HomeMy WebLinkAboutMINUTES - 08091994 - 1.39 / TO:,) BOARD OF SUPERVISORS
FR QM: Mark Finuca.ne, Health Services Director
Contra
By: Elizabeth A. Spooner, Contracts Administrator Costa
DATE: July 28, 1994 . 0 County
SUBJECT: Approve Standard Agreement #29-208-49 with the State Department of Health
Services for the Immunization Assistance Program
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
Approve and authorize the Chair, Board of Supervisors, to execute on behalf of the
County, Standard Agreement #29-208-49 with the State Department of Health Services,
in the amount of $243,770, for the period from July 1, 1994 through June 30, 1995,
for continuation of the Immunization Assistance Program.
17) II. FINANCIAL IMPACT:
Approval of this agreement by the State Department of Health Services will result
in $243,770, for the period from July 1, 1994 through June 30, 1995, for
continuation of the Immunization Assistance Program. Sources of funding are as
follows:
$ 50,687 State Funds
193,083 Federal Funds (via the State)
$243,770 TOTAL FUNDS
No County funds are required.
III. REASONS FOR RECOMMENDATIONS/BACKGROUND: =. .�
On June 21, 1994, the Board of Supervisors approved submission of Funding
Application #29-208-48, to the State Department of Health Services, for continuation
of the long-standing Immunization Assistance Program. Standard Agreement #29-208-49
is the result of that application and provides funding to continue services through
June 30, 1995.
The County's Immunization Program makes immunizations available to all persons in
need of such service in order to prevent the occurrence and transmission of
childhood diseases; and under the terms of this Contract, the State provides free
vaccine to the County. The Program monitors the compliance of preschools,
elementary schools, and secondary schools in meeting State-mandated immunization
requirements through inservice programs and limited technical assistance. An
adverse reaction monitoring system and outbreak control team are also included in
the Program.
The Board Chair should sign eight copies of this agreement, including the
Certification Regarding Lobbying. Seven signed copies of the agreement and four
certified and sealed copies of this Board Order should be returned to the Contracts
and Grants Unit for submission to the State.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMM AT N OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S)
ACTION OF BOARD ON APPROVED AS RECOMMENDED _A.Z OTHER
VOTE OF SUPERVISORS
UNANIMOUS (ABSENT ) 1 HEREBY CERTIFY THAT THIS IS A TRUE
AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN
ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD
Contact: OF SUPERVISORS ON THE DATE SHOWN.
Wendel Brunner, M.D. (313-6712)
CC: Health Services (Contracts) ATTESTED ct, I Q _
Auditor-Controller (Claims) Phil Batc elor, Clerk of the Board of
State Dept. of Health Services SuperviwrsandCnHnVAdmini!*aW
M382/7-e8 BY L �1�� Q y� DEPUTY
STATE OF CALIFORNIA
APPROVED BYTHE CONTRACTNUMBER AMNO.
STANDARD AGREEMENT— ATTORNEY GENERAL
Cj, .1
D.2(REV. •7;) - (1 �� 94-19745 00
TAXPAYERS FEDERAL EMPLOYER IDENTIFICATION NUMBER
ti
THIS AGREEMENT,made and entered into this 1st day of June lq 94. 94-6000509
in the State of California,by and between State of California,through its duly elected or appointed,qualified and acting
TITLE OF OFFICER ACTING FOR STATE AGENCY
Chief, Program Support Branch Department of Health Services hereafter called the State,and
CONTRACTOR'S NAME /�
COUNTY OF CONTRA COSTA(Health Services) 9 - 20- 8 ---`� ,hereafter called the Contractor.
WITNESSETH: That the Contractor for and in consideration of the covenants,conditions,agreements,and stipulations of the State hereinafter expressed,
does hereby agree to furnish to the State services and materials as follows: (Set forth service to be rendered by Contractor,amount to be paid Contractor,
time for performance or completion,and attach plans and specifications,if any.)
1. The Contractor shall complete the objectives as stipulated in the attached Exhibit "A" entitled `Terms" consisting of four
pages and made a part of this agreement by this reference.
2. The attached Exhibit"B"entitled"Budget"consisting of six pages is made a part of this agreement by this reference.
3. The attached Exhibit"C"entitled"Project Summary and Budget Justification"consisting of four pages is made a part of this
agreement by this reference.
4. The attached Exhibit"D"entitled"Prior to July 1, 1994 Language"consisting of one page,is incorporated herein and made
a part hereof by this reference in recognition of both parties that the validity and effectiveness of this contract are conditioned
upon the availability of funds in the Budget Act of 1994.
5. The attached Exhibit"A(F)"entitled"Additional Provisions"consisting of twenty-seven pages is made a part hereof by this
reference.
6. The attached Exhibit "Al"entitled"Equipment Purchased with State Funds"consisting of one page is made a part of this
agreement by this reference.
7. The attached Standard Form 17A entitled "Nondiscrimination Clause"consisting of one page is incorporated herein and
made a part hereof by this reference.
CONTINUED ON 4 SHEETS,EACH BEARING NAME OF CONTRACTOR AND CONTRACT NUMBER.
The provisions on the reverse side hereof constitute a part of this agreement.
IN WITNESS WHEREOF,this agreement has been executed by the parties hereto,upon the date first above written.
STATE OF CALIFORNIA CONTRACTOR
AGENCY CONTRACTOR(if other than an individual state whether a oorporation,partnership,etc.)
Department of Health Services COUNTY OFC TRA CO lth Services)
BY(AUTHORI SIGNATURE) .
D t (AUTHORIZED SIGNATU
PRINTED NAME OF PERSON SIGNING EDWARD E STAHLBERG PR NAME AND Tip OF PERSON SIGNING
PROGRAM SUPPORT BRANCH Chair, Boaid of Supervisors
TITLE ADDRESS
Chief, Program Support Branch
651 Pine Street, MartinP7 CA g1LS1;1
AMOUNT ENCUMBERED BY THIS PROGRAM/CATEGORY(CODE AND TITLE) FUND TITLE Department of General Services
DOCUMENT Local Assistance/Clearing Account General n Use Only
$ 243,770.00 (OPTIONAL USE) Subjectto the Budget Act of 1994
PRIOR AMOUNT ENCUMBERED FOR FFP 79.2% Federal Catalog#93.268
THIS CONTRACT
$ 0 ITEM 4260-111-001 CHAPTER STATUTE FISCAL YEAR
TOTAL AMOUNT ENCUMBERED TO 4260-001-001 k,l l 1994 1994/95
DATE OBJECT OF EXPENt�TlJq(;,(C�Op�9�5f9 Y02-03-95158S-94--$193,083.00 A F kl R 0 V TE, +�
$ 243,770.00 y4 y13A
I hereby certify upon my own personal knowledge that budgeted funds T.BA NO. B.R.NO. SEP 0 6
are ilable for the period and rpose of the expenditure stated above.
SIGNAT F ACCOUNTING OFFICER DA
-z1
CONTRACTOR STATE AGENCY DEPT.OF GEN.SER. CONTROLLER Asst.Chief Counsel
:SEP . . 9.4994
STATE OF CALIFORNIA `
,1 I
STANDARD AGREEMENT ,� }
STC. 2(REV. 5-91) (REVERSE)
1. The Contractor agrees to indem nify,defend and save harmless the State,its officers,agents and employees
from any and all claims and losses accruing or resulting to any and all contractors, subcontractors,
materialmen,laborers and any other person,firm or corporation furnishing or supplying work services,
materials or supplies in connection with the performance of this contract,and from any and all claims and
losses accruing or resulting to any person, firm or corporation who may be injured or damaged by the
Contractor in the performance of this contract.
2. The Contractor,and the agents and employees of Contractor,in the performance of the agreement,shall
act in an independent capacity and not as officers or employees or agents of State of California.
3. The State may terminate this agreement and be relieved of the payment of any consideration to Contractor
should Contractor fail to perform the covenants herein contained at the time and in the manner herein
provided. In the event of such termination the State may proceed with the work in any manner deemed
proper by the State. The cost to the State shall be deducted from any sum due the Contractor under this
agreement,and the balance, if any,shall be paid the Contractor upon demand.
4. Without the written consent of the State,this agreement is not assignable by Contractor either in whole
or in part.
5. Time is of the essence in this agreement.
h. No alteration or variation of the terms of this contract shall be valid unless made in writing and signed by
the parties hereto,and no oral understanding or agreement not incorporated herein,shall be binding on
any of the parties hereto.
7. The consideration to be paid Contractor, as provided herein, shall be in compensation for all of
Contractor's expenses incurred in the performance hereof, including travel and per diem, unless
otherwise expressly so provided.
• _1
91 61014
k L•;
CopContract No.: 94-19745tracto�r- County of Contra Costa Page 2
(Health Services)
8. The period of this contract shall be from July 1, 1994 through June 30, 1995.
9. Limitation of State Funding.
a. Under the terms of this contract for Fiscal Year 1994/95 ending June 30, 1995,the maximum amount payable shall not
exceed$50,687.00.
10. Limitation of Federal Funding.
a. Under the terms of this contract for the period July 1, 1994 through June 30, 1995,the maximum amount payable shall
not exceed$193,083.00
11. Under the terms of this contract,the combined maximum amount of state and federal funds payable through June 30, 1995
shall not exceed $243,770.00.
12. In accordance with Public Law 98-502 and OMB Circular A-128, it is stipulated between the parties hereto that:
1. The cost of the single audit will be charged to the federal assistance program providing funds for this agreement.
2. The Contractor shall include a clause in any contract the Contractor enters into with the audit firm doing the single audit
to provide access by the State or Federal Government to the working papers of.the independent auditor who prepares
the single audit for the Contractor.
13. Contractor agrees that this contract is subject to examination and audit by the State,including the Auditor General,for a period
of three years after final payment under said contract.
14. Provision 3, Procurement Requirement, and Provision 5, Fumishing-Qf Property by the State or Purchase of Property with
State or Federal Funds,of Exhibit A(F), pages 2 and 3, are amended to read as follows:
"3. PurchasinglProcurement Rules
A. Units of local government and public entities (including the Universities of California), whether a contractor or
subcontractor, may utilize their existing procurement systems to secure all articles, supplies, equipment
(including EDP/ADP and telecommunications),motor vehicles,and services required in the performance of this
contract without regard to dollar limit, subject to the provisions stipulated in the subparagraphs C through G of
this section. The provisions appearing in subparagraph B may be applicable if purchases are subdelegated to
subcontractors which are either private vendors or nonprofit organizations.
B. 1. All other contractors and subcontractors (nonprofit organizations and private vendors) may utilize their
existing procurement systems to secure all articles, supplies, equipment (including EDP/ADP and
telecommunications), motor vehicles, and services required in the performance of this contract up to an
annual maximum of$50,000,subject to the provisions stipulated in all of the following subparagraphs of this
section.
2. All other contractors or subcontractors (nonprofit organizations and/or private vendors) shall utilize a
procurement system that meets the following standards:
a. Maintain a code or standard of conduct that shall govern the performance of its officers,employees,or
agents engaged in awarding procurement contracts. No employee,officer,or agent shall participate in
the selection, award,or administration of a procurement contract in which,to his or her knowledge,he
or she has a financial interest.
b. Procurement shall be conducted in a manner that provides,to the maximum extent practical,open and
free competition.
Contractor: Contract No.: 94-19745 County of Contra Costa Page 3
(Health Services)
c, Procurements shall be conducted in a manner that provides for all of the following:
1. Avoidance of the purchasing of unnecessary or duplicate items.
2. Solicitation for capital expenditures shall be based upon a clear and accurate description of technical
requirements of the goods to be procured.
3. The taking of positive steps to utilize small, minority, women, or veteran owned businesses.
3. If at any time during any fiscal year of the contract the Contractor's or subcontractor's capital expenditure
(capital equipment) line item exceeds $50,000, the Contractor and/or subcontractor may procure all
equipment up to the $50,000 annual limit. To secure all items above this limit the Contractor shall make
arrangements through the State to have all of the subsequent equipment purchased through the Department
of General Service's Office of Procurement. The Contractor shall submit to the State a list of equipment
specifications for those items for which the State must arrange the procurement. The cost of said equipment
purchased by o r through the Office of Procurement shall be deducted from the funds available in the contract.
The State may pay the vendor directly for such arranged equipment purchases and title to the equipment will
remain with the State. The equipment will be delivered to the Contractor's address as stated in the contract
unless the Contractor notifies the State of an alternate delivery address in writing.
C. 1. Prior written authorization from the State will be required before the Contractor will be reimbursed for any
purchase order or subcontract exceeding$2,500 for any articles,supplies,equipment,subcontract,services
or for any fee for consultant fees of three hundred fifty dollars($350)or more per day. The Contractor must
provide in its request for authorization all particulars necessary for evaluating the necessity or desirability of
incurring such cost and the reasonableness of the price or cost. The terms '"Purchase order' and
"subcontract" as used in this paragraph only, exclude: (a) purchase orders not exceeding$2,500 and (b)
subcontracts or purchase orders for public utility services at rates established for uniform applicability to the
general public.
2. For purchases of any articles, supplies, equipment, services or consultant fees exceeding the amounts
stipulated in paragraph C.1.,three competitive quotations must be submitted with the request,orthe absence
of bidding must be adequately justified.
3. Before equipment purchases made by the Contractor and/or subcontractor are reimbursed by the State,the
Contractor must submit copies of paid vendor receipts identifying the purchase price,description of the item,
serial number,model number and the Contractor must identify the location where the equipment will be used
during the term of the contract. The paid vendor receipts are to be attached to the Contractor's invoices
submitted to the State.
D. The Contractor and/or subcontractor must maintain a copy or narrative description of the procurement guidelines,
rules, or regulations that will be employed in making purchases under this agreement. The State reserves the
`right to request copies of these documents and to inspect the purchasing practices of the Contractor and/or
subcontractor at any time.
E. The Contractor and/or subcontractor must maintain copies of documents, bids and other information used in
vendor selection. Sole source procurement justifications shall also be maintained on file by the Contractor and/
or subcontractor for inspection or audit by the State.
F. The State shall reimburse any State, local sales or use tax legally assessed on purchases, parts supplied,and
services rendered in support of this agreement. All othertaxes,including f ederal excise taxes,directly or indirectly
arising out of the performance of this agreement shall be the Contractor's and/or subcontractor's responsibility.
G. The State may, at its sole discretion, withhold, cancel or retract purchase delegation authority granted under
pararaphs A and B of this section with no less than 30-calendar days written notice to the Contractor."
r r
Contractor: County of Contra Costa Contract No.: 94-19745
(Health Services) Page 4
"5. OwnershiWDispgsition of Eouipm .n/Pro�rty Purchased Under Contract or Furnished by the tat
A. All equipment, material,supplies,or property of any kind purchased from contract funds or furnished by the State
under the terms of this contract and not fully consumed in the performance of the contract shall be the property
of the State.
B. Title to State property shall not be affected by its incorporation or attachment to any property not owned by the
State.
C. Unless otherwise stipulated, the State shall not be under obligation to pay the cost of the restoration or
rehabilitation of the Contractor's or subcontractor's facility which may be affected by the removal of any State
property.
D. The Contractor shall maintain and administer, according to State directives and sound business practices, a
program for the utilization, maintenance, repair, protection, and preservation of State property.
E. State property,equipment and vehicles purchased by the Contractorwith contract funds or provided by the State
shall be used only for the performance of this contract.
F. Contractor shall submit an annual inventory of equipment furnished and/or purchased under the terms of this
contract. The State may prescribe the inventory formats and/or may supply applicable forms for this purpose.
G. Within 30 calendar days of the termination or end of this contract,the Contractor shall provide a final inventory
to the State and shall at that time querythe State as to the State's requirements,including the manner and method,
in returning said equipment or property to the State. Final disposition of such equipment shall beat State expense
in accordance with instructions from the State to be issued immediately after receipt of the final inventory.
H. Motor Vehicles
1. If motor vehicles are purchased by contract funds or supplied by the State,within 30 calendardays of the end
or termination of this contract, the Contractor shall return such vehicles to the State and shall deliver all
necessary documents of title to enable the proper transfer of marketable title to the State.
2. If motor vehicles are purchased by the Contractoror provided by the State,the State shall be the legal owner
of said vehicles and the Contractor shall be the registered owner.
3. Contractor agrees that all operators of purchased or supplied motor vehicles shall hold a valid State of
California driver's license. In the event 12 or more passengers are to be carried in any one vehicle,a Class
2 driver's license will also be required.
4. The Contractor shall provide and maintain and shall require its subcontractors, if applicable,to provide and
maintain the following type and amount of automobile liability insurance during the term of this contract if any
motor vehicle is purchased with contract funds or provided to the Contractor by the State during the term of
this contract:
a. Automobile Liability Insurance. The Contractor, by signing this agreement hereby certifies that it
possesses or will obtain automobile liability insurance in the amount of $500,000 per occurrence for
bodily injury and property damage. Said insurance must be obtained and made effective upon the
delivery date of any motor vehicle to the Contractor.
b. If required by the State,the Contractor agrees to furnish the contract manager copies of certificates of
insurance.
c. Contractor agrees that automobile liability insurance,as required herein,shall remain in effect at all times
during the term of this contract or until such time as the motor vehicle is returned to the State.
Contractor: County of Contra Costa Contract No.: 94-19745
(Health Services) Page 5
d. Contractor agrees to provide,if required by the State,at least 30 days priorto said expiration of insurance
coverage,a copy of a new certificate of insurance evidencing coverage,as indicated herein,for not less
than the remainder of the term of this contract.
e. Contractor must provide evidence,as stipulated by the State,that any required certificates of insurance
contain the following provisions:
1. The insurer will not cancel the insured's coverage without 30 days prior written notice to the State.
2. The State shall be named as additonal insured,but only insofar as the activities of this contract are
concerned.
3. The Insurance carrier shall notify the State in writing of the Contractor's failure to pay premiums;its
cancellation of such policies;or any other substantial change,including but not limited to the status,
coverage, or scope of the required insurance.
f. The Contractor is hereby advised that all required copies of certficates of insurance may be subject to
the review and approval of the Department of General Services, Office of Insurance and Risk
Management. The Contractor shall be notified by the State if this provision is applicable to this contract."
EXHIBIT A
(FY 1994-95)
TERMS
SECTION 1. TERMS AND CONDITIONS
The Contractor must agree to the following inclusive objectives and conduct the following activities. Please
note that many of these Terms and Conditions are also objectives and activities required by the Federal
Government and are conditions for funding of the California Immunization Program and/or statutory
requirements of State and local health departments. The level of subvention contract funding to be awarded
is not represented as sufficient for support of all the required activities; a significant amount of local support
and funding is expected. Subvention contract funds must not be used to supplant (i.e., replace) Iocai funds
currently being expended for routine immunization services and activities. Subvention funds can only be
used for the activities outlined in the budget justification.
A. Objectives:
1.) Raise to (or maintain) immunization levels of 98% or greater for each of the legally required
immunizations among all kindergarten entrants and incoming transfer students to schools within the
Contractor's jurisdiction.
2.) By 1996, 90% of two-year-olds should be vaccinated with one dose of measles, mumps, and
rubella(MMR) vaccine,three doses of polio vaccine, at least three doses of diphtheria,tetanus, and
pertussis (DTP) vaccine, and at least three doses of Haemophilus influenzae type b (Hib) vaccine
within the Contractor's jurisdiction. In addition, 70% of two-year-olds should have received three
doses of hepatitis b vaccine.
3.) Through prevention, surveillance and outbreak control, reduce, and if possible eliminate, illness,
disability and death due to vaccine preventable diseases such as polio, diphtheria, tetanus,
pertussis, measles, rubella, mumps, hepatitis B, and Haemophilus Influenzae Type b within the
Contractor's jurisdiction.
B. Specific Pediatric Activities:
1.) Immunization Clinic Services
a.) eluent staffing in existing regularly scheduled public immunization clinics and/or exl2and
clinics in more locations on more days with longer hours which are reasonably accessible to
parents of children who reside within the Contractor's jurisdiction.
b.) Clinic policies must allow for the immunization of all susceptible infants, children, adolescents
and adults who visit within the scheduled hours of operation regardless of their city, county or
state of residence,
c.) Public immunization clinic policies and practices must be in general accordance with the
current recommendations approved by the U.S. Public Health Service and endorsed by the
American Academy of Pediatrics (AAP) as specified in the *Standards f rr Pedi trig
Immunization Practices. (Note: * The ,Standards represent the consensus of the National
Vaccine Advisory Committee (NVAC) and of a broad group of medical and public health experts
about what constitute the most desirable immunization practices. The ,Standards are expected
to be useful as a means of assisting providers to identify needed changes,to obtain resources
if necessary, and to actually implement the desirable immunization practices.) Accordingly,
appropriate in-service training shall be instituted to assure compliance with the Standards.
d.) Each patient(or patient's parents) receiving"pediatric"immunizations through the Contractor's
public clinics must be provided a new or updated California Immunization Record (CIR). The
month, day and year of each immunization must be recorded on the CIA.
e.) Assure that the importance of completing the recommended schedule of immunizations is
discussed with all patients (or parents of patients) receiving immunizations at the public clinics.
EXHIBIT A(Pediatric-IAP Continued)
FY 1994-95 Page 2
f.) Assure that the date the next vaccine dose(s) are due is given in writing to the patient or
parent. The appropriate space on the CIR may be used for this purpose.
g.) Within the health jurisdiction,the Contractor shall implement and maintain public immunization
clinic reminder/recall systems among all medical providers, who receive state-supplied
vaccines,to improve age-appropriate immunizations of preschool-age children.
h.) In accordance with current Immunization Branch guidelines, which were furnished to the
contractor by the State,the Contractor must participate in the national Vaccine Adverse Events
Reporting System (VAERS)for adverse events following immunization.
2.) Immunization Assessment Levels
a.) In accordance with the guidelines and timetables provided by the Immunization Branch, the
Contractor must coordinate the assessment of the immunization levels of child care centers,
Head Start Centers, and kindergarten entrants.
b.) Through coordination with Immunization Branch Representatives, county health authorities
and local child care center and school authorities, the Contractor must make efforts to ensure
that all (100%) child care centers, Head Start centers and schools fully enforce existing
regulations pertaining to the immunization of children admitted to such institutions.
c.) Annually,within the health jurisdiction,the Contractor shall select at least a 20% representative
random sample of public clinics who receive state-supplied vaccine. Of the public clinics
selected, the Contractor shall conduct immunization record audits of children (24 months -35
months old) who are served by the clinics. The sampling technique and immunization clinic
record methodology must be compatible with the methodology of the Immunization Branch of
the California Department of Health Services. The record audit specifications (with additional
detailed guidelines), if requested, will be provided to the Contractor by the CDHS
Immunization Branch.
3.) immunization of Infants and Preschool Children
In addition to the above stated activities,the Contractor agrees to the following activities intended to
assure the age-appropriate immunization of infants and preschoolers who reside within the
Contractor's jurisdiction.
a.) Make efforts to ensure that the immunization status of infants and children receiving services
through programs such as CHDP, MCH, AFDC, and WIC is assessed and that a system is
established to ensure age-appropriate immunization.
b.) Promote immunization information and education of parents with newbom children through all
hospitals with maternity services within the Contractors jurisdiction.
4.) Vaccine Preventable Disease Surveillance and Outbreak Control
a.) Establish and maintain an effective system for identification and reporting of suspect, probable
and confirmed cases of vaccine preventable diseases. Sources of surveillance information
should include practicing physicians, outpatient clinics, hospitals, schools, child care centers
and Head Start centers. Active surveillance is only required during outbreaks of measles.
b.) Investigation and Control of Measles
1.) Investigation of all reported suspect, probable and confirmed cases of measles must be
initiated within one working day of receipt of a report by the Contractor.
EXHIBIT A(Pediatric-IAP Continued)
�. FY 1994-95 Page 3
2.) Outbreak control procedures in accordance with the guidelines of the Immunization
Branch must be initiated by the Contractor within two working days of determination of a
probable or confirmed measles case.
C. Required Reports
1.) Reports of Local Program Progress and Activities
In accordance with the guidelines and format provided by the Immunization Branch,the Contractor
shall submit,through his/her Immunization Branch District Field Representative. to
the Branch identified in paragraph 6 of Section I in this Exhibit, by the 15th of the month following
the end of each quarter, a written quarterly report of progress and activities. In addition to the written
report the Contractor and Project Liaison,or his designee, may meet and discuss the above matters
in person.
2.) Upon completion of the investigation of each probable or confirmed measles case, a completed
investigation form must be submitted to the Immunization Branch.
3.) Contractor agrees that itemized gersonhel positions listed in said Exhibit B shall not be subject to
Contractors l2 .rsonnel Uglicy decisions to refrain from filling vacant p2sitions. The total amount of
the contract will be indicated as either some part, or all, of the total operations budget. If the total
amount of the contract is less than the total operations budget, the Contractor will be responsible
for providing the difference between the total amount of the contract and the total operations
budget. Further, all invoices to the State which request reimbursem - to s for positions included in
Exhibit "B" must include the name and Social Security number of the that have performed
in these p-Qsitions.
4.) The Contractor shall provide for any personnel or operating expenses that are necessary to meet
the provisions included herein but are not provided for in the Budget included as Exhibit"B".
5.) The Contractor shall submit through hider Immunization Branch District Field
Regresentative.to the Branch identified in paragraph 6 of Section I in this Exhibit, on or before
the 3rd of the month following the report month, a written Monthly Vaccine Usage Report in the form
prescribed by the State Department of Health Services, Immunization Branch.
6.) All reports, other than those required to be directed to the District Field Representatives, invoices,
and other written communications are to be addressed and delivered to the State Department of
Health Services, Immunization Branch, 2151 Berkeley Way, Berkeley, California 94704.
7.) The State reserves the right to use and reproduce all reports and data produced and delivered
pursuant to this Contract and reserves the right to authorize others to use or reproduce such
materials, provided that the confidentiality of patient information and records are protected pursuant
to California State laws and regulations.
8.) This Contract may be terminated by either party upon 30 days' written notice to the other party.
Further, this Contract may be terminated or suspended upon written notification by the State at any
time for failure on the part of the Contractor to comply with any of the provisions contained herein.
9.) In consideration of the above services, performed in a manner acceptable to the State, the State
shall reimburse the Contractor quarterly, in arrears, upon submission of a quarterly invoice by
Contractor on Contractor's letterhead, in quadruplicate stating the time period covered, stating the
contract number, for actual expenditures in accordance with the budget (attached hereto and
shown as Exhibit "B"), to: Department of Health Services, Immunization Branch, 2151 Berkeley
Way, Room 712, Berkeley,CA 94704. The Contractor may make changes in any individual line item
in the budget, provided that such changes in the sum total does not exceed $10,000 that the
Contractor submit an explanation of the need for such excess with the claim for reimbursement and
to specifically identify the line item(s) to be reduced in order to increase the excess item(s) and
EXHIBIT A(Pediatric-IAP Continued)
FY 199495 Page 4
provided further that the State reserves the right to deny any such claim for any excess
reimbursement on any item. It is further understood that in no event shall the maximum amount
payable under this agreement exceed the maximum amount specified in paragraph 11 of the
Standard Agreement.
10.) It is agreed by the Contractor that in the event that a significant portion of the Contract objectives for
the initial four months of the Contract are not met by that time; and in the event that the State
determines from quarterly invoices, performance reports, and other sources of information that the
Contractor will not perform the total quantity of services contracted for; and that therefore, the total
budget allocation will not be depleted: the State and/or Contractor may make an equitable
adjustment in the original Contract budget and Contract objectives in order to decrease the total
quantity of services and commensurate Contract amount. Any adjustment shall be by amendment
only and duly executed by both parties and approved by the Department of General Services (if
applicable).
EXHIBIT B
BUDGET
PAGE 1 OF 6 PAGES
APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION FUNDS
Applicant: County of Contra Costa (Health Services)
Budget Period From: 7/1/94 to 6/30/95
DETAILED LINE ITEM BUDGET FOR THIS PROJECT
% of time and/or Monthly salary range Dollars required
1. Personal Services hours on proiect and/or hourly rate fron California
Immunization Coordinator 50.00% 4386-6000 $33,279
Registered Nurse 2,080 24.68-30.06 $60,614
Registered Nurse 1,352 24.68-30.06 $39,401
Disease Intervention 100.00% 1925-3000 $34,861
Technician
Clerk Experienced Level 50.00% 1849-2300 $13,529
(1) State funds cover approximately 50% of Immunization
Coordinator and 50% o the Clerk personnel expenses
Total Salaries and Wages $181,684
Staff Benefits 9 10.83 — 28% $42,285
TOTAL PERSONAL SERVICES $223,969
Q13.1W4ACD\941MMBUD.WK3 20-May-94
1 1 • •
EXHIBIT B
BUDGET
PAGE 2 OF 6
APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION FUNDS PAGES
Applicant: County of Contra Costa (Health Services)
Budget Period From: 7/1/94 to 6/30/95
DETAILED LINE ITEM BUDGET FOR THIS PROJECT
Dollars required
II. Operating Expenses fron California
A. Supplies
1) Office $1,000
2) Clinic
i $1,000
B. Health Education Materials I
$1,000
C. Laboratory Screening (Hepatitis B only)
D. Travel
1) In—State $1,000
2) Out—of—State $1,200
I
E. Equipment $101
I
F. Subcontracts = 14,500
(description(s) on Exhibit B Budget, Subcontract page(s)
Total Operating Expenses $19,801
Total Budget $243,770
C:\3.1\94ACD\941MMBUD.WK3 20-May-94
EXHIBIT B
BUDGET
PAGE 3 OF 6 PAGES
APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION FUNDS
Applicant: County of Contra Costa (Health Services)
Budget Period From: 7/1/94 to 6/30/95
F. Subcontracts
(List the name of the contractor or consultant and the time period of the contract.
Also, indicate the hourly/weekly/monthly rate of reimbursement and total contract amount)
Name of Subcontractor: Pittsburg Pre—School Coordinating Council
Address: 1760 Chester Dr
City, State, & Zip Code: Pittsburg, CA 94565
Telephone #. (510) 439 2061
1. Personal Services # of Hours/ Rate of Dollars required
(List Positions) Time Period Reimbursement from California
Community Outreach Worker 450-900 $10 —20/hour $9,000
Personal Services Subtotal
11. Operating Expenses
Supplies
Health Education Materials
Travel (in—state)
Equipment
Operating Expense Subtotal
F. Subcontracts Total $9,000]
Note:
A written justification of the above Contractor service(s) and expected completed
work product(s) must be included in Exhibit C Budget Justification of this agreement.
C:\3.1\94ACD\941MMBUD.WK3 20-May-94
1 1 -
1 1
EXHIBIT B
BUDGET
PAGE 4 OF 6 PAGES
APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION FUNDS
Applicant: county of Contra Costa (Health Services)
Budget Period From: 7/1/94 to 6/30/95
F. Subcontracts
(List the name of the contractor or consultant and the time period of the contract.
Also, indicate the hourly/weekly/monthly rate of reimbursement and total contract amount)
Name of Subcontractor: Desarollo Familiar
Address: 205 39th St
City, State, & Zip Code: Richmond, CA 94805
Telephone #. (510) 412 5930
I. Personal Services # of Hours/ Rate of Dollars required
(List Positions) Time Period Reimbursement from California
Community Outreach Worker 225-450 $10 —20/hour $4,500
Personal Services Subtotal (— $4,500
II. Operating Expenses
Supplies
Health Education Materials
Travel (in—state)
Equipment
Operating Expense Subtotal
F. Subcontracts Total r $4,500
Note:
A written justification of the above Contractor service(s) and expected completed
work product(s) must be included in Exhibit C Budget Justification of this agreement.
Q\3.1194ACD1941MMBUD.WK3 20—May-94
EXHIBIT B
BUDGET
PAGE 5 OF 6 PAGES
APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION FUNDS
Applicant: County of Contra Costa (Health Services)
Budget Period From: 7/1/94 to 6/30/95
F. Subcontracts
(List the name of the contractor or consultant and the time period of the contract.
Also, indicate the hourly/weekly/monthly rate of reimbursement and total contract amount)
Name of Subcontractor: Tim Manning
Address: 2176 Orin LLa
City, State, & Zip Code: Pleasant Hill, CA 94523
Telephone #. (510) 676-3867
I. Personal Services # of Hours/ Rate of Dollars required
(List Positions) Time Period Reimbursement from California
Graphic Artist 20 $25/hr $500
Personal Services Subtotal �— $500
11. Operating Expenses
Supplies
Health Education Materials
Travel (in—state)
Equipment
Operating Expense Subtotal
F. Subcontracts Total $500
Note:
A written justification of the above Contractor service(s) and expected completed
work product(s) must be included in Exhibit C Budget Justification of this agreement.
C:1.3.1\94ACD\941MMBUD.W K3
20—May-94
EXHIBIT B
BUDGET
PAGE 6 OF 6 PAGES
APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION FUNDS
Applicant: County of Contra Costa (Health Services)
Budget Period From: 7/1/94 to 6/30/95
F. Subcontracts
(List the name of the contractor or consultant and the time period of the contract.
Also, indicate the hourly/weekly/monthly rate of reimbursement and total contract amount)
Name of Subcontractor: Center for New Americans
Address: 1135 Lacey Lane
City, State, & Zip Code: Concord, CA 94520
Telephone #. (510) 798-3492
I. Personal Services # of Hours/ Rate of Dollars required
(List Positions) Time Period Reimbursement from California
Translators 10 hours $50/hour $500
Personal Services Subtotal $500
II. Operating Expenses
Supplies
Health Education Materials
Travel (in—state)
Equipment
Operating Expense Subtotal
F. Subcontracts Total $5001
Note:
A written justification of the above Contractor service(s) and expected completed
work product(s) must be included in Exhibit C Budget Justification of this agreement.
Q\3.1194ACD194IMMBUD.WK3 20—May-94
Fri
(DHS 8312 2/94) Exhibit C
Project Summary and
Budget Justification
Page I of_ 4 pages
APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION
SHORT SUMMARY OF PROJECT (Not to exceed 200 words)
The purpose of the Immunization Program is to prevent the occurrence and transmission of vaccine
preventable diseases through immunizations, surveillance and outbreak control. The program will provide
immunization services, promote immunization awareness, encourage families to keep permanent
immunization records, and assure that schools maintain a permanent record keeping system. Program
activities will be coordinated with local school officials and community agencies.
These activities will be carried out in an attempt to: (1) raise immunization levels above 98% for all school-
age children for each of the legally required immunizations (2) ensure that by 1996, 90% of all two-year olds
within the county will have received at least 3 doses of DTP, polio, and Hib vaccines and one dose of MMR
vaccine and that 70% of these two-year olds will have also received 3 doses of hepatitis b vaccine and (3)
through prevention, surveillance and outbreak control, reduce, and if possible, eliminate illness, disability and
death from vaccine preventable diseases such as polio, diphtheria, tetanus, pertussis, measles, mumps,
rubella, Hepatitis B, and Haemophilus Influenzae Type b within the county.
Priority will be given to the: 1) annual kindergarten and preschool immunization assessments and selective
review audits, 2) annual immunization clinic record audits 3) distribution of immunization materials to all
public and private schools and preschools with inservice/consultation visits maintained, 4) expanded outreach
efforts to infants and toddlers 4) on-site clinics at WIC, State Preschool and Headstart sites, 5) toddler
immunization campaign, 6) measles elimination program, 7) provision of regularly scheduled public
immunization clinics with special clinics as needed, 8) a reminder/recall system for children who attend any
public health immunization clinic 9) outbreak control measures to contain/stop vaccine preventable disease.
9) increased provider outreach efforts to adopt the 'The Standards for Pediatric Immunization Practices"
with programs for continuing education units for professionals.
A computerized immunization system with a 386 PC and Green Lira software is updated monthly to
maintain: 1) permanent retrievable record keeping system for persons given immunizations in the
immunization-only clinics and special outreach clinics 2) vaccine usage and inventory activities, and 3)
communi- cations to schools, health care providers, hospitals, and community organizations. Other software
programs will be investigated this year in an effort to establish a computerized immunization link to public
and private immunization providers.
Name of Project Director Name and Address of Applicant Including
Organizational Unit Responsible for
Project Activity
Dottie Langthorn Contra Costa County
Public Health Division of the
Health Services Dept.
Immunization Program
597 Center Avenue Suite 200A
Martinez , Ca. 94553
(DHS 8312(2!94)
Exhibit C
' Project Summary and
Budget Justification
Page 2 of 4 pages
APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION
BUDGET JUSTIFICATION
(Please provide written justifications for all positions and operating expenses requested on Exhibit B Budget. If additional
space is required,attach additional pages.)
I. PERSONNEL SERVICES
Immunization Coordinator - $33,279
Coordinates activities to meet program goals: conducts immunization assessments
and provides consultation and technical assistance to school and child care
facilities to raise and/or maintain immunization levels of at least 98% in school
age children, participates in newborn and toddler outreach activities in an effort
to raise immunization levels in county 2 year olds to 90% by 1996, provides
immunization information to the medical and lay communities, coordinates
programs for continuing education for professionals, works to reduce/eliminate
vaccine preventable disease (ie., measles, mumps, rubella, pertussis, hemophilus
influenza type b), provides the operational link between schools and preschools
and the State IAP office, supervises the computerized record keeping system,
manages vaccine usage and accountability as well as the vaccine adverse event
reporting system.
Registered Nurses (2 positions) - $100,015 (#1--$60,614.00; #2--$39,401.00)
Provides daily immunization clinic services in the Richmond, Concord, and
Pittsburg areas and at least weekly service in Brentwood and/or Oakley.
Provides 16 hours of outreach clinics each month in all 4 WIC sites and an
additional 50 hours of outreach clinics per month in identified state preschools,
headstarts,elementary schools, churches, community centers, housing projects,
migrant camps, and mobile vans in low income minority neighborhoods. The
nurses will also assist with immunization education activities and immunization
record reviews.
Communicable Disease Technician - $34, 861
Will provide door to door outreach and information giving. Will give information
classes in clinics and to community groups in appropriate languages. Will work
with migrant workers to determine needed times for clinics and best access.
Exhibit C
Project Summary and
Budget Justification
Page 3 of 4 Pages
APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION
BUDGET JUSTIFICATION
I. PERSONNEL SERVICES (Cont.)
Clerk-Experienced Level - $13,529
Provides clerical support to accomplish the goals and objectives of the program.
The activities include: typing and filing reports and letters, xeroxing, preparing
kindergarten and preschool registration packets, filling orders, tabulating audit
results, mailing materials to schools, child care facilities, family day homes and
health care providers, maintaining the computerized retrievable immunization
record system and manual reminder system, and providing clerical support to
clinic and the Immunization Program Coordinator.
Staff Benefits @ 10.83-28% - $42,285
II. OPERATIONAL EXPENSES
A. Supplies -
$l,000--Office: Pens, paper, envelopes, phone service for such things as
alarm systems, fax/modems, toll free immunization hot-line.
sl,000--Clinic: Emergency equipment, syringes, alcohol, drapes, cotton,
bandaids, needle disposal boxes, containers to transport
equipment and store vaccine,vaccine storage alarm systems
B. Health Education Materials - $ 1,000
Developing, printing, and ordering language and cultural appropriate
outreach materials and incentives.
Exhibit C
Project Summary and
Budget Justification
Page 4 of 4 Pages
APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION
BUDGET JUSTIFICATION
II. OPERATIONAL EXPENSES
C. Travel
1. Out-of-State: $1200
National Immunization Conference- Air fare, room and meals
for 6 days.
2. In-State: $1000
Local program related activities.
D. Equipment - $101
Computer software and associated hardware to establish a computer
network system with multi-provider access and reminder/recall.
E. Subcontracts
1. Contract with Pittsburg Coordinating Council for Community
Outreach worker. -- $9,000
2. Contract with Familias Unitas in Richmond for Community
Outreach worker, Desarollo Familiar -- $4,500
3. Contract with a graphic artist to develop appropriate materials,
Tim Manning -- $ 00
4. Contract for assistance with multiple language translations of
educational materials, Center for New Americans -- $500
III. TOTAL BUDGET - $ 243,770
Exhibit D
STATE OF CALIFORNIA
DEPARTMENT OF HEALTH SERVICES
Priorto July 1, 1994 Language
1 . It is mutually understood between the parties that this contract may have
been written and executed prior to July 1, 1994 for the mutual benefit of
both parties in order to avoid program and fiscal delays which could occur
if the contract were executed after July 1, 1994.
2. This contract is valid and enforceable only if sufficient funds are made
available by the Budget Act of 1994 fo.r the Fiscal Year 1994-95. for the
purposes of this program. In addition, this contract is subject to any
additional restrictions, limitations, or conditions enacted by the~Legislature
and contained in the Budget Bill or any statute enacted by the Legislature
which may affect the provisions, terms, or funding of this contract in any
manner.
I It is mutually agreed that if the Budget Act of 1994 does not appropriate
sufficient funds for the program, this contract shall be invalid and of no
further force and effect. In this event, the State shalt have no liability to pay
any funds whatsoever to the contractor or to furnish any other
considerations under this contract, and the contractor shall not be
obligated to perform any provisions of this contract.
cros Intuuc"ona Bumonn No.Q](10!00)
E)Nbit A(F)
STATE OF CALIFORNIA
DEPARTMENT OF HEALTH SERVICES
ADDITIONAL PROVISIONS
(FOR FEDERALLY FUNDED SUBVENTION AID/LOCAL ASSISTANCE
COST REIMBURSEMENT CONTRACTS/GRANTS)
1. Equal Opportunity Clause
a. The Contractor will not discriminate against any employee or applicant for
employment because of race, color, religion, sex, national origin, physical or mental
handicap, or age. The Contractor will take affirmative action to ensure that qualified
applicants are employed, and that employees are treated during employment
without regard to their race, color religion, sex, national origin, physical or mental
handicap, or age. Such action shall include, 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 career
development opportunities and selection for training, including apprenticeship. The
Contractor agrees to post in conspicuous places, available to employees and
applicants for employment, notices to be provided by the Federal Government or the
State, setting forth the provisions of the Equal Opportunity clause and the
Rehabilitation Act of 1973. Such notices shall state the Contractor's obligation under
the law to take affirmative action to employ and advance in employment qualified
applicants without discrimination based on their race, color, religion, sex, national
origin, physical or mental handicap, or age, and the rights of applicants and
employees.
b. The Contractor will,in all solicitations or advertisements for employees placed by or on
behalf of the Contractor, state that all qualified applicants will receive consideration
for employment without regard to race, color, religion,sex, national origin, physical or
mental handicap,or age.
c. The Contractor will send to each labor union or representative of workers with which
he or she has a collective bargaining agreement or other contract or understanding a
notice, to be provided by the Federal Government or the State, advising the labor
union or worker's representative of the Contractor's commitments under this Equal
Opportunity clause and shall post copies of the notice in conspicuous places
available to employees and applicants for employment.
d. The Contractor will comply with all provisions of the Rehabilitation Act of 1973 and of
the Federal Executive Order No. 11246 as amended,and of the rules, regulations, and
relevant orders of the Secretary of Labor.
e. The Contractor will furnish all information and reports required by Federal Executive
Order No. 11246 as amended and the Rehabilitation Act of 1973, and by the rules,
regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit
access to his books, records, and accounts by the contracting agency and the
Secretary of Labor for purposes of investigation to ascertain compliance with such
rules, regulations and orders.
CMS instructiond Bulletin No.02(11/91)
f. In the event of the Contractor's noncompliance with the requirements of this Equal
Opportunity clause or with any federal rules, regulations, or orders which are
referenced in this clause, this contract may be canceled, terminated, or suspended in
whole or in part and the Contractor may be declared ineligible for further federal or
state contracts in accordance with procedures authorized in Federal Executive Order
No. 11246 as amended and such other sanctions may be imposed and remedies
invoked as provided in Federal Executive Order No. 11246 as amended, or by rule,
regulation, or order of the Secretary of Labor, or as otherwise provided by law.
g. The Contractor will include the provisions of paragraphs [a] through [g] in every
subcontract or purchase order unless exempted by rules, regulations, or orders of the
Secretary of Labor issued pursuant to Federal Executive Order No. 11246 as amended,
or Section 503 of the rehabilitation Act of 1973, so that such provisions will be binding
upon each subcontractor or vendor. The Contractor will take such action with
respect to any subcontract or purchase order as the Director of the Office of Federal
Contract Compliance Programs or the State may direct as a means of enforcing such
provisions including sanctions for noncompliance-provided, however, that in the event
the Contractor becomes involved in, or is threatened with, litigation with a
subcontractor or vendor as a result of such direction by the State, the Contractor may
request in writing to the State, who, in turn, may request the United States to enter into
such litigation to protect the interests of the State and of the United States.
2. Travel and Per Diem
Any reimbursement for necessary traveling and per diem shall be at rates not to exceed
those amounts paid to the State's represented employees under collective bargaining
agreements currently in effect. No travel outside the State of California shall be reimbursed
unless prior written authorization is obtained from the State.
3. Procurement Requirement
a. Prior authorization in writing by the State will be required before the Contractor will be
reimbursed for any purchase order or subcontract exceeding $2,500 for any articles,
supplies, equipment, or services or for any fee, or other payment, for consultation of
three hundred fifty dollars ($350) or more per day. The Contractor must provide in its
request for authorization all particulars necessary for evaluation of the necessity or
desirability of incurring such cost, and as to the reasonableness of the price or cost.
For purchases of any said articles, supplies, equipment, services, or for consultant fees
exceeding such minimum amount, three competitive quotations must be submitted
with the request, or the absence of bidding must be adequately justified.
b. If other than the lowest bidder or a sole-source provider is selected, all documents
used in contractor selection must be presented in writing to the State for prior
approval before awarding any contract, and maintained for possible future audit as
specified in paragraph 7 below.
c. The terms "purchase order" and "subcontract" as used in the above paragraph 3a
only, excludes; (a) purchase orders not exceeding $2,500, and (b) subcontracts or
purchase orders for public utility services at rates established for uniform applicability
to the general public.
-2-
ExhW A(F)
4. Standards of Work
The Contractor agrees that the performance of work and services pursuant to the
requirements of this contract shall confirm to high professional standards.
5. Furnishing ofprogg ,y J&the State or Purchase of Propertyity h state or Federal Funds
a. (1) All equipment, material, supplies, or property of any kind purchased from funds
advanced or reimbursed or furnished by the State under the terms of this
contract and not fully consumed in the performance of the contract shall be the
property of the State and shall be subject to the provisions of this paragraph (a),
as well as paragraphs(b), (c),and (d)below.
If the Equipment Line item in the budget or in any other paragraph of this
contract,exceeds$10,000 or more,the provisions of subparagraph b shall apply.
(2) Inventory and Disposition
(a) Contractor shall, at the request of the State, submit an inventory of
equipment furnished or purchased under the terms of this contract. Such
inventory will be required not more frequently than annually.
(b) At the termination of this contract, the Contractor shall provide a final
inventory to the State and shall at that time query the State as to the State's
requirements, including the manner and method, in returning said
equipment to the State. Final disposition of such equipment shall be at state
expense in accordance with instructions from the State to be issued
immediately after receipt of the final inventory.
(3) Motor Vehicles
(a) If, under the provisions of paragraph (2) above, any part of such property is
motor vehicles, the State Office of Procurement shall purchase said motor
vehicles for and on behalf of the Contractor. The provisions of clause (5b)
below are applicable to this paragraph concerning motor vehicles.
(b) If, under the provisions of paragraphs (2) or (3) above, any part of such
property is motor vehicles, the State authorizes the Contractor to use said
motor vehicles under the terms and conditions of this contract for purposes
of this contract only, and in accordance with the provisions of
subparagraphs (c) through (f) below.
(c) It is mutually understood that the State of California shall be the legal owner
of said vehicles and the Contractor shall be the registered owner.
(d) Upon return of such motor vehicles to the State, Contractor shall deliver to
State all necessary documents of title to enable proper transfer of
marketable title to the State.
(e) Contractor agrees that all operators of motor vehicles listed in said
agreement shall hold a valid State of California driver's license. In the event
12 or more passengers are to be carried in any one vehicle listed in said
agreement,a Class 2 driver's license will also be required.
(f) Contractor shall furnish.to the State a certificate of insurance stating that
there is liability insurance presently in effect for the Contractor of not less
than $500,000 per occurrence for bodily injury and property damage liability
combined.
-3-
The certificate of insurance must include provisions(i) and 00,stating that:
W The insurer will not cancel the insured's coverage without 30 days prior
written notice to the State.
(ii) The State of California,its officers, agents, employees, and servants are
included as additional insureds, but only insofar as the operations
under this contract are concerned.
Contractor agrees that the bodily injury liability insurance herein provided
for shall be in effect at all times during the term of this contract. In the event
said insurance coverage expires at any time or times during the term of this
contract, Contractor agrees to provide at least thirty (30) days prior to said
expiration date a new certificate of insurance evidencing insurance
coverage as provided for herein for not less than the remainder of the term
of the contract, or for a period of not less than one (1) year. New
certificates of insurance are subject to the approval of said Department of
General Services, and Contractor agrees that no work or services shall be
performed prior to the giving of such approval. In the event Contractor fails
to keep in effect at all times insurance coverage as herein provided, State
may, in addition to any other remedies it may have, terminate this contract
upon the occurrence of such event.
b. If the Equipment line item budget in this contract is $10,000 or more, the State shall
purchase said equipment through its Office of Procurement. The cost of the
procurement of equipment will be deducted from the contract amount. Contractor
shall submit to the State a separate list of the equipment specifications. State will pay
vendor directly for equipment purchases and title to the equipment will remain with
the State. The equipment will be delivered either to the Contractor's address as
stated in the contract unless notified by the Contractor in writing.
c. (1) Title to state property shall not be affected by the incorporation or attachment
thereof to any property not owned by the State, nor shall such state property, or
any part thereof, be or become a fixture or lose its identity as personality by
reason of affixation to any realty.
(2) Unless otherwise provided herein, the State shall not be under any duty or
obligation to restore or rehabilitate, or to pay the cost of the restoration or
rehabilitation of the Contractor's facility or any portion thereof which is affected
by removal of any state property.
(3) The Contractor shall maintain and administer, in accordance with sound business
practice, a program for the utilization, maintenance, repair, protection, and
preservation of state property so to assure its full availability and usefulness for the
performance of this contract. The Contractor shall take all reasonable steps to
comply with all appropriate directions and instructions which the State may
prescribe as reasonably necessary for the protection of state property.
d. For equipment only. Before equipment purchases made by the Contractor are
reimbursed by the State,the Contractor must submit paid vendor receipts identifying
the purchase price, description of the item, serial number, model number, and
location where equipment will be used during the term of this agreement. Said paid
receipts will be attached to Contractor's invoices submitted to the State.
-4-
Exhibit A(F)
6. Income Restrictions
The Contractor agrees that any refunds, rebates, credits, or other amounts (including any
interest thereon) accruing to or received by the Contractor under this contract shall be
paid by the Contractor to the State, to the extent that they are properly allocable to costs
for which the Contractor has been reimbursed by the State under this contract.
7. Examination of Accounts. Audit. Records. and Subcontract Language
a. The Contractor shall maintain books, records, documents, and other evidence,
accounting procedures, and practices, sufficient to reflect properly all direct and
indirect costs of whatever nature claimed to have been incurred in the performance
of this contract, including any matching costs and expenses. The foregoing
constitutes "records" for the purpose of this clause.
b. The Contractor's facility or office or such part thereof as may be engaged in the
performance of this contract and his records shall be subject at all reasonable times
to inspection, audit, and reproduction by the State or any of its duly authorized
representatives, including the Comptroller General of the United States.
c. The Contractor shall preserve and make available his records (i) for a period of three
years from the date of final payment under this contract, and (ii) for such longer
period, if any, as is required by applicable statute, by any other clause of this contract,
or by subparagraphs (1) or (2) below.
(1) If this contract is completely or partially terminated, the records relating to the
work terminated shall be preserved and made available for a period of three
years from the date of any resulting final settlement.
i
(2) If any litigation, claim, negotiation, audit, or other action involving the records
has been started before the expiration of the three-year period, the records shall
be retained until completion of the action and resolution of all issues which arise
from it, or until the end of the regular three-year period, whichever is later.
d. The Contractor further agrees to include in all his subcontracts hereunder a written
agreement with said subcontractor or vendor, the following clause:
"(Name of Vendor or Subcontractor) agrees to maintain and preserve, until three
years after termination of (Contractor's name) agreement or contract with the State
of California, and to permit the State or any of its duly authorized representatives,
including the Comptroller General of the United States, to have access to and
examine and audit any pertinent books, documents, papers, and records of(name of
subcontractor or vendor) related to this(purchase order or subcontract)."
8. Covenant Against Contingent Fees
The Contractor warrants that no person or selling agency has been employed or retained
to solicit or secure this contract upon an agreement or understanding for a commission,
percentage, brokerage, or contingent fee, excepting bona fide employees or bona fide
established commercial or selling agencies maintained by the Contractor for the purpose
of securing business. For breach or violation of this warranty, the State shall have the right
to annul this contract without liability or in its discretion to deduct from the contract price or
consideration, or otherwise recover, the full amount of such commission, percentage,
brokerage, or contingent fee.
-5-
9. lnsQection
The State, through any authorized representatives, has the right at all reasonable times to
inspect or otherwise evaluate the work performed or being performed hereunder including
subcontract supported activities and the premises in which it is being performed. If any
inspection or evaluation is made by the State of the premises of the Contractor or a
subcontractor, the Contractor shall provide and shall require his subcontractors to provide
all reasonable facilities and assistance for the safety and convenience of the state
representatives in the performance of their duties. All inspections and evaluations shall be
performed in such a manner as will not unduly delay the work.
10. Nondiscrimination in Services. Benefits. and Facilities
a. The Contractor will not discriminate in the provision of services because of race, color,
creed, national origin, sex, age, or physical or mental handicap as provided by state
and federal law.
b. For the purpose of this contract, distinctions on the grounds of race, color, creed,
national origin, sex, age, or physical or mental handicap include, but are not limited
to, the following: denying a participant any service or providing a benefit to a
participant which is different, or is provided in a different manner or at a different time
from that provided to other participants under this contract; subjecting a participant
to segregation or separate treatment in any matter related to his receipt of any
service; restricting a participant in any way in the enjoyment of any advantage or
privilege enjoyed by others receiving any service or benefit; treating a participant
differently from others in determining whether he satisfied any admission, enrollment
quota, eligibility, membership, or other requirement or condition which individuals must
meet in order to be provided any service or benefit; the assignment of times or places
for the provision of services on the basis of the race, color, creed, or national origin of
the participants to be served.
c. The Contractor will take affirmative action to ensure that intended beneficiaries are
provided services without regard to race, color, creed, national origin, sex, age, or
physical or mental handicap.
d. The Contractor agrees that complaints alleging discrimination in the delivery of
services by the Contractor or his or her subcontractor because of race, color, national
origin, creed, sex, age, or physical or mental handicap will be resolved by the State
through the Department of Health Services' Affirmative Action/Discrimination
Compliant Process.
e. The Contractor shall, subject to the approval of the Department of Health Services,
establish procedures under which service participants are informed of their rights to file
a complaint alleging discrimination or a violation of their civil rights with the
Department of Health Services.
f. The Contractor shall operate the program or activity in such a manner that it is readily
accessible to and usable by mentally or physically handicapped persons pursuant to
45 Code of Federal Regulations, Parts 84,Sections 84.21 and 84.22.
g. The Contractor shall keep records, submit required compliance reports, and permit
state access to records in order that the State can determine compliance with the
nondiscrimination requirements pursuant to 45 Code of Federal regulations, Parts 80,
84, and 90, Sections 80.6, 84.61, and 90.42.
-6-
Exhibit A(F)
1 1. Final Invoice—Final Report—Retention of Funds
If a final report is required by this contract, TO percent of the face amount of the contract
or 50 percent of the final invoice, whichever is the larger amount, but not to exceed $3,000,
shall be withheld until after receipt by the State of a report satisfactory to the State.
12. Officials Not to Benefit
No member of or delegate to Congress or the State Legislature shall be admitted to any
share or part of this contract, or to any benefit that may arise therefrom; but this provision
shall not be construed to extend to this contract if made with a corporation for its general
benefit.
13. Rights in Data
a. Subject Data. As used in this clause, the term "Subject Data" means writings, sound
recordings, pictorial reproductions, drawings, designs or graphic representations,
procedural manuals, forms, diagrams, work flow charts, equipment descriptions, data
files and data processing or computer programs, and works of any similar nature
(whether or not copyrighted or copyrightable) which are first produced or developed
under this contract. The term does not include financial reports, cost analyses, and
similar information incidental to contract administration.
b. Federal Government and State Rights. Subject only to the provisions of "c" below, the
Federal Government and State may use, duplicate, or disclose in any manner and for
any purpose whatsoever, and have or permit others to do so, all Subject Data
delivered under this contract.
c. License to Copyrighted Data. In addition to the Federal Government and State rights
as provided in [b] above, with respect to any subject data which may be
copyrighted, the Contractor agrees to and does hereby grant to the Federal
Government and State a royalty-free, nonexclusive and irrevocable license
throughout the world to use, duplicate, or dispose of such data in any manner for
State or Federal Government purposes and to have or permit others to do so.
Provided, however, that such license shall be only to the extent that Contractor now
has, or prior to completion or final settlement of this contract may acquire, the right to
grant such license without becoming liable to pay compensation to others solely
because of such grant.
d. Relation to Patents. The State reserves a license on patent rights in any contract
involving research or developmental, experimental, or demonstration work with
respect to any discovery or invention which arises under this contract.
e. Marking and Identification. The Contractor shall mark all Subject Data with the
number of this contract and the name and address of the contractor or
subcontractor who generated the data. The Contractor shall not affix any restrictive
markings upon any Subject Data, and if such markings are affixed, the Federal
Government or State shall have the right at any time to modify, remove, obliterate, or
Ignore any such markings.
f. Subcontractor Data. Whenever any Subject Data is to be obtained from a
subcontractor under this contract, the Contractor shall use this some clause in
subcontract without alteration, and no other clause shall be used to enlarge or
diminish the Federal Government's or State's rights in the subcontractor Subject Data.
-7-
g. Deferred Ordering and Delivery of Data. The Federal Government or State shall have
the right to order, at any time during the performance of this contract, or within two
years from either acceptance of all items (other than data) to be delivered under this
contract or termination of this contract, whichever is later, any Subject Data and any
data not called for in the schedule of this contract but generated in performance of
the contract, and the Contractor shall promptly prepare and deliver such data as is
ordered. If the principal investigator is no longer associated with the Contractor, the
Contractor shall exercise its best efforts to prepare and deliver such data as is ordered.
The Federal Government's or State's right to use data delivered pursuant to this
paragraph (g) shall be the same as the rights in Subject Data as provided in "b"
above. The Contractor shall be relieved of obligation to furnish data pertaining to an
item obtained from a subcontractor upon the expiration of two years from the date
he accepts such items. When data, other than Subject Data, is delivered pursuant to
this paragraph (g), payment shall be made, by equitable adjustment or otherwise, for
converting the data into the prescribed form, reproducing it or preparing it for
delivery. The terms of such payment shall be agreed upon in writing by the
Contractor and the State and/or Federal Government, whichever ordered the
production of the data.
14. Disabled Veterans and Veterans of the Vietnam Era
a. The Contractor will not discriminate against any employee or applicant for
employment because he or she is a disabled veteran or veteran of the Vietnam era in
regard to any position for which the employee or applicant for employment is
qualified. The Contractor agrees to take affirmative action to employ, advance in
employment, and otherwise treat qualified disabled veterans and veterans of the
Vietnam era without discrimination based upon their disability or veterans status in all
employment practices such as the following: employment upgrading, demotion or
transfer, recruitment, advertising, layoff or termination, rates of pay or other forms of
compensation, and selection for training, including apprenticeship.
b. The Contractor agrees that all suitable employment openings of the Contractor which
exist at the time of the execution of this contract and those which occur during the
performance of this contract, including those not generated by this contract and
Including those occurring at an establishment of the Contractor other than the one
wherein the contract is being performed but excluding those of independently
operated corporate affiliates, shall be listed at an appropriate local office of the state
employment service system wherein the opening occurs. The Contractor further
agrees to provide such reports to such local office regarding employment openings
and hires as may be required.
State and local government agencies holding federal contracts of $10,000 or more
shall also list all their suitable openings with the appropriate office of the state
employment service, but are not required to provide those reports set forth in
paragraphs "d" and "e".
c. Listing of employment openings with the employment service system pursuant to this
clause shall be made at least concurrently with the use of any other recruitment
source or effort and shall involve the normal obligations which attach to the placing
of bona fide job order, including the acceptance of referrals of veterans and
nonveterans. The listing of employment openings does not require the hiring of any
particular job applicant or from any particular group of job applicants, and nothing
herein is intended to relieve the Contractor from any requirements in Executive Orders
or regulations regarding nondiscrimination in employment:
-8-
Exhibit A(F)
d. The reports required by paragraph "b" of this clause shall include, but not be limited to,
periodic reports which shall be filed at least quarterly with the appropriate local office
or, where the Contractor has more than one hiring location in a State, with the central
office of that state employment service. Such reports shall indicate for each hiring
location (1) the number of individuals hired during the reporting period, (2) the
number of nondisabled veterans of the Vietnam era hired, (3) the number of disabled
veterans of the Vietnam era hired, and (4) the total number of disabled veterans
hired. The reports should include covered veterans hired for the on-the-job training
under 39 U.S.C. 1787. The Contractor shall submit a report within 30 days after the end
of each reporting period wherein any performance is made on this contract
identifying data for each hiring location. The Contractor shall maintain at each hiring
location copies of the reports submitted until the expiration of one year after final
payment under the contract, during which time these reports and related
documentation shall be made available, upon request, for examination by any
authorized representatives of the Federal Contracting Officer, the State, or the
Secretary of Labor. Documentation would include personnel records respecting job
openings, recruitment, and placement.
e. Whenever the Contractor becomes contractually bound to the listing provisions of this
clause, it shall advise the employment service system in each state where it has
establishments of the name and location of each hiring location in the state. As long
as the Contractor is contractually bound to these provisions and has so advised the
state system, there is no need to advise the state system of subsequent contracts. The
Contractor may advise the state system when it is no longer bound by this contract
clause.
f. This clause does not apply to the listing of employment openings which occur and are
filled outside the 50 states, the District of Columbia, Puerto Rico, Guam, and the
Virgin Islands.
g. The provisions of paragraphs "b", "c", "d", and "e" of this clause do not apply to
openings which the Contractor proposes to fill from within his own organization or to fill
pursuant to a customary and traditional employer-union hiring arrangement. This
exclusion does not apply to a particular opening once an employer decides to
consider applicants outside of his own organization or employer-union arrangement
for that opening.
h. As used in this clause:
(1) "All suitable employment openings" includes, but is not limited to, openings which
occur in the following job categories: production and nonproduction: plant and
office; laborers and mechanics; supervisory and nonsupervisory; technical and
executive, administrative, and professional openings that are compensated on a
salary basis of less than $25,000 per year. This term includes full-time employment,
temporary employment of more than three days' duration, and part-time
employment. It does not include openings which the Contractor proposes to fill
from within his own organization or to fill pursuant to a customary and traditional
employer-union hiring arrangement nor openings in an educational institution
which are restricted to students of that institution. Under the most compelling
circumstances, an employment opening may not be suitable for listing, including
such situations where the needs of the Federal Government cannot reasonably
be otherwise supplied, where listing would be contrary to national security, or
where the requirement of listing would otherwise not be for the best interest of
the Federal Government.
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(2) "Appropriate office of the state employment service system" means the local
office of the federal/state national system of public employment offices with
assigned responsibility for serving the area where the employment opening is to
be filled, including the District of Columbia, Guam, Puerto Rico, and the
Virgin Islands.
(3) "Openings which the Contractor proposes to fill from within his own organization"
means employment openings for which no consideration will be given to persons
outside the Contractor's organization (including any affiliates, subsidiaries, and
the parent companies) and includes any openings which the Contractor
proposes to fill from regularly established "recall" lists.
(4) "Openings which the Contractor proposes to fill pursuant to a customary and
traditional employer-union hiring arrangement" means employment openings
which the contractor proposes to fill from union halls which is part of the
customary and traditional hiring relationship which exists between the Contractor
and representatives of his employees.
I. The Contractor agrees to comply with the rules, regulations, and relevant orders of the
Federal Secretary of Labor issued pursuant to the Act.
j. In the event of the Contractor's noncompliance with the requirements of this clause,
actions for noncompliance may be taken in accordance with the rules, regulations,
and relevant orders of the Federal Secretary of Labor issued pursuant to the Act.
k. The Contractor agrees to post in conspicuous places available to employees and
applicants for employment notices in a form to be prescribed by the Director of the
Office of Federal Contract Compliance Programs, provided by or through the
contracting Officers or State. Such notices shall state the Contractor's obligation
under the law to take affirmative action to employ and advance in employment
qualified disabled veterans and veterans of the Vietnam era for employment, and the
rights of applicants and employees.
I. The Contractor will notify each labor union or representative of workers with which it
has a collective bargaining agreement or other contract understanding that the
Contractor is bound by terms of the Vietnam Era Veteran's Readjustment Assistance
Act and is committed to take affirmative action to employ and advance in
employment qualified disabled veterans and veterans of the Vietnam era.
m. The Contractor will include the provisions of this clause in every subcontract or
purchase order of $10,000 or more unless exempted by rules, regulations, or orders of
the Federal Secretary of Labor issued pursuant to the Act, so that such provisions will
be binding upon each subcontractor or vendor. The Contractor will take such action
with respect to any subcontract or purchase order as the Director of the Office of
Federal Contract Compliance Programs may direct to enforce such provisions,
including action for noncompliance.
15. Clean Air and Water
a. (Applicable only if the contract is not with a sole source vendor of products or
services, or if it exceeds$5,000.)
The Contractor agrees under penalty of perjury (it,he,she) is not in violation of any
order or resolution which is not subject to review promulgated by the State Air
Resources Board or an air pollution district.
-10-
' Exhibit A(F)
The Contractor agrees under penalty or perjury (it, he, she) is not subject to cease and
desist order which is not subject to review issued pursuant to Section 13301 of the
Water Code for violation of waste discharge requirements or discharge prohibitions, or
is not finally determined to be in violation of provisions of federal law relating to air or
water pollution.
b. (Applicable only if the contract or subcontract exceeds $100,000 or the contract is not
otherwise exempt under 40 CFR 15.5.)
The Contractor agrees as follows:
(1) To comply with all the requirements of Section 114 of the Clean Air act as
amended (42 U.S.C. 7401 et seq., as amended by Public Law 95-95), and section
308 of the Federal Water Pollution Control Act (33 U.S.C. 1251 et seq., as
amended by Public Law 92-500),respectively, relating to inspection, monitoring,
entry, reports, and information, as well as all other requirements specified in
Section 114 and Section 308 of the Air Act and the Water Act, respectively, and
all regulations and guidelines issued to implement those Acts before the award of
this contract.
(2) That no portion of the work required by this contract will be performed in a facility
listed on the Environmental Protection Agency List of Violating Facilities on the
date when this contract was awarded unless and until the Environmental
Protection Agency eliminates the name of such facility or facilities from such
listing.
(3) To use his best efforts to comply with clean air standards and clean water
standards at the facility in which the contract is being performed. The terms used
in this paragraph have the following meanings:
(a) The term "clean air standards" means any enforceable rules, regulations,
guidelines standards, limitations, orders, controls, or prohibitions or other
requirements which are contained in, issued under, or adopted pursuant to
the.Clean Air Act.
(b) The term "clean water standards" means any enforceable limitation, control,
condition, prohibition, standard, or another requirement which is
promulgated pursuant to the Clean Water Actor contained in a permit
issued to a discharger by EPA or by the State under an approved program
as authorized by Section 402 of the Clean Water Act (33 U.S.C. 1342), or by
a local government to ensure compliance with pretreatment regulations as
required by Section 307 of the Clean Water Act (33 U.S.C. 1317), and
regulations issued pursuant thereto.
(c) In addition to compliance with clean air and water standards, the term
compliance shall also mean compliance with a schedule or plan ordered or
approved by a court of competent jurisdiction, the Environmental Protection
Agency, or an air or water pollution control agency in accordance with the
requirements of the Clean Air Act and the Federal Water Pollution Control
Act.
(4) As a condition for the award of a contract the applicant or contractor shall notify
the State of the receipt of any communication from the Assistant Administrator
for Enforcement, U.S. EPA indicating that a facility to be utilized for the contract is
under consideration to be listed on the EPA List of Violating Facilities. Prompt
notification shall be required prior to contract award.
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(5) To report violations to the State and to the Assistant Administrator for
Enforcement.
(6) To insert the substance of the provisions of paragraph [b] into any nonexempt
subcontract, including this paragraph [b6], and to take such action as the
Federal.Government may direct as a means of enforcing such provisions.
16. Utilization of Small Business and Minority and Women Owned Business Enterprise
a. It is a federal policy to award a fair share of contracts to small, minority, and women
owned business firms. The State Legislature has declared that a fair proportion of the
total purchases and contracts or subcontracts for property and services for the State
be placed with small minority and women owned business enterprises.
b. A firm shall qualify as a small business if it meets the requirements specified in
Government Code Section 14837.
c. The Contractor hereby agrees to carry out this policy in the awarding of subcontracts
to the fullest extent consistent with efficient contract performance. As used in this
contract, the term "minority business enterprise" means a business concern (1) which is
at least 51 percent owned by one or more minority group members or women, or in
the case of publicly owned business, at least 51 percent of the stock of which is
owned by one or more minority group members or women; and (2) whose
management and daily business operations are controlled by one or more such
individuals. A minority group member is a person who is Black, Asian, Hispanic, Filipino,
Polynesian, American Indian, or Alaskan Native. "Control," as used in this clause, means
exercising the power to make policy decisions.
d. Contractors acting in good faith may rely on written representations by their
subcontractors regarding their status as minority business enterprises in lieu of an
independent investigation.
17. Printing
If Printing or other reproduction work of more than an incidental and minor dollar amount is
a reimbursable item in this contract, it shall be printed or produced by the State Printer. The
State Printer may, at his sole option, elect to forego said work and delegate the work to the
private sector. If the State Printer prints or produces said work, or the State obtains the
printing or other work through the Office of State Procurement, the cost will be deducted
from said contract amount. This requirement does not apply to normal in-house copying
necessary for routine business matters of the Contractor.
18. prior Approval of Training Seminars. Workshops, or Conferences
Contractor shall obtain prior state approval over the location, costs, dates, agenda, instructors,
instructional materials, and attendees at any reimbursable training seminar, workshop or conference,
and over any reimbursable publicity or educational materials to be made available for distribution.
The Contractor shag acknowledge the support of the State whenever publicizing the work under the
contract in any media. This paragraph does not apply to necessary staff meetings to conduct routine
business matters.
-12-
• Exhibit A(F)
19. Confidentiality of Informaflon
a. The Contractor and his or her employees agents, or subcontractors shall protect from
unauthorized disclosure names and other identifying information concerning persons
either receiving services pursuant to this contract or persons whose names or
identifying information become available or are disclosed to the Contractor, his/her
employees, agents, or subcontractors as a result of services performed under this
contract, except for statistical information not identifying any such person.
b. The Contractor, his/her employees, agents, or subcontractors shall not use such
identifying information for any purpose other than carrying out the Contractor's
obligations under this contract.
c. The Contractor, his/her employees, agents, or subcontractors shall promptly transmit
to the State all requests for disclosure of such identifying information not emanating
from the client or person.
d. The Contractor shall not disclose, except as otherwise specifically permitted by this
contract or authorized by the client, any such identifying information to anyone other
than the State without prior written authorization from the State.
e. For purposes of this paragraph, identity shall include, but not be limited to, name,
identifying number, symbol, or other identifying particular assigned to the individual,
such as finger or voice print or a photograph.
20. National Labor Relations Board Certification
(not appiicabie if Contractor is a public entity.)
Contractor, by signing this agreement, does swear under penalty of perjury that no more
than one final unappealabfe finding of contempt of court by a federal court has been
issued against Contractor within the immediately preceding two-year period because of
the Contractor's failure to comply with an order of a federal court which orders the
Contractor to comply with an order of the National Labor Relations Board.
21. Documents and Written Reports
Any document or written report prepared as a requirement of this agreement shall contain,
in a separate section preceding the main body of the document, the number and dollar
amounts of all contracts and subcontracts relating to the preparation of such document or
report, if the total cost for work by nonemployees of the State exceeds $5.,000..
22. Resolution of Direct Service Contract Disputes
a. If the Contractor believes there is a dispute or grievance between the Contractor and
the State, the procedures set forth in Chapter 2.1, Sections 20201 through 20205, of
Title 22, of the California Code of Regulations, shall be followed.
b. if the Contractor wishes to appeal the decision of the Deputy Director for Public
Health or his/her designee, the Contractor shall follow the procedures set forth in
Division 25.1 (commencing with Section 38050) of the Health and Safety Code and
the regulations adopted thereunder. (Title 1, Subchapter 2.5 commencing with
Section 251, California Code of Regulations.)
-13-
c. Disputes arising out of an audit or examination of a contract not covered by subdivision
(a) of Section 20204, of Chapter 2.1, Title 22, of the California Code of Regulations, and
for which no procedures for appeal are provided in statute, regulation or the contract
shall be handled in accordance with the procedures identified in Sections 51016
through 51047,Title 22,California Code of Regulations.
23. Fnanclal and Compliance Audit of Nonprofit Entitles
(Applicable only if Contractor is a private, nonprofit entity)
a. Definitions within this paragraph are defined in Section 38040 of the Health and Safety
Code,which,by this reference,is made a part hereof.
b. Contractor agrees to obtain an annual single, organization wide, financial and
compliance audit. The audit shall be conducted in accordance with the requirements
specified in the Federal Office of Management and the Budget (OMB) Circular A-133,
"Audits of Institutions of Higher Education and Other Nonprofit Organizations."
c. References to "Federal" in OMB Circular A-133 shall be considered to man "Federal
and/or State" in contracts where State funds are present either alone or in conjunction
with Federal funds.
d. The audit shall be completed by the 15th day of the fifth month following the end of the
Contractor's fiscal year. Two copies of the audit report shall be delivered to the State
program funding this contract. The report shall be due within 30 days after the
completion of the audit.
e. If the contractor receives less than $25,000 per year from the State, the audit shall be
conducted biennially, unless there is evidence of fraud or other violation of state law in
connection with this contract. This requirement takes precedence over the OMB A-133
section which exempts from Federal audit requirements any nonprofit institution
receiving less than $25,000 per year.
f. The cost of such audit may be included in the funding for this contract up to the
proportionate amount this contract represents of the Contractor's total revenue.
g. The State, or its authorized designee including the Auditor-General, is responsible for
conducting contract performance audits which are not financial and compliance
audits.
h. Nothing in this contract limits the State's responsibility or authority to enforce State law or
regulations, procedures,or reporting requirements arising pursuant thereto.
I. Nothing in this paragraph limits the authority of the State to make audits of this contract,
provided however, that if independent audits arranged for by Contractor meet
generally accepted governmental auditing standards, the State shall rely on those
audits and any additional audit work shall build upon the work already done.
j. The State may, at its option, direct its own auditors to perform the single audit described
in OMB Circular A-133. The State's auditors shall meet the independence standards
specified in Government Auditing Standards. The audit shall be conducted in
accordance with OMB Circular A-133 so as to satisfy all State and Federal requirements
for a single organization wide audit.
24. Contract Amendments
a. This contract may be amended by mutual agreement between the parties and, if
required by Government Code, Section 11010.5, or Public Contract Code, Section
10355,the amendment shall be subject to the approval of the Department of General
Services,unless otherwise exempted.
-14-
' Exhibit A(F)
b. If any amendment to this contract has the effect of increasing the monetary amount
of the contract or an agreement by the State to indemnify or save harmless the
Contractor, his agents or employees, the amendment shall be approved by the
Department of General Services, unless otherwise exempted.
25. Evaluation of Contractors
The Contractor's performance under this contract shall be evaluated at the conclusion of
the term of this contract. The evaluation shall include, but not be limited to:
a. Whether the contracted work or services were completed as specified in the contract
and reasons for and amount of any cost overruns.
b. Whether the contracted work or services met the quality standards specified in the
contract.
c. Whether the Contractor fulfilled all requirements of the contract.
d. Factors outside the control of the Contractor which caused difficulties in Contractor
performance. The evaluation of the Contractor shall not be a public record.
26. Conflict of Interest—Current and Former Strata Fmj2loyees
a. Current State Officers and Employees
(1) Contractor shall not utilize in the performance of this contract any state officer or
employee in the state civil service or other appointed state official unless the
employment, activity, or enterprise is required as a condition of the officer or
employee's regular state employment. Employee in the state civil service is
defined to be any person legally holding a permanent or intermittent position in
the state civil service,
(2) If any state officer or employee is utilized or employed in the performance of this
contract, Contractor shall first obtain written verification from the State that the
employment, activity, or enterprise is required as a condition of the officer's,
employee's, or official's regular state employment and shall keep said verification
on file for three years after the termination of this contract.
(3) Contractor may not accept occasional work from any currently employed state
officer, employee, or official.
(4) If Contractor accepts volunteer work from any currently employed State officer,
employee, or official, Contractor may not reimburse, or otherwise pay or
compensate, such person for expenses incurred, including, without limitation,
travel expenses, per diem, or the like, in connection with volunteer work on
behalf of contractor.
(5) Contractor shall not employ any state officers, employees, or officials who are on
paid or unpaid leave of absence from their regular state employment.
(6) Contractor or anyone having a financial interest in this contract may not
become a state officer, employee, or official during the term of this contract.
Contractor shall notify each of its employees, and any other person having a
financial interest in this contract that it is unlawful under Public Contract Code,
Section 10410 for such person to become a state officer, employee, or official
during the term of this contract unless any relationship with the Contractor giving
rise to a financial interest, as an employee or otherwise, is first terminated.
-15-
(7) Occasional or one-time reimbursement of a state employee's travel expenses is
not acceptable.
(Citation: Public Contract Code, Section 10410)
b. Former State Officers and Employees
(1) Contractor shall not utilize in the performance of this contract any formerly
employed person of any state agency or department that was employed under
the state civil service, or otherwise appointed to serve in.the State Government, if
that person was engaged in any negotiations, transactions, planning,
arrangement, or any part of the decision-making process relevant to the
contract while employed in any capacity by any state agency or department.
This prohibition shall apply for a two-year period beginning on the date the
person left state employment.
(2) Contractor shall not utilize within 12 months from the date of separation of
services, a former employee of the contracting state agency or department if
that former employee was employed in a policy making position in the same
general subject area as the proposed contract within the 12-month period prior
to the employee leaving state service.
(Citation: Public Contract Code, Section 1041 1)
c. Failure to Comply with Subparts "a" or"b"
(1) If Contractor violates any provision of Subparts "a" or "b" above, such action by
Contractor shall render this contract void, unless the violation is technical or
nonsubstontive.
(Citation: Public Contract Code, Section 10420)
27. Single Audit Act of 1984 (applicable only if Contractor is a governmental entity)
In accordance with Public Law 98-502 and OMB Circular A-128, it is stipulated between the
parties hereto that:
a. The cost of the single audit will be charged to the federal assistance program
providing funds for this agreement on a "Fair Share" basis. The amount chargeable to
federal assistance programs for the cost of the single audit is calculated based on the
ratio of federal expenditures to total expenditures of the Contractor. The State's share
of the single audit cost under this contract is based upon the ratio of federal funds
received under this agreement to total federal funds received by the Contractor
each fiscal year.
b. The Contractor shall include a clause in any contract the Contractor enters into with
the audit firm doing the single audit to provide access by the State or Federal
Government to the working papers of the independent auditor who prepares the
single audit for the.Contractor.
c. Federal or State auditors shall have "expanded scope auditing" authority to conduct
specific program audits during the same period in which a single audit is being
performed, but the audit report has not been issued. The federal or state auditors
shall review and have access to the current audit work being conducted and will not
apply any testing or review procedures which have not been satisfied by previous
audit work that has been completed.
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EAibit A(F)
The term "expanded scope auditing' is applied and defined in the U.S. General
Accounting Office (GAO) issued Standards for Audit of Governmental Organizations,
Programs,Activities and Functions,better known as the 'yellow book.'
28. Contractor Name Change
Contractor shall provide written notice to the State at least 30 days prior to any changes to
the Contractor's current legal name.
29. Novation
If the Contractor proposes any novation agreement,the State shall act upon the proposal
within 60 days after receipt of the written proposal. The State may review and consider the
proposal,consult and negotiate with the Contractor, and accept or reject all or part of the
proposal. Acceptance or rejection may be made orally within the 60 day period, and
confirmed in writing within five days.
30. Drug-Free Workplace
Contractor certifies to the State that it will provide a drug-free workplace by doing all of
the following:
a. Publishing a statement notifying employees that the unlawful manufacture,
distribution, dispensation, possession, or use of a controlled substance is prohibited in
the person's or organization's workplace and specifying the actions that will be taken
against employees for violations of the prohibition.
b. Establishing a drug-free awareness program to inform employees about all of the
following:
(1) The dangers of drug abuse in the workplace.
(2) The person's or organization's policy of maintaining a drug-free workplace.
(3) Any available drug counseling, rehabilitation, and employee assistance
programs.
(4) The penalties that may be imposed upon employees for drug abuse violations.
c. Requiring that each employee engaged in the performance of the contract or grant
be given a copy of the statement required by subdivision (a) and that,as a condition
of employment on the contract or grant,the employee agrees to abide by the terms
of the statement.
d. Contractor agrees this contract may be subject to suspension of payments or
termination of this contract,or both,and the contractor may be subject to debarment,
in accordance with the requirements of the Government Code Section 8350, et seq., if
the Department determines that any of the following has occurred:
(1) The contractor or grantee has made a false certification.
(2) The contractor violates the certification by failing to carry out the requirements of
subdivisions(a)through(c)above.
-17-
31. Debarment and Suspension Requirements
Contractor agrees to comply with the debarment and suspension requirements as found in
7 Code of Federal Regulations,Part 3017,or as amended.
32. LIMITATIONS ON PAYMENTS TO INFLUENCE
CERTAIN FEDERAL ACTIONS AND RELATED DISCLOSURES
(a) Definitions. As used in this Exhibit,
"Agency," as defined in 5 U.S.C. 552(f), includes Federal executive departments and
agencies as well as independent regulatory commissions and Government
corporations, as defined in 31 U.S.C. 9101(1).
"Covered Federal action" means any of the following Federal actions:
(1) The awarding of any Federal contract;
(2) The making of any Federal grant;
(3) The making of any Federal loan;
(4) The entering into of any cooperative agreement; and
(5) The extension, continuation, renewal, amendment, or modification of any
Federal contract,grant, loan,or cooperative agreement.
Covered Federal action does not include receiving from an agency a commitment
providing for the United States to insure of guarantee a loan.
"Indian tribe" and "tribal organization" have the meaning provided in section 4 of the
Indian Self-Determination and Education Assistance Act (25 U.S.C. 450B). Alaskan
Natives are included under the definitions of Indian tribes in the Act.
"Influencing or attempting to influence" means making, with the intent to influence,
any communication to or appearance before an officer or employee of any agency,
a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress,in connection with any covered Federal action.
"Local government" means a unit of government in a State and, if chartered,
established, or otherwise recognized by a State for the performance of a government
duty, including a local public authority, a special district, an intrastate district, a
council of governments, a sponsor group representative organization, and any other
instrumentality of a local government.
"Officer or employee of an agency" includes the following individuals who are
employed by an agency:
(1) An individual who is appointed to a position in the Government under title 5,
U. S. Code, including a position under a temporary appointment;
(2) A member of the uniformed services as defined in section 101(3), title 37,
U. S. Code;
(3) A special government employee as defined in section 202, title 18, U. S. Code;
and
(4) An individual who is a member of a Federal advisory committee, as defined by
the Federal Advisory Committee Act,title 5,U. S. Code,Appendix 2.
-18-
"Person" means an individual, corporation, company, association, authority, firm,
partnership, society, State, and local government, regardless of whether such entity is
operated for profit or not for profit. This term excludes an Indian tribe, tribal
organization, or any other Indian organization with respect to expenditures specifically
permitted by other Federal law.
"Reasonable compensation" means, with respect to a regularly employeed officer or
employee of any person, compensation that is consistent with the normal
compensation for such officer or employee for work that is not furnished to, not
funded by,or not furnished in cooperation with the Federal Government.
"Reasonable payment" means, with respect to professional and other technical
services, a payment in an amount that is consistent with the amount normally paid for
such services in the private sector.
"Recipient" includes the Contractor or Grantee, and all subcontractors or subgrantees
at any tier in connection with a Federal contract, grant, or other Federally funded
activity. The term excludes an Indian tribe, tribal or ganization, or any other Indian
organization with respect to expenditures specifically permitted by other Federal law.
"Regularly employed" means, with respect to an officer or employee of a person
requesting or receiving a Federal contract, an officer or employee who is employed
by such person for at least 130 working days within 1 year immediately preceding the
date of the submission that initiates agency consideration of such person for receipt of
such contract. An officer or employee who is employed by such person for less than
130 working days within 1 year immediately preceding the date of the submission that
initiates agency consideration of such person shall be considered to be regularly
employed as soon as he or she is employed by such person for 130 working days.
"State" means a State of the United States, the District of Columbia, the
Commonwealth of Puerto Rico, a territory or possession of the United States, an
agency or instrumentality of a State, and a multi-State, regional, or interstate entity
having governmental duties and powers.
b Prohibition.
(1) Section 1352 of title 31, U. S. Code provides in part that no appropriated funds
may be expended by the recipient of a Federal contract, grant, loan, or
cooperative agreement to pay any person for influencing or attempting to
influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in
connection with any of the following covered Federal actions: The awarding of
any Federal contract, the making of any Federal grant, the making of any
Federal loan, entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any Federal contract,
grant, loan, or cooperative agreement.
(2) The prohibition does not apply as follows:
(i) Agency and legislative liaison by Own Employees.
(A) The prohibition on the use of appropriated funds, in paragraph (b)(1),
does not apply in the case of.a payment of reasonable compensation
made to an officer or employee of a person requesting or receiving a
Federal contract if the payment is for agency and legislative liaison
activities not directly related to a covered Federal action.
-19-
(B) For purposes of paragraph (b)(2)(i)(A), providing any information
specifically requested by an agency or Congress is allowable at any
time.
(C) For purposes of paragraph (b)(2)(i)(A) of this section, the following
agency and legislative liaison activities are allowable at any time only
where they are not related to a specific solicitation for any covered
Federal action:
() Discussing with any agency (including individual demonstrations)
the qualities and characteristics of the person's products or
services,conditions or terms of sale,and service capabilities; and,
(ii) Technical discussions and other activities regarding the
application or adaptation of the person's products or services for
an agency's use.
(D) For purposes of paragraph (b)(2)(i)(A) of this section, the following
agency and legislative liaison activities are allowable only where they
are prior to formal solicitation of any covered Federal action:
(i) Providing any information not specifically requested but necessary
for an agency to make an informed decision about initiation of a
covered Federal action;
(ii) Technical discussions regarding the preparation of an unsolicited
proposal prior to its official submission; and,
(iii) Capability presentations by persons seeking awards from an
agency pursuant to the provisions of the Small Business Act, as
amended by Public Law 95-507 and other subsequent
amendments.
(E) Only those activities expressly authorized by paragraph (b)(2)(i) are
allowable under paragraph(b)(2)(i).
(ii) Professional and technical services by Own Employees.
(A) The prohibition on the use of appropriated funds, in paragraph (b)(1),
does not apply in the case of any reasonable payment of reasonable
compensation made to an officer or employee of a person requesting
or receiving a Federal contract or an extension, continuation, renewal,
amendment, or modification of a Federal contract if payment is for
professional or technical services rendered directly in the preparation,
submission or negotiation of any bid, proposal, or application for that
Federal contract or for meeting requirements imposed by or pursuant
to law as a condition for receiving that Federal contract.
-20-
J
, 1
(B) For purposes of paragraph (b)(2)(Ii)(A), "professional and technical
services" shall be limited to advice an analysis directly applying any
professional or technical discipline. For example, drafting of a legal
document accompanying a bid or proposal by a lawyer is allowable.
Similarly, technical advice provided by an engineer on the
performance or operational capability of a piece of equipment
rendered directly in the negotiation of a contract is allowable.
However, communications with the intent to influence made by a
professional (such as a licensed lawyer) or a technical person (such as
a licensed accountant) are not allowable under this section unless they
provide advice and analysis directly applying their professional or
technical expertise and unless the advice or analysis is rendered
directly and solely in the preparation, submission or negotiation of a
covered Federal action. thus, for example, communications with the
intent to influence made by a lawyer that do not provide legal advice
and analysis directly and solely related to the legal aspects of his or her
client's proposal, but generally advocate one proposal over another
are not allowable under this section because the lawyer is not
providing professional legal services. Similarly,communications with the
intent to influence made by an engineer providing an engineering
analysis prior to the preparation or submission of a bid or proposal are
not allowable under this section since the engineer is providing
technical services but not directly in the preparation, submission or
negotiation of a covered Federal action.
(C) Requirements imposed by or pursuant to law as a condition for
receiving a covered Federal award include those required by law or
regulation,or reasonably expected to be required by law or regulation,
and any other requirements in the actual award documents.
(D) Only those services expressly authorized by paragraph (b)(2)(ii) are
allowable under paragraph (b)(2)(ii).
(iii) Reporting for Own Employees.
No reporting is required with respect to payments of reasonable
compensation made to regularly employed officers or employees of a
person.
(iv) Professional and technical services by Other than Own Employees.
(A) The prohibition on the use of appropriated funds, in paragraph (b)(1),
does not apply in the case of any reasonable payment to a person,
other than an officer or employee of a person requesting or receiving a
covered Federal action, if the payment is for professional or technical
services rendered directly in the preparation,submission,or negotiation
of any bid, proposal, or application for that Federal contract or for
meeting requirements imposed by or pursuant to law as a condition for
receiving that Federal contract.
-21-
(B) For purposes of paragraph (b)(2)(iv)(A), "professional and techni-al
services" shall be limited to advice and analysis directly applying any
professional or technical discipline. For example, drafting of a legal
document accompanying a bid or proposal by a lawyer is allowable.
Similarly, technical advice provided by an engineer on the
performance or operational capability of a piece of equipment
rendered directly in the negotiation of a contract is allowable.
However, communications with the intent to influence made by a
professional (such as a licensed lawyer) or a technical person (such as
a licensed accountant) are not allowable under this section unless they
provide advice and analysis directly applying their professional or
technical expertise and unless the advice or analysis is rendered
directly and solely in the preparation, submission or negotiation of a
covered Federal action. Thus, for example, communications with the
intent to influence made by a lawyer that do not provide legal advice
or analysis directly and solely related to the legal aspects.of his or her
client's proposal, but generally advocate one proposal over another
are not allowable under this section because the lawyer is not
providing professional legal services. Similarly,communications with the
intent to influence made by an engineer providing an engineering
analysis prior to the preparation or submission of a bid or proposal are
not allowable under this section since the engineer is providing
technical services but not directly in the preparation, submission or
negotiation of a covered Federal action.
(C) Requirements imposed by or pursuant to law as a condition for
receiving a covered Federal award include those required by law or
regulation,or reasonably expected to be required by law or regulation,
and any other requirements in the actual award documents.
(D) Persons other than officers or employees of a person requesting or
receiving a covered Federal action include consultants and trade
associations.
(E) Only those services expressly authorized by paragraph (b)(2)(iv) of this
section are allowable under paragraph (b)(2)(iv).
(v) The prohibition on use of Federal appropriated funds does not apply to
influencing activities not in connection with a specific covered Federal
action. These activities include those related to legislation and regulations
for a program versus a specific covered Federal action.
(55 Fed. Reg. 24542 (June 15, 1990).)
(c) Certification and Disclosure.
(1) Each person (or recipient) who requests or receives a contract, subcontract,
grant,or subgrant,which is subject to section 1352 of title 31, United States Code,
and which exceeds $100M at any tier, shall file a certification (in the form set
forth in Attachment 1, consisting of one page, entitled "Certification Regarding
Lobbing") that the recipient has not made, and will not make, any payment
prohibited by paragraph(b) of this Exhibit.
-22-
(2) Each recipient shall file a disclosure (in the form set forth in Attachment 2
consisting of three pages, entitled "Standard Form-LLL-"Disclosure of Lobbying
Activities") if such recipient has made or has agreed to make any payment using
nonappropriated funds (to include profits from any covered Federal action) in
connection with a contract or grant or any extension or amendment of that
contract or grant,which would be prohibited under paragraph (b) of this Exhibit
if paid for with appropriated funds.
(3) Each recipient shall file a disclosure form at the end of each calendar quarter in
which there occurs any event that requires disclosure or that materially affects
the accuracy of the information contained in any disclosure form previously filed
by such person under paragraph (c)(2). An event that materially affects the
accuracy of the information reported includes:
(D A.cumulative increase of $25A00 or more in the amount paid or expected
to be paid for influencing or attempting to influence a covered Federal
action; or
(ii) A change in the person(s) or individual(s) influencing or attempting to
influence a covered Federal action; or,
(iii) A change in the officer(s), employee(s), or Member(s) contacted for the
purpose of influencing or attempting to influence a covered Federal action.
(4) Each person (or recipient) who requests or receives from a person referred to in
paragraph (c)(1) of this section a contract, subcontract, grant, or subgrant
exceeding $100,000 at any tier under a contract or grant shall file a certification,
and a disclosure form,if required,to the next tier above.
(5) All disclosure forms (but not certifications) shall be forwarded from tier to tier until
received by the person referred to in paragraph (1) of this section. That person
shall forward all disclosure forms to the State agency.
(d) Agreement. In accepting any contract,grant,subcontract or subgrant subject to this
Exhibit,the recipient(and any person submitting an offer for such a contract or grant)
agrees not to make any payment prohibited by law or this Exhibit.
(e) Penalties.
(1) Any person who makes an expenditure prohibited under paragraph (b) of this
Exhibit shall be subject to a civil penalty of not less than $10M and not more
than $100,000 for each such expenditure.
(2) Any person who fails to file or amend the disclosure form to be filed or amended
if required by this Exhibit,shall be subject to a civil penalty of not less than $10,000
and not more than $100,000 for each such failure.
(3) Recipients may rely without liability on the representations made by their
subcontractors or subgrantees in the certification and disclosure form.
(f) Cost allowability. Nothing in this Exhibit is to be interpreted to make allowable or
reasonable any costs which would be unallowable or unreasonable in accordance
with Part 31 of the Federal Acquisition Regulation. Conversely, costs made specifically
unallowable by the requirements in this Exhibit will not be made allowable under any
of the provisions of Part 31 of the Federal Acquisition Regulation.
-23-
O
Attachment 1
STATE OF CALIFORNIA
DEPARTMENT OF HEALTH SERVICES
CERTIFICATION REGARDING LOBBYING
The undersigned certifies,to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned,to any person for influencing or attempting to Influence an officer or employee of an agency
of the United States Government, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with the making, awarding or entering Into of this
Federal contract, Federal grant, or cooperative agreement, and the extension, continuation, renewal,
amendment,or modification of this Federal contract,grant,or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person
for influencing or attempting to Influence an officer or employee of any agency of the United States
Government,a Member of Congress,an officer or employee of Congress,or an employee of a Member of
Congress in connection with this Federal contract,grant,or cooperative agreement,the undersigned shall
complete and submit Standard Form LLL, 'Disclosure of Lobbying Activities' in accordance with its
instructions.
(3) The undersigned shall require that the language of this certification be included In the award
documents for all subawards at all tiers (Including subcontractors,subgrants, and contracts under grants
and cooperative agreements) of $100,000 or more, and that all subrecipients shall certify and disclose
accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction
was made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction Imposed by Section 1352, Title 31, U. S. Code, any person who falls to file the required
certification shall be subject to a civil penalty of not less than $10,000 and not more than S100A00 for each
such failure.
None of Contractor Ranted None of Person Signing for Contractor
Contract/Grant Number Signature of Ptson Signing for contractor
Dote fide
After execution by or on Behalf of Contractor,please return to:
Department of Health Services
(Name of the DHS program providing the funds)
P. O.Box 942732
714 P Street
Sacramento,CA 94234-7320
CMS hstructiond&Ilefin No.13(10/91) -24-
Y Attachment 2
DISCLOSURE OF LOBBYING ACTIVITIES A4xovedbbyy OMB
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
(See reverse for public burden disclosure)
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
❑ a. contract ❑ a. bid/offer/application ❑ a. initial filing
b. grant b. initial award b. material change
c. cooperative agreement c. post-award For Material Change Only:
d. loan
e. loan guarantee Year quarter
f. loan Insurance date of last report
4. Name and Address of Reporting Entity: 5. If Reporting Entity in No.4 is Subawardee,Enter Name
and Address of Prime:
❑ Prime ❑ Subawardee
Tier if known:
Congressional District,if known: Congressional District,if known:
6. Federal Department/Agency: 7. Federal Program Name/Description:
CFDA Number,if applicable:
S. Federal Action Number,if known: 9. Award Amount,if known:
10. a. Name and Address of Lobbying Entity b. Name and Address of Lobbying Entity
(if individual,last name,first name,MD: (if individual,last name,first name,MD:
(attach Continuation Sheet(s)SF-LLL-A,If necessary)
11. Amount of Payment(check all that apply): 13. Type of Payment(check all that apply):
S ❑ actual ❑ planned ❑ a. retainer
12. Form of Payment(check all that apply): ❑ b. one-time fee
❑ c. commission
❑ a. cash
C] b. in-kind,s eci Nature ❑ d contingent fee
P ty
❑ e, deferred
Value ❑ f. other,specify:
14. Brief Description of Services Performed or to be Performed and Date(s)of Service,Including Officer(s),Employee(s),
or Member(s)Contacted,for Payment Indicated in Item 11:
(Attach Continuation Sheet(s)SF-LLL-A,if necessary)
15. Continuation Sheet(s)SF-LLL-A Attached: ❑ Yes ❑ No
16. Information requested through this form is authorized by Title 31,
U.S.C., Section 1352. This disclosure of lobbying activities is a SigmMse
material representation of fact upon which reliance was
placed by the tier above when this transaction was made or
entered Into. This disclosure is required pursuant to Title 31, Print vane:
U.S.C.,Section 1352. This information will be reported to the
Congress semiannually and will be available for public Ti»e:
inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $70,000 and
not more than$100,000 for each such failure. Telephone No.: Dote:
:> Authorized for
Local Reproduction
.�t::: .::.::•:.::::::•::.:.::::.::::"%.....:::.::::.::::::::::::•:::.:::::::::::::::::::::::::.:::::.::::::
Standard Form—LLL
CMS Instructiond BUletin No.14(10/91) -25-
INSTRUCTIONS FOR COMPLETION OF SFALL, DISCLOSURE OF LOBBYING ACTIVITIES
V �
This disclosure form shall be completed by the reporting entity,whether subawardee or prime Federal recipient, at the
initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to Title 31. U.S.C.,
Section 1352. The filing of a form Is required for each payment or agreement to make payment to any lobbying entity for
influencing or attempting to Influence an officer or employee of any agency, a Member of congress, an officer or
employee of congress,or an employee of a Member of Congress in connection with a covered Federal action. Use the
SF-LLL-A Continuation Sheet for additional information if the space on the form is Inadequate. Complete all items that
apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of
Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the
outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a follow up report caused by a material change to the
information previously reported,enter the year and quarter in which the change occurred. Enter the date of the last
previously submitted report by this reporting entity for this covered Federal Action.
4. Enter the full name,address,city,state and zip code of the reporting entity. Include Congressional District,if known.
Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or
subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier.
Subawards include but are not limited to subcontracts,subgrants and contract awards under grants.
5. If the organization filing the report in Item 4 checks'Subawardee;then enter the full name,address,city,state and zip
code of the prime Federal recipient. Include Congressional District,if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational
level below agency name,If known. For example,Department of Transportation,United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (Item 1). If known, enter the full
Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan
commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified in Item 1
(e.g., Request for Proposal (RFP) number; Invitation for Bid (IFB)number; grant announcement number;the contract,
grant, or loan award number; the application/proposal control number assigned by the Federal agency). Include
prefixes,e.g.'RFP-DE-90-001.'
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency,enter the
Federal amount of the award/loan commitment for the prime entity identified in Item 4 or 5.
10. (a) Enter the full name, address, city,state and zip code of the lobbying entity engaged by the reproting entity
identified in Item 4 to influence the covered Federal action.
(b) Enter the full names of the Individual(s)performing services,and include full address if different from 10. (a). Enter
last name,first name,and middle initial(MI).
11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (Item 4) to the
lobbying entity(Item 10). INdicate whether the payment has been made(actual)or will be made(planned). Check
all boxes that apply. If this is a material change report,enter the cumulative amount of payment made or planned to
be made.
12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution,
specify the nature and value of the in-kind payment.
13. Check the appropriate box(es). Check all box(es)that apply. If other,specify nature.
14. Provide a specific and detailed description of the services that the lobbyist has performed, or will be expected to
perform,and the date(s)of any services rendered. Include all preparatory and related activity,not just time spent in
actual contact with Federal officials. Identify the Federal official(s) or employee(s) contacted or the officer(s),
employee(s),or Member(s)of Congress that were contacted.
15. Check wether or not a SF-LLL-A continuation Sheet(s)is attached.
16. The certifying official shall sign and date the form,print his/her name,title,and telephone number.
Public reporting burden for this collection of information is estimated to average 30 minutes per response.
including time for reviewing instructions,searching existing data sources,gathering and maintaining the
data needed,and completing and reviewing the collection of information. Send comments regarding
the burden es timate or any other aspect of this collection of information, Including suggestions for
reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project
(0348-0046).Washington.D.C.,20503.
-26-
• DISCLOSURE OF LOBBYING ACTIVITIES
CONTINUATION SHEET
Approved by OMB
-348-0046
Reporting Entity: Page of
Authorized for Locd Reproduction
CMS hstructlond Moth Na 14(10/91) -27- Standard Form-LLL-A
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STAI"OFcl LIPRNIA
11101`404SCRIMI NATION CLAUSE (OCP-1)
SFD.17A41EY.2-93)Pi
1. During the performance of this contract,contractor and its subcontractors shall not unlawfully discriminate,
harass or allow harassment,against any employee or applicant for employment because of sex,race,color,
ancestry, religious creed,national origin,physical disability (including HIV and AIDS),mental disability,
medical condition (cancer), age (over 40), marital status, and denial of family care leave. Contractors and
subcontractors shall insure that the evaluation and treatment of their employees and applicants for
employment are free from such discrimination and harassment. Contractor and subcontractors shall comply
with the provisions of the Fair Employment and Housing Act(Government Code,Section 12900 et seq.)and
the applicable regulations promulgated thereunder(California Code of Regulations,Title 2,Section 7285.0
et seq.). The applicable regulations of the Fair Employment and Housing Commission implementing
Government Code,Section 12990(a-f),set forth in Chapter 5 of Division 4 of Title 2 of the California Code
of Regulations are incorporated into this contract by reference and made a part hereof as if set forth in full.
Contractor and its subcontractors shall give written notice of their obligations under this clause to labor
organizations with which they have a collective bargaining or other agreement.
2. This contractor -shall include the nondiscrimination and compliance provisions of this -clause in all
subcontracts to perform work under the contract.