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HomeMy WebLinkAboutMINUTES - 11142006 - C.102 C � 0 Contra TO: BOARD OF SUPERVISORS ' - CostaFROM: Lionel D. Chatman, County Probation Officer - s CountyDATE:i October 31, 2006 � I SUBJECT: Mental Health Counseling Services at Orin Allen Youth Rehabilitation Facility I i SPECIFICIREQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION I I RECOMMENDATION: I I APPROVE and AUTORIZE the County Probation Officer, or designee, to execute a contract with New Connections in the amount of$46,875 to provide mental health counseling services at the Orin Allen Youth Rehabilitation Facility for the period November 15, 2006 through June 30, 2007. � I FISCAL IMPACT: I State funds appropriated from Juvenile Justice Crime Prevention Act will fully cover the cost of these services. No County funds are required. I BACKGROUND: l I I Since the elimination of mental health services at the Orin Allen Youth Rehabilitation Facility during the last budget session, the program has lacked mental health counseling services for youths residing at the Ranch. This partnership will Orovide services to the residents as they graduate from their programs and return to their families and community. Research in best practices Indicates that youths who, in addition to probation supervision, receive assistance from a mental health counselor when they return from a rehabilitative program demonstrate greater successl and decreased likelihood they will return to gout of home placement or residential care. I / CONTINUED ON ATTACHMENT: `YES SIGNATURE: ! v -1--RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE vAPPROVE OTHER Ili r I SIGNATURE(S): I II (-)- Action of Boa. i /G Approved as Recommended Other I VOTE OF SUPERVISORS 1 HEREBY CERTIFY THAT THIS IS A TRUE I V AND CORRECT COPY OF AN ACTION TAKEN UNANIMOUS(ABSENT AND ENTERED ON THE MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE AYES: NOES: SHOWN. ABSENT: ABSTAIN: l I ATTESTED: NOVEMBER 14,2006 I CONTACT: I Lionel Chatman 313-4188 JOHN CULLEN,CLERK OF THE BOARD OF cc: I CCC Probation SUPERVISORS AND COUNTY ADMINISTRATOR County Administrators Ofc-J.Enea ,/ n ,, Q County Auditors Office I BY i1,-.F .� `^-'�-- .DEPUTY I I' I 'I I Contra Costa County STANDARD.CONTRACT Number 35603 Standard Form L-1 (Purchase of Services - Long Form) Fund/Org# 3160 Revised 2002 Account # 2310 Other # C 1. Contract Identification. L ,�I P De artment: Contra Costa County Probation �, Subject: Mental health services at Orin Allen Youth Rehabilitation Facility. 2. Parties. The County of Contra Costa, California (County), for its Department named above, and the following named Contractor mutually agree and promise as follows: Contractor: New Connections Capacity: Counseling and recovery services. Address: 3024 Willow Pass Road, Concord, CA 94519 3. Term. The effective date of this Contract is November 15, 2006. It terminates on June 30, 2002 unless sooner terminated as provided herein. 4. Payment Limit', County's total payments to Contractor under this Contract shall not exceed i $ 46,875.00. 5. County's Obligations. County shall make to the Contractor those payments described in the Payment Provisions attached hereto which are incorporated herein by reference, subject to all the terms and conditions contained or incorporated herein. 6. Contractor's Obligations. Contractor shall provide those services and carry out that work described in the Service Plan attached hereto which is incorporated herein by reference, subject to all the terms and conditions contained or incorporated herein. 7. General and Special Conditions. This Contract is subject to the General,Conditions and Special Conditions (if any,) attached hereto,which are incorporated herein by reference. 8. Project. This Contract implements in whole or in part the following described Project, the application and approval documents of which are incorporated herein by reference: N/A i i L-1 (Page 1 of 2) Contra Costa County==- -;- STANDARD CONTRACT_.:_ Number 35603 . Standard'sForm L-1 (Purchase:of Services - Long Form) Revised 2002 9. Legal Authori . This Contract is entered into under and subject to the following legal authorities: California Government Code: 31000 to. Signatures. These signatures attest the parties' agreement hereto: COUNTY OF CONTRA COSTA, CALIFORNIA BOARD OF SUPERVISORS ATTEST: Clerk of the Board of Supervisors By By Chairman/Designee Deputy CONTRACTOR Name of busine a Name of business entity By ( By (Signature of indiNidual or offieer) (Print name and title A, if applicable) (Print name and title B, if applicable) Note to Contractor:For Corporations(profit or nonprofit),the contract must be signed by two officers. Signature A must be that of the president or vice-president and Signature B must be that of the secretary or assistant secretary(Civil Code Section 1190 and Corporations Code Section 313). All signatures must be acknowledged as set forth on Form L-2. L-1 (Page 2 of. 2) Contra Costa.County:.: -_ -.:__.:== APPROVALS/ACKNOWLEDGMEN.T.. Number 36603-- Standard Form:L-2 :'=- (Purchase of Services Long Form): Revised 2002 APPROVALS RECOMMENDED BY DEPARTMENT FORM APPROVED COUNTY COUNSEL By: ud Designee De uty i i APPROVED: COUNTY ADMINISTRATOR By C:L Designee i ACKNOWLEDGMENT STATE OF CALIFORNIA ) ss. COUNTY OF CONTRA COSTA ) On ' �? , before me, insert name i d title of the officer), personally appeared personally known to me (or proved to me on the basis of satisfactory evidence)to be the person(s) whose name(s) is/are subscribed to the within.instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS MY HAND AND OFFICIAL SEAL. Z7 jS -� (Seal) Signature ACKNOWLEDGMENT(by Corporation,Partnership,or Individual) (Civil Code§1185 i i i L-2 ( Page 1 of 1) =- 35603 Contra Costa County._........ -_: _':-PAYMENT PROVISIONS--- :=_ Number Standard Form P=1 (Fee Basis Contracts -Long'and Short Form) Revised 2002 1. Payment Amounts. Subject to the Payment Limit of this Contract and subject to the following Payment Provisions, County will pay Contractor the following fee as full compensation for all services, work, expeni es or costs provided or incurred by Contractor: i [Check one alternative only.] ® a. $6,250.00 monthly, or ❑ b. $ per unit, as defined in the Service Plan, or ❑ c. $ after completion of all obligations and conditions herein. ❑ d. Other: 2. Payment Demands.Contractor shall submit written demands for payment on County Demand Form D-15 in the manner and form prescribed by County. Contractor'shall submit said demands for payment no later than 30 days from the end of the month in which the contract services upon which such demand is based were actually rendered. Upon approval of payment demands by the head of the County Department for which this Contract is made, or his designee, County will make payments as specified in Paragraph 1. (Payment Amounts)above. 3. Penalty for Late Submission. If County is unable to obtain reimbursement from the State of California as a result sof Contractor's failure to submit to County a timely demand for payment as specified in Paragraph 2. (Payment Demands)above,County shall not pay Contractor for such services to the extent County's recovery of funding is prejudiced by the delay even though such services were fully provided. 4. Riaht�to Withhold. County has the right to withhold payment to Contractor when,in the opinion of County expressed in writing to Contractor, (a) Contractor's performance, in whole or in part, either has not been carried out or is insufficiently documented, (b) Contractor has neglected, failed or refused to furnish information or to cooperate with any inspection, review or audit of its program, work or records, or (c) Contractor has failed to sufficiently itemize or document its demand(s) for payment. 5. Audit Exceptions. Contractor agrees to accept responsibility for receiving, replying to, and/or complying with any audit exceptions by appropriate county, state or federal audit agencies resulting from its performance of this Contract. Within 30 days of demand, Contractor shall pay County the full amount of County's obligation,if any,to the state and/or federal government resulting from any audit exceptions,to the extent such are attributable to Contractor's failure to perform properly any of its obligations under this Contract. i y lJ� ' Initials: Contractor County Dept. Form P-1 (Page 1;of 1) i Contra Costa County Number 35603 Standard Form L-4 Revised 2002 SERVICE PLAN (Purchase of Services -Long Form) Orin Allen Youth Rehabilitation Facility Mental Health Counseling Program The New Connections Mental Health Counseling Program will provide the following services to the Orin Allen Youth Rehabilitation Facility: ■ A 40 hour/week Mental Health Counselor. ■ The position will be staffed by a post-graduate clinician in a licensure track. ■ New Connections will provide all necessary clinical supervision for the counselor. ■ The Counselor will provide individual and group sessions for residents who are referred from the Court or by any OAYRF staff member,teacher, school principal, etc. ■ The Counselor will provide referrals and linkages as needed for youth being seen by the counselor as part of the discharge planning process. ■ The Counselor will participate in treatment planning, discharge planning meetings etc. that OAYRF feels would be supportive of the residents being seen by the Counselor or that may be referred to the Counselor. ■ The Counselor will provide parent/farriily sessions as needed for those youth being seen by the counselor. ■ The Counselor will meet with other stalff involved in the youth's care on a regular basis. ■ The Counselor will complete an adolescent bio-psycho-social assessment on all youth referred to the counselor. ■ The Counselor will develop a treatment plan for each youth being seen by the counselor and document all individual group and family support sessions in a record to be maintained at OAYRF. j I Initials: I j Contractor County Dept. I I L3 (Page 1 ofi l I � I Contra Costa Coun __.-... GENERAL CONDITIONS.:. Standard Form!L-5' (Purchase of Services -Long Form.) Revised 2003 �. 1. Compliance with Law. Contractor shall be subject to and comply with all applicable federal, state and local laws and regulations with respect to its performance under this Contract, including but not limited to, licensing, employment and purchasing practices; and wages, hours and conditions of employment, including nondiscrimination. 2. Inspection. Contractor's performance, place of business and records pertaining to this Contract are subject to monitoring, inspection, review and audit by authorized representatives of the County, the State of California, and the United States Government. 3. Records. Contractor shall keep and make available for inspection and copying by authorized representatives of the County, the State of California, and the United States Government, the Contractor's regular business records and such additional recolyds pertaining to this Contract as may be required by the County. i a. Retention of Records. Contractor shall retain all documlents pertaining to this Contract for five years from the i date of submission of Contractor's final payment demand or final Cost Report;for any further period that is required by law; and until all federal/state audits are complete and exceptions resolved for this contract's funding period. Upon request,Contractor shall make these records available to authorized representatives of the County,the State of California, and the United States Government. b. Access to Books and Records of Contractor, Subcontractor. Pursuant to Section 1861(v)(1) of the Social Security Act, and any regulations promulgated thereunder, Contractor. shall, upon written request and until the expiration of four years after the furnishing of services pursuant to this Contract,make available to the County,the Secretary of Health and Human Services,or the Comptroller General,or any of their duly authorized representatives, this Contract and books,documents,and records of Contractor necessary to certify the nature and extent of al]costs and chargles hereunder. Further, if Contractor carries out any of the duties of this Contract through a subcontract with a value or cost of $10,000 it more over a twelve-month period, such subcontraI t shall contain a clause to the effect that upon written request and until the expiration of four years after the furnishing of services pursuant to such subcontract, the subcontractor shall make available to the County, the Secretary, the Comptroller General, or any of their duly authorized representatives, the subcontract and books, documents, and records of the subcontractor necessary to verify the nature and extent of all costs and charges thereunder. This special condition is in addition to any and all other terms regarding the maintenance or retention of records under this Contract and is binding on the heirs, successors, assigns and representatives of Contractor. I 4. Reporting Requirements. Pursuant to Government Code Section 7550,Contractor shall include in all documents or written reports completed and submitted to County in accordance with this Contract,a separate section listing the numbers and dollar amounts of all contracts and subcontracts relating to the preparation of each such document or written report. This section shall apply only if the payment limit under this Contract exceeds $5,000. I 5. Termination and Cancellation. a. Written Notice. This Contract may be terminated by either party,in its sole discretion,upon thirty-day advance written notice thereof to the other, and may be cancelled immediately by written mutual consent. I � L-5 (Page 1 offl 6) I a Contra Costa.County GENERAL CONDITIONS Standard Form,L-5 ° (Purchase of Services - Long Form) ...- Revised 2003 b. Failure to Perform. County, upon written notice to Contractor, may immediately terminate this Contract should Contractor fail to perform properly any of its obligations hereunder. In the event of such termination;County may proceed with the work in any reasonable manner it chooses. The cost to County of completing Contractor's performance shall be deducted from any sum due Contractor under this Contract,without prejudice to County's rights to recover) damages. C. Cessation of Funding. Notwithstanding Paragraph 5.a. above, in the event that federal, state, or other non- County funding for this Contract ceases, this Contract is terminated without notice. 6. Entire Agreement. This Contract contains all the terms and conditions agreed upon by the parties. Except as expressly provided herein,no other understanding,oral or otherwise,regarding the subject matter of this Contract shall be deemed to exist or to bind any of the parties hereto. 7. Further Specifications for Operating Procedures. Detailed specifications of operating procedures and budgets required by this Contract, including but not limited to,monitoring,evaluating,auditing,billing,or regulatory changes,may be developed and set forth in a written Informal Agreement between Contractor and County. Informal Agreements shall be designated as such and shall not be amendments to this Contract except to the extent that they further detail or clarify that which is already required hereunder. Informal Agreements may not enlarge in any manner the scope of this Contract, including any sums of money to be paid Contractor as provided herein. Informal Agreements may be approved and signed by the head of the county department for which this Contract is made or its designee. 8. Modifications and Amendments. I a. General Amendments. This Contract may be modified or amended by a written document executed by Contractor and the Contra Costa County Board of Supervisors or, after Board approval,by its designee, subject to any required state or federal approval. i b. AdmListrative Amendments. Subject to the Payment Limit,the Payment Provisions and the Service Plan may be amended by a written administrative amendment executed by Contractor and the County Administrator (or designee), subject to any required state or federal approval,provided that such administrative amendment may not materially change the Payment Provisions or the Service Plan. 9. Disputes. Disagreements between County and Contractor coincerning the meaning,requirements,or performance of this Contract shall be subject to final written determination by the head of the county department for which this Contract is made, or his designee, or in accordance with the applicable procedures (if any) required by the state or federal government. 10. Choice of Law and Personal Jurisdiction. I a. This Contract is made in Contra Costa County and shall be governed and construed in accordance with the laws I of the State of California. I ; I � L=5 (Page 2 of 6) InitialsL. " Contractor County Dept. Contra.Costa.County`.: _:: GENERAL CONDITIONS. _-... ... Standard Form L-5. (Purchase of.Services -Long Form) Revised 2003 I I b. Any action relating to this Contract shall be instituted and prosecuted in the courts of Contra Costa County.State of California. I � 11. Conformance with Federal and State Regulations and Laws. Should federal or state regulations or laws touching upon the subject of this Contract be adopted or revised during the term hereof,this Contract shall be deemed amended to assure conformance with such federal or state requirements. 12. No Waiver by County. Subject to Paragraph 9.(Disputes)of these General Conditions,inspections or approvals,or statements by any officer,agent or employee of County indicating Contractor's performance or any part thereof complies with the requirements of this Contract,or acceptance of the whole or any part of said performance,or payments therefor, or any combination of these acts,shall not relieve Contractor's obligation to fulfill this Contract as prescribed; nor shall the County be thereby estopped from bringing any action for damages or enforcement arising from any failure to comply with any of the terms and conditions of this Contract. 4 13, Subcontract and Assignment. This Contract binds the heirs!successors,assigns and representatives of Contractor. Prior written consent of the County Administrator or his designee, subject to any required state or federal approval, is required before the Contractor may enter into subcontracts for anyi work contemplated under this Contract, or before the Contractor may assign this Contract or monies due or to become due, by operation of law or otherwise. I 14. Independent Contractor Status. This Contract is by and between two independent contractors and is not intended to and shall not be construed to create the relationship between the parties of agent, servant,employee,partnership,joint venture or association. 15. Conflicts of Interest. Contractor, its officers,partners,associates,agents,and employees,shall not make,participate in making, or in any way attempt to use the position afforded them by this Contract to influence any governmental decision in which they know or have reason to know they have a�financial interest under California Government Code Sections 87100, et seq., or otherwise. 16. Confidentiality. Contractor agrees to comply and to require its officers,partners,associates,agents and employees to comply with all applicable state or federal statutes or regulations respecting confidentiality,including but not limited to, the identity of persons served under this Contract, their records, or services provided them, and assures that: I a. All !applications and records concerning any individual made or kept by Contractor or any public officer or agency in connection with the administration of or relating to services provided under this Contract will be confidential,and will not be open to examination for any purpose not directly connected with the administration of such service. i b. No person will publish or disclose or permit or cause to be published or disclosed, any list of persons receiving services,iexcept as may be required in the administration of such service. Contractor agrees to inform all employees, agents and partners of the above provisions, and that any!person knowingly and intentionally disclosing such information other than as authorized by law may be guilty of a misdemeanor. L-5 (Page .) of 6) Initials: �------ f% Contractor County Dept. I Contra Costa County------ GENERAL CONDITIONS. . _ Standard Form'L_5 � (Purchase of Services.- Long Form) Revised 2003 17. Nondiscriminatory Services. Contractor agrees that all goods and services under this Contract shall be available to all qualified persons regardless of age, sex,race,religion,color, national origin, ethnic background, disability,or sexual orientation, and that none shall be used, in whole or in part, for religious worship or instruction. I 18. Indemnification. Contractor shall defend,indemnify,save,and hold harmless County and its officers and employees from any and all claims,costs and liability for any damages,sickness,death,or injury to person(s)or property,including without limitation all consequential damages,from any cause whatsoever arising directly or indirectly from or connected with the operations or services of Contractor or its agents, servants, employees or subcontractors hereunder, save and except claims dor litigation arising through the sole negligence or sole willful misconduct of County or its officers or employees. Contractor will reimburse County for any expenditures, including reasonable attorneys' fees, County may make by reason of the matters that are the subject of this indemnification, and, if requested by County, will defend any claims or litigation to which this indemnification provision applies at the sole cost and expense of Contractor. Insurance During the entire term of this Contract and an e I tension or modification thereof, Contractor shal l keep 19 g Y � P in effect insurance policies meeting the following insurance requirements unless otherwise expressed in the Special Conditions: a. Liability Insurance. For all contracts where the total payment limit of the contract is $500,000 or less, Contractor shall provide comprehensive liability insurance, including coverage for owned and non-owned automobiles,with a minimum combined single limit coverage of$500,000 for all damages,including consequential damages due to bodily injury, sickness or disease, or death to any person or damage to or destruction of property, . including the loss of use thereof,arising from each occurrence. Such insurance shall be endorsed to include County . and its officers and employees.as additional insureds as to all services performed by Contractor under this agreement. Said policies shall constitute primary insurance as to County, the state and federal governments,and their officers, agents,and employees, so that other insurance policies held by them or their self-insurance program(s)shall not be required�to contribute to any loss covered under Contractor'si insurance policy or policies. For all contracts where the total payment limit is above $500,000, the aforementioned insurance coverage to be provided by Contractor shall have a minimum combined single limit coverage of$1,000,000,and Contractor shall be required to provide County with a copy of the endorsement making the County an l additional insured on all general liability, worker's compensation, and, if applicable, all professional liability insurance policies as required herein no later than the effective date of this Contract. b. Workers' Compensation. Contractor shall provide workers' compensation insurance coverage for its employees. C. Certificate of Insurance. The Contractor shall provide the County with (a) certificate(s) of insurance evidencing liability and worker's compensation insurance as required herein no later than the effective date of this Contract. If the Contractor should renew the insurance policy(ies) or acquire either a new insurance policy(ies)or amend the coverage afforded through an endorsement to the policy at any time during the term of this Contract,then Contractor shall provide (a) current certificate(s) of insurance. I d. Additional Insurance Provisions. The insurance policies provided by Contractor shall include a provision for thirty(30) days written notice to County before cancellation or material change of the above specified coverage. L-5 (Page 4 of 6) Initials: . ��- - ✓ Contractor County Dept. = GENERAL CONDITIONS Contra Costa County Standard Form L-5. _(Purchase of Services.-Long Form). Revised 2003 �. 20. Notices. All notices provided for by this Contract shall be in writing and maybe delivered by deposit in the United States mail, postage prepaid. Notices to County shall be addressed to the head of the county department for which this Contract is made. Notices to Contractor shall be addressed to the Contractor's address designated herein. The effective . date of notice shall be the date of deposit in the mails or of other delivery, except that the effective date of notice to County shall be the date of receipt by the head of the county department for which this Contract is made. i 21. Primacy of General Conditions. Except for Special Conditions which expressly supersede General Conditions,the I Special Conditions (if any) and Service Plan do not limit any tern of the General Conditions. 22. Nonrenewal. Contractor understands and agrees that there is no representation, implication,or understanding that the services provided by Contractor under this Contract will be purchased by County under a new contract following . expiration or termination of this Contract, and waives all rights or claims to notice or hearing respecting any failure to continue purchasing all or any such services from Contractor. I 23. Possessony Interest. If this Contract results in Contractor hiving possession of, claim or right to the possession of land or improvements, but does not vest ownership of the land orlimprovements in the same person, or if this Contract results in the placement of taxable improvements on tax exempt!land (Revenue & Taxation Code Section 107); such interest or impr�I vements may represent a possessory interest subject to property tax,and Contractor may be subject to the payment of property taxes levied on such interest. Contractor iagrees that this provision complies with the notice requirements of Revenue&Taxation Code Section 107.6,and waives all rights to further notice or to damages under that or any comparable statute. 24. No Third-Party Beneficiaries. Notwithstanding mutual recognition that services under this Contract may provide some aid or ass istance to members of the County's population, it ii not the intention of either County or Contractor that such individuals occupy the position of intended third-party benefit iaries of the obligations assumed by either party to this Contract. 25. Coyyriehts and Rights in Data. Contractor shall not publish or transfer any materials produced or resulting from activities supported by this agreement without the express written consent of the County Administrator. If any material is subject to copyright,County reserves the right to copyright, and Contractor agrees not to copyright,such material. If the material is copyrighted, County reserves a royalty-free,nonexclusive,and irrevocable license to reproduce,publish, and use such materials, in whole or in part, and to authorize others to do so. 26. Endorsements. Contractor shall not in its capacity as a contractor with Contra Costa County publicly endorse or oppose the use of any. particular brand name or commercial product without the prior approval of the Board of Supervisors. In its County contractor capacity, Contractor shall not publicly attribute qualities or lack of qualities to a particular brand name or commercial product in the absence of a well-established and widely accepted scientific basis for such claims or without the prior approval of the Board of Supervisors. In its County contractor capacity,Contractor shall not participate or appear in any commercially produced advertisements designed to promote a particular brand name or commercial product, even if Contractor is not publicly endorsing'a product, as long as the Contractor's presence in the advertisement can reasonably be interpreted as an endorsement of the product by r on behalf of Contra Costa County. L-5 (Page 5 of;6) Initials: 1 Contractor County Dept. - I Contra Costa County- ..-.-.--.-.-­.. GENERAL CONDITIONS . Standard Form L-5..: (P.urchase of Services -Long Form).._ Revised 2003 I Notwithstanding the foregoing, Contractor may express its views on products to other contractors, the Board of Supervisors, County officers, or others who may be authorized by the Board of Supervisors or by law to receive such views. 27. Required Audit. (A)If Contractor is funded by $500,000 or more in federal grant funds in any fiscal year ending after December 31, 2003 from any source, Contractor shall provide to County at Contractor's expense an audit conforming to the requirements set forth in the most current version of Office of Management and Budget Circular A- 133. (B) If Contractor is funded by less than $500,000 in federal,grant funds in any fiscal year ending after December .31, 2003 from any source, but such grant imposes specific audit requirements; Contractor shall provide to County an audit conforming to those requirements. (C) If Contractor is funded by less than $500,000 in federal grant funds in any fiscal year ending after December 31, 2003 from any source,;Contractor is exempt from federal audit requirements for I that year, however, Contractor's records must be available for and an audit may be required by, appropriate officials of the federal awarding agency, the General Accounting Office (GAO), the pass-through entity and/or the County. If any such audit is required, Contractor shall provide County with such audit. With respect to the audits specified in (A), (B) and (C) above, Contractor is solely responsible for arranging for the conduct of the audit, and for its cost. County may withhold the estimated cost of the audit or 10 percent of the contract amount, whichever is larger, or the final payment, from Contractor until County receives the audit from Contractor. I 28. Authorization. Contractor, or the representative(s) signingthis Contract on behalf of Contractor, represents and warrants that it has full power and authority to enter into this Contract and perform the obligations herein. i i I I I I I I I I I I I I i I - I I ,I i I I i I I I L-5 (Page 6 of 6) Initials: Contractor County Dept. i