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HomeMy WebLinkAboutMINUTES - 10121993 - 1.27 , 1 ,TO: ' BOARD OF SUPERVISORS 1 . 27 �- FROM: Mark Finucane, Health Services Director Contra By: Elizabeth A. Spooner, Contracts Administrat Costa DATE: September 30, 1993 County SUBJECT: Approval of Standard Agreement (Amendment) #29-316-15 with the State Department of Health Services for the High Risk Infant Follow-Up Project 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 (Amendment) #29-316-15 (State #91-12320 A-2) effective July 1, 1993 , with the State Depart- ment of Health Services for the County's High Risk Infant Follow-Up Project. II. FINANCIAL IMPACT: Approval of this amendment will increase State funding (via Federal Maternal Child Health Block Grant #93 . 994) by $251, 886, for a new total payment limit of $755, 658 . No County match is required. III. REASONS FOR RECOMMENDATIONS/BACKGROUND: On October 1, 1991 the Board approved State Standard Agreement #29- 316-11 (as amended by Standard Agreement [Amendment] #29-316-14) with the State Department of Health Services, for the period from July 1, 1993 through June 30, 1994 , for the High Risk Infant Follow- Up Project. Standard Agreement (Amendment) #29-316-15 clarifies language in the Scope of Work and provides funding for the third year of the contract. The Board Chair should sign eight copies of the agreement, including the Certification Regarding Lobbying. Seven signed copies of the agreement and five certified copies of this Board Order should be returned to the Contracts and Grants Unit for submission to the State Department of Health Services. CONTINUED ON ATTACHMENT: YES SIGNATUR RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMM DA ION OF BOARD C MMITTEE APPROVE OTHER SIGNATURE(S) ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS UNANIMOUS (ABSENT ) I HEREBY CERTIFY THAT THIS IS A TRUE AYES: l,III,IV,V NOES: --��r• AND CORRECT COPY OF AN ACTION TAKEN ABSENT: ABSTAIN: JJ.. AND ENTERED ON THE MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE SHOWN. Contact: Wendel Brunner, M.D. (313-6712) OCT 1 2 1993 CC: Health Services (Contracts) ATTESTED _ Auditor-Controller (Claims) Phil Batchelor, Clerk of the Board of State Dept. of Health Services Superv�SorsdCounrIsttator M382/7-e3 BY DEPUTY '(fATEOF'JA.IFORNIA j 1< �1��5"'�F'OARD AGREEMENT— APPROVED BY e G CONTRACTNUMBERI AM.NO. ATTORNEY GENERAL A, TAXPAYERS FEDERAL EMPLOYER IDENTIFICATION NUMBEF. ,.siIS AGREEMENT,made and entered into this l s t day of i lI l y — . 19---93 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 OQ cr ® 316 Chie Dept of Health Sa_rvicas ,hereafter called the State,and CONTRACTOR'S NTMERr County of Contra Co�ta 14921th Services/Public- 14921th Division 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.) PROJECT TITLE: HIGH RISK INFANT FOLLOW-UP PROGRAM 1. In that certain agreement between the Department and County of Contra Costa Health Services/Public Health Division, dated July 1, 1991, and amended on July 1, 1992: A. The first sentence of Paragraph 1, SCOPE OF WORK, is hereby amended to read as follows: "The attached Exhibit "B-2", consisting of 15 page(s) and entitled SCOPE OF WORK is made a part hereof by this reference." B. Upon the effective date of this amendment, all reference to Exhibit "B" or "B-1" in the body of this agreement and in exhibits thereto shall hereinafter be referred to as Exhibit "B-2". CONTINUED ON 6 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 fust above written. STATE OF CALIFORNIA CONTRACTOR AGENCY of Health Services Department CONTRACTOR I) om other than anindividua(statewhethoraaorp !ion,pwtnershio,etc.) P County olf Contra Costa RY(AUTHCRIZED S1 RE) BY(AUTHORIZED SIGNATURE-r— > > -/o9 _ PRINTED NAME OF PERSON SIGNING PRINTED NAME AND TITLE OF PERSON SIGNING _ Robert Threlkel CHAIR, BOARD OF SUPERVISORS _ TITLE ADDRESS Chief, Program Support Branch 651 Pine Street, Martinez CA 94553 AMOUNT ENCUMBERED BY THIS PROGRAM/CATEGORY(CODE AND TITLE) FUND TITLE Department of General Services DOCUMENT Local Assistance - Clearing Accint General _ Use Only _0- (OPTIONAL USE) This Standard Agreement is exempt PRIOR AMOUNT ENCUMBERED FOR Federal MCH Block #93.994 from Dept of General Services THIS CONTRACT approval GC Section 16366 ITEM CHAPTER STATUTE. FISCAL YEAR a PP per (b)• 755,658 (FBF) TOTAL AMOUNT ENCUMBERED TO 4260-111-001 55 9 4 DATE OBJECT OF EXPENDITURE(CODE AND TITLE) 755,658 93-52441-4915-702-03-939945-00._ l hereby certify upon mX own personal knowledge that budgeted funds T.B.A.NO. B.R.NO. are fldb/e for the od and pu'ypose of the expenditure stated above. SIG AT AE OF Cq I OFFICER DATE t/ el 27 5A:) 'JAN 1 9 1994 CO RACTOR F-I STATE AGENCY DEPT.OF GEN.SER. F� CONTROLLER STA::a OF CAL!FORNIA STANDARD AGREEMENT ' t STD. 2(REV.5.91) )REVERSE) �P+ 2. The Contractor agrees to indemnify,defend and save harm less 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 an 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. a. 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. 6. 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. r - 91 01014 y Y ..; Contractor: County of Contra Costa Health Services/Public Health Division r Contract Number: 91-12320 A2 C. Paragraph 2, DEFINITIONS, subparagraph F is amended to read as follows: "Good Cause: Circumstances which are beyond the control of the Contractor and includes: (1) Damage to or destruction of the Contractor's business office and/or records by a natural disaster, including fire, flood, or earthquake or when circumstances involving such disaster have substantially delayed Contractor's operations. (2) Theft, sabotage, or other deliberate, willful acts by an employee that have been reported to the appropriate law enforcement or fire agency when applicable. (3) Other circumstances that are clearly beyond the control of the Contractor that have been reported to the appropriate law enforcement or fire agency when applicable. (4) Failure by the State to fully execute the Contractor's Standard Agreement later than within six (6) months of the term of the Standard Agreement start date. (5) Untimely illness or absence of any employee trained to prepare invoices, reports, Standard Agreement amendments or budget revisions. Such circumstances shall be reviewed and approved on a case by case basis by Maternal and Child Health management. Circumstances that shall not be considered beyond the control of the Contractor include, but are not limited to: a. Negligence by employees. b. Misunderstanding of or unfamiliarity with the requirements of this Standard Agreement. C. Delays caused by governing boards or approving bodies. d. Delays caused by the United States Postal Service or any delivery service." D. Paragraph 2, DEFINITIONS, is amended by adding subparagraph N to read as follows: "Amendment: A formal change in the Standard Agreement which is caused by any of the following circumstances. (1) The amount of a numbered line item is increased or decreased by the amount of $10,060 or more per State fiscal year. Page 2 of 7 Contractor: County of Contra Costa Health Services/Public Health Division Contract Number: 91-12320 A2 (2) The maximum amount payable is increased by adding federal or state funds. (3) New provision(s) are added or revision(s) are made to existing provisions. (4) New or revised provision(s) to the Exhibit B, SCOPE OF WORK, are required. (5) A numbered line item is added to or deleted from Exhibit C, BUDGET." E. Paragraph 6, STATE AND FEDERALLY MANDATED PROVISIONS, is amended to read as follows: "The attached Exhibit A(F), entitled ADDITIONAL PROVISIONS, consisting of twenty-seven (27) pages is made a part hereof by this reference." F. Paragraph 7, PAYMENT PROVISIONS, is hereby amended to read as follows: "The attached Exhibit "C-1" consisting of eight (8) page(s) , entitled BUDGET, is made a part hereof by this reference. Changes may be made to the BUDGET, pursuant to subparagraph A and B below of this paragraph and/or Paragraph 13, AMENDMENT PROCEDURES, of this agreement. A. The Contractor must notify the State of all budget revisions in accordance with procedures, and in the format, designated by the State. Such budget revisions shall be submitted by the Contractor in accordance with the following conditions: Prior approval must be obtained from the State in advance of changes or expenditures only when: (1) New staffing positions are added to the new proposed Exhibit C, Budget; (2) The amount of funds transferred to or from the numbered line item one (1) "Total Wages" exceeds five (5) percent of the total wages or a cumulative $5,000 each budget period, whichever is smaller; (3) For Standard Agreements with Federal Financial Participation, if the change in any numbered line item causes an upward shift in either enhanced or nonenhanced budget amounts. The State shall agree to or reject the proposed budget revision in writing within thirty (30) days of receipt. Page 3 of 7 Contractor: County of Contra Costa Health Services/Public Health Division Contract Number: 91-12320 A2 B. Written notification by the Contractor to the State shall be given within thirty (30) days of occurrence for all revisions which: _ (1) Change any information in Exhibit C, BUDGET, columns; and, (2) do not require prior authorisation in accordance with Paragraph 7, A. The State shall agree to or deny the written notification change within thirty (30) days of receipt. C. Except for good cause, prior approval budget revision requests shall be considered for approval only if postmarked by March 31, or no later than ninety (90) calendar days prior to the close of the fiscal period, for which the budget is in effect. D. Budget revisions which are submitted in accordance with Paragraph B, shall be submitted by the Contractor to the State, postmarked no later than May 31, of the fiscal period for which the budget is in effect." G. Upon the effective date of this amendment, all references to Exhibit "C" or "C-1" in the body of this agreement and in any exhibits thereto shall hereinafter be referred to as Exhibit "C-2". H. Paragraph 8, REIMBURSEMENT AND REVENUE LIMITATIONS, is amended to read as follows: A. Notwithstanding any other clause of this Standard Agreement or its Exhibits, Contractor understands and agrees that it shall not claim reimbursement for any service that the Contractor may claim for reimbursement under any other state, federal , county or other governmental entity contract or grant, any private contract or agreement, or from the Medi-Cal program. B. Notwithstanding any other provision of this Standard Agreement or its Exhibits, Contractor understands and agrees that the State shall not reimburse Contractor for any services provided under this Standard Agreement which are otherwise reimbursable by any third party payor(s) . Contractor also agrees to fully exhaust its ability to receive such third-party reimbursement. Contractor also agrees that if it receives any third-party reimbursement for services already reimbursed by the State, the Contractor shall immediately remit that amount to the State or offset the amount against future invoices. Page 4 of 7 _,Contractor: County of Contra Costa Health Services/Public Health Division Contract Number: 91-12320 A2 C. State reimbursement for vacation and/or paid leave accrual or usage for personnel , shall be at rates not to exceed those allowed Contractor employees as specified/detailed in Contractor's Personnel Manuals. Reimbursement or allowances to Contractor for employee sick leave, family illness or bereavement leave, vacation, overtime and holiday credits, military leave, industrial or non-industrial injury leave, jury duty, subpoenaed witness time, or any other authorized leave shall be made only for said benefits accrued and used during the term of this agreement. Records of paid leave earned and used shall be maintained by the Contractor in accordance with generally accepted accounting principles. D. Contractor agrees that all revenue accruing to this project, based on the services supported, in whole or in part, by this Standard Agreement, shall be accounted for separately and apart from all other revenues earned or received by the Contractor." I. Paragraph 9, INVOICE, subparagraph A, is amended to read as follows: "The attached Exhibit J, entitled SAMPLE OF COVER LETTER, INVOICE FORMAT, AND INVOICING GUIDELINES, consisting of four (4) pages is made a part hereof by this reference." J. Paragraph 10, CONTRACTOR'S RELEASE, is deleted from this agreement. K. Paragraph 13, AMENDMENT PROCEDURE, subparagraph B, is amended to read as follows: "Except for good cause, Contractor amendment requests shall be considered for approval only if postmarked by March 31, or no later than ninety (90) calendar days prior to the close, of the fiscal period for which the budget is in effect. Such requests shall be addressed as specified in Paragraph 18, DELEGATION OF AUTHORITY. " L. Paragraph 16, REPORTING REQUIREMENTS, is amended to read as follows: "A. The attached Exhibit E, entitled PROGRESS REPORT, consisting of one (1) page is made a part hereof by this reference. B. The Contractor shall submit progress reports according to the format described in Exhibit E. C. An original and two copies of the Progress Report shall be submitted to the State as follows and postmarked no later than indicated: Progress Reports for the period ending December 31 shall be postmarked January 31, immediately following the end of that period. Page 5 of 7 _ 1 7 ;Contractor: County of Contra Costa Health Services/Public Health Division Contract Number: 91-12320 A2 Progress Reports for the period ending June 30 shall be postmarked July 31, immediately following the end of that period. D. The Progress Report reporting activities through June 30, shall be considered a final report relative to provisions of Exhibit A(F) , paragraph 11. E. If Contractor has not submitted an acceptable progress report by the specified date, subsequent invoices may not be approved for payment by the State until the State receives a satisfactory report. F. If there are program specific data reporting systems required by this Standard Agreement's Scope of Work, the Contractor shall report monthly or quarterly as required, and in the format designated, by the State. G. The attached Exhibit K, entitled GRANT FINANCIAL STATUS REPORT AND GRANT CASH TRANSACTIONS REPORT, consisting of five (5) pages is made a part hereof by this reference. The Grant Cash Transactions Report must be completed only if Contractor is receiving an advance payment in accordance with Exhibit H if Exhibit H is referenced and attached hereto. The State may immediately waive this requirement or part of this requirement by so notifying the Contractor in writing to the extent the State is granted waivers by the cognizant state control agency." M. Paragraph 28, CONTRACT UNIFORMITY, is amended to read as follows: "The attached Exhibit F, entitled CONTRACT UNIFORMITY, consisting of two (2) pages is made a part hereof by this reference." N. Paragraph 41, FEDERAL FINANCIAL PARTICIPATION, is added to the Agreement and reads as follows: "Notwithstanding any other provision of this Standard Agreement or its Exhibits, Contractor understands and agrees that it shall not claim federal financial participation (FFP) for any service provided under this Standard Agreement for which there is no FFP eligibility. Contractor also understands and agrees that local dollars used to claim FFP match must be expended on FFP-match activities in order to claim the FFP. Contractor further understands and agrees that for those services which are not eligible or for which there is no proper match for FFP, or for those services for which local dollars are not expended in order to claim the FFP, Contractor is responsible for audit exceptions and shall indemnify the State in the event any such audit exceptions are taken against. the State." Page 6 of 7 ~ Contractor: County of Contra Costa Health Services/Public Health Division Contract Number: 91-12320 A2 0. Paragraph 42, LABORATORY TESTS, is added to the Agreement and reads as follows: "Contractor agrees that if any performance under this agreement or under any subcontract includes any tests or examinations on materials derived from the human body for the purpose of providing information for the diagnosis, prevention, treatment or assessment of any disease, impairment, or health of a human being, all the locations at which such examinations are performed shall meet the requirements of 42 U.S.C. section 263a (CLIA) and the regulations adopted thereunder." 2. The effective date of this amendment is July 1, 1993. 3. All other terms and provisions of said agreement shall remain in full force and effect. Page 7 of 7 E*Vbit A(F) STATE OF CALIFORNIA DEPARTMENT OF HEALTH SERVICES ADDITIONAL PROVISIONS (FOR FEDERALLY FUNDED SUBVENTION AID/LOCAL ASSISTANCE _ COST REIMBURSEMENT CONTRACTS/GRANTS) 1. Eaual Oermrtunity 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 Instrictiord Bulletin No.02(11/91) I 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 30 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- 1 , 1 6dibd A(F) a 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 of Property by the State or Purchase of Procerty with 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(ii),stating that: (D The insurer will not cancel the insured's coverage without 30 days prior written notice to the State. OD The State of California,its officers, agents,employees,and servants are included as additional insureds, but only insofar as ttie 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- � , l 1 E:nibn 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. Fxnmination 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. (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. Inspection 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- Exnion A(F) 11. Final Invoice—Final Report—Retention of Funds If a final report is required by this contract, 10 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. Qfficials 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, tKe Contractor shall use this–ame 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- r , 1 i 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- i 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. -9- e (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 Act or 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 far the contract is under consideration to be listed on the EPA List of Violating Facilities. Prompt notification shall be required prior to contract award. -11- (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 jb6], 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 education6i materials to be made availabre for disMbution. The Contractor shall 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. Confidenfialily of Information 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 applicable if Contractor is a public entity.) Contractor, by signing this agreement, does swear under penalty of perjury that no more than one final unappealable 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. Financial and Compllance Audit of Nonprofit Entities (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. 1. 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- EXhlbit 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 State Employees 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 10411) 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, runless the violation is technicol 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 some 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. -16- E~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, Pogroms,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. 4508). 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)(1)(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: (i) Discussing with any agency Cncluding Individual demonstrations) the qualities and characteristics of the person's products or services,conditions or terms of sale,and service capabilities; and, (I I) 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)(1)(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; (ID 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. OD 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- (B) For purposes of paragraph (b)(2)(il)(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 contracf 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)0v)(A), 'professional and technical 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 S100A00 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. -Y -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: W A cumulative increase of $25,000 or more in the amount paid or expected to be paid for influencing or attempting to influence a covered Federal action; or (i) 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 $10,000 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- Attachment 1 STATE OF CALIFORNIA DEPARTMENT OF HEALTH SERVICES CERTIFICATION REGARDING LOBBYING The undersigned certlfles,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 fails to file the required certification shall be subject to a civil penalty of not less than$10,000 and not more than S100,000 for each such failure. None of Contractor Printed None of Person S19NrQ for Contractor :5� Controct/Grunt Nmber S gnakre of Person Spring for contractor Date me 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 txtructiond Wletin No.13(10/91) -24- Attachment 2 DISCLOSURE OF LOBBYING ACTIVITIES Approved tyva^^B 0348-OW 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 filiftig 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; ❑ Rime ❑ Subawardee Tier If known: Congressional District,if known: Congressional District,if known: 6. Federal Department/Agency: 7. Federal Program Nome/Description: CFDA Number,if applicable: 8. 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,MI): Of Individual,last name,first name.MI): (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): $ ❑ actual ❑ planned ❑ a. retainer 12. Form of Payment(check all that apply): ❑ b. one-time fee ❑ c. commission ❑ a. cash CJ b. in-kind,specify: Nature El d contingent fee' p N ❑ 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 Sgnalure 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, RintNone: U.S.C.,Section 1352. This information will be reported to the Congress semiannually and will be available for public me: inspection. Any person who falls to file the required disclosure shall be subject to a civil penalty of not less than$10A00 and = not more than$100,000 for each such failure. Telephone No.: Date: :;;YY»> ::..::.:..;...::..:.:....::..::::....::.:.::::::::.::....:::.::::::::::;:.......::::::.....:..::.::::: .ate :.::.;.:::::::.:.;:.;:.:.:.;:::.::.;::::.....:.....:;:;:.......:::::.....;:;;;;....,....::.......................... Authorized for Local Reproduction .edeca:�....: .:::::.:::..::::::.:::::::.::::. . . :.:.:, :: . ::::::::: :,,. ::: _ :::::::::::,:::.:::.::::::.,.. :::::.:::::::::•::::•.:::.:::::•::::::::::::::•:::::::::::::::::::::...................... Standard Form LLL CMS hstructiond Bulletin No.14(10/91) -25- INSTRUCTIONS FOR COMPLETION OF SFALL, DISCLOSURE OF LOBBYING ACTMTIES 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. Subowards 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 knowr-L 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. B. 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 � v Authoraed for local Reproduction CMS hshuc*md Bulletin No.14(10/91) -27- Started Form-LLL-A d T 1 _ L Y C) C W ✓) 0: y N y q q N W Y 4! N N IF w o z � -0 o Y C) q O O C d' N r W W O O aEi Q. L O U U S M 3 Im _ H O •� O C! C) OC L q G J �' n . 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C G 4- 01 M M L L W C �p O O O tm C~ > E n Y O > O Yd G y O '0r N O 1 q _T q O Lq > U 2 W y O+ J N d M. a L a C O+ ' •L U "0 ' q Goh- L W Q a+ U Q CQ c J C L y J ++ O O O N 7 W O O W y > L U O r q O 6 m Exhibit C-2 BUDGET Contractor: MIM OF CONTRA CMTA HEALTH SERVICE DEFARTMENT Page No. 1 Contract knber: 91-12320 Amendment 02 Btdget Period. 07/01/91-06/30/92 Full Rate of Pay Nem of of Time on Prg Pay Per Pay Period State Share I Pay Periods Total State Benefits PERMWEL LCH HIGH Period Lti+l HIGH LZW HIGH Ltii HIGH Support Apply 01 AURIN DIR/PRO<1 DIR NA 10 MONTHLY NA 7,900.000 NA 10.00 0.00 12.00 8,500 Y 02 PRG SPEC/PRL1J COORD NA 100 MONTHLY NA 3,900.000 NA 100.00 0.00 12.00 29,400 Y 03 PLBLIC HEALTH WASE NA 300 KNTHLY NA 5,100.000 NA 300.00 0.00 12.00 120,400 Y 04 CIM NA 50 MONTHLY NA 2,600.000 NA 50.00 0.00 12.00 9,500 Y 05 Ai."OMING TECH NA 25 KNTHLY NA 3,100.000 NA 25.00 0.00 12.00 5,500 •Y Personnel Total: 173,300 (A) SUBTOTAL: Positions Receiving 6nployee Benefits....... 173,300 (8) SUBTOTAL: Positions not receiving Evloym Benefits... NA (C)OVERALL 9FLDYEE BENEFIT RATE: 28.00%................. 48,524 (D) SALARY SAVING RATE:.................................... NA (E) TOTAL PEFSDI8......A+B+C-0........................... 221,824 Page 1 of 8 Exhibit C-2 BUDGET Contractor: COUNTY OF CONTRA COSTA HEALTH SEMCES DEPARTW Page No. 2 Contract Number: 91-12320 &x1get Period: 01/01/91-06!30/92 Amendment 02 Total Miles per State dare% Cast per Mile Contract Total State TRAVEL LOW HIGH LCW HIGH LOW HIGH Support 06 TRAVEL ; NA 100.00 NA NA NA NA 2,500 #NOT TO E>Q;fED STATE RATES (F) Total Travel E;enses: 2,500 Cast per Unit Knber of Units State Share% Total State SUBCDffWTORS/CM LTANTS Unit LOW HIGH LOM HIGH LUN HIGH Support 07 05ULTANTS HOURLY NA 125.000 NA 150.00 NA 100.00 5,000 (G) Total Sibomtrract/Consultant Egerses: 5,000 Total state OTHER OPERATING E)P9GES State Store% Support 08 TRAINING 100.00 2,000 09 GENERAL E)S3& 100.00 1,000 10 BLDG OMJPANCY COSTS 100.00 2,232 11 INDIRE3rT COSTS 100.00 17,330 (H) Total Other Operating EVenses: 22,562 Page 2 of 8 Exhibit C-2 BUDGET Contractor: MRM OF OCNTRiI COSTA WArd SEIMCS OEQARMU Page No. 3 Contract M hw: 91-12320 Amendment 02 &u d Period: O7/Ol/91-06/30/92 TOTAL STATE SilFW...................................... 251,886 Page 3 of 8 Exhibit C-2 BUDGET Contractor: COUNTY OF CONTRA COSTA HEALTH SERVICES DEPARTMENT Page No. 1 Contract Numbert31 -12320 Amendment: 02 Budget Period: 07/01/92-06/30/93 Full Rate of Pay State Share %of Number of %of Time on Prg Pay Per Pay Period Full Rate of Pay Payments Total State Benefits PERSONNEL LOW HIGH Period LCW HIGH LOW HIGH LOW HIGH Support Apply 01 ADMIN DIR/PROJ DIR NA 50 MONTHLY NA 4,900.000 NA 50.00 0.00 12.00 26,802 Y 02 PRG SPEC/PROD COORD NA 100 MONTHLY NA 3,900.000 NA 100.000 0.00 12.00 0 Y 03 PUBLIC HEALTH NURSE NA 300 MONTHLY NA 5,500.000 NA 300.00 0.00 12.00 123,430 Y 04 CLERK NA 50 MONTHLY NA 2,600.000 NA 50.00 0.00 12.00 15,131 Y 05 ACCOUNTING TEOH NA 25 MONTHLY NA 3,250.000 NA 25.00 0.00 12.00 9,137 Y Personnel Total: 174,500 (A) SUBTOTAL: Positions Receiving Employee Benefits....... 174,500 (B) SUBTOTAL: Positions not receiving Employee Benefits... NA (C) OVERALL.EMPLOYEE BENEFIT RATE: ACTUAL ................. 52,350 (D) SALARY SAVING RATE:................................... NA (E) TOTAL PERSONNEL.....A+3+V-D........................... 226,950 Salary ranges, percentages of time, and percentage of benefits listed are only yearly estimates and are subject to change over the contract period with prior written approval from MCH. These amounts represent a portion of the full-time equivalent (FTE) of positions whether or not the balance of the positions are funded by another source. _. Page 4 of 8 Exhibit C-2 BUDGET Contractor: COUNT OF CONTRA COSTA HEALTH SERVICES DEPARTMENT Page No. 2 Contract Number: 91712320 kw meat: 02 Budget Period: C7/01/92-06/30/S3 Total Miles per State share $ Cost per Mile Contract Total State TRAVEL LOW HIGH LOW HIGH LOW HIGH Support 06 TRAVEL * NA NA NA 100.00 NA NA 3,000 * NOT TO EXCEED STATE RATES (F) Total Travel Expenses: 3,000 Cost per Unit Number of Units State Share $ Total State SUBCONTRACTORS/CONSULTANTS Unit LOW HIGH LOW HIGH LOW HIGH Support 07 CCNSU•_TANTS HOURLY NA 125.000 NA 150.00 NA 100.00 6,940 (G) Total Subcontract/Consultant Expanses: 6,940 Total State OTHER OPERATING EXPENSES State Share $ Support 08 TRAINING 100.00 1,000 09 GZ'ERAL 100.00 1,100 10 BLOC O 1P.dNCY nTS 100.00 4,314 11 INDIRECT COSTS 100.00 8,682 (H) Total ^cher Operating Expenses: 15,096 Page 5 of 8 Exhibit C-2 BUDGET Ccrtractor: COUNTY OF CONTRA COSTA HEALTH SERVICES DEPARTMEr, Page No. 3 Contract Num er9l-12320 Amendment: 02 Sudget Period: 01/01/92-06/30/93 TOTAL STATE SUPPORT...................................... 251,886 Page 6 of 8 N OO O O 10 m cc Q O!Q m m La C-4 CD N N o n 10 N . 0� � � r p N p p p N } D� E O ° U w Z j } o D J O. 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O o O N It O to O (O O y O O N ro O O m R J Z QQ N r Lfi- N ^ r C4 N r a C-4 In F N N N b N N N —p Z b N N N LL N b J �zJ -za x a y J W W F- z co = m c-4 W y O O> oQ X y J F- r O7 W x W m O J 7 U 0 z Z r W O p U Z a m' s Q� Q o mz > J W } U' w tK ., W W c m 0.Lu y a E Z } — O FF-Z J Z L w V co 2�p O a LL w C� } E ¢ -j a Q W W O W � W H ¢�y J J p J Z W z W Z ~ y W m Q W K d Q 1Q Z U' o a w W a Q Q Q o } } ZL) w . Q X y Q 0 wd ¢ 0 a a OU HW O OLLO > U U U Z Z O U W u- U O F- F W W W Z O F- F- H LL U U U a M a in �o n g m State of California Health and Welfare Agency Department of Health Services Primary Care and Family Health EXHIBIT E PROGRESS REPORT contractor should duplicate this ( ( 1. REPORT PERIORD form to prepare reports. ( ) - O July to December, 19 SUBMIT ORIGINAL AAD 2 COPIES TO: (, i7 January to June , 19 ' ( 0 Other (Specify) YOUR CONTRACT MAxAGER Maternal and Child Health Branch 714 •P' Street, Room 740 ! 2. CONTRACT NUMBER P.O. Box 942732 LE ENCOURAGE YOU TO BE BRIEF. Sacramento, ZA 94734-7320 PLEASE LIMIT REPORTS TO BETWEEN 5 AND 10 PAGES 3. PROJECT TITLE 4. AGENCY NAME AND ADDRESS C 5. AGENCY REPRESENTATIVE PREPARING REPORT NAME: 1 TITLE: PHONE:, INSTRUCTIONS Item 1-5: Self explanatory Item b. ATTACH NARRATIVE STATEMENT OF PROJECT PROGRESS TO THIS FORM: The narrative must include the following: Please limit this narrative to a maximum of between 5 and 10 pages. a. Summarize progress made to date toward meeting each objective, as specified in the Scope of ilork, Exhibit B. Use quantifiable terms if applicable. b. Briefly describe any problems encountered in implementing the.cbjective. Outline strategies for dealing with the unresolved problems. Discuss personnel transactions (including vacancies) which have had an impact on meeting the objective. C. Address any issues needing the special attention of state staff. Retain 'progress report supplements on file for state review and submit required contract deliverables which may be specified in the SCOPE OF UORK, Exhibit B, directly to your Contract Manager under seperate cover. s---s-----^--sssssssa-_s--�-_-__-a-----sss=sasrias=ssss=assasssasasszassassaass:r_aassmsaassassassssssssaacsaasraasasassss:amssas CERTIFICATION BY PROJECT DIRECTOR: I affirm that the information presented in this report accurately reflects the current status of this project to the best of my knowledge. Original Signature Date (Project Director) Contract Uniformity (Continued) Accrued Compensation Examples Example No. 1: If an employee, John Doe, is allowed three weeks of vacation and twelve days of sick leave each year then that is the maximum amount that may be claimed during a contract period. If John Doe has •five weeks of vacation and eighteen days of sick leave at the beginning of the State contract term, the Contractor during a one year contract term may only claim up to three weeks of vacation and twelve days of sick leave actually used by the employee. Amounts earned/accrued in periods prior to the beginning of the contract are not an allowable cost. Example No. 2: If during a three year (multiple year) contract John Doe does not use his three weeks of vacation in year one nor his three weeks in year two, but he does actually use nine weeks in year three, then the Contractor would be allowed to claim all nine weeks paid for in year three. The total compensation over the three year period cannot exceed 156 weeks (3 x 52 weeks) of total compensation. Example No. 3: If during a single year contract John Doe works fifty weeks and uses one week of vacation and one week of sick leave and all fifty-two of these weeks have been billed to the State then the remaining unused two weeks of vacation and seven days of sick leave may not be claimed as an allowable cost. Page 2 of 2 „J r State of California-Health and Welfare Agency Department of Health Services Contract Management Section Exhibit F Contract Uniformity Pursuant to the provisions of Article 1.8 (commencing with Section 242) of Chapter 2 of Part 1 of Division 1 of the Health and Safety code, the Department of Health Services, an agency of the State of California, sets forth the following policies, procedures, and guidelines regarding fringe benefits. 1. As used in this agreement with reference to state funds, fringe benefits shall mean an employment benefit given by one's employer to an employee in addition to one's regular or normal wages or salary. 2. As used herein, fringe benefits does not include: a. Compensation for personal services paid currently or accrued by the Contractor for services of employees rendered during the term of this agreement which is identified as regular or normal salaries and wages, vacation, sick leave, holidays. jury duty and/or military leave. b. Director's and executive committee member's fees C. Incentive or bonus pay d. Allowance for off-site pay e. Incentive or bonus pay f. Location allowances g. Hardship pay h. Cast-of-living differentials 3. Specific allowable fringe benefits are identified as: Fringe benefits in the form of employer contributions for employer portion of payroll taxes (i.e., FICA, SUI, SDI, Training), employee health plans (i.e., health, dental, and vision), unemployment insurance, workers compensation insurance and employers portion of pension/retirement plans provided they are granted in accordance with established written organization policies and meet all legal and Internal Revenue Service requirements. 4. To be an allowable fringe benefit, it is agreed the cost must meet the following criteria: a. Be necessary and reasonable for the performance of the contract, b. Be determined in accordance with generally accepted accounting principles, C. Be consistent with policies that apply uniformity to all activities of the Contractor. 5. It is agreed by both parties that any and all fringe benefits shall be at actual cost. 6. Accrued Compensation a. Compensation for vacation, sick leave, and holidays is limited to that amount accrued within the contract tern. Unused vacation, sick leave, and holidays earned from periods prior to the contract period cannot be claimed as allowable costs. (See page 2 for an example). b. For multiple year contracts, vacation and sick leave compensation which is accrued but not paid, due to empioyee(s) not taking vacation or sick leave may be carried over and claimed within the overall term of the multiple years of the contract. Holidays cannot be carried over. (See page 2 for an example). C. For single year contracts, vacation, sick leave, and holiday compensation which is accrued but not paid, due to employee(s) not takinf time-off within the contract term, cannot be claimed as an allowable cost. (See page 2 for an example). Page 1 of 2 (1/93 EXHIBIT J SAMPLE OF COVER LETTER (Use Official Letterhead) Date Administrative Management Section Maternal and Child Health Branch 714 P Street, Room 740 P.O. Box 942732 Sacramento, CA 94234-7320 MATERNAL AND CHILD HEALTH (MCH) CONTRACT # Enclosed for payment is our invoice number in the amount of which covers the period of through (inclusive dates) for services rendered pursuant to the terms and conditions established in the above referenced MCH contract. Sincerely, Name, Title Enclosure Page 1 of 4 � $ � - . t k . � ■tea . &§ E k ■�s . % tc - s©&-� . 6 ««\ate Wh v . u =ƒ ' $ f . at o � - _ � \ «® � %` ■ f $ . § < � : i < O Q 'O T- a'z .. O N F 2 K r2?:; `.` ..`ori .}:w? <::r:y >h\<• Z ' . : ti;. :lv.•.::? ice}•i ME O O>> vt y UU ZZK :lh;• n Z�D C. .•ic>:.4:`.-:�{;;;?::�::a ��'� 'yTi..';;iwia: �a:;: :a4•',,,4:%'~-'''k ^� .�}�. T.>c;;Y::a*.;».T"f a a...:::�%:::pit+,:. .,. ,t't•:;: }:�` —O "\;': `� boi:•;�ri?•'nY i ?tr�;y::xµ::v.�d .`v^:: ':�k:'v , 3iv:aiS:v.;..ax� W "yy",�:::J::ii\:?T�:�:iY!���;:'O.v:. �:1�`�,:;:\`\i�:S:\: .}�:4:: rw• ,khM? >a,.w'�::•'?.....Xkh :iiJ: v::;:; :v Z`' ,Ti'kY�: Z s�o r."`+Y.`"', `'" �' �wr„k:,.�. `r\`?•:K•%:`r�-':i "`��:v+: '•b"':t:: '': ,a>,.X:�• mev:,h> '°e'• �$> :,,:.,. ilii.:< 2 p w'++w:z`f}:wrwn:.,�rYa'.�;:.y : :�',`;:Rkii?: ... .'-�•' :a• ,.'.Y+�..?'�`�•.•'-,': � iTab>,.-.'rrhTTrk-.:'<`r'ri i•<Q�C::�{:\<`•V.^.% ,?'..�5i;'.`�`w''?_•4:: • W ` Jif. r •. .:J.;.• L� kA ' p� Sa,.'�,�;:o;�'kY•f. ���y,}�,,,•a?'2•nk�4. .Lc?`` .,,�.',? �'k$' -�'.x:<"+a'';'�Y: .. :`:a`'N` k'b'y`%�L?t'a' kssk.' ;KG: �o�,?�: a'�C: `' ,` `�••.,`. '+K 'moi}`::�;;?g: x•. m..k. ...,k: :qj,;f `:EJ`'• .f p W!� .,?k:i:-.!r�`.aS��� Y�..v x'"a•`„"-_:; n � :5;y:2�:� _O w';,r}}.i".o:kxi�-"'�Y'."�<;:-ri'n""'•).�"--ri' :�:::n :.:$: i:ti_;tib:-` 'hc'• .rrr.'•�-.::{•:� .tic?• :yak: ..,;:.:-:`'`,:;i5 N�`�-.�1t}Y}�a:\��,�,�V� �.M'3- •YpY'.l n�i.; {i':':'-N-y'•ni: 4A W n �t}>.y,� v.'•ie%a..:�':.:2'aGaia `+ice'': ^•:{;' ��:-" •"�•`Yr+}:�a�^v' �Cyy�+'•ih'.}:.v.`WtiG::S+:�) iY .:n•. S 1� 'n N cc J Z •L� S �0Z _ < r u , s Z< Q J Wto < fJ! N o W O W U W _ G U a -+ u < u 0 Z ;D _. _ N O sax < W u u+ = O le E < O 0 6 W d !a. •, .("� U I•. LL 0 U u U Z Z 0 O ►- //�� • w W O r- f u u S EXHIBIT J MATERNAL AND CHILD HEALTH (MCH) BRANCH Invoicing Guidelines All invoices for funds associated with MCH contracts must be processed according to the following guidelines. Original Invoice The cover letter and invoice must be prepared and formatted as shown on this Exhibit J and Paragraph 8 of the Standard Agreement or Interagency Agreement. The original and one (1) copy of the invoice shall be submitted to the MCH Branch, Administrative Management Section, for processing. Each cover letter must: 1. Be printed on official agency letterhead; 2. Include original signatures; and 3. Have appropriate small business indicator stamp, if applicable. Each invoice must include: 1. Original signatures; and 2. Appropriate expenditure line item codes and descriptions. Please note that MCH will only process invoices based on specific NUMBERED line item codes and descriptions reflected in your Agreement.. Budgeted costs established under these numbered line items are the basis for payment. Invoices which are incorrect will either be adjusted by MCH staff or returned to the contractor for correction. Under state statute, MCH is required to return any invoice that cannot be processed within fifteen (15) days of its receipt. Supplemental Invoices Supplemental invoices may be submitted to adjust previous charges and must -be formatted similar to regular invoices. Supplemental invoices may be submitted at any time during the contract term or up to ninety (90) calendar days after the contract has expired, terminated, or at the fiscal year end, whichever is earlier. Each supplemental invoice must: 1. Be titled specifically "Supplemental Invoice" 2. Be numbered with an alpha numerical code that identifies the original invoice being corrected (i .e. , Supplemental Invoice #IA) ; and, 3. Reflect the amount of the supplemental billing only. Do not indicate the original or adjusted amount of the previous invoice. Final Invoice All final invoices shall be submitted in accordance with Paragraph 8(E) of the Standard Agreement or Interagency Agreement. All questions regarding these guidelines should be directed to the MCH contract manager responsible for your Standard Agreement or Interagency Agreement. Page 4 of 4 EXHIBIT K STATE ADMINISTRATIVE MANUAL MISCELLANEOUS ACCOIAJTING PROCMXIRES BLOCK GRANT FISCAL REPORTING REOUIREMMS (New 7/85) 8760 The Federal Government awards certain block grant funds to the State for various social service programs. These Federal block grants include, but are not limited to, the following: o Title XX (Social Security Act) o Low Income Now Energy Assistance o Preventive Health o Maternal and Child Health Services o Alcohol and Drug Abuse o Mental Health Services o Community Development o Community Services The State assumes certain fiscal administrative responsibilities for these block grants. State departments which administer block grants will require recipients (public and private non-profit organizations) to comply with certain specific fiscal requirements. Administration State Department Requirements State departments which administer block grants will: 1. Require grant recipients to submit two (2) quarterly reports-- a. the "Grant Financial Status Report", an accountability report; and b. the "Grant Cash Transaction Report", a cash flow report. The final forms of the two quarterly reports may be developed by the administering department as long as the information contained in the sample reports shown as SAM Section 8760 Illustration 1 and 2 is reported. 2.. Require grant recipients to maintain detailed accounting records which form the basis for the grant reports; 3. Retain the grant reports for fiscal management and control purposes; 4. Take appropriate action, which may include canceling/withdrawing the grant, if grant reports are not submitted timety;. and 5. Require, as an option, additional information/reports from grant recipients to supplement the information contained in the two quarterly reports. Grant Recipient Requirements All grant recipients wilt: 1. Complete two (2) quarterly grant reports-- a. The "Grant Financial Status Report" (see SAM Section 8760 Illustration 1 for a sample report format and instructions); and b. The "Grant Cash Transaction Report" (see SAM Section 8760 Illustration 2 for a sample report format and instructions); 2. Submit the grant reports to the administering department by the 20th calendar day following the end of each quarter. 3. Maintain detailed accounting records which form the basis for the grant reports; and 4. Retain and have the accounting recordsavailable for audit for a minimum of three years from the report submission date. A/S4:758/22 TL 335 MARCH 1990 Page 1 of 5 STATE ADMINISTRATIVE MANUAL NISCELLAXEOUS ACCOUNTING PROCEDURES GRANT FINANCIAL STATUS REPORT (Instructions for the Preparation of the Report on Page 3) A. Grant Information: 1. Grant Name: Contract Number: Identification Number if applicable: 2. Grant Period: From: To: 3. Quarter covered by report: From: To: 4. Final Report: Yes: No: 5. Accounting Basis: Cash: Accrual: B. Grantor Information: State Agency and Office: C. Grantee Information: 1. Grantee Organization Name: 2. Address: City and Zip Code: *3. Employer Identification Number, if applicable: D. Fiscal Information: *1. Net outlays previously reported (line D.3. from previous quarter0s report) S *2. Total net outlays this report period S *3. Net outlays to date (line D.1. plus D.2.) S *4. Less: Nongrant share of outlays S *5. Total grant share of outlays (line D.3. minus line D.4.) S *6. Total unliquidated obligations s 7. Less: Nongrant share of unliquidated obligations S *8. Grant share of unliquidated obligations (tine D.6. minus line D.7.) S *9. Total grant share of outlays and unliquidated obligations (line D.5. plus line D.8.) S- 10. Total cumulative amount of grant funds authorized S *11. Unobligated balance of grant funds (line D.10. minus line D.9.) S E. Non Fiscal Information 1. Certification: I certify, to the best of my knowledge and belief, under penalty of perjury, that this report is correct and complete and that all disbursements have been made in accordance with the grant agreement. 2. Signature: Date: 3. Name and Title: (Printed or Typed) 4. Telephone: Area: Number: Extension: F. Remarks: *instructions for completion on Page 3 A:0287AJ7584Ji8 TL 306 8760 ILLUSTRATION 1 MARCH 1990 Page 2 of 5 STATE ADMINISTRATIVE MANUAL MISCELLANEOUS ACCOUNTING PROCEDURES INSTRUCTIONS FOR GRANT FINANCIAL STATUS REPORT C.3. Enter the employer identification number assigned by the U.S. Internal Revenue Service (Applicable for private non-profit organization). D.1. Enter the net outlay. This amount should be the same as the amount reported on line D.3. of the last report. if there has been an adjustment to the amount shown previously, please attach an explanation. Show zero if this the initial report. D.2. Use work sheet and instructions below to determine NET outlays for this report period: 6. Total Gross Outlays S b. Less: Grant Income Credits S Net Outlays this report period S a. Enter the total gross outlays less rebates, refunds, and other discounts for this quarter. o For reports prepared on a cash basis, outlays are the sum of actual cash disbursements (Including cash advances to contractors and subgrantees) plus indirect expenses incurred by other than your organization. o For reports prepared on an accrued expenditure basis, outlays are: 1. For the first quarter report, the sum of cash disbursements, indirect expenses incurred, and accounts payable (accounts payable are amounts owed for goods and other property received plus services performed by employees, contractors, subgrantees, and other payees). 2. For subsequent quarter reports, the sum of cash disbursements, indirect expenses incurred, and the increase or decrease in accounts payable from the previous quarter's report. (For example: assume the first quarter reports accounts payable of $50.00. At the end of the second quarter accounts payable is 570.00. This is an increase of $20.00 which would be added as an outlay for this quarter.) b. Enter the amount of all program income received in this period that is required by the terms and conditions of the award to be deducted from total project costs. Grant program income are those dollar amounts received from all other sources to help defray block grant program costs. For reports prepared on an accrual basis, enter the same amount of income earned since the beginning of the reporting period. (When the terms or conditions allow program income to be added to the total award, the grantee will explain in remarks, the source, amount and disposition of the income.) D.L. Enter the nongrant share of program outlays included in the amount on tine 0.3. D.6. Enter the unliquidated obligations for this project including unliquidated obligations to subgrantees and contractors. Unliquidated obligations are: Cash basis - obligations incurred but not paid. Accrued expenditure basis - obligations incurred, but for which an expenditure has not been recorded. Do not include any amounts that have been included on tines DA through D.5. On the final report, line D.6 should have a zero balance. D.8. Enter the grant share of unliquidated obligations. The amount shown on this tine mitt be the difference between tines D.6 and D.7. D.9. Enter the sun of the amounts shown on tines D.5 and D.8. If the report is final, it should not contain any untiquidated obligations. D.11. Enter the unobligated balance of grant funds. This amount should be the difference between tine D.10 and D.9. The figures provided in this report must be supported by detailed accounting records. The records will be retained and available for audit for a minimum of three years. A:0287A7584J19 TL 306 8760 ILLUSTRATION 1 (Cont. 1) MARCH 1990 Page 3 of 5 E � STATE ADMINISTRATIVE MANUAL NISCELLANEOLIS ACCOUNTING PROCEDURES GRANT CASH TRANSACTIONS REPORT (Instructions for the Preparation of the Report an Page 5) A. Grant Information: 1. Grant Name: Contract Number: - Identification Number if applicable: 2. Grant Period: From: To: 3. Quarter covered by report: From: To: B. GrantorA nformation: State Agency and Office: C. Grantee Information: 1. Grantee Organization Name: 2. Address: City and Zip Code: *3. Employer Identification Number, if applicable: 0. Fiscal Information: *1. Cash on hand beginning of period S *2. Receipts: A. Reimbursements S B. Advances S C. Grant share of income S D. Interest income S Total S 3. Total Cash Available (sum of line D.1, and line D.2.) S *4. Disbursements S *5. Adjustments of prior quarters S *6. Cash on hand end of quarter S *7 The amount shown on line 6. above represents cash requirements for the next days. *8. Advances during the quarter: Sub-grantee S E. Non Fiscal Information 1. Certification: I certify, to the best of my knowledge and belief, under penalty of perjury, that this report is correct and complete and that all disbursements have been made in accordance with the grant agreement. 2. Signature Date: 3. Name and Title: (Printed or Typed) 4. Telephone: Number: Extension: F. Remarks: *Instructions for compietion on page A:0287A/7584J20 TL 306 8760 ILLUSTRATION 2 KARCH 1940 Page 4 of 5 STATE ADMINISTRATIVE MANUAL MISCELLANEOUS ACCOUNTING PROCEDURES INSTRUCTIONS FOR GRANT CASH TRANSACTION REPORT C.3. Enter employer identification number assigned by the U.S. Internal Revenue Service (Applicable for private non-profit organizations). 0.1. Enter the grant cash on hand at the beginning of the reporting period including funds.on deposit, funds on hand, and undeposited checks/warrants. D.2. (A) Enter the funds received during the quarter as grant reimbursements. (B) Enter the funds received during the quarter as grant advances. (C) Enter the grant share of program income that was required to be used on the project by the terms of the grant. Grant program income are those dollar amounts received from ail other sources to help defray block grant program costs. (D) Enter the interest earned during the quarter on grant advances. D.4. Enter the total grant cash disbursements made during the reporting period. Disbursements as used here includes advances and payments to subgrantees or contractors, salaries and wages plus employer's share of benefits, interdepartmental charges for supplies and services, and indirect costs to which the recipient is entitled. D.S. Enter all adjustments pertaining to prior quarters which affects the ending balance that have not been included in any lines above. Explain all adjustments in the remarks section; use plain sheets of paper if additional space is required. D.6. Enter the grant cash on hand at the end of the reporting period. This amount will include alt funds on deposit, funds on hand, and undeposited funds (line D.3 Less line D.4, plus or minus line D.5). D.7. Enter the estimated number of days until the cash on hand,.shown on tine D.6, will be expended. D.B. Enter the advances made to secondary recipients included in Line D.4. The figures provided in this report must be supported by detailed accounting records. The records will be retained and available for audit for a minimum of three years. A:0287A/7584J21 TL 306 8760 ILLUSTRATION 2 (Cont. 1) MARCH 1990 Page 5 of. 5