HomeMy WebLinkAboutMINUTES - 06081993 - 1.68 SIA 1 -68
TO: BOARD OF SUPERVISORS U
(nn }
FROM: Mark Finucane, Health Services Director U' X Contra
By: Elizabeth A. Spooner, Contracts Administrator Costa
DATE: May 20, 1993 County
SUBJECT: Approve Submission of Funding Application #28-537 to the State
Department of Health Services
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
Approve submission of Funding Application #28-537 to the State
Department of Health Services, in the amount of $109, 153, for the
period from January 1, 1993 through June 30, 1995, for the Childhood
Lead Poisoning Case Management Project.
II. FINANCIAL IMPACT:
Approval of this application will result in $109, 153 of State funding
during the period January 1, 1993 through June 30, 1995, for the
Childhood Lead Poisoning Case Management Project, as follows:
Fiscal Year 1992-93 $ 21, 831
Fiscal Year 1993-94 43, 661
Fiscal Year 1994-95 43 , 661
Total Three Year Allocation $109, 153
No County match is required.
III. REASONS FOR RECOMMENDATIONS/BACKGROUND:
The Centers for Disease Control (CDC) identifies lead poisoning as the
principal environmental health problem affecting children in the
United States and emphasizes that this is a problem which is entirely
preventable.
The goal of the Childhood Lead Poisoning Case Management Project is to
decrease children's health problems, including neurological,
developmental and learning deficits due to lead poisoning, by
providing timely identification and comprehensive interventions. The
project also seeks to determine the extent of lead poisoning in Contra
Costa County and to identify high-risk populations for targeted
outreach and community education.
In order to meet the deadline for submission, the application has been
forwarded to the State, but subject to Board approval. Four certified
copies of the Board Order authorizing submission of the application,
and four Statement of Compliance forms, signed by the Board Chair,
should be returned to the Contracts and Grants Unit for submission to
the State Department of Health Services.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMEND 10 OF BOARD COMMITTEE
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 SUPERVISO ON THE DATE SHOWN.
Contact: Wendel Brunner, M.D. (313-6712)
CC: Health Services (Contracts) ATTESTED _
Auditor-Controller (Claims) Al Batchelor,Clerk of the Board of
State Dept. of Health Services 3upmi6gr3III d WityAtllilinL*aW
M382/7-e8 BY . DEPUTY
1 68
Application for Funding
CHILDHOOD LEAD POISONING CASE MANAGEMENT
Fiscal Year 1992-93 through Fiscal Year 94-95
County: Contra Costa
The Childhood Lead Poisoning Prevention Branch, California Department of Health Services is offering local
assistance grants to various counties within the State for the appropriate case management of identified
lead poisoned children. The funds may not be used for environmental abatement.
Based on a formula which takes into account pre-1940 housing in your county, pre-1950 housing in your
county, numbers of children living in this housing, and number of cases identified to-date, Contra Costa
county is eligible to receive a maximum of $21,831 for the current fiscal year. The maximum amount
available in fiscal years 1993-94 and 1994-95 will be $43,661 each year for a total three year award of
$109,153. These funds will be paid quarterly, in advance, after the contract is fully approved. Since
funds cannot be transferred to local agencies prior to this approval, any money expended by these
agencies in anticipation of receiving a grant is expended at their own risk.
If you choose to apply for these funds, please enter the following information and return this form, prior to
January 15, 1993 to:
Charles G. Belknap, Program Administrator
Childhood Lead Poisoning Prevention Branch
California State Department of Health Services
5900 Hollis Street, Suite E
Emeryville, CA 94608
1. Name of County, Contra Costa County
Department, and Health Services Departinent
Mailing Address 20 Allen Street
as It will appear Martinez , CA 94553
on your invoice
2. Name and Title of Williams B. Walker, M.D.
person authorized to Health Of icer•
sign a contract for
your county.
3. Name, Title, Address, and N:s . Vee Ainars, RMPH
daytime Telephone Number Public Health epar men
of-primary contact person 38th & Bissell? SuiEe 1301
for the County. Ttfis Richmona, CA 94805
person will be Identified (510) 374—Jlb4 or 13-6 50
in the contract as the
County Project Coordinator.
I hereby apply for this funding for the County of Contra Costa, realizing that award of the funds will be
pending the full execution and approval of a formal agreement between the County and California State
Department of Health Services.
(Signature) (Title) (tate)
For additional information, please call Charles Belknap, at (510) 540-3657.
28-Apr-93
Page 1 of 3
BUDGET
Childhood Lead Poisoning Case Management
County: Contra Costa
Federal Employer ID #94-6000509W
Fiscal Year 1992-93 Fiscal Year 1993-94 * Fiscal Year 1994-95
PERSONAL SERVICES (PS)
Salaries&Wages/FTE's
Classification Monthly Number of Total Total Total ** Total Total** Total
Salary Positions Salaries FTEs Salaries FTEs Salaries FTEs
PH Nurse 5,332 30.00% 9,598 30.00% 19,771 30.00% 20,364 30.00%
Occ Health Spec 4,640 7.50% 2,088 7.50% 4,301 7.50% 4,430 7.50%
PH Aide (Span Spkg) 1,936 1,346 7.50% 2,465 10.00%
Clerk (Exp Level) 2,217 343 2.50% 706 2.50%
Subtotal, Salaries, &Wages/FTE's 11,686 37.50% 25,761 47.50% 27,965 50.00%
Overtime PHN Hours @$30.76 50 1,538 100 3,168 50 1,632
NET TOTAL, SALARIES&WAGES 13,224 28,929 29,596
Staff Benefits at 31% 4,099 8,968 9,175
TOTAL, SALARIES&WAGES 17,323 37,897 38,771
OPERATING EXPENSE AND EQUIPMENT (0 & E)
General Expense 1,286 330
Travel In-State 669 1,848 2,016
Equipment 3839
Other Items of Expense 2,630 2,544
TOTAL 0&E 4,508 5,764 4,890
TOTAL ANTICIPATED EXPENDITURES 21,831 43,661 43,661
Please attach a Budget Detail sheet briefly explaning th expenses under Operating Expenses and Equipment. The
equipment paragraph(s) should be itemized to show make, model, any special features, and a description of how it will be
used on this program. Also indicate the source of the listed price (catalog,vendor quote,etc.) and include sales tax in the
total cost.
*Salaries include estimated COLA of 3% per year
**Salaries for FY 92-93 are for 6 months
Salaries for FY 93-94 are for 12 months,except as noted
Salaries for FY 94-95 are for 12 months
C:\3.1\FILES\LEADPOIS.WK3
Childhood Lead Poisoning Case Management Page 2 of 3
County: Contra Costa
Federal Employer ID #: 94-600-0509W
BUDGET DETAIL
General Expense
Office supplies, forms, stationery, desk supplies, brochures,
flyers, training materials, general office expenses including
cost of copy machine use for duplicating educational
materials.
Travel
Staff mileage for Project-related travel to clients,
providers, community events, meetings, trainings, and other
activities at a rate of $0.28/per mile.
Equipment
Computer equipment to be used for Project-related report-
writing, recordkeeping, correspondence, production of flyers
and educational materials, data entry and communication
between offices; eventually also to be used for communication
with DHS data system.
Vendor for computer hardware: MicroAge Computers, Concord, CA
Vendor for computer software: Egghead Discount Software,
Pleasant Hill, CA
DTK IBM Compatible 386, 4Mb RAM,
120Mb hard drive, VGA Monitor, DOS 5. 0 $1305
HP Laserjet IV $1379
Hayes Ultra-Smart Modem 9600 $ 590
Printer and modem cables $ 17
WordPerfect 5. 1 $ 255
SUB-TOTAL, COMPUTER $3546
Sales tax $ 293
TOTAL, COMPUTER $3839
Childhood Lead Poisoning Case Management Page 3 of 3
County: Contra Costa
Federal Employer ID ,#: 94-600-0509W
Other Items of Expense
FY 1993-94
Laboratory blood lead testing 50 @ $22 .45 $1123
Environmental sample testing 50 @ $30. 00 $1500
Total $2623
FY 1994-95
Laboratory blood lead testing 50 @ $22 . 45 $1123
Environmental sample testing 50 @ $30. 00 $1500
Total $2623
Blood lead testing price is CHDP lab reimbursemnt rate.
Environmental sample testing price is quoted by Alameda County
Environmental Health Department.
STATE OF CALIFORWA
STATEMENT OF CQMPUANCE
STD. 19 (Rev. 3-87)
COMPANY NAME
The company named above (hereinafter referred to as "prospective contractor") hereby certifies, unless
specifically exempted, compliance with Government Code Section 12990 and California Administrative Code.
Title 2, Division 4, Chapter 5 in matters relating to the development, implementation and maintenance of a
nondiscrimination program. Prospective contractor agrees not to unlawfully discriminate against any employee
or applicant for employment because of race, religion, color, national origin, ancestry, physical handicap,
medical condition (cancer related), marital status, sex or age (over forty).
CERTIFICATION
I, the official named below, hereby swear that I am duly authorized to legally bind the prospective contractor to
the above described certification. I am fully aware that this certification, executed on the date and in the county
below, is made under penalty of perjury under the laws of the State of California.
NAME OF OFFICIAL
DATE EXECUTED EXECUTED IN THE COUNTY OF
PROSPECTIVE CON136L. 061 SAPA44-WRVE
PROSPECTIVE CONTRACTOR TrrL..E
PROSPECTIVE CONTRACTOR FEDERAL EMPLOYER I.D. NUMBER
S TATE.OF.CALIFORNIA
STATEMENT OF COMPLIANCE
STD. 19 (Rev. 3.87)
COMPANY NAME
The company named above (hereinafter referred to as "prospective contractor") hereby certifies, unless
specifically exempted, compliance with Government Code Section 12990 and California Administrative Code,
Title 2, Division 4, Chapter 5 in matters relating to the development, implementation and maintenance of a
nondiscrimination program. Prospective contractor agrees not to unlawfully discriminate against any employee
or applicant for employment because of race, religion, color, national origin, ancestry, physical handicap,
medical condition (cancer related), marital status, sex or age (over forty).
CERTIFICATION
I, the official named below, hereby swear that I am duly authorized to legally bind the prospective contractor to
the above described certification. I am fully aware that this certification, executed on the date and in the county
below, is made under penalty of perjury under the laws of the State of California.
NAME OF OFFICIAL
DATE EXECUTED EXECUTED IN THE COUNTY OF
OSPECTIVE CONTRACTOR 5 T�--
lr�ROSPECTWE CONTRACTOR TITLE
PROSPECTIVE CONTRACTOR FEDERAL EMPLOYER I.D. NUMBER
87 u8r,
STATE OF CAUIFORWA
STATEMENT OF COMPLIANCE
STD. 19 (Rev. 3-87)
COMPANY NAME
The company named above (hereinafter referred to as "prospective contractor") hereby certifies, unless
specifically exempted, compliance with Government Code Section 12990 and California Administrative Code.
Title 2, Division 4, Chapter 5 in matters relating to the development, implementation and maintenance of a
nondiscrimination program. Prospective contractor agrees not to unlawfully discriminate against any employee
or applicant for employment because of race, religion, color, national origin, ancestry, physical handicap.
medical condition (cancer related), marital status, sex or age (over forty).
CERTIFICATION
I, the official named below, hereby swear that I am duly authorized to legally bind the prospective contractor to
the above described certification. I am fully aware that this certification, executed on the date and in the count',
below, is made under penalty of perjury under the laws of the State of California.
NAME OF OFFICIAL
DATE EXECUTED EXECUTED IN THE COUNTY OF
F�tOSPECTIVE CONTRACT SJPb6k*WR/�
In
PhOSPECTIVE CONTRACTOR TITLE
PROSPECTIVE CONTRACTOR FEDERAL EMPLOYER I.D. NUMBER
STATEMENT OF COMPUANCE
STD. 19 (Rev. 3.97)
COMPANY NAME
The company named above (hereinafter referred to as "prospective contractor'; hereby certifies, unless
specifically exempted, compliance with Government Code Section 12990 and California Administrative Code.
Title 2, Division 4, Chapter 5 in matters relating to the development, implementation and maintenance of
nondiscrimination program. Prospective contractor agrees not to unlawfully discriminate against any employee
or applicant for employment because of race, religion, color, national origin, ancestry, physical handicap.
medical condition (cancer related), marital status, sex or age (over forty).
CERTIFICATION
I, the official named below, hereby swear that I am duly authorized to legally bind the prospective contractor to
the above described certification. I am fully aware that this certification, executed on the date and in the count%
below, is made under penalty of perjury under the laws of the State of California.
NAME OF OFFICIAL
DATE EXECUTED EXECUTED IN THE COUNTY OF
PSPECTIVE CONTRA _ZaR•5_ R
7
P46SPECTIVE CONTRACTOR TITLE
PROSPECTIVE CONTRACTOR FEDERAL EMPLOYER I.D. NUMBER
STATEMENT OF' COUPUANCE
STD. 19 (Rev. 3.87)
COMPANY NAME
The company named above (hereinafter referred to as "prospective contractor") hereby certifies, unless
specifically exempted, compliance with Government Code Section 12990 and California Administrative Code.
Title 2, Division 4, Chapter 5 in matters relating to the development, implementation and maintenance of a
nondiscrimination program. Prospective contractor agrees not to unlawfully discriminate against any employee
or applicant for employment because of race, religion, color, national origin, ancestry, physical handicap.
medical condition (cancer related), marital status, sex or age (over forty).
CERTIFICATION
I, the official named below, hereby swear that I am duly authorized to legally bind the prospective contractor to
the above described certification. I am fully aware that this certification, executed on the date and in the count-,
below, is made under penalty of perjury under the laws of the State of California.
NAME OF OFFICIAL
DATE EXECUTED EXECUTED IN THE COUNTY OF
PROSPECTIVE CONTRACTOR SI�XI.:RE�-
PROSPECTIVE CONTRACTOR TITLE
PROSPECTIVE CONTRACTOR FEDERAL EMPLOYER I.D. NUMBER