1

COUNTY OF NEVADA
STATE OF CALIFORNIA BOARD OF SUPERVISORS
Nate Beason, 1
st
District 950 Maidu Avenue
Ed Scofield, 2
nd
District Nevada City, CA 95959-8617
Terry Lamphier, 3
rd
District Phone: (530) 265-1480
Wm. “Hank” Weston, 4
th
District (Vice Chair) Fax: (530) 265-9836
Ted S. Owens, 5
th
District (Chair) E-Mail: bdofsupervisors@co.nevada.ca.us

******
Donna Landi, Clerk of the Board Post Comments on this Agenda and
Richard A. Haffey, County Executive Officer View Live Web Streaming of Board Meetings:
Alison Barratt-Green, County Counsel http://nevco.granicus.com/ViewPublisher.php?view_id=3


AGENDA
for a Regular Meeting of the Board of Supervisors,
Tuesday, October 9, 2012, at 9:00 a.m., in the Board Chambers,
First Floor, Eric Rood Administrative Center,
950 Maidu Avenue, Nevada City, California

This meeting is being broadcast live on NCTV Channel 17,
in the Western County
and Truckee-Tahoe Community TV (TTCTV) Channel 24

Video Conferencing at 11:45 a.m. for Public Comment
from the Board of Supervisors Chambers to the
Truckee Town Council Front Conference Room, 2nd Floor
10183 Truckee Airport Road, Truckee, California

The Board of Supervisors welcomes you to its special meeting. Your interest is encouraged and
appreciated.
ANY MEMBER OF THE AUDIENCE DESIRING TO ADDRESS THE BOARD ON A MATTER
ON THE AGENDA: Please approach the rostrum and, after receiving recognition from the Chair,
give your name and comments or questions as all meetings are recorded. In order that all interested
parties have an opportunity to speak, please limit your comments to the specific item under discussion.
Time limitations are explained on the last page of the agenda.
The meeting room is accessible to people with disabilities. Anyone requiring reasonable
accommodation to participate in the meeting should contact the Clerk of the Board’s office by calling
(530) 265-1480 at least four days prior to the meeting. TTY/Speech-to-Speech users may dial 7-1-1 for
the California Relay Service.
The agenda and all supporting documents are available for review during regular business hours at
the Clerk of the Board office, 950 Maidu Avenue, 2
nd
Floor, Suite 200, Nevada City, California. The
agenda and certain supporting documents may be obtained on the Clerk of the Board’s website at
http://www.mynevadacounty.com/nc/bos/cob. Please note that the on-line agenda may not include all
related or updated documents.
Proposed actions and supporting documents are considered draft until acted upon by the Board. All
items listed on the agenda may be acted upon by the Board of Supervisors.
*************************************************************
(10/09/2012) 2

REGULAR MEETING: 9:00 A.M.

STANDING ORDERS:

Call the meeting to order.

Pledge of Allegiance.

Corrections and/or deletions to agenda.

SCHEDULED ITEMS: 9:02 A.M.

1. Certificate of Recognition of Ron Nelson, General Manager, Nevada Irrigation District
(NID). (Supervisor Beason)

2. Certificate of Recognition of the 150
th
Anniversary of the North San Juan Fire Department.
(Supervisor Weston)

3. Resolution proclaiming the month of October 2012 as “United Way of Nevada County
Campaign Kick-off Month” in Nevada County. (Gayle Satchwell, Human Resources
Director) (Supporting Document)

CONSENT CALENDAR:
These items are expected to be routine and noncontroversial. The Board of Supervisors will act upon
them at one time without discussion. Any Board member, staff member or interested party may request
that an item be removed from the consent calendar for discussion.

Health and Human Services Director: Jeffrey Brown
4. Resolution approving submission and authorizing execution of the 2012 Final Grant
Application SF-424 to the U.S. Department of Agriculture (USDA), Rural Development,
Section 533 Housing Preservation Grant (HPG) Program to provide grants to low-income
households in the unincorporated areas of Nevada County to assist with needed housing
repair and rehabilitation, in the amount of $85,000, and authorizing the Health and Human
Services Agency Director, or designee, to sign all other documents required for participation
in the USDA HPG Program. (Supporting Document)

5. Resolution approving and authorizing execution of the 2012 Agreement with the U.S.
Department of Agriculture (USDA), Rural Development, Section 533 Housing Preservation
Grant (HPG) for repair or rehabilitation of homes for eligible residents, in the maximum
amount of $85,000, for the period September 30, 2012 through September 30, 2013.
(Supporting Document)

6. Resolution authorizing and directing the Auditor-Controller to amend the Fiscal Year 2012/13
Housing budget for the U.S. Department of Agriculture (USDA), Rural Development, Section
533 Housing Preservation Grant (HPG) Program to reflect an increase in revenue and expense
related to this Program, in the amount of $85,000. (4/5 affirmative vote required.)
(Supporting Document)

7. Resolution authorizing execution of an amendment to the 2011 U.S. Department of
Agriculture (USDA), Rural Development, Housing Preservation Grant (HPG) Agreement
(Res. 11-486), extending the ending date of the agreement from September 3 0, 2012 to June
30, 2013, to allow the remaining amount of $49,693 to be utilized by the Housing
Rehabilitation Program for necessary health and safety repairs for low income and very low
income households. (Supporting Document)


(10/09/2012) 3

Director of Behavioral Health: Michael Heggarty
8. Resolution authorizing execution of contract with Galen Ellis, dba El-Askari Consulting for
Columbia Teen Screen services through Mental Health Services Act (MHSA) Prevention
and Early Intervention (PEI) funding for establishment of a project team that will coordinate
efforts to offer program screening to students in participating Nevada County Schools that
can help link students identified as high-risk to needed services, in the maximum amount of
$185,000, for the period October 9, 2012 through September 30, 2014, with funds in the
amount of $98,300 to be encumbered for Fiscal Year 2012/13. (Supporting Document)

Public Health Officer: Dr. Karen Milman
9. Resolution approving and authorizing the Public Health Director to execute Grant
Agreement 12-10188 with the California Department of Public Health for funding
Supplemental Nutrition Assistance Program Education (SNAP-Ed) services for the County’s
Nutrition Education and Obesity Prevention (NEOP) Project to assist eligible consumers to
adopt healthy eating and physical activities to prevent obesity and develop healthy lifestyles,
in the maximum amount of $800,000, for the period October 1, 2012 through September 30,
2016. (Supporting Document)

10. Resolution authorizing execution of an agreement with Tahoe Truckee Community
Foundation (TTCF) pertaining to reimbursing the County’s Public Health Department for the
services of a Health Education Specialist for coordinating Project services related to the
Tahoe Truckee Future Without Drug Dependency (TTFWDD) Project, in the maximum
payable amount of $27,012.96, for the period October 1, 2012 through September 30, 2013.
(Supporting Document)

11. Resolution authorizing execution of contract with Lynne Lacroix to provide Project
Coordination Services related to continuation of development and implementation of the
County’s Nutrition Education and Obesity Prevention (NEOP) Program, in the maximum
amount of $85,000, for the period October 1, 2012 through September 30, 2013.
(Supporting Document)

12. Resolution authorizing execution of contract with Cynthia Schuetz to provide
communication and health outreach consultant services for the County’s Nutrition Education
and Obesity Prevention (NEOP) Program, in the maximum amount of $20,700, for the
period October 1, 2012 through September 30, 2013. (Supporting Document)

13. Resolution authorizing execution of contract with Elizabeth Matson to provide evaluation
consultant services related to the County’s Nutrition Education and Obesity Prevention
(NEOP) Program, in the maximum amount of $15,000, for the period October 1, 2012
through September 30, 2013. (Supporting Document)

Sheriff-Coroner: Keith Royal
14. Resolution authorizing execution of Project Agreement G11-03-16-L01 with the State of
California, Department of Parks and Recreation, for operations and maintenance, restoration,
law enforcement, and education and safety for Off-Highway Vehicle (OHV) recreation, in
the amount of $27,637, with the provision that a minimum of 25% in matching funds will be
provided as represented by staff time, equipment expenses and administrative costs, for the
period July 8, 2012 through July 7, 2013. (Supporting Document)


(10/09/2012) 4

Environmental Health Director: Wesley Nicks
15. Resolution accepting the grant award and authorizing the Director of Environmental Health
to execute Agreement EA23-12-30 with the California Department of Resources Recycling
and Recovery (CalRecycle) for the Local Enforcement Agency (LEA) Grant Program to
support solid waste facilities permit, inspection and enforcement programs, in the amount of
$17,460, for the period July 1, 2012 through October 28, 2013. (Supporting Document)

Director of Public Works: Steven Castleberry
16. Resolution approving Summary Vacation of utility easements on Lots 43 and 44 of Alta
Sierra Estates – Five, as shown on the map recorded in Book 2 of Subdivisions at page 46
(Assessor’s Parcel Numbers 20-560-10 and 20-560-11), declaring that from and after the
date that this Resolution is recorded, the subject easement no longer constitutes a legal
encumbrance, and directing the Clerk of the Board of Supervisors to record the Resolution of
Summary Vacation. (Dist. II) (Supporting Document)

17. Resolution authorizing execution of contract with Top Dog Timber, Inc. for snow removal,
road sanding, and snow pack removal for the Glenshire Drive, Hirschdale and Boca Roads
area of Eastern Nevada County, in the maximum amount of $40,698, for the period
November 1, 2012 through June 30, 2013. (Dist. V) (Supporting Document)

18. Resolution authorizing execution of contract with Al Pombo, Inc. for snow removal, road
sanding, and snow pack removal for the Hobart Mills-Russell Valley area of Eastern Nevada
County, in the maximum amount of $27,540, for the period November 1, 2012 through June
30, 2013. (Dist. V) (Supporting Document)

19. Resolution authorizing execution of contract with Sugar Bowl Corporation for snow
removal, road sanding, and snow pack removal for the Soda Springs area of Eastern Nevada
County, in the maximum amount of $173,400, for the period November 1, 2012 through
June 30, 2013. (Dist. V) (Supporting Document)

20. Resolution approving the appointment of the County of Nevada Transit Services Manager as
Director and the County of Nevada Risk Manager as Alternate Director to the California
Transit Systems Joint Powers Authority (CalTIP) Board of Directors for purposes of
obtaining vehicle liability coverage and risk management services through jointly pooling
resources with other public entity transit agencies. (Transit Services) (Supporting Document)

21. Resolution awarding bid and authorizing execution of contract with Deschaine Enterprises for
the Transit Bus Shelter 2012 Project – Contract No. 889814 (Res. 12-377), in the amount of
$17,900 plus a ten percent contingency, for a total encumbrance amount of $19,690. (Dist. II)
(Supporting Document)

22. Resolution authorizing execution of Amendment 8 to contract with Gold Country Telecare,
Inc. (Res. 07-134) for the provision of specialized paratransit services in Western Nevada
County, increasing the current Gold Country Telecare hourly service rate from $44.88 to
$45.66, effective July 1, 2012 through June 30, 2013. (Transit Services)
(Supporting Document)

Human Resources Director: Gayle Satchwell
23. Resolution authorizing execution of a renewal agreement for participation in the California
State Association of Counties – Excess Insurance Authority (CSAC – EIA) Memorandum of
Understanding (MOU) for the administration of a dental program for County employees
through Delta Dental of California, setting the administrative fee payable to CSAC-EIA at
$6.11 per employee per month, for the period January 1, 2013 through December 31, 2013.
(Supporting Document)


(10/09/2012) 5

Child Support Services Director: Tex Ritter
24. Resolution approving the Plan of Cooperation between the California Department of Child
Support Services and the Sierra Nevada Regional Department of Child Support Services to
reflect the program responsibilities of both agencies, for the period October 1, 2012 through
September 30, 2014, and authorizing the Director of the Sierra Nevada Regional Department
of Child Support Services to execute the Plan. (Supporting Document)

Chief Information Officer: Stephen Monaghan
25. Resolution authorizing release of International Fidelity Insurance Company Performance
Bond 0446279, in the amount of $50,000, provided by Cequel III Communications I, LLC
dba Suddenlink Communications, for construction of the Institutional Network as authorized
by Resolution 06-324. (Supporting Document)

26. Resolution awarding bid and authorizing execution of contract with David Pfadt dba
Precision Electric for the Truckee Joseph Center Generator Retrofit Project (Res. 12-380)
located at 10075 Levon Avenue, Truckee, in the amount of $24,250 plus a ten percent
contingency of $2,425, for a total encumbrance of $26,675. (Dist. V) (Supporting Document)

County Librarian: Jessica Hudson
27. Resolution formally accepting the donation of Charles W. Mosser’s published books and
music from the Charles W. Mosser 2007 Trust, and formally accepting the $575,000
charitable donation to the County of Nevada from the Charles W. Mosser 2007 Trust for the
Grass Valley Library for use by it in building an addition, wing, room or other facility
expansion as the County deems appropriate and that a room therein be named in honor of
Charles W. Mosser and dedicated in part to his published books and music, directing the
Auditor-Controller to deposit said donation and any interest accruing thereon into the Library
Fund, restricting fund balance in the Library Fund in an amount equal to the donation and
accrued interest, and further directing that the restricted funds may only be released with
approval of the Board of Supervisors. (Supporting Document)

County Executive Officer: Richard Haffey
28. Resolution authorizing execution of Amendment 1 to contract with Conflict Resolution
Center of Nevada County (Res. 12-290) to provide dispute resolution services to the citizens
of Nevada County, revising the contract payment dates to July 1, 2012, October 1, 2012,
January 1, 2013 and April 1, 2013. (Supporting Document)

29. Resolution authorizing execution of First Amendment to the Ground Lease with Sierra
Mountain Aviation, Inc. (Res. 07-533) for operation of an aircraft maintenance facility on
Ramp 5 at the Nevada County Airport, extending the lease for the second five-year term, and
establishing a new ground lease rate of $0.266 per square foot per month, effective October
1, 2012. (Airport Manager) (Supporting Document) (Supporting Document)

30. Resolution approving and authorizing execution of the Lease Assignment of two ground
leases for development, construction and operation of hangars on Lot 4A (Res. 03-337) and
Lot 4B (Res. 04-154) at the Nevada County Airport from Mark Machado to the Nevada
County Executive Hangar Owners. (Airport Manager) (Supporting Document)

31. Resolution approving and authorizing execution of the First Amendment to a Ground Lease
with James and Mary Booth (Res. 00-452) for construction and operation of an aircraft
storage hangar on an undeveloped pad area at the Nevada County Airport, establishing a new
ground lease rate of $0.04 per square foot per month, deleting Georgetown and adding
Jackson to the list of airports to be used for future prevailing rate assessments, clarifying
language concerning averaging of the lease rates, and amending the term of the lease to
commence July 10, 2001 until July 9, 2041 unless terminated earlier. (Airport Manager)
(Supporting Document)

(10/09/2012) 6

Clerk of the Board: Donna Landi
32. Resolution proclaiming Saturday, October 13 as “Power Up NCTV Day” in Nevada County.
(Supporting Document)

33. Reappointment of Ms. Sarah Hall Deardorff as Adult and Family Services Commission
representative to the Area 4 Agency on Aging Advisory Council. (Supporting Document)

34. Acceptance of Board of Supervisors minutes for September 14 and 18, 2012.

SCHEDULED ITEM: 9:15 A.M.

35. Regular meeting of the Board of Directors of the Nevada County Sanitation District No. 1.

Call meeting to Order.

a. Consent: These items are expected to be routine and noncontroversial. The Board of
Directors of the Nevada County Sanitation District No. 1 will act upon them at one time
without discussion. Any Board member, staff member, or interested party may request that
an item be removed from the consent calendar for discussion.

1. Resolution authorizing execution of contract with H&R Plumbing and Drain Cleaning
to provide manhole rehabilitation and repair and collection systems repair at Lake of
the Pines, Cascade Shores, Higgins Village, and other sewer zones as needed, in the
maximum amount of $33,800, for the period October 10, 2012 through June 30, 2013.
(Supporting Document)

2. Resolution authorizing execution of contract with West Yost and Associates to
provide on-call Sanitation District engineering support services for Lake Wildwood,
Lake of the Pines, Penn Valley and Cascade Shores Wastewater Treatment Facilities,
and other zones as needed for Nevada County Sanitation District No. 1, for a total
contract amount not to exceed $70,000, for the period October 16, 2012 through June
30, 2013. (Supporting Document)

3. Resolution authorizing the purchase of a laboratory flask-scrubber/glassware washer
from Microtech Scientific, to save labor and meet the requirements of cleanliness of
glassware used in laboratory analysis for Nevada County Sanitation District No.1, in
the amount of $10,460.82, and directing the Auditor-Controller to amend the Fiscal
Year 2012/13 budget. (4/5 affirmative vote required.) (Supporting Document)

4. Resolution rescinding Resolution SD12-08, and dedicating net revenues from the Zone
6, Penn Valley fund to payment of any and all Clean Water State Revolving Fund
and/or Water Recycling Funding Program financing for connecting the Penn Valley
Sewer System to the Lake Wildwood Wastewater Treatment Plant Improvement
Project. This dedicated source of net revenues shall remain in effect throughout the
term of such financing unless modification or change of such dedication is approved in
writing by the State Water Resources Control Board. (Dist. IV)
(Supporting Document)

5. Acceptance of Nevada County Sanitation District No. 1 minutes for June 12 and July
10, 2012. (Clerk of the Board)

b. Public comment. (Members of the public shall be allowed to address the Board on items not
appearing on the agenda that are of interest to the public and are within the subject matter
jurisdiction of the Board.)

Adjournment.

(10/09/2012) 7

DEPARTMENT HEAD MATTERS:

County Counsel: Alison Barratt-Green
36. (Waive Further Reading/Adoption) An Ordinance amending Section L-II 5.23 of the Land
Use and Development Code to allow Sheriff to issue administrative citations.
(Supporting Document)

Sheriff-Coroner: Keith Royal
37. Resolution authorizing execution of an agreement between the County of Nevada, the City of
Grass Valley, the Town of Truckee, and the City of Nevada City Police Departments for the
Sheriff’s office to provide public safety dispatch services to the three police departments by
consolidating the Truckee Dispatch Center and the Grass Valley Dispatch Center into the
existing Sheriff’s office Dispatch Center in Nevada City, for the period November 1, 2012
through June 30, 2018, for a total contract amount of $562,741 through fiscal year ending
June 30, 2013, with subsequent contract year’s adjusted annually to reflect each agency’s
allocated percentage based on the total cost to provide services. (Supporting Document)

Clerk of the Board: Donna Landi
38. Election of a Supervisor to the California State Association of Counties (CSAC) Board of
Directors for the 2012/13 Association Year beginning November 27, 2012.
(Supporting Document)

INDIVIDUAL BOARD MEMBER ITEM:

39. Review Memorandum of Agreement (MOU) and designate individual to be named in the
proposed Resolution. (Supervisors Beason and Owens) (Supporting Document)

Resolution adopting the tenets provided by the Memorandum of Agreement (MOU) between
the Regional Council of Rural Counties (RCRC), the California State Association of Counties
(CSAC), the Bureau of Land Management (BLM), and the U.S. Forest Service (USFS), for
utilization by Nevada County to improve and enhance working relationships with USFS and
BLM, and designating [individual, title, or position] as the point of contact between Nevada
County and the Tahoe National Forest and the Mother Lode field office of BLM.

SCHEDULED ITEM: 11:15 P.M. Jeffrey Brown, Health and Human Services Agency Director

40. Public hearing in order to accept public comment on the final product of the Community
Development Block Grant Program No. 09-PTAE-6306, entitled Economic Development
Over-the Counter (OTC) Application. (Supporting Document)

Resolution accepting public comment on the Community Development Block Grant
(CDBG), Economic Development, Planning and Technical Assistance Grant No. 09-PTAE-
6306 entitled “Economic Development Over-the-Counter (OTC) Application Preparation” to
support business loan development activities, and directing said comments to be submitted to
the State CDBG Program for final approval of this grant, in the amount of $35,000.

SCHEDULED ITEM: 11:30 P.M.

41. Nevada County 4-H All Stars 2012 Annual Activities Report. (All Star Advisors Ms. Cindy
McIntosh and Ms. Colleen McClain)


(10/09/2012) 8

*ANNOUNCEMENTS:
Pursuant to Government Code Section 54954.2, Board members and County Executive Officer may
make a brief announcement or brief report on his or her activities. Board members and County
Executive Officer may also provide a reference to staff or other resources for factual information,
request staff to report back to the Board at a subsequent meeting concerning any matter, or take
action to direct staff to place a matter of business on a future agenda.

*CLOSED SESSIONS:

Pursuant to Government Code Section 54956.8, the Board of Supervisors desires to hold a
closed session regarding real property negotiations. The negotiators are Steven Castleberry,
Public Works Director for the County of Nevada, and John Spencer, representative of
property owner, VLC Properties, LLC. Items under negotiation concern the price and terms
of payment for the property and the property interest to be obtained. The location of the
subject property is: 10911 Wolf Road, Grass Valley, California 95949, Assessor’s Parcel
Number (APN) 09-690-04.

Pursuant to Government Code Section 54957.6, a closed session of the Board of Supervisors
will be held for the purpose of reviewing its position and instructing its designated labor
negotiations representatives. The designated labor negotiations representatives for Nevada
County are: Alison Lehman, Assistant County Executive Officer, and Gayle Satchwell,
Human Resources Director. The labor negotiations concern the following bargaining units;
General Unit and Professional Unit both represented by Local 39.

Pursuant to Government Code Section 54956.9(b), County Counsel is requesting a closed
session with the Board of Supervisors to discuss one matter in which there is significant
exposure to litigation against the County.

PUBLIC COMMENT: 11:45 A.M.

(Members of the public shall be allowed to address the board on items not appearing on the agenda that
are of interest to the public and are within the subject matter jurisdiction of the Board.)

ADJOURNMENT:

*(The Board of Supervisors can discuss these items at any time during the meeting.)

















This agenda was posted on bulletin boards 24 hours in advance of the meeting at the following
locations: 1. Eric Rood Administrative Center; outside Board office, outside Board Chambers, and
outside 10/4/12.
COUNTY OF NEVADA
DEPARTMENT OF PERSONNEL/HUMAN RESOURCES
Eric Rood Administrative Center
950 Maidu Avenue
Nevada City , CA 95959
(530) 265-7010
September 27, 2012
Honorable Board of Supervisors
Eric Rood Administrative Center
950 Maidu Avenue
Nevada City , CA 95959
DATE OF MEETING: October 9, 2012
SUBJECT: Resolution Proclaiming th e Month of October, 2012 As United Way of Nevada
County Campaig n Kick-off Month in Nevada County
RECOMMENDATION: Approve th e Resolution.
FUNDING: N/A
BACKGROUND: United Way of Nevada County partners w ith several ag encies in th e
community to provide a variety of services w h ich support and streng th en families and w h ich
reach a w ide spectrum of th ose in need w ith in our community . Th e County of Nevada w ish es to
support th e mission of United Way by naming th e month of October, 2012, as th e campaig n
kick-off m th for th e County . During th is month , various efforts are put forth by employ ees
w h ich g ae, support for United Way and h elp reach our g oal.
Resp ctf y submi d
~~
Director of Human Resources
RESOLUTION No.
OF THE BOARD OF SUPERVISORS OF THE COUNTY OF NEVADA
RESOLUTION PROCLAIMING THE MONTH OF OCTOBER, 2012
AS UNITED WAY OF NEVADA COUNTY CAMPAIGN KICK-OFF
MONTH IN NEVADA COUNTY
WHEREAS, United Way of Nevada County is c el eb r ating its 3 0th year in th e c ommunity
and its mis s ion is to impr ove l ives b y dir ec ting c ommunity r es our c es to c ommunity needs ; and
WHEREAS, it b r ing s tog eth er 20 par tner ag enc ies to pr ovide s er vic es th at addr es s a b r oad
r ang e of is s ues , inc l uding educ ation, inc ome and h eal th , and makes c ontr ib utions th at ar e foc us ed
in a mor e c ol l ab or ative fas h ion; and
WHEREAS, th e var ious ag enc ies of United Way h el p c h il dr en and adul ts ac h ieve th eir
potential th r oug h educ ation and mentor ing pr og r ams , h el p famil ies and s enior s b ec ome
financ ial l y s tab l e and independent b y s uppor ting b as ic needs , and impr ove pub l ic h eal th b y
inc r eas ing ac c es s to c r itic al h eal th c ar e s er vic es and r educ ing s ub s tanc e ab us e, c h il d ab us e and
domes tic viol enc e; and
WHEREAS, th e 2012 c ampaig n g oal is to exc eed $3 00,000; and
WHEREAS, United Way of Nevada County 2012 c ampaig n motto is "LIVE UNITED"
w ith th e funds s taying and w or king w ith in th e County of Nevada;
NOW, THEREFORE, BE IT HEREBY RESOLVED b y th e Boar d of Super vis or s of th e
County of Nevada, State of Cal ifor nia, th at th e month of Oc tob er , 2012 is pr oc l aimed as th e
United Way of Nevada County Campaig n Kic k-Off Month in Nevada County.
COUNTY OF NEVADA
HEALTH &HUMAN SERVICES AGENCY
950 Maidu Ave. Agency Dir ect o r Telepho ne (530) 265-1627
Nevada Cit y, Calif o r nia 95959 J ef f r ey S. Br o wn, MPH, MSW Fax (530) 265-2295
Depar t ment Dir ect o r s
Michael Heggar t y, MFT, Behavio r al Healt h
Tex Rit t er , J D, Child Suppo r t Ser vices &Co llect io ns
Kar en Milman, MD, MPH, Pub lic Healt h
Kat y Eck er t , MBA, Int er im So cial Ser vices
Sept emb er 20, 2012
Ho no r ab le Bo ar d o f Super vis o r s
Er ic Ro o d Adminis t r at ive Cent er
950 Maidu Avenue
Nevada Cit y, CA 95959
DATE OF MEETING: Oct o b er 9, 2012
SUBJ ECT: Res o lut io n appr o ving s ub mis s io n o f t he 2012 f inal gr ant applicat io n t o t he U.S. Depar t ment o f
Agr icult ur e (USDA), Rur al Develo pment , Sect io n 533, f o r t he Ho us ing Pr es er vat io n Gr ant (HPG) Pr o gr am in
t he maximum amo unt o f $85, 000.
RECOMMENDATION: Ado pt t he at t ached Res o lut io n.
FUNDING: No t Applicab le
BACKGROUND: The Sect io n 533 HPG Pr o gr am is int ended t o pr o vide pub lic agencies wit h f unding t o as s is t
ver y lo w-inco me r ur al ho us eho lds wit h gr ant f unds t o r epair and r ehab ilit at e t heir ho mes . The Co unt y
pr evio us ly r eceived awar ds f r o m t he HPG pr o gr am in 2003, 2004, 2005, 2006, 2007, 2009, 2010, and 2011.
The f o cus o f t he HPG pr o gr am is t o t ar get ver y lo w-inco me ho us eho lds , and as s is t in pr o viding s af e and
s anit ar y living co ndit io ns . Thes e f unds ar e gr ant ed t o ver y lo w-inco me ho meo wner s t o mak e healt h and s af et y
r elat ed r epair s t o t heir ho mes . Such r epair s include new r o o f s , new HVAC s ys t ems , f o undat io n r epair s , and
gener al int er io r r epair s . Gr ant s r ange f r o m $1, 000 t o $20, 000 wit h an es t imat ed aver age gr ant o f $8, 300 per
ho us eho ld. The gr ant is o f t en us ed in co nj unct io n wit h lo an f unds f r o m t he ho us ing r ehab ilit at io n pr o gr am t o
help r elieve t he lo an b ur den o r t o pr o vide r ehab ilit at io n act ivit ies o ut s ide t he maximum lo an amo unt . This
pr o gr am helps pr es er ve Nevada Co unt y's af f o r dab le ho us ing s t o ck and pr o vides a met ho d t o addr es s af f o r dab le
ho us ing. It is ant icipat ed t hat t he 2012 HPG gr ant will s er ve a minimum o f s ix ho us eho lds .
CDA-Ho us ing was s ucces s f ul in s ub mit t ing apr e-applicat io n, as appr o ved per Res o lut io n 12-205, and has b een
invit ed t o s ub mit a f inal gr ant applicat io n. The f inal applicat io n is an amended pr e-applicat io n t o r ef lect a
r educed gr ant amo unt t han was o r iginally applied f o r . Unique t o t he USDA HPG pr o gr am, t he invit at io n b y
USDA-HPG t o s ub mit a f inal gr ant applicat io n is s yno nymo us wit h no t if icat io n t hat t he Co unt y's r eques t f o r
gr ant f unding, t hr o ugh t he pr e-applicat io n, has b een appr o ved b y USDA. Co ns equent ly, t he f inal gr ant
applicat io n as well as t he execut ed gr ant agr eement is t o b e r et ur ned s imult aneo us ly t o USDA. If t he Bo ar d will
no w appr o ve t he s ub mis s io n o f t he HPG f inal gr ant applicat io n, HHSA-Ho us ing will b r ing t he HPG Agr eement
b e f o r e t h i s Bo ar d f o r ap p r o v al and e x e c u t i o n i mme di at e l y f o l l o w i ng t h i s i t e m du r i ng t h e Oc t o b e r 9, 2012 Bo ar d
o f S u p e r v i s o r s me e t i ng .
P l e as e c o nt ac t me i f any addi t i o nal i nf o r mat i o n i s ne e de d.
R e s p e c t f u l l y s u b mi t t e d,
~ ~
Je f r e y . ~ ~ ~ n, T ~ i : ~ c t o r
H e al t h and H u man S e r v i c e s Ag e nc y
RESOLUTION No.
OF THE BOARD OF SUPERVISORS OF THE COUNTY OF NEVADA
K~JOL~~I~I~T L~~Pg'(l~Z''iN~ ~~Ji8 1 '~i~a Sla i~ a ~' i i~~ 2Q~~ i+~NAi, v~il~ i
APPLICATION TO THE U.S. DEPARTMENT OF AGRICULTURE (USDA),
RURAL DEVELOPMENT, SECTION 533, FOR THE HOUSING
PRESERVATION GRANT (HPG) PROGRAM IN THE AMOUNT OF
$8 5,000
WHEREAS, t h e Boa rd of Su p e rvis ors of t h e Cou nt y of Ne va da de s ire s t o c ont inu e t o
imp rove t h e living c ondit ions of it s c it iz e ns t h rou gh s e c u ring gra nt fu nds t o a s s is t w it h ne e de d
h ou s ing re p a ir a nd re h a b ilit a t ion; a nd
WHEREAS, Ne va da Cou nt y Hou s ing w a s s u c c e s s fu l in s u b mit t ing a p re -a p p lic a t ion a nd t h e
Cou nt y h a s b e e n invit e d t o s u b mit a fina l gra nt a p p lic a t ion t o t h e USDA, Se c t ion 533 HPG
Progra m; a nd
WHEREAS, a p u b lic not ic e w a s p u b lis h e d invit ing t h e p u b lic t o re vie w a nd p rovide
c omme nt s on t h e Cou nt y of Ne va da 's USDA, Se c t ion 533 HPG p rop os a l no la t e r t h a n Ju ne 1 1 ,
201 2; a nd
WHEREAS, no p u b lic inp u t w a s re c e ive d t h rou gh t h e p u b lic c omme nt p e riod.
NOW, THEREFORE BE IT RESOLVED b y t h e Boa rd of Su p e rvis ors of t h e Cou nt y of
Ne va da a s follow s :
1 ) Au t h oriz e s t h e s u b mit t a l of a n a p p lic a t ion for t h e Se c t ion 533 HPG fu nds t o t h e USDA,
Ru ra l De ve lop me nt , in t h e a mou nt of $8 5,000 t o p rovide gra nt s t o low-inc ome
h ou s e h olds in t h e u ninc orp ora t e d a re a s of Ne va da Cou nt y.
2) Th e Cou nt y of Ne va da a u t h oriz e s t h e Ch a ir of t h e Boa rd of Su p e rvis ors , t o s ign t h e
USDA, Ru ra l De ve lop me nt , Se c t ion 533 Hou s ing Pre s e rva t ion Gra nt a p p lic a t ion, SF-
424. Th e Cou nt y of Ne va da a u t h oriz e s t h e He a lt h a nd Hu ina n Se rvic e s Dire c t or, or h is
de s igne e , t o s ign a ll ot h e r doc u me nt s re q u ire d b y t h e De p a rt me nt for p a rt ic ip a t ion in
t h e USDA HPG Progra m.
OMB Number: 4040-0004
E x p i ra t i o n D a t e: 01/31/2009
Ap p li ca t i o n fo r Federa l Assi st a n ce SF-424 V ersi o n 02
"1. Typ e o f Submi ssi o n : * 2. Typ e o f Ap p li ca t i o n
" I f R ev i si o n , select a p p ro p ri a t e let t ers)
u P rea p p li ca t i o n ❑New
B. D ecrea se Awa rd
~ Ap p li ca t i o n ~ C o n t i n ua t i o n
* Ot her ( Sp eci fy)
u C ha n ged/C o rrect ed Ap p li ca t i o n ❑Revision
3. D a t e R ecei v ed: 4. Ap p li ca n t I den t i fi er:
~a : Federa l ~n # i t y I den # i ffi er: ~5b. Federa l Awa rd I den t i fi er:
St a t e Use On ly:
6. D a t e R ecei v ed by St a t e: 7. St a t e Ap p li ca t i o n I den t i fi er:
8. AP P LI C ANT I NFOR MATI ON:
"` a . Lega l Na me: C o un t y o f Nev a da
* b. E mp lo yer/Ta x p a yer I den t i fi ca t i o n Number ( E I N/TI N) : * c. Orga n i z a t i o n a l D UNS:
94-6000526 010979029
d. Address:
* St reet 1: 950 Ma i du Av en ue
St reet 2:
"C i t y: Nev a da C i t y
C o un t y: Nev a da
"St a t e: C a li fo rn i a
P ro v i n ce:
"C o un t ry: Un i t ed St a t es
* Z i p /P o st a l C o de 95959
e. Orga n i z a t i o n a l Un i t :
D ep a rt men t Na me: D i v i si o n Na me:
H ea lt h a n d H uma n Serv i ces Agen cy H o usi n g a n d C o mmun i t y Serv i ces
f. Na me a n d co n t a ct i n fo rma t i o n o f p erso n t o be co n t a ct ed o n ma t t ers i n v o lv i n g t hi s a p p li ca t i o n :
P refi x : Ms. * Fi rst Na me: Ma li
Mi ddle Na me:
* La st Na me: E ck
Suffi x :
Ti t le: Admi n i st ra t i v e An a lyst I
Orga n i z a t i o n a l Affi li a t i o n :
` Telep ho n e Number: 530-265-1632 Fa x Number: 530-265-9860
* E ma i l: ma li .dyck@co .n ev a da .ca .us ~.,
OMB Number: 4040- 0004
E x p i ra t i o n D a t e: 01 / 3 1 / 2 009
Ap p li ca t i o n fo r Federa l Assi st a n ce SF- 42 4
V ersi o n 02
' ` 9 . Typ e o f Ap p li ca n t 1 : Select Ap p li ca n t Typ e:
B. Co un t y Go vern men t
Typ e o f Ap p li ca n t 2 : Select Ap p li ca n t Typ e:
Typ e o f Ap p li ca n t 3 : Select Ap p li ca n t Typ e:
"Ot her ( Sp eci fy)
"1 0 Na me o f Federa l Agen cy:
USD A Rura l D evelo p men t , Ho usi n g a n d Co mmun i t y Fa ci li t i es Pro gra m
1 1 . Ca t a lo g o f Federa l D o mest i c Assi st a n ce Number:
1 0. 43 3
CFD A Ti t le:
Rura l Ho usi n g Preserva t i o n Gra n t s
*1 2 Fun di n g Op p o rt un i t y Number:
USD A-RD -HCFP- HPG- 2 01 2
' ` Ti t le:
Rura l Ho usi n g Preserva t i o n Gra n t s
1 3 . Co mp et i t i o n I den t i fi ca t i o n Number:
H PG- 2 01 2
Ti t le:
1 4. Area s Affect ed by Pro ject ( Ci t i es, Co un t i es, St a t es, et c. ) :
Neva da Co un t y w i ll use t he HPG fun ds i n t he un i n co rp o ra t ed a rea s o f Neva da Co un t y.
*1 5. D escri p t i ve Ti t le o f Ap p li ca n t ' s Pro ject :
Lo w a n d very lo w -i n co me si n gle fa mi ly ho me reha bi li t a t i o n gra n t i n t he un i n co rp o ra t ed a rea s o f Neva da Co un t y Ca li fo rn i a
OMB Number: 4040-0004
E x p i ra t i o n D a t e: 01/3ll2009
Ap p li ca t i o n fo r Federa l Assi st a n ce SF-424 V ersi o n 02
16. Co n gressi o n a l D i st ri ct s Of:
" ` a . Ap p li ca n t : CA 004 * b. Pro gra m/Pro j ect : CA 004
17. Pro p o sed Pro j ect :
* a . St a rt D a t e: 10/01/12 * b. E n d D a t e: 09/30/2013
18. E st i ma t ed Fun di n g-( $ ) :
' ` a . Federa l
$ 85,000
" ` u. Aj ~~i i i a i t
" c. St a t e
$ 102,000
* d. Lo ca l
* e. Ot her
` f. Pro gra m In co me
' ` g. TOTAL
$ 187,000
* 19. Is Ap p li ca t i o n Subj ect t o Revi ew By St a t e Un der E x ecut i ve Order 12372 Pro cess?
~ a . Thi s a p p li ca t i o n wa s ma de a va i la ble t o t he St a t e un der t he E x ecut i ve Order 12372 Pro cess fo r revi ew o n 06-06-12
u b. Pro gra m i s subj ect t o E .O. 12372 but ha s n o t been select ed by t he St a t e fo r revi ew.
u c. Pro gra m i s n o t co vered by E . O. 12372
* 20. Is t he Ap p li ca n t D eli n quen t On An y Federa l D ebt ? ( If " Yes" , p ro vi de ex p la n a t i o n .)
u Yes ~ No
21. " By si gn i n g t hi s a p p li ca t i o n , I cert i fy ( 1) t o t he st a t emen t s co n t a i n ed i n t he li st o f cert i fi ca t i o n s* ' ` a n d ( 2) t ha t t he st a t emen t s
herei n a re t rue, co mp let e a n d a ccura t e t o t he best o f my kn o wledge. I a lso p ro vi de t he requi red a ssura n ces" * a n d a gree t o co mp ly
wi t h a n y result i n g t erms i f I a ccep t a n a wa rd. I a m a wa re t ha t a n y fa lse, fi ct i t i o us, o r fra udulen t st a t emen t s o r cla i ms ma y subj ect
me t o cri mi n a l, ci vi l, o r a dmi n i st ra t i ve p en a lt i es. ( U. S. Co de, Ti t le 218, Sect i o n 1001)
~ * ' ' I AGRE E
" The li st o f cert i fi ca t i o n s a n d a ssura n ces, o r a n In t ern et si t e where yo u ma y o bt a i n t hi s li st , i s co n t a i n ed i n t he a n n o un cemen t o r
a gen cy sp eci fi c i n st ruct i o n s
Aut ho ri zed Rep resen t a t i ve:
Prefi x : Mr * Fi rst Na me: Ted
Mi ddle Na me: S.
" La st Na me: Owen s
Suffi x :
* Ti t le: Cha i r, Bo a rd o f Sup ervi so rs, Co un t y o f Neva da
i ei ep ~i ~ri e i J urri o er: ~3u-26~-i 48~ Fa x i J urn ber: 53~-285-9830
* E ma i l: t ed.o wen s@co .n eva da .ca .us
" Si gn a t ure o f Aut ho ri zed Rep resen t a t i ve: ' ` D a t e Si gn ed:
Aut ho ri zed fo r Lo ca l Rep ro duct i o n St a n da rd Fo rm 424 ( Revi sed 10/2005)
Prescri bed by OMB Ci rcula r A-102
i ~ ~
e~
OMB Number. 4040-0004
E x p i ra t i o n l l a t e: 01/31/2009
Ap p l i ca t i o n fo r Federa l Assi st a n ce SF-424 Versi o n 02
'`Ap p l i ca n t Federa l Debt Del i n quen cy E x p l a n a t i o n
The fo l l o w i n g sho ul d co n t a i n a n ex p l a n a t i o n i f t he Ap p l i ca n t o rg a n i z a t i o n i s del i n quen t o f a n y Federa l Debt .
t r a s ~ ~ z u c - n a t ~ s ~ e~ ~ ~ r E ~ ~ - ~ z ~
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~ i g en ~ y { a g en c y ) _ I t eg n i r ed f t em s a z e i d c m r i f i e~ t : a ~ - i t 2 e a u a s t er i s k ~ t b ~ e f o r m s u d s a e s p ec i f i ed . i a t t i e i ~ ~ - t r u ~ et i a n s ~ eY o w . l n : a d c ~ t ~ vn c a t t ~ e ~ x i s t n u t i a n s .
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i f # h i s s u b m i s s i o n i s t , ~ m a n g e w c o r r ec t a p r ~ ev~ u s Cy s u b m i f f ed ~ n i er t h e Ga t a l eg o f F ed er a l a c x n es t i ~ c As z i s t a n c e: r n i m b er a n d
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s el ec t ed _ f ~ " Ql h ~ e" i s s ~ l ~ eb ed . Rka s ~ ~ c ~ y i n i ex k b o x p ~ o vi d ~ ed .
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d i s t r i c t , NG 1 0 3 f a Mo r t h Ga r a l i n a 's 1 4 ~ c f s l r i c t ~
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a s ~ i r t ed . b 1 b e 5 '~ a 6e, i [a ` s t i l e_ a w ~ r es s i c n a l d i s f r i c E s i n N~ l a r y i a n d .
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7 . Ma t e ~ p p l i c a f i a ~ E c l en f i f i er _ LQa ve: t h i s .# i ~ l d b l i n k. TE i s i d en t i ~ i ~ er w ~
b ~ a s s i ~ ed b y t h e St a t e. i F a p ~ l i c a ~ s l e. . en Mr l l S- a l L
I# t h e p r o g r a n t t p r o j ec 4 i s o u t s i d e t h e US, en t er 1 ~ 4- O DD, .
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COUNTY OF NEVADA, HOUSING AND COMMUNITY SERVICES DIVISION
USDA 2009 SECTION 533 HOUSING PRESERVATION GRANT APPLICATION
PURSUANT To 7 CFR PART 1944, SUBPART N, SEC. 1944.674(6).
VERSION: SEPTEMBER 15, 2012
STATEMENT OF ACTIVITIES
(1) A complete d i s cu s s i on of the type of an d con d i ti on s for fi n an ci al as s i s tan ce for hou s i n g
pr es er v ati on , i n clu d i n g whether the r equ es t for as s i s tan ce i s for a homeown er
as s i s tan ce pr ogr am, a r en tal pr oper ty as s i s tan ce pr ogr am, or a cooper ati v e as s i s tan ce
pr ogr am;
If s u cces s fu l i n thi s appli cati on , the Cou n ty wi ll u s e thes e HPG fu n d s to pr omote hou s i n g
pr es er v ati on thr ou gh the Cou n ty's on goi n g Hou s i n g Rehab i li tati on Loan Pr ogr am,
her ei n after (HRLP). The HRLP i s for own er/occu pan t hou s ehold s ear n i n g u p to the low-
i n come thr es hold i n the u n i n cor por ated ar eas of Nev ad a Cou n ty. The low-i n come
thr es hold i s calcu lated on an an n u al b as i s thr ou gh the State of Cali for n i a Hou s i n g Poli cy
Di v i s i on an d i s b as ed on 80% of the Cou n ty med i an i n come, ad j u s ted b y fami ly s i z e.
Cu r r en t fi gu r es allow a fami ly of fou r to ear n u p to $57,300 an d s ti ll b e eli gi b le to the
HRLP. Lan d lor d s r en ti n g to low-i n come hou s ehold s ar e als o eli gi b le for the HRLP, b u t
mu s t s i gn a r en t li mi tati on agr eemen t.
Du e to the hou s i n g d emogr aphi cs i n the Cou n ty an d the competi ti v e n atu r e of the
fu n d i n g s tr eams , the Cou n ty has had to tar get cer tai n Cen s u s Tr acts an d Block Gr ou ps
to b e fu n d ed . Hi s tor i cally, the hou s i n g r ehab i li tati on pr ogr am has b een fu n d ed thr ou gh
the Commu n i ty Dev elopmen t Block Gr an t (CDBG) Pr ogr am, the State of Cali for n i a
Hou s i n g an d Commu n i ty Dev elopmen t CalHome Pr ogr am, an d the USDA HPG
pr ogr am. Loan paymen ts an d total loan payoff fu n d s ar e r etu r n ed to the Cou n ty (called
Pr ogr am In come) an d ar e als o u s ed i n thi s r ehab i li tati on pr ogr am. The Cou n ty has
acqu i r ed a 2006 State CaIHOME gr an t for hou s i n g r ehab i li tati on whi ch expi r es i n Au gu s t
2013.
The maxi mu m loan amou n t i n the HRLP i s $60,000. The loan s ter ms ar e attr acti v e an d
allow flexi b i li ty to meet the n eed s of the cli en ts . The loan ter m i s 3%s i mple i n ter es t, for
15 year s . If the hou s i n g cos ts exceed 30% of the hou s ehold i n come, the loan paymen ts
ar e d efer r ed . The hou s i n g cos t r ati o i s r e-ev alu ated ev er y fi v e year s to d eter mi n e i f a
d efer r ed loan i s s ti ll appr opr i ate. Loan s ter ms for lan d lor d s ar e for 3% s i mple i n ter es t,
n on-d efer r ed .
In ad d i ti on to the CDBG gr an t, the Cou n ty u s es HPG fu n d s as gr an ts i n the HRLP. Du e
to the HPG r equ i r emen t to meet the v er y low-i n come popu lati on , the Cou n ty's HRLP has
a focu s towar d homeown er s i n the v er y low-i n come categor y, the n eed i es t of low-
i n come homeown er s . Fr equ en tly, the s cope of wor k i n v olv es b as i c health an d s afety
n eed s , s u ch as fou n d ati on r epai r/i n s tallati on , r oof r epai r , an d heati n g an d cooli n g
s ys tems . Man y cli en ts hav e d efer r ed mai n tai n i n g thei r home to the poi n t that thes e
r equ i r ed fi xes ar e u r gen t.
The Cou n ty has r ecei v ed HPG awar d s i n 2003 thr ou gh 2007, 2009 ,2010 an d 2011, an d
looks for war d to an other s u cces s fu l gr an t appli cati on for 2012. HPG fu n d s i n the HRLP
Page 1 of 8
COUNTY OF NEVADA, HOUSING AND COMMUNITY SERVICES DIVISION
USDA 2009 SECTION 533 HOUSING PRESERVATION GRANT APPLICATION
PuRSUArvT To 7 CFR PAr,T 1944, SUBPART N, SEC. 1944.674(6).
VERSION: SEPTEMBER 15, 2012
are an es s ent i al t ool and great i nc ent i ve t o t he l ow-i nc ome c l i ent s i n Nevada Count y.
Thes e funds have gone a l ong way t o ens ure t hat c ert ai n l ow-i nc ome homeowners i n
Nevada Count y have a s afe and dec ent home i n whi c h t o l i ve.
The Count y's p ol i c y regardi ng Overc rowdi ng wi l l be c onduc t ed i n c onformi t y wi t h 7 CFR
p art 3460.155, s ubp art E. Thes e gui del i nes wi l l be us ed t o det ermi ne an i deal range of
p ers ons p er hous i ng uni t .
Rel oc at i on of rec i p i ent s , i f nec es s ary, wi l l c omp l y wi t h t he requi rement s of t he Uni form
Rel oc at i on As s i s t anc e and Real Prop ert y Ac qui s i t i on Ac t of 1970. If needed, HPG funds
wi l l be us ed t o c over c os t s i nc urred i n t he rel oc at i on of any di s p l ac ed p ers ons duri ng t he
p eri od of rep ai rs .
Di s p l ac ement of p ers ons , where nec es s ary, wi l l be handl ed wi t h c ons i derabl e di s c ret i on.
The Count y i nt ends t o keep t o a mi ni mum t he di s p l ac ement of any i ndi vi dual s . No
rec i p i ent wi l l be forc ed or c oerc ed t o ac c ep t di s p l ac ement . Al l di s p l ac ement s wi l l have
t he ap p roval s of t he di s p l ac ed p ers ons before p roc eedi ng. HPG funds are avai l abl e t o
fi nanc i al l y hel p di s p l ac ed i ndi vi dual s duri ng t he rehabi l i t at i on p eri od.
Any us e of funds by an ap p l i c ant for addi t i ons wi l l be done i n ac c ordanc e wi t h "RD
Ins t ruc t i ons 1944-N, s ec t i on 1944.664 (c ), i t em 11. Addi t i ons t o any dwel l i ng wi l l onl y be
undert aken when i t i s c l earl y nec es s ary t o al l evi at e overc rowdi ng or t o remove heal t h
hazards t o t he oc c up ant s .
(2) The p roc es s for s el ec t i ng rec i p i ent s for HPG as s i s t anc e, det ermi ni ng hous i ng
p res ervat i on needs of t he dwel l i ng, p erformi ng t he nec es s ary work, and
moni t ori ng/i ns p ec t i ng work p erformed;
The Count y of Nevada i s an equal op p ort uni t y l ender, and s i nc e i t i s p rop os ed t o us e
HPG funds i n t he HRLP, HPG funds wi l l be di s t ri but ed wi t hout di s c ri mi nat i on as p er
Federal requi rement s . Market i ng for t he HRLP i s done t hrough p res s rel eas es , p ri nt ed
broc hures whi c h are avai l abl e t o t he p ubl i c at our offi c e, i nformat i on on t he Count y's web
s i t e: (ht t p ://www.mynevadac ount y.c om), and word of mout h.
Us ual l y, HPG rec i p i ent s are t he s ame c l i ent s as t hos e who've al ready qual i fi ed for a l oan
t hrough t he HRLP. Oc c as i onal l y, an HPG rec i p i ent may onl y rec ei ve a grant . In a l oan
or grant s i t uat i on, HRLP ac c ep t s i nt eres t ed ap p l i c at i ons on a fi rs t c ome, fi rs t s erved
bas i s . If t here are i ns uffi c i ent l oan funds avai l abl e at ap p l i c at i on s ubmi s s i on t i me, t he
~ nnl i r_ .a~ t j nr~ i ~ r~ i i t nn a wai t i nn l i s t . F~ ~ h ~ r~ nl i C~ t i ~ r~ i s i ~ t ~ Qme s GC~ ened, wi ng t he
avai l abl e gui danc e from t he CDBG p rogram, whi c h i s es s ent i al l y t he s ame s t ep s as t he
Federal (HUD) HOME Program's "Tec hni c al Gui de for Det ermi ni ng Inc ome and
Al l owanc es for t he HOME Program." Thi s gui danc e i s ac c ep t abl e t o t he CDBG Program
and i s rec ogni zed as an i ndus t ry s t andard i n i nc ome s c reeni ng hous ehol ds for HUD
p rograms .
Page 2 of 8 ~ ~
COUNTY OF NEVADA, HOUSING AND COMMUNITY SERVICES DIVISION
USDA 2009 SECTION 533 HOUSING PRESERVATION GRANT APPLICATION
PuRSUAtvT To 7 CFR PART 1944, SUBPART N, SEC. 1944.674(8).
VERSION: SEPTEMBER 15, 2012
To determine the scope of work in a proj ect, the County sends a construction special ist
to meet with the homeowner and reviews a l ist which hel ps the homeowner determine
the basic heal th and safety issues need to be addressed within the l oan parameters.
HPG grant funds are then considered to either reduce the l oan amount or provide for
rehabil itation actions outside the maximum l oan amount. The construction special ist then
prepares a bid package which is then sent out to bid. Interested bidders/ contractors then
meet in apre-construction conference which incl udes a site visit at which the
hom~ovvn~r me~t~ the bidder~l co~tractor~. ,fit the pre-~or,~tr~ct; ~~ c~nf~rence, #h~
scope of work is discussed and cl arified. When the bids come in, the homeowner is
responsibl e for sel ecting the contractor, and the construction contract is then executed
and facil itated with the assistance of HRLP staff. Any construction issues are first deal t
with between the homeowner and the contractor. If issues are not resol ved at the initial
l evel , then the County construction special ist and HRLP housing special ist staff may
intervene. Issues not resol ved at l ower l evel s of mediation may be addressed through
l egal arbitration. To date, al l issues have been resol ved with no need for arbitration.
Al l HRLP proj ects are req uired to take out the necessary buil ding permits. The
Construction and Housing Special ist monitor the progress of al l work. Al l intermediary
and final inspections are performed through the normal County buil ding inspection
process.
(3) A description of the process for identifying potential environmental impacts in
accordance with 7 CFR 1944.672, and the provisions for compl iance with Stipul ation I,
A-G of the Programmatic Memorandum of Agreement, al so known as PMOA, (RD
Instruction 2000-FF, avail abl e in any Rural Devel opment State Office or at
http:/ /www.rurdev.usda.gov/ SupportDocuments/ 2000ff.pdfl in accordance with
7CFR 1944.673(b);
As req uired, initial l y the "Req uest for Environmental Review" (RD form 1940-20) and
form "Exhibit F-2," found in 1944-N has been fil l ed out and submitted with the HPG pre-
appl ication.
Sec. 1944.672: Since the County HRLP uses HUD CDBG Funds, a Rehabil itation
Environmental Review (RER) is req uired as per 24 CFR 58.15. Since the HRLP is a
program in which the home sites are not known until a l ater date, the RER is a two-step
process. The first step is to compl ete the appl icabl e sections of the RER and the
Statutory Worksheet (as per 24 CFR 58.6). The Statutory Worksheet covers the
fol l owing areas: Historic Preservation; Fl oodpl ain Management; Wetl and Protection; the
Coastal Zone Management Act; Sol e Source Aq uifers; the Endangered Species Act; the
Wil d and Scenic Rivers Act; the Cl ean Air Act; the Farml and Protection Pol icy Act;
Environmental J ustice; Noise Abatement and Control ; Expl osive and Fl ammabl e
Operations; Hazardous, Toxic, or Radioactive Material s and Substances; and Airport
Cl ear Zones and Accidental Potential Zones.
Page 3 of 8 `~
COUNTY OF NEVADA, HOUSING AND COMMUNITY SERVICES DIVISION
USDA 2009 SECTION 533 HOUSING PRESERVATION GRANT APPLICATION
PURSUANT To 7 CFR PART 1944, SUBPART N, SEC. 1944.674(8).
VERSION: SEPTEMBER 15, 2012
The RER i s then p u b l i s hed i n a l oc al news p ap er, and af ter the ap p rop ri ate p u b l i c
c omment wai ti ng p eri od has l ap s ed , i t i s s u b mi tted to the CDBG Prog ram f or thei r
ap p rov al . Onc e the CDBG Prog ram d etermi nes that the p rop er HUD RER p roc es s has
b een f ol l owed , the CDBG f u nd s are rel eas ed . When an el i g i b l e home s i te has b een
i d enti f i ed and i s p roc es s ed f or the HRLP, an Ap p end i x A i s c omp l eted to d etermi ne i f
mi ti g ati on i s req u i red . The f orm i s then f i l ed i n ou r rec ord s . The Ap p end i x A ad d res s es :
Hi s tori c Pres erv ati on, Ai rp ort Cl ear Zones ; Exp l os i v es and Fl ammab l e Op erati ons ; and
T3xi c ! ! -l ~zard o~~l R~~i ~ac# i :~e l :~l ater~al s ~~rtami na± i ~~. ~i ~c s ~l ~~~~d ~ r~! ~nt; • s ~a~Pr
100 mi l es f rom the Cal i f orni a Coas t, the Coas tal Barri er Res ou rc es Sys tem i s not an
i s s u e. If a home i s i n a f l ood p l ai n, a wetl and , or "not c onc u rred i n b y the Ad v i s ory
Cou nc i l on Hi s tori c Pres erv ati on," HRLP s taf f wi l l c ontac t the l oc al USDA Ru ral
Dev el op ment Of f i c e (RD) f or g u i d anc e on the env i ronmental rev i ew p roc es s as req u i red
p er 7 CFR p art 1944, s u b p art N, Sec ti on 1944.672.
Sec . 1944.673(b ): The Cou nty of Nev ad a has c omp l eted the annu al u p d ate of the
ag reement wi th the Cal i f orni a State Hi s tori c Pres erv ati on Of f i c e (SHPO) f or f i s c al year
2010/2011, f or rev i ewi ng hi s tori c p rop erti es wi thi n ou r HRLP, as p er 1944.673. Thi s i s
es s enti al l y to c omp l y wi th the USDA Ru ral Dev el op ment Prog rammati c Memorand u m of
Ag reement (PMOA). Both d oc u ments are attac hed i n the p re-ap p l i c ati on. Thi s
ag reement l ays ou t the s tep s b y whi c h to c omp l y wi th the RD hi s tori c al rev i ew
env i ronmental req u i rements as i nd i c ated i n 1944.672 and 1944.673. In anti c i p ati on of
u s i ng 2011 HPG f u nd s , the Cou nty i s i n the p roc es s of renewi ng thi s ag reement f or the
c omi ng year.
For the p rop erty' s hi s tori c al rev i ew, the s tep s i nd i c ated i n the PMOA and RD Ins tru c ti on
2000- FF, Exhi b i t A, Attac hments 1, 2, & 3 wi l l b e f ol l owed . If there are any hi s tori c al
i mp ac ts , no work s hal l p roc eed u nti l the p rop er mi ti g ati on ef f orts hav e b een ag reed
u p on. For non hi s tori c al env i ronmental i mp ac ts , the p roc ed u re d es c ri b ed i n 1944.672
wi l l b e f ol l owed . In al l c as es , i t i s the i ntent of Nev ad a Cou nty to c omp l y wi th al l
ap p l i c ab l e env i ronmental req u i rements i n the op erati on of the HPG Prog ram.
(4) The d ev el op ment s tand ard s ) the ap p l i c ant wi l l u s e f or the hou s i ng p res erv ati on work;
and , i f the ap p l i c ant wi l l u s e the Ru ral Dev el op ment s tand ard s f or exi s ti ng d wel l i ng s , the
ev i d enc e of i ts ac c ep tanc e b y the j u ri s d i c ti on where the g rant wi l l b e i mp l emented ;
Per the Hou s i ng Rehab i l i tati on Gu i d el i nes , ev ery l oan or g rant mad e i n the p rog ram wi l l
b e u s ed to f i nanc e rehab i l i tati on to at l eas t mi ni mu m p rog ram rehab i l i tati on s tand ard s .
Ap p l i c ab l e c od es i nc l u d e: The Uni f orm Bu i l d i ng Cod e, the Nati onal El ec tri c al Cod e, the
tl ni f ~rm Pl ~~hi nn ~p ~l ~,
the
l l ni f nrm Mc Ch~ni ~~I CC~d ?, ~hante~~ 5- 1~ ~f the Uni f orm
Cod e, ADA, Sec ti on 504, and rel ev ant s ec ti ons of Ti tl e 24, whi c h p ertai n to d i s ab i l i ty
ac c es s . When ap p l i anc es are i ns tal l ed or rep l ac ed , onl y Energ y Star ap p l i anc es are
u s ed . Ad d i ti onal l y, when worki ng u p the s c op e of work, attenti on i s p ai d to maki ng the
u ni t as energ y ef f i c i ent as p os s i b l e b y u s i ng energ y ef f i c i ent wi nd ows , i ns tal l i ng
i ns u l ati on, etc .
Pag e 4 of 8
~~
COUNTY OF NEVADA, HOUSING AND COMMUNITY SERVICES DIVISION
USDA 2009 SECTION 533 HOUSING PRESERVATION GRANT APPLICATION
PURSUANT 70 7 CFR PART 1944, SUBPART N, SEC. 1944.674(8).
VERSION: SEPTEMBER 15, 2012
Ad d i t i o n a l l y , t he pro gra m req u i res s pec i f i c a d d i t i o n a l u pgra d es i n a l l pro j ec t s . Thes e
i n c l u d e:
s Upgra d e o f el ec t ri c a l eq u i pmen t gro u n d i n g a n d bo n d i n g s y s t em,
s GFCI repl a c emen t i n k i t c hen , ba t hro o m a n d ex t eri o r a rea s ,
s Smo k e d et ec t o r u pgra d e t o c u rren t Un i f o rm Bu i l d i n g Co d e, a n d
s In s t a l l a t i o n o f c a rbo n mo n o x i d e d et ec t o rs when ga s f i red eq u i pmen t i s pres en t
~ 5; The t i me s ~ h~ d ~ l e f o g' ~ o mS~ l et i ~ ~ t he ~ ~ ~ ~ t ~ ~ m;
The Neva d a Co u n t y Ho u s i n g a n d Co mmu n i t y Servi c es Di vi s i o n , whi c h o pera t es t he
HRLP, a n t i c i pa t es a 12-mo n t h t i me peri o d f o r t hi s c y c l e' s HPG f u n d s , f ro m
a ppro x i ma t el y Au gu s t 2012 t hro u gh Au gu s t 2013. Du ri n g t hi s t i me, t he HPG gra n t f u n d s
wi l l be u s ed i n c o n j u n c t i o n wi t h t he c u rren t Ca IHOME c o n t ra c t , whi c h ha s been ex t en d ed
t o Au gu s t 2013.
(6) The s t a f f i n g req u i red t o c o mpl et e t he pro gra m.
Hea l t h a n d Hu ma n Servi c es Agen c y (HHSA) Sen i o r Ad mi n i s t ra t i ve An a l y s t : The
No RTEC Ex ec u t i ve Di rec t o r repo rt s d i rec t l y t o HHSA Sen i o r Ad mi n i s t ra t i ve An a l y s t . The
An a l y s t ha s o vers i ght res po n s i bi l i t i es f o r a l l t he pro gra ms u n d er t he u mbrel l a o f t he
Ho u s i n g a n d Co mmu n i t y Servi c es Di vi s i o n . Thes e pro gra ms c u rren t l y i n c l u d e CDBG
(reha bi l i t a t i o n a n d ec o n o mi c d evel o pmen t ), HOME, LIHEAP, HPG, CSBG, DOE,
Wo rk f o rc e Ho u s i n g, a n d USDA HPG.
No RTEC Ex ec u t i ve Di rec t o r: The No rt hern Ru ra l Tra i n i n g a n d Empl o y men t Co n s o rt i u m
(No RTEC) ma n a ges a l l a s pec t s o f t he pro gra ms wi t hi n t he Ho u s i n g a n d Co mmu n i t y
Servi c es Di vi s i o n . The Ex ec u t i ve Di rec t o r c o o rd i n a t es t he d evel o pmen t a n d
i mpl emen t a t i o n o f CDBG, HOME, LIHEAP, HPG, CSBG, DOE, Wo rk f o rc e Ho u s i n g, a n d
USDA HPG. The Ex ec u t i ve Di rec t o r pro vi d es d i rec t i o n a n d c o o rd i n a t i o n o f a ppl i c a t i o n s
t o n ew f u n d i n g po s s i bi l i t i es .
Ad mi n i s t ra t i ve Servi c es An a l y s t : The Ad mi n i s t ra t i ve Servi c es An a l y s t i s res po n s i bl e f o r
t he f i s c a l c o mpo n en t o f a l l f u n d i n g s o u rc es a n d en s u res t ha t t he Ho u s i n g a n d
Co mmu n i t y Servi c es Di vi s i o n meet s a l l f i s c a l repo rt i n g a n d o t her f i s c a l l y rel a t ed i s s u es .
Ho u s i n g Spec i a l i s t : The Ho u s i n g Spec i a l i s t pro c es s es c l i en t a ppl i c a t i o n s f o r a s s i s t a n c e,
o pera t es t he pro gra m, prepa res l o a n a n d c o n t ra c t d o c u men t s , d o es repo rt i n g, a n d
mo n i t o rs t he pro gra m a n d rec i pi en t s f o r c o mpl i a n c e wi t h t he f u n d i n g s o u rc es .
Co n s t ru c t i o n Spec i a l i s t : The c o n s t ru c t i o n s pec i a l i s t revi ews t he pro po s ed wri t e-u p wo rk
wi t h t he ho meo wn er, a s s i s t s i n d evel o pi n g t he bi d , a n d t hen wo rk s wi t h t he Sen i o r
Ho u s i n g Spec i a l i s t a n d t he ho meo wn er t o res o l ve a n y i s s u es t ha t mi ght a ri s e d u ri n g t he
reha bi l i t a t i o n .
Of f i c e As s i s t a n t s : The Of f i c e As s i s t a n c e po s i t i o n s pro vi d e c l eri c a l s u ppo rt t o a l l s t a f f .
Pa ge 5 o f 8
COUNTY OF NEVADA, HOUSING AND COMMUNITY SERVICES DIVISION
USDA 2009 SECTION 533 HOUSING PRESERVATION GRANT APPLICATION
PURSUANT To 7 CFR PART 1944, SUBPART N, SEC. 1944.674(6).
VERSION: SEPTEMBER 15, 2012
(7) The estimated number of very low- and low-income minority and nonminority persons
the grantee will assist with HPG funds; and, if a rental property or cooperative assistance
program, the number of units and the term of restrictive covenants on their use for very
low- and low-income persons;
Based on an award of $85,000, it is estimated that at least 6 households will be served
vrith ~he~e ~~'G {unu~. At l~aJ t 7~° % ~f these households ~,~il! b~ ;~ ±he :~~r;-! ~~r~ i~c~~? ~
category. The grant amounts will be from $1,000 up to $20,000 per rehabilitated unit,
depending upon the specific circumstance. It is noteworthy that per the 2005-2009
Census (American Community Service) figures, 92.2% of the population is Caucasian,
yet outreach will be made to market to minorities and any other under-represented
groups across the County. For example, the County does have a significant number of
seniors, 18% , of which a significant amount could be eligible for this grant.
(8) The geographical areas) to be served by the HPG program;
The geographic areas to be served with the HPG funds are the unincorporated areas of
Nevada County. The current CalHome grant is available in all the unincorporated areas
of the County. Generally speaking, CDBG new grant funds (when available) are
expended in certain target areas. Loan payments and satisfied loans from previous
grant sources (the State CalHome and previous CDBG awards) are considered program
income, and may be used in non-target areas of the unincorporated regions of Nevada
County. This strategy provides for new funding in target areas, a funding source for non-
target areas in the ensuing years, and an opportunity for HPG funds to be used in all the
areas of unincorporated Nevada County.
(9) The annual estimated budget for the program period based on the financial needs to
accomplish the obj ectives outlined in the proposal. The budget should include proposed
direct and indirect administrative costs, such as personnel, fringe benefits, travel,
equipment, supplies, contracts, and other cost categories, detailing those costs for which
the grantee proposes to use the HPG grant separately from non-HPG resources, if an rL.
The applicant budget should also include a schedule (with amounts) of how the applicant
proposes to draw HPG grant funds, i.e., monthly, quarterly, lump sum for program
activities, etc.;
The proposed budget is contained on Form 424A. The County will use 15% or less of
HPG funds for administration. This form addresses both HPG and non-HPG funding. It
is antic;~ated that :^ :p ~~,~ill dra~rl down funs on a mon# hly basis.
(10) A copy of an indirect cost proposal as required in 7 CFR parts 3015, 3016, and 3019, as
applicable, when the applicant has another source of Federal funding in addition to the
Rural Development HPG program;
Page 6 of 8
COUNTY OF NEVADA, HOUSING AND COMMUNITY SERVICES DIVISION
USDA 2009 SECTION 533 HOUSING PRESERVATION GRANT APPLICATION
PuRSUArvT 70 7 CFR PART 1944, SUBPART N, SEC. 1944.674(8).
VERSION: SEPTEMBER 15, 2012
In d i re c t c ost s w i l l be c harge d base d on ac t ual c ost an d re l at e d t o t he hours c harge d t o
t he fun d i n g sourc e . In d i re c t c ost s w i l l be spre ad t o al l fun d i n g sourc e s base d on t he
pe rc e n t age of t ot al hours spe n t on e ac h fun d i n g sourc e . Thi s c al c ul at i on w i l l oc c ur on a
mon t hl y basi s. (Se e At t ac hme n t B, Form 424A, Se c t i on B).
(11) A bri e f d e sc ri pt i on of t he ac c oun t i n g syst e m t o be use d ;
Ne vad a Coun t y i s usi n g "Pe n t amat i on ," an i n t e grat e d ac c oun t i n g syst e m —ge n e ral
l e d ge r, payrol l , ac c oun t s re c e i vabl e , ac c oun t s payabl e an d proj e c t c ost i n g syst e m. The
d e part me n t i s al so ve ry profi c i e n t at usi n g Exc e l for t rac k i n g i n t e rn al d e part me n t al c ost s
an d se rvi c e s, an d c re at i n g ac c urat e re port s t o d oc ume n t program d e l i ve ry.
(12) The me t hod of e val uat i on t o be use d by t he appl i c an t t o d e t e rmi n e t he e ffe c t i ve n e ss of
i t s program w hi c h e n c ompasse s t he re qui re me n t s for quart e rl y re port s t o Rural
De ve l opme n t i n ac c ord an c e w i t h 7 CFR 1944.683(b) an d t he mon i t ori n g pl an for re n t al
prope rt i e s an d c oope rat i ve s (w he n appl i c abl e ) ac c ord i n g t o 7 CFR 1944.689;
An an n ual re port of t he program e ffe c t i ve n e ss i s pre pare d e ac h ye ar as part of t he
Coun t y's bud ge t i n g proc e ss. Thi s i n c l ud e s t he use of Pe rforman c e Me asure s, w hi c h
re vi e w s t he goal s of t he program an d t he ac t ual out c ome s an d d e l i ve rabl e s. Wi t h past
HPG gran t s, t he Housi n g Di vi si on c on d uc t e d re port i n g as pe r HPG gui d e l i n e s, an d i f t he
Di vi si on i s suc c e ssful w i t h t hi s appl i c at i on , t he same re port i n g me t hod s w i l l c on t i n ue for
t he 2011 HPG gran t . No re n t al prope rt i e s w i l l be assi st e d w i t h HPG fun d s.
(13) The sourc e an d e st i mat e d amoun t of ot he r fi n an c i al re sourc e s t o be obt ai n e d an d use d
by t he appl i c an t for bot h HPG ac t i vi t i e s an d housi n g d e ve l opme n t an d / or support i n g
ac t i vi t i e s;
The Coun t y has an ope n gran t from t he Cal Home Program for re habi l i t at i on w hi c h has
be e n e xt e n d e d t o August 2013. Program i n c ome (payoffs an d payme n t s from pre vi ous
HRLP proj e c t l oan s) w i l l be use d i n t he HRLP as w e l l . The program i n c ome bal an c e i s
subj e c t t o c han ge on a mon t hl y basi s d e pe n d i n g upon ac t i ve proj e c t s an d payoffs from
pre vi ous l oan s.
Shoul d t he Coun t y be suc c e ssful i n t hi s HPG appl i c at i on , t he Coun t y w i l l c ommi t as
l e ve rage $102,000 of St at e Cal Home Fun d s for t hi s gran t appl i c at i on .
(14) The _use _of program i n c ome , i f an y, an d t he t rac k i n g syst e m use d for mon i t ori n g same ;
Si n c e t hi s program w i l l c on si st of gran t i n g HPG fun d s t o t he l ow - an d ve ry l ow -i n c ome
ow n e rs of si n gl e-fami l y re si d e n c e s, n o program i n c ome w i l l be ge n e rat e d d i re c t l y from
HPG fun d s. How e ve r, t he Di vi si on has t w o ot he r program i n c ome fun d s for housi n g
re habi l i t at i on , on e for CDBG an d on e for t he Cal Home program. As fun d s are avai l abl e ,
bot h of t he se Program In c ome fun d s w i l l be use d i n c on j un c t i on w i t h HPG fun d s i n
Page 7 of 8
COUNTY OF NEVADA, HOUSING AND COMMUNITY SERVICES DIVISION
USDA 2009 SECTION 533 HOUSING PRESERVATION GRANT APPLICATION
PURSUANT To 7 CFR PART 1944, SUBPART N, SEC. 1944.674(8).
VERSION: SEPTEMBER 15, 2012
op e r a t i n g t he HRLP. The se p r og r a m i n come a ccoun t s a r e t r a ck e d usi n g t he sa me
t r a ck i n g syst e m, Pe n t a ma t i on a s w i t h HRLP g r a n t fun d s. Se e a l so # 11 a bove .
(15) The a p p l i ca n t ' s p l a n for d i sp osi t i on of a n y se cur i t y i n st r ume n t s he l d by t he m a s a r e sul t
of i t s HPG a ct i vi t i e s i n t he e ve n t of i t s l oss of l e g a l st a t us;
~ ~ ,[ U2~ t i vi l i ~ n i t a p p l i ca b~ ~ #~ she ! - l ~ ~ ~ i r ~ ~ ur ~ ~ C~ mr ~ :.i n i t y~ cQn ; i ce s ~ i ~ :! S!^! ?
Sl n r a #~ ~
Di vi si on i s a p a r t of t he Coun t y Gove r n me n t .
(16) An v ot he r i n for ma t i on n e ce ssa r y t o e x p l a i n t he p r op ose d HPG p r og r a m;
A cop y of t he Coun t y' s cur r e n t Housi n g Re ha bi l i t a t i on Gui d e l i n e s i s a va i l a bl e for r e vi e w
on l i n e a t ht t p ://d ocs.co.n e va d a .ca .us/d sc i s /~ d s.p y/Ge t /Fi l e -
157121/2005 Ne vCo Re ha b Gui d e l i n e s- Fi n a l .p d f. Thi s d ocume n t w i l l be a r e fe r e n ce
d ocume n t t o t he con t r a ct t o cl a r i fy a n y i ssue s.
(17) The out r e a ch e ffor t s out l i n e d i n 7 CFR 1944,671(b);
Ne va d a Coun t y st r e t che s fr om t he Yuba Ri ve r t o t he We st a n d t o t he St a t e of Ne va d a
Ea st . The Ne va d a Coun t y Housi n g a n d Commun i t y Se r vi ce s Di vi si on ' s g oa l i s t o p r ovi d e
a r e ha bi l i t a t i on l oa n p r og r a m i n a l l p or t i on s of t he un i n cor p or a t e d a r e a s of t he Coun t y.
Si n ce ce r t a i n fun d i n g st r e a ms ma y ha ve t a r g e t a r e a s a s a con d i t i on of fun d i n g , t hi s
coun t yw i d e cove r a g e i s a ccomp l i she d by t a k i n g a d va n t a g e of mul t i p l e fun d i n g
op p or t un i t i e s. As a r e sul t , t he Coun t y Housi n g a n d Commun i t y Se r vi ce s Di vi si on
ma r k e t s coun t yw i d e for i t s r e ha bi l i t a t i on p r og r a ms. Cur r e n t ma r k e t i n g e ffor t s ha ve
i n cl ud e d p r e ss r e l e a se s, n e w s a r t i cl e s, n ot i ce s of p ubl i c he a r i n g s, d e ve l op me n t a n d
d i st r i but i on of p r og r a m br ochur e s, ma i n t a i n i n g a p ubl i c i n for ma t i on l i br a r y of cur r e n t
g r a n t s, a n d ma i n t a i n i n g a n i n for ma t i ve w e b si t e for t he Housi n g Di vi si on ;
(ht t p ://n e w.myn e va d a coun t y.com/housi n g/). It i s t hr oug h t he se e ffor t s t ha t t he Housi n g
a n d Commun i t y Se r vi ce s Di vi si on i s a bl e t o p r ovi d e a n e ffe ct i ve ma r k e t i n g a p p r oa ch for
t he ci t i z e n s of Ne va d a Coun t y.
t ~ ~ ,.
Pa g e 8 of 8 ~ ~
COUNTY OF NEVADA
HEALTH &HUMAN SERVICES AGENCY
950 Maidu Ave. Agency Dir ect o r Telepho ne (530) 265-1627
Nevada Cit y, Calif o r nia 95959 J ef f r ey S. Br o wn, MPH, MSW Fax (530) 265-2295
Depar t ment Dir ect o r s
Michael Heggar t y, MFT, Behavio r al Healt h
Tex Rit t er , J D, Child Suppo r t Ser vices &Co llect io ns
Kar en Milman, MD, MPH, Pub lic Healt h
Kat y Eck er t , MBA, Int er im So cial Ser vices
Sept emb er 25, 2012
Ho no r ab le Bo ar d o f Super vis o r s
Er ic Ro o d Adminis t r at ive Cent er
950 Maidu Avenue
Nevada Cit y, CA 95959
DATE OF MEETING: Oct o b er 9, 2012
SUBJ ECT: 1) Res o lut io n aut ho r iz ing execut io n o f t he 2012 U.S. Depar t ment o f Agr icult ur e (USDA), Rur al
Develo pment , Sect io n 533 Ho us ing Pr es er vat io n Gr ant (HPG) Agr eement f o r lo w-inco me ho us ing
r ehab ilit at io n in t he maximum amo unt o f $85, 000; and 2) Res o lut io n aut ho r iz ing and dir ect ing t he Audit o r -
Co nt r o ller t o amend Ho us ing's Budget f o r F/Y 2012/13.
RECOMMENDATION: Appr o ve t he at t ached Res o lut io ns .
FUNDING: In 1949, t he U.S. Depar t ment o f Agr icult ur e (USDA) aut ho r iz ed a r ur al ho us ing gr ant pr o gr am
under Sect io n 533 o f t he Ho us ing Act . The Ho us ing Pr es er vat io n Gr ant (HPG) Pr o gr am awar ds f eder al f unds t o
o r ganiz at io ns f o r t he r epair o r r ehab ilit at io n o f lo w- inco me ho us ing. The gr ant s ar e co mpet it ive and ar e made
availab le in ar eas wher e t her e is a co ncent r at io n o f need. The maximum amo unt o f t his Gr ant Agr eement is
$85, 000, and t her e ar e no co unt y gener al f und do llar s r eq uir ed in t he Agr eement .
This new gr ant year 's awar d f o r r eceipt o f f unding and t he as s o ciat ed pr o gr am expendit ur es was no t b udget ed.
The at t ached Budget Res o lut io n is s ub mit t ed t o adj us t t he HHSA Ho us ing Budget f o r F/Y 2012/13, and needs
t o b e ado pt ed b y 4/5's appr o val b y t he Bo ar d o f Super vis o r s .
BACKGROUND: The f o cus o f t he HPG pr o gr am is t o t ar get ver y lo w-inco me ho us eho lds , and as s is t in
pr o viding s af e and s anit ar y living co ndit io ns . Thes e f unds ar e gr ant ed t o ver y lo w-inco me ho meo wner s t o mak e
healt h and s af et y r elat ed r epair s t o t heir ho mes . Such r epair s include new r o o f s , new HVAC (co o ling and
heat ing) s ys t ems , f o undat io n r epair s , and gener al int er io r r epair s . Gr ant s r ange f r o m $1, 000 t o $20, 000 wit h an
es t imat ed aver age gr ant o f $8, 300 per ho us eho ld. The gr ant is o f t en us ed in co nj unct io n wit h lo an f unds f r o m
t he ho us ing r ehab ilit at io n pr o gr am t o help r elieve t he lo an b ur den o r t o pr o vide r ehab ilit at io n act ivit ies o ut s ide
t he maximum lo an amo unt . This pr o gr am helps pr es er ve Nevada Co unt y's af f o r dab le ho us ing s t o ck and
pr o vides a met ho d o f addr es s ing af f o r dab le ho us ing. It is ant icipat ed t hat t he 2012 HPG gr ant will s er ve a
minimum o f s ix ho us eho lds . The gr ant t er m is 12 mo nt hs , ending Sept emb er 30, 2013.
I t i s recommended t h a t t h e Boa rd a pprove t h e a t t a ch ed Hous i ng P res erva t i on Gra nt Agreement a s i t provi des
fundi ng t o a s s i s t Count y h omeowners wh o ma y not ot h erwi s e be a bl e t o ma ke a va ri et y of needed repa i rs a nd
upda t es t o t h ei r h omes .
P l ea s e cont a ct me i f a ny a ddi t i ona l i nforma t i on i s req ui red.
R es pect ful l y s ubmi t t ed,
~~
J effrey S. rown, D i rect or
Hea l t h a nd Huma n Servi ces Agency
RESOLUTION No.
OF THE BOARD OF SUPERVISORS OF THE COUNTY OF NEVADA
RESOLUTION AUTHORIZING EXECUTION OF THE 2012 U. S.
DEPARTMENT OF AGRICULTURE (USDA), RURAL
DEVELOPMENT, SECTION 533 HOUSING PRESERVATION
GRANT (HPG) AGREEMENT FOR LOW-INCOME HOUSING
REHABILITATION
WIIEREAS, t h e Board of Su p e rv i s ors of t h e Cou nt y of Ne v ada de s i re s t o i mp rov e t h e
l i v i ng c ondi t i ons of i t s l ow and v e ry l ow-i nc ome re s i de nt s wh o ne e d h ou s i ng re p ai r and
re h ab i l i t at i on t h rou g h t h e u s e of USDA g rant fu nds ; and
WHEREAS, t h e Cou nt y ap p l i e d for and was awarde d $85,000 i n g rant fu nds t h rou g h t h e
USDA, Ru ral De v e l op me nt , Se c t i on 533 HPG Prog ram; and
WHEREAS, t h e Cou nt y now de s i re s t o ac c e p t a 2012 Se c t i on 533 HPG p rog ram g rant
and au t h ori z e e xe c u t i on of a Se c t i on 533 IIPG Ag re e me nt wi t h t h e USDA Ru ral De v e l op me nt .
NOW, THEREFORE, BE IT HEREBY RESOLVED b y t h e Board of Su p e rv i s ors of t h e
Cou nt y of Ne v ada, St at e of Cal i forni a t h at t h e Hou s i ng Pre s e rv at i on Grant Ag re e me nt dat e d t h e
30t h day of Se p t e mb e r 2012, b y and b e t we e n t h e USDA, Ru ral De v e l op me nt , p e rt ai ni ng t o
awardi ng t h e Cou nt y fu nds i n t h e maxi mu m amou nt of $85,000 for t h e Hou s i ng Pre s e rv at i on
Grant Prog ram for re p ai r or re h ab i l i t at i on of h ome s for e l i g i b l e re s i de nt s for t h e t e rm of
Se p t e mb e r 30, 2012 t h rou g h Se p t e mb e r 30, 2013 b e and h e re b y i s ap p rov e d, and t h at t h e Ch ai r of
t h e Board of Su p e rv i s ors b e and i s h e re b y au t h ori z e d t o e xe c u t e t h e Ag re e me nt on b e h al f of t h e
Cou nt y of Ne v ada.
Fu nds t o b e de p os i t e d i nt o re v e nu e ac c ou nt : 1610-50605-451-2012-445590.
RD Instruction 1944-N
Exhibit A
HOUSING PRESERVATION GRANT AGREEMENT
This agreement dated September 30, 2012, is between County of Nevada,
the grantee, organized and operating under California State Law, and
the United States of America acting through the Rural Development.
Rural Development agrees to grant a sum not to exceed $85,000.00,
subject to the terms and conditions of this agreement; provided,
however, that the grant funds actually advanced and not needed for
grant purposes shall be returned immediately to Rural Development. The
Housing Preservation Grant (HPG) statement of activities approved by
Rural Development, is attached, and shall commence within 10 days of
the date of execution of this agreement by Rural Development and be
completed by September 30, 2013. Rural Development may terminate the
grant in whole, or in part, at any time before the date of completion,
whenever it is determined that the grantee has failed to comply with
the conditions of this grant agreement or Rural Development regulations
related hereto. The grantee may appeTdverse decisions in accordance
with Rural Development's appeal procedures contained in Subpart B of
Part 1900 of this chapter.
In consideration of said grant by Rural Development to the grantee, to
be made pursuant to Section 533 of the Housing Act of 1949, HPG
program, the grantee will provide such a program in accordance with the
terms of this grant agreement and applicable Rural Development
regulations.
PART A Definitions.
1. "Beginning dame" means the date this agreement is
executed by Rural Development and costs can be incurred.
2. "Ending date" means the date this agreement is
scheduled to be completed. It is also the latest date
grant funds will be provided under this agreement, without
an approved extension.
3. "Disallowed costs" are those charges to a grant which
Rural Development determines cannot be authorized in
accordance with applicable Federal cost principles
contained in 7 CFR Parts 3015 and 3016, as appropriate.
9. "Grant closeout" is the process by which the grant
operation is concluded at the expiration of the grant
period or following a decision to terminate the grant.
(09-01-93) PN 212
RD Instruction 1944-N
Exhibit A
Page 2
5. "Termination" of the grant means the cancellation of
Federal assistance, in whole or in part, at any time before
the date of completion.
PART B Terms of agreement.
Rural D~v~lopment and tie grantee agree that:
1. All grant activities shall be limited to those
authorized in this subpart.
2. This agreement shall be effective when executed by both
parties.
3. The HPG activities approved by Rural Development shall
commence and be completed by the date indicated above,
unless earlier terminated under paragraph B, 18, of this
grant agreement, or extended.
4. The grantee shall carry out the HPG activities and
processes as described in the approved statement of
activities which is made a part of this grant agreement.
Grantee will be bound by the activities and processes set
forth in the statement of activities and the further
conditions set forth in this grant agreement. If the
statement of activities is inconsistent with this grant
agreement, then the latter will govern. A change of any
activities and processes must be in writing and must be
signed by the approval official.
5. The grantee shall use grant funds only for the purposes
and activities approved by Rural Development in the HPG
budget. Any uses-not -provided--for in the approved budget --
must be approved in writing by Rural Development in
advance.
6. If the grantee is a private nonprofit corporation,
expenses charged for travel or per diem will not exceed the
rates paid to Federal employees or (if lower) an amount
authorized by the grantee for similar purposes. If the
grantee is a public body, the rates will be those that are
allowable under the customary practice in the government of
which the grantee is a party; if none are customary, the
Rural Development rate's will be the maximum allowed.-
RD Instruction 1944-N
Exhibit A
Page 3
7. Grant funds will not be used for any of the following:
(a) To pay obligations incurred before the beginning
date or after 'the ending date o~ this agreement;
(b) For any entertainment purposes;
(c) To pay for any capital assets, the purchase of
real estate or vehicles, the improvement or
renovation of the grantee's office space, or for the
repair or maintenance of privately owned vehicles;
(d) Any other purpose specified in X1944.664 (g) or
X1944.666 (b) of this subpart; or
(e) For administrative expenses exceeding 20 percent
of the HPG grant funds.
---5: The grant funds shall no~be us~~sub~3tute for any
financial support previously provided and currently
available or assured from any other source.
9. The dispersal of grants will be governed as follows:
(a) In accordance with Treasury Circular 1075
(fourth revision) Part 205, Chapter II of Title 31 of
the Code of Federal Regulations, grant funds will be
provided by Rural Development as cash advances on an
as needed basis not to exceed one advance every 30
days. The advance will be made by direct Treasury
check to the grantee. In addition, the grantee must
submit Standard Form (SF) 272, "Federal Cash
Transactions Report, "--each time--an advance of funds -
is made. This report shall be used by Rural
Development to monitor cash advances made to the
grantee. The financial management system of the
recipient organization shall provide for effective
control over and accountability for all Federal funds
as stated in
7 CFR Parts 3015 and 3016.
(09-01-93) PN 212
RD Instruction 1944-N
Exhibit A
Page 4
(b) Cash advances to the grantee shall be limited to
the minimum amounts needed and shall be timed to be
in accord only with the actual, immediate cash
requirements of the grantee in carrying -out the
purpose of the planned project. The timing and
amount of cash advances shall be as close as
administratively feasible to the actual disbursements
by the grantee for direct program costs (as
identified in the grantee's statement of activities
and budget and fund use plan) and proportionate share
of any allowable indirect costs.
(c) Grant funds should be promptly refunded to the
Rural Development and redrawn when needed if the
funds are erroneously drawn in excess of immediate
disbursement needs. The only exceptions to the
requirement for prompt refunding are when the funds
involved:
(i) Will be disbursed--5y the recipient
organization within 7 calendar days from the
date of the Treasury check; or
(ii) Are less than $10,000 and will be
disbursed within 30 calendar days from the date
of the Treasury check.
(d) Grantee shall provide satisfactory evidence to
Rural Development that all officers of the grantees'
organization authorized to receive and/or disburse.
Federal funds are covered by fidelity bonds in an
amount not to exceed the grant amount to protect
Rural Development's interests.
10. The grantee will submit performance, financial, and
annual reports as indicated in this subpart to the
appropriate Rural Development office. These reports must
be reconciled to the grantees' accounting records,
especially on the final report.
(a) As needed, but not more frequently than once
every 30 calendar days, submit an original and two
copies of SF-270, "Request for Advance or
Reimbursement." In addition, the grantee must submit
an SF-272, each time an advance of funds is made.
This report shall be used by Rural Development to
monitor cash advances made to the grantee.
RD Instruction 1944-N
Exhibit A
Page 5
(b) Quarterly reports will be submitted within 15
days, but no later than 45 days after the end of each
calendar quarter. An original and one copy of SF-
269, "Financial Status Report," and a quarterly
performance report in accordance with X1944.683 of
this subpart. Item 10, g (total program outlays) of
SF-269, should be less any rebates, refunds, or other
discounts.
(c) Within 90 days after the termination or
expiration of the grant agreement, an original and
two copies of SF-269, and a final performance report
which will include a summary of the project's
accomplishments, problems, and planned future
activities of the grantee for HPG. Final reports may
serve as the last quarterly report.
(d) Rural Development may require performance
reports more frequently if deemed necessary.
11. In accordance with Office of Management and Budget
(OMB) Circular A-87, "Cost Principles for State and Local
Governments" (available in any Rural Development office),
compensation for employees will be considered reasonable to
the extent that such compensation is consistent with that
paid for similar work in other activities of the State or
local government.
12. If the grant exceeds $100,000, cumulative transfers
among direct cost budget categories totaling more than 5
percent of the total budget must have prior written
approval by Rural Development.
13. The results of the program assistecT by grant funds may
be published by the grantee without prior review by Rural
Development, provided that such publications acknowledge
the support provided by funds pursuant to the provisions of
Title V of the Housing Act of 1949, as amended, and that
five copies of each such publications are furnished to
Rural Development.
14. The grantee certifies that no person or organization
has been employed or retained to solicit or secure this
grant for a commission, percentage, brokerage, or
contingent fee.
(09-O1-93) PN 212
RD Instruction 1944-N
Exhibit A
Paqe 6
15. No person in the United States shall, on the grounds
of race, religion, color, sex, familial status, age,
national origin, or handicap, be excluded from
participating in, be denied the proceeds of, or be subject
to discrimination in connection with the use of grant
funds. Grantee will comply with the nondiscrimination
regulations of Rural Development contained in Subpart E of
Part 1901 of this chapter.
16. In all hiring or employment made possible by or
resulting from this grant, the grantee:
(a) Will not discriminate against any employee or
applicant for employment because of race, religion,
color, sex, familial status, age, national origin, or
handicap, and
(b) Will take affirmative action to insure that '
employees a,re treated during employment without _ _
regard to their race, religion, color, sex, familial
status, age, national origin, or handicap. This
requirement shall apply to, but not be limited to,
the following: employment, upgrading, demotion, or
transfer; recruitment or recruitment advertising,
layoff or termination, rates of pay or other forms of
compensation; and selection for training, including
apprenticeship.
(c) In the event grantee signs a contract related to
this grant which would be covered by any Executive
Order, law, or regulation prohibiting discrimination,
grantee shall include in the contract the "Equal
Employment Clause" as specified by Form RD 400-1,
--- "Equal Opportunity Agreement."
17. The grantee accepts responsibility for accomplishing
the HPG program as submitted and included in its
preapplication, application, including its statement of
activities. The grantee shall also:
(a) Endeavor to coordinate and provide liaison with
State and local housing organizations, where they
exist.
(b) Provide continuing information to Rural
Development on the status of grantee HPG programs,
projects, related activities, and problems.
RD Instruction 1944-N
Exhibit A
Page 7
(c) Inform Rural Development as soon as the
following types of conditions become known:
(J Problems, delays, or adverse conditions
which materially affect the ability to attain
program objectives, prevent the meeting of time
schedules or goals, or preclude the attainment
of project work units by established time
periods. This disclosure shall be accompanied
by a statement of the action taken or
contemplated, new time schedules required and
any Rural Development assistance needed to
resolve the situation.
(ii) Favorable developments or events which
enable meeting time schedules and goals sooner
than anticipated or producing more work units
than originally projected.
_ _ ._ _
18. The grant closeout and termination procedures will be
as follows:
(a) Promptly after the date of completion or a
decision to terminate a grant, grant closeout actions
are to be taken to allow the orderly discontinuation
of grantee activity.
(i) The grantee shall immediately refund to
Rural Development any uncommitted balance of
grant funds.
(ii} The grantee will furnish to Rural
Development within 90 calendar days after the
date of completion of the grant, SF-269 and all
financial, performance, and other reports
required as a condition of the grant, including
a final audit report, as required by 7 CFR
Parts 3015 and 3016.
(iii)The grantee shall account for any property
acquired with HPG grant funds or otherwise
received from Rural Development.
-- (iv) After the grant closeout, Rural
Development retains the right to recover any
disallowed costs which may be discovered as a
result of an audit.
(09-O1-93) PN 212
RD Instruction 1944-N
Exhibit A
Page 8
(b) When there is reasonable evidence that the
grantee has failed to comply with the terms of this
grant agreement, the State Director can; on
reasonable notice, suspend the grant pe-riding
corrective action or terminate the grant in
accordance with paragraph B, 18 (c) of this grant
agreement. In such instances, Rural Development may
reimburse the grantee for eligible costs incurred
prior to the effective date of the suspension or
termination and may allow all necessary and proper
costs which the grantee could not reasonably avoid.
Rural Development will withhold further advances and
grantees are prohibited from further use of grant
funds, pending corrective action.
(c) Grant termination will be based on the
following:
(i) Termination for cause. This grant may be
terminat~in w~o1e, or in part, at any time
_ ...
_ _ _ _
before the date of completion, whenever Rural
Development determines that the grantee has
failed to comply with the terms of this
agreement. The reasons for termination may
include, but are not limited to, such problems
as:
(A) Failure to make reasonable and
satisfactory progress in attaining grant
objectives.
(B) Failure of grantee to use grant
funds only for authorized purposes.
(C) Failure of grantee to submit
adequate and timely reports of its
operation.
(D) Violation of any of the provisions
of any laws administered by Rural
Development or any regulation issued
thereunder.
(E) Violation of any nondiscrimination
or equal opportunity requirement
administered by Rural Development in
connection with any Rural Development
programs.
(F) Failure to maintain an accounting
system acceptable to Rural Development.
RD Instruction 1944-N
Exhibit A
Page 9
(ii) Termination for convenience. Rural
Development or the grantee may terminate the
grant in whole, or in part, when both parties
agree that the continuation of the project
would not produce beneficial results
commensurate with the further expenditure of
funds. The two parties shall agree upon the
termination conditions, including the effective
date and, in case of partial termination, the
portion to be terminated.
(d) Rural Development shall notify the grantee in
writing of the determination and the reasons for and
the effective date of the suspension or termination.
Except for termination for convenience, grantees have
the opportunity to appeal a suspension or termination
under Rural Development's appeal procedure, Subpart B
of Part 1900 of this chapter.
19. Upon any default under its representatives or
agreements set forth in this instrument, the grantee, at
the option and demand of Rural Development, will, to the
extent legally permissible, repay to Rural Development
forthwith the grant funds received with interest at the
rate of 5 percent per annum from the date of the default.
The provisions of this grant agreement may be enforced by
Rural Development, at its options and without regard to
prior waivers by it or previous defaults of the grantee, by
judicial proceedings to require specific performance of the
terms of this grant agreement or by such other proceedings
in law or equity, in either Federal or State courts, as may
be deemed necessary by Rural Development to assure
compliance-with the provisions of this grant agreement and
the laws and reg~~ations Winder which this grant is mad~:-
20. Extension of this grant agreement, modifications of the
statement of activities, or changes in the grantee's budget
may be approved by Rural Development provided, in Rural
Development's opinion, the extension or modification is
justified and there is a likelihood that the grantee can
accomplish the goals set out and approved in the statement
of activities during the period of the extension and/or
modifications as specified in X1944.684 of this subpart.
(09-O1-93) PN 212
\~
RD Instruction 1944-N
Exhibit A
Page 10
PART C Grantee agrees:
1. To comply with property management standards for
expendable and nonexpendable personal property established
by 7 CFR Parts 3015 and 3016.
2. To pLo~ide a financial management SyJLG~'1ll which will
include:
(a) Accurate, current, and complete disclosure of
the financial results of each grant. Financial
reporting will be on a cash basis. The financial
management system shall include a tracking system to
insure that all program income, including loan
repayments, are used properly.
(b) Records which identify adequately the source and
application of funds for grant-supported activities.
-- Those records sham:-- corrtazn in-farmation pertaining to
grant awards and authorizations, obligations,
unobligated balances, assets, liabilities, outlays,
and income.
(c) Effecting control over and accountability for
all funds, property, and other assets. Grantee shall
adequately safeguard all such assets and shall assure
that they are solely for authorized purposes.
(d) Accounting records supported by source
documentation.
3. To retain financial records,
statistical records, arrd all oth
grant for a period of at least 3
of the final performance report,
paragraph B 10 (c) of this grant
following situations:
supporting documents,
~r records pertinent to the
years after the submission
in accordance with
agreement, except in the
(a) If any litigation, claim, audit, or
investigation is commenced before the expiration of
the 3-year period, the records shall be retained
until all litigations, claims, audit, or
investigative findings involving the records have
been- resolved.
(b) Records for nonexpendable property acquired by
Rural Development, the 3-year retention requirement
is not applicable.
13
RD Instruction 1944-N
Exhibit A
Page 11
(c) When records are transferred to or maintained by
Rural Development, the 3-year retention requirement
is not applicable.
(d) Microfilm copies may be substituted in lieu of
original records. Rural Development and the
Comptroller General of the Unit2~ St3teS~ or any of
their duly authorized representatives, shall have
access to any books, documents, papers, and records
of the grantee which are pertinent to the specific
grant program for the purpose of making audits,
examinations, excerpts, and transcripts.
4. To provide information as requested by Rural
Development concerning the grantee's actions in soliciting
citizen participation in the applications process,
including published notices of public meetings, actual
public meetings held, and content of written comments
received.
5. Not to encumber, transfer, or dispose of the property
or any part thereof, furnished by Rural Development or
acquired wholly or in part with HPG funds without the
written consent of Rural Development.
6. To provide Rural Development with such periodic reports
of grantee operations as may be required by authorized
representatives of Rural Development.
7. To execute Form RD 400-1, and to execute any other
agreements required by Rural Development to implement the
civil rights requirements.
8. To include in all contracts in excess of $100,000, a
provision for compliance with all applicable standards,
orders, or regulations issued pursuant to the Clean Air
Act, 42 U.S.C. §1875C-9, as amended. Violations shall be
reported to Rural Development and the Regional Office of
the Environmental Protection Agency.
9. That no member of Congress shall be admitted to any
share or part of this grant or any benefit that may arise
therefrom, but this provision shall not be construed to bar
as a contractor under the grant a public-held corporation..._.
whose ownership might include a member of Congress.
(09-O1-93) PN 212
RD Instruction 1944-N
Exhibit A
Page 12
10. That all nonconfidential information resulting from
its activities shall be made available to the general
public on an equal basis.
11. That the purpose for which this grant is made may
complement, but shall not duplicate programs for which
monies have been received, are committed, or are applied
for from other sources, public and private.
12. That the grantee shall relinquish any and all
copyrights and/or privileges to the materials developed
under this grant, such material being the sole property of
the Federal Government. In the event anything developed
under this grant is published in whole or in part, the
material shall contain a notice and be identified by
language to the following effect: "The material is the
result of tax-supported research and as such is not
copyrightable. It may be freely reprinted with the
customary crediting of the source."
13. That the grantee shall abide by the policies
promulgated in 7 CFR Parts 3015 or 3016, as applicable,
which provides standards for use by grantees in
establishing procedures for the procurement of supplies,
equipment, and other services with Federal grant funds.
14. That it is understood and agreed that any assistance
granted under this grant agreement will be administered
subject to the limitations of Title V of the Housing Act of
1949, as amended, 42 U.S.0 1471, et. seq., and related
regulations, and that all rights granted to Rural
Development herein or elsewhere may be exercised by it in
its sole discretion to carry our the purposes of the
assistance, and protect Rural Development's financial
interest.
15. That the grantee will adopt a standard of conduct that
provides that, if an employee, officer, or agency of the
grantee, or such person's immediate family members conducts
business with the grantee, the grantee must not:
(a) Participate in the selection, award, or
administration of a contract to such persons for
which Federal funds are used;
RD Instruction 1944-N
Exhibit A
Page 13
(b) Knowingly permit the award or administration of
the contract to be delivered to such persons or other
immediate family members or to any entity (i.e.,
partnerships, -corporations, etc.) in which such
persons or their immediate family members have an
ownership interest; or
(c) Permit such person to solicit or accept
gratuities, favors, or anything of monetary value
from landlords or developers of rental or ownership
housing projects or any other person receiving HPG
assistance.
16. That the grantee will be in compliance with and
provide the necessary forms concerning the Debarment and
Suspension and the Drug-free Workplace requirements found
in §1944.654 of this subpart.
17. That_._the grantee will comply witlLthe rQ C rt,T? r_? ments in
respect to rental properties and cooperatives (co-ops) and
will execute an agreement with the owners or co-op as found
in ~~1944.662 and 1944.663 of this subpart, specifically:
(a) If the co-op or rental property owner s) or
their successors in interest fail to carry out the
requirements of this grant agreement, the ownership
agreement, or any requirements noted in this subpart
during the applicable period, they shall make a
payment to Rural Development in an amount that equals
the total amount of the assistance provided by the
grantee plus interest thereon (without compounding)
for each year and any fraction thereof that the
assistance was outstanding The interest rate shall
be that as determined by Rural Development at the
time of infraction taking into account the average
yield on outstanding marketable long-term obligations
of the United States during the month preceding the
date on which the assistance was initially made
available.
(b) Notwithstanding any other provision of law, any
assistance provided shall constitute a debt, which is
payable in the case of any failure to carry out the
agreement between the grantee and the rental property
owner s) or co-op and shall be secured by the
security instruments provided by them to Rural
Development.
18. That all requirements of this subpart concerning HPG's
will be followed.
(09-01-93) PN 212
RD Instruction 1944-N
Exhibit A
Page 14
_ . . . . _ - ----
-_ _ . . _ _ _ r}
- - -_
_ . .
--
-. _ _ _ ~
PART D Rural Development agrees:
1. That it will assist the grantee, within available
appropriations, with such technical and management
assistance as needed in coordinating the statement of
activities with local officials, comprehensive plans, and
any State or area plans for improving housing for very low-
and low-income households in the area in which the project
or program is located.
2. That at its sole discretion, Rural Development may at
any time give any consent, deferment, subordination,
release, satisfaction, or termination of any or all of the
grantee's grant obligations, with or without valuable
consideration, upon such terms and conditions as the
grantor may determine to be:
— - advisable to further the purposes—o~f the—grant--
or to protect Rural Development's financial interests
therein; and
(b)Consistent with the statutory purposes of the
grant and the limitations of the statutory authority
under which it is made and Rural Development's
regulations.
PART E Attachments:
The statement of activities is attached to and made a part of this
grant agreement.
RD Instruction 1944-N
Exhibit A
Page 15
This grant agreement is subject to current Rural Development
regulations and any future regulations not inconsistent with the
express terms hereof.
Grantee has caused this grant agreement to be executed by its duly
authorized Deputy County Executive Director, properly attested to and
its corporate seal affixed by its duly authorized n/a.
Attest: Grantee:
By:
By: Ted S. Owens, Chair, Board of Supervisors,
County of Nevada
Date of Execution of Grant Agreement by
Grantee:
United States Of America
Rural Development
Stephen Nnodim, Multi-Family Housing Program
Director
Date of Execution of Grant Agreement by Rural
Development:
(09-O1-93) PN 212
\'(~
v
COUNTY OF NEVADA
HEALTH &HUMAN SERVICES AGENCY
950 Maidu Ave. Agency Dir ect o r Telepho ne (530) 265-1627
Nevada Cit y, Calif o r nia 95959 J ef f r ey S. Br o wn, MPH, MSW Fax (530) 265-2295
Depar t ment Dir ect o r s
Michael Heggar t y, MFT, Behavio r al Healt h
Tex Rit t er , J D, Child Suppo r t Ser vices &Co llect io ns
Kar en Milman, MD, MPH, Pub lic Healt h
Kat y Eck er t , MBA, Int er im So cial Ser vices
Sept emb er 25, 2012
Ho no r ab le Bo ar d o f Super vis o r s
Er ic Ro o d Adminis t r at ive Cent er
950 Maidu Avenue
Nevada Cit y, CA 95959
DATE OF MEETING: Oct o b er 9, 2012
SUBJ ECT: 1) Res o lut io n aut ho r iz ing execut io n o f t he 2012 U.S. Depar t ment o f Agr icult ur e (USDA), Rur al
Develo pment , Sect io n 533 Ho us ing Pr es er vat io n Gr ant (HPG) Agr eement f o r lo w-inco me ho us ing
r ehab ilit at io n in t he maximum amo unt o f $85, 000; and 2) Res o lut io n aut ho r iz ing and dir ect ing t he Audit o r -
Co nt r o ller t o amend Ho us ing's Budget f o r F/Y 2012/13.
RECOMMENDATION: Appr o ve t he at t ached Res o lut io ns .
FUNDING: In 1949, t he U.S. Depar t ment o f Agr icult ur e (USDA) aut ho r iz ed a r ur al ho us ing gr ant pr o gr am
under Sect io n 533 o f t he Ho us ing Act . The Ho us ing Pr es er vat io n Gr ant (HPG) Pr o gr am awar ds f eder al f unds t o
o r ganiz at io ns f o r t he r epair o r r ehab ilit at io n o f lo w- inco me ho us ing. The gr ant s ar e co mpet it ive and ar e made
availab le in ar eas wher e t her e is a co ncent r at io n o f need. The maximum amo unt o f t his Gr ant Agr eement is
$85, 000, and t her e ar e no co unt y gener al f und do llar s r eq uir ed in t he Agr eement .
This new gr ant year 's awar d f o r r eceipt o f f unding and t he as s o ciat ed pr o gr am expendit ur es was no t b udget ed.
The at t ached Budget Res o lut io n is s ub mit t ed t o adj us t t he HHSA Ho us ing Budget f o r F/Y 2012/13, and needs
t o b e ado pt ed b y 4/5's appr o val b y t he Bo ar d o f Super vis o r s .
BACKGROITND: The f o cus o f t he HPG pr o gr am is t o t ar get ver y lo w-inco me ho us eho lds , and as s is t in
pr o viding s af e and s anit ar y living co ndit io ns . Thes e f unds ar e gr ant ed t o ver y lo w-inco me ho meo wner s t o mak e
healt h and s af et y r elat ed r epair s t o t heir ho mes . Such r epair s include new r o o f s , new HVAC (co o ling and
heat ing) s ys t ems , f o undat io n r epair s , and gener al int er io r r epair s . Gr ant s r ange f r o m $1, 000 t o $20, 000 wit h an
es t imat ed aver age gr ant o f $8, 300 per ho us eho ld. The gr ant is o f t en us ed in co nj unct io n wit h lo an f unds f r o m
t he ho us ing r ehab ilit at io n pr o gr am t o help r elieve t he lo an b ur den o r t o pr o vide r ehab ilit at io n act ivit ies o ut s ide
t he maximum lo an amo unt . This pr o gr am helps pr es er ve Nevada Co unt y's af f o r dab le ho us ing s t o ck and
pr o vides a met ho d o f addr es s ing af f o r dab le ho us ing. It is ant icipat ed t hat t he 2012 HPG gr ant will s er ve a
minimum o f s ix ho us eho lds . The gr ant t er m is 12 mo nt hs , ending Sept emb er 30, 2013.
I t i s recommended t h a t t h e Boa rd a pprove t h e a t t a ch ed Hous i ng P res erva t i on Gra nt Agreement a s i t provi des
f undi ng t o a s s i s t Count y h omeowners wh o ma y not ot h erwi s e be a bl e t o ma ke a va ri et y of needed repa i rs a nd
upda t es t o t h ei r h omes .
P l ea s e cont a ct me i f a ny a ddi t i ona l i nf orma t i on i s req ui red.
R es pect f ul l y s ubmi t t ed,
J ef f rey S . rown, D i rect or
Hea l t h a nd Huma n S ervi ces Agency
_ R _ E S O _ L _ U T i O _ I V
_
N o . _ _
_
_ _ _ _ _
_ _ _ _
t ~ F i ~ i E B t ~ ~ ~ ~ i ~ F j u ~ P ~ R ~ v ~ I j V ~ ' C J V C i He C t ~ U i i ~ ~ ' T v ~ i ~ E ~ ' ~ t D ~ r
R E SOL U TI ON AU THOR I ZI NG AND D I R E C TI NG THE AU D I TOR -
C ONTR OL L E R TO AME ND HOU SI NG' S B U D GE T F OR
F I SC AL YE AR 2012/13
WHE R E AS, t h e C ou nt y of Nev ada h as ent er ed i nt o a Gr ant Agr eement wi t h t h e U . S. D epar t ment of
Agr i c u l t u r e (U SD A), R u r al D ev el opment , for $85,000 of gr ant fu ndi ng fox t h e Sec t i on 533 Hou si ng
P r eser v at i on P r ogr am; and
WHE R E AS, t h e HHSA Hou si ng needs t o adj u st t h ei r bu dget for F i sc al Year 2012/13 t o r efl ec t t h i s
i nc r ease i n r ev enu e and ex pendi t u r es r el at ed t o t h i s pr ogr am.
NOW, THE R E F OR E , B E I T R E SOL V E D by t h e B oar d of Su per v i sor s of t h e C ou nt y of Nev ada
h er eby au t h or i z es and di r ec t or t h e Au di t or -C ont r ol l er t o amend Hou si ng' s B u dget for F i sc al Year
2012/13 as fol l ows:
Ac c ou nt s Amou nt s
1610- 50605- 451- 2012/ 446690 $85,000
1610- 50605- 451- 2012/ 521552 $12,750
1610- 50605- 451- 2012/ 521520 $72,250
COUNTY OF NEVADA
'HEALTH &HUMAN SERVICES AGENCY
950 Maidu Ave.
Nevada Cit y , Cal if o r n ia
95959
Sept ember 24, 2012
Agen cy Dir ect o r
J ef f r ey S. Br o wn , MPH, MSW
Depar t men t Dir ect o r s
Michl el Heggar t y , MPT, Behavio r al Heal t h
Tex Rit t er , J D, Chil d Suppo r t Ser vices &Co l l ect io n s
Kar en Mil man , MD, MPH, Publ ic Heal t h
Kat y Eck er t , MBA, In t er im, So cial Ser vices
Ho n o r abl e Bo ar d o f Super vis o r s
Er ic Ro o d Admin is t r at ive Cen t er
950 Maidu Aven ue
Nevada Cit y , CA 95959
DATE OF MEETING: Oct o ber 9, 2012
Tel epho n e (530) 265-1627
Fax (530)265-2295
I~ECEl VED
OCT v 2
" z Gi2
NEVADA COUNTY
BOARD
SUPERVIS4R~
SUBJ ECT: Res o l ut io n aut ho r iz in g execut io n o f an Amen dmen t t o t he 2011 Un it ed
St at es Depar t men t o f Agr icul t ur e (USDA) Ho us in g Pr es er vat io n Gr an t (HPG) agr eemen t ,
ext en din g t he gr an t t er min at io n dat e t o J un e 30, 2013.
RECOMMENDATION: Appr o ve t he at t ached r es o l ut io n
FUNDING: In 1949, t he U.S. Depar t men t o f Agr icul t ur e (USDA) aut ho r iz ed a r ur al
ho us in g gr an t pr o gr am un der Sect io n 533 o f t he Ho us in g Act . The Ho us in g Pr es er vat io n
Gr an t (HPG) Pr o gr am awar ds f eder al f un ds t o o r gan iz at io n s f o r t he r epair o r
r ehabil it at io n o f l o w-in co me ho us in g. The gr an t s ar e co mpet it ive an d ar e made avail abl e
in ar eas wher e t her e is a co n cen t r at io n o f n eed. Ther e ar e n o co un t y gen er al f un d do l l ar s
r eq uir ed in t he Agr eemen t an d t he F/Y 201 1/12 budget was amen ded t o al l o w f o r t he
gr an t f un ds . The 2011 gr an t agr eemen t amo un t r emain s t he s ame at $75, 000.
BACKGROUND: Per Res o l ut io n #11-486, t he Co un t y en t er ed in t o an agr eemen t wit h
t he USDA t o r eceive $75, 000 o f t he 2011 HPG f un ds . The HPG f un ds ar e l ever aged
wit h Ca1HOME ho us in g r ehabil it at io n f un ds . Thes e f un ds ar e gr an t ed t o q ual if ied l o w-
in co me an d ver y l o w-in co me ho me o wn er s t o mak e heal t h an d s af et y r epair s t o t heir
ho mes . Such r epair s in cl ude n ew r o o f s , n ew HVAC (co o l in g an d heat in g) s y s t ems ,
f o un dat io n r epair s an d gen er al in t er io r r epair s . This pr o gr am hel ps pr es er ve Nevada
Co un t y 's af f o r dabl e ho us in g s t o ck an d pr o vides a met ho d o f addr es s in g af f o r dabl e
ho us in g.
Nevada County Housing D ivision completed th r ee gr ants totaling $25,307 leaving
$49,693 r emaining in th e 2011 gr ant pr ogr am. D ue to h ousing pr ogr am staf f ing
ch allenges and th e tr ansition of th e Pr ogr am to th e Health and Human S er vices Agency
(HHS A) in August of 2012, pr ogr am outr each was limited f or a per iod of time. Th e
tr ansition to HHS A is now complete and outr each h as r esumed. Th e depar tment is
conf ident th e f unds will be spent in a timely manner , with th e gr ant ex tension in place.
I t is r ecommended th at th e Boar d appr ove th e Amendment, wh ich ex tends th e gr ant
ter mination date to June 30, 2013, as it will assist County h omeowner s wh o with out th e
gr ants would not be able to make th e needed h ealth and saf ety r epair s to th eir h omes.
R espectf ully
D ir ector
Health and Human S er vices Agency
.~
RESOLUTION No.
OF THE BOARD OF SUPERVISORS OF THE COUNTY OF NEVADA
~?ESOLTJ~'I011T QLTT~I~RIZIN~'I'~- IE EXF~'~JT'IQN OF' A1V
AMENDMENT TO THE 2011 U.S. DEPARTMENT OF
AGRICULTURE (USDA), RURAL DEVELOPMENT, HOUSING
PRESERVATION GRANT (HPG) AGREEMENT, EXTENDING
THE GRANT TERMINATION DATE TO JUNE 30, 2013
WHEREAS, HPG funds have been used as g r ant s i n t he Count y's housi ng r ehabi l i t at i on
l oan pr og r am for l ow i ncome and ver y l ow i ncome househol ds t o make necessar y heal t h and
safet y r epai r s t o t hei r homes; and
WHEREAS, per Resol ut i on 11- 486, Nevada Count y ent er ed i nt o an ag r eement wi t h t he
USDA t o r ecei ve $75,000 of t hese funds t hr oug h Sept ember 30, 2012; and
WHEREAS, $49,693 of t he or i g i nal g r ant amount has not yet been ut i l i z ed by t he Housi ng
Rehabi l i t at i on Pr og r am; and
WHEREAS, t hi s Amendment wi l l ext end t he g r ant t hr oug h June 30, 2013.
NOW THEREFORE, BE IT HEREBY RESOLVED by t he Boar d of Super vi sor s, of t he
Count y of Nevada, St at e of Cal i for ni a, t hat t he Amendment t o t he Housi ng Pr eser vat i on Gr ant
Ag r eement (Res. 11- 486) by and bet ween t he Count y and t he Uni t ed St at es of Amer i ca act i ng
t hr oug h t he Rur al Devel opment , Depar t ment of Ag r i cul t ur e, per t ai ni ng t o ext endi ng t he endi ng
dat e of t he g r ant ag r eement fr om Sept ember 30, 2012 t o June 30, 2013 be and her eby i s appr oved,
and t hat t he Chai r of t he Boar d of Super vi sor s be, and i s her eby, aut hor i z ed t o execut e t he g r ant
amendment on behal f of t he Count y of Nevada.
Funds t o be deposi t ed i nt o r evenue account : 1610 50605 4512011 446690.
J
RD Instruction 1944-N
Exhibit B
AMENDMENT
TO
HOUSING PRESERVATION GRANT AGREEMENT
This amendment between County of Nevada, herein called the "Grantee," and the
United States of America acting through the Rural Development, Department of
Agriculture, herein called "Rural Development," hereby amends the Housing
Preservation Grant Agreement originally executed by said parties on October
11, 2011.
Said grant agreement is amended by extending the ending date of the grant
agreement from September 30, 2012 to June 30, 2013, and/or by making the
following changes noted in the attachments hereto (list and identify
proposal (s) and any other documents pertinent to the grant agreement which
are attached to this amendment).
The grantee has caused this "Amendment to Housing Preservation Grant
Agreement" to be executed by its duly authorized Chair of the Board of
Supervisors, properly attested to and its corporate seal affixed by its duly
authorized Clerk of the Board.
Attest:
Donna Landi
Clerk of the Board
Of Supervisors
(09-O1-93) PN 212
Grantee:
By: Ted S. Owens, Chair, Nevada County Board of
Supervisors
Date of Execution of Amendment to Grant
Agreement by Grantee:
United States of America
Rural Development:
By:
(Title)
Date of Execution of Amendment to Grant
Agreement by Rural Development:
NEVADA COUNTY
HEALTH &HUMAN SERVICES
AGENCY
BEHAVIORAL HEALTH DEPARTMENT
(Mental Health , Drug and Alc o h o l Pro gram)
500 CROWN POINT CIRCLE, STE. 120
10075 LEVON AVE., STE 204
September 19 , 2012
Ho no rable Bo ard o f Superv i s o rs
Eri c Ro o d Admi ni s trati v e Center
9 50 Mai du Av enue
Nev ada Ci ty , Ca 9 59 59
GRASS VALLEY CALIFORNIA 9 59 45
TRUCKEE, CALIFORNIA 9 6161
DATE OF MEETING: Oc to ber 9 , 2012
Health &Human Serv i c es J(
Agenc y Di rec to r U
Jeffrey S. Bro wn, MPH, MSW
Beh av i o ral Health Di rec to r:
Mi c h ael Heggarty , MFT
Beh av i o ral Health Medi c al
Di rec to r:
Aubrey Eubanks , M.D.
TELEPHONE (530) 265-1437
FAX (530) 271-0257
TELEPHONE (530) 582-7803
FAX (530) 582-7729
SUBJECT: Res o luti o n auth o ri z i ng ex ec uti o n o f th e c o ntrac t wi th Galen Elli s , d/ b/ a El-As kari Co ns ulti ng
related to th e pro v i s i o n o f Co lumbi a Teen Sc reen Serv i c es as a c o mpo nent o f th e Co unty 's MHSA
Prev enti o n and Early Interv enti o n (PEI) Plan i n th e max i mum amo unt o f $185, 000 fo r th e term o f
Oc to ber 9 , 2012 th ro ugh September 30, 2014.
RECOMMENDATION: Appro v e th e attac h ed Res o luti o n.
FUNDING: Co ntrac t s erv i c es are funded by MHSA (Mental Health Serv i c es Ac t) Prev enti o n and
Early Interv enti o n (PEI) do llars . PEI fundi ng i s i ntended to s uppo rt s trategi es to h elp i denti fy and
i nc reas e prev enti o n effo rts and res po ns es to early s i gns o f emo ti o nal and beh av i o ral h ealth
pro blems amo ng s pec i fi c at-ri s k po pulati o ns . Th e c o ntrac t max i mum i s $185, 000 fo r th e enti re
c o ntrac t term, and s erv i c es are wi th i n th e department's FY 2012-13 budget. Th ere are no c o unty
general fund do llars req ui red i n th e c o ntrac t.
BACKGROUND: Teen Sc reen Sc h o o ls and Co mmuni ti es i s a nati o nal mental h ealth and s ui c i de
ri s k s c reeni ng pro gram fo r y o ung peo ple, ages 11-18. Under th i s Agreement, th e Co ntrac to r wi ll
wo rk to i mplement th e Co lumbi a Teen Sc reen pro to c o l i n h i gh s c h o o ls i n bo th th e Wes tern and
Eas tern Regi o n o f Nev ada Co unty . Teen Sc reen was dev elo ped by Co lumbi a Uni v ers i ty 's Di v i s i o n
o f Ch i ld and Ado les c ent Ps y c h i atry i n res po ns e to res earc h rev eali ng th at 9 0 perc ent o f y o uth wh o
di e by s ui c i de s uffer fro m a di agno s able mental i llnes s and th at 64 perc ent ex peri enc e s y mpto ms fo r
at leas t a y ear pri o r to th ei r death s .
Ev ery c o mmuni ty and s c h o o l h o pes to dev elo p a ro admap fo r s uc c es s o f all s tudents , and i t h as
bec o me ev i dent th at s c h o o ls c anno t fo c us s o lely o n th e ac ademi c s uc c es s o f y o ung peo ple. Bo th th e
ph y s i c al and mental well-bei ng o f a y o ung pers o n h av e di rec t i mpli c ati o ns fo r th at c h i ld's abi li ty to
be pro duc ti v e as a s tudent and as a member o f th e s c h o o l and c o mmuni ty . Embrac i ng th e c o nc ept o f
th e wh o le c h i ld h as led s c h o o ls and c o mmuni ti es to i ntegrate s y s tems th at addres s th e ac ademi c ,
s o c i al, and emo ti o nal needs o f teens . ,
Pri nted o n rec y c led paper
The C o n t r a c t o r s ha l l es t a b l i s h a P r o j ec t Tea m whi c h wi l l i n c l u d e t he f o l l o wi n g c o r e p o s i t i o n s : a
P r o j ec t C o o r d i n a t o r , C l i n i c a l C o o r d i n a t o r , a n d C a s e Ma n a g er t ha t wi l l c o o r d i n a t e ef f o r t s t o o f f er
s c r een i n g t o a l l t en t h g r a d er s i n p a r t i c i p a t i n g Neva d a C o u n t y s c ho o l s . The p r o g r a m i s c o mp l et el y
vo l u n t a r y, a n d p a r en t a l c o n s en t a n d yo u t h a s s en t a r e r eq u i r ed f o r p a r t i c i p a t i o n i n t he Teen Sc r een
p r o g r a m. The i mp l emen t a t i o n o f C o l u mb i a Teen Sc r een wi l l f o l l o w t he f o l l o wi n g s t ep s :
• O b t a i n i n g wr i t t en a p p r o va l f r o m t he p r i n i c i p a l/ s u p er i n t en d en t o f t he s c ho o l wher e t he
p r o g r a m wi l l b e i mp l emen t ed ;
• O b t a i n i n g wr i t t en p a r en t a l c o n s en t ;
• Yo u t h mu s t g i ve wr i t t en a s s en t t o p a r t i c i p a t e;
• Sc r een i n g / s c o r i n g u s i n g t he C o l u mb i a Hea l t h Sc r een (C HS) a n d t he D i a g n o s t i c P r ed i c t i ve
Sc a l es (D P S);
• D eb r i ef i n g ;
• C l i n i c a l I n t er vi ew- yo u t h who r evea l c u r r en t s u i c i d e i d ea t i o n o r a p a s t s u i c i d e a t t emp t wi l l
b e i n t er vi ewed i mmed i a t el y a f t er c o mp l et i n g t he s c r een i n g q u es t i o n n a i r e;
• P a r en t No t i f i c a t i o n - i f r ef er r a l f o r a n y men t a l hea l t h s er vi c es i s i n d i c a t ed f o r a p a r t i c i p a t e
u n d er t he a g e o f 18, hi s/ her p a r en t s mu s t b e n o t i f i ed wi t hi n 24 ho u r s o f s c r een i n g ;
C a s e Ma n a g emen t ;
Rec o r d Keep i n g - i n c o mp l i a n c e wi t h s t r i c t c o n f i d en t i a l i t y g u i d el i n es
Thi s c o n t r a c t wa s a wa r d ed u n d er t he C o u n t y's RFP (Req u es t f o r P r o p o s a l s ) p r o c es s a n d t he
s er vi c es a r e s t r o n g l y s u p p o r t ed b y t he C o u n t y's MHSA St eer i n g C o mmi t t ee. Res ea r c h r evea l ed t ha t
C o l u mb i a Teen Sc r een ef f ec t i vel y i d en t i f i ed a t- r i s k yo u t h, a n d i t s ho wed t ha t ma n y yo u t h i d en t i f i ed
t hr o u g h t he s c r een i n g wer e n o t p r evi o u s l y k n o wn t o ha ve p r o b l ems .
I t i s r ec o mmen d ed t ha t t he Bo a r d a p p r o ve t hi s c o n t r a c t a s i t p r o vi d es s er vi c es t ha t c a n i n t er ven e
wi t h a t- r i s k yo u t h a n d c o n n ec t t hem wi t h t he men t a l hea l t h s er vi c es t ha t c a n hel p s a ve l i ves .
P l ea s e c o n t a c t me i f a n y a d d i t i o n a l i n f o r ma t i o n i s r eq u i r ed .
Res p ec t f u l l y s u b mi t t ed ,
Mi c ha el J . Heg g a r t y, MFT
Beha vi o r a l Hea l t h D i r ec t o r
MJ H/ c s
P r i n t ed o n r ec yc l ed p a p er
~~
RESOLUTION NO.
OF THE BOARD OF SUPERVISORS OF THE COUNTY OF NEVADA
RESOLUTION AUTHORIZING EXECUTION OF THE PERSONAL
SERVICES CONTRACT WITH GALEN ELLIS, D/B/A EL-ASKARI
CONSULTING FOR COLUMBIA TEEN SCREEN SERVICES
WHEREAS, Co n t r a c t s e r v i c e s a r e fun de d by Me n t a l He a lt h Se r v i c e s Ac t (MHSA)
Pr e v e n t i o n a n d Ea r ly In t e r v e n t i o n (PEI) fun di n g , wh i c h i s i n t e n de d t o s up p o r t s t r a t e g i e s t o
h e lp i de n t i fy a n d i n c r e a s e p r e v e n t i o n e ffo r t s a n d r e s p o n s e s t o e a r ly s i g n s o f e m o t i o n a l a n d
be h a v i o r a l h e a lt h p r o ble m s a m o n g s p e c i fi c a t-r i s k p o p ula t i o n s ; a n d
WHEREAS, t h e Te e n Sc r e e n p r o t o c o l wa s de v e lo p e d by Co lum bi a Un i v e r s i t y' s
Di v i s i o n o f Ch i ld a n d Ado le s c e n t Ps yc h i a t r y i n r e s p o n s e t o r e s e a r c h r e v e a li n g t h a t a h i g h
p e r c e n t a g e o f yo ut h wh o di e by s ui c i de s uffe r fr o m a di a g n o s a ble m e n t a l i lln e s s a n d m a y
e x p e r i e n c e s ym p t o m s fo r a t le a s t a ye a r p r i o r t o t h e i r de a t h s ; a n d
WHEREAS, t h e Co n t r a c t o r s h a ll e s t a bli s h a Pr o j e c t Te a m t h a t wi ll c o o r di n a t e
e ffo r t s t o o ffe r p r o g r a m s c r e e n i n g t o s t ude n t s i n p a r t i c i p a t i n g Ne v a da Co un t y Sc h o o ls t h a t
c a n h e lp li n k s t ude n t s i de n t i fi e d a s h i g h-r i s k t o n e e de d s e r v i c e s .
NOW, THEREFORE, BE IT HEREBY RESOLVED by t h e Bo a r d o f Sup e r v i s o r s
o f t h e Co un t y o f Ne v a da , St a t e o f Ca li fo r n i a , t h a t t h e Pe r s o n a l Se r v i c e s Co n t r a c t da t e d t h e
9 t 1 ' da y o f Oc t o be r 201 2, by a n d be t we e n t h e Co un t y a n d Ga le n Elli s , d/b/a El-As k a r i
Co n s ult i n g r e la t e d t o t h e p r o v i s i o n Co lum bi a Te e n Sc r e e n Se r v i c e s i n t h e m a x i m um
a m o un t o f $1 85,000 fo r t h e t e r m o f Oc t o be r 9 , 201 2 t h r o ug h Se p t e m be r 30, 201 4 be a n d
h e r e by i s a p p r o v e d, a n d t h a t t h e Ch a i r o f t h e Bo a r d o f Sup e r v i s o r s be a n d i s h e r e by
a ut h o r i z e d t o e x e c ut e t h e Co n t r a c t o n be h a lf o f t h e Co un t y o f Ne v a da . Fun ds i n t h e a m o un t
o f $9 8,300 t o be e n c um be r e d fo r Fi s c a l Ye a r 201 2/1 3, a n d t o be di s bur s e d fr o m a c c o un t :
1 51 2-401 04-49 3-1 000/521 520.
PERSONAL SERVICES CONTRACT
County of Nevada, Cal i for ni a
Th i s Per s onal Ser vi ces Contr act i s made between th e COUNTY OF NEVADA ( h er ei n "County") , and
L~ GALEN ELLIS, D/B1A EL-ASKARI CONSULTIPIG ~ --~~
( h er ei n "Contr actor") , wh er ei n County des i r es to r etai n a per s on or enti ty to pr ovi de th e fol l owi ng s er vi ces ,
mater i al s and pr oducts g ener al l y des cr i bed as fol l ows :
(§1~ Th e pr ovi s i on of Col umbi a Teen Scr een Ser vi ces as a component of th e
Count 's MHSA Pr eventi on and Ear fy Inter venti on ( PEt) Pl an. ___ _~._~
SUMMARY OF MATERIAL TERMS
{§2) Maxi mum Contr act Pr i ce: $185,000
(§3) Contr act Beg i nni ng Date: 10/09/'f2 Contr act Ter mi nati on Date: 09130/2014
(§4) Li qui dated Damag es : N/A
INSURANCE POLICIES
Des i g nate ai l r equi r ed pol i ci es :
Req'd Not Req'd
(§6) Commer ci al Gener al Li abi l i ty ( $1,00,000) X_
(§7) Automobi l e Li abi l i ty ( $ 300,000) Per s onal Auto ~X
( $1,000,000) Bus i nes s Ratecf X
( $1,000,000) Commer ci al Pol i cy X
(§8) Wor ker 's Compens ati on
X
(§9) Er r or s and Omi s s i ons ( $1,000,000)
~__ X
Des i g nate aH r equi r ed l i cens 6s :
(§14) N/A
LICENSES
NOTICE 8~ IDENTIFICATION
(§26) Contr actor : Gal en El l i s , County of Nevada:
d/b/a EI-As kar i Cons ul ti ng 950 Mai du Avenue
PO. Box 901 Nevada Ci ty, Cal i for ni a 95959
Nevada Ci ty, Cal i for ni a 95959
Contact Per s on: Gal en El l i s Contact Per s on: Rebecca Sl ade
( 530) 264-7127 { 530 ) 470-2539
e-mai l : g al en@el as kar i ,com e-mai l : r ebecca.s l ade@co.nevada.ca.us
Fund: 1512-401 Q4-493-1000/521520
Contr actor i s a: ( ch eck al l th at appl y)
Cor por ati on: Cal i f., Oth er , LLC, Non-pr ofi t
Par tner s h i p: Cal i f., __ Oth er , LLP, Li mi ted
Per s on: X Indi v., Dba, As s n Oth er
EDD: Independent Contr actor Wor ks h eet Requi r ed: X Yes No
HIPAA: Sch edul e of Requi r ed Pr ovi s i ons ( Exh i bi t D) : X Yes No
ATTACHMENTS
Des i g nate al l r equi r ed attach ments :
Req'd Not Req'd
Exh i bi t A: Sch edul e of Ser vi ces ( Pr ovi ded by Contr actor ) X _ ___
Exh tbl t B: Sch edul e of Ch ar g es and Payments ( Pai d by County) X
Exh i bi t C: Sch edul e of Ch ang es ( Addi ti ons , Del eti ons &Amendments ) X
Exh i bi t D: Sch edul e of NIPAA Pr ovi s i ons ( Pr otected Heal th Infor mati on) X
EI As kar l —PEI PSK Contr actor appr oves th i s pag e_
Pag e 1 of fi
r
Terms
Each term of thi s Contract below sp eci fi cally i ncorp orates the i nformati on set forth i n the Summary at p age
one (1) above as to each resp ecti ve secti on (§) therei n, as the case may be.
Servi ces
1. Scop e of Servi ces:
Contractor shall p rovi d e all of the servi ces, materi als and p rod ucts (herei n "Servi ces") generally d escri bed
i n Exhi bi t "A", accord i ng to a p erformance sched ule, i f ap p li cable, as set forth i n sai d exhi bi t (herei n "Performance
Sched ule") . I f requested , Contractor agrees to serve as an exp ert wi tness for County i n any thi rd p arty acti on or
p roceed i ng ari si ng out of thi s Contract.
Pay ment
2. Charges and Pay ments:
The charges (herei n "Charges") for furni shi ng the aforesai d Servi ces und er thi s Contract are set forth i n
Exhi bi t "B", i nclud i ng, i f ap p li cable, hourly rates, uni t p ri ci ng, and exp ense, mi leage and cost li mi ts. Sai d Charges
shall be p resented monthly by i nvoi ce, and shall be d ue wi thi n thi rty (30) d ay s of recei p t unless p ay ment i s othernri se
set forth i n sai d Exhi bi t "B", and shall remai n i n effect for the enti re term of thi s Contract, and any extensi on hereof.
I n no event wi ll the cost to County for Servi ces to be p rovi d ed und er thi s Contract, i nclud i ng d i rect non- salary
exp enses, exceed the Maxi mum Contract Pri ce set forth at §2, p age one (1), above.
Ti me for Performance
3. Contract Term:
Thi s Contract shall commence on the Contract Begi nni ng Date set forth at §3, p age one (1), above. All
Servi ces requi red to be p rovi d ed by thi s Contract shall be comp leted and read y for accep tance no later than the
Contract Termi nati on Date set forth at §3, p age one (1), above.
4. Li qui d ated Damages:
County and Contractor agree that d amages to County d ue to d elay s i n ti mely p rovi d i ng Servi ces i n
accord ance wi th the aforesai d Performance Sched ule and Contract Termi nati on Date are i mp racti cal and d i ffi cult to
ascertai n. Therefore, i f §4 at p age one (1) hereof shall i nd i cate a d ai ly amount as Li qui d ated Damages, County
shall have the ri ght to assess sai d d ai ly sum, not as a p enalty , but as and for d amages to County d ue to d elay s i n
p rovi d i ng Servi ces not i n accord ance wi th the sai d Performance Sched ule, or later than the Contract Termi nati on
Date (herei n "Delay"). Li qui d ated Damages shall be offset agai nst amounts owi ng to Contractor, i nclud i ng retenti on
sums.
To the extent that any Delay i s a result of matters or ci rcumstances wholly bey ond the control of Contractor,
County may excuse sai d Li qui d ated Damages; p rovi d ed however, that County may cond i ti on such excuse up on
Contractor havi ng gi ven p romp t noti ce to County of such d elay i mmed i ately by telep hone and thereafter by wri tten
exp lanati on wi thi n a reasonable ti me. The ti me for Contractor' s p erformance shall be extend ed by the p eri od of
d elay , or such other p eri od as County may elect.
5. Ti me of the Essence:
Ti me i s of the essence wi th resp ect to Contractor' s p erformance und er thi s Contract. Delay i n meeti ng the
ti me commi tments contemp lated herei n wi ll result i n the assessment of li qui d ated d amages, i f i nd i cated at §4 at
p age one (1), hereof. I f Li qui d ated Damages are not so i nd i cated , d amages shall be as otherwi se p rovi d ed by law.
I nsurance
6. Commerci al General Li abi li ty I nsurance: (County R esoluti on No. 90674)
I f §6 at p age one (1) hereof shall i nd i cate a Commerci al General Li abi li ty i nsurance p oli cy i s requi red ,
Contractor shall p romp tly p rovi d e p roof of such i nsurance evi d enced by a certi fi cate of i nsurance wi th p rop erly
executed end orsements attached , whi ch i nsurance shall i nclud e the followi ng:
(i ) Broad form coverage for li abi li ty for d eath or bod i ly i nj ury to a p erson or p ersons,
and for p rop erty d amage, combi ned si ngle li mi t coverage, i n the mi ni mum amount
i nd i cated at sai d §6;
(i i ) An end orsement nami ng County as an ad d i ti onal i nsured und er sai d p oli cy , wi th
resp ect to clai ms or sui ts ari si ng from the Servi ces p rovi d ed or the relati onshi p s created
und er thi s Contract;
(i i i ) A p rovi si on that sai d i nsurance shall be p ri mary and other i nsurance mai ntai ned
by the County of Nevad a shall be excess only and not contri buti ng wi th Contractor' s
i nsurance;
~ ~ , ,
EI Ask ari —PEI PSK Contractor ap p roves thi s p age (~
Page 2 of 6
( i v ) A p r o v i s i o n t h a t s a i d i n s ur a n ce s h a l l p r o v i d e f o r t h i r t y ( 30) d a y s w r i t t en n o t i ce t o
Co un t y o f a n y t er m i n a t i o n o r ch a n ge i n co v er a ge p r o t ect i o n , o r r ed uct i o n i n co v er a ge
l i m i t s ( excep t t en ( 10) d a y s n o t i ce f o r n o n -p a y m en t o f p r em i um ) .
7. Aut o m o bi l e L i a bi l i t y In s ur a n ce: ( Co un t y R es o l ut i o n No . 90676)
If §7 a t p a ge o n e ( 1) h er eo f s h a l l r eq ui r e ei t h er a Bus i n es s R a t ed o r a Co m m er ci a l Aut o m o bi l e L i a bi l i t y
i n s ur a n ce p o l i cy , f o r ea ch v eh i cl e us ed i n cl ud i n g n o n - o w n ed a n d h i r ed a ut o m o bi l es , Co n t r a ct o r s h a l l p r o m p t l y
p r o v i d e p r o o f o f s uch i n s ur a n ce ev i d en ced by a cer t i f i ca t e o f i n s ur a n ce w i t h p r o p er l y execut ed en d o r s em en t s
a t t a ch ed , w h i ch i n s ur a n ce s h a l l i n cl ud e t h e f o l l o w i n g p r o v i s i o n s :
( i ) L i a bi l i t y p r o t ect i o n f o r d ea t h o r bo d i l y i n j ur y t o a p er s o n o r p er s o n s , p r o p er t y
d a m a ge, a n d un i n s ur ed a n d un d er i n s ur ed co v er a ge, co m bi n ed s i n gl e l i m i t co v er a ge, i n
t h e m i n i m um a m o un t i n d i ca t ed a t s a i d §7;
( i i ) An en d o r s em en t n a m i n g Co un t y a s a n a d d i t i o n a l i n s ur ed un d er s a i d p o l i cy , w i t h
r es p ect t o cl a i m s o r s ui t s a r i s i n g f r o m t h e Ser v i ces p r o v i d ed o r t h e r el a t i o n s h i p s cr ea t ed
un d er t h i s Co n t r a ct ;
( i i i ) A p r o v i s i o n t h a t s a i d i n s ur a n ce s h a l l be p r i m a r y a n d o t h er i n s ur a n ce m a i n t a i n ed
by t h e Co un t y o f Nev a d a s h a l l be exces s o n l y a n d n o t co n t r i but i n g w i t h Co n t r a ct o r ' s
i n s ur a n ce;
( i v ) A p r o v i s i o n t h a t s a i d i n s ur a n ce s h a l l p r o v i d e f o r t h i r t y ( 30) d a y s w r i t t en n o t i ce t o
Co un t y o f a n y t er m i n a t i o n o r ch a n ge i n co v er a ge p r o t ect i o n , o r r ed uct i o n i n co v er a ge
l i m i t s ( excep t t en ( 10) d a y s n o t i ce f o r n o n-p a y m en t o f p r em i um ) .
If §7 a t p a ge o n e ( 1) h er eo f s h a l l r eq ui r e a Per s o n a l Aut o p o l i cy , f o r ea ch v eh i cl e us ed i n cl ud i n g n o n- o w n ed
a n d h i r ed a ut o m o bi l es , Co n t r a ct o r s h a l l p r o m p t l y p r o v i d e p r o o f o f s uch i n s ur a n ce f o r a m i n i m um o f t h r ee h un d r ed
t h o us a n d d o l l a r s , ( $300, 000) , i n co m bi n ed s i n gl e l i m i t s , a n d n a m i n g t h e Co un t y a s a d d i t i o n a l l y i n s ur ed .
8. Wo r ker ' s Co m p en s a t i o n : ( Co un t y R es o l ut i o n No . 90674)
If §8 a t p a ge o n e ( 1) h er eo f s h a l l i n d i ca t e a Wo r ker ' s Co m p en s a t i o n i n s ur a n ce p o l i cy i s r eq ui r ed ,
Co n t r a ct o r s h a l l m a i n t a i n s a i d p o l i cy a s r eq ui r ed by l a w , a n d s h a l l p r o m p t l y p r o v i d e p r o o f o f s uch i n s ur a n ce
ev i d en ced by a cer t i f i ca t e o f i n s ur a n ce, o r o t h er d o cum en t a t i o n a ccep t a bl e t o Co un t y .
Bef o r e co m m en ci n g t o ut i l i z e em p l o y ees i n p r o v i d i n g Ser v i ces un d er t h i s Co n t r a ct , Co n t r a ct o r w a r r a n t s t h a t
i t w i l l co m p l y w i t h t h e p r o v i s i o n s o f t h e Ca l i f o r n i a L a bo r Co d e, r eq ui r i n g Co n t r a ct o r t o be i n s ur ed f o r w o r ker ' s
co m p en s a t i o n l i a bi l i t y o r t o un d er t a ke a p r o gr a m o f s el f -i n s ur a n ce t h er ef o r .
9. Er r o r s a n d Om i s s i o n s :
If §9 a t p a ge o n e ( 1) h er eo f s h a l l i n d i ca t e Er r o r s a n d Om i s s i o n s i n s ur a n ce i s r eq ui r ed , Co n t r a ct o r s h a l l
m a i n t a i n ei t h er a p r o f es s i o n a l l i a bi l i t y o r er r o r s &o m i s s i o n s p o l i cy i n t h e m i n i m um a m o un t i n d i ca t ed , a n d s h a l l
p r o m p t l y p r o v i d e p r o o f o f s uch i n s ur a n ce ev i d en ced by a cer t i f i ca t e o f i n s ur a n ce, o r o t h er d o cum en t a t i o n a ccep t a bl e
t o Co un t y .
10. Mi s cel l a n eo us In s ur a n ce Pr o v i s i o n s : ( Co un t y R es o l ut i o n No . 90675)
Al l p o l i ci es o f i n s ur a n ce r eq ui r ed by t h i s Co n t r a ct s h a d r em a i n i n f ul l f o r ce a n d ef f ect t h r o ugh o ut t h e l i f e o f
t h i s Co n t r a ct a n d s h a l l be p a y a bl e o n a "p er o ccur r en ce" ba s i s un l es s Co un t y s p eci f i ca l l y co n s en t s t o "cl a i m s m a d e"
co v er a ge. If t h e Co un t y d o es co n s en t t o "cl a i m s m a d e" co v er a ge a n d i f Co n t r a ct o r ch a n ges i n s ur a n ce ca r r i er s
d ur i n g t h e t er m o f t h i s Co n t r a ct o r a n y ext en s i o n s h er eo f , t h en Co n t r a ct o r s h a l l ca r r y p r i o r a ct s co v er a ge.
In s ur a n ce a f f o r d ed by t h e a d d i t i o n a l i n s ur ed en d o r s em en t s h a l l a p p l y a s p r i m a r y i n s ur a n ce, a n d o t h er
i n s ur a n ce m a i n t a i n ed by Co un t y , i t s o f f i cer s , a gen t s a n d / o r em p l o y ees , s h a l l be exces s o n l y a n d n o t co n t r i but i n g
w i t h i n s ur a n ce r eq ui r ed o r p r o v i d ed un d er t h i s a gr eem en t .
At a l l t i m es , Co n t r a ct o r s h a l l keep a n d m a i n t a i n i n f ul l f o r ce a n d ef f ect t h r o ugh o ut t h e d ur a t i o n o f t h i s
Co n t r a ct , p o l i ci es o f i n s ur a n ce r eq ui r ed by t h i s Co n t r a ct w h i ch p o l i ci es s h a l l be i s s ued by co m p a n i es w i t h a Bes t s
R a t i n g o f B+ o r h i gh er ( B+, g++, A- , A, A+ o r A++) , o r a Bes t s F i n a n ci a l Per f o r m a n ce R a t i n g ( F PR ) o f 6 o r h i gh er ( 6,
7, 8 o r 9) a cco r d i n g t o t h e cur r en t Bes t s Key R a t i n g Gui d e, o r s h a l l be i s s ued by co m p a n i es a p p r o v ed by t h e Co un t y
R i s k Ma n a ger . In t h e ev en t t h e Bes t s R a t i n g o r Bes t s F PR s h a l l f a l l bel o w t h e r a t i n g r eq ui r ed by t h i s p a r a gr a p h ,
Co n t r a ct o r s h a l l be r eq ui r ed t o f o r t h w i t h s ecur e a l t er n a t e p o l i ci es w h i ch co m p l y w i t h t h e r a t i n g r eq ui r ed by t h i s
p a r a gr a p h , o r h e i n m a t er i a l br ea ch o f t h i s Co n t r a ct .
F a i l ur e t o p r o v i d e a n d m a i n t a i n t h e i n s ur a n ce p o l i ci es ( i n cl ud i n g Bes t s r a t i n gs ) , en d o r s em en t s , o r
cer t i f i ca t es o f i n s ur a n ce r eq ui r ed by t h i s Co n t r a ct s h a l l co n s t i t ut e a m a t er i a l br ea ch o f t h i s a gr eem en t ( h er ei n
"Ma t er i a l Br ea ch ") ; a n d , i n a d d i t i o n t o a n y o t h er r em ed y a v a i l a bl e a t l a w o r o t h er w i s e, s h a l l s er v e a s a ba s i s up o n
w h i ch Co un t y m a y el ect t o s us p en d p a y m en t s h er eun d er , o r t er m i n a t e t h i s Co n t r a ct , o r bo t h . ( See §13, ¶2, bel o w ,
a s t h es e p r o v i s i o n s a d d i t i o n a l l y a p p l y t o s ubco n t r a ct o r s .)
11. In d em n i t y :
No t h i n g h er ei n s h a l l be co n s t r ued a s a l i m i t a t i o n o f Co n t r a ct o r ' s l i a bi l i t y , a n d Co n t r a ct o r s h a l l i n d em n i f y ,
d ef en d a n d h o l d h a r m l es s t h e Co un t y a n d i t s o f f i cer s , o f f i ci a l s , em p l o y ees , a gen t s a n d v o l un t eer s f r o m a n y
a ~
EI As ka r i —PEI PSK
~ Co n t r a ct o r a p p r o v es t h i s p a ge_
Pa ge 3 o f 6
l i a b i l i t i e s , c l a i m s , de m a nds , da m a ge s , l os s e s a nd e xpe ns e s ( i nc l u di ng, w i t h ou t l i m i t a t i on, de fe ns e c os t s a nd a t t or ne y
fe e s of l i t i ga t i on) w h i c h r e s u l t fr om t h e ne gl i ge nt a c t , w i l l fu l m i s c ondu c t , or e r r or or om i s s i on of C ont r a c t or , e xc e pt
s u c h l os s or da m a ge w h i c h w a s c a u s e d b y t h e s ol e ne gl i ge nc e or w i l l fu l m i s c ondu c t of C ou nt y or i t s offi c e r s ,
offi c i a l s , e m pl oy e e s , a ge nt s a nd v ol u nt e e r s .
Pe r s ona l Se r v i c e s
12. C ont r a c t or a s Inde pe nde nt :
In pr ov i di ng s e r v i c e s h e r e i n, C ont r a c t or , a nd t h e a ge nt s a nd e m pl oy e e s t h e r e of, s h a l l a c t i n a n i nde pe nde nt
c a pa c i t y a nd a s a n i nde pe nde nt c ont r a c t or a nd not a s a ge nt s or e m pl oy e e s of C ou nt y .
13. As s i gnm e nt a nd Su b c ont r a c t i ng:
Exc e pt a s s pe c i fi c a l l y pr ov i de d h e r e i n, t h e r i gh t s , r e s pons i b i l i t i e s , du t i e s a nd Se r v i c e s t o b e pe r for m e d
u nde r t h i s C ont r a c t a r e pe r s ona l t o t h e C ont r a c t or a nd m a y not b e t r a ns fe r r e d, s u b c ont r a c t e d, or a s s i gne d w i t h ou t
t h e pr i or w r i t t e n c ons e nt of C ou nt y . C ont r a c t or s h a l l not s u b s t i t u t e nor r e pl a c e a ny pe r s onne l for t h os e s pe c i fi c a l l y
na m e d h e r e i n or i n i t s pr opos a l w i t h ou t t h e pr i or w r i t t e n c ons e nt of C ou nt y .
C ont r a c t or s h a l l c a u s e a nd r e q u i r e e a c h t r a ns fe r e e , s u b c ont r a c t or a nd a s s i gne e t o c om pl y w i t h t h e
i ns u r a nc e pr ov i s i ons s e t for t h h e r e i n a t §§6, 7, 8, 9 a nd 10, t o t h e e xt e nt s u c h i ns u r a nc e pr ov i s i ons a r e r e q u i r e d of
C ont r a c t or u nde r t h i s C ont r a c t . F a i l u r e of C ont r a c t or t o s o c a u s e a nd r e q u i r e s u c h c om pl i a nc e b y e a c h t r a ns fe r e e ,
s u b c ont r a c t or a nd a s s i gne e s h a l l c ons t i t u t e a M a t e r i a l Br e a c h of t h i s a gr e e m e nt , a nd, i n a ddi t i on t o a ny ot h e r
r e m e dy a v a i l a b l e a t l a w or ot h e r w i s e , s h a l l s e r v e a s a b a s i s u pon w h i c h C ou nt y m a y e l e c t t o s u s pe nd pa y m e nt s
h e r e u nde r , or t e r m i na t e t h i s C ont r a c t , or b ot h .
14. Li c e ns i ng a nd Pe r m i t s :
C ont r a c t or w a r r a nt s ( i ) C ont r a c t or i s q u a l i fi e d a nd c om pe t e nt t o pr ov i de a l l Se r v i c e s u nde r t h i s c ont r a c t ; ( i i )
C ont r a c t or a nd a l l e m pl oy e e s of C ont r a c t or h ol d a l l ne c e s s a r y a nd a ppr opr i a t e l i c e ns e s t h e r e for , i nc l u di ng t h os e
l i c e ns e s s e t for t h a t §14, pa ge one ( 1) h e r e of; a nd, ( i i i ) C ont r a c t or s h a l l ob t a i n, a nd r e m a i n i n c om pl i a nc e w i t h , a l l
pe r m i t s ne c e s s a r y a nd a ppr opr i a t e t o pr ov i de s a i d Se r v i c e s . C ont r a c t or s h a l l c a u s e s a i d l i c e ns e s a nd pe r m i t s t o b e
m a i nt a i ne d t h r ou gh ou t t h e l i fe of t h i s C ont r a c t . F a i l u r e t o do s o s h a l l c ons t i t u t e a M a t e r i a l Br e a c h of t h i s a gr e e m e nt ,
a nd, i n a ddi t i on t o a ny ot h e r r e m e dy a v a i l a b l e a t l a w or ot h e r w i s e , s h a l l s e r v e a s a b a s i s u pon w h i c h C ou nt y m a y
e l e c t t o s u s pe nd pa y m e nt s h e r e u nde r , or t e r m i na t e t h i s C ont r a c t , or b ot h .
Pu b l i c C ont r a c t s
15. Pr e v a i l i ng Wa ge a nd Appr e nt i c e s :
To t h e e xt e nt m a de a ppl i c a b l e b y l a w , pe r for m a nc e of t h i s c ont r a c t s h a l l b e i n c onfor m i t y w i t h t h e pr ov i s i ons
of C a l i for ni a La b or C ode , D i v i s i on 2, Pa r t 7, C h a pt e r 1, c om m e nc i ng w i t h Se c t i on 1720 r e l a t i ng t o pr e v a i l i ng w a ge s
w h i c h m u s t b e pa i d t o w or ke r s e m pl oy e d on a pu b l i c w or k a s de fi ne d i n La b or C ode §§ 1720, e t s e q . ; a nd s h a l l b e i n
c onfor m i t y w i t h Ti t l e 8 of t h e C a l i for ni a C ode of Re gu l a t i ons §§ 200 e t s e q . , r e l a t i ng t o a ppr e nt i c e s h i p. C ont r a c t or
s h a l l c om pl y w i t h t h e pr ov i s i ons t h e r e of a t t h e c om m e nc e m e nt of Se r v i c e s t o b e pr ov i de d h e r e i n, a nd t h e r e a ft e r
du r i ng t h e t e r m of t h i s C ont r a c t . A b r e a c h of t h e r e q u i r e m e nt s of t h i s s e c t i on s h a l l b e de e m e d a m a t e r i a l b r e a c h of
t h i s c ont r a c t A c opy of t h e r e l e v a nt pr e v a i l i ng w a ge a s de fi ne d i n La b or C ode §1770 e t s e q . i s on fi l e w i t h t h e
D e pa r t m e nt of Tr a ns por t a t i on, C ou nt y of Ne v a da , 950 M a i du Av e nu e , Ne v a da C i t y , C a l i for ni a 95959. C opi e s w i l l b e
pr ov i de d u pon r e q u e s t .
16. Ac c e s s i b i l i t y ( C ou nt y Re s ol u t i on No. 00190) :
It i s t h e pol i c y of t h e C ou nt y of Ne v a da t h a t a l l C ou nt y s e r v i c e s , pr ogr a m s , m e e t i ngs , a c t i v i t i e s a nd fa c i l i t i e s
s h a l l b e a c c e s s i b l e t o a l l pe r s ons , a nd s h a l l b e i n c om pl i a nc e w i t h t h e pr ov i s i ons of t h e Am e r i c a ns Wi t h D i s a b i l i t i e s
Ac t a nd Ti t l e 24, C a l i for ni a C ode of Re gu l a t i ons . To t h e e xt e nt t h i s C ont r a c t s h a l l c a l l for C ont r a c t or t o pr ov i de
C ou nt y c ont r a c t e d s e r v i c e s di r e c t l y t o t h e pu b l i c , C ont r a c t or s h a l l c e r t i fy t h a t s a i d di r e c t Se r v i c e s a r e a nd s h a l l b e
a c c e s s i b l e t o a l l pe r s ons .
17. Nondi s c r i m i na t or y Em pl oy m e nt :
In pr ov i di ng Se r v i c e s h e r e u nde r , C ont r a c t or s h a l l not di s c r i m i na t e a ga i ns t a ny e m pl oy e e or a ppl i c a nt for
e m pl oy m e nt b e c a u s e of r a c e , c ol or , r e l i gi on, a ge , s e x, na t i ona l or i gi n, pol i t i c a l a ffi l i a t i on, a nc e s t r y , m a r i t a l s t a t u s or
di s a b i l i t y . Th i s pol i c y doe s not r e q u i r e t h e e m pl oy m e nt of u nq u a l i fi e d pe r s ons .
18. Pr i or Ne v a da C ou nt y Em pl oy m e nt ( C ou nt y Re s ol u t i on No. 03- 353) :
Effe c t i v e J u l y 22, 2003, i t i s t h e pol i c y of t h e C ou nt y of Ne v a da t h a t for m e r m e m b e r s of t h e Boa r d of
Su pe r v i s or s , a for m e r C EO, or a for m e r Pu r c h a s i ng Age nt , for a pe r i od of t w e l v e ( 12) m ont h s fol l ow i ng t h e l a s t da y
of e m pl oy m e nt , s h a l l not e nt e r i nt o a ny r e l a t i ons h i p w h e r e i n t h a t for m e r e m pl oy e e or for m e r Boa r d m e m b e r r e c e i v e s
di r e c t r e m u ne r a t i on fr om a l e ga l e nt i t y t h a t , du r i ng t h e l a s t t w e l v e ( 12) m ont h s of s a i d e m pl oy m e nt or Boa r d
m e m b e r 's s e r v i c e , e nt e r e d i nt o a c ont r a c t w i t h , or r e c e i v e d a gr a nt fr om t h e C ou nt y of Ne v a da . Pr ov i de d h ow e v e r ,
t h a t t h i s pr oh i b i t i on s h a l l not a ppl y t o a ny e m pl oy e e t h a t di d not pe r s ona l l y a ppr ov e a c ont r a c t w i t h or gr a nt t o s a i d
l e ga l e nt i t y du r i ng t h e l a s t t w e l v e ( 12) m ont h s of s a i d e m pl oy m e nt , a nd s h a l l not a ppl y w h e n t h e Boa ~~~~
EI As ka r i —PEI PSK ~ C ont r a c t or a ppr ov e s t h i s pa ge
Pa ge 4 of 6
Supervisors d id n ot approve a c on t ac t w it h or g ran t t o said l eg al en t it y d urin g t h e l ast t w el ve (12) mon t h s of said
Board member's servic e.
A viol at ion of t h is pol ic y sh al l subj ec t C on t rac t or t o al l of t h e remed ies en umerat ed in said resol ut ion an d as
ot h erw ise provid ed in l aw , w h ic h remed ies sh al l in c l ud e but n ot be l imit ed t o in j un c t ive rel ief , c an c el l at ion an d void in g
of t h is c on t rac t by C oun t y , a ret urn of g ran t mon ey , a c ause of ac t ion f or breac h of c on t rac t , an d en t it l emen t t o c ost s
an d reason abl e at t orn ey f ees in an y ac t ion based upon a breac h of c on t rac t un d er t h is provision .
19. C ost Disc l osure:
I n ac c ord an c e w it h Govern men t C od e Sec t ion 7550, sh oul d a w rit t en report be prepared un d er or req uired
by t h e provision s of t h is C on t rac t , C on t rac t or ag rees t o st at e in a separat e sec t ion of said report t h e n umbers an d
d ol l ar amoun t s of al l c on t rac t s an d subc on t rac t s rel at in g t o t h e preparat ion of said report
Def aul t an d Termin at io
20. Termin at ion :
A M at erial Breac h of t h is C on t rac t pursuan t t o t h e t erms h ereof or ot h erw ise, in ad d it ion t o an y ot h er
remed y avail abl e at l aw or ot h erw ise, sh al l serve as a basis upon w h ic h C oun t y may el ec t t o immed iat el y suspen d
pay men t s h ereun d er, or t ermin at e t h is c on t rac t , or bot h , w it h out n ot ic e.
I f C on t rac t or f ail s t o t imel y provid e in an y man n er t h e servic es mat erial s an d prod uc t s req uired un d er t h is
C on t rac t , or ot h erw ise f ail s t o prompt l y c ompl y w it h t h e t erms of t h is C on t rac t , or viol at es an y ord in an c e, reg ul at ion
or ot h er l aw w h ic h appl ies t o it s perf orman c e h erein , C oun t y may t ermin at e t h is C on t rac t by g ivin g f ive (5) d ay s
w rit t en n ot ic e t o C on t rac t or.
E it h er part y may t ermin at e t h is C on t rac t f or an y reason , or w it h out c ause, by g ivin g t h irt y (30) c al en d ar
d ay s w rit t en n ot ic e t o t h e ot h er, w h ic h n ot ic e sh al l be sen t by reg ist ered mail in c on f ormit y w it h t h e n ot ic e
provision s, bel ow . I n t h e even t of t ermin at ion n ot t h e f aul t of t h e C on t rac t or, t h e C on t rac t or sh al l be paid f or servic es
perf ormed t o t h e d at e of t ermin at ion in ac c ord an c e w it h t h e t erms of t h is C on t rac t . C on t rac t or sh al l be exc used f or
f ail ure t o perf orm servic es h erein if suc h perf orman c e is preven t ed by ac t s of God , st rik es, l abor d isput es or ot h er
f orc es over w h ic h t h e C on t rac t or h as n o c on t rol .
C oun t y , upon g ivin g sixt y (60) c al en d ar d ay s w rit t en n ot ic e t o C on t rac t or, sh al l h ave t h e rig h t t o t ermin at e
it s obl ig at ion s un d er t h is C on t rac t at t h e en d of an y f isc al y ear if t h e C oun t y or t h e St at e of C al if orn ia, as t h e c ase
may be, d oes n ot appropriat e f un d s suf f ic ien t t o d isc h arg e C oun t y 's obl ig at ion s c omin g d ue un d er t h is c on t rac t .
M isc el l an eous
21. Book s of Rec ord an d Aud it Provision :
C on t rac t or sh al l main t ain c ompl et e rec ord s rel at in g t o t h is C on t rac t f or a period of f ive (5) y ears f rom t h e
c ompl et ion of Servic es h ereun d er. Said rec ord s sh al l in c l ud e but n ot be l imit ed t o bid s an d al l support in g
d oc umen t s, orig in al en t ry book s, c an c el ed c h ec k s, rec eipt s, in voic es, pay rol l rec ord s in c l ud in g subsist en c e, t ravel
an d f iel d expen ses, t og et h er w it h a g en eral l ed g er it emiz in g al l d ebit s an d c red it s
C on t rac t or sh al l permit C oun t y t o aud it said rec ord s as w el l as suc h rel at ed rec ord s of an y busin ess en t it y
c on t rol l ed by C on t rac t or. Said aud it may be c on d uc t ed on C on t rac t or's premises or at a l oc at ion d esig n at ed by
C oun t y , upon f if t een (15) d ay s n ot ic e. C on t rac t or sh al l prompt l y ref un d an y mon ey s erron eousl y c h arg ed an d sh al l
be l iabl e f or t h e c ost s of aud it if t h e aud it est abl ish es an over-c h arg ed of f ive perc en t (5%) or more of t h e M aximum
C on t rac t Pric e.
22. I n t el l ec t ual Propert y :
Al l orig in al ph ot og raph s, d iag rams, pl an s, d oc umen t s, in f ormat ion , report s, c omput er c od e an d al l
rec ord abl e med ia t og et h er w it h al l c opy rig h t in t erest s t h eret o (h erein " I n t el l ec t ual Propert y '), w h ic h c on c ern or rel at e
t o t h is C on t rac t an d w h ic h h ave been prepared by , f or or submit t ed t o C on t rac t or, sh al l be t h e propert y of C oun t y ,
an d upon f if t een (15) d ay s d eman d t h eref or, sh al l be prompt l y d el ivered t o C oun t y w it h out exc ept ion . Provid ed
h ow ever, f or person al purposes on l y an d n ot f or c ommerc ial , ec on omic or an y ot h er purpose, C on t rac t or may ret ain
a c opy of C on t rac t or's w ork prod uc t h ereun d er.
23. E n t ire Ag reemen t :
T" is C on t rac t represen t s t re en t ire ag reemen t of t h e pa~ iies, an t i i~ o represen t at ion s n ave been mad e or
rel ied upon exc ept as set f ort h h erein . Th is C on t rac t may be amen d ed or mod if ied on l y by w rit t en , f ul l y exec ut ed
ag reemen t of t h e part ies.
24. J urisd ic t ion an d Ven ue:
Th is C on t rac t sh al l be c on st rued in ac c ord an c e w it h t h e l aw s of t h e St at e of C al if orn ia an d t h e part ies
h eret o ag ree t h at ven ue sh al l be in Nevad a C oun t y , C al if orn ia.
E I Ask ari —PE I PSK
~ C on t rac t or approves t h is pag e ~ ~
Pag e 5 of 6
25. Compliance with Applicable Laws:
The Contr actor shall comply with any and all f eder al, state and local laws, codes, or dinances, r u les and
r eg u lations which r elate to, concer n of af f ect the Ser vices to be pr ovided by this Contr act.
26. Notices:
This Contr act shall be manag ed and administer ed on Cou nty's behalf by the depar tment and the per son set
f or th at §26, pag e one (1) of this Contr act, and all invoices shall be su bmitted to and appr oved by this Depar tment.
I n addition to per sonal ser vice, all notices may be g iven to Cou nty and to Contr actor by f ir st class mail addr essed as
set f or th at said §26 Said notices shall be deemed r eceived the f if th (5th) day f ollowing the date of mailing or the
ear lier date of per sonal ser vice, as the case may be.
27. Au thor ity:
Ali individu als execu ting this Contr act on behalf of Contr actor r epr esent and war r ant that they ar e
au thor iz ed to execu te and deliver this Contr act on behalf of Contr actor .
I N WI TNESS WHEREOF, the par ties have execu ted this Contr act ef f ective on the Beg inning Date, above.
CONTRALTO
Name: Gaen Ellis
Title: Consu ltant ~ , Z~ ,
Dated:
COUNTY OF NEVADA:
Honor able Ted S. Owens
Chair , Boar d of Su per visor s
Dated:
Attest:
Donna Landi
Cler k of the Boar d of Su per visor s
EI Ask ar i —PEI PSK Contr actor appr oves this pag e
Pag e 6 of 6
EXHIBIT "A"
SCHEDULE OF SERVICES
GALEN ELLIS, DB/A EL-ASKARI CONSULTING
This Agreement is entered into by and between the Co unty o f Nevad a, Department o f
Behavio ral Health, herein referred to as "Co unty", and Galen Ellis, d/b/a El-Askari
Co nsulting herein referred to as "Co ntracto r", fo r Co lumbia Teen Screen Services as a
co mpo nent o f the Co unty's Mental Health Services Act (MHSA) Preventio n and Early
Interventio n (PEI) Plan.
BACKGROUND:
Teen Screen Pro gram
Every co mmunity and scho o l ho pes to d evelo p a ro ad map fo r success o f all stud ents, and
it has beco me evid ent that scho o ls canno t fo cus so lely o n the acad emic success o f yo ung
peo ple. Bo th the physical and mental well-being o f a yo ung perso n have d irect
implicatio ns fo r that child 's ability to be pro d uctive as a stud ent and as a member o f the
scho o l and co mmunity. Embracing the co ncept o f the who le child has led scho o ls and
co mmunities to integrate systems that ad d ress the acad emic, so cial, and emo tio nal need s
o f teens.
Teen Screen Scho o ls and Co mmunities is a natio nal mental health and suicid e risk
screening pro gram fo r yo ung peo ple, ages 11 -18 . Nearly o ne millio n teens have been
o ffered a mental health checkup thro ugh mo re than 550 scho o ls and co mmunity sites
implementing Teen Screen acro ss the co untry. Teen Screen was d evelo ped by Co lumbia
University's Divisio n o f Child and Ad o lescent Psychiatry in respo nse to research
revealing that 90 percent o f yo uth who d ie by suicid e suffer fro m a d iagno sable mental
illness and that 63 percent experience sympto ms fo r at least a year prio r to their d eaths.
This stud y was amo ng the first to shatter the myth that suicid e is a rand o m and
unpred ictable event in yo uth. It also highlighted the fact that there is ample time to
intervene with at-risk yo uth and co nnect them with the mental health services that can
save their lives. Research revealed that Co lumbia Teen Screen effectively id entified at-
risk yo uth. It also sho wed that mo st o f the yo uth id entified thro ugh the screening were
no t previo usly kno wn to have had pro blems.
Nevad a Co unty Behavio ral Health has set the go al o f making vo luntary mental health
checkups available to all o f Nevad a Co unty's tenth grad ers and any o ther child o ver age
12 that the scho o ls and/o r parents refer.
DESCRIPTION OF SERVICES:
Co ntracto r shall establish a Pro j ect Team which will includ e the fo llo wing co re po sitio ns:
a Pro j ect Co o rd inato r, Clinical Co o rd inato r, and Case Manager (with j o b d uties d escribed
belo w).
In ad d itio n, El-Askari Co nsulting will also attempt to engage the services o f at least two
(2) o f the Co unty's Family Reso urce Centers fo r Spanish-language interpreting and
assistance in creating o ppo rtunities fo r o utreach in the Hispanic co mmunities in Grass
Valley and Truckee.
`~
~,
El-Askari Co nsulting EX ` Co ntracto r appro ves this page j
STAFFING:
1) Project Coordinator: The Project Coordinator w il l ov ers ee the adm inis trativ e and
f is cal du ties as s ociated w ith contracted s erv ices , incl u ding contract m anag em ent,
s u b contracting f or the Cl inical Coordinator and Cas e Manag er p os itions and as s u ring that
any and al l s u b contractors hav e and m aintain the ap p rop riate l ev el of ins u rance cov erag e,
incl u ding f or p erf orm ance of p rof es s ional s erv ices b y a l icens ed p rof es s ional
( m al p ractice) ins u rance of not l es s than $1, 000, 000 p er occu rrence, f is cal accou nting ,
ens u ring that p roject team m em b ers are p rop erl y trained, m eeting rep orting and q u al ity
as s u rance req u irem ents , and p rog ram ev al u ation.
2) Cl inical Coordinator: s hal l rev iew each s chool ' s Cris is Pl an and incorp orate that into
a w ritten p l an on w hat w il l b e done w hen a chil d is at ris k f or dang er to s el f or others .
This p l an w il l b e s hared w ith s chool adm inis trators , Cou nty B ehav ioral H eal th and Teen
Screen s taf f . Cl inical Coordinator s hal l :
V is it s chool s ites and coordinate w ith s chool of f icial s to g ain p rog ram b u y- in and
ap p rov al .
Ob tain p arental cons ent, ob tain as s ent f rom s creening p articip ants , receiv e s tu dent
ref erral s f or s chool of f icial s , and adm inis ter the Teen Screen q u es tionnaire.
Prov ide deb rief ing f or s tu dents w ho s core neg ativ e and cl inical interv iew s w ith s tu dents
w ho s core p os itiv e on the s creening q u es tionnaire. Determ ine w hether the you th w ou l d
b enef it f rom a ref erral f or f u rther ev al u ation.
In accordance w ith Teen Screen req u irem ents , cons u l t w ith f am il ies ab ou t s creening
res u l ts . Ref er s tu dents and p arents to Cas e Manag er f or f u rther as s is tance w ith
com m u nity ref erral s .
3) Cas e Manag er: s hal l v is it s chool s ited and coordinate w ith s chool of f icial s to g ain
p rog ram b u y- in and ap p rov al . Cas e Manag er s hal l :
Condu ct com m u nity ou treach.
Ob tain p arental cons ent, ob tain as s ent f rom s creening p articip ants , receiv e s tu dent
ref erral s f rom s chool of f icial s , and adm inis ter the Teen Screen q u es tionnaire.
Inf orm f am il ies of ref erral recom m endations and p rov ide as s is tance to p arents w ith
ob taining a com p l ete p os t-s creening ev al u ation.
Connect f am il ies w ith ap p rop riate m ental heal th ref erral s and heal th ins u rance, ens u ring
they are p rov ided acces s to res ou rces rel ated to their chil d' s m ental heal th.
Prov ide edu cational m aterial s reg arding m ental heal th is s u es to p arents .
Staf f w ho adm inis ter the cl inical interv iew p roces s m u s t b e l icens ed p rof es s ional s of the
heal ing arts w ith at l eas t tw o years of p os t-l icens u re ex p erience or a reg is tered intern w ith
the Cal if ornia B oard of B ehav ioral Sciences and s u p erv is ed b y a l icens ed p rof es s ional of
the heal ing arts . Staf f w il l condu ct the s creening b y ob taining p arent and p articip ant
as s ent, adm inis tering and s coring the s creening q u es tionnaires , deb rief ing you th w ho
E l - As k ari Cons u l ting E X 1` Contractor ap p rov es this p ag e ~ 2
s c o r e n e g a t i v e a n d p r o v i di n g i n t e r v i e w s (by C l i n i c a l C o o r di n a t o r ) f o r t h o s e w h o s c o r e
p o s i t i v e . S c r e e n i n g w i l l t a k e p l a c e o n a r e g u l a r ba s i s t h r o u g h o u t t h e ye a r by bo t h t h e
C l i n i c a l C o o r di n a t o r a n d C a s e Ma n a g e r . A v i t a l c o mp o n e n t o f t h e s c r e e n i n g i s t h e
i mp o r t a n t r o l e o f t a l k i n g t o f a mi l i e s a bo u t s c r e e n i n g r e s u l t s , h e l p i n g t o c o n n e c t i de n t i f i e d
t e e n s t o l o c a l me n t a l h e a l t h s e r v i c e s a n d t r a c k i n g da t a f o l l o w-u p r e c o r ds .
C o n t r a c t o r w i l l o f f e r s c r e e n i n g t o a l l t e n t h g r a de r s i n t h e Ne v a da C o u n t y s c h o o l s .
C o n t r a c t o r w i l l s c r e e n yo u t h o n p o r t a bl e l a p t o p s t h e c o n t r a c t o r w i l l o w n . Th e s e l a p t o p s
w i l l be p a s s w o r d p r o t e c t e d.
TEEN S C REEN PROGRAM PRINC IPLES :
C o n t r a c t o r s h a l l a s s u r e t h a t t h e y h a v e r e a d Th e "De v e l o p me n t Gu i de " o n
w w w . t e e n s c r e e n . o r ~ a n d w i l l c o mp l y w i t h s a i d p r o t o c o l . C o n t r a c t o r w i l l be r e s p o n s i bl e
f o r o n g o i n g c o mmu n i c a t i o n w i t h C o l u mbi a Te e n S c r e e n a n d u p da t i n g t h e e l e c t r o n i c
i n f o r ma t i o n C o l u mbi a Te e n S c r e e n n e e ds . C o n t r a c t o r mu s t c o mp l e t e t h e o n l i n e t r a i n i n g
c o u r s e a n d u s e a l l o f t h e C o l u mbi a Te e n S c r e e n f o r ms w h e n s c r e e n i n g .
THE S C REENING PROC ES S INVOLVES THE FOLLOWING S TAGES :
1 . Pa r e n t C o n s e n t
2. Pa r t i c i p a n t As s e n t
3 . S c r e e n i n g Q u e s t i o n n a i r e
4. C l i n i c a l/ De br i e f i n g In t e r v i e w
5. Pa r e n t No t i f i c a t i o n
In p r e p a r a t i o n t o i mp l e me n t , C o n t r a c t o r w i l l w o r k c l o s e l y w i t h Ne v a da C o u n t y
Be h a v i o r a l He a l t h a n d w i l l bu i l d c o mmu n i t y s u p p o r t f o r Te e n S c r e e n t o o u r c o mmu n i t y,
i n Ea s t e r n a n d We s t e r n Ne v a da C o u n t y. A c o mmi t t e e w i l l be c r e a t e d t o o v e r s e e t h e
i mp l e me n t a t i o n o f t h e p r o g r a m a n d t o o v e r s e e t h e p r o g r a m o n a n o n g o i n g ba s i s . S c h o o l
Admi n i s t r a t o r s , Ne v a da C o u n t y Be h a v i o r a l He a l t h , e du c a t o r s , h e a l t h p r o v i de r s , p a r e n t s
a n d yo u t h w i l l be o n t h e c o mmi t t e e .
C o n t r a c t o r a n d s u bc o n t r a c t o r s mu s t s u bmi t o r h a v e s u bmi t t e d t h e i r f i n g e r p r i n t l i v e s c a n
t o DOJ f o r c l e a r a n c e . C o n t r a c t o r mu s t c e r t i f y t h a t a n y i n di v i du a l w h o h a s mo r e t h a n
l i mi t e d c o n t a c t w i t h s t u de n t s h a v e n o a r r e s t s p e n di n g o r c o n v i c t i o n s o f a v i o l e n t o r
s e r i o u s f e l o n y p u r s u a n t t o Pe n a l C o de §§ 667. 5 a n d 1 1 92. 7.
C o n t r a c t o r mu s t c o mp l y w i t h a n y r e g u l a t i o n s s p e c i f i c t o p r o v i di n g s e r v i c e s w h i l e o n
s c h o o l s i t e p r e mi s e (s ) .
C o n t r a c t o r w i l l u l t i ma t e l y be r e s p o n s i bl e f o r t h e o v e r a l l i mp l e me n t a t i o n a n d s u c c e s s o f
i i i G S ~TC ~i i i i i ~ ~f i v 2`~. i i 2C C v i i i i u ~~v i Wl i i v C i 1 2C Yu v i i ~ l u ~~ C i i t i c S C P~. C i l i i i ~ Yi v ~i a i i i a i i u
s h o u l d be c a p a bl e o f s e e i n g t h e "bi g p i c t u r e " r e l a t e d t o c o mmu n i t y r e l a t i o n s a n d l o n g e r -
t e r m p r o g r a m e x p a n s i o n . C o n t r a c t o r w i l l be r e s p o n s i bl e f o r i n c r e a s i n g t h e p e r c e n t a g e o f
p a r e n t s w h o a l l o w f o r t h e i r c h i l dr e n t o be s c r e e n e d. C o n t r a c t o r w i l l c o n s t a n t l y do
c r e a t i v e o u t r e a c h a n d e n g a g e me n t w i t h t h e s c h o o l c o mmu n i t y, p a r e n t s a n d yo u t h .
C o n t r a c t o r w i l l w o r k c l o s e l y w i t h t h e c o u n t y o n t h i s o u t r e a c h a n d w i l l t u r n i n q u a r t e r l y
r e p o r t s s t a t i n g t h e i r e f f o r t s a t i n c r e a s i n g t h e p e r c e n t a g e o f s c r e e n e d yo u t h .
El -As k a r i C o n s u l t i n g EX ~ C o n t r a c t o r a p p r o v e s t h i s p a g e ~l " ~~ 3
IMPLEMENTATION OF COLUMBIA TEEN SCREEN: by following the steps below.
1 .1 Obtain wr itten appr oval fr om the pr inc ipal the su per intend ent of the sc hool wher e the
pr ogr am will be implemented
1 .2 Infor m the fac u lty and the sc hool' s par ent gr ou p (PTA, PTO) of the sc r eening plan. It
is impor tant that par ents and the sc hool c ommu nity ar e awar e of the pr ogr am.
1 .3 Par tner with loc al mental health and health ser vic e pr ovid er s, and c ompile a list of
those that ar e willing to ac c ept r efer r als fr om the sc r eening pr ogr am. Contr ac tor will
c r eate a r efer r al pac ket on mental health r esou r c e manu al to shar e with families that
par tic ipate in sc r eenings.
1 .4 Develop a wr itten plan for managing c r isis situ ations and r epor ting c ases of abu se.
Make su r e that the plan is c onsistent with the pr otoc ols of the sc hool in whic h you will be
sc r eening. Distr ibu te and r eview the plan with the sc r eening team and sc hool
ad ministr ator s/ or ganiz ation lead er ship so that ever yone knows what to d o in the event of
an emer genc y and when abu se is r evealed .
Rec or d Keeping: Contr ac tor shall follow all FERPA and Colu mbia Teen Sc r een
gu id elines.
Contr ac tor shall assu r e c omplianc e with all Teen Sc r een Pr ogr am Pr inc iples.
OUTREACH TO INCREASE PARENT CONSENT: In all the inter ac tions with the
sc hools, you th, par ents, and br oad er c ommu nity, Contr ac tor will emphasiz e the benefits
of pr evention and ear ly inter vention. Contr ac tor will d evelop c ommu nic ation str ategies to
help r ed u c e stigma, pr omote wellness, inc r ease soc ial su ppor t, and enc ou r age par ental
c onsent. Contr ac tor will implement a nu mber of ou tr eac h
Contr ac tor will per for m a pr ogr am evalu ation following MHSA gu id anc e and r epor t
evalu ation r esu lts q u ar ter ly and annu ally to the Pr ogr am Manager and the MHSA
Coor d inator .
Contr ac tor will r epor t aggr egate sc r eening r esu lts to the Colu mbia Teen Sc r een Pr ogr am
on an annu al basis, inc lu d ing an annu al q u ality assu r anc e q u estionnair e.
Ad d itionally, Contr ac tor shall be r esponsible for pr ovid ing:
1 . Q u ar ter ly Pr ogr ess Repor ts within 3 0 d ays of the end of eac h q u ar ter ;
2 . An Annu al Pr ogr ess Repor t within 3 0 d ays of the end of the fisc al year ;
3 . Any MHSA Pr ogr ess or Evalu ation Repor t that is r eq u ir ed , and or as may be
r eq u ested by the Cou nty. The Contr ac tor shall c ooper ate with the Cou nty for the
c ompilation of any d ata or infor mation for ser vic es r end er ed u nd er this
Agr eement as may be nec essar y for the Cou nty to c onfor m to MHSA PEI
r epor ting gu id elines.
El-Askar i Consu lting EX ~ ~ Contr ac tor appr oves this page 4
EXHIBIT "B"
SCHEDULE OF CHARGES AND PAYMENTS
GALEN ELLIS, D/B/A EL - ASKARI CONSULTING
County s h a l l pa y to Contr a c tor a ma ximum not to exc eed $185,000 f or th e entir e c ontr a c t
ter m, f or s a tis f a c tor y per f or ma nc e of s er v ic es in a c c or da nc e w ith Exh ib it "A".
As c ompens a tion f or s er v ic es r ender ed to County, Contr a c tor s h a l l b e r eimb ur s ed f or
a c tua l s a l a r y/b enef its a nd pr oj ec t c os ts inc ur r ed in c a r r ying out th e ter ms of th e c ontr a c t.
Contr a c tor s h a l l b il l County month l y, a nd ea c h inv oic e s h a l l s ta te th e a mount of
per s onnel h our s/b enef its a nd r eimb ur s ement expens es b eing c l a imed.
Contr a c tor a g r ees to b e r es pons ib l e f or th e v a l idity of a l l inv oic es .
Th e pr oj ec t ma ximum is b a s ed on th e f ol l ow ing es tima ted pr oj ec t c os ts :
10/9 /12 - 7 /1/13 - 7 /1/14 -
Pos ition 6/3 0/13 6/3 0/14 9 /3 0/14 Tota l
Pr oj ec t Coor dina tor $19 ,800 $10,000 $1,800 $3 1,600
Cl inic a l Coor dina tor 4 0,500 3 6,000 2 ,7 00 7 9 ,2 00
Ca s e Ma na g er 2 3 ,4 00 2 4 ,000 2 ,64 0 50,04 0
Tota l Sta f f Cos ts 83 ,7 00 7 0,000 7 ,14 0 160,84 0
Oth er Dir ec t Cos ts
La ptops (2 ) & IT s uppor t 2 ,000 - 2 ,000
Loc a l Mil ea g e (inc l uding Tr uc kee) 4 ,800 2 ,4 4 0 3 2 0 7 ,560
Of f ic e Expens es (s uppl ies , pr inting ,
r oom r enta l , c ommunic a tions , etc .) 3 ,2 00 2 ,000 - 5,2 00
Tr a ining 1,000 - - 1,000
Stipends f or FRC Pr omotor a s 3 ,600 4 ,800 - 8,4 00
Tota IODC 14 ,600 9 ,2 4 0 3 2 0 14 ,600
Tota l Pr o'ec t Cos ts $9 8,3 00 $7 9 ,2 4 0 $7 ,7 80 $185,000
Unexpended f unds not us ed dur ing th e pr ev ious f is c a l yea r under th is Contr a c t ma y b e
r ol l ed ov er b y th e depa r tment f or c ontr a c t s er v ic es pr ov iding dur ing th e next f is c a l yea r .
County s h a? ? r P~ > ; ew th e b il ? ~ r g a nd notif y ± h P c ontr a c tor ~ x~ i± h in f if teen (? 5; .x~ ~ r kir g da ys
if a n indiv idua l item or g r oup of c os ts is b eing q ues tioned. Contr a c tor h a s th e option of
del a ying th e entir e c l a im pending r es ol ution of th e c os t(s ). Pa yments of a ppr ov ed b il l ing
s h a l l b e ma de w ith in th ir ty (3 0) da ys of r ec eipt of a c ompl ete, c or r ec t, a nd a ppr ov ed
b il l ing .
To expedite pa yment, Contr a c tor s h a l l r ef er enc e th e Res ol ution Numb er a s s ig ned to h er
Contr a c t on ea c h inv oic e.
~ ~ ,
El - As ka r i Cons ul ting EX ~ ~ Contr a c tor a ppr ov es th is pa g e 5
C o n t r a c t o r s h a l l s ubmit in v o ic e s f o r s e r v ic e s t o :
Ne v a da C o un t y Be h a v io r a l He a l t h De pa r t me n t
A t t n : F is c a l S t a f f
500 C r o wn Po in t C ir c l e , S uit e 120
Gr a s s V a l l e y, C A 95945
E l -A s k a r i C o n s ul t in g E X / ~C o n t r a c t o r a ppr o v e s t h is pa g e 6
EXHIBIT "C"
SCHEDULE OF CHANGES
(Personal Services Cont ract - Ment al Healt h )
MENTAL HEALTH PROVISIONS
Wh ere Ex h ib it "C" revises t h e language in t h e Personal Services Cont ract , t h e p rovisions of Ex h ib it C sh all
govern and sup ersede any inconsist ent p rovisions.
Paragrap h 20, Term inat ion, is delet ed in it s ent iret y and rep laced w it h t h e f ollow ing:
"20. Term inat ion:
A Mat erial Breach of t h is Cont ract p ursuant t o t h e t erm s h ereof or ot h erw ise, in addit ion t o
any ot h er rem edy availab le at law , sh all serve as a b asis up on w h ich Count y m ay elect t o
im m ediat ely susp end p aym ent s h ereunder, or t erm inat e t h is cont ract , or b ot h w it h out
not ice.
if Cont ract or f ails t o t im ely p rovide in any m anner t h e services, m at erials and p roduct s
req uired under t h is Cont ract , or ot h erw ise f ails t o p rom p t ly com p ly w it h t h e t erm s of t h is
Cont ract , or violat es any ordinance, regulat ion or ot h er law w h ich ap p lies t o it s
p erf orm ance h erein, Count y m ay t erm inat e t h is Cont ract b y giving f ive (5) days w rit t en
not ice t o Cont ract or.
Count y, up on giving seven (7) calendar days w rit t en not ice t o Cont ract or, sh all h ave
t h e righ t t o t erm inat e it s ob ligat ions under t h is Cont ract if t h e Count y, t h e Federal
Governm ent or t h e St at e of Calif ornia, as t h e case m ay b e, does not ap p rop riat e f unds
suf f icient t o disch arge Count y's ob ligat ions com ing due under t h is cont ract .
Eit h er p art y m ay t erm inat e t h is Cont ract f or any reason, or w it h out cause, b y giving t h irt y
(30) calendar days w rit t en not ice t o t h e ot h er, w h ich not ice sh all b e sent b y regist ered
m ail in conf orm it y w it h t h e not ice p rovisions. In t h e event of t erm inat ion not t h e f ault of
t h e Cont ract or, t h e Cont ract or sh all b e p aid f or services p erf orm ed t o t h e dat e of
t erm inat ion in accordance w it h t h e t erm s of t h is Cont ract . Cont ract or sh all b e ex cused f or
f ailure t o p erf orm services h erein if such p erf orm ance is p revent ed b y act s of God,
st rik es, lab or disp ut es or ot h er f orces over w h ich t h e Cont ract or h as no cont rol.
Any not ice t o b e p rovided under t h is sect ion m ay b e given b y t h e Count y Ex ecut ive Of f icer
or Designee or Agency Direct or. "
2. Paragrap h 20. A, Susp ension, is h ereb y added t o read:
"20. A. Susp ension:
Count y, up on giving seven (7) calendar days w rit t en not ice t o Cont ract or, sh all h ave t h e
righ t t o susp end t h is Cont ract , in w h ole or in p art , f or any t im e p eriod as Count y deem s
necessary due t o delays in f ederal, st at e or Count y ap p rop riat ion of f unds, lack of dem and
f or services t o b e p rovided under t h is cont ract , or ot h er good cause. Up on receip t of a
not ice of susp ension f rom Count y, Cont ract or sh all im m ediat ely susp end or st op w ork as
direct ed b y Count y and sh all not resum e w ork unt il and unless Count y gives Cont ract or a
w rit t en not ice t o resum e w ork . In t h e event of a susp ension not t h e f ault of t h e
Cont ract or, Cont ract or sh all b e p aid f or services p erf orm ed t o t h e dat e of t h e not ice of
susp ension in accordance w it h t h e t erm s of t h is Cont ract .
EX C HHSA Personal Services Ment al Healt h Page 1 of 3 ~ " ` . ` t om Cont ract or ap p roves t h is p age
~ ~
Suspension of work pursuant to th is Paragraph sh al l not rel iev e th e C ontrac tor of oth er
l egal or c ontrac tual responsib il ities under th is C ontrac t.
Any notic e to b e prov ided under th is sec tion may b e giv en b y th e C ounty E x ec utiv e O ffic er
or Designee or Agenc y Direc tor. "
ME NTAL HE ALTH PRO VISIO NS
3 . Paragraph s 28 th rough 29 are h ereb y added to read as fol l ows:
" 28. C l ient/ Patient Rec ords:
a. HE ALTH RE C O RDS: Wh ere th is c ontrac t is for serv ic es rel ating to th e mental h eal th or
th e medic al needs or c ondition of c l ients or patients, C ontrac tor sh al l maintain adequate mental and/ or
medic al h eal th rec ords of eac h indiv idual c l ient/ patient wh ic h sh al l inc l ude a rec ord of serv ic es prov ided b y
th e v arious professional personnel in suffic ient detail to make possib l e an ev al uation of serv ic es, and
wh ic h sh al l c ontain al l nec essary data as required b y th e Department of B eh av ioral Heal th and state or
federal regul ations, inc l uding b ut not l imited to rec ords of c l ient/ patient interv iews and progress notes.
b . TRE ATME NT PLAN: C ontrac tor sh al l al so maintain a rec ord of serv ic es prov ided,
inc l uding th e goal s and ob j ec tiv es of any treatment pl an and th e progress toward ac h iev ing th ose goal s
and ob j ec tiv es. C ounty sh al l b e al l owed to rev iew al l c l ient/ patient rec ords) during site v isits, or at any
reasonab l e time.
c . LO C ATIO N / O WNE RSHIP O F RE C O RDS: If C ontrac tor works primaril y in a C ounty
fac il ity, rec ords sh al l b e kept in th e C ounty's fac il ity. If C ontrac tor works in anoth er fac il ity, th e rec ords
may b e maintained at th at fac il ity. If C ontrac tor works in a sc h ool setting, original rec ords sh al l b e
maintained at th e Department of B eh av ioral Heal th , b ut C ontrac tor may keep dupl ic ate rec ords at th e
sc h ool until termination of th e C ontrac t, at wh ic h time said dupl ic ate rec ords sh al l b e returned to th e
Department of B eh av ioral Heal th . Al l rec ords are th e property of C ounty. Upon demand b y C ounty, al l
original rec ords sh al l b e del iv ered to C ounty with in a reasonab l e time from th e c onc l usion of th is C ontrac t.
C ontrac tor may keep c opies at C ontrac tor's ex pense.
d. C O NFIDE NTIALITY: Suc h rec ords and information sh al l b e maintained in a manner and
pursuant to proc edures designed to protec t th e c onfidential ity of th e c l ient/ patient rec ords, in ac c ordanc e
with th e prov isions of Heal th and Safety c ode § 11812, et seq. , and in c onformity with al l appl ic ab l e l egal
requirements and rec ognized standards of professional prac tic e. Al l c l ient/ patient rec ords maintained b y
C ontrac tor must b e retained b y C ontrac tor for sev en (7) years or one (1) year b eyond th e c l ient/ patienYs
reac h ing th e age of maj ority, wh ic h ev er is l ater.
e. RE PO RTS: Reports are not required on a regul ar b asis. Howev er, C ontrac tor sh al l
prov ide reports to C ounty from time to time as nec essary, and as reasonab l y requested b y C ounty.
f. C O PIE S O F RE C O RDS: Upon termination of th is C ontrac t, C ontrac tor agrees to
c ooperate with c l ient/ patients, C ounty and sub sequent prov iders with respec t to th e orderl y and prompt
transfer of c l ient or patient rec ords. Th is C ontrac t does not prec l ude C ontrac tor from assessing
reasonab l e c h arges for th e ex pense of transferring suc h rec ords if appropriate. Said c h arges sh al l b e
twenty- fiv e C ents ($0. 25) per page, pl us th e c ost of l ab or, not to ex c eed Six teen Dol l ars ($16. 00) per h our
or pro rata frac tion th ereof, for ac tual time required to ph otoc opy said rec ords.
29. Financ ial , Statistic al and C ontrac t- Rel ated Rec ords:
a. B O O K AND RE C O RDS: C ontrac tor sh al l maintain statistic al rec ords and sub mit reports
as required b y C ounty on or b efore th e fifth (5t" ) working day of eac h month . C ontrac tor sh al l al so
maintain ac c ounting and administrativ e b ooks and rec ords, program proc edures and doc umentation
E X C HHSA Personal Serv ic es Mental Heal th Page 2 of 3 ~ ~ C ontrac tor approv es th is page -
r e l a t i n g t o l i c e n s u r e a n d a c c r e di t a t i o n a s t h e y p e r t a i n t o t h i s C o n t r a c t . A l l s u c h f i n a n c i a l , s t a t i s t i c a l a n d
c o n t r a c t- r e l a t e d r e c o r ds s h a l l be r e t a i n e d f o r f i v e (5) y e a r s o r u n t i l p r o g r a m r e v i e w f i n di n g s a n d/ o r a u di t
f i n di n g s a r e r e s o l v e d, w h i c h e v e r i s l a t e r .
b. INSPEC TION: Up o n r e a s o n a bl e a dv a n c e n o t i c e a n d du r i n g n o r ma l bu s i n e s s h o u r s o r a t
s u c h o t h e r t i me s a s ma y be a g r e e d u p o n , C o n t r a c t o r s h a l l ma ke a l l o f i t s bo o ks a n d r e c o r ds a v a i l a bl e f o r
i n s p e c t i o n , e x a mi n a t i o n o r c o p y i n g , t o C o u n t y , o r t o t h e St a t e De p a r t me n t o f M e n t a l H e a l t h , t h e F e de r a l
De p a r t me n t o f H e a l t h a n d H u ma n Se r v i c e s , t h e C o n t r o l l e r Ge n e r a l o f t h e Un i t e d St a t e s a n d t o a l l o t h e r
a u t h o r i z e d f e de r a l a n d s t a t e a g e n c i e s , o r t h e i r du l y a u t h o r i z e d r e p r e s e n t a t i v e s
c . A UDIT: C o n t r a c t o r s h a l l p e r mi t t h e a f o r e s a i d a g e n c i e s o r t h e i r du l y a u t h o r i z e d
r e p r e s e n t a t i v e s t o a u di t a l l bo o ks , a c c o u n t s o r r e c o r ds r e l a t i n g t o t h i s C o n t r a c t , a n d a l l bo o ks , a c c o u n t s o r
r e c o r ds o f a n y bu s i n e s s e n t i t i e s c o n t r o l l e d by C o n t r a c t o r w h o p a r t i c i p a t e d i n t h i s C o n t r a c t i n a n y w a y . A l l
s u c h r e c o r ds s h a l l be a v a i l a bl e f o r i n s p e c t i o n by a u di t o r s de s i g n a t e d by C o u n t y o r St a t e , a t r e a s o n a bl e
t i me s du r i n g n o r ma l bu s i n e s s h o u r s . A n y a u di t ma y be c o n du c t e d o n C o n t r a c t o r ' s p r e mi s e s o r , a t
C o u n t y ' s o p t i o n , C o n t r a c t o r s h a l l p r o v i de a l l bo o ks a n d r e c o r ds w i t h i n f i f t e e n (15) da y s u p o n de l i v e r y o f
w r i t t e n n o t i c e f r o m C o u n t y . C o n t r a c t o r s h a l l f o r t h w i t h r e f u n d a n y mo n e y s e r r o n e o u s l y c h a r g e d. "
EX C H H SA Pe r s o n a l Se r v i c e s M e n t a l H e a l t h Pa g e 3 o f 3 ~C o n t r a c t o r a p p r o v e s t h i s p a g e '
EXHIBIT "D"
SCHEDULE OF HIPAA PROVISIONS
If and t o t he ex t ent , and so l o ng as, r eq u i r ed by bo t h t he p r o v i si o ns o f 42 U.S.C. § 1171, et seq ., enact ed
as t he Heal t h Insu r ance Po r t abi l i t y and Acco u nt abi l i t y Act o f 1996 (HIPAA), and 45 U.S.C. Par t s 160 —
164, enact ed as t he Heal t h Inf o r m at i o n Techno l o g y f o r Eco no m i c and Cl i ni cal Heal t h Act o f 2009
(HITECH), and t ho se r eg u l at i o ns p r o m u l g at ed t her eu nder , i ncl u di ng any su bseq u ent am endm ent s m ade
t her et o , Co nt r act o r do es her eby assu r e Co u nt y t hat Co nt r act o r w i l l ap p r o p r i at el y saf eg u ar d Pr o t ect ed
Heal t h Inf o r m at i o n m ade av ai l abl e t o o r o bt ai ned by Co nt r act o r .
In i m p l em ent at i o n o f su ch assu r ance and w i t ho u t l i m i t i ng t he o bl i g at i o n o f Co nt r act o r o t her w i se set f o r t h i n
t hi s Ag r eem ent o r i m p o sed by ap p l i cabl e l aw , Co nt r act o r her eby ag r ees t o co m p l y w i t h ap p l i cabl e
r eq u i r em ent s o f l aw r el at i ng t o Pr o t ect ed Heal t h Inf o r m at i o n and w i t h r esp ect t o any t ask o r o t her act i v i t y
Co nt r act o r p er f o r m s o n behal f o f Co u nt y, t o t he ex t ent Co u nt y w o u l d be r eq u i r ed t o co m p l y w i t h su ch
r eq u i r em ent s.
The ag r eem ent o f Co nt r act o r set f o r t h i n t he t w o p r ecedi ng sent ences, and t he addi t i o nal p r o v i si o ns
r el at i ng t o p er m i t t ed and r eq u i r ed u ses and di scl o su r es t her eo f t hat shal l f r o m t i m e t o t i m e be p r o v i ded t o
Co nt r act o r by Co u nt y i n acco r dance w i t h ap p l i cabl e l aw , co nst i t u t es a co nt r act bet w een Co u nt y and
Co nt r act o r est abl i shi ng t he p er m i t t ed and r eq u i r ed u ses and di scl o su r es o f su ch Pr o t ect ed Heal t h
Inf o r m at i o n by Co nt r act o r .
If o ne o r bo t h p ar t i es t o t hi s ag r eem ent ar e "Co v er ed Ent i t i es" w i t hi n t he m eani ng o f 45 C.F.R. 160.103,
t he Co v er ed Ent i t y w i l l co m p l y w i t h al l r eq u i r em ent s f o r Co v er ed Ent i t i es i n acco r dance w i t h t he r u l es and
r eg u l at i o ns p r o m u l g at ed u nder t he HIPAA and HITECH Act s. In t he ev ent Co nt r act o r i s det er m i ned t o be
a "Bu si ness Asso ci at e" w i t hi n t he m eani ng o f 45 C.F.R. 160.103, t hen i n am p l i f i cat i o n, and no t i n
l i m i t at i o n, o f t he p r o v i si o ns o f t hi s Ag r eem ent , i ncl u di ng t hi s Sect i o n o f t hi s Ag r eem ent , Co nt r act o r ag r ees
t hat Co nt r act o r shal l :
No t u se o r f u r t her di scl o se su ch i nf o r m at i o n o t her t han as p er m i t t ed o r r eq u i r ed by t hi s
Ag r eem ent . Co nt r act o r shal l no t , ex cep t as necessar y f o r t he p r o p er m anag em ent and
adm i ni st r at i o n o f t he Co nt r act o r t o car r y o u t t he l eg al r esp o nsi bi l i t i es o f t he Co nt r act o r f o r
p er f o r m ance o f Co nt r act o r ' s du t i es u nder t hi s Ag r eem ent , and as ap p l i cabl e u nder l aw , u se,
r ep r o du ce, di scl o se, o r p r o v i de t o t hi r d p ar t i es, any co nf i dent i al do cu m ent s o r i nf o r m at i o n r el at i ng
t o t he Co u nt y o r p at i ent s o f t he Co u nt y w i t ho u t p r i o r w r i t t en co nsent o r au t ho r i z at i o n o f t he Co u nt y
o r o f t he p at i ent . If Co nt r act o r u ses su ch i nf o r m at i o n f o r t he p u r p o ses set f o r t h abo v e, i t w i l l o nl y
do so i f t he di scl o su r e i s r eq u i r ed by l aw o r Co nt r act o r o bt ai ns r easo nabl e assu r ances f r o m t he
p er so n t o w ho m t he i nf o r m at i o n i s di scl o sed t hat i t w i l l be hel d co nf i dent i al l y and u sed o r f u r t her
di scl o sed o nl y as r eq u i r ed by l aw o r f o r t he p u r p o se f o r w hi ch Co nt r act o r di scl o sed i t t o t he
p er so n. Co nt r act o r shal l al so ensu r e t hat t he p er so n no t i f i es Co nt r act o r o f any i nst ances o f
br each o f co nf i dent i al i t y su ch p er so n i s aw ar e o f . Co nt r act o r shal l ensu r e t hat i t s p er so nnel ,
em p l o yees, af f i l i at es, and ag ent s m ai nt ai n t he co nf i dent i al i t y o f p at i ent heal t h i nf o r m at i o n and
bu si ness o f t he Co u nt y. As a Bu si ness Asso ci at e o f t he Co u nt y, as t hat t er m i s u sed u nder t he
HIPAA and HITECH Act s, t he co nt r act o r shal l abi de by t he HIPAA Pr i v acy Ru l e and o t her
Pr o t ect ed Heal t h Inf o r m at i o n di scl o su r e r eq u i r em ent s o f 45 CFR 164.504(e).
2. No t u se o r f u r t her di scl o se t he i nf o r m at i o n i n a m anner t hat w o u l d v i o l at e t he r eq u i r em ent s o f
ap p l i cabl e l aw . The Co u nt y and Co nt r act o r ack no w l edg e t hat Sect i o n 13404 o f t he HITECH Act
cr eat es a st at u t o r y o bl i g at i o n f o r Bu si ness Asso ci at es o f Co v er ed Ent i t i es t o u se and di scl o se
Pr o t ect ed Heal t h Inf o r m at i o n o nl y i f t he u se and di scl o su r e i s i n co m p l i ance w i t h t he r eq u i r em ent s
o f 45 C.F.R. 164.504(e), w hi ch est abl i shes t he st andar ds and i m p l em ent at i o n sp eci f i cat i o ns f o r
Bu si ness Asso ci at e ag r eem ent s, i ncl u di ng t he p r o hi bi t i o n o f Bu si ness Asso ci at es f r o m u si ng o r
di scl o si ng Pr o t ect ed Heal t h Inf o r m at i o n i n a m anner t hat i s i nco nsi st ent w i t h t he HIPAA Pr i v acy
Ru l e and t he p r i v acy and secu r i t y r eq u i r em ent s o f t he HITECH Act .
EX D ~\ Co nt r act o r ap p r o v es t hi s p ag e
Ex hi bi t "D" Pag e 1 o f 2
Implement a d mi ni s tr a ti v e, ph y s i c a l, a nd tec h ni c a l s a fegua r d s th a t r ea s ona bly a nd a ppr opr i a tely
pr otec t th e c onfi d enti a li ty , i ntegr i ty , a nd a v a i la bi li ty of s uc h P r otec ted H ea lth Infor ma ti on th a t i t
c r ea tes , r ec ei v es , ma i nta i ns , tr a ns mi ts or d es tr oy s on beh a lf of County i n a ma nner th a t i s
c ons i s tent w i th th e s ta nd a r d s r eq ui r ed und er th e H IP AA a nd H ITECH Ac ts ;
4. In th e ev ent th a t Contr a c tor bec omes a w a r e of a ny us e or d i s c los ur e of P r otec ted H ea lth
Infor ma ti on th a t i s not a uth or i z ed by th i s Agr eement, i t w i ll r epor t th a t ev ent to th e County w i th i n
tw enty- four h our s of bec omi ng a w a r e of th e una uth or i z ed us e or d i s c los ur e;
Ens ur e th a t a ny s ubc ontr a c tor s or a gents to w h om Contr a c tor pr ov i d es P r otec ted H ea lth
Infor ma ti on r ec ei v ed fr om County a gr ee to th e s a me r es tr i c ti ons a nd c ond i ti ons th a t a pply to
Contr a c tor w i th r es pec t to s uc h i nfor ma ti on;
6. Ma ke a v a i la ble P r otec ted H ea lth Infor ma ti on i n a c c or d a nc e to a ppli c a ble la w ;
7 . Th e a bov e r eq ui r ements a pply eq ua lly to a ll elec tr oni c r ec or d s . Contr a c tor s h a ll not r elea s e a ny
elec tr oni c i nfor ma ti on w i th out c omply i ng w i th a ll a bov e r eq ui r ements ;
8. Contr a c tor w i ll ma i nta i n a d mi ni s tr a ti v e, ph y s i c a l a nd tec h ni c a l s a fegua r d s th a t r ea s ona bly a nd
a ppr opr i a tely pr otec t th e c onfi d enti a li ty , i ntegr i ty a nd a v a i la bi li ty of P r otec ted H ea lth Infor ma ti on i n
a ma nner c ons i s tent w i th H IP AA a nd H ITECH Ac t s ta nd a r d s . Contr a c tor w i ll noti fy c us tomer of
a ny s ec ur i ty i nc i d ent of w h i c h i t bec omes a w a r e, i nc lud i ng br ea c h of c onfi d enti a li ty , i ntegr i ty or
a v a i la bi li ty of P r otec ted H ea lth Infor ma ti on w i th i n tw enty- four h our s or i mmed i a tely i f noti fi c a ti on i s
ur gent, of i ts d i s c ov er y of th e br ea c h , a nd w i ll c omply w i th a ll a ppli c a ble br ea c h noti fi c a ti on
r eq ui r ements a s pr ov i d ed und er th e H IP AA a nd H ITECH Ac ts . Contr a c tor s h a ll ta ke pr ompt
c or r ec ti v e a c ti on to c ur e a ny br ea c h or a c ti on per ta i ni ng to th e una uth or i z ed d i s c los ur e of
P r otec ted H ea lth Infor ma ti on;
9 . Ma ke Contr a c tor ' s i nter na l pr a c ti c es , books , a nd r ec or d s r ela ti ng to th e us e a nd d i s c los ur e of
P r otec ted H ea lth Infor ma ti on r ec ei v ed fr om County a v a i la ble to th e S ec r eta r y of th e U ni ted S ta tes
H ea lth a nd H uma n S er v i c es for pur pos es of d eter mi ni ng Contr a c tor ' s c ompli a nc e w i th a ppli c a ble
la w ( i n a ll ev ents Contr a c tor s h a ll i mmed i a tely noti fy County of a ny s uc h r eq ues t, a nd s h a ll pr ov i d e
County w i th c opi es of a ny s uc h ma ter i a ls ) ;
10. Inc or por a te a ny a mend ments or c or r ec ti ons to P r otec ted H ea lth Infor ma ti on w h en noti fi ed
pur s ua nt to a ppli c a ble la w . Contr a c tor a gr ees th a t th i s Agr eement ma y be a mend ed fr om ti me to
ti me by County i f a nd to th e ex tent r eq ui r ed by th e pr ov i s i on of 42 U .S .C. § 117 1, et s eq ., ena c ted
by H IP AA a nd r egula ti ons pr omulga ted th er eund er , i n or d er to a s s ur e th a t th i s Agr eement i s
c ons i s tent th er ew i th ; a nd
11. Auth or i z e ter mi na ti on of th e Agr eement by County i f County d eter mi nes th a t Contr a c tor h a s
v i ola ted a ma ter i a l pr ov i s i on of th e H IP AA a nd / or H ITECH Ac ts .
EX D Contr a c tor a ppr ov es th i s pa ge
Ex h i bi t "D" P a ge 2 of 2
NEVADA COUNTY BEHAVIORAL HEALTH DEPARTMENT
DECLARATION OF ELIGIBILITY FOR PROSPECTIVE
EMPLOYEES/CONTRACTORS
POLICY:
The Nevada County Be~ :avi or al Heal th Depar tment (`BHD") w i l l not empl oy or engage
as c ontr ac tor s any Inel i gi b l e Per s on f or any depar tment or pr ogr am r ec ei vi ng f eder al
f unds .
An "Inel i gi b l e Per s on" i s any i ndi vi dual or enti ty w ho: (a) i s c ur r entl y ex c l uded,
s us pended, deb ar r ed or other w i s e i nel i gi b l e to par ti c i pate i n Feder al heal th c ar e pr ogr ams
or i n Feder al pr oc ur ement or non- pr oc ur ement pr ogr ams ; or , (b ) has b een c onvi c ted of a
c r i mi nal of f enc e r el ated to the pr ovi s i on of heal th c ar e i tems or s er vi c es , b ut has not yet
b een deb ar r ed, or other w i s e dec l ar ed i nel i gi b l e.
INSTRUCTIONS:
As a pr os pec ti ve empl oyee or c ontr ac tor w i th the BHD, pl eas e c ompl ete the dec l ar ati on
under penal ty of per j ur y b el ow . If you ar e or the enti ty you r epr es ent i s an Inel i gi b l e
Per s on as def i ned ab ove, pl eas e i mmedi atel y noti f y the BHD Di r ec tor .
I,
x , mys el f , or
DECLARATION
(name) on b ehal f of
(c or por ati on, par tner s hi p, LLC)
dec l ar e under penal ty of per j ur y under the l aw s of the State of Cal i f or ni a that:
I am not, or
the enti ty I r epr es ent i s not
an Inel i gi b l e Per s on as def i ned i n the Pol i c y r ec i ted ab ove. If , w hi l e empl oyed or
engaged as a c ontr ac tor b y BHD, I (or the enti ty I r epr es ent) b ec ome an Inel i gi b l e Per s on,
I w i l l noti f y the BHD Di r ec tor i mmedi atel y.
(Si gnatur e)
BH Ex c l us i on Sc r eeni ng BH
(Date)
JEFFREY S. BROWN, MPH, MSW
Health and Human Services Agency
Qirector
500 CROWN PO[NT CIRCLE, STE 110
GRASS VALLEY, CA 95945
TELEPHONE (530) 265-1450
(888) 303-1450
FAX (530) 271-0837
September 7, 2012
Honorable Board of Supervisors
Eric Rood Administrative Center
950 Maidu Avenue
Nevada City, CA 95959
Public.
DATE OF MEETING: October 9, 2012
.' ~ ;
~ OUIl~ ~
K areiz M~ lmun, MD, MPH
T,..+ ' Public Health Officer/Director
Hume
10075 LEVON AVE STE 207
artment
TRUCK EE, CALIFORNIA 96161
TELEPHONE (530) 582-7814
~ FAX (530) 582-7732
~ ~ ~ ~ ~ ~ _ ~ i i~ ~ ' ~ ' ~ z
SUBJECT: Resolution approving Agreement Number 12-10188 with the California Department of
Public Health for funding Supplemental Nutrition Assistance Program Education (SNAP-Ed) services
in the amount of $800,000 for the term of October 1, 2012 through September 30, 2016, and
authoriz ing the Director of Public Health to sign said Agreement.
RECOMMENDATION: Approve the attached Resolution.
FUNDING: California SNAP-Ed is federally funded by the United States Department of Agriculture
(USDA) and administered at the state level by the California Department of Social Services (CDSS)
and the California Department of Public Health' s (CDPHs) Network for a Healthy California. Funding
is provided to selected counties for improving community nutrition education and to carry out a set of
nutritional activities that will serve local eligible low income populations. The County has been
approved to receive continuation of funding in the amount of $200,000 per federal fiscal years (2012-
2016) for a total contract maximum of $800,000 for the department' s Nutrition Education and Obesity
Prevention (NEOP) Proj ect. Funds will support program related personnel costs, operating expenses,
subcontractors, trainings materials, and indirect costs. There are no county general fund dollars
req uired in the Agreement.
BACK GROUND: The California Department of Public Health, in conj unction with the California
Department of Social Services, is continuing to fund local health departments throughout California.
This funding initiative stems from the United States Department of Agriculture (USDA),
Supplemental Nutrition Assistance Program Education (SNAP- Ed). Last year, Public Health applied
for and was a successful applicant to receive funding and the State has approved continuation of
funding for the next four years for the County' s program. The goal is to create innovative partnerships
that will assist eligible consumers in adopting healthy eating and physical activity behaviors, as part of
a healthy lifestyle.
The County' s Program will seek to establish a stronger county-wide presence through both the public
health and social services departments. The departments will partner closely to coordinate efforts for
community nutrition interventions and education for CalFresh (formerly known as Food Stamp
_ ~ "
Program) p art i c i p an t s f or maki n g h e al t h i e r c h oi c e s w i t h i n t h e i r l i mi t e d b u d ge t s . Th e d e p art me n t s w i l l
i d e n t i f y a s e ri e s of j oi n t ac t i v i t i e s t o c oord i n at e an d n u t ri t i on e d u c at i on an d ob e s i t y p re v e n t i on
t h rou gh ou t t h e c ou n t y .
Th e Cou n t y 's p rogram w i l l w ork t o i mp l e me n t a c omp re h e n s i v e p u b l i c h e al t h n u t ri t i on p rogram t o
p romot e t h e e s t ab l i s h e d Di e t G u i d e l i n e s , an d t o i n c re as e f ru i t an d v e ge t ab l e c on s u mp t i on an d p h y s i c al
ac t i v i t i e s . S e rv i c e s w i l l b e d i re c t e d t ow ard s i mp rov i n g c ommu n i t y n u t ri t i on al kn ow l e d ge an d
p romot i n g ac c e s s t o h e al t h y f ood s an d d ai l y p h y s i c al ac t i v i t y t o t arge t p op u l at i on grou p s . Ke y
ac t i v i t i e s f or t h i s p rogram w i l l b e c on t i n u i n g t o s t re n gt h e n t h e i n f ras t ru c t u re f or c ommu n i t y ou t re ac h
an d c on d u c t i n g n u t ri t i on e d u c at i on ac t i v i t i e s t h at are al s o e f f e c t i v e ob e s i t y p re v e n t i on s t rat e gi e s . A
s e ri e s of n u t ri t i on e d u c at i on c l as s e s an d p romot i on al ac t i v i t i e s w i l l b e c on d u c t e d s u c h as : F ru i t an d
V e ggi e F e s t , Re Th i n k You r Dri n k Camp ai gn , re gi on al t rai n i n gs an d ot h e r me d i a e d u c at i on al e v e n t s
an d mat e ri al s . At l e as t f ou r (4) t i me s a y e ar, t h e p rogram w i l l c on v e n e a Cou n t y N u t ri t i on Ac t i on Pl an
G rou p (CN AP) t o e v al u at e e x i s t i n g s y s t e ms an d f u rt h e r i mp l e me n t an ov e ral l p l an f or i mp rov i n g
h e al t h y f ood av ai l ab i l i t y , i n c re as i n g an d e n s u ri n g c on s i s t e n t n u t ri t i on me s s age s , an d w orki n g t ow ard s
b e t t e r h e al t h ou t c ome s . Ot h e r ac t i v i t i e s w i l l i n c l u d e h os t i n g at l e as t t h re e - f i v e n u t ri t i on ob e s i t y
p re v e n t i on f oru ms/t ow n h al l s re ac h i n g t arge t e d p op u l at i on s an d c on d u c t i n g n e i gh b orh ood f ood an d
p h y s i c al ac t i v i t y e n v i ron me n t s u rv e y s .
I t i s re c omme n d e d t h at t h e Board ap p rov e t h i s Agre e me n t as i t w i l l p rov i d e c on t i n u at i on of an
i mp ort an t f u n d i n g s ou rc e t o p romot e h e al t h y l i f e s t y l e c h oi c e s t h at c an h e l p re d u c e h e al t h ri s k
as s oc i at e d w i t h p oor n u t ri t i on an d l i mi t e d p h y s i c al e x e rc i s e f or re s i d e n t s of N e v ad a Cou n t y .
Pl e as e c on t ac t me i f an y ad d i t i on al i n f ormat i on i s re q u i re d .
Re s p e c t f u l l y s u b mi t t e d ,
Kan e Mi l man , MD, MPH
Pu b l i c He al t h Of f i c e r/Di re c t or
~~s
RESOLUTION NO.
C~1~. _ : ~L~~!Z~1~~~1»:~~I~~~1~~~1~i:l ~I~~1~1~~i ~( ~7 ~~T~1%17 _ 1
RESOLUTION APPROVING GRANT AGREEMENT NUMBER 12-
10188 WITH THE CALIFORNIA DEPARTMENT OF PUBLIC
HEALTH FOR FUNDING SUPPLEMENTAL NUTRITION
ASSISTANCE PROGRAM EDUCATION ( SNAP-Ed) SERVICES
( CFDA No.10.561), AND AUTHORIZING THE DIRECTOR OF
PUBLIC HEALTH TO SIGN SAID AGREEMENT
WHEREAS, t h e Ca l i f or n i a De pa r t me n t of Publ i c He a l t h ' s Ne t wor k f or a He a l t h y
Ca l i f or n i a ( Ne t wor k) i n con j un ct i on wi t h t h e Ca l i f or n i a De pa r t me n t of Soci a l Se r v i ce s i s
pr ov i di n g Un i t e d St a t e s De pa r t me n t of Agr i cul t ur e ( USDA) Suppl e me n t a l Nut r i t i on As s i s t a n ce
Pr ogr a m Educa t i on ( SNAP-Ed) f un di n g t o i mpr ov e commun i t y n ut r i t i on a n d t o ca r r y out a s e t of
n ut r i t i on a l a ct i v i t i e s t h a t wi l l s e r v e e l i gi bl e l ow i n come popul a t i on s i n t h e Coun t y; a n d
WHEREAS, t h e Coun t y' s Publ i c He a l t h De pa r t me n t h a s be e n a ppr ov e d t o r e ce i v e f un ds i n
t h e a moun t of $200,000 pe r Fe de r a l Fi s ca l Ye a r f or t h e t e r m of Oct obe r 1, 2012 t h r ough
Se pt e mbe r 30, 2016 f or a t ot a l of $800,000 f or t h e de pa r t me n t ' s Nut r i t i on Educa t i on a n d Obe s i t y
Pr e v e n t i on ( NEOP) Pr oj e ct .
BE IT HEREBY RESOLVED by t h e Boa r d of Supe r v i s or s of t h e Coun t y of Ne v a da , St a t e
of Ca l i f or n i a , t h a t t h e Gr a n t Agr e e me n t Numbe r 12-10188 da t e d t h e l s ` da y of Oct obe r 2012, by
a n d be t we e n t h e Coun t y a n d Ca l i f or n i a De pa r t me n t of Publ i c He a l t h pe r t a i n i n g t o f un di n g
pr ogr a m a ct i v i t i e s t h a t wi l l a s s i s t e l i gi bl e con s ume r s t o a dopt h e a l t h y e a t i n g a n d ph ys i ca l
a ct i v i t i e s t o pr e v e n t obe s i t y a n d de v e l op h e a l t h y l i f e s t yl e s f or t h e t e r m of Oct obe r 1, 2012 t h r ough
Se pt e mbe r 30, 2016, i n t h e t ot a l ma xi mum a moun t of $800,000, be a n d h e r e by i s ma t e r i a l l y
a ppr ov e d i n f or m, a n d t h a t t h e Di r e ct or of Publ i c He a l t h i s h e r e by a ut h or i z e d t o e xe cut e t h e
Agr e e me n t on be h a l f of t h e Coun t y of Ne v a da .
Fun ds t o be de pos i t e d i n t o r e v e n ue a ccoun t : 1589-40102-492-27 61/446690.
State of C al i for n i a—H eal th an d H uman Ser vi ces Agen cy--C al i for n i a Depar tmen t of Publ i c H eal th
AGREEMENT NUMBER
GRANT AGREEMENT
C DPH 1229 (3/12)
1
12-10188
REGISTRATION. NUMBER:
Th e C al i for n i a Depar tmen t of Publ i c H eal th h er eby makes a gr an t awar d of fun ds to th e Gr an tee n amed bel ow:
Gr an tee' s Name
Nevada C oun ty Publ i c H eal th Depar tmen t
2. Gr an t ter m
13. To# al gr an t amoun t
Fr om October 1, 2012
th r ough
September 30, 2016 $ 800,000
4. Gr an tee' s Pr oj ect Di r ector
---______-----------------~ -----__ --___~ _---,------- -----T----------------.._..._....-----...__---
.._.—
_...~ --------__ __ __--
Name
~ Tel eph on e n umber ;Addr ess, i f di ffer en t fr om Gr an tee' s addr ess
Dr . Kar en Mi l man
i (530) 265-1459
5. Gr an tee' s Fi n an ci al Offi cer
Name
;Tel eph on e n umber ;Addr ess, i f di ffer en t fr om Gr an tee' s addr ess
Katy Ecker t ~ (530) 265-7226 k
6. Th e gr an tee,. i n accepti n g th i s gr an t awar d, agr ees to compl y wi th th e ter ms an d con di ti on s of th e fol l owi n g ex h i bi ts
wh i ch ar e made a par t of th i s gr an t awar d by th i s r efer en ce an d an y appl i cabl e statutes or r egul ati on s:
Ex h i bi t A —Scope of Wor k
49 pages
Ex h i bi t B —Budget Detai l an d Paymen t Pr ovi si on s 4 pages
Ex h i bi t BAttach men t I —Budget (Year 1) 2 pages
Ex h i bi t B Attach men t I, Sch edul e I Subgr an tee Budget (Year 1) 1 page
Ex h i bi t B Attach men t IL —Budget (Year 2) 2 pages
Ex h i bi t B Attach men t II — Sch edul e I Subgr an tee Budget (Year 2) 1 page
Ex h i bi t B Attach men t III —Budget (Year 3) 2 pages
Ex h i bi t B Attach men t III — Sch edul e. I Subgr an tee Budget (Year 3) 1 page
Ex h i bi t B Attach men t IV —Budget (Year 4) 2 pages
Ex h i bi t B Attach men t IV — Sch edul e I Subgr an tee Budget (Year 4) 1 page
Ex h i bi t C —Gen er al Ter ms an d C on di ti on s GTC 610
Ex h i bi t D(F) —Speci al Ter ms an d C on di ti on s 25 pages
Ex h i bi t E —Addi ti on al Pr ovi si on s 3 pages
Ex h i bi t F —C on tr actor ' s Rel ease 1 page
Ex h i bi t G —Tr avel . Rei mbur semen t In for mati on
2 pages
* Item mar ked wi th an Aster i sk (*) i s i n cor por ated h er ei n as i f attach ed. Vi ew at: h ttq :/l www.ol s.dgs.ca.q ov/Stan dar d+L an q uage.
In Wi tn ess Wh er eof, th i s agr eemen t h as been ex ecuted by th e par ti es h er eto.
GRANTEE
Gr an tee' s Name (l f oth er th an an i n di vi dual , state r f a cor por ati on , par tn er sh i p, n on pr ofi t or gan i z ati on , etc.)
Nevada C oun ty Publ i c H eal th Depar tmen t
Si gn ed By ( ufh or i z ed Si gn atur e) Date Si gn ed.
,~ S
~° ,O~ f f Z
Pr i n ted f~ fame an d Ti tl e of Per son Si gn i n g th -afl i-as del egated auth or i ty to bi n d th e Gr an tee
Dr . Kar en Mi l man , Publ i c H eal th Di r ector
Mai l i n g Addr ess
5uu C r own Poi n t C i r cl e, Sui te 11 U Gr ass Val l ey, C A 95945
STATE OF C AL IFORNIA
Agen cy Name
C al i for n i a Depar tmen t of Publ i c H eal th
Si gn ed. By (Auth or i z ed Si gn atur e) I Date. Si gn ed.
,~ S
Pr i n ted. or Stamped Name an d Ti tl e of Per son Si gn i n g or th ei r Desi gn ee
An gel a. Sal as, C h i ef C on tr acts Man agemen t Un i t
Addr ess
1501 C api tol Aven ue, Sui te 71.5178, MS 1802, P.O. Box 997377, Sacr amen to, C A 95899-7377
_ ~ ~
u Ex empt fr om DGS
r evi ew per AG
Opi n i on s
~ Ex empt fr om DGS
r evi ew per th i s
auth or i ty:
H&S 131085(a)(b)
2.
Exhibit A
Scope of Work
Service Overview
Nevada County P ubl ic Heal th Department
12-10188
Grantee agrees to provide to the Cal ifornia Department of P ubl ic Heal th the services described
herein:
A. Grantee wil l provide nutrition education interventions and physical activity promotion to
U nited States Department of Agricul ture (U SDA) Nutrition Education Obesity P revention
(NEOP ) el igibl e famil ies described herein per Heal th and Safety Code 104650-104655.
B. The Grantee shal l provide the specific services, del iverabl es, and obj ectives specified in the
approved SOW and any subsequent formal amendments approved in writing as required
pursuant to this agreement.
C. The Grantee shal l cooperate with CDP H or its designee by participating in meetings and/ or
site visits as CDP H may deem necessary to monitor Grantee compl iance with the
agreement.
P roj ect Representative
A. The proj ect representatives during the term of this agreement wil l be:
Cal ifornia Department of P ubl ic Heal th
CDP H Grant Manager: Kisha Hol mes
Tel ephone: (916) 552-9836
Fax: (916) 449-5414
E-mail : kisha.hol mes@cdph.ca.
B. Direct al l inquiries to:
Cal ifornia Department of P ubl ic Heal th
Network for a Heal thy Cal ifornia
Attention: Mel issa Meade, Chief
Administration Operations Section
1616 Capitol Avenue, Suite 74.516, MS 7204
P .O. Box 997377, MS 7204
Sacramento, CA 95899-7377
Tel ephone: (916) 449-5409
Fax: (916) 449-5414
E-mail : mel issa.meade@cdph.ca.
Nevada County P ubl ic Heal th
Department
P roj ect Director: : Dr. Karen Mil man, P ubl ic
Heal th Director
Tel ephone: (530) 265-1459
Fax: (530) 271-0837
E-mail : Karen.mil man@co.nevada.ca.us
Nevada County P ubl ic Heal th
Department
Attention: Dr. Karen Mil man, P ubl ic Heal th
Director
c/ o Grants U nit
500 Crown P oint Circl e, Suite 110
Grass V al l ey, CA 95945
Tel ephone: (530) 265-1459
Fax: (530) 271-0837
E-mail : Karen.mil man co.nevada.ca.us
C. Either party may make changes to the information above by giving written notice to the other
party. Said changes shal l not require an amendment to this agreement.
P age 1 of 49
5 ~ -
E x h i ~ i i t A
Scope of Work
3. Grant ee Requi rement s
Nevada Count y P ub l i c Heal t h Depart ment
12-10188
Th e Grant ee sh al l compl y w i t h t h e g ui del i nes for t h e devel opment of ai l educat i on mat eri al s as
out l i ned i n t h e Net w ork Local P roj ect s Gui del i nes Manual . Th ese Gui del i nes h ave b een
i ncorporat ed i nt o t h i s ag reement and made a part h ereof b y reference i n E x h i b i t E , Addi t i onal
P rovi si ons, parag raph 1. Wi t h out l i mi t at i on, t h e Grant ee sh al l compl y w i t h t h e fol l ow i ng
requi rement s:
A. Sub mi t any new s rel ease rel at ed t o t h i s ag reement t o t h e St at e for revi ew pri or t o i t s
rel ease.
B. Th e Grant ee ag rees t o cooperat e w i t h t h e St at e i n dat a col l ect i on rel at ed t o eval uat i on of
prog ram effect i veness as request ed i n t h e manner, format , and t i mel i ne prescri b ed b y t h e
St at e. Dat a sh al l i ncl ude, at a mi ni mum, demog raph i c descri pt i ons of t h e popul at i on served,
audi ence reach , and i t ems t o measure prog ram effect i veness. Th e dat a sh al l b e sub mi t t ed
i n t h e requi red form prescri b ed b y t h e St at e.
C. Th e Grant ee ag rees t o cooperat e w i t h t h e St at e i n t h e revi ew and, w h en appropri at e, t h e
fi el d t est i ng of st at ew i de eval uat i on i nst rument s and new l y devel oped educat i onal mat eri al s.
D. Th e Grant ee sh al l ensure t h at t h e USDA SNAP-E d i s cl earl y i dent i fi ed as a sponsor or
support org ani z at i on on al l mat eri al s and product s funded b y t h e ag reement ( el ect roni c,
pri nt , audi ovi sual , medi a, et c.) . Th e Grant ee ag rees t o ab i de b y t h e g ui del i nes set for usag e
of t h e Net w ork l og os on any product s g enerat ed b y t h e Grant ee.
E . Th e Grant ee ag rees t o cooperat e w i t h t h e St at e b y part i ci pat i ng i n st at ew i de meet i ng s and
si t e vi si t s, as deemed necessary b y t h e St at e.
4. See t h e fol l ow i ng pag es for a det ai l ed descri pt i on of t h e servi ces t o b e performed.
P ag e 2 of 49
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JEFFREY S. BROWN, MPH, MSW
Health and Human Services Agency
Qirector
500 CROWN PO[NT CIRCLE, STE 110
GRASS VALLEY, CA 95945
TELEPHONE (530) 265-1450
(888) 303-1450
FAX (530) 271-0837
September 7, 2012
Honorable Board of Supervisors
Eric Rood Administrative Center
950 Maidu Avenue
Nevada City, CA 95959
Public.
DATE OF MEETING: October 9, 2012
.' ~ ;
~ OUIl~ ~
K areiz M~ lmun, MD, MPH
T,..+ ' Public Health Officer/Director
Hume
10075 LEVON AVE STE 207
artment
TRUCK EE, CALIFORNIA 96161
TELEPHONE (530) 582-7814
~ FAX (530) 582-7732
~ ~ ~ ~ ~ ~ _ ~ i i~ ~ ' ~ ' ~ z
SUBJECT: Resolution approving Agreement Number 12-10188 with the California Department of
Public Health for funding Supplemental Nutrition Assistance Program Education (SNAP-Ed) services
in the amount of $800,000 for the term of October 1, 2012 through September 30, 2016, and
authoriz ing the Director of Public Health to sign said Agreement.
RECOMMENDATION: Approve the attached Resolution.
FUNDING: California SNAP-Ed is federally funded by the United States Department of Agriculture
(USDA) and administered at the state level by the California Department of Social Services (CDSS)
and the California Department of Public Health' s (CDPHs) Network for a Healthy California. Funding
is provided to selected counties for improving community nutrition education and to carry out a set of
nutritional activities that will serve local eligible low income populations. The County has been
approved to receive continuation of funding in the amount of $200,000 per federal fiscal years (2012-
2016) for a total contract maximum of $800,000 for the department' s Nutrition Education and Obesity
Prevention (NEOP) Proj ect. Funds will support program related personnel costs, operating expenses,
subcontractors, trainings materials, and indirect costs. There are no county general fund dollars
req uired in the Agreement.
BACK GROUND: The California Department of Public Health, in conj unction with the California
Department of Social Services, is continuing to fund local health departments throughout California.
This funding initiative stems from the United States Department of Agriculture (USDA),
Supplemental Nutrition Assistance Program Education (SNAP- Ed). Last year, Public Health applied
for and was a successful applicant to receive funding and the State has approved continuation of
funding for the next four years for the County' s program. The goal is to create innovative partnerships
that will assist eligible consumers in adopting healthy eating and physical activity behaviors, as part of
a healthy lifestyle.
The County' s Program will seek to establish a stronger county-wide presence through both the public
health and social services departments. The departments will partner closely to coordinate efforts for
community nutrition interventions and education for CalFresh (formerly known as Food Stamp
_ ~ "
Program) p art i c i p an t s f or maki n g h e al t h i e r c h oi c e s w i t h i n t h e i r l i mi t e d b u d ge t s . Th e d e p art me n t s w i l l
i d e n t i f y a s e ri e s of j oi n t ac t i v i t i e s t o c oord i n at e an d n u t ri t i on e d u c at i on an d ob e s i t y p re v e n t i on
t h rou gh ou t t h e c ou n t y .
Th e Cou n t y 's p rogram w i l l w ork t o i mp l e me n t a c omp re h e n s i v e p u b l i c h e al t h n u t ri t i on p rogram t o
p romot e t h e e s t ab l i s h e d Di e t G u i d e l i n e s , an d t o i n c re as e f ru i t an d v e ge t ab l e c on s u mp t i on an d p h y s i c al
ac t i v i t i e s . S e rv i c e s w i l l b e d i re c t e d t ow ard s i mp rov i n g c ommu n i t y n u t ri t i on al kn ow l e d ge an d
p romot i n g ac c e s s t o h e al t h y f ood s an d d ai l y p h y s i c al ac t i v i t y t o t arge t p op u l at i on grou p s . Ke y
ac t i v i t i e s f or t h i s p rogram w i l l b e c on t i n u i n g t o s t re n gt h e n t h e i n f ras t ru c t u re f or c ommu n i t y ou t re ac h
an d c on d u c t i n g n u t ri t i on e d u c at i on ac t i v i t i e s t h at are al s o e f f e c t i v e ob e s i t y p re v e n t i on s t rat e gi e s . A
s e ri e s of n u t ri t i on e d u c at i on c l as s e s an d p romot i on al ac t i v i t i e s w i l l b e c on d u c t e d s u c h as : F ru i t an d
V e ggi e F e s t , Re Th i n k You r Dri n k Camp ai gn , re gi on al t rai n i n gs an d ot h e r me d i a e d u c at i on al e v e n t s
an d mat e ri al s . At l e as t f ou r (4) t i me s a y e ar, t h e p rogram w i l l c on v e n e a Cou n t y N u t ri t i on Ac t i on Pl an
G rou p (CN AP) t o e v al u at e e x i s t i n g s y s t e ms an d f u rt h e r i mp l e me n t an ov e ral l p l an f or i mp rov i n g
h e al t h y f ood av ai l ab i l i t y , i n c re as i n g an d e n s u ri n g c on s i s t e n t n u t ri t i on me s s age s , an d w orki n g t ow ard s
b e t t e r h e al t h ou t c ome s . Ot h e r ac t i v i t i e s w i l l i n c l u d e h os t i n g at l e as t t h re e - f i v e n u t ri t i on ob e s i t y
p re v e n t i on f oru ms/t ow n h al l s re ac h i n g t arge t e d p op u l at i on s an d c on d u c t i n g n e i gh b orh ood f ood an d
p h y s i c al ac t i v i t y e n v i ron me n t s u rv e y s .
I t i s re c omme n d e d t h at t h e Board ap p rov e t h i s Agre e me n t as i t w i l l p rov i d e c on t i n u at i on of an
i mp ort an t f u n d i n g s ou rc e t o p romot e h e al t h y l i f e s t y l e c h oi c e s t h at c an h e l p re d u c e h e al t h ri s k
as s oc i at e d w i t h p oor n u t ri t i on an d l i mi t e d p h y s i c al e x e rc i s e f or re s i d e n t s of N e v ad a Cou n t y .
Pl e as e c on t ac t me i f an y ad d i t i on al i n f ormat i on i s re q u i re d .
Re s p e c t f u l l y s u b mi t t e d ,
Kan e Mi l man , MD, MPH
Pu b l i c He al t h Of f i c e r/Di re c t or
~~s
RESOLUTION NO.
C~1~. _ : ~L~~!Z~1~~~1»:~~I~~~1~~~1~i:l ~I~~1~1~~i ~( ~7 ~~T~1%17 _ 1
RESOLUTION APPROVING GRANT AGREEMENT NUMBER 12-
10188 WITH THE CALIFORNIA DEPARTMENT OF PUBLIC
HEALTH FOR FUNDING SUPPLEMENTAL NUTRITION
ASSISTANCE PROGRAM EDUCATION ( SNAP-Ed) SERVICES
( CFDA No.10.561), AND AUTHORIZING THE DIRECTOR OF
PUBLIC HEALTH TO SIGN SAID AGREEMENT
WHEREAS, t h e Ca l i f or n i a De pa r t me n t of Publ i c He a l t h ' s Ne t wor k f or a He a l t h y
Ca l i f or n i a ( Ne t wor k) i n con j un ct i on wi t h t h e Ca l i f or n i a De pa r t me n t of Soci a l Se r v i ce s i s
pr ov i di n g Un i t e d St a t e s De pa r t me n t of Agr i cul t ur e ( USDA) Suppl e me n t a l Nut r i t i on As s i s t a n ce
Pr ogr a m Educa t i on ( SNAP-Ed) f un di n g t o i mpr ov e commun i t y n ut r i t i on a n d t o ca r r y out a s e t of
n ut r i t i on a l a ct i v i t i e s t h a t wi l l s e r v e e l i gi bl e l ow i n come popul a t i on s i n t h e Coun t y; a n d
WHEREAS, t h e Coun t y' s Publ i c He a l t h De pa r t me n t h a s be e n a ppr ov e d t o r e ce i v e f un ds i n
t h e a moun t of $200,000 pe r Fe de r a l Fi s ca l Ye a r f or t h e t e r m of Oct obe r 1, 2012 t h r ough
Se pt e mbe r 30, 2016 f or a t ot a l of $800,000 f or t h e de pa r t me n t ' s Nut r i t i on Educa t i on a n d Obe s i t y
Pr e v e n t i on ( NEOP) Pr oj e ct .
BE IT HEREBY RESOLVED by t h e Boa r d of Supe r v i s or s of t h e Coun t y of Ne v a da , St a t e
of Ca l i f or n i a , t h a t t h e Gr a n t Agr e e me n t Numbe r 12-10188 da t e d t h e l s ` da y of Oct obe r 2012, by
a n d be t we e n t h e Coun t y a n d Ca l i f or n i a De pa r t me n t of Publ i c He a l t h pe r t a i n i n g t o f un di n g
pr ogr a m a ct i v i t i e s t h a t wi l l a s s i s t e l i gi bl e con s ume r s t o a dopt h e a l t h y e a t i n g a n d ph ys i ca l
a ct i v i t i e s t o pr e v e n t obe s i t y a n d de v e l op h e a l t h y l i f e s t yl e s f or t h e t e r m of Oct obe r 1, 2012 t h r ough
Se pt e mbe r 30, 2016, i n t h e t ot a l ma xi mum a moun t of $800,000, be a n d h e r e by i s ma t e r i a l l y
a ppr ov e d i n f or m, a n d t h a t t h e Di r e ct or of Publ i c He a l t h i s h e r e by a ut h or i z e d t o e xe cut e t h e
Agr e e me n t on be h a l f of t h e Coun t y of Ne v a da .
Fun ds t o be de pos i t e d i n t o r e v e n ue a ccoun t : 1589-40102-492-27 61/446690.
State of C al i for n i a—H eal th an d H uman Ser vi ces Agen cy--C al i for n i a Depar tmen t of Publ i c H eal th
AGREEMENT NUMBER
GRANT AGREEMENT
C DPH 1229 (3/12)
1
12-10188
REGISTRATION. NUMBER:
Th e C al i for n i a Depar tmen t of Publ i c H eal th h er eby makes a gr an t awar d of fun ds to th e Gr an tee n amed bel ow:
Gr an tee' s Name
Nevada C oun ty Publ i c H eal th Depar tmen t
2. Gr an t ter m
13. To# al gr an t amoun t
Fr om October 1, 2012
th r ough
September 30, 2016 $ 800,000
4. Gr an tee' s Pr oj ect Di r ector
---______-----------------~ -----__ --___~ _---,------- -----T----------------.._..._....-----...__---
.._.—
_...~ --------__ __ __--
Name
~ Tel eph on e n umber ;Addr ess, i f di ffer en t fr om Gr an tee' s addr ess
Dr . Kar en Mi l man
i (530) 265-1459
5. Gr an tee' s Fi n an ci al Offi cer
Name
;Tel eph on e n umber ;Addr ess, i f di ffer en t fr om Gr an tee' s addr ess
Katy Ecker t ~ (530) 265-7226 k
6. Th e gr an tee,. i n accepti n g th i s gr an t awar d, agr ees to compl y wi th th e ter ms an d con di ti on s of th e fol l owi n g ex h i bi ts
wh i ch ar e made a par t of th i s gr an t awar d by th i s r efer en ce an d an y appl i cabl e statutes or r egul ati on s:
Ex h i bi t A —Scope of Wor k
49 pages
Ex h i bi t B —Budget Detai l an d Paymen t Pr ovi si on s 4 pages
Ex h i bi t BAttach men t I —Budget (Year 1) 2 pages
Ex h i bi t B Attach men t I, Sch edul e I Subgr an tee Budget (Year 1) 1 page
Ex h i bi t B Attach men t IL —Budget (Year 2) 2 pages
Ex h i bi t B Attach men t II — Sch edul e I Subgr an tee Budget (Year 2) 1 page
Ex h i bi t B Attach men t III —Budget (Year 3) 2 pages
Ex h i bi t B Attach men t III — Sch edul e. I Subgr an tee Budget (Year 3) 1 page
Ex h i bi t B Attach men t IV —Budget (Year 4) 2 pages
Ex h i bi t B Attach men t IV — Sch edul e I Subgr an tee Budget (Year 4) 1 page
Ex h i bi t C —Gen er al Ter ms an d C on di ti on s GTC 610
Ex h i bi t D(F) —Speci al Ter ms an d C on di ti on s 25 pages
Ex h i bi t E —Addi ti on al Pr ovi si on s 3 pages
Ex h i bi t F —C on tr actor ' s Rel ease 1 page
Ex h i bi t G —Tr avel . Rei mbur semen t In for mati on
2 pages
* Item mar ked wi th an Aster i sk (*) i s i n cor por ated h er ei n as i f attach ed. Vi ew at: h ttq :/l www.ol s.dgs.ca.q ov/Stan dar d+L an q uage.
In Wi tn ess Wh er eof, th i s agr eemen t h as been ex ecuted by th e par ti es h er eto.
GRANTEE
Gr an tee' s Name (l f oth er th an an i n di vi dual , state r f a cor por ati on , par tn er sh i p, n on pr ofi t or gan i z ati on , etc.)
Nevada C oun ty Publ i c H eal th Depar tmen t
Si gn ed By ( ufh or i z ed Si gn atur e) Date Si gn ed.
,~ S
~° ,O~ f f Z
Pr i n ted f~ fame an d Ti tl e of Per son Si gn i n g th -afl i-as del egated auth or i ty to bi n d th e Gr an tee
Dr . Kar en Mi l man , Publ i c H eal th Di r ector
Mai l i n g Addr ess
5uu C r own Poi n t C i r cl e, Sui te 11 U Gr ass Val l ey, C A 95945
STATE OF C AL IFORNIA
Agen cy Name
C al i for n i a Depar tmen t of Publ i c H eal th
Si gn ed. By (Auth or i z ed Si gn atur e) I Date. Si gn ed.
,~ S
Pr i n ted. or Stamped Name an d Ti tl e of Per son Si gn i n g or th ei r Desi gn ee
An gel a. Sal as, C h i ef C on tr acts Man agemen t Un i t
Addr ess
1501 C api tol Aven ue, Sui te 71.5178, MS 1802, P.O. Box 997377, Sacr amen to, C A 95899-7377
_ ~ ~
u Ex empt fr om DGS
r evi ew per AG
Opi n i on s
~ Ex empt fr om DGS
r evi ew per th i s
auth or i ty:
H&S 131085(a)(b)
2.
Exhibit A
Scope of Work
Service Overview
Nevada County P ubl ic Heal th Department
12-10188
Grantee agrees to provide to the Cal ifornia Department of P ubl ic Heal th the services described
herein:
A. Grantee wil l provide nutrition education interventions and physical activity promotion to
U nited States Department of Agricul ture (U SDA) Nutrition Education Obesity P revention
(NEOP ) el igibl e famil ies described herein per Heal th and Safety Code 104650-104655.
B. The Grantee shal l provide the specific services, del iverabl es, and obj ectives specified in the
approved SOW and any subsequent formal amendments approved in writing as required
pursuant to this agreement.
C. The Grantee shal l cooperate with CDP H or its designee by participating in meetings and/ or
site visits as CDP H may deem necessary to monitor Grantee compl iance with the
agreement.
P roj ect Representative
A. The proj ect representatives during the term of this agreement wil l be:
Cal ifornia Department of P ubl ic Heal th
CDP H Grant Manager: Kisha Hol mes
Tel ephone: (916) 552-9836
Fax: (916) 449-5414
E-mail : kisha.hol mes@cdph.ca.
B. Direct al l inquiries to:
Cal ifornia Department of P ubl ic Heal th
Network for a Heal thy Cal ifornia
Attention: Mel issa Meade, Chief
Administration Operations Section
1616 Capitol Avenue, Suite 74.516, MS 7204
P .O. Box 997377, MS 7204
Sacramento, CA 95899-7377
Tel ephone: (916) 449-5409
Fax: (916) 449-5414
E-mail : mel issa.meade@cdph.ca.
Nevada County P ubl ic Heal th
Department
P roj ect Director: : Dr. Karen Mil man, P ubl ic
Heal th Director
Tel ephone: (530) 265-1459
Fax: (530) 271-0837
E-mail : Karen.mil man@co.nevada.ca.us
Nevada County P ubl ic Heal th
Department
Attention: Dr. Karen Mil man, P ubl ic Heal th
Director
c/ o Grants U nit
500 Crown P oint Circl e, Suite 110
Grass V al l ey, CA 95945
Tel ephone: (530) 265-1459
Fax: (530) 271-0837
E-mail : Karen.mil man co.nevada.ca.us
C. Either party may make changes to the information above by giving written notice to the other
party. Said changes shal l not require an amendment to this agreement.
P age 1 of 49
5 ~ -
E x h i b i t A
Scope of Work
3. Grant ee Requi rement s
Nevada Count y P ub l i c H eal t h Depart ment
12-10188
Th e Grant ee sh al l compl y w i t h t h e g ui del i nes for t h e devel opment of ai l educat i on mat eri al s as
out l i ned i n t h e Net w ork Local P roj ect s Gui del i nes Manual . Th ese Gui del i nes h ave b een
i ncorporat ed i nt o t h i s ag reement and made a part h ereof b y reference i n E x h i b i t E , Addi t i onal
P rovi si ons, parag raph 1. Wi t h out l i mi t at i on, t h e Grant ee sh al l compl y w i t h t h e fol l ow i ng
requi rement s:
A. Sub mi t any new s rel ease rel at ed t o t h i s ag reement t o t h e St at e for revi ew pri or t o i t s
rel ease.
B. Th e Grant ee ag rees t o cooperat e w i t h t h e St at e i n dat a col l ect i on rel at ed t o eval uat i on of
prog ram effect i veness as request ed i n t h e manner, format , and t i mel i ne prescri b ed b y t h e
St at e. Dat a sh al l i ncl ude, at a mi ni mum, demog raph i c descri pt i ons of t h e popul at i on served,
audi ence reach , and i t ems t o measure prog ram effect i veness. Th e dat a sh al l b e sub mi t t ed
i n t h e requi red form prescri b ed b y t h e St at e.
C. Th e Grant ee ag rees t o cooperat e w i t h t h e St at e i n t h e revi ew and, w h en appropri at e, t h e
fi el d t est i ng of st at ew i de eval uat i on i nst rument s and new l y devel oped educat i onal mat eri al s.
D. Th e Grant ee sh al l ensure t h at t h e USDA SNAP-E d i s cl earl y i dent i fi ed as a sponsor or
support org ani z at i on on al l mat eri al s and product s funded b y t h e ag reement ( el ect roni c,
pri nt , audi ovi sual , medi a, et c.) . Th e Grant ee ag rees t o ab i de b y t h e g ui del i nes set for usag e
of t h e Net w ork l og os on any product s g enerat ed b y t h e Grant ee.
E . Th e Grant ee ag rees t o cooperat e w i t h t h e St at e b y part i ci pat i ng i n st at ew i de meet i ng s and
si t e vi si t s, as deemed necessary b y t h e St at e.
4. See t h e fol l ow i ng pag es for a det ai l ed descri pt i on of t h e servi ces t o b e performed.
P ag e 2 of 49
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2 . LABOR CODE/WORKERS' COMPENSATION: Co n t r a c t o r n eeds t o be a wa r e o f t h e
p r o v i si o n s wh i c h r eq u i r e ev er y emp lo yer t o be i n su r ed a g a i n st li a bi li t y fo r Wo r ker 's
Co mp en sa t i o n o r t o u n der t a ke self-i n su r a n c e i n a c c o r da n c e wi t h t h e p r o v i si o n s, a n d
Co n t r a c t o r a ffi r ms t o c o mp ly wi t h su c h p r o v i si o n s befo r e c o mmen c i n g t h e p er fo r ma n c e
o f t h e wo r k o f t h i s Ag r eemen t . (La bo r Co de Sec t i o n 3700)
3. AMERICANS WITH DISABILITIES ACT: Co n t r a c t o r a ssu r es t h e St a t e t h a t i t
c o mp li es wi t h t h e Amer i c a n s wi t h Di sa bi li t i es Ac t (ADA) o f 1990, wh i c h p r o h i bi t s
di sc r i mi n a t i o n o n t h e ba si s o f di sa bi li t y, a s well a s a ll a p p li c a ble r eg u la t i o n s a n d
g u i deli n es i ssu ed p u r su a n t t o t h e ADA. (42 U. S. C. 12 101 et seq . )
4. CONTRACTOR NAME CHANGE: An a men dmen t i s r eq u i r ed t o c h a n g e t h e
Co n t r a c t o r 's n a me a s li st ed o n t h i s Ag r eemen t . Up o n r ec ei p t o f leg a l do c u men t a t i o n o f
t h e n a me c h a n g e t h e St a t e wi ll p r o c ess t h e a men dmen t . Pa ymen t o f i n v o i c es p r esen t ed
wi t h a n ew n a me c a n n o t be p a i d p r i o r t o a p p r o v a l o f sa i d a men dmen t .
5 . CORPORATE QUALIFICATIONS TO DO BUSINESS 1N CALIFORNIA:
a . Wh en a g r eemen t s a r e t o be p er fo r med i n t h e st a t e by c o r p o r a t i o n s, t h e c o n t r a c t i n g
a g en c i es wi ll be v er i fyi n g t h a t t h e c o n t r a c t o r i s c u r r en t ly q u a li fi ed t o do bu si n ess i n
Ca li fo r n i a i n o r der t o en su r e t h a t a ll o bli g a t i o n s du e t o t h e st a t e a r e fu lfi lled.
b. "Do i n g bu si n ess" i s defi n ed i n R&TC Sec t i o n 2 3101 a s a c t i v ely en g a g i n g i n a n y
t r a n sa c t i o n fo r t h e p u r p o se o f fi n a n c i a l o r p ec u n i a r y g a i n o r p r o fi t . Alt h o u g h t h er e a r e
so me st a t u t o r y ex c ep t i o n s t o t a x a t i o n , r a r ely wi ll a c o r p o r a t e c o n t r a c t o r p er fo r mi n g
wi t h i n t h e st a t e n o t be su bj ec t t o t h e fr a n c h i se t a x .
c . Bo t h do mest i c a n d fo r ei g n c o r p o r a t i o n s (t h o se i n c o r p o r a t ed o u t si de o f Ca li fo r n i a ) mu st
be i n g o o d st a n di n g i n o r der t o be q u a li fi ed t o do bu si n ess i n Ca li fo r n i a . Ag en c i es wi ll
det er mi n e wh et h er a c o r p o r a t i o n i s i n g o o d st a n di n g by c a lli n g t h e Offi c e o f t h e Sec r et a r y
o f St a t e.
6. RESOLUTION: A c o u n t y, c i t y, di st r i c t , o r o t h er lo c a l p u bli c bo dy mu st p r o v i de t h e
St a t e wi t h a c o p y o f a r eso lu t i o n , o r der , mo t i o n , o r o r di n a n c e o f t h e lo c a l g o v er n i n g bo dy
wh i c h by la w h a s a u t h o r i t y t o en t er i n t o a n a g r eemen t , a u t h o r i z i n g ex ec u t i o n o f t h e
a g r eemen t .
7. AIR OR WATER POLLUTION VIOLATION: Un der t h e St a t e la ws, t h e Co n t r a c t o r
sh a ll n o t be: (1) i n v i o la t i o n o f a n y o r der o r r eso lu t i o n n o t su bj ec t t o r ev i ew p r o r n u lg a t ed
by t h e St a t e Ai r Reso u r c es Bo a r d o r a n a i r p o llu t i o n c o n t r o l di st r i c t ; (2 ) su bj ec t t o c ea se
a n d desi st o r der n o t su bj ec t t o r ev i ew i ssu ed p u r su a n t t o Sec t i o n 13301 o f t h e Wa t er
Co de fo r v i o la t i o n o f wa st e di sc h a r g e r eq u i r emen t s o r di sc h a r g e p r o h i bi t i o n s; o r (3)
fi n a lly det er mi n ed t o be i n v i o la t i o n o f p r o v i si o n s o f feder a l la w r ela t i n g t o a i r o r wa t er
p o llu t i o n .
8 . PAYEE DATA RECORD FORM STD. 2 04: Th i s fo r m mu st be c o mp let ed by a ll
c o n t r a c t o r s t h a t a r e n o t a n o t h er st a t e a g en c y o r o t h er g o v er n men t a l en t i t y.
or the Department of J u s ti c e to determi ne the c ontrac tor' s c ompli anc e wi th the
requ i rements u nder paragraph ( a) .
7. DOMESTIC PARTNERS: For c ontrac ts over $100,000 exec u ted or amended after
J anu ary 1, 2007, the c ontrac tor c erti fi es that c ontrac tor i s i n c ompli anc e wi th Pu bli c
Contrac t Code s ec ti on 10295. 3.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The followi ng laws apply to pers ons or enti ti es doi ng bu s i nes s wi th the State of
Cali forni a.
1. CONFLICT OF INTEREST: Contrac tor needs to be aware of the followi ng provi s i ons
regardi ng c u rrent or former s tate employees . If Contrac tor has any qu es ti ons on the
s tatu s of any pers on renderi ng s ervi c es or i nvolved wi th the Agreement, the awardi ng
agenc y mu s t be c ontac ted i mmedi ately for c lari fi c ati on.
Cu rrent State Employees ( Pu b. Contrac t Code § 10410) :
1) . No offi c er or employee s hall engage i n any employment, ac ti vi ty or enterpri s e from
whi c h the offi c er or employee rec ei ves c ompens ati on or has a fi nanc i al i nteres t and
whi c h i s s pons ored or fu nded by any s tate agenc y, u nles s the employment, ac ti vi ty or
enterpri s e i s requ i red as a c ondi ti on of regu lar s tate employment.
2) . No offi c er or employee s hall c ontrac t on hi s or her own behalf as an i ndependent
c ontrac tor wi th any s tate agenc y to provi de goods or s ervi c es .
Former State Employees ( Pu b. Contrac t Code § 10411) :
1) . For the two-year peri od from the date he or s he left s tate employment, no former s tate
offi c er or employee may enter i nto a c ontrac t i n whi c h he or s he engaged i n any of the
negoti ati ons , trans ac ti ons , planni ng, arrangements or any part of the dec i s i on-maki ng
proc es s relevant to the c ontrac t whi le employed i n any c apac i ty by any s tate agenc y.
2) . For the twelve-month peri od from the date he or s he left s tate employment, no former
s tate offi c er or employee may enter i nto a c ontrac t wi th any s tate agenc y i f he or s he was
employed by that s tate agenc y i n apoli c y-maki ng pos i ti on i n the s ame general s u bjec t
area as the propos ed c ontrac t wi thi n the 12-month peri od pri or to hi s or her leavi ng s tate
s ervi c e.
If Contrac tor vi olates any provi s i ons of above paragraphs , s u c h ac ti on by Contrac tor s hall
render thi s Agreement voi d. ( Pu b. Contrac t Code § 10420)
Members of boards and c ommi s s i ons are exempt from thi s s ec ti on i f they do not rec ei ve
payment other than payment of eac h meeti ng of the board or c ommi s s i on, payment for
preparatory ti me and payment for per di em. ( Pu b. Contrac t Code § 10430 ( e) )
_ ~j
c e r t i f i c a t i o n by f a i l i n g t o c a r r y o ut t h e r e qui r e me n t s a s n o t e d a bo ve . (Go v. Co de §8350 e t
se q.)
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Co n t r a c t o r c e r t i f i e s
t h a t n o mo r e t h a n o n e (1) f i n a l un a ppe a l a bl e f i n di n g o f c o n t e mpt o f c o ur t by a Fe de r a l
c o ur t h a s be e n i ssue d a g a i n st Co n t r a c t o r w i t h i n t h e i mme di a t e l y pr e c e di n g t w o - ye a r
pe r i o d be c a use o f Co n t r a c t o r ' s f a i l ur e t o c o mpl y w i t h a n o r de r o f a Fe de r a l c o ur t , w h i c h
o r de r s Co n t r a c t o r t o c o mpl y w i t h a n o r de r o f t h e Na t i o n a l La bo r Re l a t i o n s Bo a r d. (Pub.
Co n t r a c t Co de § 10296) (No t a ppl i c a bl e t o publ i c e n t i t i e s.)
4. CONTRACTS r OR LEGAL S~RVIC~S $50, 000 OR MORE- PRO BONO
REQUIREMENT: Co n t r a c t o r h e r e by c e r t i f i e s t h a t c o n t r a c t o r w i l l c o mpl y w i t h t h e
r e qui r e me n t s o f Se c t i o n 6072 o f t h e Busi n e ss a n d Pr o f e ssi o n s Co de , e f f e c t i ve Ja n ua r y 1,
2003.
Co n t r a c t o r a g r e e s t o ma ke a g o o d f a i t h e f f o r t t o pr o vi de a mi n i mum n umbe r o f h o ur s o f
pr o bo n o l e g a l se r vi c e s dur i n g e a c h ye a r o f t h e c o n t r a c t e qua l t o t h e l e sso r o f 30
mul t i pl i e d by t h e n umbe r o f f ul l t i me a t t o r n e ys i n t h e f i r m' s o f f i c e s i n t h e St a t e , w i t h t h e
n umbe r o f h o ur s pr o r a t e d o n a n a c t ua l da y ba si s f o r a n y c o n t r a c t pe r i o d o f l e ss t h a n a f ul l
ye a r o r 10% o f i t s c o n t r a c t w i t h t h e St a t e .
Fa i l ur e t o ma ke a g o o d f a i t h e f f o r t ma ybe c a use f o r n o n -r e n e w a l o f a st a t e c o n t r a c t f o r
l e g a l se r vi c e s, a n d ma y be t a ke n i n t o a c c o un t w h e n de t e r mi n i n g t h e a w a r d o f f ut ur e
c o n t r a c t s w i t h t h e St a t e f o r l e g a l se r vi c e s.
5. EXPATRIATE CORPORATIONS: Co n t r a c t o r h e r e by de c l a r e s t h a t i t i s n o t a n
e x pa t r i a t e c o r po r a t i o n o r subsi di a r y o f a n e x pa t r i a t e c o r po r a t i o n w i t h i n t h e me a n i n g o f
Publ i c Co n t r a c t Co de Se c t i o n 10286 a n d 10286.1, a n d i s e l i g i bl e t o c o n t r a c t w i t h t h e
St a t e o f Ca l i f o r n i a .
6. SWEATFREE CODE OF CONDUCT:
a . Al l Co n t r a c t o r s c o n t r a c t i n g f o r t h e pr o c ur e me n t o r l a un de r i n g o f a ppa r e l , g a r me n t s o r
c o r r e spo n di n g a c c e sso r i e s, o r t h e pr o c ur e me n t o f e qui pme n t , ma t e r i a l s, o r suppl i e s, o t h e r
t h a n pr o c ur e me n t r e l a t e d t o a publ i c w o r ks c o n t r a c t , de c l a r e un de r pe n a l t y o f pe r j ur y t h a t
n o a ppa r e l , g a r me n t s o r c o r r e spo n di n g a c c e sso r i e s, e qui pme n t , ma t e r i a l s, o r suppl i e s
f un l i sh e d t o t h e st a t e pur sua n t t o t h e c o n t r a c t h a ve be e n l a un de r e d o r pr o duc e d i n w h o l e
o r i n pa r t by sw e a t sh o p l a bo r , f o r c e d l a bo r , c o n vi c t l a bo r , i n de n t ur e d l a bo r un de r pe n a l
sa n c t i o n , a busi ve f o r ms o f c h i l d l a bo r o r e x pl o i t a t i o n o f c h i l dr e n i n sw e a t sh o p l a bo r , o r
w i t h t h e be n e f i t o f sw e a t sh o p l a bo r , f o r c e d l a bo r , c o n vi c t l a bo r , i n de n t ur e d l a bo r un de r
pe n a l sa n c t i o n , a busi ve f o r ms o f c h i l d l a bo r o r e x pl o i t a t i o n o f c h i l dr e n i n sw e a t sh o p
l a bo r . Th e c o n t r a c t o r f ur t h e r de c l a r e s un de r pe n a l t y o f pe r j ur y t h a t t h e y a dh e r e t o t h e
Sw e a t f r e e Co de o f Co n duc t a s se t f o r t h o n t h e Ca l i f o r n i a De pa r t me n t o f In dust r i a l
Re l a t i o n s w e bsi t e l o c a t e d a t r ~~~Tw .di r .c a .~o v, a n d Publ i c Co n t r a c t Co de Se c t i o n 6108.
b. Th e c o n t r a c t o r a g r e e s t o c o o pe r a t e f ul l y i n pr o vi di n g r e a so n a bl e a c c e ss t o t h e
c o n t r a c t o r ' s r e c o r ds, do c ume n t s, a g e n t s o r e mpl o ye e s, o r pr e mi se s i f r e a so n a bl y r e qui r e d
by a ut h o r i z e d o f f i c i a l s o f t h e c o n t r a c t i n g a g e n c y, t h e De pa r t me n t o f In dust r i a l Re l a t i o n s,
~—
CCC-307
CERTIFICATION
I, t h e o f f i c i a l na me d be l o w, CERTIFY UNDER PENALTY OF PERTURY t h a t I a m dul y
a ut h o r i z e d t o l e g a l l y bi nd t h e p r o s p e c t i v e Co nt r a c t o r t o t h e c l a us e s ) l i s t e d be l o w. Th i s
c e r t i f i c a t i o n i s ma de unde r t h e l a ws o f t h e S t a t e o f Ca l i f o r ni a .
Co nt r a c t o r/Bi dde r Fi r m Na me (Pr i nt e d) Fe de r a l ID Numbe r
Co unt o f Ne v a da 94-6000526
By (Aut h o r z S i g na t uYe )
Pr i nt e d me a nd Ti t l e o f Pe r s o n S i g ni ng
Ka r e n Mi l ma n, MD Publ i c He a l t h Of f i c e r /Di r e c t o r Publ i c He a l t h
Da t e Exe c ut e d Exe c ut e d i n t h e Co unt y o f
Ne v a da
CONTRACTOR CERTIFICATION CLAUS ES
1 . S TATEMENT OF COMPLIANCE: Co nt r a c t o r h a s , unl e s s e xe mp t e d, c o mp l i e d wi t h
t h e no ndi s c r i mi na t i o n p r o g r a m r e qui r e me nt s . (Go v . Co de § 1 2990 (a-~ a nd CCR, Ti t l e 2,
S e c t i o n 81 03) (No t a p p l i c a bl e t o p ubl i c e nt i t i e s .)
2. DRUG-FREE WORKPLACE REQUIREMENTS : Co nt r a c t o r wi l l c o mp l y wi t h t h e
r e qui r e me nt s o f t h e Dr ug-Fr e e Wo r kp l a c e Ac t o f 1 990 a nd wi l l p r o v i de a dr ug-f r e e
wo r kp l a c e by t a ki ng t h e f o l l o wi ng a c t i o ns :
a . Publ i s h a s t a t e me nt no t i f yi ng e mp l o ye e s t h a t unl a wf ul ma nuf a c t ur e , di s t r i but i o n,
di s p e ns a t i o n, p o s s e s s i o n o r us e o f a c o nt r o l l e d s ubs t a nc e i s p r o h i bi t e d a nd s p e c i f yi ng
a c t i o ns t o be t a ke n a g a i ns t e mp l o ye e s f o r v i o l a t i o ns .
b. Es t a bl i s h a Dr ug-Fr e e Awa r e ne s s Pr o g r a m t o i nf o r m e mp l o ye e s a bo ut :
1 ) t h e da ng e r s o f dr ug a bus e i n t h e wo r kp l a c e ;
2) t h e p e r s o n' s o r o r g a ni z a t i o n' s p o l i c y o f ma i nt a i ni ng a dr ug-f r e e wo r kp l a c e ;
3) a ny a v a i l a bl e c o uns e l i ng , r e h a bi l i t a t i o n a nd e mp l o ye e a s s i s t a nc e p r o g r a ms ; a nd,
4) p e na l t i e s t h a t i na y be i mp o s e d up o n e mp l o ye e s f o r dr ug a bus e v i o l a t i o ns .
c . Ev e r y e mp l o ye e wh o wo r ks o n t h e p r o p o s e d Ag r e e me nt wi l l :
1 ) r e c e i v e a c o p y o f t h e c o mp a ny' s dr ug-f r e e wo r kp l a c e p o l i c y s t a t e me nt ; a nd,
2) a g r e e t o a bi de by t h e t e r ms o f t h e c o mp a ny' s s t a t e me nt a s a c o ndi t i o n o f e mp l o yme nt
o t i i ne Ag r e e me nt .
Fa i l ur e t o c o mp l y wi t h t h e s e r e qui r e me nt s ma y r e s ul t i n s us p e ns i o n o f p a yme nt s unde r
t h e Ag r e e me nt o r t e r mi na t i o n o f t h e Ag r e e me nt o r bo t h a nd Co nt r a c t o r ma y be i ne l i g i bl e
f o r a wa r d o f a ny f ut ur e S t a t e a g r e e me nt s i f t h e de p a r t me nt de t e r mi ne s t h a t a ny o f t h e
f o l l o wi ng h a s o c c ur r e d: t h e Co nt r a c t o r h a s ma de f a l s e c e r t i f i c a t i o n, o r v i o l a t e d t h e
.p ~ —
7
Travel Reimbursement Information (Continued) E x h ibit G
2. If any of th e reimbursement rates stated h erein is ch anged by DPA, no formal contract amendment w ill be req uired to
incorporate th e new rates. How ever, CDPH sh all inform th e contractor, in w riting, of th e revised travel reimbursement rates
and th e applicable effective date of any rate ch ange.
At CDPH's discretion, ch anges or revisions made by CDPH to th is ex h ibit, ex cluding travel reimbursement policies
establish ed by DPA may be applied retroactively to any agreement to w h ich a Travel Reimbursement Information ex h ibit is
attach ed, incorporated by reference, or applied by CDPH program policy. Ch anges to th e travel reimbursement rates
stated h erein may not be applied earlier th an th e date a rate ch ange is approved by DPA.
3. For transportation ex penses, th e contractor must retain receipts for park ing; tax i, airline, bus, or rail tick ets; car rental; or
any oth er travel receipts pertaining to each trip for attach ment to an invoice as substantiation for reimbursement.
Reimbursement may be req uested for commercial carrier fares; private car mileage; park ing fees; bridge tolls; tax i, bus, or
streetcar fares; and auto rental fees w h en substantiated by a receipt.
4. Note on use of autos: If a contractor uses h is/h er or a company car for transportation, th e rate of reimbursement w ill be
55.5 cents max imum per mile. If a contractor uses h is/h er or a company car " in lieu of airfare, th e air coach fare w ill be
th e max imum paid by th e State. Th e contractor must provide a cost comparison upon req uest by th e State. Gasoline and
routine automobile repair ex penses are not reimbursable.
5. Th e contractor is req uired to furnish details surrounding each period of travel. Travel ex pense reimbursement detail may
include, but not be limited to: purpose of travel, departure and return times, destination points, miles driven, mode of
transportation, etc. Reimbursement for travel ex penses may be w ith h eld pending receipt of adeq uate travel documentation.
6. Contractors are to consult w ith th e program w ith w h ich th e contract is h eld to obtain specific invoicing procedures.
Per Diem Reimbursement Guide
Length of travel Th is condition ex ists.. ~ `~ ~ ~ ` ~ ~ Allow able Meal{s)
period
Less th an 24 h ours Trip begins at or before 6 a.m. and ends at or after 9 a.m. Break fast may be claimed.
Less th an 24 h ours Trip begins at or before 4 p.m. and ends at or after 7 p.m. Dinner may be claimed.
Contractor may not claim lunch or incidentals on one-day trips. Wh en trips are Jess-th an 24 h ours and th ere's no
overnigh t stay, meals claimed are tax able.
24 h ours Trip begins at or before 6 a.m. Break fast may be claimed.
24 h ours Trip begins at or before 11 a.m. Lunch may be claimed.
24 h ours Trip begins at or before 5 p.m. Dinner may be claimed.
More th an 24 h ours Trip ends at or after 8 a.m. Break fast may be claimed.
More th an 24 h ours Trip ends at or after 2 p.m. Lunch may be claimed.
More th an 24 h ours Trip ends at or after 7 p.m.
Dinner may be claimed.
Canfractor may not claim meals provided by th e State, meals included in h otel. ex penses or conference fees,
meals included in transportation costs such as airline tick ets; or meals th at are oth erw ise provided. Smack s and .
continental break fasts such as rolls, j uice, and coffee are-not considered to be meals.
CDPH CMU 01 (07/11)
Page 2 of 2
9' z
C a l i f o r n i a Depa r tmen t o f P u b l i c Hea l th
E x hi b i t G
Tr a vel Rei mb u r semen t In f o r ma ti o n
(Mi l ea ge Rei mb u r semen t i n c r ea se E f f ec ti ve 7/7/11)
1. The f o l l o w i n g r a te po l i c y i s to b e a ppl i ed f o r r ei mb u r si n g the tr a vel ex pen ses o f per so n s u n d er c o n tr a c t. The ter ms
" c o n tr a c t' a n d/o r " su b c o n tr a c t' ha ve the sa me mea n i n g a s " gr a n tee" a n d/o r " su b gr a n tee" w her e a ppl i c a b l e.
a . Rei mb u r semen t f o r tr a vel a n d/o r per d i em sha l l b e a t the r a tes esta b l i shed f o r n o n r epr esen ted/ex c l u d ed sta te
empl o y ees. E x c epti o n s to Depa r tmen t o f P er so n n el A d mi n i str a ti o n (DP A ) l o d gi n g r a tes ma y b e a ppr o ved b y the
C a l i f o r n i a Depa r tmen t o f P u b l i c Hea l th (C DP H) u po n the r ec ei pt o f a sta temen t o n /w i th a n i n vo i c e i n d i c a ti n g tha t su c h
r a tes a r e n o t a va i l a b l e.
b . Sho r t Ter m Tr a vel i s d ef i n ed a s a 24-ho u r per i o d , a n d l ess tha n 31 c o n sec u ti ve d a y s, a n d i s a t l ea st 50 mi l es f r o m the
ma i n o f f i c e, hea d qu a r ter s o r pr i ma r y r esi d en c e. Sta r ti n g ti me i s w hen ever a c o n tr a c t o r su b c o n tr a c t empl o y ee l ea ves
hi s o r her ho me o r hea d qu a r ter s. " Hea d qu a r ter s" i s d ef i n ed a s the pl a c e w her e the c o n tr a c ted per so n n el spen d s the
l a r gest po r ti o n o f thei r w o r ki n g ti me a n d r etu r n s to u po n the c o mpl eti o n o f a ssi gn men ts. Hea d qu a r ter s ma y b e
i n d i vi d u a l l y esta b l i shed f o r ea c h tr a vel er a n d a ppr o ved ver b a l l y o r i n w r i ti n g b y the pr o gr a m f u n d i n g the a gr eemen t.
Ver b a l a ppr o va l sha l l b e f o l l o w ed u p i n w r i ti n g o r ema i l .
c . C o n tr a c to r s o n tr a vel sta tu s f o r mo r e tha n o n e 24-ho u r per i o d a n d l ess tha n 31 c o n sec u ti ve d a y s ma y c l a i m a
f r a c ti o n a l pa r t o f a per i o d o f mo r e tha n 24 ho u r s. C o n su l t the c ha r t a ppea r i n g o n P a ge 2 o f thi s ex hi b i t to
d eter mi n e the r ei mb u r semen t a l l o w a n c e. A l l l o d gi n g r ei mb u r semen t c l a i ms mu st b e su ppo r ted b y a r ec ei pt* . If a
c o n tr a c to r d o es n o t o r c a n n o t pr esen t r ec ei pts, l o d gi n g ex pen ses w i l l n o t b e r ei mb u r sed .
(1) Lo d gi n g (w i th r ec ei pts* ):
T ` a V' el LpC a ti On . !•A r ;~a ` = - Re~mb u r semer t Ra te_.
Sta tew i d e (ex c l u d i n g the c o u n ti es i d en ti f i ed b el o w ) $ 84. 00 pl u s ta x
C o u n ti es o f Lo s A n gel es a n d Sa n Di ego $110. 00 pl u s ta x
C o u n ti es o f A l a med a , Sa n Fr a n c i sc o , Sa n Ma teo , a n d Sa n ta C l a r a $140. 00 pl u s ta x
Rei mb u r semen t f o r a c tu a l l o d gi n g ex pen ses tha t ex c eed the a b o ve a mo u n ts ma y b e a l l o w ed w i th the a d va n c e
a ppr o va l o f the Depu ty Di r ec to r o f the C a l i f o r n i a Depa r tmen t o f P u b l i c Hea l th (C DP H) o r hi s o r her d esi gn ee.
Rec ei pts a r e r equ i r ed .
" Rec ei pts f r o m In ter n et l o d gi n g r eser va ti o n ser vi c es su c h a s P r i c el i n e. c o m w hi c h r equ i r e pr epa y men t f o r tha t
ser vi c e, A RE NOT A C C E P TA BLE LODGING RE C E IP TS a n d a r e n o t r ei mb u r sa b l e w i tho u t a va l i d l o d gi n g r ec ei pt
f r o m a l o d gi n g esta b l i shmen t.
(2) Mea l/Su ppl emen ta l E x pen ses (w i th o r w i tho u t r ec ei pts): Wi th r ec ei pts, the c o n tr a c to r w i l l b e r ei mb u r sed a c tu a l
a mo u n ts spen t u p to the ma x i mu m f o r ea c h f u l l 24-ho u r per i o d o f tr a vel .
Mea l /E x pen se
Br ea kf a st
Lu n c h
Di n n er
In c i d en ta l ex pen ses
Rei mb u r semen t Ra te
$ 6. 00
$10. 00
$18. 00
$ 6. 00
d . Ou t-o f-sta te tr a vel ma y o n l y b e r ei mb u r sed i f su c h tr a vel i s n ec essi ta ted b y the sc o pe o r sta temen t o f w o r k a n d ha s
b een a ppr o ved i n a d va n c e b y the pr o gr a m w i th w hi c h the c o n tr a c t i s hel d . Fo r o u t-o f-sta te tr a vel , c o n tr a c to r s ma y b e
r ~i ~b u r sed a c tu a l i o d gi n y ex pen ses, su ppo r ted b y a r ec ei pf , a n d ma y b e r ei mb u r sed f o r mea l s a n d su ppl emen ta l
ex pen ses f o r ea c h 24-ho u r per i o d c o mpu ted a t the r a tes l i sted i n c . (2) a b o ve. Fo r a l l o u t-o f-sta te tr a vel ,
c o n tr a c to r s/su b c o n tr a c to r s mu st ha ve pr i o r C DP H w r i tten o r ver b a l a ppr o va l . Ver b a l a ppr o va l sha l l b e c o n f i r med i n
w r i ti n g (ema i l o r memo ).
e. In c o mpu ti n g a l l o w a n c es f o r c o n ti n u o u s per i o d s o f tr a vel o f l ess tha n 24 ho u r s, c o n su l t the c ha r t a ppea r i n g o n P a ge 2
o f thi s ex hi b i t.
f . No mea l o r l o d gi n g ex pen ses w i l l b e r ei mb u r sed f o r a n y per i o d o f tr a vel tha t o c c u r s w i thi n n o r ma l w o r ki n g ho u r s, u n l ess
ex pen ses a r e i n c u r r ed a t l ea st 50 mi l es f r o m hea d qu a r ter s.
C DP H C MU 01 (07/11)
P a ge 1 o f 2
~p~
. ~
State of C al i for n i a —Heal th an d Human Ser vi ces Agen cy
C al i for n i a Depar tmen t of Publ i c Heal th
C on tr actor 's Rel ease
In str ucti on s to C on tr actor :
E x hi bi t F
Wi th fi n al i n voi ces) submi t on e (1) or i gi n al an d on e (1) copy. The or i gi n al must bear the or i gi n al si gn atur e of a per son
author i zed to bi n d the C on tr actor . The addi ti on al copy may bear photocopi ed si gn atur es.
Submi ssi on of Fi n al In voi ce
Pur suan t to con tr act n umber 12-10188 en ter ed i n to between the C al i for n i a Depar tmen t of Publ i c Heal th (C DPH)
an d the C on tr actor (i den ti fi ed bel ow), the C on tr actor does ackn owl edge that fi n al paymen t has been r equested vi a i n voi ce
n umber s) , i n the amoun ts) of $ an d dated
If n ecessar y, en ter "See Attached" i n the appr opr i ate bl ocks an d attach a l i st of i n voi ce n umber s, dol l ar amoun ts an d i n voi ce dates.
Rel ease of al l Obl i gati on s
By si gn i n g thi s for m, an d upon r ecei pt of the amoun t speci fi ed i n the i n voi ce n umber s) r efer en ced above, the C on tr actor does
her eby r el ease an d di schar ge the State, i ts offi cer s, agen ts an d empl oyees of an d fr om an y an d al I l i abi l i ti es, obl i gati on s, cl ai ms, an d
deman ds whatsoever ar i si n g fr om the above r efer en ced con tr act.
Repaymen ts Due to Audi t E x cepti on s /Recor d Reten ti on
By si gn i n g thi s for m, C on tr actor ackn owl edges that ex pen ses author i zed for r ei mbur semen t does n ot guar an tee fi n al al l owabi l i ty of
sai d ex pen ses. C on tr actor agr ees that the amoun t of an y sustai n ed audi t ex cepti on s r esul ti n g fr om an y subsequen t audi t made
after fi n al paymen t wi l l be r efun ded to the State.
Al l ex pen se an d accoun ti n g r ecor ds r el ated to the above r efer en ced con tr act must be mai n tai n ed for audi t pur poses for n o l ess than
thr ee year s beyon d the date of fi n al paymen t, un l ess a l on ger ter m i s stated i n sai d con tr act.
Recycl ed Pr oduct Use C er ti fi cati on
By si gn i n g thi s for m, C on tr actor cer ti fi es un der pen al ty of per j ur y that a mi n i mum of 0% un l ess other wi se speci fi ed i n wr i ti n g of post
con sumer mater i al , as defi n ed i n the Publ i c C on tr act C ode Secti on 12200, i n pr oducts, mater i al s, goods, or suppl i es offer ed or sol d
to the State r egar dl ess of whether i t meets the r equi r emen ts of Publ i c C on tr act C ode Secti on 12209. C on tr actor speci fi es that
pr i n ter or dupl i cati on car tr i dges offer ed or sol d to the State compl y wi th the r equi r emen ts of Secti on 12156(e).
Remi n der to Retur n State E qui pmen t/Pr oper ty (If Appl i cabl e).
(Appl i es on l y i f equi pmen t was pr ovi ded by C DPH or pur chased wi th or r ei mbur sed by con tr act fun ds)
Un l ess C DPH has appr oved the con ti n ued use an d possessi on of State equi pmen t (as defi n ed i n the above r efer en ced con tr act) for
use i n con n ecti on wi th an other C DPH agr eemen t, C on tr actor agr ees to pr omptl y i n i ti ate ar r an gemen ts to accoun t for an d r etur n sai d
equi pmen t to C DPH, at C DPH's ex pen se, i f sai d equi pmen t has n ot passed i ts useful l i fe ex pectan cy as defi n ed i n the above
r efer en ced con tr act.
Paten ts /Other Issues
By si gn i n g thi s for m, C on tr actor fur ther agr ees, i n con n ecti on wi th paten t matter s an d wi th an y cl ai ms that ar e n ot speci fi cal l y
r el eased as set for th above, that i t wi l l compl y wi th al l of the pr ovi si on s con tai n ed i n the above r efer en ced con tr act, i n cl udi n g, but n ot
l i mi ted to, those pr ovi si on s r el ati n g to n oti fi cati on to the State an d r el ated to the defen se or pr osecuti on of l i ti gati on .
ONLY SIGN AND DATE THIS DOC UME NT WHE N ATTAC HING IT TO THE FINAL INVOIC E
C on tr actor 's Legal Name has on con tr act):
Si gn atur e of C on tr actor or Offi ci al Desi gn ee:
Pr i n ted Nar n e/Ti tl e of Per son Si gn i n g:
Di str i buti on :
C DPH 2352 (7/07)
Nevada C oun tv Publ i c Heal th Depar tmen t
Accoun ti n g (Or i gi n al ) Pr ogr am
1 ~O
Date:
;Nevada County Pubiic Health Department
12-10188
Exhibit E
Additional Provisions
desire f or private gain f or themselves or others, such as those w ith w hom they have
f amily, business or other ties.
C. I f CDPH is or becomes aw are of a know n or suspected conf lict of interest, the Grantee w ill
be given an opportunity to submit additional inf ormation or to resolve the conf lict. A Grantee
w ith a suspected conf lict of interest under this agreement w ill have f ive (5) w orking days
f rom the date of notif ication of the conf lict by CDPH to provide complete inf ormation
regarding the suspected conf lict. I f a conf lict of interest is determined to exist by CDPH and
cannot be resolved to the satisf action of CDPH, the conf lict w ill be grounds f or terminating
the agreement. CDPH may, at its discretion upon receipt of a w ritten request f rom the
Grantee, authoriz e an extension of the timeline indicated herein.
$G~ -
Page 3 of 3
Nevada County P ub l i c Heal th Department
12-10188
Exhi b i t E
Addi ti onal P rovi si ons
F . I n the event of termi nati on, and at the request of CDP H, the Grantee shal l furni sh c opi es of
al l proposal s, spec i fi c ati ons, desi gns, proc edures, l ayouts, c opy, and other materi al s rel ated
to the servi c es or del i verab l es provi ded under thi s agreement, whether fi ni shed or i n
progress on the termi nati on date.
G. The Grantee wi l l not b e enti tl ed to rei mb ursement for any expenses i nc urred for servi c es
and del i verab l es pursuant to thi s agreement after the effec ti ve date of termi nati on.
H. Upon rec ei pt of noti fi c ati on of termi nati on of thi s agreement, and exc ept as otherwi se
spec i fi ed b y CDP H, the Grantee shal l :
1) P l ac e no further order or sub grants for materi al s, servi c es, or fac i l i ti es.
2) S ettl e al l outstandi ng l i ab i l i ti es and al l c l ai ms ari si ng out of suc h termi nati on of orders
and sub grants.
3) Upon the effec ti ve date of termi nati on of the agreement Grantee shal l transfer, assi gn
and make avai l ab l e to CDP H al l property and materi al s b el ongi ng to CDP H, al l ri ghts
and c l ai ms to any and al l reservati ons, grants, and arrangements wi th owners of
medi a/P R materi al s, or others, and shal l make avai l ab l e to CDP H al l wri tten i nformati on
regardi ng CDP H's medi a/P R materi al s, and no extra c ompensati on i s to b e pai d to
Grantee for i ts servi c es.
4) Take suc h ac ti on as may b e nec essary, or as CDP H may spec i fy, to protec t and
preserve any property rel ated to thi s agreement whi c h i s i n the possessi on of the
Grantee and i n whi c h CDP H has or may ac qui re an i nterest.
I . CDP H may, at i ts di sc reti on, requi re the Grantee to c ease performanc e of c ertai n
c omponents of the S c ope of Work as desi gnated b y CDP H and c ompl ete performanc e of
other c omponents pri or to the termi nati on date of the agreement.
3. Avoi danc e of Confl i c ts of I nterest b y Grantee
A. CDP H i ntends to avoi d any real or apparent c onfl i c t of i nterest on the part of the Grantee,
sub grantees, or empl oyees, offi c ers and di rec tors of the Grantee or sub grantees. Thus,
CDP H reserves the ri ght to determi ne, at i ts sol e di sc reti on, whether any i nformati on,
asserti on, or c l ai m rec ei ved from any sourc e i ndi c ates the exi stenc e of a real or apparent
c onfl i c t of i nterest; and, i f a c onfl i c t i s found to exi st, to requi re the Grantee to sub mi t
addi ti onal i nformati on or a pl an for resol vi ng the c onfl i c t, sub jec t to pri or CDP H revi ew and
approval .
B. Confl i c ts of i nterest i nc l ude, b ut are not l i mi ted to:
1) An i nstanc e where the Grantee or any of i ts sub grantees, or any empl oyee, offi c er, or
di rec tor of the Grantee or any sub grantee has an i nterest, fi nanc i al or otherwi se,
whereb y the use or di sc l osure of i nformati on ob tai ned whi l e performi ng servi c es under
the agreement woul d al l ow for pri vate or personal b enefi t or for any purpose that i s
c ontrary to the goal s and ob jec ti ves of the agreement.
2) An i nstanc e where the Grantee's or any sub grantee's empl oyees, offi c ers, or di rec tors
use thei r posi ti ons for purposes that are, or gi ve the appearanc e of b ei ng, moti vated b y a
~$ g —
P age 2 of 3
:Nevada County P ub l i c Heal th Department
12-10188
Exhi b i t E
Addi ti onal P rovi si ons
1. Addi ti onal Inc orporated Doc uments
A. The f ol l ow i ng doc uments and any sub sequent updates are not attac hed, b ut are
i nc orporated herei n and made a part hereof b y thi s ref erenc e. These doc uments may b e
updated peri odi c al l y b y CDP H, as requi red b y prog ram di rec ti ves. CDP H shal l provi de the
Grantee w i th c opi es of sai d doc uments and any peri odi c updates thereto, under separate
c over. CDP H w i l l mai ntai n on f i l e, al l doc uments ref erenc ed herei n and any sub sequent
updates.
1. Netw ork Loc al P roj ec ts Netw ork f or a Heal thy Cal i f orni a Gui del i nes Manual and any
revi si ons thereto. (Revi si on Oc tob er 2011)
http:/ /w w w .c dph.c a.qov/ prog rams/ c pns/ P ag es/ Gui del i nesManual .aspx
2. Netw ork f or a Heal thy Cal i f orni a P rog ram Letters and any revi si ons thereto.
http:/ /w w w .c dph.c a.qov/ prog rams/ c pnsl P ag esl P roqramLetters.aspx
3 . U ni ted States Department of Ag ri c ul ture, Suppl emental Nutri ti on Assi stanc e P rog ram
Educ ati on (SNAP-Ed) P l an Gui danc e. (Revi si on Date FFY 2013 )
http:/ /w w w .nal .usda.qov/f snl Gui danc e1FY2013 SNAP -EdP l anGui danc e.pdf
2. Canc el l ati on / Termi nati on
A. Thi s ag reement may b e c anc el l ed b y CDP H w i thout c ause upon 3 0 c al endar days advanc e
w ri tten noti c e to the Grantee.
B. CDP H reserves the ri g ht to c anc el or termi nate xhi s ag reement i mmedi atel y f or c ause. The
Grantee may sub mi t a w ri tten request to termi nate thi s ag reement onl y i f CDP H sub stanti al l y
f ai l s to perf orm i ts responsi b i l i ti es as provi ded herei n.
C. The term " f or c ause" shal l mean that the Grantee f ai l s to meet the terms, c ondi ti ons, and/ or
responsi b i l i ti es of thi s ag reement. Causes f or termi nati on i nc l ude, b ut are not l i mi ted to the
f ol l ow i ng oc c urrenc es:
1) If the Grantee know i ng l y f urni shes any statement, representati on, w arranty, or
c erti f i c ati on i n c onnec ti on w i th the ag reement, w hi c h representati on i s materi al l y f al se,
dec epti ve, i nc orrec t, or i nc ompl ete.
2) If the Grantee f ai l s to perf orm any materi al requi rement of thi s ag reement or def aul ts i n
perf ormanc e of thi s ag reement.
3 ) If the Grantee f i l es f or b ankruptc y, or i f CDP H determi nes that the Grantee b ec omes
f i nanc i al l y i nc apab l e of c ompl eti ng thi s ag reement.
D. Ag reement termi nati on or c anc el l ati on shal l b e ef f ec ti ve as of the date i ndi c ated i n CDP H's
noti f i c ati on to the Grantee. The noti c e shal l sti pul ate any f i nal perf ormanc e, i nvoi c i ng or
payment requi rements.
E. In the event of earl y termi nati on or c anc el l ati on, the Grantee shal l b e enti tl ed to
c ompensati on f or servi c es perf ormed sati sf ac tori l y under thi s ag reement and expenses
i nc urred up to the date of c anc el l ati on and any non-c anc el ab l e ob l i g ati ons i nc urred i n
support of thi s ag reement.
g 7 --
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C a l i f o r n i a Depa r tmen t o f Publ i c Hea l th - Speci a l Ter ms a n d C o n di ti o n s E x hi bi t D (F)
INSTRUC TIONS FOR C OMPLE TION OF SF- LLL, DISC LOSURE OF LOBBYING AC TIVITIE S
Thi s di scl o sur e f o r m sha l l be co mpl eted by the r epo r ti n g en ti ty, whether suba wa r dee o r pr i me Feder a l r eci pi en t, a t the i n i ti a ti o n o r r ecei pt o f a co ver ed Feder a l a cti o n , o r a
ma ter i a l cha n g e to a pr evi o us f i l i n g , pur sua n t to ti tl e 31 U.S.C . secti o n 1352. The f i l i n g o f a f o r m i s r eq ui r ed f o r ea ch pa ymen t o r a g r eemen t to ma ke pa ymen t to a n y l o bbyi n g
en ti ty f o r i n Fl uen ci n g o r a ttempti n g to i n f l uen ce a n o f f i cer o r empl o yee o f a n y a g en cy, a Member o f C o n g r ess, a n o f f i cer o r empl o yee o f C o n g r ess, o r a n empl o yee o f a Member
o f C o n g r ess i n co n n ecti o n wi th a co ver ed Feder a l a cti o n . C o mpl ete a l l i tems tha t a ppl y f o r bo th the i n i ti a l f i l i n g a n d ma ter i a l cha n g e r epo r t. Ref er to the i mpl emen ti n g g ui da n ce
publ i shed by the On ce o f Ma n a g emen t a n d Budg et f o r a ddi ti o n a l i n f o r ma ti o n .
1. Iden ti f y the type o f co ver ed Feder a l a cti o n f o r whi ch l o bbyi n g a cti vi ty i s a n d/ o r ha s been secur ed to i n Fl uen ce the o utco me o f a co ver ed Feder a l a cti o n .
2. Iden ti f y the sta tus o f the co ver ed Feder a l a cti o n .
3. Iden ti f y the a ppr o pr i a te cl a ssi f i ca ti o n o f thi s r epo r t. If thi s i s a f o l l o w- up r epo r t ca used by a ma ter i a l cha n g e to the i n f o r ma ti o n pr evi o usl y r epo r ted, en ter the yea r a n d
q ua r ter i n whi ch the cha n g e o ccur r ed. E n ter the da te o f the l a st pr evi o usl y submi tted r epo r t by thi s r epo r ti n g en ti ty f o r thi s co ver ed Feder a l a cti o n .
4. E n ter the f ul l n a me, a ddr ess, ci ty, Sta te a n d z i p co de o f the r epo r ti n g en ti ty. In cl ude C o n g r essi o n a l Di str i ct, i f kn o wn . C heck the a ppr o pr i a te cl a ssi f i ca ti o n o f the
r epo r ti n g en ti ty tha t desi g n a tes i f i t i s, o r ex pects to be a pr i me o r suba wa r d r eci pi en t. Iden ti f y the ti er o f the suba wa r dee, e.g ., the f i r st suba wa r dee o f the pr i me i s
the 1st ti er . Suba wa r ds i n cl ude but a r e n o t l i mi ted to subco n tr a cts, subg r a n ts a n d co n tr a ct a wa r ds un der g r a n ts.
5. If the o r g a n i z a ti o n f i l i n g the r epo r t i n i tem 4 checks "Suba wa r dee," then en ter the f ul l n a me, a ddr ess, ci ty, Sta te a n d z i p co de o f the pr i me Feder a l r eci pi en t. In cl ude
C o n g r essi o n a l Di str i ct, i f kn o wn .
6. E n ter the n a me o f the Feder a l a g en cy ma ki n g the a wa r d o r l o a n co mmi tmen t. In cl ude a t l ea st o n e o r g a n i z a ti o n a l l evel bel o w a g en cy n a me, i f kn o wn . Fo r ex a mpl e,
Depa r tmen t o f Tr a n spo r ta ti o n , Un i ted Sta tes C o a st Gua r d.
7. E n ter the Feder a l pr o g r a m n a me o r descr i pti o n f o r the wver ed Feder a l a cti o n (i tem 1). If kn o wn , en ter the f ul l C a ta l o g o f Feder a l Do mesti c Assi sta n ce (C FDA)
n umber f o r g r a n ts, co o per a ti ve a g r eemen ts, l o a n s, a n d l o a n wmmi tmen ts.
S. E n ter the mo st a ppr o pr i a te Feder a l i den ti f yi n g n umber a va i l a bl e f o r the Feder a l a cti o n i den ti f i ed i n i tem 1 (e.g ., Req uest f o r Pr o po sa l (RFP) n umber ; In vi ta ti o n f o r Bi d
(IFB) n umber ; g r a n t a n n o un cemen t n umber ; the co n tr a ct, g r a n t, o r l o a n a wa r d n umber ; the a ppl i ca ti o n/ pr o po sa l co n tr o l n umber a ssi g n ed by the Feder a l a g en cy).
In cl ude pr ef i x es, e.g ., "RFP- DE- 90- 001."
9. Fo r a co ver ed Feder a l a cti o n wher e ther e ha s been a n a wa r d o r l o a n co mmi tmen t by the Feder a l a g en cy, en ter the Feder a l a mo un t o f the a wa r d/ l o a n co mmi tmen t
f o r the pr i me en ti ty i den ti f i ed i n i tem 4 o r 5.
10. (a ) E n ter the f ul l n a me, a ddr ess, ci ty, Sta te a n d z i p co de o f the l o bbyi n g r eg i str a n t un der the Lo bbyi n g Di scl o sur e Act o f 1995 en g a g ed by the r epo r ti n g en ti ty
i den ti f i ed i n i tem 4 to i n Fl uen ce the co ver ed Feder a l a cti o n .
(b) E n ter the f ul l n a mes o f the i n di vi dua l s) per f o r mi n g ser vi ces, a n d i n cl ude f ul l a ddr ess i f di f f er en t f r o m 10 (a ). E n ter La st Na me, Fi r st Na me, a n d Mi ddl e In i ti a l
(MI).
11. The cer ti f yi n g o f f i ci a l sha l l si g n a n d da te the f o r m, pr i n t hi s/ her n a me, ti tl e, a n d tel epho n e n umber .
Acco r di n g to the Pa per wo r k Reducti o n Act, a s a men ded, n o per so n s a r e r eq ui r ed to r espo n d to a co l l ecti o n o f i n f o r ma ti o n un l ess i t di spl a ys a va l i d
OMB C o n tr o l Number . The va l i d OMB co n tr o l n umber f o r thi s i n f o r ma ti o n co l l ecti o n i s OMB No . 0348- 0046. Publ i c r epo r ti n g bur den f o r thi s
co l l ecti o n o f i n f o r ma ti o n i s esti ma ted to a ver a g e 10 mi n utes per r espo n se, i n cl udi n g ti me f o r r evi ewi n g i n str ucti o n s, sea r chi n g ex i sti n g da ta so ur ces,
g a ther i n g a n d ma i n ta i n i n g the da ta n eeded, a n d co mpl eti n g a n d r evi ewi n g the co l l ecti o n o f i n f o r ma ti o n . Sen d co mmen ts r eg a r di n g the bur den
esti ma te o r a n y o ther a spect o f thi s co l l ecti o n o f i n f o r ma ti o n , i n cl udi n g sug g esti o n s f o r r educi n g thi s bur den , to the Of f i ce o f Ma n a g emen t a n d
Budg et, Pa per wo r k Reducti o n Pr o ject (0348-0046), Wa shi n g to n , DC 20503.
C DPH E x hi bi t D(F) (8/ 10)
Pa g e 25 o f 25
_.
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C a l i f o r n i a Depa r tmen t o f Publ i c Hea l th - Speci a l Ter ms a n d C o n di ti o n s E x hi bi t D (F)
Atta chmen t 2
C E RTIFIC ATION RE GARDING LOBBYING Appr o vetl by OMB
C o mpl ete thi s f o r m to di scl o se l o bbyi n g a cti vi ti es pur sua n t to 31 U.S.C . 1352 0 3« .0 0 4 s
(See r ever se f o r publ i c bur den di scl o sur e)
1. Type o f Feder a l Acti o n : 2. Sta tus o f Feder a l Acti o n : 3. Repo r t Type:
[ ] a . co n tr a ct [ ] a . bi d/ o f f er/ a ppl i ca ti o n (] a . i n i ti a l f i l i n g
b. gr a n t
b. i n i ti a l a wa r d b. ma ter i a l cha n ge
c. co o per a ti ve a gr eemen t
d. l o a n
c. po st- a wa r d
Fo r Ma ter i a l C ha n ge On i y:
e. l o a n gua r a n tee
f . l o a n i n sur a n ce
Yea r qua r ter
da te o f l a st r epo r t
4 . Na me a n d Addr ess o f Repo r ti n g E n ti ty:
5. If Repo r ti n g E n ti ty i n No . 4 i s Suba wa r dee, E n ter Na me
a n d Addr ess o f Pr i me:
u Pr i me u Suba wa r dee
Ti er _, i f kn o wn :
C o n sessi o n a l Di str i ct If kn o wn : C o n sessi o n a l Di str i ct, If kn o wn :
6. Feder a l Depa r tmen UAgen cy 7. Feder a l Pr o gr a m Na me/ Descr i pti o n :
C DFA Number , i f a ppl i ca bl e:
8. Feder a l Acti o n Number , i f kn o wn : 9. Awa r d Amo un t, i f kn o wn :
1 O.a . Na me a n d Addr ess o f Lo bbyi n g Regi str a n t b. In di vi dua l s Per f o r mi n g Ser vi ces (i n cl udi n g a ddr ess i f di f f er en t f r o m
(If i n di vi dua l , l a st n a me, f i r st n a me, MI): 10 a .
(La st n a me, Fi r st n a me, Ml ):
11. In f o r ma ti o n r equested thr o ugh thi s f o r m i s a utho r i z ed by ti tl e 31
U.S.C . secti o n 1352. Thi s di scl o sur e o f l o bbyi n g a cti vi ti es i s a ma ter i a l
Si gn a tur e:
Pr i n t Na me:
r epr esen ta ti o n o f f a ct upo n whi ch r el i a n ce wa s pl a ced by the ti er
a bo ve when thi s tr a n sa cti o n wa s ma de o r en ter ed i n to . Thi s
Ti tl e:
di scl o sur e i s r equi r ed pur sua n t to 31 U.S.C . 1352. Thi s i n f o r ma ti o n
wi l l be a va i l a bl e f o r publ i c i n specti o n . r equi r ed di scl o sur e sha l l be
subject to a n o t mo r e tha n $10 0 ,0 0 0 f o r ea ch such f a i l ur e.
Tel epho n e No .: Da te:
i?: f
~ ~ j' : ;~
~ ~ ~ , ~ s" A..
..
~ a S. ~ r t. > . i t ~ hv~
Autho r i z ed f o r Lo ca l Repr o ducti o n
tc Sta n da r d Fo r m- LLL (Rev. 7- 97)
i
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C DPH E x hi bi t D(F) (8/ 10 ) ~ ~ ~ ,._ Pa ge 24 o f 25
C a l i f o r n i a Depa r tmen t o f P u b l i c H ea l th - Spec i a l Ter ms a n d C o n di ti o n s E x h i b i t D (F)
Atta c h men t 1
STATE OF C ALIFORNIA
C ALIFORNIA DE P ARTME NT OF P UBLIC H E ALTH
C E RTIFIC ATION RE GARDING LOBBYING
Th e u n der si gn ed c er ti f i es, to th e b est o f h i s o r h er kn o wl edge a n d b el i ef , th a t:
(1) No Feder a l a ppr o pr i a ted f u n ds h a ve b een pa i d o r wi l l b e pa i d, b y o r o n b eh a l f o f th e u n der si gn ed, to
a n y per so n f o r i n f l u en c i n g o r a ttempti n g to i n f l u en c e a n o f f i c er o r empl o yee o f a n a gen c y, a Memb er o f C o n gr ess,
a n o f f i c er o r empl o yee o f C o n gr ess, o r a n empl o yee o f a Memb er o f C o n gr ess i n c o n n ec ti o n wi th th e ma ki n g,
a wa r di n g o r en ter i n g i n to o f th i s Feder a l c o n tr a c t, Feder a l gr a n t, o r c o o per a ti ve a gr eemen t, a n d th e ex ten si o n ,
c o n ti n u a ti o n , r en ewa l , a men dmen t, o r mo di f i c a ti o n o f th i s Feder a l c o n tr a c t, gr a n t, o r c o o per a ti ve a gr eemen t.
(2) If a n y f u n ds o th er th a n Feder a l a ppr o pr i a ted f u n ds. h a ve b een pa i d o r wi l l b e pa i d to a n y per so n f o r
i n f l u en c i n g o r a ttempti n g to i n f l u en c e a n o f f i c er o r empl o yee o f a n y a gen c y o f th e Un i ted Sta tes Go ver n men t, a
Memb er o f C o n gr ess, a n o f f i c er o r empl o yee o f C o n gr ess, o r a n empl o yee o f a Memb er o f C o n gr ess i n
c o n n ec ti o n wi th th i s Feder a l c o n tr a c t, gr a n t, o r c o o per a ti ve a gr eemen t, th e u n der si gn ed sh a l l c o mpl ete a n d su b mi t
Sta n da r d Fo r m LLL, "Di sc l o su r e o f Lo b b yi n g Ac ti vi ti es" i n a c c o r da n c e wi th i ts i n str u c ti o n s.
(3) Th e u n der si gn ed sh a l l r eq u i r e th a t th e l a n gu a ge o f th i s c er ti f i c a ti o n b e i n c l u ded i n th e a wa r d
do c u men ts f o r a l l su b a wa r ds a t a l l ti er s (i n c l u di n g su b c o n tr a c to r s, su b gr a n ts, a n d c o n tr a c ts u n der gr a n ts a n d
c o o per a ti ve a gr eemen ts) o f $100, 000 o r mo r e, a n d th a t a l l su b r ec i pi en ts sh a l l c er ti f y a n d di sc l o se a c c o r di n gl y.
Th i s c er ti f i c a ti o n i s a ma ter i a l r epr esen ta ti o n o f f a c t u po n wh i c h r el i a n c e wa s pl a c ed wh en th i s tr a n sa c ti o n wa s
ma de o r en ter ed i n to . Su b mi ssi o n o f th i s c er ti f i c a ti o n i s a pr er eq u i si te f o r ma ki n g o r en ter i n g i n to th i s tr a n sa c ti o n
i mpo sed b y Sec ti o n 1352, Ti tl e 31, U.S.C ., a n y per so n wh o f a i l s to f i l e th e r eq u i r ed c er ti f i c a ti o n sh a l l b e su b jec t to
a c i vi l pen a l ty o f n o t l ess th a n $10, 000 a n d n o t mo r e th a n $100, 000 f o r ea c h su c h f a i l u r e.
Neva da C o u n ty P u b l i c H ea l th Depa r tmen t
Na me o f C o n tr a c to r
12- 10188
C o n tr a c t /Gr a n t Nu mb er
/~ G ~ /~ Z
Da te
Af ter ex ec u ti o n b y o r o n b eh a l f o f C o n tr a c to r , pl ea se r etu r n to :
C a l i f o r n i a Depa r tmen t o f P u b l i c H ea l th
Netwo r k f o r a H ea l th y C a l i f o r n i a
Attn : Ki sh a H o l mes
1616 C a pi ta l Ave MS 7204
P O Bo x 7204
Sa c r a men to , C A 95899- 7377
Dr . Ka r en Mi l ma n
P r i n ted Na me o f P er so n Si gn i n g f o r C o n tr a c to r
a
—~__
Si gn a r e o f P er so n Si gn i n g f o r C o n tr a c to r
P u b l i c H ea l th Di r ec to r
C DP H r eser ves th e r i gh t to n o ti f i y th e c o n tr a c to r i n wr i ti n g o f a n a l ter n a te su b mi ssi o n a ddr ess.
C DP H E x h i b i t D(F) (8/10) , - .. p C a m— P a ge 23 o f 25
l ~
C a l i f o r n i a Depa r tmen t o f P u b l i c H ea l th - Spec i a l Ter ms a n d C o n di ti o n s E x h i b i t D (F)
Atta c h men t 1
STATE OF C ALIFORNIA
C ALIFORNIA DE P ARTME NT OF P UBLIC H E ALTH
C E RTIFIC ATION RE GARDING LOBBYING
Th e u n der si gn ed c er ti f i es, to th e b est o f h i s o r h er kn o wl edge a n d b el i ef , th a t:
(1) No Feder a l a ppr o pr i a ted f u n ds h a ve b een pa i d o r wi l l b e pa i d, b y o r o n b eh a l f o f th e u n der si gn ed, to
a n y per so n f o r i n f l u en c i n g o r a ttempti n g to i n f l u en c e a n o f f i c er o r empl o yee o f a n a gen c y, a Memb er o f C o n gr ess,
a n o f f i c er o r empl o yee o f C o n gr ess, o r a n empl o yee o f a Memb er o f C o n gr ess i n c o n n ec ti o n wi th th e ma ki n g,
a wa r di n g o r en ter i n g i n to o f th i s Feder a l c o n tr a c t, Feder a l gr a n t, o r c o o per a ti ve a gr eemen t, a n d th e ex ten si o n ,
c o n ti n u a ti o n , r en ewa l , a men dmen t, o r mo di f i c a ti o n o f th i s Feder a l c o n tr a c t, gr a n t, o r c o o per a ti ve a gr eemen t.
(2) If a n y f u n ds o th er th a n Feder a l a ppr o pr i a ted f u n ds h a ve b een pa i d o r wi l l b e pa i d to a n y per so n f o r
i n f l u en c i n g o r a ttempti n g to i n f l u en c e a n o f f i c er o r empl o yee o f a n y a gen c y o f th e Un i ted Sta tes Go ver n men t, a
Memb er o f C o n gr ess, a n o f f i c er o r empl o yee o f C o n gr ess, o r a n empl o yee o f a Memb er o f C o n gr ess i n
c o n n ec ti o n wi th th i s Feder a l c o n tr a c t, gr a n t, o r c o o per a ti ve a gr eemen t, th e u n der si gn ed sh a l l c o mpl ete a n d su b mi t
Sta n da r d Fo r m LLL, "Di sc l o su r e o f Lo b b yi n g Ac ti vi ti es" i n a c c o r da n c e wi th i ts i n str u c ti o n s.
(3) Th e u n der si gn ed sh a l l r eq u i r e th a t th e l a n gu a ge o f th i s c er ti f i c a ti o n b e i n c l u ded i n th e a wa r d
do c u men ts f o r a l l su b a wa r ds a t a l l ti er s (i n c l u di n g su b c o n tr a c to r s, su b gr a n ts, a n d c o n tr a c ts u n der gr a n ts a n d
c o o per a ti ve a gr eemen ts) o f $100, 000 o r mo r e, a n d th a t a l l su b r ec i pi en ts sh a l l c er ti f y a n d di sc l o se a c c o r di n gl y.
Th i s c er ti f i c a ti o n i s a ma ter i a l r epr esen ta ti o n o f f a c t u po n wh i c h r el i a n c e wa s pl a c ed wh en th i s tr a n sa c ti o n wa s
ma de o r en ter ed i n to . Su b mi ssi o n o f th i s c er ti f i c a ti o n i s a pr er eq u i si te f o r ma ki n g o r en ter i n g i n to th i s tr a n sa c ti o n
i mpo sed b y Sec ti o n 1352, Ti tl e 31, U.S.C ., a n y per so n wh o f a i l s to f i l e th e r eq u i r ed c er ti f i c a ti o n sh a l l b e su b jec t to
a c i vi l pen a l ty o f n o t l ess th a n $10, 000 a n d n o t mo r e th a n $100, 000 f o r ea c h su c h f a i l u r e.
Neva da C o u n ty P u b l i c H ea l th Depa r tmen t Dr . Ka r en Mi l ma n
Na me o f C o n tr a c to r P r i n ted Na me o f P er so n Si gn i n g f o r C o n tr a c to r
f `
12- 10188 '
C o n tr a c t /Gr a n t Nu mb er ~ Si gn a tu r e o f P er so n Si gn i n g f o r C o n tr a c to r
~ ~ ~ ~ l ' v P u b l i c H ea l th Di r ec to r
Da te Ti tl e
Af ter ex ec u ti o n b y o r o n b eh a l f o f C o n tr a c to r , pl ea se r etu r n to :
C a l i f o r n i a Depa r tmen t o f P u b l i c H ea l th
Netwo r k f o r a H ea l th y C a l i f o r n i a
Attn : Ki sh a H o l mes
1616 C a pi ta l Ave MS 7204
P O Bo x 7204
Sa c r a men to , C A 95899- 7377
C DP H r eser ves th e r i gh t to n o ti f i y th e c o n tr a c to r i n wr i ti n g o f a n a l ter n a te su b mi ssi o n a ddr ess.
C DP H E x h i b i t D(F) (8/10) ~ v J ~ P a ge 23 o f 25
C a l i f o r n i a Depa r tmen t o f P u b l i c Hea l th - Spec i a l Ter ms a n d C o n di ti o n s E x hi b i t D (F)
(a ) A c u mu l a ti ve i n c r ea se o f $25,000 o r mo r e i n the a mo u n t pa i d o r ex pec ted to b e pa i d f o r
i n f l u en c i n g o r a ttempti n g to i n f l u en c e a c o ver ed f eder a l a c ti o n ;
(b ) A c ha n g e i n the per so n s) o r i n di vi du a l s(s) i n f l u en c i n g o r a ttempti n g to i n f l u en c e a c o ver ed f eder a l
a c ti o n ; o r
(c ) A c ha n g e i n the o f f i c er (s), empl o yee(s), o r memb er s) c o n ta c ted f o r the pu r po se o f i n f l u en c i n g o r
a ttempti n g to i n f l u en c e a c o ver ed f eder a l a c ti o n .
(4) E a c h per so n (o r r ec i pi en t) who r equ ests o r r ec ei ves f r o m a per so n r ef er r ed to i n P a r a g r a ph a (1) o f
thi s pr o vi si o n a c o n tr a c t o r a g r eemen t, su b c o n tr a c t, g r a n t o r su b g r a n t ex c eedi n g $100,000 a t a n y ti er
u n der a c o n tr a c t o r a g r eemen t, o r g r a n t sha l l f i l e a c er ti f i c a ti o n , a n d a di sc l o su r e f o r m, i f r equ i r ed, to
the n ex t ti er a b o ve.
(5) Al l di sc l o su r e f o r ms (b u t n o t c er ti f i c a ti o n s) sha l l b e fo►wardedf r o m ti er to ti er u n ti l r ec ei ved b y the
per so n r ef er r ed to i n P a r a g r a ph a (1) o f thi s pr o vi si o n . Tha t per so n sha l l f o r wa r d a l l di sc l o su r e f o r ms
to C DP H P r o g r a m C o n tr a c t Ma n a g er .
b . P r o hi b i ti o n
Sec ti o n 1352 o f Ti n e 31, U. S. C . , pr o vi des i n pa r t tha t n o a ppr o pr i a ted f u n ds ma y b e ex pen ded b y the
r ec i pi en t o f a f eder a l c o n tr a c t o r a g r eemen t, g r a n t, l o a n , o r c o o per a ti ve a g r eemen t to pa y a n y per so n f o r
i n f l u en c i n g o r a ttempti n g to i n f l u en c e a n o f f i c er o r empl o yee o f a n y a g en c y, a Memb er o f C o n g r ess, a n
o f f i c er o r empl o yee o f C o n g r ess, o r a n empl o yee o f a Memb er o f C o n g r ess i n c o n n ec ti o n wi th a n y o f the
f o l l o wi n g c o ver ed f eder a l a c ti o n s: the a wa r di n g o f a n y f eder a l c o n tr a c t o r a g r eemen t, the ma ki n g o f a n y
f eder a l g r a n t, the ma ki n g o f a n y f eder a l l o a n , en ter i n g i n to o f a n y c o o per a ti ve a g r eemen t, a n d the
ex ten si o n , c o n ti n u a ti o n , r en ewa l , a men dmen t, o r mo di f i c a ti o n o f a n y f eder a l c o n tr a c t o r a g r eemen t, g r a n t,
l o a n , o r c o o per a ti ve a g r eemen t.
C DP H E x hi b i t D(F) (8/10) — Q Z "~ P a g e 22 o f 25
v
C a l i f o r n i a Depa r tmen t o f Publ i c Hea l th - Speci a l Ter ms a n d C o n di ti o n s E x hi bi t D (F)
f . E a r n ed/Accr ued C o mpen sa ti o n
(1) C o mpen sa ti o n f o r v a ca ti o n , si ck l ea v e a n d ho l i da y s i s l i mi ted to tha t a mo un t ea r n ed/a ccr ued w i thi n
the a gr eemen t ter m. Un used v a ca ti o n , si ck l ea v e a n d ho l i da y s ea r n ed f r o m per i o ds pr i o r to the
a gr eemen t ter m ca n n o t be cl a i med a s a l l o w a bl e co sts. See Pr o v i si o n f (3)(a ) f o r a n ex a mpl e.
(2) Fo r mul ti pl e y ea r a gr eemen ts, v a ca ti o n a n d si ck l ea v e co mpen sa ti o n , w hi ch i s ea r n ed/a ccr ued but n o t
pa i d, due to empl o y ees) n o t ta k i n g ti me o f f ma y be ca r r i ed o v er a n d cl a i med w i thi n the o v er a l l ter m o f
the mul ti pl e y ea r s o f the Agr eemen t. Ho l i da y s ca n n o t be ca r r i ed o v er f r o m o n e a gr eemen t y ea r to the
n ex t. See Pr o v i si o n f (3)(b) f o r a n ex a mpl e.
(3) Fo r si n gl e y ea r a gr eemen ts, v a ca ti o n , si ck l ea v e a n d ho l i da y co mpen sa ti o n tha t i s ea r n ed/a ccr ued but
n o t pa i d, due to empl o y ees) n o t ta k i n g ti me o f f w i thi n the ter m o f the Agr eemen t, ca n n o t be cl a i med
a s a n a l l o w a bl e co st. See Pr o v i si o n f (3)(c) f o r a n ex a mpl e.
(a ) E x a mpl e No . 1:
I f a n empl o y ee, Jo hn Do e, ea r n s/a ccr ues thr ee w eek s o f v a ca ti o n a n d tw el v e da y s o f si ck l ea v e
ea ch y ea r , then tha t i s the ma x i mum a mo un t tha t ma y be cl a i med dur i n g a o n e y ea r a gr eemen t.
I f Jo hn Do e ha s f i v e w eek s o f v a ca ti o n a n d ei ghteen da y s o f si ck l ea v e a t the begi n n i n g o f a n
a gr eemen t, the C o n tr a cto r dur i n g co n e- y ea r budget per i o d ma y o n l y cl a i m up to thr ee w eek s o f
v a ca ti o n a n d tw el v e da y s o f si ck l ea v e a s a ctua l l y used by the empl o y ee. Amo un ts
ea r n ed/a ccr ued i n per i o ds pr i o r to the begi n n i n g o f the Agr eemen t a r e n o t a n a l l o w a bl e co st.
(b) E x a mpl e No . 2:
I f dur i n g a thr ee- y ea r (mul ti pl e y ea r ) a gr eemen t, Jo hn Do e do es n o t use hi s thr ee w eek s o f
v a ca ti o n i n y ea r o n e, o r hi s thr ee w eek s i n y ea r tw o , but he do es a ctua l l y use n i n e w eek s i n y ea r
thr ee; the C o n tr a cto r w o ul d be a l l o w ed to cl a i m a l l n i n e w eek s pa i d f o r i n y ea r thr ee. The to ta l
co mpen sa ti o n o v er the thr ee- y ea r per i o d ca n n o t ex ceed 156 w eek s (3 x 52 w eek s).
(c) E x a mpl e No . 3:
I f dur i n g a si n gl e y ea r a gr eemen t, Jo hn Do e w o r k s f i f ty w eek s a n d used o n e w eek o f v a ca ti o n a n d
o n e w eek o f si ck l ea v e a n d a l l f i f ty- tw o w eek s ha v e been bi l l ed to C DPH, the r ema i n i n g un used
tw o w eek s. o f v a ca ti o n a n d sev en da y s o f si ck l ea v e ma y n o t be cl a i med a s a n a l l o w a bl e co st.
31. Lo bby i n g Restr i cti o n s a n d Di scl o sur e C er ti f i ca ti o n
(Appl i ca bl e to f eder a l l y f un ded a gr eemen ts i n ex cess o f $100, 000 per Secti o n 1352 o f the 31, U. S. C . )
a . C er ti f i ca ti o n a n d Di scl o sur e Requi r emen ts
(1) E a ch per so n (o r r eci pi en t) w ho r equests o r r ecei v es a co n tr a ct o r a gr eemen t, subco n tr a ct, gr a n t, o r
subgr a n t, w hi ch i s subject to Secti o n 1352 o f the 31, U. S. C . , a n d w hi ch ex ceeds $100, 000 a t a n y ti er ,
sha l l f i l e a cer ti f i ca ti o n (i n the f o r m set f o r th i n Atta chmen t 1, co n si sti n g o f o n e pa ge, en ti tl ed
" C er ti f i ca ti o n Rega r di n g Lo bby i n g" ) tha t the r eci pi en t ha s n o t ma de, a n d w i l l n o t ma k e, a n y pa y men t
pr o hi bi ted by Pa r a gr a ph b o f thi s pr o v i si o n .
(2) E a ch r eci pi en t sha l l f i l e a di scl o sur e (i n the f o r m set f o r th i n Atta chmen t 2, en ti tl ed " Sta n da r d Fo r m-
LLL ` di scl o sur e o f Lo bby i n g Acti v i ti es" ' ) i f such r eci pi en t ha s ma de o r ha s a gr eed to ma k e a n y
pa y men t usi n g n o n a ppr o pr i a ted f un ds (to i n cl ude pr o f i ts f r o m a n y co v er ed f eder a l a cti o n ) i n
co n n ecti o n w i th a co n i r a ci , o r gr a n t o r a n y ex ten si o n o r a men dmen t o f tha t co n tr a ct, o r gr a n t, w hi ch
w o ul d be pr o hi bi ted un der Pa r a gr a ph b o f thi s pr o v i si o n i f pa i d f o r w i th a ppr o pr i a ted f un ds.
(3) E a ch r eci pi en t sha l l f i l e a di scl o sur e f o r m a t the en d o f ea ch ca l en da r qua r ter i n w hi ch ther e o ccur s
a n y ev en t tha t r equi r es di scl o sur e o r tha t ma ter i a l l y a f f ect the a ccur a cy o f the i n f o r ma ti o n co n ta i n ed i n
a n y di scl o sur e f o r m pr ev i o usl y f i l ed by such per so n un der Pa r a gr a ph a (2) her ei n . An ev en t tha t
ma ter i a l l y a f f ects the a ccur a cy o f the i n f o r ma ti o n r epo r ted i n cl udes:
C DPH E x hi bi t D(F) (8/10) „ Q ~ Pa ge 21 o f 25
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C a l i f o r n i a Depa r tmen t o f P u b l i c Hea l th - Spec i a l Ter ms a n d C o n di ti o n s E x hi b i t D (F)
29. Un i o n Or ga n i zi n g
(Appl i c a b l e o n l y to gr a n t a gr eemen ts.)
Gr a n tee, b y si gn i n g thi s Agr eemen t, her eb y a c kn o wl edges the a ppl i c a b i l i ty o f Go ver n men t C o de Sec ti o n s
16645 thr o u gh 16649 to thi s Agr eemen t. Fu r ther mo r e, Gr a n tee, b y si gn i n g thi s Agr eemen t, her eb y c er ti f i es
tha t:
a . No sta te f u n ds di sb u r sed b y thi s gr a n t wi l l b e u sed to a ssi st, pr o mo te o r deter u n i o n o r ga n i zi n g.
b . Gr a n tee sha l l a c c o u n t f o r sta te f u n ds di sb u r sed f o r a spec i f i c ex pen di tu r e b y thi s gr a n t, to sho w tho se
f u n ds wer e a l l o c a ted to tha t ex pen di tu r e.
c . Gr a n tee sha l l , wher e sta te f u n ds a r e n o t desi gn a ted a s desc r i b ed i n b her ei n , a l l o c a te, o n a pr o- r a ta b a si s,
a l l di sb u r semen ts tha t su ppo r t the gr a n t pr o gr a m.
d. I f Gr a n tee ma kes ex pen di tu r es to a ssi st, pr o mo te o r deter u n i o n o r ga n i zi n g, Gr a n tee wi l l ma i n ta i n r ec o r ds
su f f i c i en t to sho w tha t n o sta te f u n ds wer e u sed f o r tho se ex pen di tu r es, a n d tha t Gr a n tee sha l l pr o vi de
tho se r ec o r ds to the Atto r n ey Gen er a l u po n r equ est.
30. C o n tr a c t Un i f o r mi ty (Fr i n ge Ben ef i t Al l o wa b i l i ty )
(Appl i c a b l e o n l y to n o n pr o f i t o r ga n i za ti o n s.)
P u r su a n t to the pr o vi si o n s o f Ar ti c l e 7 (c o mmen c i n g wi th Sec ti o n 100525) o f C ha pter 3 o f P a r t 1 o f Di vi si o n
101 o f the Hea l th a n d Sa f ety C o de, C DP H sets f o r th the f o l l o wi n g po l i c i es, pr o c edu r es, a n d gu i del i n es
r ega r di n g the r ei mb u r semen t o f f r i n ge b en ef i ts.
a . As u sed her ei n f r i n ge b en ef i ts sha l l mea n a n empl o y men t b en ef i t gi ven b y o n e's empl o y er to a n empl o y ee
i n a ddi ti o n to o n e's r egu l a r o r n o r ma l wa ges o r sa l a r y .
b . As u sed her ei n , f r i n ge b en ef i ts do n o t i n c l u de:
(1) C o mpen sa ti o n f o r per so n a l ser vi c es pa i d c u r r en tl y o r a c c r u ed b y the C o n tr a c to r f o r ser vi c es o f
empl o y ees r en der ed du r i n g the ter m o f thi s Agr eemen t, whi c h i s i den ti f i ed a s r egu l a r o r n o r ma l
sa l a r i es a n d wa ges, a n n u a l l ea ve, va c a ti o n , si c k l ea ve, ho l i da y s, j u r y du ty a n d/ o r mi l i ta r y
l ea ve/ tr a i n i n g.
(2) Di r ec to r 's a n d ex ec u ti ve c o mmi ttee memb er 's f ees.
(3) I n c en ti ve a wa r ds a n d/ o r b o n u s i n c en ti ve pa y .
(4) Al l o wa n c es f o r o f f- si te pa y .
(5) L o c a ti o n a l l o wa n c es.
(6) Ha r dshi p pa y .
(7) C o st- o f -l i vi n g di f f er en ti a l s
c . Spec i f i c a l l o wa b l e f r i n ge b en ef i ts i n c l u de:
(1) Fr i n ge b en ef i ts i n the f o r m o f empl o y er c o n tr i b u ti o n s f o r the empl o y er 's po r ti o n o f pa y r o l l ta x es (i .e.,
FI C A, SUI , SDI ), empl o y ee hea l th pl a n s (i .e., hea l th, den ta l a n d vi si o n ), u n empl o y men t i n su r a n c e,
wo r ker 's c o mpen sa ti o n i n su r a n c e, a n d the empl o y er 's sha r e o f pen si o n/ r eti r emen t pl a n s, pr o vi ded
they a r e gr a n ted i n a c c o r da n c e wi th esta b l i shed wr i tten o r ga n i za ti o n po l i c i es a n d meet a l l l ega l a n d
I n ter n a l Reven u e Ser vi c e r equ i r emen ts.
d. To b e a n a l l o wa b l e f r i n ge b en ef i t, the c o st mu st meet the f o l l o wi n g c r i ter i a :
(1) Be n ec essa r y a n d r ea so n a b l e f o r the per f o r ma n c e o f the Agr eemen t.
(2) Be deter mi n ed i n a c c o r da n c e wi th gen er a l l y a c c epted a c c o u n ti n g pr i n c i pl es.
(3) Be c o n si sten t wi th po l i c i es tha t a ppl y u n i f o r ml y to a l l a c ti vi ti es o f the C o n tr a c to r .
e. C o n tr a c to r a gr ees tha t a l l f r i n ge b en ef i ts sha l l b e a t a c tu a l c o st.
C DP H E x hi b i t D(F) (8/ 10) ,. ~O P a ge 20 o f 25
C a l i f o r n i a Depa r tmen t o f Publ i c Hea l th - Speci a l Ter ms a n d C o n di ti o n s E x hi bi t D (F)
24. O f f i ci a l s No t to Ben ef i t
No member s o f o r del ega te o f C o n gr ess o r the Sta te L egi sl a tur e sha l l be a dmi tted to a n y sha r e o r pa r t o f thi s
Agr eemen t, o r to a n y ben ef i t tha t ma y a r i se ther ef r o m. Thi s pr o v i si o n sha l l n o t be co n str ued to ex ten d to thi s
Agr eemen t i f ma de w i th a co r po r a ti o n f o r i ts gen er a l ben ef i ts.
25. Fo ur- Di gi t Da te C o mpl i a n ce
(Appl i ca bl e to a gr eemen ts i n w hi ch I n f o r ma ti o n Techn o l o gy (I T) ser v i ces a r e pr o v i ded to C DPH o r i f I T
equi pmen t i s pr o cur ed.)
C o n tr a cto r w a r r a n ts tha t i t w i l l pr o v i de o n l y Fo ur- Di gi t Da te C o mpl i a n t (a s def i n ed bel o w ) Del i v er a bl es a n d/ o r
ser v i ces to the Sta te. "Fo ur Di gi t Da te co mpl i a n t' Del i v er a bl es a n d ser v i ces ca n a ccur a tel y pr o cess, ca l cul a te,
co mpa r e, a n d sequen ce da te da ta , i n cl udi n g w i tho ut l i mi ta ti o n da te da ta a r i si n g o ut o f o r r el a ti n g to l ea p yea r s
a n d cha n ges i n cen tur i es. Thi s w a r r a n ty a n d r epr esen ta ti o n i s subject to the w a r r a n ty ter ms a n d co n di ti o n s o f
thi s C o n tr a ct a n d do es n o t l i mi t the gen er a l i ty o f w a r r a n ty o bl i ga ti o n s set f o r th el sew her e her ei n .
26. Pr o hi bi ted Use o f Sta te Fun ds f o r So f tw a r e
(Appl i ca bl e to a gr eemen ts i n w hi ch co mputer so f tw a r e i s used i n per f o r ma n ce o f the w o r k.)
C o n tr a cto r cer ti f i es tha t i t ha s a ppr o pr i a te systems a n d co n tr o l s i n pl a ce to en sur e tha t sta te f un ds w i l l n o t be
used i n the per f o r ma n ce o f thi s Agr eemen t f o r the a cqui si ti o n , o per a ti o n o r ma i n ten a n ce o f co mputer so f tw a r e
i n v i o l a ti o n o f co pyr i ght l a w s.
27. Use o f Sma l l , Mi n o r i ty O w n ed a n d Wo men 's Busi n esses
(Appl i ca bl e to tha t po r ti o n o f a n a gr eemen t tha t i s f eder a l l y f un ded a n d en ter ed i n to w i th i n sti tuti o n s o f hi gher
educa ti o n , ho spi ta l s, n o n pr o f i t o r ga n i za ti o n s o r co mmer ci a l busi n esses.)
Po si ti v e ef f o r ts sha l l be ma de to use sma l l busi n esses, mi n o r i ty- o w n ed f i r ms a n d w o men 's busi n ess
en ter pr i ses, w hen ev er po ssi bl e (i .e., pr o cur emen t o f go o ds a n d/ o r ser v i ces). C o n tr a cto r s sha l l ta ke a l l o f the
f o l l o w i n g steps to f ur ther thi s go a l .
(1) E n sur e tha t sma l l busi n esses, mi n o r i ty- o w n ed f i r ms, a n d w o men 's busi n ess en ter pr i ses a r e used to the
f ul l est ex ten t pr a cti ca bl e.
(2) Ma ke i n f o r ma ti o n o n f o r thco mi n g pur cha si n g a n d co n tr a cti n g o ppo r tun i ti es a v a i l a bl e a n d a r r a n ge ti me
f r a mes f o r pur cha ses a n d co n tr a cts to en co ur a ge a n d f a ci l i ta te pa r ti ci pa ti o n by sma l l busi n esses, mi n o r i ty-
o w n ed f i r ms, a n d w o men 's busi n ess en ter pr i ses.
(3) C o n si der i n the co n tr a ct pr o cess w hether f i r ms co mpeti n g f o r l a r ger co n tr a cts i n ten d to subco n tr a ct w i th
sma l l busi n esses, mi n o r i ty- o w n ed f i r ms, a n d w o men 's busi n ess en ter pr i ses.
(4) E n co ur a ge co n tr a cti n g w i th co n so r ti ums o f sma l l busi n esses, mi n o r i ty- o w n ed f i r ms a n d w o men 's busi n ess
en ter pr i ses w hen a co n tr a ct i s to o l a r ge f o r o n e o f these f i r ms to ha n dl e i n di v i dua l l y.
(5) Use the ser v i ces a n d a ssi sta n ce, a s a ppr o pr i a te, o f such o r ga n i za ti o n s a s the Feder a l Sma l l Busi n ess
Admi n i str a ti o n a n d the U.S. Depa r tmen t o f C o mmer ce's Mi n o r i ty Busi n ess Dev el o pmen t Agen cy i n the
so l i ci ta ti o n a n d uti l i za ti o n o f sma l l busi n esses, mi n o r i ty- o w n ed f i r ms a n d w o men 's busi n ess en ter pr i ses.
2i s. i ~ i i en i n ei i gi bi l i i y C er ti f i ca ti o n
(Appl i ca bl e to so l e pr o pr i eto r s en ter i n g f eder a l l y f un ded a gr eemen ts.)
By si gn i n g thi s Agr eemen t,
l o ca l ben ef i ts, a s def i n ed i n
1601, et seq.)
the C o n tr a cto r cer ti f i es tha t he/ she i s n o t a n a l i en tha t i s i n el i gi bl e f o r sta te a n d
Subti tl e B o f the Per so n a l R espo n si bi l i ty a n d Wo r k O ppo r tun i ty Act. (8 U.S.C .
C DPH E x hi bi t D(F) (8/ 10)
Pa ge 19 o f 25
~ ~ ~
C a l i f o r n i a Depa r tmen t o f P u b l i c Hea l th - Spec i a l Ter ms a n d C o n di ti o n s E x hi b i t D (F)
20. Smo ke- Fr ee Wo r kpl a c e C er ti f i c a ti o n
(Appl i c a b l e to f eder a l l y f u n ded a gr eemen ts/ gr a n ts a n d su b c o n tr a c ts/ su b a wa r ds, tha t pr o v i de hea l th, da y c a r e,
ea r l y c hi l dho o d dev el o pmen t ser v i c es, edu c a ti o n o r l i b r a r y ser v i c es to c hi l dr en u n der 18 di r ec tl y o r thr o u gh
l o c a l go v er n men ts.)
a . P u b l i c La w 103- 227, a l so kn o wn a s the P r o-C hi l dr en Ac t o f 1994 (Ac t), r eq u i r es tha t smo ki n g n o t b e
per mi tted i n a n y po r ti o n o f a n y i n do o r f a c i l i ty o wn ed o r l ea sed o r c o n tr a c ted f o r b y a n en ti ty a n d u sed
r o u ti n el y o r r egu l a r l y f o r the pr o v i si o n o f hea l th, da y c a r e, ea r l y c hi l dho o d dev el o pmen t ser v i c es, edu c a ti o n
o r l i b r a r y ser v i c es to c hi l dr en u n der the a ge o f 18, i f the ser v i c es a r e f u n ded b y f eder a l pr o gr a ms ei ther
di r ec tl y o r thr o u gh sta te o r l o c a l go v er n men ts, b y f eder a l gr a n t, c o n tr a c t, l o a n , o r l o a n gu a r a n tee. The l a w
a l so a ppl i es to c hi l dr en ' s ser v i c es tha t a r e pr o v i ded i n i n do o r f a c i l i ti es tha t a r e c o n str u c ted, o per a ted, o r
ma i n ta i n ed wi th su c h f eder a l f u n ds. The l a w do es n o t a ppl y to c hi l dr en ' s ser v i c es pr o v i ded i n pr i v a te
r esi den c es; po r ti o n s o f f a c i l i ti es u sed f o r i n pa ti en t dr u g o r a l c o ho l tr ea tmen t; ser v i c e pr o v i der s who se so l e
so u r c e o f a ppl i c a b l y f eder a l f u n ds i s Medi c a r e o r Medi c a i d; o r f a c i l i ti es wher e WIC c o u po n s a r e
r edeemed.
b . Fa i l u r e to c o mpl y wi th the pr o v i si o n s o f the l a w ma y r esu l t i n the i mpo si ti o n o f a c i v i l mo n eta r y pen a l ty o f
u p to $1,000 f o r ea c h v i o l a ti o n a n d/ o r the i mpo si ti o n o f a n a dmi n i str a ti v e c o mpl i a n c e o r der o n the
r espo n si b l e pa r ty .
c . By si gn i n g thi s Agr eemen t, C o n tr a c to r o r Gr a n tee c er ti f i es tha t i t wi l l c o mpl y wi th the r eq u i r emen ts o f the
Ac t a n d wi l l n o t a l l o w smo ki n g wi thi n a n y po r ti o n o f a n y i n do o r f a c i l i ty u sed f o r the pr o v i si o n o f ser v i c es f o r
c hi l dr en a s def i n ed b y the Ac t. The pr o hi b i ti o n s her ei n a r e ef f ec ti v e Dec emb er 26, 1994.
d. C o n tr a c to r o r Gr a n tee f u r ther a gr ees tha t i t wi l l i n ser t thi s c er ti f i c a ti o n i n to a n y su b a wa r ds (su b c o n tr a c ts o r
su b gr a n ts) en ter ed i n to tha t pr o v i de f o r c hi l dr en ' s ser v i c es a s desc r i b ed i n the Ac t.
21. C o v en a n t Aga i n st C o n ti n gen t Fees
(Appl i c a b l e o n l y to f eder a l l y f u n ded a gr eemen ts.)
The C o n tr a c to r wa r r a n ts tha t n o per so n o r sel l i n g a gen c y ha s b een empl o y ed o r r eta i n ed to so l i c i U sec u r e thi s
Agr eemen t u po n a n a gr eemen t. o f u n der sta n di n g f o r a c o mmi ssi o n , per c en ta ge, b r o ker a ge, o r c o n ti n gen t f ee,
ex c ept b o n a f i de empl o y ees o r b o n a f i de esta b l i shed c o mmer c i a l o r sel l i n g a gen c i es r eta i n ed b y the
C o n tr a c to r f o r the pu r po se o f sec u r i n g b u si n ess. Fo r b r ea c h o r v i o l a ti o n o f thi s wa r r a n ty , C DP H sha l l ha v e the
r i ght to a n n u l thi s Agr eemen t wi tho u t l i a b i l i ty o r i n i ts di sc r eti o n to dedu c t f r o m the Agr eemen t pr i c e o r
c o n si der a ti o n , o r o ther wi se r ec o v er , the f u l l a mo u n t o f su c h c o mmi ssi o n , per c en ta ge, a n d b r o ker a ge o r
c o n ti n gen t f ee.
22. P a y men t Wi thho l ds
(Appl i c a b l e o n l y i f a f i n a l r epo r t i s r eq u i r ed b y thi s Agr eemen t. No t a ppl i c a b l e to go v er n men t en ti ti es.)
U n l ess wa i v ed o r o ther wi se sti pu l a ted i n thi s Agr eemen t, C DP H ma y , a t i ts di sc r eti o n , wi thho l d 10 per c en t
(10%) o f the f a c e a mo u n t o f the Agr eemen t, 50 per c en t (50%) o f the f i n a l i n v o i c e, o r $3,000 whi c hev er i s
gr ea ter , u n ti l C DP H r ec ei v es a f i n a l r epo r t tha t meets the ter ms, c o n di ti o n s a n d/ o r sc o pe o f wo r k r eq u i r emen ts
o f thi s Agr eemen t.
23. P er f o r ma n c e E v a l u a ti o n
(No t a ppl i c a b l e to gr a n t a gr eemen ts.)
C DP H ma y , a t i ts di sc r eti o n , ev a l u a te the per f o r ma n c e o f the C o n tr a c to r a t the c o n c l u si o n o f thi s Agr eemen t.
If per f o r ma n c e i s ev a l u a ted, the ev a l u a ti o n sha l l n o t b e a pu b l i c r ec o r d a n d sha l l r ema i n o n f i l e wi th C DP H.
Nega ti v e per f o r ma n c e ev a l u a ti o n s ma y b e c o n si der ed b y C DP H pr i o r to ma ki n g f u tu r e c o n tr a c t a wa r ds.
C DP H E x hi b i t D(F) (8/ 10) ~,O - - P a ge 18 o f 25
I~
C a l i f o r n i a Depa r tmen t o f P u b l i c Hea l th - Spec i a l Ter ms a n d C o n di ti o n s
18.
19.
E x hi b i t D (F)
By si g n i n g thi s Ag r eemen t, C o n tr a c to r a g r ees tha t i f a n y per f o r ma n c e u n der thi s Ag r eemen t o r a n y
su b c o n tr a c t o r su b a g r eemen t i n c l u des a n y tests o r ex a mi n a ti o n o f ma ter i a l s der i ved f r o m the hu ma n b o dy f o r
the pu r po se o f pr o vi di n g i n f o r ma ti o n , di a g n o si s, pr even ti o n , tr ea tmen t o r a ssessmen t o f di sea se, i mpa i r men t,
o r hea l th o f a hu ma n b ei n g , a l l l o c a ti o n s a t whi c h su c h ex a mi n a ti o n s a r e per f o r med sha l l meet the
r equ i r emen ts o f 42 U.S.C . Sec ti o n 263a (C LIA) a n d the r eg u l a ti o n s ther eu n der .
No va ti o n Requ i r emen ts
If the C o n tr a c to r pr o po ses a n y n o va ti o n a g r eemen t, C DP H sha l l a c t u po n the pr o po sa l wi thi n 60 da ys a f ter
r ec ei pt o f the wr i tten pr o po sa l . C DP H ma y r evi ew a n d c o n si der the pr o po sa l , c o n su l t a n d n eg o ti a te wi th the
C o n tr a c to r , a n d a c c ept o r r ej ec t a l l o r pa r t o f the pr o po sa l . Ac c epta n c e o r r ej ec ti o n o f the pr o po sa l ma y b e
ma de o r a l l y wi thi n the 60- da y per i o d a n d c o n f i r med i n wr i ti n g wi thi n f i ve da ys o f sa i d dec i si o n . Upo n wr i tten
a c c epta n c e o f the pr o po sa l , C DP H wi l l i n i ti a te a n a men dmen t to thi s Ag r eemen t to f o r ma l l y i mpl emen t the
a ppr o ved pr o po sa l .
Deb a r men t a n d Su spen si o n C er ti f i c a ti o n
(Appl i c a b l e to a l l a g r eemen ts f u n ded i n pa r t o r who l e wi th f eder a l f u n ds.)
a . By si g n i n g thi s Ag r eemen t, the C o n tr a c to r/Gr a n tee a g r ees to c o mpl y wi th a ppl i c a b l e f eder a l su spen si o n
a n d deb a r men t r eg u l a ti o n s i n c l u di n g , b u t n o t l i mi ted to 7 C FR P a r t 3017, 45 C FR 76, 40 C FR 32 o r 34
C FR 85.
b . By si g n i n g thi s Ag r eemen t, the C o n tr a c to r c er ti f i es to the b est o f i ts kn o wl edg e a n d b el i ef , tha t i t a n d i ts
pr i n c i pa l s:
(1) Ar e n o t pr esen tl y deb a r r ed, su spen ded, pr o po sed f o r deb a r men t, dec l a r ed i n el i g i b l e, o r vo l u n ta r i l y
ex c l u ded b y a n y f eder a l depa r tmen t o r a g en c y;
(2) Ha ve n o t wi thi n a thr ee- yea r per i o d pr ec edi n g thi s a ppl i c a ti o n/pr o po sa l/a g r eemen t b een c o n vi c ted o f
o r ha d a c i vi l j u dg men t r en der ed a g a i n st them f o r c o mmi ssi o n o f f r a u d o r a c r i mi n a l o f f en se i n
c o n n ec ti o n wi th o b ta i n i n g , a ttempti n g to o b ta i n , o r per f o r mi n g a pu b l i c (Feder a l , Sta te o r l o c a l )
tr a n sa c ti o n o r c o n tr a c t u n der a pu b l i c tr a n sa c ti o n ; vi o l a ti o n o f Feder a l o r Sta te a n ti tr u st sta tu tes o r
c o mmi ssi o n o f emb ezzl emen t, thef t, f o r g er y, b r i b er y, f a l si f i c a ti o n o r destr u c ti o n o f r ec o r ds, ma ki n g
f a l se sta temen ts, o r r ec ei vi n g sto l en pr o per ty;
(3) Ar e n o t pr esen tl y i n di c ted f o r o r o ther wi se c r i mi n a l l y o r c i vi l l y c ha r g ed b y a g o ver n men ta l en ti ty
(Feder a l , Sta te o r l o c a l ) wi th c o mmi ssi o n o f a n y o f the o f f en ses en u mer a ted i n P a r a g r a ph b (2) her ei n ;
a n d
(4) Ha ve n o t wi thi n a thr ee- yea r per i o d pr ec edi n g thi s a ppl i c a ti o n /pr o po sa l/a g r eemen t ha d o n e o r mo r e
pu b l i c tr a n sa c ti o n s (Feder a l , Sta te o r l o c a l ) ter mi n a ted f o r c a u se o r def a u l t.
(5) Sha l l n o t kn o wi n g l y en ter i n to a n y l o wer ti er c o ver ed tr a n sa c ti o n wi th a per so n who i s pr o po sed f o r
deb a r men t u n der f eder a l r eg u l a ti o n s (i .e., 48 C FR pa r t 9, su b pa r t 9.4), deb a r r ed, su spen ded, dec l a r ed
i n el i g i b l e, o r vo l u n ta r i l y ex c l u ded f r o m pa r ti c i pa ti o n i n su c h tr a n sa c ti o n , u n l ess a u tho r i zed b y the Sta te.
(6) W i l l i n c l u de a c l a u se en ti tl ed, "Deb a r men t a n d Su spen si o n C er ti f i c a ti o n " tha t essen ti a l l y sets f o r th the
pr o vi si o n s her ei n , i n a l l l o wer ti er c o ver ed tr a n sa c ti o n s a n d i n a l l so l i c i ta ti o n s f o r l o wer ti er c o ver ed
tr a n sa c ti o n s.
c . If the C o n tr a c to r i s u n a b l e to c er ti f y to a n y o f the sta temen ts i n thi s c er ti f i c a ti o n , the C o n tr a c to r sha l l
su o mi f a n ex pl a n a ti o n to the C DP H P r o g r a m C o n tr a c t Ma n a g er .
d. The ter ms a n d def i n i ti o n s her ei n ha ve ' the mea n i n g s set o u t i n the Def i n i ti o n s a n d C o ver a g e sec ti o n s o f
the r u l es i mpl emen ti n g Feder a l E x ec u ti ve Or der 12549.
e. If the C o n tr a c to r kn o wi n g l y vi o l a tes thi s c er ti f i c a ti o n , i n a ddi ti o n to o ther r emedi es a va i l a b l e to the Feder a l
Go ver n men t, the C DP H ma y ter mi n a te thi s Ag r eemen t f o r c a u se o r def a u l t.
C DP H E x hi b i t D(F) (8/10)
_ ~~- -- ~ P a g e 17 o f 25
C a l i f o r n i a Depa r tmen t o f Publ i c Hea l th - Speci a l Ter ms a n d C o n di ti o n s E x hi bi t D (F)
be co mpl eted by the en d o f the n i n th mo n th f o l l o w i n g the en d o f the a udi t per i o d. The r equi r emen ts o f
thi s pr o v i si o n a ppl y i f :
(a ) The C o n tr a cto r i s a r eci pi en t ex pen di n g Feder a l a w a r ds r ecei v ed di r ectl y f r o m Feder a l a w a r di n g
a g en ci es, o r
(b) The C o n tr a cto r i s a subr eci pi en t ex pen di n g Feder a l a w a r ds r ecei v ed f r o m a pa ss-thr o ug h en ti ty
such a s the Sta te, C o un ty o r co mmun i ty ba sed o r g a n i z a ti o n .
(4) I f the C o n tr a cto r submi ts to C DPH a r epo r t o f a n a udi t o ther tha n a n OMB A- 133 a udi t, the C o n tr a cto r
must a l so submi t a cer ti f i ca ti o n i n di ca ti n g the C o n tr a cto r ha s n o t ex pen ded $500,000 o r mo r e i n
f eder a l f un ds f o r the yea r co v er ed by the a udi t r epo r t.
d. Tw o co pi es o f the a udi t r epo r t sha l l be del i v er ed to the C DPH pr o g r a m f un di n g thi s Ag r eemen t. The a udi t
r epo r t must i den ti f y the C o n tr a cto r ' s l eg a l n a me a n d the n umber a ssi g n ed to thi s Ag r eemen t. The a udi t
r epo r t sha l l be due w i thi n 30 da ys a f ter the co mpl eti o n o f the a udi t. Upo n r ecei pt o f sa i d a udi t r epo r t, the
C DPH Pr o g r a m C o n tr a ct Ma n a g er sha l l f o r w a r d the a udi t r epo r t to C DPH' s Audi ts a n d I n v esti g a ti o n s Un i t
i f the a udi t r epo r t w a s submi tted un der Secti o n 16 . c(3), un l ess the a udi t r epo r t i s f r o m a C i ty, C o un ty, o r
Speci a l Di str i ct w i thi n the Sta te o f C a l i f o r n i a w her eby the r epo r t w i l l be r eta i n ed by the f un di n g pr o g r a m.
The co st o f the a udi ts descr i bed her ei n ma y be i n cl uded i n the f un di n g f o r thi s Ag r eemen t up to the
pr o po r ti o n a te a mo un t thi s Ag r eemen t r epr esen ts o f the C o n tr a cto r ' s to ta l r ev en ue. The C DPH pr o g r a m
f un di n g thi s Ag r eemen t must pr o v i de a dv a n ce w r i tten a ppr o v a l o f the speci f i c a mo un t a l l o w ed f o r sa i d
a udi t ex pen ses.
f . The Sta te o r i ts a utho r i z ed desi g n ee, i n cl udi n g the Bur ea u o f Sta te Audi ts, i s r espo n si bl e f o r co n ducti n g
a g r eemen t per f o r ma n ce a udi ts w hi ch a r e n o t f i n a n ci a l a n d co mpl i a n ce a udi ts. Per f o r ma n ce a udi ts a r e
def i n ed by Gen er a l l y Accepted Go v er n men t Audi ti n g Sta n da r ds.
g . No thi n g i n thi s Ag r eemen t l i mi ts the Sta te' s r espo n si bi l i ty o r a utho r i ty to en f o r ce Sta te l a w o r r eg ul a ti o n s,
pr o cedur es, o r r epo r ti n g r equi r emen ts a r i si n g ther eto .
No thi n g i n thi s pr o v i si o n l i mi ts the a utho r i ty o f the Sta te to ma ke a udi ts o f thi s Ag r eemen t, pr o v i ded
ho w ev er , tha t i f i n depen den t a udi ts a r r a n g ed f o r by the C o n tr a cto r meet Gen er a l l y Accepted
Go v er n men ta l Audi ti n g Sta n da r ds, the Sta te sha l l r el y o n tho se a udi ts a n d a n y a ddi ti o n a l a udi t w o r k a n d
sha l l bui l d upo n the w o r k a l r ea dy do n e.
The Sta te. ma y, a t i ts o pti o n , di r ect i ts o w n a udi to r s to per f o r m ei ther o f the a udi ts descr i bed a bo v e. The
C o n tr a cto r w i l l be g i v en a dv a n ce w r i tten n o ti f i ca ti o n , i f the Sta te cho o ses to ex er ci se i ts o pti o n to per f o r m
sa i d a udi ts.
The C o n tr a cto r sha l l i n cl ude a cl a use i n a n y a g r eemen t the C o n tr a cto r en ter s i n to w i th the a udi t f i r m do i n g
the si n g l e o r g a n i z a ti o n w i de a udi t to pr o v i de a ccess by the Sta te o r Feder a l Go v er n men t to the w o r ki n g
pa per s o f the i n depen den t a udi to r w ho pr epa r es the si n g l e o r g a n i z a ti o n . w i de a udi t f o r the C o n tr a cto r .
k. Feder a l o r sta te a udi to r s sha l l ha v e "ex pa n ded sco pe a udi ti n g " a utho r i ty to co n duct speci f i c pr o g r a m
a udi ts dur i n g the sa me per i o d i n w hi ch a si n g l e o r g a n i z a ti o n w i de a udi t i s bei n g per f o r med, but the a udi t
r epo r t ha s n o t been i ssued. The f eder a l o r sta te a udi to r s sha l t r ev i ew a n d ha v e a ccess to the cur r en t a udi t
w o r k bei n g co n ducted a n d w i l l n o t a ppl y a n y testi n g o r r ev i ew pr o cedur es w hi ch ha v e n o t been sa ti sf i ed by
pr ev i o us a udi t w o r k tha t ha s been co mpl eted.
The ter m "ex pa n ded sco pe a udi ti n g " i s a ppl i ed a n d def i n ed i n the U. S. Gen er a l Acco un ti n g Of f i ce (GAO)
i ssued Sta n da r ds f o r Audi t o f Go v er n men t Or g a n i z a ti o n s, Pr o g r a ms, Acti v i ti es a n d Fun cti o n s, better
kn o w n a s the "yel l o w bo o k".
17. Huma n Subjects Use Requi r emen ts
(Appl i ca bl e o n l y to f eder a l l y f un ded a g r eemen ts/g r a n ts i n w hi ch per f o r ma n ce, di r ectl y o r thr o ug h a
subco n tr a cUsuba w a r d, i n cl udes a n y tests o r ex a mi n a ti o n o f ma ter i a l s der i v ed f r o m the huma n bo dy. )
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the br a n ch i s o r ga n i zed w i thi n ten (10) w o r ki n g da ys f r o m r ecei pt o f the Br a n ch C hi ef ' s deci si o n . The
Deputy Di r ecto r o f the di v i si o n i n w hi ch the br a n ch i s o r ga n i zed o r hi s/ her desi gn ee sha l l meet w i th the
C o n tr a cto r to r ev i ew the i ssues r a i sed. A w r i tten deci si o n si gn ed by the Deputy Di r ecto r o f the di v i si o n
i n w hi ch the br a n ch i s o r ga n i zed o r hi s/ her desi gn ee sha l l be di r ected to the C o n tr a cto r w i thi n tw en ty
(20) w o r ki n g da ys o f r ecei pt o f the C o n tr a cto r ' s seco n d l ev el a ppea l .
b. I f the C o n tr a cto r w i shes to a ppea l the deci si o n o f the Deputy Di r ecto r o f the di v i si o n i n w hi ch the br a n ch i s
o r ga n i zed o r hi s/ her desi gn ee, the C o n tr a cto r sha l l f o l l o w the pr o cedur es set f o r th i n Di v i si o n 25.1
(co mmen ci n g w i th Secti o n 38050) o f the Hea l th a n d Sa f ety C o de a n d the r egul a ti o n s a do pted ther eun der .
(Ti tl e 1, Di v i si o n 2, C ha pter 2, Ar ti cl e 3 (co mmen ci n g w i th Secti o n 1140) o f the C a l i f o r n i a C o de o f
R egul a ti o n s).
c. Di sputes a r i si n g o ut o f a n a udi t, ex a mi n a ti o n o f a n a gr eemen t o r o ther a cti o n n o t co v er ed by subdi v i si o n
(a ) o f Secti o n 20204, o f C ha pter 2.1, Ti tl e 22, o f the C a l i f o r n i a C o de o f R egul a ti o n s, a n d f o r w hi ch n o
pr o cedur es f o r a ppea l a r e pr o v i ded i n sta tute, r egul a ti o n o r the Agr eemen t, sha l l be ha n dl ed i n
a cco r da n ce w i th the pr o cedur es i den ti f i ed i n Secti o n s 51016 thr o ugh 51047, Ti tl e 22, C a l i f o r n i a C o de o f
R egul a ti o n s.
d. Un l ess o ther w i se sti pul a ted i n w r i ti n g by C DPH, a l l di spute, gr i ev a n ce a n d/ o r a ppea l co r r espo n den ce sha l l
be di r ected to the C DPH Pr o gr a m C o n tr a ct Ma n a ger .
e. Ther e. a r e o r ga n i za ti o n a l di f f er en ces w i thi n C DPH' s f un di n g pr o gr a ms a n d the ma n a gemen t l ev el s
i den ti f i ed i n thi s di spute r eso l uti o n pr o v i si o n ma y n o t a ppl y i n ev er y co n tr a ctua l si tua ti o n . When a
gr i ev a n ce i s r ecei v ed a n d o r ga n i za ti o n a l di f f er en ces ex i st, the C o n tr a cto r sha l l be n o ti f i ed i n w r i ti n g by the
C DPH Pr o gr a m C o n tr a ct Ma n a ger o f the l ev el , n a me, a n d/ o r ti tl e o f the a ppr o pr i a te ma n a gemen t o f f i ci a l
tha t i s r espo n si bl e f o r i ssui n g a deci si o n a t a gi v en l ev el .
16. Fi n a n ci a l a n d C o mpl i a n ce Audi t R equi r emen ts
a . The def i n i ti o n s used i n thi s pr o v i si o n a r e co n ta i n ed i n Secti o n 38040 o f the Hea l th a n d Sa f ety C o de, w hi ch
by thi s r ef er en ce i s ma de a pa r t her eo f .
b. Di r ect ser v i ce co n tr a ct mea n s a co n tr a ct o r a gr eemen t f o r ser v i ces co n ta i n ed i n l o ca l a ssi sta n ce o r
subv en ti o n pr o gr a ms o r bo th (see Hea l th a n d Sa f ety [H &S] C o de secti o n 38020). Di r ect ser v i ce co n tr a cts
sha l l n o t i n cl ude co n tr a cts, a gr eemen ts, gr a n ts, o r subv en ti o n s to o ther go v er n men ta l a gen ci es o r un i ts o f
go v er n men t n o r co n tr a cts o r a gr eemen ts w i th r egi o n a l cen ter s o r a r ea a gen ci es o n a gi n g (H&S C o de
secti o n 38030).
c. The C o n tr a cto r , a s i n di ca ted bel o w , a gr ees to o bta i n o n e o f the f o l l o w i n g a udi ts:
(1) I f the C o n tr a cto r i s a n o n pr o f i t o r ga n i za ti o n (a s def i n ed i n H&S C o de secti o n 38040) a n d r ecei v es
$25,000 o r mo r e f r o m a n y Sta te a gen cy un der a di r ect ser v i ce co n tr a ct o r a gr eemen t; the C o n tr a cto r
a gr ees to o bta i n a n a n n um si n gl e, o r ga n i za ti o n w i de, f i n a n ci a l a n d co mpl i a n ce a udi t. Sa i d a udi t sha l l
be co n ducted a cco r di n g to Gen er a l l y Accepted Audi ti n g Sta n da r ds. Thi s a udi t do es n o t f ul f i l l the a udi t
r equi r emen ts o f Pa r a gr a ph c(3) bel o w . The a udi t sha l l be co mpl eted by the 15th da y o f the f i f th
mo n th f o l l o w i n g the en d o f the C o n tr a cto r ' s f i sca l yea r , a n d/ o r
(2) I f the C o n tr a cto r i s a n o n pr o f i t o r ga n i za ti o n (a s def i n ed i n H&S C o de secti o n 38040) a n d r ecei v es l ess
tha n $25,000 per yea r f r o m a n y Sta te a gen cy un der a di r ect ser v i ce co n tr a ct o r a gr eemen t, the
C o n tr a cto r a gr ees to o bta i n a bi en n i a l si n gl e, o r ga n i za ti o n w i de f i n a n ci a l a n d co mpl i a n ce a udi t, un l ess
ther e i s ev i den ce o f f r a ud o r o ther v i o l a ti o n o f sta te l a w i n co n n ecti o n w i th thi s Agr eemen t. Thi s a udi t
do es n o t f ul f i l l the a udi t r equi r emen ts o f Pa r a gr a ph c(3) bel o w . The a udi t sha l l be co mpl eted by the
15th da y o f f hs f i f th mo n th f o l l ~ dv i r g ;he en d o f the C o n tr a cto r ' s f i sca l yedi , a r i dl o r
(3) I f the C o n tr a cto r i s a Sta te o r Lo ca l Go v er n men t en ti ty o r N o n pr o f i t o r ga n i za ti o n (a s def i n ed by the
Feder a l O f f i ce o f Ma n a gemen t a n d Budget [O MB] C i r cul a r A- 133) a n d ex pen ds $500,000 o r mo r e i n
Feder a l a w a r ds, the C o n tr a cto r a gr ees to o bta i n a n a n n ua l si n gl e, o r ga n i za ti o n w i de, f i n a n ci a l a n d
co mpl i a n ce a udi t a cco r di n g to the r equi r emen ts speci f i ed i n O MB C i r cul a r A- 133 en ti tl ed "Audi ts o f
Sta tes, Lo ca l Go v er n men ts, a n d N o n -Pr o f i t O r ga n i za ti o n s". An a udi t co n ducted pur sua n t to thi s
pr o v i si o n w i l l f ul f i l l the a udi t r equi r emen ts o utl i n ed i n Pa r a gr a phs c(1) a n d c(2) a bo v e. The a udi t sha l l
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13. C o n f i den ti a l i ty o f In f o r ma ti o n
a . The C o n tr a c to r a n d i ts empl o yees, a gen ts, o r su b c o n tr a c to r s sha l l pr o tec t f r o m u n a u tho r i zed di sc l o su r e
n a mes a n d o ther i den ti f yi n g i n f o r ma ti o n c o n c er n i n g per so n s ei ther r ec ei v i n g ser v i c es pu r su a n t to thi s
Agr eemen t o r per so n s who se n a mes o r i den ti f yi n g i n f o r ma ti o n b ec o me a v a i l a b l e o r a r e di sc l o sed to the
C o n tr a c to r , i ts empl o yees, a gen ts, o r su b c o n tr a c to r s a s a r esu l t o f ser v i c es per f o r med u n der thi s
Agr eemen t, ex c ept f o r sta ti sti c a l i n f o r ma ti o n n o t i den ti f yi n g a n y su c h per so n .
b . The C o n tr a c to r a n d i ts empl o yees, a gen ts, o r su b c o n tr a c to r s sha l l n o t u se su c h i den ti f yi n g i n f o r ma ti o n f o r
a n y pu r po se o ther tha n c a r r yi n g o u t the C o n tr a c to r ' s o b l i ga ti o n s u n der thi s Agr eemen t.
c . The C o n tr a c to r a n d i ts empl o yees, a gen ts, o r su b c o n tr a c to r s sha l l pr o mptl y tr a n smi t to the C DP H
P r o gr a m C o n tr a c t Ma n a ger a l l r equ ests f o r di sc l o su r e o f su c h i den ti f yi n g i n f o r ma ti o n n o t ema n a ti n g f r o m
the c l i en t o r per so n .
d. The C o n tr a c to r sha l l n o t di sc l o se, ex c ept a s o ther wi se spec i f i c a l l y per mi tted b y thi s Agr eemen t o r
a u tho r i zed b y the c l i en t, a n y su c h i den ti f yi n g i n f o r ma ti o n to a n yo n e o ther tha n C DP H wi tho u t pr i o r wr i tten
a u tho r i za ti o n f r o m the C DP H P r o gr a m C o n tr a c t Ma n a ger , ex c ept i f di sc l o su r e i s r equ i r ed b y Sta te o r
Feder a l l a w.
e. Fo r pu r po ses o f thi s pr o v i si o n , i den ti ty sha l l i n c l u de, b u t n o t b e l i mi ted to n a me, i den ti f yi n g n u mb er ,
symb o l , o r o ther i den ti f yi n g pa r ti c u l a r a ssi gn ed to the i n di v i du a l , su c h a s f i n ger o r v o i c e pr i n t o r a
pho to gr a ph.
f . As deemed a ppl i c a b l e b y C DP H, thi s pr o v i si o n ma y b e su ppl emen ted b y a ddi ti o n a l ter ms a n d c o n di ti o n s
c o v er i n g per so n a l hea l th i n f o r ma ti o n (P HI) o r per so n a l , sen si ti v e, a n d/ o r c o n f i den ti a l i n f o r ma ti o n (P SC I).
Sa i d ter ms a n d c o n di ti o n s wi l l b e o u tl i n ed i n o n e o r mo r e ex hi b i ts tha t wi l l ei ther b e a tta c hed to thi s
Agr eemen t o r i n c o r po r a ted i n to thi s Agr eemen t b y r ef er en c e.
14. Do c u men ts, P u b l i c a ti o n s a n d Wr i tten Repo r ts
(Appl i c a b l e to a gr eemen ts o v er $5,000 u n der whi c h pu b l i c a ti o n s, wr i tten r epo r ts a n d do c u men ts a r e
dev el o ped o r pr o du c ed. Go v er n men t C o de Sec ti o n 7550.)
An y do c u men t, pu b l i c a ti o n o r wr i tten r epo r t (ex c l u di n g pr o gr ess r epo r ts, f i n a n c i a l r epo r ts a n d n o r ma l
c o n tr a c tu a l c o mmu n i c a ti o n s) pr epa r ed a s a r equ i r emen t o f thi s Agr eemen t sha l l c o n ta i n , i n a sepa r a te sec ti o n
pr ec edi n g the ma i n b o dy o f the do c u men t, the n u mb er a n d do l l a r a mo u n ts o f a l l c o n tr a c ts o r a gr eemen ts a n d
su b c o n tr a c ts r el a ti n g to the pr epa r a ti o n o f su c h do c u men t o r r epo r t, i f the to ta l c o st f o r wo r k b y n o n empl o yees
o f the Sta te ex c eeds $5,000.
15. Di spu te Reso l u ti o n P r o c ess
a . A C o n tr a c to r gr i ev a n c e ex i sts when ev er ther e i s a di spu te a r i si n g f r o m C DP H' s a c ti o n i n the
a dmi n i str a ti o n o f a n a gr eemen t. If ther e i s a di spu te o r gr i ev a n c e b etween the C o n tr a c to r a n d C DP H, the
C o n tr a c to r mu st seek r eso l u ti o n u si n g the pr o c edu r e o u tl i n ed b el o w.
(1) The C o n tr a c to r sho u l d f i r st i n f o r ma l l y di sc u ss the pr o b l em wi th the C DP H P r o gr a m C o n tr a c t Ma n a ger .
If the pr o b l em c a n n o t b e r eso l v ed i n f o r ma l l y, the C o n tr a c to r sha l l di r ec t i ts gr i ev a n c e to gether wi th a n y
ev i den c e, i n wr i ti n g, to the pr o gr a m Br a n c h C hi ef . The gr i ev a n c e sha l l sta te the i ssu es i n di spu te, the
l ega l a u tho r i ty o r o ther b a si s f o r the C o n tr a c to r ' s po si ti o n a n d the. r emedy so u ght. The Br a n c h C hi ef
sha l l r en der a dec i si o n wi thi n ten (10) wo r ki n g da ys a f ter r ec ei pt o f the wr i tten gr i ev a n c e f r o m the
C o n tr a c to r . The Br a n c h C hi ef sha l l r espo n d i n wr i ti n g to the C o n tr a c to r i n di c a ti n g the dec i si o n a n d
r ea so n s ther ef o r e. If the C o n tr a c to r di sa gr ees wi th the Br a n c h C hi ef ' s dec i si o n , the C o n tr a c to r ma y
a ppea l to the sec o n d l ev el .
(2) When a ppea l i n g to the sec o n d l ev el , the C o n tr a c to r mu st pr epa r e a n a ppea l i n di c a ti n g the r ea so n s f o r
di sa gr eemen t wi th Br a n c h C hi ef ' s dec i si o n . ' The C o n tr a c to r sha l l i n c l u de wi th the a ppea l a c o py o f the
C o n tr a c to r ' s o r i gi n a l sta temen t o f di spu te a l o n g wi th a n y su ppo r ti n g ev i den c e a n d a c o py o f the
Br a n c h C hi ef ' s dec i si o n . The a ppea l sha l l b e a ddr essed to the Depu ty Di r ec to r o f the di v i si o n i n whi c h
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Pr o per ty ma de, co n cei ved, der i ved f r o m, o r r educed to pr a cti ce by C o n tr a cto r o r C DPH a n d whi ch
r esul t di r ectl y o r i n di r ectl y f r o m thi s Agr eemen t. Thi s i n demn i ty o bl i ga ti o n sha l l a ppl y i r r especti ve o f
whether the i n f r i n gemen t cl a i m i s ba sed o n a pa ten t, tr a dema r k o r co pyr i ght r egi str a ti o n tha t i ssued
a f ter the ef f ecti ve da te o f thi s Agr eemen t. C DPH r eser ves the r i ght to pa r ti ci pa te i n a n d/ o r co n tr o l , a t
C o n tr a cto r ' s ex pen se, a n y such i n f r i n gemen t a cti o n br o ught a ga i n st C DPH.
(2) Sho ul d a n y I n tel l ectua l Pr o per ty l i cen sed by the C o n tr a cto r to C DPH un der thi s Agr eemen t beco me
the subject o f a n I n tel l ectua l Pr o per ty i n f r i n gemen t cl a i m, C o n tr a cto r wi l l ex er ci se i ts a utho r i ty
r ea so n a bl y a n d i n go o d f a i th to pr eser ve C DPH' s r i ght to use the l i cen sed I n tel l ectua l Pr o per ty i n
a cco r da n ce wi th thi s Agr eemen t a t n o ex pen se to C DPH. C DPH sha l l ha ve the r i ght to mo n i to r a n d
a ppea r thr o ugh i ts o wn co un sel (a t C o n tr a cto r ' s ex pen se) i n a n y such cl a i m o r a cti o n . I n the def en se
o r settl emen t o f the cl a i m, C o n tr a cto r ma y o bta i n the r i ght f o r C DPH to co n ti n ue usi n g the l i cen sed
I n tel l ectua l Pr o per ty; o r , r epl a ce o r mo di f y the l i cen sed I n tel l ectua l Pr o per ty so tha t the r epl a ced o r
mo di f i ed I n tel l ectua l Pr o per ty beco mes n o n - i n f r i n gi n g pr o vi ded tha t such r epl a cemen t o r mo di f i ca ti o n
i s f un cti o n a l l y equi va l en t to the o r i gi n a l l i cen sed I n tel l ectua l Pr o per ty. I f such r emedi es a r e n o t
r ea so n a bl y a va i l a bl e, C DPH sha l l be en ti tl ed to a r ef un d o f a l l mo n i es pa i d un der thi s Agr eemen t,
wi tho ut r estr i cti o n o r l i mi ta ti o n o f a n y o ther r i ghts a n d r emedi es a va i l a bl e a t l a w o r i n equi ty.
(3) C o n tr a cto r a gr ees tha t da ma ges a l o n e wo ul d be i n a dequa te to co mpen sa te C DPH f o r br ea ch o f a n y
ter m o f thi s I n tel l ectua l Pr o per ty E x hi bi t by C o n tr a cto r . C o n tr a cto r a ckn o wl edges C DPH wo ul d suf f er
i r r epa r a bl e ha r m i n the even t o f such br ea ch a n d a gr ees C DPH sha l l be en ti tl ed to o bta i n equi ta bl e
r el i ef , i n cl udi n g wi tho ut l i mi ta ti o n a n i n jun cti o n , f r o m a co ur t o f co mpeten t jur i sdi cti o n , wi tho ut
r estr i cti o n o r l i mi ta ti o n o f a n y o ther r i ghts a n d r emedi es a va i l a bl e a t l a w o r i n equi ty.
h. Feder a l Fun di n g
I n a n y a gr eemen t f un ded i n who l e o r i n pa r t by the f eder a l go ver n men t, C DPH ma y a cqui r e a n d ma i n ta i n
the I n tel l ectua l Pr o per ty r i ghts, ti tl e, a n d o wn er shi p, whi ch r esul ts di r ectl y o r i n di r ectl y f r o m the Agr eemen t;
ex cept a s pr o vi ded i n 37 C o de o f Feder a l Regul a ti o n s pa r t 401.14; ho wever , the f eder a l go ver n men t sha l l
ha ve a n o n -ex cl usi ve, n o n tr a n sf er a bl e, i r r evo ca bl e, pa i d- up l i cen se thr o ugho ut the wo r l d to use, dupl i ca te,
o r di spo se o f such I n tel l ectua l Pr o per ty thr o ugho ut the wo r l d i n a n y ma n n er f o r go ver n men ta l pur po ses
a n d to ha ve a n d per mi t o ther s to do so .
i . Sur vi va l
The pr o vi si o n s set f o r th her ei n sha l l sur vi ve a n y ter mi n a ti o n o r ex pi r a ti o n o f thi s Agr eemen t o r a n y pr o ject
schedul e.
11. Ai r o r Wa ter Po l l uti o n Requi r emen ts
An y f eder a l l y f un ded a gr eemen t a n d/ o r subco n tr a ct i n ex cess o f $100,000 must co mpl y wi th the f o l l o wi n g
pr o vi si o n s un l ess sa i d a gr eemen t i s ex empt un der 40 C FR 15 .5 .
a . Go ver n men t co n tr a cto r s a gr ee to co mpl y wi th a l l a ppl i ca bl e sta n da r ds, o r der s, o r r equi r emen ts i ssued
un der secti o n 306 o f the C l ea n Ai r Act [42 U.S.C . 18 5 7(h)] , secti o n 5 08 o f the C l ea n Wa ter Act (33 U.S.C .
1368 ), E x ecuti ve Or der 11738 , a n d E n vi r o n men ta l Pr o tecti o n Agen cy r egul a ti o n s (40 C FR pa r t 15 ).
b. I n sti tuti o n s o f hi gher educa ti o n , ho spi ta l s, n o n pr o f i t o r ga n i za ti o n s a n d co mmer ci a l busi n esses a gr ee to
co mpl y wi th a l l a ppl i ca bl e sta n da r ds, o r der s, o r r equi r emen ts i ssued un der the C l ea n Ai r Act (42 U.S.C .
7401 et seq.), a s a men ded, a n d the Feder a l Wa ter Po l l uti o n C o n tr o l Act (33 U.S.C . 125 1 et seq.), a s
a men ded.
12. Pr i o r Appr o va l o f Tr a i n i n g Semi n a r s, Wo r ksho ps o r C o n f er en ces
C o n tr a cto r sha l l o bta i n pr i o r C DPH a ppr o va l o f the l o ca ti o n , co sts, da tes, a gen da , i n str ucto r s, i n str ucti o n a l
ma ter i a l s, a n d a tten dees a t a n y r ei mbur sa bl e tr a i n i n g semi n a r , wo r ksho p, o r co n f er en ce co n ducted pur sua n t
to thi s Agr eemen t a n d o f a n y r ei mbur sa bl e publ i ci ty o r educa ti o n a l ma ter i a l s to be ma de a va i l a bl e f o r
di str i buti o n . The C o n tr a cto r sha l l a ckn o wl edge the suppo r t o f the Sta te when ever publ i ci zi n g the wo r k un der
thi s Agr eemen t i n a n y medi a . Thi s pr o vi si o n do es n o t a ppl y to n ecessa r y sta f f meeti n gs o r tr a i n i n g sessi o n s
hel d f o r the sta f f o f the C o n tr a cto r o r Subco n tr a cto r to co n duct r o uti n e busi n ess ma tter s.
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C o n tr a cto r ' s per f o r ma n ce o f thi s Agr eemen t, C o n tr a cto r sha l l o bta i n a l i cen se un der ter ms a ccepta bl e to
C DPH.
f . Wa r r a n ti es
(1) C o n tr a cto r r epr esen ts a n d wa r r a n ts tha t:
(a ) I t i s f r ee to en ter i n to a n d f ul l y per f o r m thi s Agr eemen t.
(b) I t ha s secur ed a n d wi l l secur e a l l r i ghts a n d l i cen ses n ecessa r y f o r i ts per f o r ma n ce o f thi s
Agr eemen t.
(c) Nei ther C o n tr a cto r ' s per f o r ma n ce o f thi s Agr eemen t, n o r the ex er ci se by ei ther Pa r ty o f the r i ghts
gr a n ted i n thi s Agr eemen t, n o r a n y use, r epr o ducti o n , ma n uf a ctur e, sa l e, o f f er to sel l , i mpo r t,
ex po r t, mo di f i ca ti o n , publ i c a n d pr i v a te di spl a y/per f o r ma n ce, di str i buti o n , a n d di spo si ti o n o f the
I n tel l ectua l Pr o per ty ma de, co n cei v ed, der i v ed f r o m, o r r educed to pr a cti ce by C o n tr a cto r o r
C DPH a n d whi ch r esul t di r ectl y o r i n di r ectl y f r o m thi s Agr eemen t wi l l i n f r i n ge upo n o r v i o l a te a n y
I n tel l ectua l Pr o per ty r i ght, n o n -di scl o sur e o bl i ga ti o n , o r o ther pr o pr i eta r y r i ght o r i n ter est o f a n y
thi r d- pa r ty o r en ti ty n o w ex i sti n g un der the l a ws o f , o r her ea f ter ex i sti n g o r i ssued by , a n y sta te,
the Un i ted Sta tes, o r a n y f o r ei gn co un tr y . Ther e i s cur r en tl y n o a ctua l o r thr ea ten ed cl a i m by a n y
such thi r d pa r ty ba sed o n a n a l l eged v i o l a ti o n o f a n y such r i ght by C o n tr a cto r .
(d) Nei ther C o n tr a cto r ' s per f o r ma n ce n o r a n y pa r t o f i ts per f o r ma n ce wi l l v i o l a te the r i ght o f pr i v a cy o f ,
o r co n sti tute a l i bel o r sl a n der a ga i n st a n y per so n o r en ti ty .
(e) I t ha s secur ed a n d wi l l secur e a l l r i ghts a n d l i cen ses n ecessa r y f o r I n tel l ectua l Pr o per ty i n cl udi n g,
but n o t l i mi ted to , co n sen ts, wa i v er s o r r el ea ses f r o m a l l a utho r s o f musi c o r per f o r ma n ces used,
a n d ta l en t (r a di o , tel ev i si o n a n d mo ti o n pi ctur e ta l en t), o wn er s o f a n y i n ter est i n a n d to r ea l esta te,
si tes, l o ca ti o n s, pr o per ty o r pr o ps tha t ma y be used o r sho wn .
(f ) I t ha s n o t gr a n ted a n d sha l l n o t gr a n t to a n y per so n o r en ti ty a n y r i ght tha t wo ul d o r mi ght
der o ga te, en cumber , o r i n ter f er e wi th a n y o f the r i ghts gr a n ted to C DPH i n thi s Agr eemen t.
(g) I t ha s a ppr o pr i a te sy stems a n d co n tr o l s i n pl a ce to en sur e tha t sta te f un ds wi l l n o t be used i n the
per f o r ma n ce o f thi s Agr eemen t f o r the a cq ui si ti o n , o per a ti o n o r ma i n ten a n ce o f co mputer
so f twa r e i n v i o l a ti o n o f co py r i ght l a ws.
(h) I t ha s n o kn o wl edge o f a n y o utsta n di n g. cl a i ms, l i cen ses o r o ther cha r ges, l i en s, o r en cumbr a n ces
o f a n y ki n d o r n a tur e wha tso ev er tha t co ul d a f f ect i n a n y wa y C o n tr a cto r ' s per f o r ma n ce o f thi s
Agr eemen t.
(2) C DPH MAKE S NO WARRANTY THAT THE I NTE LLE C TUAL PROPE RTY RE SULTI NG FROM THI S
AGRE E ME NT DOE S NOT I NFRI NGE UPON ANY PATE NT, TRADE MARK, C OPYRI GHT OR THE
LI KE , NOW E XI STI NG OR SUBSE QUE NTLY I SSUE D.
g. I n tel l ectua l Pr o per ty I n demn i ty
(1) C o n tr a cto r sha l l i n demn i f y , def en d a n d ho l d ha r ml ess C DPH a n d i ts l i cen sees a n d a ssi gn ees, a n d i ts
o f f i cer s, di r ecto r s, empl o y ees, a gen ts, r epr esen ta ti v es, successo r s, a n d user s o f i ts pr o ducts,
("I n demn i tees") f r o m a n d a ga i n st a l l cl a i ms, a cti o n s, da ma ges, l o sses, l i a bi l i ti es (o r a cti o n s o r
pr o ceedi n gs wi th r espect to a n y ther eo f ), whether o r n o t r i ghtf ul , a r i si n g f r o m a n y a n d a l l a cti o n s o r
cl a i ms by a n y thi r d pa r ty o r ex pen ses r el a ted ther eto (i n cl udi n g, but n o t l i mi ted to , a l l l ega l ex pen ses,
co ur t co sts, a n d a tto r n ey ' s f ees i n cur r ed i n i n v esti ga ti n g, pr epa r i n g, ser v i n g a s a wi tn ess i n , o r
def en di n g a ga i n st, a n y such cl a i m, a cti o n , o r pr o ceedi n g, co mmen ced o r thr ea ten ed) to whi ch a n y o f
the I n demn i tees ma y be subj ect, whether o r n o t C o n tr a cto r i s a pa r ty to a n y pen di n g o r thr ea ten ed
l i ti ga ti o n , whi ch a r i se o ut o f o r a r e r el a ted to (i ) the i n co r r ectn ess o r br ea ch o f a n y o f the
r epr esen ta ti o n s, wa r r a n ti es, co v en a n ts o r a gr eemen ts o f C o n tr a cto r per ta i n i n g to I n tel l ectua l Pr o per ty ;
o r (i i ) a n y I n tel l ectua l Pr o per ty i n f r i n gemen t, o r a n y o ther ty pe o f a ctua l o r a l l eged i n f r i n gemen t cl a i m,
a r i si n g o ut o f C DPH' s use, r epr o ducti o n , ma n uf a ctur e, sa l e, o f f er to sel l , di str i buti o n , i mpo r t, ex po r t,
mo di f i ca ti o n , publ i c a n d pr i v a te per f o r ma n ce/di spl a y , l i cen se, a n d di spo si ti o n o f the I n tel l ectua l
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b . Reta i n ed Ri ghts /Li c en se Ri ghts
(1) E x c ept f o r I n tel l ec tu a l P r o per ty ma de, c o n c ei ved, der i ved f r o m, o r r edu c ed to pr a c ti c e b y C o n tr a c to r
o r C DP H a n d whi c h r esu l t di r ec tl y o r i n di r ec tl y f r o m thi s Agr eemen t, C o n tr a c to r sha l l r eta i n ti tl e to a l l
o f i ts I n tel l ec tu a l P r o per ty to the ex ten t su c h I n tel l ec tu a l P r o per ty i s i n ex i sten c e pr i o r to the ef f ec ti ve
da te o f thi s Agr eemen t. C o n tr a c to r her eb y gr a n ts to C DP H, wi tho u t a ddi ti o n a l c o mpen sa ti o n , a
per ma n en t, n o n -ex c l u si ve, r o ya l ty f r ee, pa i d- u p, wo r l dwi de, i r r evo c a b l e, per petu a l , n o n -ter mi n a b l e
l i c en se to u se, r epr o du c e, ma n u f a c tu r e, sel l , o f f er to sel l , i mpo r t, ex po r t, mo di f y, pu b l i c l y a n d pr i va tel y
di spl a y/per f o r m, di str i b u te, a n d di spo se C o n tr a c to r ' s I n tel l ec tu a l P r o per ty wi th the r i ght to su b l i c en se
thr o u gh mu l ti pl e l a yer s, f o r a n y pu r po se wha tso ever , to the ex ten t i t i s i n c o r po r a ted i n the I n tel l ec tu a l
P r o per ty r esu l ti n g f r o m thi s Agr eemen t, u n l ess C o n tr a c to r a ssi gn s a l l r i ghts, ti tl e a n d i n ter est i n the
I n tel l ec tu a l P r o per ty a s set f o r th her ei n .
(2) No thi n g i n thi s pr o vi si o n sha l l r estr i c t, l i mi t, o r o ther wi se pr even t C o n tr a c to r f r o m u si n g a n y i dea s,
c o n c epts, kn o w- ho w, metho do l o gy o r tec hn i qu es r el a ted to i ts per f o r ma n c e u n der thi s Agr eemen t,
pr o vi ded tha t C o n tr a c to r ' s u se do es n o t i n f r i n ge the pa ten t, c o pyr i ght, tr a dema r k r i ghts, l i c en se o r
o ther I n tel l ec tu a l P r o per ty r i ghts o f C DP H o r thi r d pa r ty, o r r esu l t i n a b r ea c h o r def a u l t o f a n y
pr o vi si o n s o f thi s E x hi b i t o r r esu l t i n a b r ea c h o f a n y pr o vi si o n s o f l a w r el a ti n g to c o n f i den ti a l i ty.
c . C o pyr i ght
(1) C o n tr a c to r a gr ees tha t f o r pu r po ses o f c o pyr i ght l a w, a l l wo r ks [a s def i n ed i n P a r a gr a ph a ,
su b pa r a gr a ph (2)(a ) o f thi s pr o vi si o n ] o f a u tho r shi p ma de b y o r o n b eha l f o f C o n tr a c to r i n c o n n ec ti o n
wi th C o n tr a c to r ' s per f o r ma n c e o f thi s Agr eemen t sha l l b e deemed "wo r ks ma de f o r hi r e". C o n tr a c to r
f u r ther a gr ees tha t the wo r k o f ea c h per so n u ti l i z ed b y C o n tr a c to r i n c o n n ec ti o n wi th the per Fo r ma n c e
o f thi s Agr eemen t wi l l b e a "wo r k ma de f o r hi r e," whether tha t per so n i s a n empl o yee o f C o n tr a c to r o r
tha t per so n ha s en ter ed i n to a n a gr eemen t wi th C o n tr a c to r to per f o r m the wo r k. C o n tr a c to r sha l l
en ter i n to a wr i tten a gr eemen t wi th a n y su c h per so n tha t: (i ) a l l wo r k per f o r med f o r C o n tr a c to r sha l l b e
deemed a "wo r k ma de f o r hi r e" u n der the C o pyr i ght Ac t a n d (i i ) tha t per so n sha l l a ssi gn a l l r i ght, ti tl e,
a n d i n ter est to C DP H to a n y wo r k pr o du c t ma de, c o n c ei ved, der i ved f r o m, o r r edu c ed to pr a c ti c e b y
C o n tr a c to r o r C DP H a n d whi c h r esu l t di r ec tl y o r i n di r ec tl y f r o m thi s Agr eemen t.
(2) Al l ma ter i a l s, i n c l u di n g, b u t n o t l i mi ted to , vi su a l wo r ks o r tex t, r epr o du c ed o r di str i b u ted pu r su a n t to
thi s Agr eemen t tha t i n c l u de I n tel l ec tu a l P r o per ty ma de, c o n c ei ved, der i ved f r o m, o r r edu c ed to
pr a c ti c e b y C o n tr a c to r o r C DP H a n d whi c h r esu l t di r ec tl y o r i n di r ec tl y f r o m thi s Agr eemen t, sha l l
i n c l u de C DP H' s n o ti c e o f c o pyr i ght, whi c h sha l l r ea d i n 3mm o r l a r ger typef a c e: "O (E n ter C u r r en t
Yea r e.g., 2007, etc .J , Depa r tmen t o f P u b l i c Hea l th. Thi s ma ter i a l ma y n o t b e r epr o du c ed o r
di ssemi n a ted wi tho u t pr i o r wr i tten per mi ssi o n f r o m the Depa r tmen t o f P u b l i c Hea l th." Thi s n o ti c e
sho u l d b e pl a c ed pr o mi n en tl y o n the ma ter i a l s a n d set a pa r t f r o m o ther ma tter o n the pa ge wher e i t
a ppea r s. Au di o pr o du c ti o n s sha l l c o n ta i n a si mi l a r a u di o n o ti c e o f c o pyr i ght.
d. P a ten t Ri ghts
Wi th r espec t to i n ven ti o n s ma de b y C o n tr a c to r i n the per f o r ma n c e o f thi s Agr eemen t, whi c h di d n o t r esu l t
f r o m r esea r c h a n d devel o pmen t spec i f i c a l l y i n c l u ded i n the Agr eemen ts sc o pe o f wo r k, C o n tr a c to r her eb y
gr a n ts to C DP H a l i c en se a s desc r i b ed u n der Sec ti o n b o f thi s pr o vi si o n f o r devi c es o r ma ter i a l
i n c o r po r a ti n g, o r ma de thr o u gh the u se o f su c h i n ven ti o n s. I f su c h i n ven ti o n s r esu l t f r o m r esea r c h a n d
devel o pmen t wo r k spec i f i c a l l y i n c l u ded wi thi n the Agr eemen ts sc o pe o f wo r k, then C o n tr a c to r a gr ees to
a ssi gn to C DP H, wi tho u t a ddi ti o n a l c o mpen sa ti o n , a l l i ts r i ght, ti tl e a n d i n ter est i n a n d to su c h i n ven ti o n s
a n d to a ssi st C DP H i n sec u r i n g Un i ted Sta tes a n d f o r ei gn pa ten ts wi th r espec t ther eto .
e. Thi r d- P a r ty I n tel l ec tu a l P r o per ty
E x c ept a s pr o vi ded her ei n , C o n tr a c to r a gr ees tha t i ts per f o r ma n c e o f thi s Agr eemen t sha l l n o t b e
depen den t u po n o r i n c l u de a n y I n tel l ec tu a l P r o per ty o f C o n tr a c to r o r thi r d pa r ty wi tho u t f i r st: (i ) o b ta i n i n g
C DP H' s pr i o r wr i tten a ppr o va l ; a n d (i i ) gr a n ti n g to o r o b ta i n i n g f o r C DP H, wi tho u t a ddi ti o n a l c o mpen sa ti o n ,
a l i c en se, a s desc r i b ed i n Sec ti o n b o f thi s pr o vi si o n , f o r a n y o f C o n tr a c to r ' s o r thi r d- pa r ty' s I n tel l ec tu a l
P r o per ty i n ex i sten c e pr i o r to the ef f ec ti ve da te o f thi s Agr eemen t. I f su c h a l i c en se u po n the these ter ms
i s u n a tta i n a b l e, a n d C DP H deter mi n es tha t the I n tel l ec tu a l P r o per ty sho u l d b e i n c l u ded i n o r i s r equ i r ed f o r
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c. I t i s mutua l l y a gr eed tha t i f the C o n gr ess do es n o t a ppr o pr i a te suf f i ci en t f un ds f o r the pr o gr a m, thi s
Agr eemen t sha l l be a men ded to r ef l ect a n y r educti o n i n f un ds.
C DPH ha s the o pti o n to i n v a l i da te o r ca n cel the Agr eemen t w i th 30- da ys a dv a n ce w r i tten n o ti ce o r to
a men d the Agr eemen t to r ef l ect a n y r educti o n i n f un ds.
10. I n tel l ectua l Pr o per ty Ri ghts
a . Ow n er shi p
(1) E x cept w her e C DPH ha s a gr eed i n a si gn ed w r i ti n g to a ccept a l i cen se, C DPH sha l l be a n d r ema i n ,
w i tho ut a ddi ti o n a l co mpen sa ti o n , the so l e o w n er o f a n y a n d a l l r i ghts, ti tl e a n d i n ter est i n a l l I n tel l ectua l
Pr o per ty, f r o m the mo men t o f cr ea ti o n , w hether o r n o t j o i n tl y co n cei v ed, tha t a r e ma de, co n cei v ed,
der i v ed f r o m, o r r educed to pr a cti ce by C o n tr a cto r o r C DPH a n d w hi ch r esul t di r ectl y o r i n di r ectl y f r o m
thi s Agr eemen t.
(2) Fo r the pur po ses o f thi s Agr eemen t, I n tel l ectua l Pr o per ty mea n s r eco gn i zed pr o tecta bl e r i ghts a n d
i n ter est such a s: pa ten ts, (w hether o r n o t i ssued) co pyr i ghts, tr a dema r ks, ser v i ce ma r ks, a ppl i ca ti o n s
f o r a n y o f the f o r ego i n g, i n v en ti o n s, tr a de secr ets, tr a de dr ess, l o go s, i n si gn i a , co l o r co mbi n a ti o n s,
sl o ga n s, mo r a l r i ghts, r i ght o f publ i ci ty, a utho r ' s r i ghts, co n tr a ct a n d l i cen si n g r i ghts, w o r ks, ma sk
w o r ks, i n dustr i a l desi gn r i ghts, r i ghts o f pr i o r i ty, kn o w ho w , desi gn f l o w s, metho do l o gi es, dev i ces,
busi n ess pr o cesses, dev el o pmen ts, i n n o v a ti o n s, go o d w i l l a n d a l l o ther l ega l r i ghts pr o tecti n g
i n ta n gi bl e pr o pr i eta r y i n f o r ma ti o n a s ma y ex i st n o w a n d/ o r her e a f ter co me i n to ex i sten ce, a n d a l l
r en ew a l s a n d ex ten si o n s, r ega r dl ess o f w hether tho se r i ghts a r i se un der the l a w s o f the Un i ted Sta tes,
o r a n y o ther sta te, co un tr y o r j ur i sdi cti o n .
(a ) Fo r the pur po ses o f the def i n i ti o n o f I n tel l ectua l Pr o per ty, "w o r ks" mea n s a l l l i ter a r y w o r ks, w r i ti n gs
a n d pr i n ted ma tter i n cl udi n g the medi um by w hi ch they a r e r eco r ded o r r epr o duced, pho to gr a phs,
a r t w o r k, pi cto r i a l a n d gr a phi c r epr esen ta ti o n s a n d w o r ks o f a si mi l a r n a tur e, f i l m, mo ti o n pi ctur es,
di gi ta l i ma ges, a n i ma ti o n cel l s, a n d o ther a udi o v i sua l w o r ks i n cl udi n g po si ti v es a n d n ega ti v es
ther eo f , so un d r eco r di n gs, ta pes, educa ti o n a l ma ter i a l s, i n ter a cti v e v i deo s a n d a n y o ther ma ter i a l s
o r pr o ducts cr ea ted, pr o duced, co n ceptua l i zed a n d f i x ed i n a ta n gi bl e medi um o f ex pr essi o n . I t
i n cl udes pr el i mi n a r y a n d f i n a l pr o ducts a n d a n y ma ter i a l s a n d i n f o r ma ti o n dev el o ped f o r the
pur po ses o f pr o duci n g tho se f i n a l pr o ducts. Wo r ks do es n o t i n cl ude a r ti cl es submi tted to peer
r ev i ew o r r ef er en ce j o ur n a l s o r i n depen den t r esea r ch pr o j ects.
(3) I n the per f o r ma n ce o f thi s Agr eemen t, C o n tr a cto r w i l l ex er ci se a n d uti l i ze cer ta i n o f i ts I n tel l ectua l
Pr o per ty i n ex i sten ce pr i o r to the ef f ecti v e da te o f thi s Agr eemen t. I n a ddi ti o n , un der thi s Agr eemen t,
C o n tr a cto r ma y a ccess a n d uti l i ze cer ta i n o f C DPH' s I n tel l ectua l Pr o per ty i n ex i sten ce pr i o r to the
ef f ecti v e da te o f thi s Agr eemen t. E x cept a s o ther w i se set f o r th her ei n , C o n tr a cto r sha l l n o t use a n y o f
C DPH' s I n tel l ectua l Pr o per ty n o w ex i sti n g o r her ea f ter ex i sti n g f o r a n y pur po ses w i tho ut the pr i o r
w r i tten per mi ssi o n o f C DPH. E x cept a s o ther w i se set f o r th her ei n , n ei ther the C o n tr a cto r n o r
C DPH sha l l gi v e a n y o w n er shi p i n ter est i n o r r i ghts to i ts I n tel l ectua l Pr o per ty to the o ther
Pa r ty. I f dur i n g the ter m o f thi s Agr eemen t, C o n tr a cto r a ccesses a n y thi r d- pa r ty I n tel l ectua l Pr o per ty
tha t i s l i cen sed to C DPH, C o n tr a cto r a gr ees to a bi de by a l l l i cen se a n d co n f i den ti a l i ty r estr i cti o n s
a ppl i ca bl e to C DPH i n the thi r d- pa r ty' s l i cen se a gr eemen t.
(4) C o n tr a cto r a gr ees to co o per a te w i th C DPH i n esta bl i shi n g o r ma i n ta i n i n g C DPH' s ex cl usi v e r i ghts i n
the I n tel l ectua l Pr o per ty, a n d i n a ssur i n g C DPH' s so l e r i ghts a ga i n st thi r d pa r ti es w i th r espect to the
I n tel l ectua l Pr o per ty. I f the C o n tr a cto r en ter s i n to a n y a gr eemen ts o r subco n tr a cts w i th o ther pa r ti es
i n o r der to per f o r m thi s Agr eemen t, C o n tr a cto r sha l l r eq ui r e the ter ms o f the Agr eemen ts) to i n cl ude
a l l I n tel l ectua l Pr o per ty pr o v i si o n s. Such ter ms must i n cl ude, but a r e n o t l i mi ted to , the subco n tr a cto r
a ssi gn i n g a n d a gr eei n g to a ssi gn to C DPH a l l r i ghts, ti tl e a n d i n ter est i n I n tel l ectua l Pr o per ty ma de,
co n cei v ed, der i v ed f r o m, o r r educed to pr a cti ce by the subco n tr a cto r , C o n tr a cto r o r C DPH a n d w hi ch
r esul t di r ectl y o r i n di r ectl y f r o m thi s Agr eemen t o r a n y subco n tr a ct.
(5) C o n tr a cto r f ur ther a gr ees to a ssi st a n d co o per a te w i th C DPH i n a l l r ea so n a bl e r espects, a n d ex ecute
a l l do cumen ts a n d, subj ect to r ea so n a bl e a v a i l a bi l i ty, gi v e testi mo n y a n d ta ke a l l f ur ther a cts
r ea so n a bl y n ecessa r y to a cq ui r e, tr a n sf er , ma i n ta i n , a n d en f o r ce C DPH' s I n tel l ectua l Pr o per ty r i ghts
a n d i n ter ests.
C DPH E x hi bi t D(F) (8/ 10)
Pa ge 10 o f 25
~~
C a l i f o r n i a Depa r tmen t o f Publ i c H ea l th - Speci a l Ter ms a n d C o n di ti o n s E x h i bi t D (F)
r evi ew a n d to co py a n y r eco r ds a n d suppo r ti n g do cumen ta ti o n per ta i n i n g to th e per f o r ma n ce o f th i s
Agr eemen t. C o n tr a cto r a gr ees to a l l o w th e a udi to r s) a ccess to such r eco r ds dur i n g n o r ma l busi n ess
h o ur s a n d to a l l o w i n ter vi ews o f a n y empl o yees wh o mi gh t r ea so n a bl y h a ve i n f o r ma ti o n r el a ted to such
r eco r ds. Fur th er , th e C o n tr a cto r a gr ees to i n cl ude a si mi l a r r i gh t o f th e Sta te to a udi t r eco r ds a n d
i n ter vi ew sta f f i n a n y subco n tr a ct r el a ted to per f o r ma n ce o f th i s Agr eemen t. (GC 8546.7, C C R Ti tl e 2,
Secti o n 1896).
d. Th e C o n tr a cto r a n d/ o r Subco n tr a cto r sh a l l pr eser ve a n d ma ke a va i l a bl e h i s/ h er r eco r ds (1) f o r a per i o d o f
th r ee yea r s f r o m th e da te o f f i n a l pa ymen t un der th i s Agr eemen t, a n d (2) f o r such l o n ger per i o d, i f a n y, a s
i s r eq ui r ed by a ppl i ca bl e sta tute, by a n y o th er pr o vi si o n o f th i s Agr eemen t, o r by subpa r a gr a ph s (1) o r (2)
bel o w.
(1) I f th i s Agr eemen t i s co mpl etel y o r pa r ti a l l y ter mi n a ted, th e r eco r ds r el a ti n g to th e wo r k ter mi n a ted sh a l l
be pr eser ved a n d ma de a va i l a bl e f o r a per i o d o f th r ee yea r s f r o m th e da te o f a n y r esul ti n g f i n a l
settl emen t.
(2) I f a n y l i ti ga ti o n , cl a i m, n ego ti a ti o n , a udi t, o r o th er a cti o n i n vo l vi n g th e r eco r ds h a s been sta r ted bef o r e
th e ex pi r a ti o n o f th e th r ee- yea r per i o d, th e r eco r ds sh a l l be r eta i n ed un ti l co mpl eti o n o f th e a cti o n a n d
r eso l uti o n o f a l l i ssues wh i ch a r i se f r o m i t, o r un ti l th e en d o f th e r egul a r th r ee- yea r per i o d, wh i ch ever
i s l a ter .
e. Th e C o n tr a cto r a n d/ o r Subco n tr a cto r sh a l l co mpl y wi th th e a bo ve r eq ui r emen ts a n d be a wa r e o f th e
pen a l ti es f o r vi o l a ti o n s o f f r a ud a n d f o r o bstr ucti o n o f i n vesti ga ti o n a s set f o r th i n Publ i c C o n tr a ct C o de §
10115.10, i f a ppl i ca bl e.
f . Th e C o n tr a cto r a n d/ o r Subco n tr a cto r ma y, a t i ts di scr eti o n , f o l l o wi n g r ecei pt o f f i n a l pa ymen t un der th i s
Agr eemen t, r educe i ts a cco un ts, bo o ks a n d r eco r ds r el a ted to th i s Agr eemen t to mi cr o f i l m, co mputer di sk,
C D ROM, o r o th er da ta sto r a ge medi um. Upo n r eq uest by a n a uth o r i zed r epr esen ta ti ve to i n spect, a udi t
o r o bta i n co pi es o f sa i d r eco r ds, th e C o n tr a cto r a n d/ o r Subco n tr a cto r must suppl y o r ma ke a va i l a bl e
a ppl i ca bl e devi ces, h a r dwa r e, a n d/ o r so f twa r e n ecessa r y to vi ew, co py a n d/ o r pr i n t sa i d r eco r ds.
Appl i ca bl e devi ces ma y i n cl ude, but a r e n o t l i mi ted to , mi cr o f i l m r ea der s a n d mi cr o f i l m pr i n ter s, etc.
g. Th e C o n tr a cto r sh a l l , i f a ppl i ca bl e, co mpl y wi th th e Si n gl e Audi t Act a n d th e a udi t r epo r ti n g r eq ui r emen ts
set f o r th i n OMB C i r cul a r A- 133.
8. Si te I n specti o n
Th e Sta te, th r o ugh a n y a uth o r i zed r epr esen ta ti ves, h a s th e r i gh t a t a l l r ea so n a bl e ti mes to i n spect o r o th er wi se
eva l ua te th e wo r k per f o r med o r bei n g per f o r med h er eun der i n cl udi n g subco n tr a ct suppo r ted a cti vi ti es a n d th e
pr emi ses i n wh i ch i t i s bei n g per f o r med. I f a n y i n specti o n o r eva l ua ti o n i s ma de o f th e pr emi ses o f th e
C o n tr a cto r o r Subco n tr a cto r , th e C o n tr a cto r sh a l l pr o vi de a n d sh a l l r eq ui r e Subco n tr a cto r s to pr o vi de a l l
r ea so n a bl e f a ci l i ti es a n d a ssi sta n ce f o r th e sa f ety a n d co n ven i en ce o f th e a uth o r i zed r epr esen ta ti ves i n th e
per f o r ma n ce o f th ei r duti es. Al l i n specti o n s a n d eva l ua ti o n s sh a l l be per f o r med i n such a ma n n er a s wi l l n o t
un dul y del a y th e wo r k.
9. Feder a l C o n tr a ct Fun ds
(Appl i ca bl e o n l y to th a t po r ti o n o f a n a gr eemen t f un ded i n pa r t o r wh o l e wi th f eder a l f un ds.)
a . I t i s mutua l l y un der sto o d between th e pa r ti es th a t th i s Agr eemen t ma y h a ve been wr i tten bef o r e
a scer ta i n i n g th e a va i l a bi l i ty o f co n gr essi o n a l a ppr o pr i a ti o n o f f un ds, f o r th e mutua l ben ef i t o f bo th pa r ti es,
i n o r der to a vo i d pr o gr a m a n d f i sca l del a ys wh i ch wo ul d o ccur i f th e Agr eemen t wer e ex ecuted a f ter th a t
deter mi n a ti o n wa s ma de.
b. Th i s a gr eemen t i s va l i d a n d en f o r cea bl e o n l y i f suf f i ci en t f un ds a r e ma de a va i l a bl e to th e Sta te by th e
Un i ted Sta tes Go ver n men t f o r th e f i sca l yea r s co ver ed by th e ter m o f th i s Agr eemen t. I n a ddi ti o n , th i s
Agr eemen t i s subject to a n y a ddi ti o n a l r estr i cti o n s, l i mi ta ti o n s, o r co n di ti o n s en a cted by th e C o n gr ess o r
a n y sta tute en a cted by th e C o n gr ess wh i ch ma y a f f ect th e pr o vi si o n s, ter ms o r f un di n g o f th i s Agr eemen t
i n a n y ma n n er .
C DPH E x h i bi t D(F) (8/ 10) ~/ ~ — Pa ge 9 o f 25
7
C a l i f o r n i a Depa r tmen t o f P u b l i c Hea l th - Spec i a l Ter ms a n d C o n di ti o n s E x hi b i t D (F)
(1) Upo n r ec ei pt o f a w r i tten n o ti c e f r o m C DP H r eq u i r i n g the su b sti tu ti o n a n d/ o r ter mi n a ti o n o f a
su b c o n tr a c t, the C o n tr a c to r sha l l ta ke steps to en su r e the c o mpl eti o n o f a n y w o r k i n pr o g r ess a n d
sel ec t a r epl a c emen t, i f a ppl i c a b l e, w i thi n 30 c a l en da r da ys, u n l ess a l o n g er per i o d i s a g r eed to b y
C DP H.
c . Ac tu a l su b c o n tr a c ts (i .e., w r i tten a g r eemen t b etw een the C o n tr a c to r a n d a su b c o n tr a c to r ) o f $5,000 o r
mo r e a r e su b jec t to the pr i o r r evi ew a n d w r i tten a ppr o va l o f C DP H. C DP H ma y, a t i ts di sc r eti o n , el ec t to
w a i ve thi s r i g ht. Al l su c h w a i ver s sha l l b e c o n f i r med i n w r i ti n g b y C DP H.
d. C o n tr a c to r sha l l ma i n ta i n a c o py o f ea c h su b c o n tr a c t en ter ed i n to i n su ppo r t o f thi s Ag r eemen t a n d sha l l ,
u po n r eq u est b y C DP H, ma ke c o pi es a va i l a b l e f o r a ppr o va l , i n spec ti o n , o r a u di t.
e. C DP H a ssu mes n o r espo n si b i l i ty f o r the pa ymen t o f su b c o n tr a c to r s u sed i n the per f o r ma n c e o f thi s
Ag r eemen t. C o n tr a c to r a c c epts so l e r espo n si b i l i ty f o r the pa ymen t o f su b c o n tr a c to r s u sed i n the
per f o r ma n c e o f thi s Ag r eemen t.
f . The C o n tr a c to r i s r espo n si b l e f o r a l l per f o r ma n c e r eq u i r emen ts u n der thi s Ag r eemen t even tho u g h
per f o r ma n c e ma y b e c a r r i ed o u t thr o u g h a su b c o n tr a c t.
g . The C o n tr a c to r sha l l en su r e tha t a l l su b c o n tr a c ts f o r ser vi c es i n c l u de pr o vi si o n s) r eq u i r i n g c o mpl i a n c e
w i th a ppl i c a b l e ter ms a n d c o n di ti o n s spec i f i ed i n thi s Ag r eemen t.
The C o n tr a c to r a g r ees to i n c l u de the f o l l o w i n g c l a u se, r el eva n t to r ec o r d r eten ti o n , i n a l l su b c o n tr a c ts f o r
ser vi c es:
"(Su b c o n tr a c to r Na me) a g r ees to ma i n ta i n a n d pr eser ve, u n ti l thr ee yea r s a f ter ter mi n a ti o n o f
(Ag r eemen t Nu mb er ) a n d f i n a l pa ymen t f r o m C DP H to the C o n tr a c to r , to per mi t C DP H o r a n y du l y
a u tho r i zed r epr esen ta ti ve, to ha ve a c c ess to , ex a mi n e o r a u di t a n y per ti n en t b o o ks, do c u men ts,
pa per s a n d r ec o r ds r el a ted to thi s su b c o n tr a c t a n d to a l l o w i n ter vi ew s o f a n y empl o yees w ho
mi g ht r ea so n a b l y ha ve i n f o r ma ti o n r el a ted to su c h r ec o r ds."
Un l ess o ther w i se sti pu l a ted i n w r i ti n g b y C DP H, the C o n tr a c to r sha l l b e the su b c o n tr a c to r ' s so l e po i n t o f
c o n ta c t f o r a l l ma tter s r el a ted to per f o r ma n c e a n d pa ymen t u n der thi s Ag r eemen t.
C o n tr a c to r sha l l , a s a ppl i c a b l e, a dvi se a l l su b c o n tr a c to r s o f thei r o b l i g a ti o n s pu r su a n t to the f o l l o w i n g
n u mb er ed pr o vi si o n s o f thi s E x hi b i t: 1, 2, 3, 4, 5, 6, 7, 8, 10, 11, 12, 13, 14, 17, 19, 20, 24, a n d 31 o r o ther
n u mb er ed pr o vi si o n s her ei n tha t deemed a ppl i c a b l e.
6. In c o me Restr i c ti o n s
Un l ess o ther w i se sti pu l a ted i n thi s Ag r eemen t, the C o n tr a c to r a g r ees tha t a n y r ef u n ds, r eb a tes, c r edi ts, o r
o ther a mo u n ts (i n c l u di n g a n y i n ter est ther eo n ) a c c r u i n g to o r r ec ei ved b y the C o n tr a c to r u n der thi s Ag r eemen t
sha l l b e pa i d b y the C o n tr a c to r to C DP H, to the ex ten t tha t they a r e pr o per l y a l l o c a b l e to c o sts f o r w hi c h the
C o n tr a c to r ha s b een r ei mb u r sed b y C DP H u n der thi s Ag r eemen t.
7. Au di t a n d Rec o r d Reten ti o n
(Appl i c a b l e to a g r eemen ts i n ex c ess o f $10,000.)
a . The C o n tr a c to r a n d/ o r Su b c o n tr a c to r sha l l ma i n ta i n b o o ks, r ec o r ds, do c u men ts, a n d o ther evi den c e,
a c c o u n ti n g pr o c edu r es a n d pr a c ti c es, su f f i c i en t to pr o per l y r ef l ec t a l l di r ec t a n d i n di r ec t c o sts o f w ha tever
n a tu r e c l a i med to ha ve b een i n c u r r ed i n the per f o r ma n c e o f thi s Ag r eemen t, i n c l u di n g a n y ma tc hi n g c o sts
a n d ex pen ses. The f o r eg o i n g c o n sti tu tes "r ec o r ds" f o r the pu r po se o f thi s pr o vi si o n .
b . The C o n tr a c to r ' s a n d/ o r su b c o n tr a c to r ' s f a c i l i ty o r o f f i c e o r su c h pa r t ther eo f a s ma y b e en g a g ed i n the
per f o r ma n c e o f thi s Ag r eemen t a n d hi s/ her r ec o r ds sha l l b e su b jec t a t a l l r ea so n a b l e ti mes to i n spec ti o n ,
a u di t, a n d r epr o du c ti o n .
c . C o n tr a c to r a g r ees tha t C DP H, the Depa r tmen t o f Gen er a l Ser vi c es, the Bu r ea u o f Sta te Au di ts, o r thei r
desi g n a ted r epr esen ta ti ves i n c l u di n g the C o mptr o l l er Gen er a l o f the Un i ted Sta tes sha l l ha ve the r i g ht to
C DP H E x hi b i t D(F) (8/ 10) P a g e 8 o f 25
~/ ~""
SO
C a l i f o r n i a Depa r tmen t o f P u b l i c Hea l th - Spec i a l Ter ms a n d C o n di ti o n s E x hi b i t D (F)
(e) The C o n tr a c to r a n d/ o r Su b c o n tr a c to r , i f n o t a sel f -i n su r ed go ver n men t a n d/ o r pu b l i c en ti ty , mu st
pr o vi de evi den c e, tha t a n y r eq u i r ed c er ti f i c a tes o f i n su r a n c e c o n ta i n the f o l l o w i n g pr o vi si o n s:
[1] The i n su r er w i l l n o t c a n c el the i n su r ed' s c o ver a ge w i tho u t gi vi n g thi r ty (30) c a l en da r da y s pr i o r
w r i tten n o ti c e to the Sta te (C a l i f o r n i a Depa r tmen t o f P u b l i c Hea l th (C DP H)).
[2] The Sta te o f C a l i f o r n i a , i ts o f f i c er s, a gen ts, empl o y ees, a n d ser va n ts a r e i n c l u ded a s
a ddi ti o n a l i n su r eds, b u t o n l y w i th r espec t to w o r k per f o r med f o r the Sta te u n der thi s
Agr eemen t a n d a n y ex ten si o n o r c o n ti n u a ti o n o f thi s Agr eemen t.
[3] The i n su r a n c e c a r r i er sha l l n o ti f y C DP H, i n w r i ti n g, o f the C o n tr a c to r ' s f a i l u r e to pa y
pr emi u ms; i ts c a n c el l a ti o n o f su c h po l i c i es; o r a n y o ther su b sta n ti a l c ha n ge, i n c l u di n g, b u t n o t
l i mi ted to , the sta tu s, c o ver a ge, o r sc o pe o f the r eq u i r ed i n su r a n c e. Su c h n o ti c es sha l l
c o n ta i n a r ef er en c e to ea c h a gr eemen t n u mb er f o r w hi c h the i n su r a n c e w a s o b ta i n ed.
(f ) The C o n tr a c to r a n d/ o r Su b c o n tr a c to r i s her eb y a dvi sed tha t c o pi es o f c er ti f i c a tes o f i n su r a n c e
ma y b e su b jec t to r evi ew a n d a ppr o va l b y the Depa r tmen t o f Gen er a l Ser vi c es (DGS), O f f i c e o f
Ri sk a n d In su r a n c e Ma n a gemen t. The C o n tr a c to r sha l l b e n o ti f i ed b y C DP H, i n w r i ti n g, i f thi s
pr o vi si o n i s a ppl i c a b l e to thi s Agr eemen t. If DGS a ppr o va l o f the c er ti f i c a te o f i n su r a n c e i s
r eq u i r ed, the C o n tr a c to r a gr ees tha t n o w o r k o r ser vi c es sha l l b e per f o r med pr i o r to o b ta i n i n g sa i d
a ppr o va l .
(g) In the even t the C o n tr a c to r a n d/ o r Su b c o n tr a c to r f a i l s to keep i n su r a n c e c o ver a ge, a s r eq u i r ed
her ei n , i n ef f ec t a t a l l ti mes du r i n g vehi c l e po ssessi o n , C DP H ma y , i n a ddi ti o n to a n y o ther
r emedi es i t ma y ha ve, ter mi n a te thi s Agr eemen t u po n the o c c u r r en c e o f su c h even t.
5. Su b c o n tr a c t Req u i r emen ts
(Appl i c a b l e to a gr eemen ts u n der w hi c h ser vi c es a r e to b e per f o r med b y su b c o n tr a c to r s i n c l u di n g i n depen den t
c o n su l ta n ts.)
a . P r i o r w r i tten a u tho r i z a ti o n w i l l b e r eq u i r ed b ef o r e the C o n tr a c to r en ter s i n to o r i s r ei mb u r sed f o r a n y
su b c o n tr a c t f o r ser vi c es c o sti n g $5,000 o r mo r e. E x c ept a s i n di c a ted i n P a r a gr a ph a (3) her ei n , w hen
sec u r i n g su b c o n tr a c ts f o r ser vi c es c o sti n g $5,000, the C o n tr a c to r sha l l o b ta i n a t l ea st thr ee b i ds o r ju sti f y
a so l e so u r c e a w a r d.
(1) The C o n tr a c to r mu st pr o vi de i n i ts r eq u est f o r a u tho r i z a ti o n , a l l i n f o r ma ti o n n ec essa r y f o r eva l u a ti n g
the n ec essi ty o r desi r a b i l i ty o f i n c u r r i n g su c h c o st.
(2) The Sta te ma y i den ti f y the i n f o r ma ti o n n eeded to f u l f i l l thi s r eq u i r emen t.
(3) Su b c o n tr a c ts per f o r med b y the f o l l o w i n g en ti ti es o r f o r the ser vi c e ty pes l i sted b el o w a r e ex empt f r o m
the b i ddi n g a n d so l e so u r c e ju sti f i c a ti o n r eq u i r emen ts:
(a ) A l o c a l go ver n men ta l en ti ty o r the f eder a l go ver n men t,
(b ) A Sta te c o l l ege o r u n i ver si ty f r o m a n y Sta te,
(c ) A J o i n t P o w er s Au tho r i ty ,
(d) An a u x i l i a r y o r ga n i z a ti o n o f a C a l i f o r n i a Sta te U n i ver si ty o r a C a l i f o r n i a c o mmu n i ty c o l l ege,
(e) A f o u n da ti o n o r ga n i z ed to su ppo r t the Bo a r d o f Go ver n o r s o f the C a l i f o r n i a C o mmu n i ty C o l l eges,
(f ) An a u x i l i a r y o r ga n i z a ti o n o f the Stu den t Ai d C o mmi ssi o n esta b l i shed u n der E du c a ti o n C o de §
69522,
(g) E n ti ti es o f a n y ty pe tha t w i l l pr o vi de su b ven ti o n a i d o r di r ec t ser vi c es to the pu b l i c ,
(h) E n ti ti es a n d/ o r ser vi c e ty pes i den ti f i ed a s ex empt f r o m a dver ti si n g i n Sta te C o n tr a c ti n g Ma n u a l
5.80. Vi ew thi s pu b l i c a ti o n a t the f o l l o w i n g In ter n et a ddr ess:
http:// w w w .o l s.dgs.c a .go v/C o n tr a c t+Ma n u a l/ C ha pter s4thr o u gh6.htm.
C DP H r eser ves the r i ght to a ppr o ve o r di sa ppr o ve the sel ec ti o n o f su b c o n tr a c to r s a n d w i th a dva n c e
w r i tten n o ti c e, r eq u i r e the su b sti tu ti o n o f su b c o n tr a c to r s a n d r eq u i r e the C o n tr a c to r to ter mi n a te
su b c o n tr a c ts en ter ed i n to i n su ppo r t o f thi s Agr eemen t.
C DP H E x hi b i t D(F) (8/ 10) ~~_. P a ge 7 o f 25
C a l i f o r n i a Depa r tmen t o f P u b l i c H ea l th - Spec i a l Ter ms a n d C o n di ti o n s E x h i b i t D (F)
W i th i n si x ty (60) c a l en da r da y s pr i o r to th e ter mi n a ti o n o r en d o f th i s Agr eemen t, th e C o n tr a c to r sh a l l
pr o vi de a f i n a l i n ven to r y r epo r t o f equ i pmen t a n d/ o r pr o per ty to th e C DP H P r o gr a m C o n tr a c t Ma n a ger a n d
sh a l l , a t th a t ti me, qu er y C DP H a s to th e r equ i r emen ts, i n c l u di n g th e ma n n er a n d meth o d, o f r etu r n i n g
sta te equ i pmen t a n d/ o r pr o per ty to C DP H . Fi n a l di spo si ti o n o f equ i pmen t a n d/ o r pr o per ty sh a l l b e a t
C DP H ex pen se a n d a c c o r di n g to C DP H i n str u c ti o n s. E qu i pmen t a n d/ o r pr o per ty di spo si ti o n i n str u c ti o n s
sh a l l b e i ssu ed b y C DP H i mmedi a tel y a f ter r ec ei pt, o f th e f i n a l i n ven to r y r epo r t. At th e ter mi n a ti o n o r
c o n c l u si o n o f th i s Agr eemen t, C DP H ma y a t i ts di sc r eti o n , a u th o r i ze th e c o n ti n u ed u se o f sta te equ i pmen t
a n d/ o r pr o per ty f o r per f o r ma n c e o f wo r k u n der a di f f er en t C DP H a gr eemen t.
g. Mo to r Veh i c l es
(Appl i c a b l e o n l y i f mo to r veh i c l es a r e pu r c h a sed/ r ei mb u r sed wi th a gr eemen t f u n ds o r f u r n i sh ed b y C DP H
u n der th i s Agr eemen t.)
(1) I f mo to r veh i c l es a r e pu r c h a sed/ r ei mb u r sed wi th .a gr eemen t f u n ds o r f u r n i sh ed b y C DP H u n der th e
ter ms o f th i s Agr eemen t, wi th i n th i r ty (30) c a l en da r da y s pr i o r to th e ter mi n a ti o n o r en d o f th i s
Agr eemen t, th e C o n tr a c to r a n d/ o r Su b c o n tr a c to r sh a l l r etu r n su c h veh i c l es to C DP H a n d sh a l l del i ver
a l l n ec essa r y do c u men ts o f ti tl e o r r egi str a ti o n to en a b l e th e pr o per tr a n sf er o f a ma r keta b l e ti tl e to
C DP H .
(2) I f mo to r veh i c l es a r e pu r c h a sed/ r ei mb u r sed wi th a gr eemen t f u n ds o r f u r n i sh ed b y C DP H u n der th e
ter ms o f th i s Agr eemen t, th e Sta te o f C a l i f o r n i a sh a l l b e th e l ega l o wn er o f sa i d mo to r veh i c l es a n d th e
C o n tr a c to r sh a l l b e th e r egi ster ed o wn er . Th e C o n tr a c to r a n d/ o r a su b c o n tr a c to r ma y o n l y u se sa i d
veh i c l es f o r per f o r ma n c e a n d u n der th e ter ms o f th i s Agr eemen t.
(3) Th e C o n tr a c to r a n d/ o r Su b c o n tr a c to r a gr ee th a t a l l o per a to r s o f mo to r veh i c l es,
pu r c h a sed/ r ei mb u r sed wi th a gr eemen t f u n ds o r f u r n i sh ed b y C DP H u n der th e ter ms o f th i s
Agr eemen t, sh a l l h o l d a va l i d Sta te o f C a l i f o r n i a dr i ver ' s l i c en se. I n th e even t th a t ten o r mo r e
pa ssen ger s a r e to b e tr a n spo r ted i n a n y o n e veh i c l e, th e o per a to r sh a l l a l so h o l d a Sta te o f C a l i f o r n i a
C l a ss B dr i ver ' s l i c en se.
(4) I f a n y mo to r veh i c l e i s pu r c h a sed/ r ei mb u r sed wi th a gr eemen t f u n ds o r f u r n i sh ed b y C DP H u n der th e
ter ms o f th i s Agr eemen t, th e C o n tr a c to r a n d/ o r Su b c o n tr a c to r , a s a ppl i c a b l e, sh a l l pr o vi de, ma i n ta i n ,
a n d c er ti f y th a t, a t a mi n i mu m, th e f o l l o wi n g ty pe a n d a mo u n t o f a u to mo b i l e l i a b i l i ty i n su r a n c e i s i n
ef f ec t du r i n g th e ter m o f th i s Agr eemen t o r a n y ex ten si o n per i o d du r i n g wh i c h a n y veh i c l e r ema i n s i n
th e C o n tr a c to r ' s a n d/ o r Su b c o n tr a c to r ' s po ssessi o n :
Au to mo b i l e L i a b i l i ty I n su r a n c e
(a ) Th e C o n tr a c to r , b y si gn i n g th i s Agr eemen t, h er eb y c er ti f i es th a t i t po ssesses o r wi l l o b ta i n
a u to mo b i l e l i a b i l i ty i n su r a n c e i n th e a mo u n t o f $1,000,000 per o c c u r r en c e f o r b o di l y i n j u r y a n d
pr o per ty da ma ge c o mb i n ed. Sa i d i n su r a n c e mu st b e o b ta i n ed a n d ma de ef f ec ti ve u po n th e
del i ver y da te o f a n y mo to r veh i c l e, pu r c h a sed/ r ei mb u r sed wi th a gr eemen t f u n ds o r f u r n i sh ed b y
C DP H u n der th e ter ms o f th i s Agr eemen t, to th e C o n tr a c to r a n d/ o r Su b c o n tr a c to r .
(b ) Th e C o n tr a c to r a n d/ o r Su b c o n tr a c to r sh a l l , a s so o n a s pr a c ti c a l , f u r n i sh a c o py o f th e c er ti f i c a te o f
i n su r a n c e to th e C DP H P r o gr a m C o n tr a c t Ma n a ger . Th e c er ti f i c a te o f i n su r a n c e sh a l l i den ti f y th e
C DP H c o n tr a c t o r a gr eemen t n u mb er f o r wh i c h th e i n su r a n c e a ppl i es.
(c ) Th e C o n tr a c to r a n d/ o r Su b c o n tr a c to r a gr ee th a t b o di l y i n j u r y a n d pr o per ty da ma ge l i a b i l i ty
i n su r a n c e, a s r equ i r ed h er ei n , sh a l l r ema i n i n ef f ec t a t a l l ti mes du r i n g th e ter m o f th i s Agr eemen t
o r u n ti l su c h ti me a s th e mo to r veh i c l e i s r etu r n ed to C DP H .
(d) Th e C o n tr a c to r a n d/ o r Su b c o n tr a c to r a gr ee to pr o vi de, a t l ea st th i r ty (30) da y s pr i o r to th e
ex pi r a ti o n da te o f sa i d i n su r a n c e c o ver a ge, a c o py o f a n ew c er ti f i c a te o f i n su r a n c e evi den c i n g
c o n ti n u ed c o ver a ge, a s i n di c a ted h er ei n , f o r n o t l ess th a n th e r ema i n der o f th e ter m o f th i s
Agr eemen t, th e ter m o f a n y ex ten si o n o r c o n ti n u a ti o n th er eo f , o r f o r a per i o d o f n o t l ess th a n o n e
(1) y ea r .
C DP H E x h i b i t D(F) (8/ 10)
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(Of 0
C a l i f o r n i a Depa r tmen t o f P u b l i c H ea l th - Spec i a l Ter ms a n d C o n di ti o n s E x h i b i t D (F)
4. E qu i pmen t Own er sh i p /In ven to r y /Di spo si ti o n
(Appl i c a b l e to a gr eemen ts i n wh i c h equ i pmen t a n d/o r pr o per ty i s f u r n i sh ed b y C DP H a n d/o r wh en sa i d i tems
a r e pu r c h a sed o r r ei mb u r sed wi th sta te o r f eder a l f u n ds.)
a . Wh er ever th e ter ms equ i pmen t en d/o r pr o per ty a r e u sed i n P r o vi si o n 4, th e def i n i ti o n s i n P r o vi si o n 3,
P a r a gr a ph a , sh a l l a ppl y.
Un l ess o th er wi se sti pu l a ted i n th i s Agr eemen t, a l l equ i pmen t a n d/o r pr o per ty th a t a r e
pu r c h a sed/r ei mb u r sed wi th a gr eemen t f u n ds o r f u r n i sh ed b y C DP H u n der th e ter ms o f th i s Agr eemen t
sh a l l b e c o n si der ed sta te equ i pmen t a n d th e pr o per ty o f C DP H .
(1) C DP H r equ i r es th e r epo r ti n g, ta ggi n g a n d a n n u a l i n ven to r yi n g o f a l l equ i pmen t a n d/o r pr o per ty th a t i s
f u r n i sh ed b y C DP H o r pu r c h a sed/r ei mb u r sed wi th f u n ds pr o vi ded th r o u gh th i s Agr eemen t.
Upo n r ec ei pt o f equ i pmen t a n d/o r pr o per ty, th e C o n tr a c to r sh a l l r epo r t th e r ec ei pt to th e C DP H
P r o gr a m C o n tr a c t Ma n a ger . To r epo r t th e r ec ei pt o f sa i d i tems a n d to r ec ei ve pr o per ty ta gs,
C o n tr a c to r sh a l l u se a f o r m o r f o r ma t desi gn a ted b y C DP H 's Asset Ma n a gemen t Un i t. If th e
a ppr o pr i a te f o r m (i .e., C o n tr a c to r E qu i pmen t P u r c h a sed wi th C DP H Fu n ds) do es n o t a c c o mpa n y th i s
Agr eemen t, C o n tr a c to r sh a l l r equ est a c o py f r o m th e C DP H P r o gr a m C o n tr a c t Ma n a ger .
(2) If th e C o n tr a c to r en ter s i n to a n a gr eemen t wi th a ter m o f mo r e th a n twel ve mo n th s, th e C o n tr a c to r
sh a l l su b mi t a n a n n u a l i n ven to r y o f sta te equ i pmen t a n d/o r pr o per ty to th e C DP H P r o gr a m C o n tr a c t
Ma n a ger u si n g a f o r m o r f o r ma t desi gn a ted b y C DP H 's Asset Ma n a gemen t Un i t. If a n i n ven to r y
r epo r t f o r m (i .e., In ven to r y/Di spo si ti o n o f C DP H - Fu n ded E qu i pmen t) do es n o t a c c o mpa n y th i s
Agr eemen t, C o n tr a c to r sh a l l r equ est a c o py f r o m th e C DP H P r o gr a m C o n tr a c t Ma n a ger . C o n tr a c to r
sh a l l :
(a ) In c l u de i n th e i n ven to r y r epo r t, equ i pmen t a n d/o r pr o per ty i n th e C o n tr a c to r 's po ssessi o n a n d/o r i n
th e po ssessi o n o f a su b c o n tr a c to r (i n c l u di n g i n depen den t c o n su l ta n ts).
(b ) Su b mi t th e i n ven to r y r epo r t to C DP H a c c o r di n g to th e i n str u c ti o n s a ppea r i n g o n th e i n ven to r y f o r m
o r i ssu ed b y th e C DP H P r o gr a m C o n tr a c t Ma n a ger .
(c ) C o n ta c t th e C DP H P r o gr a m C o n tr a c t Ma n a ger to l ea r n h o w to r emo ve, tr a de- i n , sel l , tr a n sf er o r
su r vey o f f , f r o m th e i n ven to r y' r epo r t, ex pi r ed equ i pmen t a n d/o r pr o per ty th a t i s n o l o n ger wa n ted,
u sa b l e o r h a s pa ssed i ts l i f e ex pec ta n c y. In str u c ti o n s wi l l b e su ppl i ed b y C DP H 's Asset
Ma n a gemen t Un i t.
Ti tl e to sta te equ i pmen t a n d/o r pr o per ty sh a l l n o t b e a f f ec ted b y i ts i n c o r po r a ti o n o r a tta c h men t to a n y
pr o per ty n o t o wn ed b y th e Sta te.
c . Un l ess o th er wi se sti pu l a ted, C DP H sh a l l b e u n der n o o b l i ga ti o n to pa y th e c o st o f r esto r a ti o n , o r
r eh a b i l i ta ti o n o f th e C o n tr a c to r 's a n d/o r Su b c o n tr a c to r 's f a c i l i ty wh i c h ma y b e a f f ec ted b y th e r emo va l o f
a n y sta te equ i pmen t a n d/o r pr o per ty.
Th e C o n tr a c to r a n d/o r Su b c o n tr a c to r sh a l l ma i n ta i n a n d a dmi n i ster a so u n d b u si n ess pr o gr a m f o r
en su r i n g th e pr o per u se, ma i n ten a n c e, r epa i r , pr o tec ti o n , i n su r a n c e a n d pr eser va ti o n o f sta te equ i pmen t
a n d/o r pr o per ty.
(1) In a dmi n i ster i n g th i s pr o vi si o n , C DP H ma y r equ i r e th e C o n tr a c to r a n d/o r Su b c o n tr a c to r to r epa i r o r
r ?~l a c e, t~ C DP H 's sa ti sf ~~ti ~n , a n y da ma ged, ! o s± o r sto l en sta te equ i pmen t a n d;c r pr o per ty.
C o n tr a c to r a n d/o r Su b c o n tr a c to r sh a l l i mmedi a tel y f i l e a th ef t r epo r t wi th th e a ppr o pr i a te po l i c e a gen c y
o r th e C a l i f o r n i a H i gh wa y P a tr o l a n d C o n tr a c to r sh a l l pr o mptl y su b mi t o n e c o py o f th e th ef t r epo r t to
th e C DP H P r o gr a m C o n tr a c t Ma n a ger .
e. Un l ess o th er wi se sti pu l a ted b y th e pr o gr a m f u n di n g th i s Agr eemen t, equ i pmen t a n d/o r pr o per ty
pu r c h a sed/r ei mb u r sed wi th a gr eemen t f u n ds o r f u r n i sh ed b y C DP H u n der th e ter ms o f th i s Agr eemen t,
sh a l l o n l y b e u sed f o r per f o r ma n c e o f th i s Agr eemen t o r a n o th er C DP H a gr eemen t.
C DP H E x h i b i t D(F) (8/10)
P a ge 5 o f 25
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C a l i f o r n i a Depa r tmen t o f P u b l i c Hea l th - Spec i a l Ter ms a n d C o n di ti o n s E x hi b i t D (F)
equ i pmen t pu r c ha sed thr o u gh C DP H's P u r c ha si n g U n i t. The c o st o f equ i pmen t pu r c ha sed b y o r
thr o u gh C DP H sha l l b e dedu c ted f r o m the f u n ds a v a i l a b l e i n thi s Agr eemen t. C o n tr a c to r sha l l su b mi t
to the C DP H P r o gr a m C o n tr a c t Ma n a ger a l i st o f equ i pmen t spec i f i c a ti o n s f o r tho se i tems tha t the
Sta te mu st pr o c u r e. The Sta te ma y pa y the v en do r di r ec tl y f o r su c h a r r a n ged equ i pmen t pu r c ha ses
a n d ti tl e to the equ i pmen t w i l l r ema i n w i th C DP H. The equ i pmen t w i l l b e del i v er ed to the C o n tr a c to r 's
a ddr ess, a s sta ted o n the f a c e o f the Agr eemen t, u n l ess the C o n tr a c to r n o ti f i es the C DP H P r o gr a m
C o n tr a c t Ma n a ger , i n w r i ti n g, o f a n a l ter n a te del i v er y a ddr ess.
(2) Al l equ i pmen t pu r c ha ses a r e su b jec t to P a r a gr a phs d thr o u gh h o f P r o v i si o n 3. P a r a gr a ph b o f
P r o v i si o n 3 sha l l a l so a ppl y, i f equ i pmen t pu r c ha ses a r e del ega ted to su b c o n tr a c to r s tha t a r e ei ther a
go v er n men t o r pu b l i c en ti ty.
(3) N o n pr o f i t o r ga n i za ti o n s a n d c o mmer c i a l b u si n esses, sha l l u se a pr o c u r emen t system tha t meets the
f o l l o w i n g sta n da r ds:
(a ) Ma i n ta i n a c o de o r sta n da r d o f c o n du c t tha t sha l l go v er n the per f o r ma n c e o f i ts o f f i c er s,
empl o yees, o r a gen ts en ga ged i n a w a r di n g pr o c u r emen t c o n tr a c ts. N o empl o yee, o f f i c er , o r
a gen t sha l l pa r ti c i pa te i n the sel ec ti o n , a w a r d, o r a dmi n i str a ti o n o f a pr o c u r emen t, o r b i d c o n tr a c t
i n w hi c h, to hi s o r her kn o w l edge, he o r she ha s a f i n a n c i a l i n ter est.
(b ) P r o c u r emen ts sha l l b e c o n du c ted i n a ma n n er tha t pr o v i des, to the ma x i mu m ex ten t pr a c ti c a l ,
o pen , a n d f r ee c o mpeti ti o n .
(c ) P r o c u r emen ts sha l l b e c o n du c ted i n a ma n n er tha t pr o v i des f o r a l l o f the f o l l o w i n g:
[1] Av o i d pu r c ha si n g u n n ec essa r y o r du pl i c a te i tems.
[2] E qu i pmen t so l i c i ta ti o n s sha l l b e b a sed u po n a c l ea r a n d a c c u r a te desc r i pti o n o f the tec hn i c a l
r equ i r emen ts o f the go o ds to b e pr o c u r ed.
[3] Ta ke po si ti v e steps to u ti l i ze sma l l a n d v eter a n o w n ed b u si n esses.
U n l ess w a i v ed o r o ther w i se sti pu l a ted i n w r i ti n g b y C DP H, pr i o r w r i tten a u tho r i za ti o n f r o m the a ppr o pr i a te
C DP H P r o gr a m C o n tr a c t Ma n a ger w i l l b e r equ i r ed b ef o r e the C o n tr a c to r w i l l b e r ei mb u r sed f o r a n y
pu r c ha se o f $5,000 o r mo r e f o r c o mmo di ti es, su ppl i es, equ i pmen t, a n d ser v i c es r el a ted to su c h
pu r c ha ses. . The C o n tr a c to r mu st pr o v i de i n i ts r equ est f o r a u tho r i za ti o n a l l pa r ti c u l a r s n ec essa r y, a s
spec i f i ed b y C DP H, f o r ev a l u a ti n g. the n ec essi ty o r desi r a b i l i ty o f i n c u r r i n g su c h c o sts. The ter m
"pu r c ha se" ex c l u des the pu r c ha se o f ser v i c es. f r o m a su b c o n tr a c to r a n d pu b l i c u ti l i ty ser v i c es a t r a tes
esta b l i shed f o r u n i f o r m a ppl i c a b i l i ty to the gen er a l pu b l i c .
I n spec i a l c i r c u msta n c es, deter mi n ed b y C DP H (e. g. , w hen C DP H ha s a n eed to mo n i to r c er ta i n
pu r c ha ses, etc . ), C DP H ma y r equ i r e pr i o r w r i tten a u tho r i za ti o n a n d/ o r the su b mi ssi o n o f pa i d v en do r
r ec ei pts f o r a n y pu r c ha se, r ega r dl ess o f do l l a r a mo u n t. C DP H r eser v es the r i ght to ei ther den y c l a i ms f o r
r ei mb u r semen t o r to r equ est r epa ymen t f o r a n y C o n tr a c to r a n d/ o r su b c o n tr a c to r pu r c ha se tha t C DP H
deter mi n es to b e u n n ec essa r y i n c a r r yi n g o u t per f o r ma n c e u n der thi s Agr eemen t.
f . The C o n tr a c to r a n d/ o r su b c o n tr a c to r mu st ma i n ta i n a c o py o r n a r r a ti v e desc r i pti o n o f the pr o c u r emen t
system, gu i del i n es, r u l es, o r r egu l a ti o n s tha t w i l l b e u sed to ma ke pu r c ha ses u n der thi s Agr eemen t. The
Sta te r eser v es the r i ght to r equ est a c o py o f these do c u men ts a n d to i n spec t the pu r c ha si n g pr a c ti c es o f
the C o n tr a c to r a n d/ o r su b c o n tr a c to r a t a n y ti me.
g. Fo r a l l pu r c ha ses, the C o n tr a c to r a n d/ o r su b c o n tr a c to r mu st ma i n ta i n c o pi es o f a l l pa i d v en do r i n v o i c es,
do c u men ts, b i ds a n d o ther i n f o r ma ti o n u sed i n v en do r sel ec ti o n , f o r i n spec ti o n o r a u di t. J u sti f i c a ti o n s
su ppo r ti n g the a b sen c e o f b i ddi n g (i . e. , so l e so u r c e pu r c ha ses) sha l l a l so b e ma i n ta i n ed o n f i l e b y the
C o n tr a c to r a n d/ o r su b c o n tr a c to r f o r i n spec ti o n o r a u di t.
h. C DP H ma y, w i th c a u se (e. g. , w i th r ea so n a b l e su spi c i o n o f u n n ec essa r y pu r c ha ses o r u se o f i n a ppr o pr i a te
pu r c ha se pr a c ti c es, etc . ), w i thho l d, c a n c el , mo di f y, o r r etr a c t the del ega ted pu r c ha se a u tho r i ty gr a n ted
u n der P a r a gr a phs b a n d/ o r c o f P r o v i si o n 3 b y gi v i n g the C o n tr a c to r n o l ess tha n 30 c a l en da r da ys w r i tten
n o ti c e.
C DP H E x hi b i t D(F) (8/ 10) ^ ~~/ , . - - - P a ge 4 o f 25
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C a l i f o r n i a Depa r tmen t o f Publ i c Hea l th - Speci a l Ter ms a n d C o n di ti o n s E x hi bi t D (F)
g. The C o n tr a cto r w i l l i n cl ude the pr o v i si o n s o f Pa r a gr a phs a thr o ugh g i n ev er y subco n tr a ct o r pur cha se
o r der un l ess ex empted by r ul es, r egul a ti o n s, o r o r der s o f the Secr eta r y o f La bo r i ssued pur sua n t to
Feder a l E x ecuti v e Or der No . 11246 a s a men ded, i n cl udi n g by E x ecuti v e Or der 11375, 'Amen di n g
E x ecuti v e Or der 11246 R el a ti n g to E qua l E mpl o ymen t Oppo r tun i ty, ' a n d a s suppl emen ted by r egul a ti o n a t
41 C FR pa r t 60, " Of f i ce o f the Feder a l C o n tr a ct C o mpl i a n ce Pr o gr a ms, E qua l E mpl o ymen t Oppo r tun i ty,
Depa r tmen t o f La bo r , " o r Secti o n 503 o f the R eha bi l i ta ti o n Act o f 1973 o r (38 U.S.C . 4212) o f the Vi etn a m
E r a Veter a n 's R ea djustmen t Assi sta n ce Act, so tha t such pr o v i si o n s w i l l be bi n di n g upo n ea ch
subco n tr a cto r o r v en do r . The C o n tr a cto r w i l l ta ke such a cti o n w i th r espect to a n y subco n tr a ct o r pur cha se
o r der a s the Di r ecto r o f the Of f i ce o f Feder a l C o n tr a ct C o mpl i a n ce Pr o gr a ms o r C DPH ma y di r ect a s a
mea n s o f en f o r ci n g such pr o v i si o n s i n cl udi n g sa n cti o n s f o r n o n co mpl i a n ce pr o v i ded, ho w ev er , tha t i n the
ev en t the C o n tr a cto r beco mes i n v o l v ed i n , o r i s thr ea ten ed w i th l i ti ga ti o n by a subco n tr a cto r o r v en do r a s a
r esul t o f such di r ecti o n by C DPH, the C o n tr a cto r ma y r equest i n w r i ti n g to C DPH, w ho , i n tur n , ma y
r equest the Un i ted Sta tes to en ter i n to such l i ti ga ti o n to pr o tect the i n ter ests o f the Sta te a n d o f the Un i ted
Sta tes.
2. Tr a v el a n d Per Di em R ei mbur semen t
(Appl i ca bl e i f tr a v el a n d/ o r per di em ex pen ses a r e r ei mbur sed w i th a gr eemen t f un ds.)
R ei mbur semen t f o r tr a v el a n d per di em ex pen ses f r o m C DPH un der thi s Agr eemen t sha l l , un l ess o ther w i se
speci f i ed i n thi s Agr eemen t, be a t the r a tes cur r en tl y i n ef f ect, a s esta bl i shed by the C a l i f o r n i a Depa r tmen t o f
Per so n n el Admi n i str a ti o n (DPA), f o r n o n r epr esen ted sta te empl o yees a s sti pul a ted i n C DPH's Tr a v el
R ei mbur semen t I n f o r ma ti o n E x hi bi t. i f the DPA r a tes cha n ge dur i n g the ter m o f the Agr eemen t, the n ew r a tes
sha l l a ppl y upo n thei r ef f ecti v e da te a n d n o a men dmen t to thi s Agr eemen t sha l l be n ecessa r y. E x cepti o n s to
DPA r a tes ma y be a ppr o v ed by C DPH upo n the submi ssi o n o f a sta temen t by the C o n tr a cto r i n di ca ti n g tha t
such r a tes a r e n o t a v a i l a bl e to the C o n tr a cto r . No tr a v el o utsi de the Sta te o f C a l i f o r n i a sha l l be r ei mbur sed
w i tho ut pr i o r a utho r i z a ti o n f r o m C DPH. Ver ba l a utho r i z a ti o n sho ul d be co n f i r med i n w r i ti n g. Wr i tten
a utho r i z a ti o n ma y be i n a f o r m i n cl udi n g f a x o r ema i l co n f i r ma ti o n .
3. Pr o cur emen t R ul es
(Appl i ca bl e to a l l a gr eemen ts i n w hi ch equi pmen t, pr o per ty, co mmo di ti es a n d/ o r suppl i es a r e f ur n i shed by
C DPH o r ex pen ses f o r sa i d i tems a r e r ei mbur sed w i th sta te o r f eder a l f un ds.)
a . E qui pmen t def i n i ti o n s
Wher ev er the ter m equi pmen t / pr o per ty i s used, the f o l l o w i n g def i n i ti o n s sha l l a ppl y:
(1) Ma jo r equi pmen t pr o per ty: Ata n gi bl e o r i n ta n gi bl e i tem ha v i n g a ba se un i t co st o f $5, 000 o r mo r e
w i th a l i f e ex pecta n cy o f o n e (1) yea r o r mo r e a n d i s ei ther f ur n i shed by C DPH o r the co st i s
r ei mbur sed thr o ugh. thi s Agr eemen t. So f tw a r e a n d v i deo s a r e ex a mpl es o f i n ta n gi bl e i tems tha t meet
thi s def i n i ti o n .
(2) Mi n o r equi pmen Upr o per ty: Ata n gi bl e i tem ha v i n g a ba se un i t co st o f l ess tha n $5, 000 w i th a l i f e
ex pecta n cy o f o n e (1) yea r o r mo r e a n d i s ei ther f ur n i shed by C DPH o r the co st i s r ei mbur sed thr o ugh
thi s Agr eemen t.
b. Go v er n men t a n d publ i c en ti ti es (i n cl udi n g sta te co l l eges/ un i v er si ti es a n d a ux i l i a r y o r ga n i z a ti o n s),
w hether a cti n g a s a co n tr a cto r a n d/ o r subco n tr a cto r , ma y secur e a l l co mmo di ti es, suppl i es, equi pmen t
a n d ser v i ces r el a ted to such pur cha ses tha t a r e r equi r ed i n per f o r ma n ce o f thi s Agr eemen t. Sa i d
pr o cur emen ts a r e subject to Pa r a gr a phs d thr o ugh h o f Pr o v i si o n 3. Pa r a gr a ph c o f Pr o v i si o n 3 sha l l a l so
a ppl y, i f equi pmen t pur cha ses a r e del ega ted to subco n tr a cto r s tha t a r e n o n pr o f i t o r ga n i z a ti o n s o r
co mmer ci a l busi n esses.
No n pr o f i t o r ga n i z a ti o n s a n d co mmer ci a l busi n esses, w hether a cti n g a s a co n tr a cto r a n d/ o r
subco n tr a cto r , ma y secur e co mmo di ti es, suppl i es, equi pmen # a n d ser v i ces r el a ted to such pur cha ses f o r
per f o r ma n ce un der thi s Agr eemen t.
(1) E qui pmen t pur cha ses sha l l n o t ex ceed $50, 000 a n n ua l l y.
To secur e equi pmen t a bo v e the a n n ua l ma x i mum l i mi t o f $50, 000, the C o n tr a cto r sha l l ma ke
a r r a n gemen ts thr o ugh the a ppr o pr i a te C DPH Pr o gr a m C o n tr a ct Ma n a ger , to ha v e a l l r ema i n i n g
C DPH E x hi bi t D(F) (8/ 10) Pa ge 3 o f 25
~~~- - ~
C a l i f o r n i a Depa r tmen t o f P u b l i c Hea l th - Spec i a l Ter ms a n d C o n di ti o n s E x hi b i t D (F)
1. Feder a l E qu a l Oppo r tu n i ty Requ i r emen ts
(Appl i c a b l e to a l l f eder a l l y f u n ded a gr eemen ts en ter ed i n to b y the C a l i f o r n i a Depa r tmen t o f P u b l i c Hea l th
(C DP H) f o r mer l y kn o wn a s C a l i f o r n i a Depa r tmen t o f Hea l th Ser vi c es (C DHS).)
a . The C o n tr a c to r wi l l n o t di sc r i mi n a te a ga i n st a n y empl o yee o r a ppl i c a n t f o r empl o ymen t b ec a u se o f r a c e,
c o l o r , r el i gi o n , sex , n a ti o n a l o r i gi n , physi c a l o r men ta l ha n di c a p, di sa b i l i ty, a ge o r sta tu s a s a di sa b l ed
veter a n o r veter a n o f the Vi etn a m er a . The C o n tr a c to r wi l l ta ke a f f i r ma ti ve a c ti o n to en su r e tha t qu a l i f i ed
a ppl i c a n ts a r e empl o yed, a n d tha t empl o yees a r e tr ea ted du r i n g empl o ymen t, wi tho u t r ega r d to thei r r a c e,
c o l o r , r el i gi o n , sex , n a ti o n a l o r i gi n , physi c a l o r men ta l ha n di c a p, di sa b i l i ty, a ge o r sta tu s a s a di sa b l ed
veter a n o r veter a n o f the Vi etn a m er a . Su c h a c ti o n sha l l i n c l u de, b u t n o t b e l i mi ted to the f o l l o wi n g:
empl o ymen t, u pgr a di n g, demo ti o n o r tr a n sf er ; r ec r u i tmen t o r r ec r u i tmen t a dver ti si n g; l a yo f f o r ter mi n a ti o n ;
r a tes o f pa y o r o ther f o r ms o f c o mpen sa ti o n ; a n d c a r eer devel o pmen t o ppo r tu n i ti es a n d sel ec ti o n f o r
tr a i n i n g, i n c l u di n g a ppr en ti c eshi p. The C o n tr a c to r a gr ees to po st i n c o n spi c u o u s pl a c es, a va i l a b l e to
empl o yees a n d a ppl i c a n ts f o r empl o ymen t, n o ti c es to b e pr o vi ded b y the Feder a l Go ver n men t o r C DP H,
setti n g f o r th the pr o vi si o n s o f the E qu a l Oppo r tu n i ty c l a u se, Sec ti o n 503 o f the Reha b i l i ta ti o n Ac t o f 1973
a n d the a f f i r ma ti ve a c ti o n c l a u se r equ i r ed b y the Vi etn a m E r a Veter a n s' Rea dju stmen t Assi sta n c e Ac t o f
1974 (38 U.S.C . 4212). Su c h n o ti c es sha l l sta te the C o n tr a c to r 's o b l i ga ti o n u n der the l a w to ta ke
a f f i r ma ti ve a c ti o n to empl o y a n d a dva n c e i n empl o ymen t qu a l i f i ed a ppl i c a n ts wi tho u t di sc r i mi n a ti o n b a sed
o n thei r r a c e, c o l o r , r el i gi o n , sex , n a ti o n a l o r i gi n physi c a l o r men ta l ha n di c a p, di sa b i l i ty, a ge o r sta tu s a s a
di sa b l ed veter a n o r veter a n o f the Vi etn a m er a a n d the r i ghts o f a ppl i c a n ts a n d empl o yees.
b . The C o n tr a c to r wi l l , i n a l l so l i c i ta ti o n s o r a dva n c emen ts f o r empl o yees pl a c ed b y o r o n b eha l f o f the
C o n tr a c to r , sta te tha t a l l qu a l i f i ed a ppl i c a n ts wi l l r ec ei ve c o n si der a ti o n f o r empl o ymen t wi tho u t r ega r d to
r a c e, c o l o r , r el i gi o n , sex , n a ti o n a l o r i gi n physi c a l o r men ta l ha n di c a p, di sa b i l i ty, a ge o r sta tu s a s a di sa b l ed
veter a n o r veter a n o f the Vi etn a m er a .
c . The C o n tr a c to r wi l l sen d to ea c h l a b o r u n i o n o r r epr esen ta ti ve o f wo r ker s wi th whi c h i t ha s a c o l l ec ti ve
b a r ga i n i n g a gr eemen t o r o ther c o n tr a c t o r u n der sta n di n g a n o ti c e, to b e pr o vi ded b y the Feder a l
Go ver n men t o r the Sta te, a dvi si n g the l a b o r u n i o n o r wo r ker s' r epr esen ta ti ve o f the C o n tr a c to r 's
c o mmi tmen ts u n der the pr o vi si o n s her ei n a n d sha l l po st c o pi es o f the n o ti c e i n c o n spi c u o u s pl a c es
a va i l a b l e to empl o yees a n d a ppl i c a n ts f o r empl o ymen t.
d. The C o n tr a c to r wi l l c o mpl y wi th a l l pr o vi si o n s o f a n d f u r n i sh a l l i n f o r ma ti o n a n d r epo r ts r equ i r ed b y Sec ti o n
503 o f the Reha b i l i ta ti o n Ac t o f 1973, a s a men ded, the Vi etn a m E r a Veter a n s' Rea dju stmen t Assi sta n c e
Ac t o f 1974 (38 U.S.C . 4212) a n d o f the Feder a l E x ec u ti ve Or der No . 11246 a s a men ded, i n c l u di n g b y
E x ec u ti ve Or der 11375, `Amen di n g E x ec u ti ve Or der 11246 Rel a ti n g to E qu a l E mpl o ymen t Oppo r tu n i ty,'
a n d a s su ppl emen ted b y r egu l a ti o n a t 41 C FR pa r t 60, " Of f i c e o f the Feder a l C o n tr a c t C o mpl i a n c e
P r o gr a ms, E qu a l E mpl o ymen t Oppo r tu n i ty, Depa r tmen t o f La b o r ," a n d o f the r u l es, r egu l a ti o n s, a n d
r el eva n t o r der s o f the Sec r eta r y o f La b o r .
e. The C o n tr a c to r wi l l f u r n i sh a l l i n f o r ma ti o n a n d r epo r ts r equ i r ed b y Feder a l E x ec u ti ve Or der No . 11246 a s
a men ded, i n c l u di n g b y E x ec u ti ve Or der 11375, `Amen di n g E x ec u ti ve Or der 11246 Rel a ti n g to E qu a l
E mpl o ymen t Oppo r tu n i ty,' a n d a s su ppl emen ted b y r egu l a ti o n a t 41 C FR pa r t 60, " Of f i c e o f the Feder a l
C o n tr a c t C o mpl i a n c e P r o gr a ms, E qu a l E mpl o ymen t Oppo r tu n i ty, Depa r tmen t o f La b o r ," a n d the
Reha b i l i ta ti o n Ac t o f 1973, a n d b y the r u l es, r egu l a ti o n s, a n d o r der s o f the Sec r eta r y o f La b o r , o r pu r su a n t
ther eto , a n d wi l l per mi t a c c ess to i ts b o o ks, r ec o r ds, a n d a c c o u n ts b y the Sta te a n d i ts desi gn a ted
r epr esen ta ti ves a n d the Sec r eta r y o f La b o r f o r pu r po ses o f i n vesti ga ti o n to a sc er ta i n c o mpl i a n c e wi th su c h
r u l es, r egu l a ti o n s, a n d o r der s.
I n the even t o f the C o n tr a c to r 's n o n c o mpl i a n c e wi th the r equ i r emen ts o f the pr o vi si o n s her ei n o r wi th a n y
f eder a l r u l es, r egu l a ti o n s, o r o r der s whi c h a r e r ef er en c ed her ei n , thi s Agr eemen t ma y b e c a n c el l ed,
ter mi n a ted, o r su spen ded i n who l e o r i n pa r t a n d the C o n tr a c to r ma y b e dec l a r ed i n el i gi b l e f o r f u r ther
f eder a l a n d sta te c o n tr a c ts i n a c c o r da n c e wi th pr o c edu r es a u tho r i zed i n Feder a l E x ec u ti ve Or der No .
11246 a s a men ded a n d su c h o ther sa n c ti o n s ma y b e i mpo sed a n d r emedi es i n vo ked a s pr o vi ded i n
Feder a l E x ec u ti ve Or der No . 11246 a s a men ded, i n c l u di n g b y E x ec u ti ve Or der 11375, 'Amen di n g
E x ec u ti ve Or der 11246 Rel a ti n g to E qu a l E mpl o ymen t Oppo r tu n i ty,' a n d a s su ppl emen ted b y r egu l a ti o n a t
41 C FR pa r t 60, " Of f i c e o f the Feder a l C o n tr a c t C o mpl i a n c e P r o gr a ms, E qu a l E mpl o ymen t Oppo r tu n i ty,
Depa r tmen t o f La b o r ," o r b y r u l e, r egu l a ti o n , o r o r der o f the Sec r eta r y o f La b o r , o r a s o ther wi se pr o vi ded
b y l a w.
C DP H E x hi b i t D(F) (8/10)
P a ge 2 o f 25
'~ 7i
~.nuw~nia vepar[meni of rUDI~C H¢21t11
txhiblt D(F)
Special Terms and Conditions
(For federally funded service contracts or agreements and grant agreements)
The use of headings or titles throughout this exhibit is for convenience only and shall not be used to interpret or to
govern the meaning of any specific term or condition.
The terms " contract" , " Contractor" and " Subcontractor" shall also mean, " agreement', " grant', " grant agreement',
" Grantee" and " Subgrantee" respectively .
The terms " California Department of Public Health" and " CDPH" shall have the same meaning and refer to the
California State agency that is a party to this Agreement.
This exhibit contains provisions that req uire strict adherence to various contracting laws and policies. Some
provisions herein are conditional and only apply if specified conditions exist (i.e., agreement total exceeds a certain
amount, agreement is federally funded, etc.). The provisions herein apply to this Agreement unless the provisions
are removed by reference on the face of this Agreement, the provisions are superseded by an alternate provision
appearing elsewhere in this Agreement, or the applicable conditions do not exist.
Index of Special Terms and Conditions
1. Federal Eq ual Employ ment Opportunity 17. Human Subjects Use Req uirements
Req uirements
18. Novation Req uirements
2. Travel and Per Diem Reimbursement
19. Debarment and Suspension Certification
3. Procurement Rules
2p. Smoke-Free Workplace Certification
4. Eq uipment Ownership /Inventory /Disposition
21. Covenant Against Contingent Fees
5. Subcontract Req uirements
22. pay ment Withholds
6. Income Restrictions
23. Performance Evaluation
7. Audit and Record Retention
24. Officials Not to B enefit
8. Site Inspection
25. Four-Digit Date Compliance
9. Federal Contract Funds
26. Prohibited Use of State Funds for Software
10. Intellectual Property Rights
27. Use of Small, M inority Owned and Women's
11. Air or Water Pollution Req uirements B usinesses
12. Prior Approval of Training Seminars, Workshops 28. Alien Ineligibility Certification
or Conferences
29. Union Organizing
13. Confidentiality of Information
30. Contract Uniformity (Fringe B enefit Allowability )
14. Documents, Publications, and Written Reports
31. Lobby ing Restrictions and Disclosure Certification
15. Dispute Resolution Process
16. Financial and Compliance Audit Req uirements
CDPH Exhibit D(F) (8/10)
Page 1 of 25
Nevada County P ub l i c Heal th Department
12-10188
E x hi b i t B Attac hment IV - Sc hedul e i
Oc tob er 1, 2015 - Septemb er 30, 2016
Sub grantee Budget
Sub grant3eea~~ A - NE oP Coor~l i rl ~tatyc ~r 4 y, `
-~~ ;-, r '3 ^ ~i ~'? .'~i .~~A 4 Yl ... .` ~:c c 1~k V,- 7 YE T + .
Li ne Item Total
P ersonnel $ 50,000
Operati ng $
E qui pment $ -
Travel $ 1,255
Sub grants $ -
Indi rec t Costs
Total Costs $ 51,255
~~~~,~~.. b g[a~ e' ~~ N~~? P ~~c al i taf ot~~^ r
Li ne Item Total
P ersonnel $ 4 ,000
Operati ng $ -
E qui pment $ -
Travel $ -
Sub grants $ -
Indi rec t Costs
Total Costs $ 4 ,000
'~ " r ~ ~ ~ ~ul i gran~ees~Varri e
Li ne Item Total
P ersonnel $
Operati ng $ -
E qui pment $ -
Travel $ -
Sub grants $
Indi rec t Costs
Total Costs $ -
r~,~* ,. Sub grante~ 11~ame .-
Li ne Item Total
P ersonnel $ -
Operati ng $ -
E qui pment $ -
Travel $ -
Sub grants $
Indi rec t Costs
Total Costs $ -
Sub grantee Name B~ NE 'O~, E val Uat~on Consul tant:;.
K S
Li ne Item Total
P ersonnel $ 7,500
Operati ng $ -
E qui pment $ -
Travel $ 280
Sub grants $
Indi rec t Costs
Total Costs $ 7,780
y
~~Sub gran#ee ~a~~g~aa.
- x
~~.~,
.~
.t ~A~~-~~. ter.
Li ne Item Total
P ersonnel $ -
Operati ng $ -
E qui pment $ -
Travel $ -
Sub grants $ -
Indi rec t Costs
Total Costs $
< .~-Sub grantee~#Vame?
~.~. 1~._
Li ne Item Total
P ersonnel $
Operati ng $ -
E qui pment $ -
Travel $
Sub grants $ -
Indi rec t Costs
Total Costs $ -
,~b grantee N~f i e ~~ , F
_ _ . ..._ ..r _ .
Li ne Item Total
P ersonnel $
Operati ng $ -
E qui pment $ -
Travel $ -
Sub grants $ -
Indi rec t Costs
Total Costs $
~~ Q
Nevada County P ub l i c Heal th Department
12-10188
Exhi b i t B Attac hment IV
BUDGET
(Year 4)
(10/01/2015 through 09/30/2016)
Sub Grantees
A NEOP Coordi nator - Coordi nate program staf f and nutri ti on educ ati on ac ti vi ti es; pl an $51,255
and f ol l ow through on educ ati onal events at heal th f ai rs, sc hool s, and other
promoti onal ac ti vi ti es; w ork w i th sc hool s, and c ommuni ty organi z ati ons i n pl anni ng
and promoti ng good heal th through di ssemi nati on of nutri ti on educ ati on materi al s;
ac ti vel y ac q ui re and devel op c ul tural l y and l i ngui sti c al l y c ompetent nutri ti on
c urri c ul um and educ ati onal materi al s; to promote exi sti ng and/or to devel op new
physi c al ac ti vi ty promoti onal c omponents of nutri ti on educ ati on; and expand our
exi sti ng c ommuni ty w el l ness program to enc ompass nutri ti onal c omponents to
i nc rease c ommuni ty aw areness and know l edge of good nutri ti on and heal thy ac ti ve
l i f est l es. Goal 1 Ob '. 1-17
B NEOP Eval uati on Consul tant -The Eval uati on c onsul tant w i l l b e an i ndependentl y $7,780
c ontrac ted person w ho w i l l devel op an eval uati on pl an and methodol ogy i nc l udi ng
measurement tool s Goal 1 Ob '. 1-17
C NEOP F ac i l i tator Consul tant -The f ac i l i tator w i l l c onduc t Cal F resh F oc us groups. $4,000
Ti me i s al l oc ated to preparati on, f ac i l i tati on, f ol l ow-up, f i nal report and strategi c
anal si s. Goal 1 Ob '. 1-17
Total : $63,035
Other Costs
Internal Du l i c ati on of doc uments - 9,200 c o i es X $. 10/c o = $920 Goal 1 Ob '. 1-17 $920
P urc hase of nutri ti onal handouts, c ookb ooks, b roc hures w hi c h are l i sted on the USDA $4,698
approved materi al s i temi z ed l i st. P urc hases shal l i nc l ude: Nutri ti on educ ati on materi al s, as
avai l ab l e through the Uni ted States Department of Agri c ul ture, i nc l udi ng MyP l ate and
SNAP-Ed and Cal i f orni a Department of P ub l i c Heal th Netw ork materi al s.
Goal 1 Ob '. 1-17
Si gn and P osters f or event announc ements b y l oc al vendor (Real Graphi c s) - 8 events @ $1,600
$200/event = $1,600
Goal 1 Ob '. 1-17
Col or c opi es f or handouts at events, f orums, and other support of SOW ac ti vi ti es - 5,000 X $1,600
. 32 = $1,600
Goal 1 Ob ~ . 1-17
Total : $8,818
Indi rec t Cost
22% of P ersonnel and F ri n e Benef i ts Cost
Total : $22,013
Total Bud et
Total : $200,000
-s" 9
Nevada County P ub l i c Heal th Department
12-10188
Exhi b i t B Attac hment IV
BUDGET
(Year 4j
(10/01/2015 through 09/30/2016)
P ersonnel
P osi ti on Ti tl e
Annual
Sal a /Ran e
Total
FTE /o
Budget
Heal th &Wel l ness P ro ram Mana er $84,636 45% $38,086
Nutri ti oni st $74,658 25% $18,665
Heal th Tec hni c i an II $39,825 25% $9,956
Total : $66,707
rri n e rsenents
50% of P ersonnel $33,354
Total : $33,354
P ersonnel and Fri n e
Total : $100,061
O erati n Ex enses
General Offi c e Su l i es $600
P ostage - i nc l udi ng, b ut not l i mi ted to, event announc ements and i nvi tati ons, mai l i ngs to $300
SNAP-Ed c l i ents, c orres ondenc e w i th CDP H. $25/month X 12 months = $300
Rec rui t 75 Cal Fresh parti c i pants to attend nei ghb orhood c ommuni ty roundtab l es to present $2,250
nei ghb orhood fi ndi ngs and determi ne areas of greatest c onc ern; i denti fy potenti al b arri ers
that w oul d prevent c l i ents from parti c i pati ng i n i nventi ons. P rovi de an hourl y rate to
parti c i pants for thei r servi c es: $15/hour x 2 hours X 25 parti c i pants = $750.00 X 3 =
$2,250.00
Room Rental for 3 events i nc l udi n Communi t Roundtab l es = $600 $600
Non -food su l i es for c l asses and events - $30/month X 12 months = $360 $360
Food Sam l es for Nutri ti on c l asses - 400 arti c i ants X $2.50/ arti c i ant = $1,000 $1,000
Food sam l es for Frui t and Ve etab l es Event - 300 arti c i ants X $2.50/ arti c i ant = $750 $750
Memb ershi p Cal i forni a Conferenc e of Loc al Heal th Department Nutri ti oni sts - 1 $90
memb ershi X $90/memb ershi = $90
Total : $5,950
Equi pment
N/A Total : $0
Travel *
CCLHDN trai ni n ,Los An el es, 1 staff
Tota I : $123
` Travel c osts as requi red to meet stated ob jec ti ves as outl i ned i n the Sc ope of Work. Al l travel rates w i l l al i gn w i th
c urrent CaIHR (formerl y DP A)