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HomeMy WebLinkAboutMINUTES - 04161996 - C49 �. TO: BOARD OF SUPERVISORS . FROM: William Walker, M.D. , Health Services Director f ' ' Contra - Costa DATE: April 4, 1996 --;; County SUBJECT: Approve Standard Agreement (Amendment) #29-208-53 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, or his designee, to execute on behalf of the County, Standard Agreement (Amendment) #29-208-53 (State #95-22779, Al) , effective July 1, 1995 with the State Department of Health Services (Immunization Unit) to increase the contract payment limit by $193,534 from $254,968 to a new payment limit of $448,502 for FY 1995-96. 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 $193,534` of State and Federal funding for the Immunization Assistance Program. No County match is required. III. REASONS FOR RECOMMENDATIONS/BACKGROUND: On July 11, 1995, the Board of Supervisors approved Standard Agreement #29-208- 52 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. Standard Agreement (Amendment) #29-208-53 will provide additional funds to enhance and expand immunization services for County's Immunization Assistance Program. Eight signed copies of this agreement and three certified/sealed copies of this Board Order should be returned to the Contracts and Grants Unit for submission to the State Department of Health Services. CONTINUED ON ATTACHMENT: YES SIGNATURE: J RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S) ACTION OF BOARD ON April 16, I qQ6 APPROVED AS RECOMMENDED _X_ OTHER VOTE OF SUPERVISORS X 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 Dept. (Contracts) ATTESTED _Dr-j-1- 16 1996 State DOHS Phil Batchelor, Clerk of the Board of Supervisors and Gou0q Administrator M382/7-88 BY d1.A',4 YJ r4 �� -Y�� n DEPUTY - i s -STATE OF CALIfiORNIA 99A d, 49 STANDAE3'D AGREEMENT- APPROVED BY THE CONTRACTNUMBER M.NO. ATTORNEY GENERAL STD.2(REV.5-91) 95-22779 A-1 TAXPAYERS FEDERAL EMPLOYER IDENTIFICATION NUMBER THIS AGREEMENT,malde and entered into this I St day of July 19 95 , 94-.6000509 in the State of California,by and between State of California,through its duly elected or appointed,qualified and acting TITLE OF OFFICER ACTING FOR STATE AGENCY Chief, Program Support Branch Department of Health Services ,hereafter called the State,and CONTRACTOR'S NAME ® o COUNTY OF CONTRA COSTA ;5 3 hereafter called the Contractor. WITNESSETH: That the Contractor for and in consideration of the covenants,conditions,agreements,and stipulations of the State hereinafter expressed, does hereby agree to furnish to the State services and materials as follows: (Set forth service to be rendered by Contractor,amount to be paid Contractor, time for performance or completion,and attach plans and specifications,if any.) In that certain agreement between this Department and the County of Contra Costa (Health Services) dated June 1, 1995: Paragraph 1 is amended to read: "1. The Contractor shall complete the objectives as stipulated in the attached Exhibit A Revised entitled"Terms"consisting of seven pages and made a part of this agreement by this reference". 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. Exhibit B Revised,Schedule 1,page 2,entitled"Desarollo Familiar",Schedule 2,page 3,entitled"Planned Parenthood",and Schedule 3,page 4,entitled"Pittsburg Pre-School Coordinating Council,Inc.", are for informational purposes only. All references to Exhibit B shall now read Exhibit B Revised". CONTINUED ON I SHEETS,EACH BEARING NAME OF CONTRACTOR AND CONTRACT NUMBER. FORM APPROVED The provisions on the reverse side hereof constitute a part of this agreement. yip U ' `,+P'A s 'CSU Se IN WITNESS WHEREOF,this agreement has been executed by the parties hereto,upon the date first above written.IV Plyqt� STATE OF CALIFORNIA CONTRACTOR AGENCY - CONTRACTOR(if other than an individu ,sta)a whether a corporation,partnership,etc.) Department of Health Services COUNTCACATF(AZOSTA BY(AUTHORIZED SIGNATURE) BY AUTHOR ED E) D PRINTED NAME OF PERSON SIGNINGEDWARD E. STAHLBERG CHIEF PRINTED NAME ND/ITJE OF ON SIGNING PROGRAM SUPPORT BRANCH Chair, Board of Supervisors or his designee TITLE ADDRESS Chief Program Support Branch 651 Line :3treeci 11ar'tinez , California 94553 AMOUNT ENCUMBERED BY THIS PROGRAM/CATEGORY(CODE AND TITLE) FUND TITLE Department of General Services DOCUMENT Clearing Account General Use Only $ 193,534.00 (OPTIONAL USE) PRIOR AMOUNT ENCUMBERED FOR FFP 88.9% Federal Catalog #93.268 THIS CONTRACT $ 254,968.00 ITEM CHAPTER I STATUTE FISCAL YEAR 4260-001-001 303 1995 1995/96 TOTAL AMOUNT ENCUMBERED TO DATE OBJECT OF EXPENDITURE(CODE AND TITLE) $ 448,502.00 95-95330-9159-702-03-95158S-95 1 hereby certify upon my own personal knowledge that budgeted funds T.B.A7DATE B.R.NO. are available for the period and purpose of the expenditure stated above. SIGNATURE OF ACCOUNTING OFFICER D CONTRACTOR 0 STATE AGENCY DEPT.OF GEN.SER. ❑ CONTROLLER STATE OF CALIFORNIA STANDARD AGREEMENT STC.2(REV.5.91) (REVERSE) 1. The Contractor agrees to indemnify,defend and save harmless the State,its officers,agents and employees from anv and all claims and losses accruing or resulting to any and all contractors, subcontractors, materialmen,laborers and any other person,firm or corporation furnishing or supplying work services, materials or'supplies in connection with the performance of this contract,and from any and all claims and losses accruing or resulting to any person,firm or corporation who may be injured or damaged by the_ Contractor in the performance of this contract. 2. The Contractor,and the agents and employees of Contractor,in the performance of the agreement,shall act in an independent capacity and not as officers or employees or agents of State of California. 3.The State may terminate this agreement and be relieved of the payment of any consideration to Contractor should Contractor fail to perform the covenants herein contained at the time and in the manner herein provided. In the event of such termination the State may proceed with the work in any manner deemed proper by the State. The cost to the State shall be deducted from any sum due the Contractor under this agreement,and the balance,if any,shall be paid the Contractor upon demand. 4. Without the written consent of the State,this agreement is not assignable by Contractor either in whole or in part. 5. Time is of the essence in this agreement. 6. No alteration or variation of the terms of this contract shall be valid unless made in writing and signed by the parties hereto,and no oral understanding or agreement not incorporated herein,shall be binding on any of the parties hereto. 7. The consideration to be paid Contractor, as provided herein, shall be in compensation for all of Contractor's expenses incurred in the performance hereof, including travel and per diem, unless otherwise expressly so provided. 91 61014 Contractor: County of Contra Costa Contract No.: 95-22779 A-1 (Health Services) Page 2 Paragraph 11. a. is amended to read: "a. Under the terms of this contract for the period July 1, 1995 through June 30, 1996,the maximum amount payable shall not exceed $398,502". Paragraph 12 is amended to read: "12. Under the terms of this contract, the combined maximum amount of state and federal funds payable through June 30, 1996 shall not exceed$448,502". Paragraph 15 is amended to read: 15. The attached Exhibit E entitled "Subcontracts for Services"consisting of one page is made a part of this agreement by this reference". Paragraph 16 is added to read: "16. The attached Exhibit F entitled"Freeze Exemptions"consisting of one page is made apart of this agreement by this reference". Paragraph 17 is added to read: 1.7. The attached 7/95 version of Exhibit A(F) entitled "Additional Provisions" consisting of six pages, back-to-back, numbered 1-4.2, hereby replace pages 1-4 of the (11/91) version of Exhibit A(F) entitled, "Additional Provisions referenced in paragraph 5 of the original contract". Paragraph 18 is added to read: 18. The Contractor(Grantee)shall comply with all requirements established under the Americans with Disabilities Act,in order to make programs accessible to all participants and to provide equally effective communications". Paragraph 19 is added to read: 19. The budget detail shown for subcontracts is displayed for information purposes only. Changes to a subcontractor's identification or budget will not result in a formal contract amendment•. Copies of the budget detail and any changes are on file with the State and the Contractor". The effective date of this amendment is July 1, 1995. All other terms and provisions of said contract shall remain in full force and effect. EXHIBIT A REVISED FY 1995-96 Pediatric - IAP TERM'S SECTION I. 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 P-rggram'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 all kindergarten entrants and incoming transfer students to schools within the Contractor's jurisdiction. 2.) By 1996, 90% of two-year-olds should be vaccinated with one dose of measles, mumps, and rubella (MMR) vaccine, three doses of polio vaccine, at least three dose of diphtheria, tetanus, and pertussis (DTP) vaccine, and at least three doses of Haemophilus influenzae type b (Hib) vaccine within the Contractors jurisdiction. In addition, 70% of two-year-olds should have received three doses of hepatitis b vaccine. 3.) Through prevention, surveillance and outbreak control, reduce, and if possible eliminate, illness, disability and death due to vaccine preventable diseases such as polio, diphtheria, tetanus, pertussis, measles, rubella, mumps, hepatitis B, and Haemophilus Influenzae Type b within the Contractor's jurisdiction. B. Specific Pediatric Activities: 1.) Immunization Clinic Services a.) Augment staffing in existing regularly scheduled public immunization clinics and/or expand clinics in more locations on more days with longer hours which are reasonably accessible to parents of children who reside within the Contractor's jurisdiction. b.) Clinic policies must allow for the immunization of all,susceptible infants, children, adolescents and adults who visit within the scheduled hours of operation regardless of their city, county or state of residence. c.) Public immunization clinic policies and practices must be in general accordance with the current recommendations approved by the U.S. Public Health Service and endorsed by the American Academy of Pediatrics (AAP) as specified in the 'Standards 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. 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. ' EXHIBIT A(PediatriclAP Continued)REVISED FY 1995-96 Page 2 f.) Assure that the date the next vaccine dose(s) are due is given in writing to the patient or parent. The appropriate space on the CIR may be used for this purpose. g.) Within the health jurisdiction, the Contractor shall implement and maintain public immunization clinic reminder/recall systems among all medical providers,who receive state-supplied vaccines, to improve age-appropriate immunizations of preschool-age children.'„ h.) In accordance with current Immunization Branch guidelines, which were furnished to the contractor by the State, the Contractor must participate in the national Vaccine Adverse Events Reporting System (VAERS)for adverse events following immunization. 2.) Immunization Assessment Levels a.) In accordance with the guidelines and timetables provided by the Immunization Branch, the Contractor must coordinate the assessment of the immunization levels of child care centers, Head Start Centers, and kindergarten entrants. b.) Through coordination with Immunization Branch Representatives, county health authorities and local child care center and school authorities, the Contractor must make efforts to ensure that all (100%) child care centers, Head Start centers and schools fully enforce existing regulations pertaining to the immunization of children admitted to such institutions. c.) Annually, within the health jurisdiction, the Contractor shall select at least a 20% representative random sample of public clinics who receive state-supplied vaccine. Of the public clinics selected, the Contractor shall conduct immunization record audits of children (24 months - 35 months old) who are served by the clinics. The sampling technique and immunization clinic record methodology must be compatible with the methodology of the Immunization Branch of the California Department of Health Services. The record audit specifications (with additional detailed guidelines), if requested,will be provided to the Contractor by the CDHS Immunization Branch. 3.) Immunization of Infants and Preschool Children In addition to the above stated activities, the Contractor agrees to the following activities intended to assure the age-appropriate immunization of infants and preschoolers who reside within the Contractor's jurisdiction. a.) Make efforts to ensure that the immunization status'bf infants and children receiving services through programs such as CHDP, MCH, AFDC, and WIC are 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. c.) The Contractor (local health department) receiving federal or state funds for immunization activities shall ensure that all programs within the jurisdiction which deal with childhood immunizations, including MCH and CHDP Programs, and private and primary care clinics, are kept informed of planned activities aimed at raising immunization levels of infants and preschoolers, so that they have the opportunity to provide assistance in the development, implementation, and maintenance of these activities. 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. EXHIBIT A(Pediatric IAP Continued)REVISED FY 1995-96 Page 3 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. o 2.) Outbreak control procedures in accordance with the guidelines of the Immunization Branch must be initiated by the Contractor within two working days of determination of a probable or confirmed measles case. C. Required Reports 1.) Reports of Local Program Progress and Activities In accordance with the guidelines and format provided by the Immunization Branch, the Contractor shall submit, through his/her Immunization Branch District Field Representative, to the Branch identified in paragraph 6 of Section I in this Exhibit, by the 15th of the month following the end of each quarter, a written quarterly report of progress and activities. In addition to the written report the Contractor and Project Liaison, or his designee, may meet and discuss the above matters in person. 2.) Upon completion of the investigation of each probable or confirmed measles case, a completed investigation form must be submitted to the Immunization Branch. 3.) Contractor agrees that itemized personnel positions listed in the Application for Immunization Project Subvention Funds shall not be subject to Contractor's personnel policy 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 the Contractor's Application for Immunization Project Subvention Funds submitted bey the Contractor on APR 14 JJ9� shall include the name and position title of the persons that have performed in{hese positions. 4.) The Contractor shall provide for any personnel or operating expenses that are necessary to meet the provisions included herein but are not provided for in the Budget included as Exhibit "B". 5.) The Contractor shall submit through his/her Immunization Branch District Field Representative, to the Branch identified in paragraph 6 of Section I in this Exhibit, on or before the 3rd of the month following the report month, a written Monthly Vaccine Usage Report in'the form prescribed by the State Department of Health Services, Immunization Branch. 6.) All reports, other than those required to be directed to the District Field Representatives, invoices, and other written communications are to be addressed and delivered to the State Department of Health Services, Immunization Branch, 2151 Berkeley Way, Berkeley, California 94704. 7.) The State reserves the right to use and reproduce all reports and data produced and delivered pursuant to this Contract and reserves the right to authorize others to use or reproduce such materials, provided that the confidentiality of patient information and records are protected pursuant to California State laws and regulations. 8.) This Contract may be terminated by either party upon 30 days' written notice to the other party. Further, this Contract may be terminated or suspended upon written notification by the State at any time for failure on the part of the Contractor to comply with any of the provisions contained herein. 9.) In consideration of the above services, performed in a manner acceptable to the State, the State shall reimburse the Contractor quarterly, in arrears, upon submission of a quarterly invoice by Contractor on Contractor's letterhead, in quadruplicate stating the time period covered, stating the EXHIBIT A(Pediatric IAP Continued) REVISED FY 1995-96 Page 4 contract number, for actual expenditures in accordance with the approved budgetary detail, titled, A p cation for Immunization Project Subvention Funds, submitted by the Contractor on. ��R 141995 ,to the Department of Health Services, Immunization Branch, 2151 Berkeley Way, Room 712, Berkeley, CA 94704. The Contractor may request and the State in its sole discretion may approve cumulative line item shifts of up to a maximum of$10,000 per line item, so long as the annual contract amount does not increase or decrease. Approved line item shifts meeting the criteria herein, shall not require a formal contract amendment or control agency approval. Line item shifts may be proposed/requested by either the State or the Contractor. Any changes to the approved budgetary detail, titled Application for Immunization Project Subvention Funds, shall require prior approval by the State. The Contractor shall submit a written explanation of the need for such excess and specifically identify the line item(s) to be reduced in order to increase the excess iterri 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 12 of the Standard Agreement. 10.) It is agreed by the Contractor that in the event that a significant portion of the Contract objectives for the initial four months of the Contract are not met by that time; and in the event that the State determines from quarterly invoices, performance reports, and other sources of information that the Contractor will not perform the total quantity of services contracted for; and that therefore, the total budget allocation will not be depleted; the State and/or Contractor may make an equitable adjustment in the original Contract budget and Contract objectives in order to decrease the total quantity of services and commensurate Contract amount. Any adjustment shall be by amendment only and duly executed by both parties and approved by the Department of General Services (if applicable). SECTION 11. 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 California/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 Statement"for each vaccine dose to be administered'(in the case of hepatitis B vaccine given to 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 Statement(s)"; 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; f.) provided the authorized appropriate translations of the "Important Information" statements and/or"Vaccine Information Statements" if English is not their first language and their language is one for which the State has made translations available. EXHIBIT A(Pediatric IAP Continued) REVISED FY 1995-96 Page 5 The Immunization Branch will supply to all local.health departments camera-ready copies of the current "Important Information" statements and a supply of the "Vaccine Information Statements" in English and Spanish. In addition, should a sufficient need exist, the Immunization Branch will arrange for authorized translations and provide camera-ready copies of the "Important Information" statements and a supply of "Vaccine Information Statements" in other languages. 7 2.) Health care providers are not required to obtain the signature of the patient, parent, or legal representative, acknowledging receipt of the "Important Information" statement(s) and/or "Vaccine Information Statement(s)". However, to ensure that a record of provision of the materials exists, health care providers must make notation in each patient's permanent medical record at the time the "statements" are provided. For health care providers who obtain vaccine via federal contract, the CDC Immunization Grant Guidance defines this as (1) date printed on the appropriate "Important Information" statement(s) and/or "Vaccine Information Statement(s)" and (2) date the "Important Information" statement(s) and/or "Vaccine Information Statement(s)" was given to the vaccine recipient, parent, or legal representative. 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 f.) 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 (optional) m.) date of signature (optional) n.) date(s) printed on the "Important Information"statement(s) and/or"Vaccine Information Statements" provided to the.patient or parent/guardian NO ALTERATION, VARIATIONS OR ADDITIONS TO THE IMPORTANT INFORMATION STATEMENTS, VACCINE INFORMATION STATEMENTS, OR VACCINE AGREEMENT MAY BE MADE WITHOUT THE PRIOR WRITTEN APPROVAL OF,THE CHIEF OF THE IMMUNIZATION BRANCH OF THE CALIFORNIA DEPARTMENT OF HEALTH SERVICES. 3.) The authorized immunization 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 was provided to the vaccine recipient, parent, or legal representative. 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 Statement(s)" are to be read 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 Branch before they may receive State purchased vaccine. Medical providers of immunization services who sign the agreement must agree to use the "Important Information" A EXHIBIT A(Pediatric IAP Continued) REVISED +t FY 1995-96 Page 6 statements and/or "Vaccine Information Statements" and must be provided as many copies of the statements 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 Statements" are required in clinic settings even if the clinics are supervised by a physician in attendance. The "Outside Provider Agreement..." shall be signed annually by non-health department medical providers and retained by the local health department for a minimum of ten years following the last calendar year in which the State Immunization Branch 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 Branch. 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 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, must 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 and/or hepatitis B immune globulin (HBIG) 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 Branch. Reports should be submitted to the Immunization Branch 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 Branch will supply the reporting forms. All local health departments are to notify their Immunization Branch 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 Branch purchased vaccine of the manufacturers' specifications for vaccine storage and handling. EXHIBIT A(Pediatric-IAP-Hepatitis B Continued) Revised FY 1995-96 Page 7, SECTION III. TERMS AND CONDITIONS FOR COLLABORATIVE FUNDS A. Objective 1) By June 30, 1996, within the catchment area the Contractor shall have implemented and shown documented progress of targeting the "highest risk" children under four years of age to ensure they receive age-appropriate immunizations on time. B. Required Reports 1) The quarterly progress report will document the efforts made toward achieving the revised goals, objectives, and activities stated in the Contractor's Request for Proposal (collaborative application) originally submitted to the California Department of Health Services Immunization Branch,July 1995. EXHIBIT B REVISED BUDGET Page 1 County of Contra Costa (Health Services) Contract Number 95-22779 A-1 July 1, 1995 - June 30, 1996 Adjustment Effective Prior Approved 7/1/95 New Approved Amount (-)and/or+ Amount 1. PERSONNEL COSTS $184,703.00 $29,052.00 $213,755.00 II. FRINGE BENEFITS @ 11.09%- 31% $49,374.00 - $3,998.00 $53,372.00 III. OPERATING EXPENSES $5,000.00 $29,221.00 $34,221.00 IV. EQUIPMENT EXPENSES $3,000.00 $1,605.00 $4,605.00 V: TRAVEL AND PER DIEM $4,200.00 $3,195.00 $7,395.00 VI. SUBCONTRACTS $8,691.00 $125,463.00 $134,154.00 VI1. DIRECT OVERHEAD TOTAL = I. - VI. $254,968.00 $192,534.00 $447,502.00 VIII. INDIRECT COSTS @ 0% $0.00 $0.00 $0.00 IX. OTHER COSTS $0.00 $1,000.00 $1,000.00 TOTAL BUDGET $254,968.00 $193,534.00 $448,502.00 'DHS'83 2(2/94) EXHIBIT B REVISED -SCHEDULE 1 BUDGET PAGE APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION FUNDS Applicant: County of Contra Costa (Health Services) Budget Period From: 7/1/95-6/30/96 Subcontracts Name of Applicant(subcontractor): Deparollo, Familiar Contact Person. Frank Address: 2W-Mth Street CRY.$11ale,&zip owe: Richmond, Cai J nia 94aas Telephone 9: 510-412-5930 Federal Tax 1.0.Nun-ber- . 94-2751073 Dollar Amount I.Personal Services. %of Time or Salary Range or Requested from of gms; vw&iab Outreach Workers (2) 188 Hours I1. $ 2068.00 Persona(Servioes Subtotal $ $ 2068 00 Fringe Benefit Rate 29 % 600.00 Personal$ervices suf2fatal --2668,.00 11.Operating Expenses Supplies 1032.00 Printing 100.00 Travel 100.00 Equipment Telephone 100.00 operig(Irig EXpenseS 5abiota1 —1332.00 Subcordract Total = Q. Per.Services*ti.Operating Expen-1 r$ 4()OO.OT Note: A written justification of the above Contractor service(s)and expected completed work product(s) must be included in Exhibit C Budget Justification of this agreement. This schedule is being provided for informational purposes. Changes to the schedule do not require a contract amendment. Q DHS 8312(2/94) EXHIBIT B REVISED -SCHEDULE 2 BUDGET PAGE 3 APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION FUNDS. Applicant: County of Contra Costa (Health Services) Budget Period From: 7/1/95- 6/30/96 Subcontracts Names of Subwnbwtor. Planned Parenthood Addrees: 2186 Pacheco St, City, Staff, &Zip Code. Concord, CA 9452.0 Telephone*. X510) sm 0505 - Federal Tax ID# 94-1575233 1. r$onalSenrices Rate of Dollars requkod Lust Positions) Time Period Reimbursement from California MediCW its-3 15 hrstwk $9 -11/hour $17,580 CliniciM (PNNP) 3 6 hrsfwk X25-31N $21,06p Out Serialist 4 hrs/wts $15-1 VW $2,625 Pro wam &Dery rDr 5 hrs $15-181hr $3,120 Fmoo is @ 19% $8,427 Persona!Serum Subtofti r1. Op ►g Mpmsw Supplies 3.781.00 Health Education Mate s 3,150m Trani (in—state) 750.00 Equipment Operating Expense Subtotal T,-6 6 11.o F- Subcon tsTOW 60,463.00 Note: A written justification of the above Contractor service(s)and expected completed work product(s) must be included in Exhibit C Budget Justification of this agreement. This schedule is being provided for informational purposes. Changes to the schedule do not require a contract amendment. DHS 8312(2/94) EXHIBIT B REVISED - SCHEDULE 3 C.q7 BUDGET PAGE 4 APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION FUNDS Applicant: County of Contra Costa (Health Services) Budget Period From: 7/1/95-6/30/96 Subcontracts Pittsburg Pre-school Coordinating Council, Inc. Name of Subcontractor: Address: City, State, &Zip Code: Pittsburg, CA 94565 Telephone#: Federal Tax I.D. Number: I. PERSOMEL SERVICES % of Time Range 0 of Mo. Amount 1 . Fxecut.lve Director 2.5% $6587-6666 6 $ 986 2. Health Ed Coordinator 2.5% 2917-3000 12 876 3 , Out7Ceat`h Coordinator 11) _099 1993-2253 6 1 .352 4. Tmmun. Outreach Super , 54 . 0% 1560-1994 .6 5,980 5. Sr. Oul-reach Worker 40.0% 19117-1993 6 4.576 6. Outreach Workers (3) 100.0% 14-77-1560 6 2151.080 7. Outreach Worker 12.5% 1477--15613 12 2.340 B. clank 20.0% 121.3- 1387 6 1 ,664 Per3onne 1 9ervi c.ez Subtotal 45,856 Staff Benefits @ 24% 11 . 004 Pemonne I Services Total $56,860 11. OPERAT'[NG EXPENSES 1 . Suppl ie's &. materials $ 1 ,800 2. Printing 750 3. Local Travel 4. 506 4. Equspm'1at +4.575 5. TeIecarranunicat ions 1.200 Operating Expepoefr Subtotal $1 2.831 TOTAL SUBG03FTRACT BUDGET $69.691 Note: A written justification of the above Contractor service(s) and expected completed work product(s) must be included in Exhibit C Budget Justification of this agreement. This schedule is being provided for informational purposes. Changes to the schedule do not require a contract amendment. EXHIBIT E C �9 SUBCONTRACTS FOR SERVICES A. Prior written authorization will be required before the Contractor enters into or is_reimbursed for any subcontract for services costing$5,000 or more. For subcontracts for services exceeding$5,000, Contractors shall obtain at least three bids or justify a sole source award. 1. The Contractor must provide in its request for authorization, all particulars necessary for evaluating the necessity or desirability of incurring such cost. 2. The State may identify the information needed to fulfill this requirement. B. The State reserves the right to approve or disapprove the selection of subcontractors, require the substitution of subcontractors, and order the termination of subcontracts entered into in support of this agreement. C. Actual subcontracts (i.e., written agreement between the Contractor and a subcontractor) of $5,000 or more are subject to the prior review and written approval of the State. The State may, at its discretion, elect to waive this right. All such waivers shall be confirmed in writing by the State. D. Contractor shall maintain a copy of each subcontract entered into in support of this agreement and shall, upon request by the State, make said copies available for approval, inspection,or audit. E. Sole responsibility rests with the Contractor to ensure that Subcontractors are paid in a timely manner. F. The Contractor is responsible for all performance requirements under this agreement even though performance may be carried out through a subcontract. G. The Contractor is responsible for a subcontractor's actions or failure to take action in fulfilling the requirements of this agreement. H. The Contractor may be required to supply budget detail for each subcontractor and/or each major subcontracted activity under this agreement. 1. Budget detail format and submission requirements will be prescribed by the State. 2. Methods of including budget detail in this agreement, if applicable,will be prescribed by the State. 3. Any subcontractor budget detail displayed in this agreement, oG incorporated by reference, is included for information purposes only. a. Changes to a subcontractor's identity or subcontract budget detail may be made with the mutual consent of the State and the Contractor and said changes shall not require the processing of a formal amendment to this agreement. I. The Contractor shall ensure that all subcontracts for services include provision(s) requiring compliance with applicable terms and conditions specified in this agreement. J. The Contractor agrees to include the following clause, relevant to record retention, in all subcontracts for services: "(Subcontractor Name) agrees to maintain and preserve, until three years after termination of (Contract Number] and final payment from the State, and to permit the State or any duly authorized representative, to have access to, examine or audit any pertinent books, documents, papers and records related to this subcontract." K. Unless otherwise stipulated in writing by the State,the Contractor shall be the subcontractor's sole point of contact for all matters related to performance and payment under this agreement. L EXHIBIT F Freeze Exemptions A. Contractor agrees that any hiring freeze adopted during the term of this agreement shall not be applied to the positions funded, in whole or in part, by this agreement. B. Contractor agrees not to implement any personnel policy which may adversely affect performance or the positions funded, in whole or in part, by this agreement. C. Contractor agrees that any travel freeze or travel limitation policy adopted during the term of this agreement shall not restrict travel funded, in whole or in part, by this agreement. D. Contractor agrees that any purchasing freeze or purchase limitation policy adopted during the term of this agreement shall not restrict or limit purchases funded, in whole or in part, by this agreement. Exhibit A (F) STATE OF CALIFORNIA DEPARTMENT OF HEALTH SERVICES ADDITIONAL PROVISIONS (FOR FEDERALLY FUNDED SUBVENTION AID/LOCAL ASSISTANCE AND COST REIMBURSEMENT CONTRACTS/GRANTS) 1. Equal Opportunity Clause A. The Contractor will not discriminate against any employee or applicant for employment because of race, color, religion, sex, national origin, physical or mental handicap, or age. The Contractor will take affirmative action to ensure that qualified applicants are employed, and that,employees are treated during employment without regard to their race, color, religion, sex, national origin, physical or mental handicap, or age. Such action shall include, but not be limited to the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination, rates of pay or other forms of compensation; and careerdevelopment 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 the State, setting forth the provisions of the Equal Opportunity clause and the Rehabilitation Act of 1973. Such notices shall state the Contractor's obligation under the law to take affirmative action to employ and advance in employment qualified applicants without discrimination based on their race, color, religion, sex, national origin, physical or mental handicap or age and the rights of applicants and employees. B. The Contractor will, in all solicitations or advertisements for employees placed by or on behalf of the Contractor, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, physical or mental handicap or age. C. The Contractor will send to each labor union or representative of workers with which he or she has a collective bargaining agreement or other contract or understanding a notice, to be provided by the Federal Government or the State, advising the labor union or worker's representative of the Contractor's commitments under this Equal Opportunity clause and shall post copies of the notice in conspicuous places available to employees and applicants for employment. D. The Contractor will comply with all provisions of the Rehabilitation Act of 1973 and of the Federal Executive Order No. 11246 as amended, and of the rules, regulations, and relevant orders of the Secretary of Labor. E. The Contractor will furnish all information and reports required by Federal Executive Order No. 11246 as amended and the Rehabilitation Act of 1973, and by the rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his books, records, and accounts by the contracting agency and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules, regulations and orders. CMS Instructional Bulletin No.02(Rev.7195) -1- Exhibit A (F) 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. 111246 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 travel and per diem shall be at rates currently in effect, as established by the Department of Personnel Administration, for similar State employees. Exceptions to these rates may be approved by the State upon the verification of a statement submitted by the Contractor indicating that such rates are not available to the Contractor. No travel outside the State of California shall be reimbursed without prior written authorization from the.State. 3. Purchasing/Procurement Rules A. Units of local government, public entities (including the Universities of California and California State University and auxiliary organizations/foundations thereof), and State or federal agencies, whether acting as a contractor and/or subcontractor, may use their existing procurement systems to secure all articles, supplies, equipment (e.g., nonexpendable items with a unit cost of$500 or more and a useful life expectancy of four or more years, including EDP/ADP, telecommunications and motor vehicles), and services related to such purchases that are required in performance of this agreement, without regard to dollar limit, subject to the provisions in paragraphs E through I of this section. The provisions in paragraphs B. C. and D of this section may also apply, if purchases are subdelegated to subcontractors that are nonprofit organizations, for-profit entities or private vendors. B. All other entities (nonprofit organizations and for-profit entities or private vendors), whether acting as a contractor.or subcontractor, may use their existing procurement systems to secure articles, supplies, equipment (e.g., nonexpendable items with a unit cost of$500 or more and a useful life expectancy of four or more years, including EDP/ADP, telecommunications and motor vehicles), and services related to such purchases that are required in performan-ce of this agreement. Equipment procurement shall not exceed an annual maximum limit of$50.000, subject to the provisions in paragraphs C through I of this section. The provisions in paragraph A of this section may also apply, if purchases are subdelegated to subcontractors that are units of local government or pubic entities. State or federal agencies. CMS Instructional Bulletin No.02(Rev.7(95) -27 Exhibit A (F) C. All other entities(nonprofit organizations and for-profit entities or private vendors), whether acting as a contractor or subcontractor, shall use procurement systems that meet the following standards: (1) Maintain a code or standard of conduct that shall govern the performance of its officers, employees, or agents engaged in awarding procurement contracts. No employee, officer, or agent shall participate in the selection, award, or administration of a procurement contract in which, to his or her knowledge, he or she has a financial interest. (2) Procurements shall be conducted in a manner that provides, to the maximum extent practical, open and free competition. (3) Procurements shall be conducted in a manner that provides for all of the following: (a) Avoidance of the purchasing of unnecessary or duplicate items. (b) Solicitations for capital expenditures (equipment) shall be based upon a clear and accurate description of the technical requirements of the goods to be procured. (c) The taking of positive steps to utilize small, minority, women, or veteran owned businesses. D. To secure equipment above the annual maximum limit of $50,000, the Contractor shall make arrangements through the appropriate Department of Health Services (DHS) program contract manager, to have all remaining equipment purchased through the. DHS Purchasing Unit by way of the Department of General Services, Office of Procurement. The cost of equipment purchased by or through State shall be deducted from the funds available in this agreement. Contractor shall submit to the DHS Purchasing Unit a list of equipment specifications for those items which the State must procure. The State may pay the vendor directly for such arranged equipment purchases and title to the equipment will remain with the State. The equipment will be delivered to jhe Contractor's address, as stated on the face of the agreement, unless the Contractor notifies the State, in writing, of an alternate delivery address. E. Prior written authorization from the appropriate DHS program contract manager will be required before the Contractor will be reimbursed for any purchase of$5,000 or more for articles, supplies, equipment, and services related to such purchases. The Contractor must provide in its request for authorization all particulars necessary, as specified by the State, for evaluating the necessity or desirability of incurring such costs. The term "purchase" excludes the purchase of services from a subcontractor and public utility services at rates established for uniform applicability to the general public. F. In special circumstances, defined by the State, the State may require prior written authorization and/or the submission of paid vendor receipts for any purchase, regardless of dollar amount. The State reserves the right to either deny claims for reimbursement or to request repayment for any Contractor and/or Subcontractor purchase that the State determines to be unnecessary in carrying out performance under this agreement. CMS Instructional Bulletin No.02(Rev.7195) -3- Exhibit A (F) G. The Contractor and/or Subcontractor must maintain a copy or narrative description,of the procurement system, guidelines, rules, or regulations that will be used to make purchases under this agreement. The State reserves the right to request copies of these - documents and to inspect the purchasing practices of the Contractor and/or a Subcontractor at any time. H. For all purchases, the Contractor and/or Subcontractor must maintain copies of all paid vendor invoices, documents, bids and other information used in vendor selection, for inspection or audit by the State. Justifications supporting the absence of bidding (i.e., sole source purchases) shall also be maintained on file by the Contractor and/or Subcontractor for inspection or audit by the State. I. The State may, with cause (e.g., with reasonable suspicion of unnecessary purchases or use of inappropriate purchase practices, etc.), withhold, cancel, modify, or retract the delegated purchase authority granted under paragraphs A and\or B of this section, by giving the Contractor no less than 30 calendar days written notice. 4. OWNERSHIP/DISPOSITION OF EQUIPMENT PURCHASED/REIMBURSED WITH CONTRACT FUNDS OR FURNISHED BY THE STATE A. All equipment of any kind, as defined in section 3 paragraph A, purchased/reimbursed with contract funds or furnished by the State under the terms of this agreement and not fully consumed in performance of this agreement shall be considered State equipment and the property of the State. B. Title to State.equipment shall not be affected by its incorporation or attachment to any property not owned by the State. C. Unless otherwise stipulated, the State shall be under no obligation to pay the cost of restoration, or rehabilitation of the Contractor's and/or a Subcontractor's facility which may be affected by the removal of any State equipment. D. The Contractor and/or Subcontractor shall maintain and administer, according to State directives and sound business practices, a program for the proper use, maintenance, repair, protection, insurance and preservation of State equipment. E. Equipment, as defined in section 3 paragraph`A, purchased/reimbursed with contract funds or furnished by the State under the terms of this agreement, shall only be used for, performance of this agreement. F. Contractor shall submit an annual inventory of equipment, as defined in section 3 paragraph A, purchased/reimbursed with contract funds or furnished by the State under the terms of this agreement. Include in that inventory, said equipment in the Contractor's possession and/or in the possession of a subcontractor. The State will prescribe the inventory format and may supply applicable forms to be used for this purpose. G. Within 90 calendar days prior to the termination or end of this agreement, the Contractor shall provide a final inventory of equipment to the State and shall at that time query the State as to the requirements, including the manner and method, of returning State equipment to DHS. Final disposition of equipment shall be at State expense and according to State instructions. Property disposition instructions shall be issued by the State immediately after receipt of the final equipment inventory. CMS Instructional Bulletin No.02(Rev.7195) -4.0- Exhibit A(F) H. Motor Vehicles : 1. If motor vehicles are purchased/reimbursed with contract funds or furnished by the State under the terms of this agreement, within 30 calendar days prior to the termination or end of this agreement, the Contractor and/or Subcontractor shall return such vehicles to the State and shall deliver all necessary documents of title or registration to enable the proper transfer of a marketable title to the State. 2. If motor vehicles are purchased/reimbursed with contract funds or furnished by the State under the terms of this agreement, the State shall be the legal owner of said motor vehicles and the Contractor shall be the registered owner. The Contractor and/or a Subcontractor may only use said vehicles for performance and under the terms of this agreement. 3. The Contractor and/or Subcontractor agree that all operators of motor'vehicles, purchased/reimbursed with contract funds or furnished by the State under the terms of this agreement, shall hold a valid State of California driver's license. In the event that 10 or more passengers are to be transported in any one vehicle, the operator shall also hold a State of California Class B driver's license. 4. If any motor vehicle is purchased/reimbursed with contract funds or furnished by the State under the terms of this agreement, the Contractor and/or Subcontractor, as applicable, shall provide, maintain and certify that, at a minimum, the following type and amount of automobile liability insurance is in effect during the term of this agreement or any period of contract extension during which any vehicle remains in the Contractor's and/or a Subcontractor's possession: a. Automobile Liability Insurance The Contractor, by signing this agreement, hereby certifies that it possesses or will obtain automobile liability,insurance in the amount of $500,000 per occurrence for bodily injury and property damage combined. Said insurance must be obtained and made effective upon the delivery date of any motor vehicle, purchased/reimbursed with contract funds or furnished by the State under the terms of this agreement, to the Contractor and/or Subcontractor. b. The Contractor and/or Subcontractor shall, as soon as practical, furnish a copy of the certificate of insurance to the State. C. The Contractor and/or Subcontractor agree that bodily injury and property damage liability insurance, as required herein, shall remain in effect at all times during the term of this agreement or until such time as the motor vehicle is returned to the State. d. The Contractor and/or Subcontractor agree to provide, at least 30 days prior to the expiration date of said insurance coverage, a copy of a new certificate of insurance evidencing continued coverage, as indicated herein, for not less than the remainder of the term of this agreement, the term of any extension or continuation thereof, or for a period of not less than one (1) year. CMS Instructional Bulletin No.02(Rev.V95) -4.1- Exhibit A (F) e. The.Contractor and/or Subcontractor must provide evidence, that any required certificates of insurance contain the following provisions: 1. The insurer will not cancel the insured's coverage without giving . 30 calendar days prior written notice to the State (Department of Health Services). 2. The State of California, its officers, agents, employees, and servants are included as additional insureds, but only insofar as the operations under this agreement and any extension or continuation of this agreement are concerned. 3. The insurance carrier shall notify the State of California Department of Health Services, in writing, of the Contractor's failure to pay premiums; its cancellation of such policies; or any other substantial change, including, but not limited to, the status, coverage, or scope of the required insurance. Such notices shall contain a reference to the contract number for which the insurance was obtained. f. The Contractor and/or Subcontractor is hereby advised that copies of certificates of insurance may be subject to review and approval by the Department of General Services, Office of Insurance and Risk Management. The Contractor shall be notified by the State, in writing, if this provision is applicable to this agreement. g. In the event the Contractor and/or Subcontractor fails to keep insurance coverage, as required herein, in effect at all times during vehicle possession, the State may, in addition to any other remedies it may have, terminate this agreement upon the occurrence of such event. 5: Standards of Work The Contractor agrees that the performance of work and services pursuant to the requirements of this contract shall conform to high professional standards. CMS Instructional Bulletin No.02(Rev.7195) -4,2-