HomeMy WebLinkAboutMINUTES - 04271993 - 1.52 TO: BOARD OF SUPERVISORS
FROM. Mark Finucane, Health Services Director (/LL ' Contra
By: Elizabeth A. Spooner, Contracts AdministratorCOSta
DATE: April 15, 1993 County
SUBJECT: Approve Standard Agreement (Amendment) #29-208-43 with the State Department of
Health Services for the Immunization Assistance Program
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
Approve and authorize the Chair, Board of Supervisors, to execute on behalf of
the County, the required Certification Regarding Lobbying and Standard Agreement
(Amendment) #29-208-43 (State #92-15083, Al) , effective January 1, 1993, with the
State Department of Health Services (Immunization Unit) to increase the contract
payment limit by $73,488, from $45,687 to a new payment limit of $119,175 for FY
1992-93. This program provides funds for County's Immunization Assistance
Program.
II. FINANCIAL IMPACT:
Approval of this Standard Agreement (Amendment) by the State will result in an
increase of $73,488 of State funding (via new federal subvention funds, Catalog
#93.268) for the Immunization Assistance Program. No County match is required.
III. REASONS FOR RECOMMENDATIONS/BACKGROUND:
On August 11, 1992, the Board approved Standard Agreement #29-208-42 with the
State Department of Health Services for continuation of the long-standing
Immunization Assistance Program operated by the Public Health Division of the
Health Services Department. The County maintains this program to make
immunizations available to all persons in need of this service in order to
prevent the occurrence and transmission of childhood diseases. This program
also includes an adverse reaction monitoring system and outbreak control team.
This contract must be maintained in order for the County to continue to receive
free vaccine from the State.
Approval of Standard Agreement (Amendment) #29-208-43 will provide for new
subvention funds to enhance and expand immunization clinical services for
County's Immunization Assistance Program.
The Board Chair should sign nine copies of this agreement, eight of which should
then be returned to the Contracts and Grants Unit for submission to the State
Department of Health Services.
CONTINUED ON ATTACHMENT: YES SIGNATURE: (2.
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMEAT NOF 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: NOES: AND CORRECT COPY OF AN ACTION TAKEN
ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD
OF SUPERVISORS ON THE DATE SHOWN.
Contact: Wendel Brunner, M.D. (313-6712)
CC: Health Services (Contracts) ATTESTED
Auditor-Controller (Claims) Phil Batchelor, Clerk of the Board of
State Dept. of Health Services SupenWjsaadC MtyAdministrator
Mee2/7-ee BY DEPUTY
STATE OF CALIFORNIA
STAND' - APPROVED BY THE
ARD AGREEMENT— ATTORNEY GENERAL CO�' " T�' "BER AMp,°1
STD.2(REV.5-91)
TAXPAYERS FEDERAL EMPLOYER IDENTIFICATION NUMBER
THIS AGREEMENT,made and entered into this 1 SC day of January 19 93
94-6000509
in the State of California,by and between State of California,through its duly elected or appointed,qualified and acting
TITL F.O FI ER ACTING F R STATE AGENCY
Cnie , grogram support Branch Department of Health Services
hereafter called the State,and
CONTRACTOR'S NAME � _ ® C7711 0
COUNTY OF CONTRA COSTA (Health Services) 43
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,
ti ormgnce or completion,and attach plans and s ecif ications,i any.)
"'fr��i�a r certain agreement between this Department and the County of Contra Costa(Department of Health Services)dated June
1, 1992:
Paragraph 1 is amended to read:
1. The Contractor shall complete the objectives as stipulated in the attached Exhibit A Revised, Entitled"Terms". Exhibit
A Revised includes one new additional page for a total of seven pages and is made a part of this agreement by this
reference.
All references to Exhibit A shall now read Exhibit A Revised".
Paragraph 2 is amended to read:
"2. The attached Exhibit B Revised, entitled'Budget", consisting of one page is made a part of this agreement by this
reference.
All references to Exhibit B shall now read Exhibit B Revised".
Paragraph 3 is amended to read:
"3. The attached Exhibit C Revised, entitled "Project Summary and Budget Justification", consisting of four pages is
made a part of this agreement by this reference.
All references to Exhibit C shall now read Exhibit C Revised".
CONTINUED ON 1 SHEETS,EACH BEARING NAME OF CONTRACTOR AND CONTRACT NUMBER.
The provisions on the reverse side hereof Constitute a part of this agreement.
IN WITNESS WHEREOF,this agreement has been executed by the parties hereto,upon the date first above written.
STATE OF CALIFORNIA CONTRACTOR
AGENCY Department of Health Services C N FACTOR If other than an individual state whether corporation,parfnersh',etc.)
p �bUNTI�OF CONTRA COSTA (Health Serv(c'3S
BY(AUTHORIZED SIGNATURE) BY(AUTHOR5F.Q4I to
PRINTED NAME OF PERSON SIGNING PRINTED NAME AND TITLE OF PERSON SIGNING
Chair, Board of Supervisors
TITLE Chief, Program Support Branch ADDRESS
651 Pira Street, Marti-ie-7,, CA 94553
AMOUNT.ENCUMBERED BY THIS PROGRAMLC 1Fta? 6?a&gy nTIITLE�OUnt FUND IuLefleral Department of General Services
DOCUMENT HHSSSS�Ia�33ff11GCCCI/ll�r�l ddrrll A C� Use Only
$ 73,488.00
PRIOR AMOUNT ENCUMBERED FOR (OPTIONE
61.7% Federal Catalog#93.268
THIS CONTRACT
$ 45,687.00 ITEM - CHAPTER I STATUTE FISCAL YEAR
4260-001-001 587 1992 1992/93
TOTAL AMOUNT ENCUMBERED TO
DATE OBJECT OF EXPENDITURE(CODE AND TITLE)
$ 119,175.00 92-95330-9159-701-03-951581-93
f hereby certify upon my own personal knowledge that budgeted funds T.B.A.NO. B.R.NO.
are available for the period and purpose of the expenditure stated above.
SIGNATURE OF ACCOUNTING OFFICER DATE
D
CONTRACTOR R STATE AGENCY DEPT.OF GEN.SER. F-1 CONTROLLER
STANIDA90AGREEMENT
1. The C'ontr.acmr ag.Tees to indemnify,defend and save harmless the State,its olTicers,agents and enip I oyces
from any and all c!aims and losses accruing or resulting to any and all contractors, subcontractors,
materialmen.11aborers and any other person,firm or corporation furnislting or supplying work ser,-icrs,
n,ateri.Jsorsupplies in connection with,the performance of this contract,and from any and all claims and
losses accruing or resulting to any' person, firm or corporation who may be injured or damaged I)v the
Contractor in the perforniance ol—this contract.
2. The Contractor,and the a,,jentsand employees of Contractor,in the performance of the
tic, :-I an independent capa6ty and not Its officers or employees or agents ail'State of California.
3.The State inay be relieved of the payment of-any-consideration to CoPr-I!#-!-
shouid 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-,vork in any manner deemc.-d
proper by the State. T he cost to the State shall be deducted from any sum due the Contractor under J-.I';S
aoreenienL,and the ;valance. if any,shall be paid the Contractor upon demand.
4, dVithout the written consent of the State, this agreement is not asci g
gnable by Contractor either in vilvi-
or in part.
4 'rime
is of the essence in this agreement.
6. \o alteration or var%ifion of fl)e terms of this contract shall be valid unless made in writin(zand
the parties bereto,and no ora!understanding or agreement not incorpor-,ited herein.shadLti
any of the parties he.-eto.
7. 'Hie consideration to be paid Contractor. as provided herein, shall be in compensatio-ii for ail of
Contractor's expenses incurred in the performance hereof. including ituvel and per
otherwise expressly so provided.
91 61014
Contractor: County of Contra Costa Contract No.: 92-15083 A-1
(Health Services) Page 2
i
Paragraph 5 is amended to read:
"5. The attached Exhibit A(F)entitled"Additional Provisions"consisting of twenty-seven pages is made apart hereof by
i this reference".
Paragraph 8 is amended to read:
"8. Federal funds are presently not available for all costs identified in the attached Exhibit B Revised(Budget)under this
agreement until January 1, 1993. The State's obligation for continued funding of these costs beyond that date is
contingent upon funds in the Public Health Federal Fund being appropriated for encumbrance by the State
Legislature in the 1992-93 Budget Act. If funding is reduced or deleted by the Federal Government for these costs,
the State shall have the option to either:
a. Cancel this agreement pursuant to Paragraph 9 of Exhibit A (Terms),the 30-day cancellation clause.
b. Offer a contract amendment to the Contractor to reflect the reduced funding for this agreement".
Paragraph 9 is amended to read:
"9. Limitation of State Funding
a. Under the terms of this contract for Fiscal Year 1992/93 ending June 30, 1993,the maximum amount payable
shall not exceed$45,687".
Paragraph 10 is added to read:
"10. Limitation of Federal Funding
a. The maximum amount payable forthe period January 1,1993 through June 30,1993 shall not exceed$73,488".
a
Paragraph 11 is added to read:
"11. Under the terms of this contract, the combined maximum amount of. state and federal funds payable through
June 30, 1993 shall not exceed$119,175".
Paragraph 12 is added to read:
`l
"12. In accordance with Public Law 98-502 and OMB Circular A-128, it is stipulated between the parties hereto that:
1. The cost of the single audit will be charged to the federal assistance program providing funds
for this agreement.
2. The Contractor shall include aclause 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".
Paragraph 13 is added to read:
"13. Contractor agrees that this contract is subject to examination and audit by the State,including the Auditor General,
for a period of three years after final payment under said contract."
The effective date of this amendment is January 1, 1993.
All other terms and provisions of said contract shall remain in full,force and effect.
EXHIBIT A Revised
TERMS
SECTION 1. TERMS AND CONDITIONS
The Contractor must agree to the following inclusive objectives and conduct the following activities. Please
note that many of these Terms and Conditions are also objectives and activities required by the Federal
Government and are conditions for funding of the California Immunization Program and/or statutory
requirements of State and local health departments. The level of subvention contract funding to be awarded
is not represented as sufficient for support of all the required activities: a significant amount of local support
and funding is expected. Subvention contract funds must not be used to supplant (i.e., replace) local funds
currently being expended for routine immunization services and activities. Subvention funds can only be
used for the activities outlined in the budget justification.
A. Objectives:
1.) Raise to (or maintain) immunization levels of 98% or greater for each of the legally required
immunizations among ail kindergarten entrants and incoming transfer students to schools within the
Contractor's jurisdiction.
2.) Raise age-appropriate immunization levels to 95% or greater among infants and preschool age
children residing within the Contractor's jurisdiction.
3.) Through prevention, surveillance and outbreak control, reduce, and if possible eliminate, illness,
disability and death due to vaccine preventable diseases such as polio, diphtheria, tetanus,
pertussis, measles, rubella, mumps, hepatitis B, and Haemophilus Influenzae Type b within the
Contractor's jurisdiction.
B. Specific Pediatric Activities:
1.) Immunization Clinic Services
a.) Provide regularly scheduled, public clinic services which are reasonably accessible to parents
of children who reside within the Contractor's jurisdiction.
b.) Clinic policies must allow for the immunization of all susceptible infants, children, adolescents
and adults who visit within the scheduled hours of operation regardless of their city, county or
state of residence.
c.) Immunization public clinic policies and practices must be in general accordance with the
current recommendations of the U.S. Public Health Service (ACIP) or the American Academy
of Pediatrics (AAP). Appropriate in-service training must be instituted to assure compliance
with the approved immunization practices.
d.) Each patient (or patient's parents) receiving "pediatric" immunizations through the Contractor's
public clinics must be provided a new or updated California Immunization Record (CIR). The
month, day and year of each immunization must be recorded on the CIR.
e.) Assure that the importance of completing the recommended schedule of immunizations is
discussed with all patients(or parents of patients) receiving immunizations at the public clinics.
f.) Assure that the date the next vaccine dose(s) are due is given in writing to the patient or
parent. The appropriate space on the CIR may be used for this purpose.
g.) In accordance with Immunization Unit current guidelines, which were furnished to the
contractor by the State,the Contractor must participate in the national Vaccine Adverse Events
Reporting System(VAERS) for adverse events following immunization.
EXHIBIT A(Pediatric Continued) Revised
FY 1992-93 Page 2
2.) Immunization Levels Assessment
a.) In accordance with the guidelines and timetables provided by the Immunization Unit, the
Contractor must coordinate the assessment of the immunization levels of child care centers,
Head Start Centers, and kindergarten entrants.
b.) Through coordination with Immunization Unit representatives, county health authorities and
local child care center and school authorities,the Contractor must make efforts to ensure that
all(100%) child care centers, Head Start centers and schools fully enforce existing regulations
pertaining to the immunization of children admitted to such institutions.
3.). Immunization of Infants and Preschool Children
In addition to the above stated activities,the Contractor agrees to the following activities intended to
assure the age-appropriate immunization of infants and preschoolers who reside within the
Contractor's jurisdiction.
a.) Make efforts to ensure that the immunization status of infants and children receiving services
through programs such as CHDP, MCH, AFDC, and WIC is assessed and that a system is
established to ensure age-appropriate immunization.
b.) Promote immunization information and education of parents with newborn children through all
hospitals with maternity services within the Contractor's jurisdiction.
4.) Vaccine Preventable Disease Surveillance and Outbreak Control
a.) Establish and maintain an effective system for identification and reporting of suspect, probable
and confirmed cases of vaccine preventable diseases. Sources of surveillance information
should include practicing physicians, outpatient clinics, hospitals, schools, child care centers
and Head Start centers. Active surveillance is only required during outbreaks of measles.
b.) Investigation and Control of Measles
1.) Investigation of all reported suspect, probable and confirmed cases of measles must be
initiated within one working day of receipt of a report by the Contractor.
2.) Outbreak control procedures in accordance with the guidelines of the Immunization Unit
must be initiated by the Contractor within two working days of determination of a probable
or confirmed measles case.
C. Required Reports
1.) Reports of Local Program Progress and Activities
In accordance with the guidelines and format provided by the Immunization Unit, the Contractor
shall submit, through his/her Immunization Unit District Field Representative, to the
Unit identified in paragraph 7 of Section I in this Exhibit, by the 15th of the month following the end
of each quarter, a written quarterly report of progress and activities. In addition to the written report
the Contractor and Project Liaison, or his designee, may meet and discuss the above matters in
person.
2.) The Contractor shall submit a comprehensive annual progress report in a format prescribed by the
State. The annual progress report shall be submitted to the State by the 15th of the month (July
15, 1993) following termination of the contract.
EXHIBIT A(Pediatric Continued)Revised
FY 1992-93 Page 3
3.) Reports of Vaccine Preventable Disease
a.) In accordance with the guidelines and format provided by the Immunization Unit, a weekly
telephone report of suspected, probable and confirmed measles cases must be made each
week to the Immunization Unit or its designated representative.
b.) Upon the completion of the investigation of each probable and suspected measles case, a
completed investigation report must be submitted to the Immunization Unit.
4.) Contractor agrees that itemized personnel ;gsof ons lasted in Said Exhibit Shall not be subiect to
Contractor's 12ersonnel aglow decisions to refrain from filling vacant positions. The total amount of
the contract will be indicated as either some part, or all, of the total operations budget. If the total
amount of the contract is less than the total operations budget, the Contractor will be responsible
for providing the difference between the total amount of the contract and the total operations
budget. Further, all invoices to the State which request reimbursements for;positions included in
Exhibit "B" must include the name and Social Security, number of the persons that have performed
in these positions.
5.) The Contractor shall provide for any personnel or operating expenses that are necessary to meet
the provisions included herein but are not provided for in the Budget included as Exhibit "B"
6.) The Contractor shall submit through his/her Immunization Unit District Fleld
Representative.to the Unit identified in paragraph 7 of Section I in this Exhibit, on or before the
3rd of the month following the report month, the written Monthly Vaccine Usage Report in the form
prescribed by the State Department of Health Services, Immunization Unit.
7.) All reports, other than those required to be directed to the District Field Representatives, invoices,
and other written communications are to be addressed and delivered to the State Department of
Health Services, Immunization Unit, 2151 Berkeley Way, Berkeley, California 94704.
8.) The State reserves the right to use and reproduce all reports and data produced and delivered
pursuant to this Contract and reserves the right to authorize others to use or reproduce such
= materials, provided that the confidentiality of patient information and records are protected pursuant
to California State laws and regulations.
9.) This Contract may be terminated by either party upon 30 days' written notice to the other party.
Further, this Contract may be terminated or suspended upon written notification by the State at any
time for failure on the part of the Contractor to comply with any of the provisions contained herein.
10.) In consideration of the above services, performed in a manner acceptable to the State, the State
shall reimburse the Contractor quarterly, in arrears, upon submission of a quarterly invoice by
Contractor on Contractors letterhead, in quadruplicate stating the time period covered, stating the
contract number, for actual expenditures in accordance with the budget (attached hereto and
shown as Exhibit "B"),to: Department of Health Services, Infectious Disease Branch, Immunization
Unit, 2151 Berkeley Way, Room 712, Berkeley, CA 94704. The Contractor may make changes in
any individual line item in the budget, provided that such changes in the sum total does not exceed
$10,000; that the Contractor submit an explanation of the need for such excess with the claim for
reimbursement and to specifically identify the line item(s) to be reduced in order to increase the
excess item(s) and provided further that the State reserves the right to deny any such claim for any
excess reimbursement on any item. It is further understood that in no event shall the maximum
amount payable under this agreement exceed the maximum amount specified in paragraph 11 of
the Standard Agreement.
11.) It is agreed by the Contractor that in the event that a significant portion of the Contract objectives for
the initial four months of the Contract are not met by that time; and in the event that the State
determines from quarterly invoices, performance reports, and other sources of information that the
Contractor will not perform the total quantity of services contracted for; and that therefore,the total
EXHIBIT A(Pediatric Continued) Revised
FY 1992-93 Page 4
budget allocation will not be depleted; the State and/or Contractor may make an equitable
adjustment in the original Contract budget and Contract objectives in order to decrease the total
quantity of services and commensurate Contract amount. Any adjustment shall be by amendment
only and duly executed by both parties and approved by the Department of General Services (if
applicable).
SECTION It. TERMS AND CONDITIONS FOR RECEIPT OF VACCINE PURCHASED
WITH STATE OF CALIFORNIA OR FEDERAL FUNDS
The local health department receiving vaccine purchased with State of Caldomia/Federal funds, herein
called State purchased vaccines, agrees to the following terms and conditions.
1.) Prior to receipt of an immunization,all patients(or their parents or legal guardians) must be:
a.) provided a copy of the current "Important Information" statement and/or "Vaccine
Information Pamphlet"for each vaccine dose to be administered (in the case of hepatitis B
vaccine for newborn infants this can be provided to the mother during prenatal care or
within 12 hours after delivery);
b.) provided a reasonable opportunity to read the "Important Information" statement(s) and/or
"Vaccine Information Pamphlets)";
c.) provided an opportunity to ask questions and have questions answered concerning the
benefits and risks of each immunization;
d.) specifically asked if they understand the information provided to them and if they have any
questions;
e.) given a telephone number to call should the patient become ill and have to visit a physician,
clinic or hospital within the 28 days following the immunization;
I.) provided the authorized appropriate translations of the "Important Information" statements
and/or "Vaccine Information Pamphlets" if English is not their first language and their
language is one for which the State has made translations available.
The Immunization Unit will supply to all local health departments camera-ready copies of the current
"Important Information" statements and a supply of the "Vaccine Information Pamphlets" in English
and Spanish. In addition, should a sufficient need exist, the Immunization Unit will arrange for
authorized translations and provide camera-ready copies of the "important Information" statements
and a supply of"Vaccine Information Pamphlets" in other languages.
2.) If a signature card or clinic log is used in lieu of the bottom portion of the "Important Information"
statement and/or "Vaccine Information Pamphlet", the patient (or parent or legal guardian) must
read the following statement which is required to appear at the top of the signature record card cr
log sheet and then sign for each antigen administered:
"I have been given a copy and have read, or have had explained to me the
information contained in the Vaccine information Pamphlet(s) or the appropriate
Important Information Statement(s) about the disease(s) and vaccines(s) indicated
below. I have had a chance to ask questions which were answered to my satisfaction.
I believe I understand the benefits and the risks of vaccine(s) and request that the
vaccine(s) indicated below be given to me or to the person named below for whom I
am authorized to make this request."
EXHIBIT A(Pediatric Continued) Revised
FY 1992-93 Page 5
The record card or log sheet must include as a minimum the following information:
a.) patient name
b.) address
c.) date of birth
d.) age at time of immunization
e.) type of vaccine(s) given
I.) clinic identification
g.) date of immunization
h.) site of immunization
i.) name and title of person administering the vaccine (e.g., S. Smith, R.N.)
j.) vaccine manufacturer
k.) vaccine lot number
I.) signature of patient or parent/guardian authorizing immunization
m.) date of signature
n.) date(s) printed on the "Important Information"statement(s) and/or"Vaccine
Information Pamphlets"provided to the patient or parent/guardian
NO ALTERATION, VARIATIONS OR ADDITIONS TO THE IMPORTANT
INFORMATION STATEMENTS, VACCINE INFORMATION PAMPHLETS, OR
VACCINE AGREEMENT MAY BE MADE WITHOUT THE PRIOR WRITTEN
APPROVAL OF THE CHIEF OF THE IMMUNIZATION UNIT OF THE CALIFORNIA
DEPARTMENT OF HEALTH SERVICES.
3.) The agreement/signature portion of the "Important Information" statement and/or "Vaccine
Information Pamphlet' or the authorized signature record card or authorized clinic log sheets
must be stored by the local health department in a retrievable file for a minimum of 10 years
following the end of the calendar year in which the statement/pamphlet was signed. In addition,
if a notice of a claim or lawsuit has been made, the record must be retained until after a final
disposition has been made.
4.) In the case of a school-based program, or other programs where the "Important Information"
statement(s) and/or "Vaccine Information Pamphlet(s)" are to be read and signed in advance of
the immunization by the patient or parent/guardian or other authorized person who will not be
present at the site where the immunizations are to be given, procedures shall be established and
made known for answering questions by telephone.
5.) Outside non-profit providers of immunization services must sign the State provided "Outside
Provider Agreement for Receipt of State-Supplied Vaccines" terms prepared by the State
Immunization Unit before they may receive State purchased vaccine. Medical providers of
immunization services who sign the agreement must agree to use the "Important Information"
statements and/or"Vaccine Information Pamphlets" and must be provided as many copies of the
statements/pamphlets as vaccine doses distributed, or at least one camera-ready copy of each
vaccine statement. The "Outside Provider Agreement..." and the use of the "Important
Information" statements and/or "Vaccine Information Pamphlets" are required in clinic settings
even if the clinics are supervised by a physician in attendance. "Outside Provider Agreement..."
must be retained by the local health department for a minimum of ten years following the last
calendar year in which the State Immunization Unit purchased vaccine was provided.
6.) No charge may be made to the patient, parent, guardian or third party payer for the cost of State
purchased vaccine provided to local health departments by the Immunization Unit. In addition,
outside, non-profit providers of immunization services receiving State purchased vaccine may
not charge patients or parents for the cost of vaccine. Charges made by local health
departments for the direct costs incurred for administration or injection of the vaccine are
EXHIBIT A(Pediatric Continued) Revised
FY 1992-93 Page 6
discouraged but are not specifically prohibited. Should the health department or outside
medical provider receiving state vaccine establish an administration fee for an injection of
vaccine, information, e.g., sign/poster,= be prominently displayed which indicates that no
one receiving an immunization in a public clinic may be denied vaccine provided through public
funds for failure to pay the administration fee or failure to make a donation to the provider.
7.) Local health departments and other private and public providers utilizing State-purchased
vaccine must report quarterly the vaccine and HBIG doses administered,by vaccine type and age
group of patient, and dose in series (for multiple-dose vaccines) in a format provided by the
Immunization Unit. Reports should be submitted to the Immunization Unit by the third day of the
following month.
8.) Each quarter,the local health department must report a current vaccine inventory including all
sites within the county or local jurisdiction. The Immunization Unit will supply the reporting forms.
All local health departments are to notify their ImmunIzatlon Unit Field Representative
of any vaccine which is unlikely to be used not later than three months prior to its date of
expiration.
9.) The local health department agrees to ensure that the storage and handling of State purchased
vaccine within its facilities is in accordance with the manufacturers' specifications. The local
health department also agrees to inform other providers who receive Immunization Unit
purchased vaccine of the manufacturers'specifications for vaccine storage and handling.
EXHIBIT A Revised
(attachment) Page 7
TERMS
In accordance with page 2 of the Standard Agreement, this attached page Is made a part
of this contract as referenced below.
SECTION I. TERMS AND CONDITIONS
A. New Objective:
1.) During the twelve-month (12) period of this agreement, the number of fourth doses of DTP
administered in public clinics to children before their second birthday will increase by ten
percentage (10%) points compared to the number administered to children of the identical age
during the preceding twelve-month (12) period.
B. New Activities:
1.) Immunization Clinic Services and Activities
a.) VIII staffing in existing regularly scheduled public immunization clinics and/or end
clinics in more locations on more days with longer hours which are reasonably accessible to
parents of children who reside within the Contractor's jurisdiction.
b.) Public immunization clinic policies and practices must be in general accordance with the
current recommendations approved by the U.S. Public Health Service and endorsed by the
American Academy of Pediatrics (AAP) as specified in the `Standards for Pediatric
Immunization Practices. (Note: ' The Standards represent the consensus of the National
Vaccine Advisory Committee (NVAC) and of a broad group of medical and public health experts
about what constitute the most desirable immunization practices. The Standards are expected
to be useful as a means of assisting providers to identify needed changes,to obtain resources
if necessary, and to actually implement the desirable immunization practices.) Accordingly,
appropriate in-service training shall be instituted to assure compliance with the Standards.
c.) Within the health jurisdiction, the Contractor will strive to implement and maintain public
immunization clinic reminder/recall systems among all medical providers, who receive state-
supplied vaccines,to improve age-appropriate immunizations of preschool-age children.
d.) Annually, within the health jurisdiction,the Contractor shall select at least a 20%representative
random sample of public clinics who receive state-supplied vaccine. Of the public clinics
selected, the Contractor shall conduct immunization record audits of children (24 months - 35
months old) who are served by the clinics. The sampling technique and immunization clinic
record methodology must be compatible with the methodology of the Immunization Branch
(formerly Immunization Unit)of the California Department of Health Services. The record audit
specifications (with additional detailed guidelines), if requested, will be provided to the
Contractor by the CDHS Immunization Branch.
COUNTY OF CONTRA COSTA EXHIBIT B REVISED
(Health Services) Page 1 of 1 Page
Prior Adjustment New
Monthly Percent Approved Effective Approved
Personal Services Salary of Time Amount 1/1/93 Amount
Immunization Coordinator $3,500 -$4,000 100% $ 28,052 $ -0- $ 28,052 (1)
(.12 months)
Clerk Experienced Level $1,700 -$1,900 100% 4,499 -0- 4,499 (1)
(12 months)
Registered Nurse $3,548-$4,323 100% -0- + 23,613 23,613
(6 months)
Registered Nurse $3,548 -$4,323 50% -0- + 11,806 11,806
(6 months)
Clerk Experienced Level $1,824-$2,217 100% -0- + 12,123 12,123
(6 months)
Communicable Disease $1,868 -$2,270 50% -0- + 6,208 6,208
Technician--(Outreach)
(6 months)
Staff Benefits @ 30% 9,765 + 16,125 25,890
Total Personal Services $ 42,316 $+ 69,875 $ 112,191
Operating Expenses
A. Supplies
1. Office $ 3,300 $+ 500 $ 3,800
2. Clinic -0- + 1,000 1,000
B. Health Education Materials -0- + 913 913
C. Laboratory Screening -0- -0- -0-
D. Travel- In-State 71 -0- 71
Travel--Out-of-State -0- + 1,200 1,200
! E. Equipment(Computer and Peripherals) -0- -0- -0-
Total Operating Expenses $ 3,371 $+ 3,613 $ 6,984
TOTAL BUDGET $ 45,687 $+ 73,488 $ 119,175
(1) State Funds cover approximately 58.44% of Immunization Coordinator, and
20% of .the Clerk personnel expenses.
Exhibit C REVISED
Project Summary and
Budget Justification
Page t of 4 Pages
APPLICATION FOR IMMUNIZATION PROJECT SUBVEN71ON
SHORT SUMMARY OF PROJECT (Not to exceed 200 words)
The purpose of the Immunization Program is to prevent the occurrence and
transmission of vaccine preventable diseases through immunizations,
surveillance and outbreak control. The program will provide immunization
services, promote immunization awareness, encourage families to keep permanent
immunization records, and assure that schools maintain a permanent record
keeping system. Program activities will be coordinated with local school
officials and community agencies.
These activities will be carried out in an attempt to raise immunization
levels above 98% for all school age children and 95% for all infants and
preschool children 'who are inadequately protected against measles, mumps,
rubella, poliomyelitis, diphtheria, tetanus, pertussis and hemophilus
influenza type b. A mechanism has been established to inform parents of
infants born in Contra Costa County of the importance early immunizations and
of resources available to obtain immunization services.
Surveillance and outbreak control measures are incorporated into the program
which include measles and other vaccine preventable disease.
Priority will be given to the: 1) annual kindergarten and preschool
immunization assessments and selective review audits, 2) distribution of
immunization materials to all public and private schools and preschools with
inservice/consultation visits maintained, 3) newborn out:each efforts, 4}
toddler immunization campaign, 5) measles eliminationprogram, 6) provision of
regularly scheduled public immunization clinics, and 7) a reminder/recall
system for children who attend the monthly immunization clinics, 8) outbreak
control measures to contain/stop vaccine preventable disease.
A computer system with the IBM XT has been established and is updated monthly
to maintain the following Immunization Assistance Program activities: 1)
permanent retrievable record keeping system for persons given immunizations in
the immunization-only clinics, 2) vaccine usage and inventory activities, and
3) communications to schools, health care providers, hospitals, and community
organizations.
There are 13,000 live births in Contra Costa County each year; 3,100 of these
infants receive immunizations in the County Public Health Clinics. with
Hepatitis B vaccine contractual funds, infants served in these clinics, would
receive Hepatitis B vaccine and be sent a reminder of when the next dose is
due. Infants failing to respond to the reminder would be contacted. This
would be achieved initially by utilizing the recall program contained in Green
Lira. Other improved recall software will be investigated.
Name of Project Director Name and Address of Applicant Including
Organizational Unit Responsible for
Project Activity
Wendel Brunner, M.D. County of Contra Costa
Assistant Director of Health Services (Health Services)
Public Health 597 Center Avenue Suite 200A
Martinez, Ca, 94703
Exhibit C REVISED
Project Summary and
Budget Justification
Page 2_ of 4 Pages
APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION FUNDS
SHORT SUMMARY OF PROJECT (Not to exceed 200 words)
-----------------------------------------------------------------------------
Expanded Immunization services will be provided to areas in which the children have the lowest immunization rates. East
county will receive more attention because of rapid growth, high number of migrant workers/families and low immunization
rates.
All WIC clinics in the east and west county will have an immunization nurse at least twice a month. This
clinic will operate concurrently with the WIC "sign up"and return visits to provide immunizations to children
enrolled in WIC as well as their siblings.
The State Head Start Pre School Program in the east county will be targeted in January through May with
twice a month special clinics. Language with appropriate messages will be sent to families twice during this
period regarding immunization clinics.
All Family Day Homes in the county will receive targeted mailings to assess attendees immunization status
and remind operators/parents of importance.
A bilingual outreach worker will go door to door in targeted neighborhoods in east county to give
information on immunizations and clinics.
In May through September clinic hours will be altered to evening hours 5:30-8:30 pm to accommodate
workers and their children.
Spanish Speaking Council and Migrant Farm Bureau will assist in planning the best access to/for workers
and help with employer cooperation.
Exhibit C REVISED
Project Summary and
.I Budget Justification
Page 3 of 4 Pages
APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION FUNDS
BUDGET JUSTIFICATION
----------------------------------------------------------------------------s
I. PERSONAL SERVICES
Immunization Coordinator -- $28,052
The position is necessary in order to assure that the goals of meeting at least 98% immunization levels for all school
age children and 95%for all infants and preschool children are met as well as participating in newborn outreach efforts,
providing immunization information to the medical and lay communities, and working with the nurse epidemiologist to
reduce/eliminate vaccine preventable disease (i.e., measles, mumps, rubella, pertussis, hemophilus influenza type b).
Provides the operational link between schools and preschools and the State IAP office. Manages vaccine and vaccine
accountability. Supervises the computerized record keeping system.
Clerk-Experienced Level -- $4,499
Provides the necessary clerical support to accomplish the goals and objectives of the program. The activities include:
typing and filing reports and letters, xeroxing, preparing kindergarten and preschool registration packets, filling orders,
tabulating audit results, mailing materials to schools and health care providers, and maintaining the computerized
y retrievable immunization record system.
The amount budgeted last year was far below the amount necessary to fund the tasks needed.
Registered Nurse -- $23,613
r WIC clinics operate throughout the county 15-19 times a month. There an average of 2000 to 5000 children are seen
in each area of the county per month. The nurse will provide immunizations, information on immunizations and health
.f
referrals for other needed medical care.
Registered Nurse -- $11 ,806
The nurse will staff the special clinics in targeted areas, assist with health education information development and
assist with evaluation of Day Home assessments.
Clerk-Experienced Level -- $12,123
Will assist with data entry into Immunization record/recall system. Provide clerical support to clinics and Immunization
Program Coordinator. Provide clerical support for mailers and pamphlet development.
i Communicable Disease Tech niclan-(Outreach) -- $6,208
Will provide door-to-door outreach and information giving. Will give information classes in clinics and to community
1 groups in appropriate languages. Will work with migrant workers to determine needed times for clinics and best
access.
Staff Benefits 0 30% -- $25,890
Exhibit C REVISED
Project Summary and
Budget Justification
Page 4 of 4 Pages
APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION FUNDS
BUDGET JUSTIFICATION
-----------------------------------------------------------------------------
II. OPERATING EXPENSES
A. Supplies: Office -- $3,800 : Mailing supplies. Mailer will be sent twice in six month period to targeted areas
to inform regarding immunizations and clinic availability. Hepatitis B reminder/recall printing and
postage.
Clinic -- $1,000 : Syringes, alcohol, drapes, cotton, bandaids, needle disposal boxes.
B. Health Education Materials -- $913:
Printing of mailer and reproduction of posters for clinic and meeting areas where parents with small children gather
as well as Spanish Speaking Center.
C. Travel: In-State --$71 Mileage for In-State travel.
Out-of-State -- $1,200 National Immunization Conference--air fare, room and meals for 5 days.
i
.F
EXWA(F)
STATE OF CALIFORNIA
DEPARTMENT OF HEALTH SERVICES
ADDITIONAL PROVISIONS
(FOR FEDERALLY FUNDED SUBVENTION AID/LOCAL ASSISTANCE
COST REIMBURSEMENT CONTRACTS/GRANTS)
1. Equal Onnortunity 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 fake 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 Instrucflond&llefln No.02(11/91)
f. In the event of the Contractor's noncompliance with the requirements of this Equal
Opportunity clause or with any federal rules, regulations, or orders which are
referenced in this clause, this contract may be canceled, terminated, or suspended in
whole or in part and the Contractor may be declared ineligible for further federal or
state contracts in accordance with procedures authorized in Federal Executive Order
No. 11246 as amended and such other sanctions may be imposed and remedies
invoked as provided In Federal Executive Order No. 11246 as amended, or by rule,
regulation, or order of the Secretary of Labor, or as otherwise provided by law.
g. The Contractor will include the provisions of paragraphs [a] through [g] In every
subcontract or purchase order unless exempted by rules, regulations, or orders of the
Secretary of Labor issued pursuant to Federal Executive Order No. 11246 as amended,
or Section 503 of the rehabilitation Act of 1973, so that such provisions will be binding
upon each subcontractor or vendor. The Contractor will take such action. with
respect to any subcontract or purchase order as the Director of the Office of Federal
Contract Compliance Programs or the State may direct as a means of enforcing such
provisions including sanctions for noncompliance-provided, however, that in the event
the Contractor becomes involved in, or is threatened with, litigation with a
subcontractor or vendor as a result of such direction by the State, the Contractor may
request In writing to the State, who, in turn, may request the United States to enter Into
such litigation to protect the Interests of the State and of the United States.
2. Travel and Per Diem
Any reimbursement for necessary traveling and per diem shall be at rates not to exceed
those amounts paid to the State's represented employees under collective bargaining
agreements currently In effect. No travel outside the State of California shall be reimbursed
unless prior written authorization Is obtained from the State.
3._ procurement Requirement
a. Prior authorization In writing by the State will be required before the Contractor will be
reimbursed for any purchase order or subcontract exceeding $2,500 for any articles,
supplies, equipment, or services or for any fee, or other payment, for consultation of
three hundred fifty dollars ($350) or more per day. The Contractor must provide in Its
request for authorization all particulars necessary for evaluation of the necessity or
desirability of incurring such cost, and as to the reasonableness of the price or cost.
For purchases of any said articles, supplies, equipment, services, or for consultant fees
exceeding such minimum amount, three competitive quotations must be submitted
with the request, or the absence of bidding must be adequately justified.
b. If other than the lowest bidder or a sole-source provider is selected, all documents
used in contractor selection must be presented in writing to the State for prior
approval before awarding any contract, and maintained for possible future audit as
specified in paragraph 7 below.
c. The terms "purchase order" and "subcontract" as used in the above paragraph 3a
only, excludes; (a) purchase orders not exceeding $2,500, and (b) subcontracts or
purchase orders for public utility services at rates established for uniform applicability
to the general public.
-2-
6QibB A(F)
4. Standards of Work
The Contractor agrees that the performance of work and services pursuant to the
requirements of this contract shall confirm to high professional standards.
5. Furnishing of Propedy by the State or Purchase of Prooertv with Stcde or Federal Funds
I
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)I below.
If the Equipment Line item in the bludget 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 cit 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) beIlow.
(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 opStaerators 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-
I
The certificate of insurance must include provisions(i) and(ii),stating that:
() The insurer will not cancel the insured's coverage without 30 days prior
written notice to the State.
(ii) The State of California,its officers,agents,employees,and servants are
included as additional insureds, but only insofar as the operations
under this contract are concerned.
Contractor agrees that the bodily injury liability insurance herein provided
for shall be in effect at all times during the term of this contract. In the event
said insurance coverage expires at any time or times during the term of this
contract, Contractor agrees to provide at least thirty (30) days prior to said
expiration date a new certificate of Insurance evidencing Insurance
coverage as provided for herein for not less than the remainder of the term
of the contract, or for a period of not less than one (1) year. New
certificates of insurance are subject to the approval of said Department of
General Services, and Contractor agrees that no work or services shall be
performed prior to the giving of such approval. In the event Contractor fails
to keep in effect at all times insurance coverage as herein provided, State
may, in addition to any other remedies it may have,terminate this contract
upon the occurrence of such event.
b. If the Equipment line item budget in this contract is $10,000 or more, the State shall
purchase said equipment through its Office of Procurement. The cost of the
procurement of equipment will be deducted from the contract amount. Contractor
shall submit to the State a separate list of the equipment specifications. State will pay
vendor directly for equipment purchases and title to the equipment will remain with
the State. The equipment will be delivered either to the Contractor's address as
stated in the contract unless notified by the Contractor in writing.
c. (1) Title to state property shall not be affected by the incorporation or attachment
thereof to any property not owned by the State, nor shall such state property, or
any part thereof, be or become a fixture or lose its identity as personality by
reason of affixation to any realty.
(2) Unless otherwise provided herein, the State shall not be under any duty or
obligation to restore or rehabilitate, or to pay the cost of the restoration or
rehabilitation of the Contractor's facility or any portion thereof which is affected
by removal of any state property.
(3) The Contractor shall maintain and administer, in accordance with sound business
practice, a program for the utilization, maintenance, repair, protection, and
preservation of state property so to assure its full availability and usefulness for the
performance of this contract. The Contractor shall take all reasonable steps to
comply with all appropriate directions and instructions which the State may
prescribe as reasonably necessary for the protection of state property.
d. For equipment only. Before equipment purchases made by the Contractor are
reimbursed by the State, the Contractor must submit paid vendor receipts identifying
the purchase price, description of the item, serial number, model number, and
location where equipment will be used during the term of this agreement. Said paid
receipts will be attached to Contractor's invoices submitted to the State.
r,
-4J
Exhibit A(F)
6. Income Restrictions
The Contractor agrees that any refunds, rebates, credits, or other amounts (including any
interest thereon) accruing to or received by the Contractor under this contract shall be
paid by the Contractor to the State, to the extent that they are properly allocable to costs
for which the Contractor has been reimbursed by the State under this contract.
7. Examination of Accounts. Audit. Records_ and Subcontract Language
a. The Contractor shall maintain books, records, documents, and other evidence,
accounting procedures, and practices, sufficient to reflect properly all direct and
indirect costs of whatever nature claimed to have been incurred in the performance
of this contract, Including any matching costs and expenses. The foregoing
constitutes"records"for the purpose of this clause.
b. The Contractor's facility or office or such part thereof as may be engaged in the
performance of this contract and his records shall be subject at all reasonable times
to inspection, audit, and reproduction by the State or any of its duly authorized
representatives, including the Comptroller General of the United States.
c. .The Contractor shall preserve and make available his records (i) for a period of three
years from the date of final payment under this contract, and (ii) for such longer
period, if any, as is required by applicable statute, by any other clause of this contract,
or by subparagraphs (1) or (2) below.
(1) If this contract is completely or partially terminated, the records relating to the
work terminated shall be preserved and made available for a period of three
- years from the date of any resulting final settlement.
(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-
Exhibit A(F)
1 1. 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. Officials Not to Benefit
No member of'or delegate to Congress or the State Legislature shall be admitted to any
share or part of this contract, or to any benefit that may arise therefrom; but this provision
shall not be construed to extend to this contract if made with a corporation for its general
benefit.
13. Rights in Data
a. Subject Data. As used in this clause, the term "Subject Data" means writings, sound
recordings, pictorial reproductions, drawings, designs or graphic representations,
procedural manuals, forms, diagrams, work flow charts, equipment descriptions, data
files and data processing or computer programs, and works of any similar nature
(whether or not copyrighted or copyrightable) which are first produced or developed
under this contract. The term does not include financial reports, cost analyses, and
similar information incidental to contract administration.
b. Federal Government and State Rights. Subject only to the provisions of "c" below, the
Federal Government and State may use, duplicate, or disclose in any manner and for
any purpose whatsoever, and have or permit others to do so, all Subject Data
delivered under this contract.
c. License to Copyrighted Data. In addition to the Federal Government and State rights
as provided in [b] above, with respect to any subject data which may be
.copyrighted, the Contractor agrees to and does hereby grant to the Federal
Government and State a royalty-free, nonexclusive and irrevocable license
throughout the world to use, duplicate, or dispose of such data in any manner for
State or Federal Government purposes and to have or permit others to do so.
Provided, however, that such license shall be only to the extent that Contractor now
has, or prior to completion or final settlement of this contract may acquire, the right to
grant such license without becoming liable to pay compensation to others solely
because of such grant.
d. Relation to Patents. The State reserves a license on patent rights in any contract
Involving research or developmental, experimental, or demonstration work with
respect to any discovery or Invention which arises under this contract.
e. Marking and Identification. The Contractor shall mark all Subject Data with the
number of this contract and the name and address of the contractor or
subcontractor who generated the data. The Contractor shall not affix any restrictive
markings upon any Subject Data, and if such markings are affixed, the Federal
Government or State shall have the right at any time to modify, remove, obliterate, or
Ignore any such markings.
f. Subcontractor Data. Whenever any Subject Data is to be obtained from a
subcontractor under this contract, the Contractor shall .use this same clause in
subcontract without alteration, and no other clause shall be used to enlarge or
diminish the Federal Government's or State's rights in the subcontractor Subject Data.
-7-
g. Deferred Ordering and Delivery of Data. The Federal Government or State shall have
the right to order, at any time during the performance of this contract, or within two
years from either acceptance of all items (other than data) to be delivered under this
contract or termination of this contract, whichever is later, any Subject Data and any
data not called for in the schedule of this contract but generated in performance of
the contract, and the Contractor shall promptly prepare and deliver such data as Is
ordered. If the principal investigator is no longer associated with the Contractor, the
Contractor shall exercise its best efforts to prepare and deliver such data as is ordered.
The Federal Government's or State's right to use data delivered pursuant to this
paragraph (g) shall be the same as the rights in Subject Data as provided in "b"
above.. The Contractor shall be relieved of obligation to furnish data pertaining to an
item obtained from a subcontractor upon the expiration of two years from.the date
he accepts such Items. When data, other than Subject Data, is delivered pursuant to
this paragraph (g), payment shall be made, by equitable adjustment or otherwise, for
converting the data Into the prescribed form, reproducing it or preparing it for
delivery. The terms of such payment shall be agreed upon in writing by the
Contractor and the State and/or Federal Government, whichever ordered the
production of the data.
14. Disabled Veterans and Veterans of the Vietnam Era
a. The Contractor will not discriminate against any employee or applicant for
employment because he or she is a disabled veteran or veteran of the Vietnam era in
regard to any position for which the employee or applicant for employment Is
qualified. The Contractor agrees to take affirmative action to employ, advance in
employment, and otherwise treat qualified disabled veterans and veterans of the
Vietnam era without discrimination based upon their disability or veterans status in all
employment practices such as the following: employment upgrading, demotion or
transfer, recruitment, advertising, layoff or termination, rates of pay or other forms of
compensation, and selection for training, including apprenticeship.
b. The Contractor agrees that all suitable employment openings of the Contractor which
exist at the time of the execution of this contract and those which occur during the
performance of this contract, including those not generated by this contract and
including those occurring at an establishment of the Contractor other than the one
wherein the contract Is being performed but excluding those of independently
operated corporate affiliates, shall be listed at an appropriate local office of the state
employment service system wherein the opening occurs. The Contractor further
agrees to provide such reports to such local office regarding employment openings
and hires as may be required.
State and local government agencies holding federal contracts of $10,000 or more
shall also list all their suitable openings with the appropriate office of the state
employment service, but are not required to provide those reports set forth in
paragraphs"d" and "e".
c. Listing of employment openings with the employment service system pursuant to this
clause shall be made at least concurrently with the use of any other recruitment
source or effort and shall Involve the normal obligations which attach to the placing
of bona fide job order, Including the acceptance of referrals of veterans and
nonveterans. The listing of employment openings does not require the hiring of any
particular job applicant or from any particular group of job applicants, and nothing
herein is intended to relieve the Contractor from any requirements in Executive Orders
or regulations regarding nondiscrimination in employment.
-8-
Exhibit A(F)
d. The reports required by paragraph "b" of this clause shall include, but not be limited to,
periodic reports which shall be filed at least quarterly with the appropriate local office
or, where the Contractor has more than one hiring location in a State, with the central
office of that state employment service. Such reports shall indicate for each hiring
location (1) the number of individuals hired during the reporting period, (2) the
number of nondisabled veterans of the Vietnam era hired, (3) the number of disabled
veterans of the Vietnam era hired, and (4) the total number of disabled veterans
hired. The reports should include covered veterans hired for the on-the-job training
under 39 U.S.C. 1787. The Contractor shall submit a report within 30 days after the end
of each reporting period wherein any performance is made on this contract
identifying data for each hiring location. The Contractor shall maintain at each hiring
location copies of.the reports submitted until the expiration of one year after final
payment under the contract, during which time these reports and related
documentation shall be made available, upon request, for examination by any
authorized representatives of the Federal Contracting Officer, the State, or the
Secretary of Labor. Documentation would include personnel records respecting job
openings, recruitment, and placement.
e. Whenever the Contractor becomes contractually bound to the listing provisions of this
clause, it shall advise the employment service system in each state where it has
establishments of the name and location of each hiring location in the state. As long
as the Contractor is contractually bound to these provisions and has so advised the
state system, there is no need to advise the state system of subsequent contracts. The
Contractor may advise the state system when it is no longer bound by this contract
clause.
f. This clause does not apply to the listing of employment openings which occur and are
filled outside the 50 states, the District of Columbia, Puerto Rico, Guam, and the
Virgin Islands.
g. The provisions of paragraphs "b", "c", "d", and "e" of this clause do not apply to
openings which the Contractor proposes to fill from within his own organization or to fill
pursuant to a customary and traditional employer-union hiring arrangement. This
exclusion does not apply to a particular opening once an employer decides to
consider applicants outside of his own organization or employer-union arrangement
for that opening.
h. As used in this clause:
(1) "All suitable employment openings".includes, but is not limited to, openings which
occur in the following job categories: production and nonproduction: plant and
office; laborers and mechanics; supervisory and nonsupervisory; technical and
executive, administrative, and professional openings that are compensated on a
salary basis of less than $25,000 per year. This term includes full-time employment,
temporary employment of more than .three days' duration, and part-time
employment. It does not include openings which the Contractor proposes to fill
from within his own organization or to fill pursuant to a customary and traditional
employer-union hiring arrangement nor openings in an educational institution
which are restricted to students of that institution. Under the most compelling
circumstances, an employment opening may not be suitable for listing, including
such situations where the needs of the Federal Government cannot reasonably
be otherwise supplied, where listing would.be contrary to national security, or
where the requirement of listing would otherwise not be for the best Interest of
the Federal Government.
-9-
(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 for the contract Is
under consideration to be listed on the EPA List of Violating Facilities. Prompt
notification shall be required prior to contract award.
-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 [b6], and to take such action as the
Federal Government may direct as a means of enforcing such provisions.
16. Utilization of Small Business and Minority and Women Owned Business Enterprise
a. It is a federal policy to award a fair share of contracts to small, minority, and women
owned business firms. The State Legislature has declared that a fair proportion of the
total purchases and contracts or subcontracts for property and services for the State
be placed with small minority and women owned business enterprises.
b. A.firm shall qualify as a small business if it meets the requirements specified in
Government Code Section 14837.
c. The Contractor hereby agrees to carry out this policy in the awarding of subcontracts
to the fullest extent consistent with efficient contract performance. As used in this
contract, the term "minority business enterprise" means a business concern (1) which is
at least 51 percent owned by one or more minority group members or women, or in
the case of publicly owned business, at least 51 percent of the stock of which is
owned by one or more minority group members or women; and (2) whose
management and daily business operations are controlled by one or more such
individuals. A minority group member is a person who is Black, Asian, Hispanic, Filipino,
Polynesian, American Indian, or Alaskan Native. "Control," as used in this clause, means
exercising the power to make policy decisions.
d. Contractors acting in good faith may rely on written representations by their
subcontractors regarding their status as minority business enterprises in lieu of an
Independent investigation.
17. Printing
If.Printing or other reproduction work of more than an incidental and minor dollar amount is
a reimbursable Item in this contract, it shall be printed or produced by the State Printer. The
State Printer may, at his sole option, elect to forego said work and delegate the work to the
private sector. If the State Printer prints or produces said work, or the State obtains the
printing or other work through the Office of State Procurement, the cost will be deducted
from said contract amount. This requirement does not apply to normal in-house copying
necessary for routine business matters of the Contractor.
18. Prior Approval of Training Seminars. Workshops. or Conferences
Contractor shall obtain prior state approval over the location, costs, dates, agenda, instructors,
instructional materials, and attendees at any.reimbursable training seminar, workshop or conference,
and over any reimbursable publicity or educational materials to be made available for distribution.
The Contractor 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. Confidenfiaitiv 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 Dilutes
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.' Rnanclal and Comollance Audit of Nongroflt 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 low or
regulations, procedures,or reporting requirements arising pursuant thereto.
L Nothing in this paragraph limits the authority of the State to make audits of this contract,
provided however, that if independent audits arranged for by Contractor meet
generally accepted governmental auditing standards, the State shall rely on those
audits and any additional audit work shall build upon the work already done.
j. The State may, at its option, direct its own auditors to perform the single audit described
in OMB Circular A-133. The State's auditors shall meet the independence standards
specified in Government Auditing Standards. The audit shall be conducted in
accordance with OMB Circular A-133 so as to satisfy all State and Federal requirements
for a single organization wide audit.
24. Contract Amendments
a. This contract may be amended by mutual agreement between the parties and, if
required by Government Code, Section 11010.5, or Public Contract Code, Section
10355,the amendment shall be subject to the approval of the Department of General
Services,unless otherwise exempted.
-14-
Exhibit A(F)
b. If any amendment to this contract has the effect of increasing the monetary amount
of the contract or an agreement by the State to indemnify or save harmless the
Contractor, his agents or employees, the amendment shall be approved by the
Department of General Services, unless otherwise exempted.
25. Evaluation of Contractors
The Contractor's performance under this contract shall be evaluated at the conclusion of
the term of this contract. The evaluation shall Include, but not be limited to:
a. Whether the contracted work or services were completed as specified in the contract
and reasons for and amount of any cost overruns.
b. Whether the contracted work or services met the quality standards specified in the
contract.
c. Whether the Contractor fulfilled all requirements of the contract.
d. Factors outside the control of the Contractor which caused difficulties in Contractor
performance. The evaluation of the Contractor shall not be a public record.
26. Conflict of Interest—Current and Former 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 some
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, unless th . violation is technical or
nonsubstantive.
(Citation: Public Contract Code, Section 10420)
27. Single Audit Act of 1984 (applicable only if Contractor is a governmental entity)
In accordance with Public Law 98-502 and OMB Circular A-128, it is stipulated between the
parties hereto that:
a. The cost of the single audit will be charged to the federal assistance program
providing funds for this agreement.on a "Fair Share" basis. The amount chargeable to
federal assistance programs for the cost of the single audit is calculated based on the
ratio of federal expenditures to total expenditures of the Contractor. The State's share
of the single audit cost under this contract is based upon the ratio of federal funds
received under this agreement to total federal funds received by the Contractor
each fiscal year.
b. The Contractor shall include a clause in any contract the Contractor enters into with
the audit firm doing the single audit to provide access by the State or Federal
Government to the working papers of the independent auditor who prepares the
single audit for the Contractor.
c. Federal or State auditors shall have "expanded scope auditing" authority to conduct
specific program audits during the same period in which a single audit is being
performed, but the audit report has not been issued. The federal or state auditors
shall review and have access to the current audit work being conducted and will not
apply any testing or review procedures which have not been satisfied by previous
audit work that has been completed.
-16-
E~A M
The term 'expanded scope auditing' is applied and defined in the U.S. General
Accounting Office (GAO) issued Standards for Audit of Governmental Organizations,
Programs,Activities and Functions,better known as the 'yellow book.'
28. Contractor Name Change.
Contractor shall provide written notice to the State at least 30 days prior to any changes to
the Contractor's current legal name.
29. Novation
If the Contractor proposes any novation agreement,the State shall act upon the proposal
within 60 days after receipt of the written proposal. The State may review and consider the
proposal,consult and negotiate with the Contractor,and accept or reject all or part of the
proposal. Acceptance or rejection may be made orally within the 60 day period, and
confirmed in writing within five days.
30. Drug-Free Workplace
Contractor certifies to the State that it will provide a drug-free workplace by doing all of
the following:
a. ' Publishing a statement notifying employees that the unlawful manufacture,
distribution, dispensation, possession, or use of a controlled substance is prohibited in
the person's or organization's workplace and specifying the actions that will be taken
against employees for violations of the prohibition.
b. Establishing a drug-free awareness program to inform employees about all of the
following:
(1) The dangers of drug abuse in the workplace.
(2) The person's or organization's policy of maintaining a drug-free workplace.
(3) Any available drug counseling, rehabilitation, and employee assistance
programs.
(4) The penalties that may be imposed upon employees for drug abuse violations.
c. Requiring that each employee engaged in the performance of the contract or grant
be given a copy of the statement required by subdivision(a) and that,as a condition
of employment on the contract or grant,the employee agrees to abide by the terms
of the statement.
d. Contractor agrees this contract may be subject to suspension of payments or
termination of this contract,or both,and the contractor may be subject to debarment,
in accordance with the requirements of the Government Code Section 8350, et seq., if
the Department determines that any of the following has occurred:
(1) The contractor or grantee has made a false certification.
(2) The contractor violates the certification by failing to carry out the requirements of
subdivisions(a)through(c) above.
-17-
31. Debarment and Suspension Requirements
Contractor agrees to comply with the debarment and suspension requirements as found in
7 Code of Federal Regulations,Part 3017,or as amended.
32. LIMITATIONS ON PAYMENTS TO INFLUENCE
CERTAIN FEDERAL ACTIONS AND RELATED DISCLOSURES
(a) Definitions. As used in this Exhibit,
"Agency," as defined in 5 U.S.C. 552(f), includes Federal executive departments and
agencies as well as independent regulatory commissions and Government
corporations,as defined in 31 U.S.C. 9101(1).
"Covered Federal action"means any of the following Federal actions:
(1) The awarding of any Federal contract;
(2) The making of any Federal grant;
(3) The making of any Federal loan;
(4) The entering into of any cooperative agreement; and
(5) The extension, continuation, renewal, amendment, or modification of any
Federal contract,grant,loan,or cooperative agreement. -
Covered Federal action does not. include receiving from an agency a commitment
providing for the United States to insure of guarantee a loan.
"Indian tribe" and 'tribal organization" have the meaning provided in section 4 of the
Indian Self-Determination and Education Assistance Act (25 U.S.C. 450B). Alaskan
Natives are included under the definitions of Indian tribes in the Act.
"Influencing or attempting to influence" means making, with the intent to influence,
any communication to or appearance before an officer or employee of any agency,
a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress,in connection with any covered Federal action.
"Local government" means a unit of government in a State and, if chartered,
established,or otherwise recognized by a State for the performance of a government
duty, including a local public authority, a special district, an intrastate district, a
council of governments, a sponsor group representative organization, and any other
instrumentality of a local government.
"Officer or employee of an agency" includes the following individuals who are
employed by an agency:
(1) An individual who is appointed to a position in the Government under title 5,
U. S. Code,including a position under a temporary appointment;
(2) A member of the uniformed services as defined in section 101(3), title 37,
U. S. Code;
(3) A special government employee as defined in section 202, title 18, U. S. Code;
and
(4) An individual who is a member of a Federal advisory committee, as defined by
the Federal Advisory Committee Act,title 5,U. S. Code,Appendix 2.
-18-
"Person" means an individual, corporation, company, association, authority, firm,
partnership, society, State, and local government, regardless of whether such entity is
operated for profit or not for profit. This term excludes an Indian tribe, tribal
organization,or any other Indian organization with respect to expenditures specifically
permitted by other Federal law.
"Reasonable compensation" means, with respect to a regularly employeed officer or
employee of any person, compensation that is consistent with the normal
compensation for such officer or employee for work that is not furnished to, not
funded by,or not furnished in cooperation with the Federal Government.
"Reasonable payment" means, with respect to professional and other technical
services, a payment in an amount that is consistent with the amount normally paid for
such services in the private sector.
"Recipient" includes the Contractor or Grantee,and all subcontractors or subgrantees
at any tier in connection with a Federal contract, grant, or other Federally funded
activity. The term excludes an Indian tribe, tribal or ganization, or any other Indian
organization with respect to expenditures specifically permitted by other Federal law.
"Regularly employed" means, with respect to an officer or employee of a person
requesting or receiving a Federal contract, on 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:
(D Discussing with any agency (including individual demonstrations)
the qualities and characteristics of the person's products or
services,conditions or terms of sale,and service capabilities; and,
(i0 Technical discussions and other activities regarding the
application or adaptation of the person's products or services for
an agency's use.
(D) For purposes of paragraph (b)(2)(i)(A) of this section, the following
agency and legislative liaison activities are allowable only where they
are prior to formal solicitation of any covered Federal action:
(D Providing any information not specifically requested but necessary
for an agency to make an informed decision about initiation of a
covered Federal action;
0D 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)(D.
(ii) Professional and technical services by Own Employees.
(A) The prohibition on the use of appropriated funds, in paragraph (bY(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)(ii)(A), "professional and technical
services" shall be limited to advice an analysis directly applying any
professional or technical discipline. For example, drafting of a legal
document accompanying a bid or proposal by a lawyer is allowable.
Similarly, technical advice provided by an engineer on the
performance or operational capability of a piece of equipment
rendered directly in the negotiation of a contract is allowable.
However, communications with the intent to influence made by a
professional (such as a licensed lawyer) or a technical person (such as
a licensed accountant)are not allowable under this section unless they
provide advice and analysis directly applying their professional or
technical expertise and unless the advice or analysis is rendered
directly and solely in the preparation, submission or negotiation of a
covered Federal action. thus, for example, communications with the
intent to influence made by a lawyer that do not provide legal advice
and analysis directly and solely related to the legal aspects of his or her
client's proposal, but generally advocate one proposal over another
are not allowable under this section because the lawyer is not
providing professional legal services. Similarly,communications with the
intent to influence made by an engineer providing an engineering
analysis prior to the preparation or submission of a bid or proposal are
not allowable under this section since the engineer is providing
technical services but not directly in the preparation, submission or
negotiation of a covered Federal action.
(C) Requirements imposed by or pursuant to law as a condition for
receiving a covered Federal award include those required by law or
regulation,or reasonably expected to be required by law or regulation,
and any other requirements in the actual award documents.
(D) Only those services expressly authorized by paragraph (b)(2)(ii) are
allowable under paragraph(b)(2)(ii).
(iii) Reporting for Own Employees.
No reporting is required with respect to payments of reasonable
compensation made to regularly employed officers or employees of a
person.
(iv) Professional and technical services by Other than Own Employees.
(A) The prohibition on the use of appropriated funds, in paragraph (b)(1),
does not apply in the case of any reasonable payment to a person,
other than an officer or employee of a person requesting or receiving a
covered Federal action, if the payment is for professional or technical
services rendered directly in the preparation,submission,or negotiation
of any bid, proposal, or application for that Federal contract or for
meeting requirements imposed by or pursuant to law as a condition for
receiving that Federal contract.
-21-
(B) For purposes of paragraph (b)(2)(iv)(A), 'professional and 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 on 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 $100fM at any tier, shall file a certification (in the form set
forth in Attachment 1, consisting of one page, entitled "Certification Regarding
Lobbing") that the recipient has not made, and will not make, any payment
prohibited by paragraph(b)of this Exhibit.
-22-
(2) Each recipient shall file a disclosure (in the form set forth in Attachment 2
` consisting of three pages, entitled "Standard Form-LLL-"Disclosure of Lobbying
Activities") if such recipient has made or has agreed to make any payment using
nonappropriated funds (to include profits from any covered Federal action) in
connection with a contract or grant or any extension or amendment of that
contract or grant, which would be prohibited under paragraph (b) of this Exhibit
if paid for with appropriated funds.
(3) Each recipient shall file a disclosure form at the end of each calendar quarter in
which there occurs any event that requires disclosure or that materially affects
the accuracy of the information contained in any disclosure form previously filed
by such person under paragraph (c)(2). An event that materially affects the
accuracy of the information reported includes:
(i) A cumulative increase of $25A00 or more in the amount paid or expected
to be paid for influencing or attempting to influence a covered Federal
action; or
(ii) A change in the person(s) or individual(s) influencing or attempting to
influence a covered Federal action; or,
(iii) A change in the officer(s), employee(s), or Member(s) contacted for the
purpose of influencing or attempting to influence a covered Federal action.
(4) Each person (or recipient) who requests or receives from a person referred to in
paragraph (c)(1) of this section a contract, subcontract, grant, or subgrant
exceeding $100,000 at any tier under a contract or grant shall file a certification,
and a disclosure form,if required,to the next tier above.
(5) All disclosure forms(but not certifications) shall be forwarded from tier to tier until
received by the person referred to in paragraph (1) of this section. That person
shall forward all disclosure forms to the State agency.
(d) Agreement. In accepting any contract,grant,subcontract or subgrant subject to this
Exhibit,the recipient (and any person submitting an offer for such a contract or grant)
agrees not to make any payment prohibited by law or this Exhibit.
(e) Penalties.
(1) Any person who makes an expenditure prohibited under paragraph (b) of this
Exhibit shall be subject to a civil penalty of not less than $10A00 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 $10A00
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.
(fl 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
r
STATE OF CALIFORNIA
DEPARTMENT OF HEALTH SERVICES
CERTIFICATION REGARDING LOBBYING
The undersigned certifies,to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned,to any person for Influencing or attempting to Influence an officer or employee of an agency
of the United States Government, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress In connection with the making, awarding or entering Into of this
Federal contract, Federal grant, or cooperative agreement, and the extension, continuation, renewal,
amendment,or modification of this Federal contract,grant,or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person
for influencing or attempting to Influence an officer or employee of any agency of the United States
Government,a Member of Congress,an officer or employee of Congress,or an employee of a Member of
Congress In connection with this Federal contract,grant,or cooperative agreement,the undersigned shall
complete and submit Standard Form LLL, 'Disclosure of Lobbying Activities' in accordance with its
instructions.
(3) The undersigned shall require that the language of this certification be Included in the award
documents for all subawards at all tiers (Including subcontractors,subgrants, and contracts under grants
and cooperative agreements) of $100,000 or more, and that all subreclpients 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 $100,000 for each
such failure.
CONTRA COSTA COUNTY
None of Contractor Printed Nane of Person Sigring for Contractor
1�lalk� ;
Contract/Grant Number sighature of Person gong for contractor
APR 2 7 1993 Chair, Board of Supervisors
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 hstructionol OdeM No.13(10/91) -24-
Attachment 2
DISCLOSURE OF LOBBYING ACTIVITIES Approved
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
(See reverse for public burden disclosure)
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
❑ a. contract ❑ a. bid/offer/application ❑ a. initial filing
b. grant b. initial award b. material change
c. cooperative agreement c. post-award For Material Change Only:
d. loan
e. loan guarantee Year quarter
f. loan Insurance date of last report
4. Name and Address of Reporting Entity: 5. If Reporting Entity In No.4 is Subawardee,Enter Name
and Address of PrI
❑ Rime ❑ Subawatdee
Tier If known:
Congressional District,if known: Congressional District,If known:
6. Federal Department/Agency: 7. Federal Program Name/Descriptlon:
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): (if 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):
S ❑ actual ❑ planned ❑ a. retainer
12. Form of Payment(check all that apply): ❑ b. one-time fee
❑ c. commission
❑ a. cash
❑ b. in-kind,specify: Nature ❑ d contingent fee
❑ 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 signature
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, PrintN—e:
U.S.C., Section 1352. This Information will be reported to the
Congress semiannually and will be available for public Tme:
Inspection. Any person who falls to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and
not more than$100,000 for each such failure. I Telephone No.: Dare:
:Fc>:
t ::::; ;:•;;;:.;:.;
Authorized for
Local ReP
roduc i
on
Standard Form—LLL
CMS Instructional Bulletin No.14(10/91) -25-
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the
initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to Title 31, U.S.C.,
Section 1352. The filing of a form Is required for each payment or agreement to make payment to any lobbying entity for
influencing or attempting to Influence an officer or employee of any agency, a Member of congress, an officer or
employee of congress,or an employee of a Member of Congress In connection with a covered Federal action. Use the
SF-LLL-A Continuation Sheet for additional information If the space on the form Is Inadequate. Complete all items that
apply for both the Initial filing and material change report. Refer to the Implementing guidance published by the Office of
Management and Budget for additional Information.
1. Identify the type of covered Federal action for which lobbying activity Is and/or has been secured to Influence the
outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a follow up report caused by a material change to the
Information previously reported,enter the year and quarter In which the change occurred. Enter the date of the last
previously submitted report by this reporting entity for this covered Federal Action.
4. Enter the full name,address,city,state and zip code of the reporting entity. Include Congressional District,if known.
Check the appropriate classification of the reporting entity that designates if It Is, or expects to be, a prime or
subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier.
Subawards Include but are not limited to subcontracts,subgrants and contract awards under grants.
5. if the organization filing the report in Item 4 checks'Subawardee,'then enter the full name,address,city,state and zip
code of the prime Federal recipient. Include Congressional District,If known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational
level below agency name,If known. For example,Department of Transportation,United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (Item 1). If known, enter the full
Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan
commitments.
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 zlp 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 Entlty: Page of
Authorized for Locd Reproduction
CMS Instructiond&Iletin No.14(10/91) -27- Standard Form-LLL-A