALTH ASSESSI\4ENT SERVICES\CONTRACTS &
AIV]ENDMENTS\P-20-249 AMEND 1 - PACIFIC FORENSIC PSYCHOLOGY ASSOCIATES,DOCX
333 W. Pontiac Way, Clovis, CA 93612 / (559) 600-71L0
" The County of Fresno is an Equal Employment Opportunity Employer *
GoNTRACT NO. P-20-249
Pacific Forensic Psychology Associates
DBA Sharper Future
December 18,2020
Page 2
CONTRACTOR TO COMPLETE:
company: Qit , fr.,nsi. ?c*.h-l-hr, Dss,r,oIrs OS* Shr.p,r FJrre
Type ot Entrty:
E lndividual E Limiteo Liabitity Company
I Sole Proprietorship I Limited Liability Parlnership
$Corporation I General Partnership
Signature
(\2,,b..*Lu"l.ss c?c,\zl e>l> o
Print Name and Title Date
/ ?z3o SaNa zt,4 //c,-:Y srz Zoa SanLa m4 e4- ?r(7/ffi
7o7-J?r<s-ao /' Et.catn-
Signature
Telepriolre NuMgeR FRx NuMeeR E-unt Aooness
ACCOUNTING USE ONLY
ORG No.:561 06645
Account No.: 7870
RequisitionNo.: 5612100593
(1t2020)
G:\PUBLIC\CONTMCTS & EXTMCTSBO2O CONTRACTSUO-24g GR MENTAL HEALTH ASSESSMENT
SERVICES\CONTMCTS & AMENDMENTS\P-20-249 AMEND 1 - PACIFIC FORENSIC PSYCHOLOGY
ASSOCIATES.DOCX
Print Name and Title
GoNTRACT NO. P-20-249
Pacific Forensic Psychology Associates
DBA Sharper Future
December 18,2020
ORGANIZATION:
ADDRESS:
TELEPHONE:
CONTACT:
EMAIL:
MAX COMPENSATION:
TERM:
CONTRACT:
Page 3
Revised Attachment "A"
SUMMARY OF SERVICES
Pacific Forensic Psychology Associates dba Sharper Future
911 E. Shields Ave, Fresno, CA 93704
(310) 696-9019
Joshua Craig, Psy.D.
JCraiq@SharperF uture. com
$120,450
July 1 ,2020 to December 31,2020
January 1,2021 to June 30,2021 (optional)
General Relief Mental Health Assessments
OVERVIEW OF SERVICES
Sharper Future (CONTRACTOR) shall provide employability-related mental health
assessment services for General Relief applicants and recipients referred by the
COUNTY's Department of Social Services (DSS). The assessment shall determine
whether the referred client has a mental health condition that prevents or limits the client's
ability to engage in work or employment training. CONTACTOR shall document the
assessment results on the DSS GR 8085 form (Exhibit B)and, if the client signs a release
of information, securely transmit the form to DSS.
CONTRACTOR SHALL BE RESPONSIBLE FOR THE FOLLOWING
A. Designate staff with an active registration or license from the California Board of
Behavioral Sciences or the California Board of Psychology to provide the services under
this agreement. At all times, staff shall act within the policies, rules, and regulations of
state and local statutes relating to mental health services. ln the event there are staffing
changes, CONTRACTOR shall inform DSS in writing within seven days.
B. Assess each referred client for a mental health condition that prevents or limits the client's
ability to engage in work or employment training. Document the results of the assessment
on the GR 8085 form and retain a copy to document the service. The GR 8085 form may
be updated from time to time, and CONTRACTOR is required to use the most recent
version as provided by DSS.
C. Provide a release of information to each assessed client and inform the client of their right
to decline to sign the release. lf the release is signed, securely transmit an electronic copy
of the GR 8085 to DSS within one week. lf the release is not signed, give the client their
GR 8085 form and inform the client of the need to return the completed for to DSS within
the timeframe required by DSS.
G:\PUBLIC\CONTMCTS & EXTMCTS\2020 CONTRACTS\20-249 GR MENTAL HEALTH ASSESSMENT
SERVICES\CONTRACTS & AMENDMENTS\P-20-249 AMEND 1 - PACIFIC FORENSIC PSYCHOLOGY
ASSOCIATES.DOCX
GoNTRACT NO. P-20-249
Pacific Forensic Psychology Associates
DBA Sharper Future
December 18,2020
Page 4
D. Refer assessed clients with severe mental illness to the Department of Behavioral Health
Urgent Care Wellness Center for additional services. Refer clients with mild to moderate
mental illness to service providers participating in the Fresno County Mental Health Plan
(https://www.co.fresno.ca.us/departments/behavioral-health/managed-care/provider-directory).
E. Provide clients with limited English proficiency with interpreting and translation services
d uring contracted services.
F. Work with DSS to collect and report anonymous data on the referred population.
G. Document services provided in sufficient detail to substantiate invoices and summarize
services provided on a monthly activity report, by the tenth of the month following the
service month.
H. Meet with DSS as often as needed for service coordination, problem/issue resolution,
information sharing, and review and monitoring of project services and fiscal reports.
DSS SHALL BE RESPONSIBLE FOR THE FOLLOWING
A. Refer General Relief applicants and recipients self-attesting a mental health disability to
CONTRACTOR, provide clients with a copy of the GR 8085 from to take to their
assessment, and notify CONTRACTOR of any non-English speaking applicants.
B. Meet with CONTRACTOR as often as needed for service coordination, problem/issue
resolution, information sharing, and review and monitoring of project services and fiscal
reports.
FEE FOR SERVICES
Cost per assessment determining whether the referred client has a mental health
condition that prevents or limits the client's ability to engage in work or employment
training: $109.50
The price is inclusive of language access services and is payable whether or not the client
signs a release of information.
G:\PUBLIC\CONTRACTS & EXTMCTS\2020 CONTRACTS\20-249 GR MENTAL HEALTH ASSESSMENT
SERVICES\CONTMCTS & AMENDMENTS\P.20-249 AMEND 1 - PACIFIC FORENSIC PSYCHOLOGY
ASSOCIATES.DOCX
SIGNATURE REQUIREMENTS FOR A CORPORATION UNDER CALIFORNIA LAW
lf your company is a Corporation, the following options apply as to who must sign the
Agreement to clearly bind your corporation to this Agreement:
o Two otficers of your corporation:
1. One officer must be either President, Chairman of the Board or any vice-
president;
2. The other officer must be either Secretary, Chief Financial Officer or
Treasurer (or assistant Treasurer);
or,
. One person who holds corporate offices in each of the above-mentioned
categories;
OT,
. A statement from your corporation's legal counsel that the signatory (or
signatories) has legal authority to bind your corporation;
or,
o Proof that the governing board of your corporation has either (1) ratified this
specific Agreement and authorized xxxxxx (name of person) to execute the
Agreement on behalf of your corporation, or (2) authorized xxxxxxx to execute
contracts/leases on behalf of your corporation.
G:\Public\Electronic Signature lnstructionsvendor Signature Requirements and Electronjc Signature lnstruciions