HomeMy WebLinkAbout19- Parks, Recreations and Community Services " RIGINAL
CITY OF SAN BERNARDINO-REQUEST FOR COUNCIL ACTION
From: Kevin Hawkins, Director Subject: Resolution of the Mayor and
Common Council of the City of San
Dept: Parks, Recreation and Bernardino authorizing the City Manager to
Community Services Dept. execute a contract with the County of San
Bernardino Department of Aging and Adult
Date: April 26, 2010 Services (DAAS), accepting the proposal
amount of$176,960 for the period of July 1,
2010 through June 30, 2011 for the Senior
Nutrition Program.
M/CC Meeting Date: May 17, 2010
Synopsis of Previous Council Action:
January 19, 2010 - Resolution No. 2010-5
June 1, 2009—Resolution No. 2009-136
Recommended Motion:
Adopt Resolution
Signature
Contact person: Robert Lennox Phone: 384-5031
Supporting data attached: Staff report,grant contract Ward: All
FUNDING REQUIREMENTS: Amount: $176,960 grant funds
$68.229 city in-kind
Source: (Acct. No.) 123-513-xxxx
(Acct Description) Grants
Finance:
Council Notes: efso --9 0/0 - /O 1/
Agenda Item No.
5-11-UM
Op l accwteU&Pv-s
CITY OF SAN BERNARDINO — REQUEST FOR COUNCIL ACTION
Staff Report
Subject:
Resolution of the Mayor and Common Council of the City of San Bernardino authorizing the
City Manager to execute a contract with the County of San Bernardino Department of Aging and
Adult Services (DAAS), accepting the proposal amount of $176,960 for the period of July 1,
2010 through June 30,2011 for the Senior Nutrition Program
Background:
The FAS Standard Contract for Senior Nutrition Services is an agreement between the City and
the County of San Bernardino Department of Adult and Aging Services (DAAS) to provide
senior nutrition services for the County of San Bernardino for the period of July 1, 2010 through
June 30, 2011. During FY 08/09, the Senior Nutrition Program served over 54,227 total meals
for a daily average of 197 meals or 616 clients at six (6) nutrition sites: 5th Street Senior Center,
Perris Hill Senior Center, New Hope Family Life Center, Hernandez Community Center, Lytle
Creek Community Center, and Highland Senior Center.
The current grant began in FY 07/08 covering three (3) years of contract services. This contract
for Senior Nutrition Services covers one (1) year of service for Fiscal Year 2010/11. Attached is
the FAS Standard Contract, with contract number to be assigned by the County once executed by
the City.
The FY 10/11 requested contract amount was $282,014 with the program expecting to serve
57,757 congregate meals at all seven meal sites accumulatiively. However the contract award for
FY 10/11 form DAAS is $176,960 with the program expected to serve 32,000 congregate meals.
The County has experienced delays in awarding contract amounts due to budget hardships but
does anticipate awarding additional funds to the City as a contract amendment in the coming
months.
The Grants Ad Hoc Committee recommended approval of the grant application and the full
Council ratified the submittal on January 19, 2010.
Financial Impact:
Account Budgeted Amount: N/A
Balance as of: N/A
Balance after approval of this item: N/A
Please note this balance does not indicate available funding. It does not include non-
encumbered reoccurring expenses or expenses incurred but not yet processed.
The amount of grant funding available for FY 10/11 is $176,960. There is no General Fund cash
match required; the City's in-kind contribution is budgeted at $68,229 for FY 10/11, as an
11.11% minimum in-kind matching contribution requirement for FY 10/11. Tbis is met through
a percentage of personnel, building and utility costs, which are funded in the Parks, Recreation
and Community Services operating budget (001-386-xxxx). The program's goals include
collecting $40,000 in `Program Income' or meal recipient donations and another $10,000 in
`Matching Cash' or sponsorships from outside organizations to support meal service.
Recommendation:
Adopt Resolution
RESOLUTION NO. COPY
�v 2 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE
CITY OF SAN BERNARDINO AUTHORIZING THE CITY MANAGER TO
3
EXECUTE A CONTRACT WITH THE COUNTY OF SAN BERNARDINO
4 DEPARTMENT OF AGING AND ADULT SERVICES (DAAS), ACCEPTING
THE PROPOSAL AMOUNT OF $176,960 FOR THE PERIOD OF JULY 1, 2010
5 THROUGH JUNE 30,2011 FOR THE SENIOR NUTRITION PROGRAM.
6 BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF
THE CITY OF SAN BERNARDINO AS FOLLOWS:
7
8 SECTION 1. That the City Manager is hereby authorized to execute a FAS
9 Standard Agreement with the County of San Bernardino, for a grant in the amount of
10 $176,960 for a one-year period - July 1, 2010 through June 30, 2011, a copy of which is
11 attached hereto, marked Exhibit "A" and incorporated herein by reference as fully as
12 though set forth at length; and
13
SECTION 2. That the authorization granted hereunder shall expire and be void
14
15 and of no further effect if the Standard Agreement is not executed by both parties and
16 returned to the Office of the City Clerk within one hundred and twenty days (120) days
17 following effective date of the Resolution.
18
19
20
21
22
23
24
25 ///
26 ///
27 � 17 I o
289
1 RESOLUTION NO.
2 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE
CITY OF SAN BERNARDINO AUTHORIZING THE CITY MANAGER TO
3 EXECUTE A CONTRACT WITH THE COUNTY OF SAN BERNARDINO
4 DEPARTMENT OF AGING AND ADULT SERVICES (DAAS), ACCEPTING
THE PROPOSAL AMOUNT OF $176,960 FOR THE PERIOD OF JULY 1, 2010
5 THROUGH JUNE 30,2011 FOR THE SENIOR NUTRITION PROGRAM.
6 I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the
7 Mayor and Common Council of the City of San Bernardino at a meeting
8 thereof,held on the_day of 2010, by the following vote,to wit:
9
Council Members: AYES NAYS ABSTAIN ABSENT
10
MARQUEZ _
11
12 DESJARDINS
13 BRINKER
14 SHORETT
15 KELLEY
16 JOHNSON
17
MC CAMMACK
18
19
20 City Clerk
21 The foregoing resolution is hereby approved this day of_ 2010.
22
23 Patrick J. Morns,Mayor
City of San Bernardino
24 Approv d as to Form:
25 By:
26 Gam.
�Imes F. Penman, City Attorney
27
28
FOR COUNTY USE ONLY
X New Vendor Code Dept. t
10F n change S
CITYOFS772 `� OOA
Cancel
County Department Dept. Orgn. Contractor's License No.
Department of Aging and Adult Services
County Department Contract Representative Telephone Total Contract Amount
County of San Bernardino Jeri Quick 388-0255 $176,960
F A S Contract Type
❑ Revenue ® Encumbered ❑ Unencumbered ❑ Other:
STANDARD CONTRACT If not encumbered or revenue contract type,provide reason:
Commodity Code Contract Start Date Contract En Date 0 final Am t Amendment Amount
95200 July 1, 2010 June 30, 40111 $176, 0
Fund Dept. Organization Appr. Obj/ S urce GRC/PRO /JOB No. Amount
AAF ODA 210 200 445 $157,668
Fund Dept. Organization Appr. bj/Re Source GRC/PR /JOB No. Amount
AAF ODA 235 200 24 1 $18,507
Fund Dept. Organization Appr. O j/Rev Source GRC/PROJ/JOB No. Amount
AAF OOA 280 200 45 $785
P ct Name imated Payment Total by Fiscal Year
Elderly n Services Y A unt' I/D FY Amount 1/D
Pro r 10- 1 $1 ,960 1
THIS CONTRACT is entered into in t State of Calif mia by and between the County of San Bernardino,
Department of Aging and Adult Services, reinafter call the County, and
Name
City of San Bernardino hereinafter called Contractor
Address
300 North D Street
San Bernardino, CA 92418
Phone Birth Date
(909) 384-5231
Federal ID No.or Social Secunty No.
95-6000772
IT IS HEREBY AGREED AS FOLLOWS:
WHEREAS the County desires to provide nutrition programs for the elderly; and
WHEREAS, the Older Americans Act of 1965 provides assistance to State and local agencies to develop nutrition
programs for the elderly, and
WHEREAS, the County has been allocated Older Americans Act funds by the California Department of Aging for the
purpose of administering nutrition programs for the elderly; and
WHEREAS, County finds Contractor qualified to provide nutrition programs for the elderly; and
WHEREAS, County desires that such services be provided by Contractor and Contractor agrees to perform these
services according to the specific terms and conditions provided by the Contract.
NOW THEREFORE, in consideration of the mutual promises contained herein, County and Contractor mutually
agree to the following terms and conditions:
AuditorlController-Recorder Use Only
❑Contract Database ❑FAS
Input Date Keyetl By
Pace 1 of 25
TABLE OF CONTENTS
I. DEFINITIONS...................................................................................................................................3
II. CONTRACTOR SERVICE RESPONSIBILITIES..............................................................................5
III. CONTRACTOR GENERAL RESPONSIBILITIES ............................................................................5
IV. COUNTY RESPONSIBILITIES ......................................................................................................16
V. FISCAL PROVISIONS ...................................................................................................................16
VI. RIGHT TO MONITOR AND AUDIT .....................................................................................................19
VII. CORRECTION OF PERFORMANCE DEFICIENCIES........................................................................20
VIII. TERM...................................................................................................................................................21
IX. EARLY TERMINATION .......................................................................................................................21
X. GENERAL PROVISIONS....................................................................................................................21
XI. CONCLUSION.....................................................................................................................................25
ATTACHMENT A - SCOPE OF WORK
ATTACHMENT B - CLIENT COMPLAINT AND GRIEVANCE PROCEDURE
ATTACHMENT C - CONTRACTO RIVEN DOR CONFIDENTIALITY STATEMENT (CDA 1024)
ATTACHMENT D - SECURITY INCIDENT REPORT FORM (CDA 1025)/SECURITY
INCIDENT REPORT INSTRUCTIONS
ATTACHMENT E - ASSURANCE OF COMPLIANCE
ATTACHMENT F - DISCLOSURE OF LOBBYING ACTIVITIES (FORM)
ATTACHMENT G INFORMATION SHEET
ATTACHMENT H - COMMUNITY FOCAL POINTS
ATTACHMENT I - MONTHLY NUTRITION PROGRAM REQUEST FOR REIMBURSEMENT
FORM
ATTACHMENT - NUTRITION PROGRAM CONTRACTOR QUARTERLY EXPENDITURE
REPORT
ATTACHMENT K - BUDGET SUMMARY
ATTACHMENT L - BUDGET IN-KIND NARRATIVE STATEMENT
Page 2 of 25
I. DEFINITIONS
A. Cash Match —Cash, other than program income, contributed to the project from local or State funds.
With the exception of Community Development Block Grants (CDBG), Federal funds cannot be used
as cash match.
B. CCR—California Code of Regulations
C. CDA—California Department of Aging
D. CDA PM — Title III Program Manual for Area Agencies on Aging —This manual is based on Federal
Regulations for Title III published March 31, 1980 (CRF, Chapter 8, Subchapter C, Part 1321), and
pertinent parts of 45 CFR Subtitle A, Part 74, published June 3, 1980.
E. CFDA—Catalog of Federal Domestic Assistance
F. CFR—Code of Federal Regulations
G. Congregate Nutrition Services (C-1) — Meals provided in a congregate setting for older individuals in
an atmosphere that is pleasant and encourages socialization.
H. Contract — The cover sheet, terms and conditions, attachments, addendums, and amendments,
unless otherwise specified.
I. Contractor—The entity (Contractor/ProviderNendor) to which funds are awarded under this Contract
and which is accountable to DAAS for use of these funds and is responsible for executing its
provisions and services.
i
J. CRFC — California Retail Food Code (Section 113700 et seq., California Health and Safety Code),
replaces California Uniform Retail Food Facilities Law(CURFFL).
K. DAAS — Department of Aging and Adult Services, and the designated Area Agency on Aging in San
Bernardino County.
L. DHS—California State Department of Health Services
M. Disability — a condition attributable to mental or physical impairment, or a combination of mental and
physical impairments, that results in substantial functional limitations in one (1) or more of the
following areas of major life activity:
1. Self-care
2. Receptive and expressive language
3. Learning
4. Mobility
5. Self-direction
6. Capacity for independent living
7. Economic self-sufficiency
8. Cognitive functioning
9. Emotional adjustment
N. Elderly—Any individual who is sixty(60) years of age or older, also under"older individual."
O. Elderly Nutrition Program — a program which provides nutrition services, as authorized by the Older
Americans Act of 1965, as amended, and which shall be provided in accordance with the provisions
of this Article.
P. Equipment — Tangible personal property with a useful life of more than one year and an acquisition
cost of$5,000 or more per unit.
Q. Financial Statement — For non-Federal entities that expend less than $500,000 in a fiscal year in
Federal awards, a statement that reflects the contractor's financial position, results of operations or
changes in net assets, and, where appropriate, cash flows for the fiscal year audited.
R., General Program Income — Meal income received in the form of contributions or donations made by
the elderly for services rendered under this Contract.
Page 3 of 25
S. HACCP—Hazard Analysis Critical Control Point.
T. HACCP Plan — a written document that delineates the formal procedures for following the HACCP
principles that were developed by the National Advisory Committee on Microbiological Criteria for
Foods and complies with the requirements of Section 114055, Health and Safety Code.
U. HACCP Principles—the seven basic steps of HACCP which are:
1. The completion of hazard analysis identification by identifying the likely hazards to consumers
presented by a specific food.
2. The determination of critical control points in receiving, storage, preparation, display, and
dispensing of a food.
3. The setting of measurable critical limits for each critical control point determined.
4. Developing and maintaining monitoring practices to determine if critical limits are being met.
5. Developing and utilizing corrective action plans when failure to meet critical limits is detected.
6. Establishing and maintaining a recordkeeping system to verify adherence to a HACCP plan.
7. Establishing a system of audits to:
a. Initially verify the effectiveness of the critical limits set and appropriateness of the
determination of critical control points.
b. Periodically verify the effectiveness of the HACCP plan.
V. Home Delivered Nutrition Services (C-2)—meal provided to older individuals who are homebound.
W. HIS — Human Services —A system of integrated services, where the programs and resources of nine
County departments come together to provide a rich, more complete array of services to the citizens
of San Bernardino County under one coordinated effort.
X. MIS— Management Information System
Y. Nutrition Education — informing recipients of congregate and home-delivered meals about current
facts and information which will promote improved food selection, eating habits, nutrition, health
promotion, and disease prevention practices.
Z. Nutrition Services—the procurement, preparation, transport, and service of meals, nutrition education,
nutrition screening, and nutrition counseling, to eligible individuals at congregate sites or in their
homes.
AA. OAA — Older Americans Act — Provides comprehensive, coordinated, community-based systems of
services to the elderly to enable them to maintain health, personal dignity, and independence.
BB. Older Individual —A person sixty (60) years of age or older.
CC. OMB—Office of Management and Budget.
DD. Program Income — Revenue generated by the Contractor or subcontractor from contract-supported
activities. Program income is:
1. Voluntary contributions received from a participant or responsible party as a result of services.
2. Income from usage or rental fees of real or personal property acquired with grant funds or
funds provided under this Agreement.
3. Royalties received on patents and copyrights from contract-supported activities.
4. Proceeds from sale of items fabricated under a contract agreement.
EE. Provider — an entity providing nutrition services. The provider may either be an AAA providing
nutrition services directly with Department approval in accordance with subsection 7320(c) of Title 22,
or an entity under contract with an AAA to provide nutrition services in accordance with Section 7352
of Title 22.
FF. Registered Dietitian —a person who shall be both:
1. Qualified as specified in Sections 2585 and 2586, Business and Professions Code, and,
2. Registered by the Commission on Dietetic Registration.
GG. Reimbursable Item—Allowable cost and compensable item.
Page 4 of 25
HH. SEFA—Schedule of Expenditures of Federal Awards
II: Single Audit Entity — Non-Federal entities that expend $500,000 or more in a fiscal year in Federal
awards. Single Audit Entities must have a single or program-specific audit conducted for the year in
accordance with OMB Circular A-133.
JJ. State—State of California
KK. Title III —Title III of the Older Americans Act
LL. USC—United States Code
MM. USDA—United States Department of Agriculture
NN. Volunteer — an individual who provides services without pay, but may receive reimbursement for
expenses.
00. W& I —California Welfare and Institutions Code
II. CONTRACTOR SERVICE RESPONSIBILITIES
Contractor shall provide all services as outlined in Scope of Work (Attachment A).
III. CONTRACTOR GENERAL RESPONSIBILITIES
A. In the performance of this Contract, Contractor, its agents and employees, shall act in an
independent capacity and not as officers, employees, or agents of the County of San Bernardino.
Contractor certifies that neither it nor its principals is presently disbarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any
federal department or agency as required by Executive Order 12549 and implemented as 45 Code
of Federal Regulations part 76.
B. Without the prior written consent of the Assistant County Administrator for Human Services, this
Contract is not assignable by Contractor either in whole or in part. Contractor agrees not to enter into
any subcontracts for work contemplated under this Contract without first obtaining written approval
from the Assistant County Administrator— Human Services. Any subcontractor shall be subject to
the same provisions as Contractor. Contractor shall be fully responsible for the performance of any
subcontractor.
C. Contractor agrees to provide or has already provided information on former County of San
Bernardino administrative officials (as defined below) who are employed by or represent
Contractor. The information provided includes a list of former County administrative officials who
terminated County employment within the last five years and who are now officers, principals,
partners, associates or members of the business. The information also includes the employment
with or representation of Contractor. For purposes of this provision, "County administrative official"
is defined as a member of the Board of Supervisors or such officer's staff, County Administrative
Officer or member of such officer's staff, County department or group head, assistant department
or group head, or any employee in the Exempt Group, Management Unit or Safety Management
Unit.
D. If during the course of the administration of this Contract, the County determines that the
Contractor has made a material misstatement or misrepresentation or that materially inaccurate
information has been provided to the County, this Contract may be immediately terminated. If this
Contract is terminated according to this provision, the County is entitled to pursue any available
legal remedies.
E. Contractor shall maintain all records and books pertaining to the delivery of services under this
Contract and demonstrate accountability for contract performance.
Said records shall be kept and maintained within the County of San Bernardino or within
reasonable driving distance. County shall have the right upon reasonable notice and at reasonable
hours of business to examine and inspect such records and books.
Page 5 of 25
Records should include, but are not limited to, monthly summary sheets, sign-in sheets, and other
primary source documents. Fiscal records shall be kept in accordance with Generally Accepted
Accounting Principles and must account for all funds, tangible assets, revenue and expenditures.
Fiscal records must also comply with the appropriate Office of Management and Budget (OMB)
Circulars that state the administrative requirements, cost principles and other standards for
accountancy.
All records shall be complete and current and comply with all Contract requirements. Failure to
maintain acceptable records per the preceding requirements shall be considered grounds for
withholding of payments for billings submitted and for termination of the Contract.
F. Contractor shall notify County in writing of any change in mailing address and/or physical location
within ten (10) days of the change, and shall immediately notify County of changes in telephone or
fax numbers.
G. Contractor shall notify County of any continuing vacancies and any positions that become vacant
during the term of this Contract that will result in reduction of services to be provided under this
Contract. Upon notice of vacancies, the Contractor shall apprise County of the steps being taken to
provide the services and to fill the position as expeditiously as possible. All vacancies and associated
problems shall be reported to County on each periodically required report for the duration of said
vacancies and/or problems.
! H. Contractor shall designate an individual to serve as the primary point of contact for the Contract.
Contractor shall notify the County when the primary contact will be unavailable/out of the office for one
(1) or more workdays. Contractor or designee must respond to County inquiries within two (2) County
j business days.
I. Contractor shall provide a system, approved by the County, through which recipients of service shall
have the opportunity to express and have considered their views and complaints regarding the
delivery of services. The procedure (Attachment B) must be in writing and posted in clear view of all
recipients.
J. Contractor shall keep the County apprised of any and all actions taken by its Board of Directors which
may impact on the Contract. Further, a County representative shall have the option of attending Board
meetings during the term of this Contract.
L. Information Integrity and Security
1. Information Assets
The Contractor shall have in place operational policies, procedures, and practices to protect
State information assets, i.e., public, confidential, sensitive and/or personal information as
specified in State Administrative Manual, Section 4841.2., GC Section 11019, Department
of Finance (DOF) Management Memo 06-12, and DOF Budget Letter 06-34.
Information assets include (but are not limited to):
• Information collected and/or accessed in the administration of the State programs
and services.
• Information stored in any media form, paper or electronic.
2. Encryption on Portable Computing Devices
The Contractor is required to encrypt (or use an equally effective measure), any data
collected under this agreement that is confidential, sensitive, and/or personal including data
stored on portable computing devices (including but not limited to, laptops, personal digital
assistants, and notebook computers) and/or portable electronic storage media (including
but not limited to, discs and thumb/flash drives, portable hard drives).
Page 6 of 25
3. Disclosure
a. The Contractor shall ensure that personal, sensitive and confidential information is
protected from inappropriate or unauthorized access or disclosure in accordance
with applicable laws, regulations and State policies. The requirement to protect
information shall remain in force until superseded by laws, regulations or policies.
b. The Contractor shall protect from unauthorized disclosure names and other
identifying information, concerning persons receiving services pursuant to this
Agreement, except for statistical information not identifying any participant.
C. "Identifying information" shall include, but not be limited to, name, identifying
number, social security number, state driver's license or state identification number,
financial account numbers, symbol or other identifying characteristic assigned to the
individual, such as finger or voice print or a photograph.
d. The Contractor shall not use such identifying information for any purpose other than
carrying out the Contractor's obligations under this agreement.
e. The Contractor shall not, except as otherwise specifically authorized or required by
this agreement, release any identifying information obtained under the terms of this
agreement to anyone other than DAAS and/or CDA without prior written
authorization from DAAS or CDA, except by court. order. The Contractor may be
authorized, in writing, by a participant to disclose identifying information specific to
the authorizing participant.
f. The Contractor may allow a participant to authorize the release of information to
specific entities, but shall not request or encourage any participant to give a blanket
authorization or sign a blank release, nor shall the Contractor accept such blanket
authorization from any participant.
4. Training/Education
a. The Contractor must provide ongoing education and training, at least annually, to all
employees and subcontractors who handle personal, sensitive or confidential
information. Contractor employees, subcontractors, and volunteers must complete
the required Security Awareness Training module located at www.aging.ca.goy
within 30 days of the start date of the ContracUAgreement or within 30 days of the
start date of any new employee, subcontractor or volunteer. The Contractor must
maintain certificates of completion on file and provide them to DAAS upon request.
Training may be provided on an individual basis or in groups. A sign-in sheet is
acceptable documentation for group training in lieu of individual certificates. If
internet access is not available, a hardcopy of the training module may be provided
to employees and/or volunteers for their completion.
b. Contractor may substitute CDA's Security Awareness Training program with its own
Security Training provided such training meets or exceeds CDA's training
requirement. ContractorsNendors shall maintain documentation of training and
education provided to their staff, volunteers, and/or subcontractors.
C. All employees and volunteers who handle personal, sensitive or confidential
information relating to CDA's programs must participate in Security Awareness
Training.
5. Health Insurance Portability and Accountability Act (HIPAA)
The Contractor agrees to comply with the privacy and security requirements of the HIPAA to
the extent applicable and to take all reasonable efforts to implement HIPAA requirements.
Contractor will make reasonable efforts to ensure that subcontractors comply with the privacy
and security requirements of HIPAA.
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6. Contractor Confidentiality Statement
The Contractor shall sign and return a ContractorNendor Confidentiality Statement CDA
1024 form (Attachment C) with this Agreement. This is to ensure that Contractor/Vendors
are aware of, and agree to comply with, their obligations to protect CDA information assets
from unauthorized access and disclosure.
Contractor shall protect from unauthorized use or disclosure names and other identifying
information concerning persons receiving services pursuant to this Contract, except for
statistical information not identifying any participant. The Contractor shall not use or
disclose any identifying information for any other purpose other than carrying out the
Contractor's obligations under this Contract, except as may be otherwise required by law.
The provision will remain in force even after the termination of the Contract.
7. Security Incident Reporting
A security incident occurs when CDA information assets are accessed, modified, destroyed,
or disclosed without proper authorization, or are lost, or stolen. The Contractor must report
all security incidents to DAAS immediately upon detection. A Security Incident Report form
(CDA 1025) (Attachments D) must be submitted to DAAS within five (5) business days of
the date the incident was detected.
8. Notification of Security Breach to Data Subjects
a. Notice must be given by the Contractor or subcontractor to any data subject whose
personal information could have been breached.
b. Notice must be given in the most expedient time possible and without unreasonable
delay except when notification would impede a criminal investigation, or when
necessary measures to restore system integrity are required.
C. Notice may be provided in writing, electronically, or by substitute notice in
accordance with State law, regulation, or policy.
9. Software Maintenance
The Contractor shall apply security patches and upgrades and keep virus software up-to-date
on all systems on which data collected under this agreement that is confidential, sensitive
and/or personal may be used.
10. Provisions of this Article
The provisions contained in this Information Integrity and Security Paragraph shall be
included in all contracts of both the contractor and its subcontractors.
11. Contractor shall ensure that all staff, volunteers and/or subcontractors performing services
under this Contract comply with the terms and conditions as set forth in the Human Services
Information Privacy and Security Requirements prior to providing any services. Contractor
shall immediately notify the County of any suspected or actual breach of confidential
information as further detailed in the requirements. These requirements specified at
http://hss.sbcounty.gov/Privacy are hereby incorporated by this reference.
M. Elder and Dependent Adult Abuse Reporting
Contractor agrees to and shall comply with the County's Elder and Dependent Adult Abuse Reporting
requirements: Under the terms of this Contract, as changes in the Elder and Dependent Adult
Reporting Laws are enacted, the Contractor is bound to comply with the most current regulations.
Paqe 8 of 25
1. Who Must Report:
In accordance with W & I Code Section 15630, all employees of the Contractor and its
subcontractors are mandated reporters of elder and dependent adult abuse. Contractor
assures all employees, agents, consultants or volunteers who perform services under this
Contract and are mandated to report elder and dependent adult abuse will sign a statement
(SOC 341 A) http://www.dss.cahwnet.gov/Forms/English/SOC341.pdf, upon the
commencement of their employment, acknowledging their reporting requirements and their
compliance with them.
2. When To Report:
Mandated reporters are required to report all instances of known or suspected abuse of the
elderly and dependent adults immediately or as soon as practically possible, under the
following circumstances:
a. When the mandated reporter has observed or has knowledge of an incident that
reasonably appears to be physical abuse, abandonment, isolation, neglect, financial
abuse, mental abuse or sexual abuse; or
b. When the mandated reporter is told by an elder or dependent adult that he or she has
experienced behavior constituting physical abuse, abandonment, isolation, neglect,
financial abuse, mental abuse or sexual abuse.
3. To Whom To Report:
Incidents of elder and dependent adult abuse must be reported to the correct agency as
follows:
a. If the abuse has occurred in a long term care facility, except a state mental hospital
or state developmental center, the report shall be made to the local Long-Term Care
Ombudsman or local law enforcement;
b. If the abuse has occurred in a state mental hospital or state developmental center,
the report shall be made to the designated investigators of the State Department of
Mental Health or the State Department of Developmental Services or to the local law
enforcement;
C. If the abuse occurred anywhere other than a long-term care facility or State mental
hospital or State developmental center, the report shall be made to Adult Protective
Services or local law enforcement.
4. How To Report:
Mandated reporters are required to take the following steps in all instances of known or
suspected abuse of the elderly and dependent adults:
a. Place an immediate telephone call to Adult Protective services (1-877-565-2020) or
local law enforcement to report the incident.
b. Within two (2) working days of making the telephonic report to the responsible
agency, complete a written 'Report of Suspected Dependent Adult/Elder Abuse"
(SOC 341) form, http://www.dss.cahwnet.gov/Forms/English/SOC341.pd . The
completed form must be submitted to the same agency to which the incident was
reported by telephone.
N. Contractor shall ensure that all known or suspected instances of child abuse or neglect are reported
to the appropriate law enforcement agency or to the appropriate Child Protective Services agency.
This responsibility shall include:
1. Assurance that all employees, agents, consultants or volunteers who perform services
under this Contract and are mandated by Penal Code Sections 11164 et seq. to report child
Paae 9 of 25
I
abuse or neglect, sign a statement, upon the commencement of their employment,
acknowledging their reporting requirements and their compliance with them.
2. Development and implementation of procedures for employees, agents, consultants, or
volunteers who are not subject to the mandatory reporting laws for child abuse to report any
observed or suspected incidents of child abuse to a mandated reporting party, within the
program, who will ensure that the incident is reported to the appropriate agency.
3. Provision for or arrangement of training in child abuse reporting laws (Penal Code section
11164 et seq.) for all employees, agents, consultants, and volunteers, or verification that
such persons have received training in the law within thirty (30) days of
employment/volunteer activity.
O. Contractor shall obtain from the Department of Justice (DOJ) records of all convictions involving
any sex crimes, drug crimes, or crimes of violence of a person who is offered employment or
volunteers for all positions in which he or she would have contact with a minor, the aged, the blind,
the disabled or a domestic violence client, as provided for in Penal Code section 11105.3 prior to
providing any services. This includes licensed personnel who are not able to provide
documentation of prior DOJ clearance. A copy of a license from the State of California is sufficient
proof. The County must be immediately notified of any records showing a conviction. The County
may instruct Contractor to take action to deny/terminate employment or terminate internship and/or
volunteer services where the records show the person is unsuitable for employment, internship, or
volunteer services.
P. Contractor shall notify the County of any staff member, paid intern or volunteer who is knowingly or
negligently employed who has been convicted of any crime of violence or of any sexual crime.
Contractor shall investigate all incidents where an applicant, employee, intern or volunteer has
been arrested and/or convicted for any crime listed in Penal Code Section 11105.3 and shall notify
the County. In the County's discretion, the County may instruct Contractor to take action to either
deny/terminate employment or terminate internship and/or volunteer services where the
investigation shows that the underlying conduct renders the person unsuitable for employment,
internship, or volunteer services.
Contractor shall immediately notify the County concerning the arrest and/or conviction, for other
than minor traffic offenses, of any paid employee, agent, consultant, intern, or volunteer staff, when
such information becomes known to Contractor.
Q. Conflict of Interest
1. The Contractor shall prevent employees, consultants, or members of governing bodies from
using their positions for purposes including, but
not limited to, the selection of subcontractors, that are, or give the appearance of being,
motivated by a desire for private gain for themselves or others, such as family, business, or
other ties. In the event that the County determines that a conflict of interest exists, funds
may be disallowed by the County and such conflict may constitute grounds for termination
of the Agreement.
2. This provision shall not be construed to prohibit employment of persons with whom the
Contractors officers, agents, or employees have family, business, or other ties, so long as
the employment of such persons does not result in a conflict of interest (real or apparent) or
increased costs over those associated with the employment of any other equally qualified
applicant, and such persons have successfully competed for employment with the other
applicants on a merit basis.
R. Contractor agrees to and shall comply with the following indemnification and insurance requirements:
1. Indemnification — The Contractor agrees to indemnify, defend (with counsel reasonably
approved by County) and hold harmless the County and its authorized officers, employees,
agents and volunteers (Indemnitees) from any and all claims, actions, losses, damages,
and/or liability arising out of this contract from any cause whatsoever, including the acts,
Page 10 of 25
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errors or omissions of any person and for any costs or expenses incurred by the County on
account of any claim except where such indemnification is prohibited by law. This
indemnification provision shall apply regardless of the existence or degree of fault of
Indemnitees. The Contractor's indemnification obligation applies to the County's "active" as
well as "passive" negligence but does not apply to the County's "sole negligence" or "willful
misconduct"within the meaning of Civil Code Section 2782.
2. Additional Insured — All policies, except for the Workers' Compensation, Errors and
Omissions and Professional Liability policies, shall contain endorsements naming the
County and its officers, employees, agents and volunteers as additional insureds with
respect to liabilities arising out of the performance of services hereunder. The additional
insured endorsements shall not limit the scope of coverage for the County to vicarious
liability but shall allow coverage for the County to the full extent provided by the policy. Such
additional insured coverage shall be at least as broad as Additional Insured (Form B)
endorsement form ISO, CG 2010.11 85.
3. Waiver of Subrogation Rights — The Contractor shall require the carriers of required
coverages to waive all rights of subrogation against the County, its officers, employees,
agents, volunteers, contractors and subcontractors. All general or auto liability insurance
coverage provided shall not prohibit the Contractor and Contractor's employees or agents
from waiving the right of subrogation prior to a loss or claim. The Contractor hereby waives
all rights of subrogation against the County.
4. Policies Primary and Non-Contributory —All policies required herein are to be primary and
non-contributory with any insurance or self-insurance programs carried or administered by
the County.
5. Severability of Interests — The Contractor agrees to ensure that coverage provided to meet
these requirements is applicable separately to each insured and there will be no cross
liability exclusions that preclude coverage for suits between the Contractor and the County
or between the County and any other insured or additional insured under the policy.
6. Proof of Coverage — The Contractor shall furnish Certificates of Insurance to the County
Department administering the contract evidencing the insurance coverage, including
endorsements, as required, prior to the commencement of performance of services
hereunder, which certificates shall provide that such insurance shall not be terminated or
expire without thirty (30) days written notice to the Department, and Contractor shall
maintain such insurance from the time Contractor commences performance of services
hereunder until the completion of such services. Within fifteen (15) days of the
commencement of this contract, the Contractor shall furnish a copy of the Declaration page
for all applicable policies and will provide complete certified copies of the policies and
endorsements immediately upon request.
7. Acceptability of Insurance Carrier — Unless otherwise approved by Risk Management,
insurance shall be written by insurers authorized to do business in the State of California
and with a minimum "Best" Insurance Guide rating of"A-VII".
8. Deductibles and Self-Insured Retention - Any and all deductibles or self-insured retentions
in excess of$10,000 shall be declared to and approved by Risk Management.
9. Failure to Procure Coverage — In the event that any policy of insurance required under this
contract does not comply with the requirements, is not procured, or is canceled and not
replaced, the County has the right but not the obligation or duty to cancel the contract or
obtain insurance if it deems necessary and any premiums paid by the County will be
promptly reimbursed by the Contractor or County payments to the Contractor will be
reduced to pay for County purchased insurance.
10. Insurance Review — Insurance requirements are subject to periodic review by the County.
The Director of Risk Management or designee is authorized, but not required, to reduce,
waive or suspend any insurance requirements whenever Risk Management determines that
Page 11 of 25
any of the required insurance is not available, is unreasonably priced, or is not needed to
protect the interests of the County. In addition, if the Department of Risk Management
determines that heretofore unreasonably priced or unavailable types of insurance coverage
or coverage limits become reasonably priced or available, the Director of Risk Management
or designee is authorized, but not required, to change the above insurance requirements to
require additional types of insurance coverage or higher coverage limits, provided that any
such change is reasonable in light of past claims against the County, inflation, or any other
item reasonably related to the County's risk.
Any change requiring additional types of insurance coverage or higher coverage limits must
be made by amendment to this contract. Contractor agrees to execute any such
amendment within thirty (30) days of receipt.
Any failure, actual or alleged, on the part of the County to monitor or enforce compliance
with any of the insurance and indemnification requirements will not be deemed as a waiver
of any rights on the part of the County.
11. The Contractor agrees to provide insurance set forth in accordance with the requirements
herein. If the Contractor uses existing coverage to comply with these requirements and that
coverage does not meet the specified requirements, the Contractor agrees to amend,
supplement or endorse the existing coverage to do so. The type(s) of insurance required is
determined by the scope of the contract services.
Without in anyway affecting the indemnity herein provided and in addition thereto, the
Contractor shall secure and maintain throughout the contract term the following types of
insurance with limits as shown:
a. Workers' Compensation/Employers Liability—A program of Workers' Compensation
insurance or a state-approved, self-insurance program in an amount and form to
meet all applicable requirements of the Labor Code of the State of California,
including Employer's Liability with $250,000 limits covering all persons including
volunteers providing services on behalf of the Contractor and all risks to such
persons under this contract.
If Contractor has no employees, it may certify or warrant to the County that it does
not currently have any employees or individuals who are defined as "employees"
under the Labor Code and the requirement for Workers' Compensation coverage will
be waived by the County's Director of Risk Management.
With respect to Contractors that are non-profit corporations organized under
California or Federal law, volunteers for such entities are required to be covered by
Workers' Compensation insurance.
b. Commercial/General Liability Insurance —The Contractor shall carry General Liability
Insurance covering all operations performed by or on behalf of the Contractor
providing coverage for bodily injury and property damage with a combined single
limit of not less than one million dollars ($1,000,000), per occurrence. The policy
coverage shall include:
1) Premises operations and mobile equipment.
2) Products and completed operations.
3) Broad form property damage (including completed operations).
4) Explosion, collapse and underground hazards.
5) Personal injury
6) Contractual liability.
7) $2,000,000 general aggregate,limit.
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C. Automobile Liability Insurance.— Primary insurance coverage shall be written on ISO
Business Auto coverage form for all owned, hired and non-owned automobiles or
symbol 1 (any auto). The policy shall have a combined single limit of not less than
one million dollars ($1,000,000) for bodily injury and property damage, per
occurrence.
If the Contractor is transporting one or more non-employee passengers in
performance of contract services, the automobile liability policy shall have a
combined single limit of two million dollars ($2,000,000) for bodily injury and property
damage per occurrence.
If the Contractor owns no autos, a non-owned auto endorsement to the General
Liability policy described above is acceptable.
d. Umbrella Liability Insurance — An umbrella (over primary) or excess policy may be
used to comply with limits or other primary coverage requirements. When used, the
umbrella policy shall apply to bodily injury/property damage, personal
injury/advertising injury and shall include a "dropdown" provision providing primary
coverage for any liability not covered by the primary policy. The coverage shall also
apply to automobile liability.
e. Professional Liability — Professional Liability Insurance with limits of not less than
one million ($1,000,000) per claim or occurrence 'and two million ($2,000,000)
f aggregate limits
or
Errors and Omissions Liability Insurance with limits of not less than one million
($1,000,000) and two million ($2,000,000) aggregate limits
or
Directors and Officers Insurance coverage with limits of not less than one million
($1,000,000) shall be required for Contracts with charter labor committees or other
not-for-profit organizations advising or acting on behalf of the County.
If insurance coverage is provided on a "claims made" policy, the "retroactive date"
shall be shown and must be before the date of the start of the contract work. The
claims made insurance shall be maintained or "tail" coverage provided for a
minimum of five (5) years after contract completion.
S. Contractor shall comply with all applicable laws, statutes, ordinances, administrative orders, rules or
regulations relating to its duties, obligations and performance under the terms of the Contract and
shall procure all licenses and pay all fees and other charges required thereby. Contractor shall
maintain all required licenses during the term of this Contract. Failure to comply with the provisions of
this section may result in immediate termination of this Contract.
T. Contractor shall comply with all applicable local health and safety clearances, including fire
clearances, for each site where services are provided under the terms of this Contract.
U. Contractor agrees to and shall comply with the County's Equal Employment Opportunity Program
and Civil Rights Compliance requirements:
1. Equal Employment Opportunity Program: The Contractor agrees to comply with the
provisions of the Equal Employment Opportunity Program of the County of San Bernardino
and all rules and regulations adopted pursuant thereto: Executive Orders 11246, as
amended by Executive Order 11375, 11625, 12138, 12432, 12250; Title VII of the Civil
Rights Act of 1964, Division 21 of the California Department of Social Services Manual of
Policies and Procedures; California Welfare and Institutions Code section 10000, the
California Fair Employment and Housing Act; and other applicable federal, state, and county
laws, regulations and policies relating to equal employment or social services to welfare
recipients, including laws and regulations hereafter enacted.
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The Contractor shall not unlawfully discriminate against any employee, applicant for
employment, or service recipient on the basis of race, color, national origin or ancestry,
religion, gender, marital status, sexual orientation, age, political affiliation or disability.
Information on the above rules and regulations may be obtained from the County Human
Services Contracts Unit.
2. Civil Rights Compliance: The Contractor shall develop and maintain internal policies and
procedures to assure compliance with each factor outlined by state regulation. These
policies must be developed into a Civil Rights Plan, which is to be on file with the County
Human Services Contracts Unit within 30 days of awarding of the Contract. The Plan must
address prohibition of discriminatory practices, accessibility, language services, staff
development and training, dissemination of information, complaints of discrimination,
compliance review, and duties of the Civil Rights Liaison. Upon request, the County shall
supply a sample of the Plan format. The Contractor shall be monitored by the County for
compliance with provisions of its Civil Rights Plan. Contractor is required to submit
Assurance of Compliance statement (Attachment E) along with their agency's Civil Rights
Plan.
V. Contractor agrees to comply with all applicable provisions of the Americans with Disabilities Act
(ADA).
W. Contractor shall observe the mandatory standards and policies relating to energy efficiency in the
State Energy Conservation Plan (California Code of Regulations title 20, section 1401 et seq.).
X. If the amount available to Contractor under this Contract, as specified in Section IV, Paragraph A,
exceeds $100,000, Contractor agrees to comply with the Clean Air Act (42 U.S.C. Section 7606),
section 508 of the Clean Water Act (33 U.S.C. section 1368), Executive Order 11738 and
Environmental Protection Agency regulations (40 C.F.R. section 1.1 at seq.).
Y. Contractor shall use recycled and recyclable products, whenever practicable, in fulfilling the terms of
this Contract. Recycled printed products shall include a symbol identifying the recycled material.
Z. Contractor understands and agrees that any and all legal fees or costs associated with lawsuits
concerning this Contract against the County shall be the Contractor's sole expense and shall not be
charged as a cost under this Contract. In the event of any Contract dispute hereunder, each Party
to this Contract shall bear its own attorney's fees and costs regardless of who prevails in the
outcome of the dispute.
AA. Contractor shall report immediately to the County in writing any incidents or alleged fraud and/or
abuse by either Contractor or Contractor's subcontract(s). Contractor shall maintain any records,
documents, or other evidence of fraud and abuse until otherwise notified by the County.
1313. The Contractor, by signing this Contract, hereby certifies to the best of his or her knowledge and
j belief, that:
{ 1. No federal appropriated funds have been paid or will be paid, by or on behalf of the
Contractor, to 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 the awarding of any federal contract, the making
of any federal grant, the making of any federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment, or modification of any
federal contract, grant, loan, 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, 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, loan or cooperative agreement, the
Contractor shall complete and submit Standard Form-LLL, "Disclosure of Lobbying
Activities" form (Attachment F), in accordance with its instructions.
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3. The Contractor shall require that the language of this certification be included in any
subcontracts at all tiers, and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when
this transaction was made or entered into. 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.
CC. Contractor shall complete and submit Information Sheet (Attachment G) in accordance with its
instructions.
DD. Per DAAS contract with CDA, Article II.A.(27), Community Focal Points (Attachment H) provides
Contractors with additional resources for their customers.
EE. Contractor agrees to and shall comply with the following American Recovery and Reinvestment Act
funding requirements:
1. Use of ARRA Funds and Requirements: This Contract may be funded in whole or in part
with funds provided by the American Recovery and Reinvestment Act of 2009 ("ARRA"),
signed into law on February 17, 2009. Section 1605 of ARRA prohibits the use of recovery
funds for a project for the construction, alteration, maintenance or repair of a public building
or public work (both as defined in 2 CFR 176.140) unless all of the iron, steel and
manufactured goods (as defined in 2 CFR 176.140) used in the project are produced in the
United States. A waiver is available under three limited circumstances: (i) Iron, steel or
relevant manufactured goods are not produced in the United States in sufficient and
reasonable quantities and of a satisfactory quality; (ii) Inclusion of iron, steel or
manufactured goods produced in the United States will increase the cost of the overall
project by more than 25 percent; or (iii) Applying the domestic preference would be
inconsistent with the public interest. This is referred to as the "Buy American" requirement.
Request for a waiver must be made to the County for an appropriate determination.
Section 1606 of ARRA requires that laborers and mechanics employed by contractors and
subcontractors on projects funded directly by or assisted in whole or in part by and through
the Federal Government pursuant to ARRA shall be paid wages at rates not less than those
prevailing on projects of a character similar in the locality as determined by the Secretary of
Labor in accordance with the Davis-Bacon Act (40 U.S.C. 31). This is referred to as the
"wage rate" requirement.
The above described provisions constitute notice under ARRA of the Buy American and
wage rate requirements. Contractor must contact the County contact if it has any questions
regarding the applicability or implementation of the ARRA Buy American and wage rate
requirements. Contractor will also be required to provide detailed information regarding
compliance with the Buy American requirements, expenditure of funds and wages paid to
employees so that the County may fulfill any reporting requirements it has under ARRA.
The information may be required as frequently as monthly or quarterly. Contractor agrees
to fully cooperate in providing information or documents as requested by the County
pursuant to this provision. Failure to do so will be deemed a default and may result in the
withholding of payments and termination of this Contract.
Contractor may also be required to register in the Central Contractor Registration (CCR)
database at http://www.ccr.gov and may be required to have its subcontractors also register
in the same database. Contractor must contact the County with any questions regarding
registration requirements.
2. Schedule of Expenditure of Federal Awards: In addition to the requirements described in
"Use of ARRA Funds and Requirements," proper accounting and reporting of ARRA
expenditures in single audits is required. Contractor agrees to separately identify the
expenditures for each grant award funded under ARRA on the Schedule of Expenditures of
Federal Awards (SEFA) and the Data Collection Form (SF-SAC) required by the Office of
Paqe 15 of 25
Management and Budget Circular A-133, "Audits of States, Local Governments, and
Nonprofit Organizations." This identification on the SEFA and SF-SAC shall include the
Federal award number, the Catalog of Federal Domestic Assistance (CFDA) number, and
amount such that separate accountability and disclosure is provided for ARRA funds by
Federal award number consistent with the recipient reports required by ARRA Section 1512
(c).
In addition, Contractor agrees to separately identify to each subcontractor and document at
the time of sub-contract and at the time of disbursement of funds, the Federal award
number, any special CFDA number assigned for ARRA purposes, and amount of ARRA
funds.
Contractor may be required to provide detailed information regarding expenditures so that
the County may fulfill any reporting requirements under ARRA described in this section.
The information may be required as frequently as monthly or quarterly. Contractor agrees
to fully cooperate in providing information or documents as requested by the County
pursuant to this provision. Failure to do so will be deemed a default and may result in the
withholding of payments and termination of this Contract.
3. Contractor agree that both it and its subcontractors shall comply with Section 1553 of the
Whistleblower Protection Act-ARRA, which prohibits all non-federal Contractors, including
the State, and all contractors of the State, from discharging, demoting or otherwise
discriminating against an employee for disclosures by the employee that the employee
reasonably believes are evidence of (1) gross mismanagement of a contract relating to
ARRA funds; (2) a gross waste of ARRA funds; (3) a substantial and specific danger to
public health or safety related to the implementation or use of ARRA funds; or (4) a violation
of law, rule, or regulation related to an agency contract (including the competition for or
negotiation of a contract) awarded or issued related to ARRA funds. Contractor agrees that
it and its subcontractors shall post notice of the rights and remedies available to employees
under Section 1553 of the Title XV of Division A of the ARRA.
4 Contractor agrees both it and its subcontractors shall comply with Section 106 (g) of the
Trafficking Victims Protection Act of 2000, as amended (22 U.S.C. 7104).
IV. COUNTY RESPONSIBILITIES
A. The County shall monitor and evaluate the performance of the Contractor in meeting the terms of
the Contract and the quality and effectiveness of services provided based on the criteria as
determined by the County.
B. The County shall provide consultation and technical assistance in monitoring the terms of this
Contract.
C. The County shall compensate the Contractor for approved expenses in accordance with Section V
of this Contract.
V. FISCAL PROVISIONS
A. The maximum amount of funds available for payment under this Contract shall not exceed
$176,960, of which $163,359 may be federally funded, and shall be subject to availability of funds
to the County. The consideration to be paid to Contractor shall be in full payment for all
Contractor's services and expenses incurred in the performance hereof, including travel and per
diem.
B. Contractor shall be compensated on a fee-for-service basis based on the following rate, as
specified in Scope of Work (Attachment A):
Congregate Site: $5.53 per meal, up to 32,000 meals
C. The County shall not approve any request for payment of funds until Contractor has properly filed
completed reports as required under this Contract. If Contractor is not in compliance with any
Page 16 of 25
provision of this Contract, DAAS may withhold payment of any invoice submitted to DAAS by
Contractor until such time as suitable documentation is submitted to DAAS and/or Contractor is
deemed to be in compliance by DAAS.
D. Reports
1. Contractor, at such times and in such forms as DAAS may require, shall furnish statements,
records, reports, data, and information requested by DAAS pertaining to the Contractor's
performance of services hereunder and other matters covered by this Contract. The forms
shall be reviewed for timeliness, completeness, and correctness of the information
submitted, by the Program Director or his/her designee, prior to submission to DAAS.
Incomplete forms shall be returned to the Contractor for completion. (In the event of
changes in these forms, DAAS shall advise the Contractor via written notice.) The
Contractor shall develop and implement a process for ensuring quality control.
2. Contractor shall meet the following standards for the submission of required financial
reports:
a. Accurate, current and complete disclosure of the financial results of the program
shall be made in accordance with the financial reporting requirements of this
Contract. The following reports are to be submitted to DAAS when indicated:
1) Monthly
• Monthly Nutrition Program Request for Reimbursement form
(Attachment 1) — Due to DAAS Administration by the 5th working day
of the month following the month of service to the address stated
below:
DAAS Administration
Attention: Nutrition Program Fiscal Clerk
686 East Mill Street
San Bernardino, CA 92415-0515
2) Quarterly
• Nutrition Program Contractor Quarterly Expenditure Report
(Attachment J) — Due to DAAS Administration by the 5th calendar day
of October, January, March, and June for the previous quarter of
services to the address stated in the above paragraph.
• Quarterly reports shall be based on the Budget Summary
(Attachment K).
3) Annually — The following reports are due on an annual basis no later than
August 1:
Financial Close-out Report
• Periodic Inventory Report
• Single Audit or Financial Statement
• Schedule of Expenditures of Federal Awards (SEFA)
E. Upon written demonstration of need by Contractor and at the option of County, up to 10 % of the
Title III funds may be advanced to Contractor by County upon the approval of the Director of DAAS.
Any such advance shall cause the amounts payable to Contractor in subsequent months to be
reduced to the amount determined by dividing the balance left by the number of months remaining
in the Contract term. No advance will increase the amount shown in Section V, Paragraph A.
F. If, as a result of advanced income, the project earns interest on funds awarded by DAAS, that
interest shall be identified as income to the program and used for program expenditures, with full
documentation on file.
G. Contractor shall expend all funds received hereunder in accordance with this Contract.
Page 17 of 25
H. DAAS reserves the right to refuse payment to the Contractor or later disallow costs for any
expenditure determined by DAAS and/or CDA not to be in compliance with this Contract, or
inappropriate to such activities, or for which there is inadequate supporting documentation
presented, or for which prior approval is required but not granted.
I. Contractor shall return to DAAS, immediately upon written demand, any funds provided under the
Contract which are not payable for goods or services delivered prior to the termination,
cancellation, or expiration of this Contract, or the dissolution of the entity.
J. Contractor must return any unspent funds with submittal of the final invoice.
K. Contractor shall maintain accounting records to account for the funds received under the terms and
conditions of this Contract separate from any other funds administered by the Contractor.
Contractor shall maintain records in accordance with generally accepted accounting principles.
L. General program income shall be used to increase the number of elderly served by a project, to
facilitate access to such meals, and to provide supportive services directly related to nutrition as
defined in the Work Plan/Scope of Work (Attachment A). General program income shall be used
within the program in which it was earned.
M. Matching contributions
1. The Contractor shall provide in-kind matching contributions of a minimum of$17,604, which
is the Title III portion of the Contract multiplied by 11.11%.
2. Allowable match shall be in compliance with the following requirements:
3. Matching in-kind contributions must be for allowable costs as determined by CDA PM.
Allowable costs include but are not limited to rent, utilities, supplies, and volunteers.
4. To qualify as a matching in-kind contribution, indirect or Contractor allocated overhead
expenses must be supported by a documented cost allocation plan.
5. Matching in-kind contributions in excess of the minimum required in one service component
may be used to match another service component within the Older Americans Act. As an
example, match exceeding the minimum requirement in a transportation program may be
used to offset an under match in in-home supportive services.
6. Contractor shall provide by August 1, 2010 at Budget In-Kind Narrative statement
(Attachment L) to DAAS identifying the type, rates applied and, if applicable, source/location
of in-kind to be used as match for the period of the Contract. The identified in-kind match
shall be reported monthly on the monthly expense reports.
a. Services of volunteers shall be valued at rates consistent with those ordinarily paid
for similar work by the Contractor. If the Contractor does not have similar work, the
rate shall be consistent with those in the labor market. In either case, a reasonable
amount of employee benefits may be included.
b. All other in-kind contributions shall be valued at current market value.
7. Costs incurred by the Contractor or subcontractor must be verifiable from the records of the
Contractor or subcontractor.
8. Non-Matching Contributions are local funding that does not qualify as matching
contributions and/or is not being budgeted as matching contributions (e.g., Title V,
overmatch, etc.).
N. The County shall pay Contractor for the authorized services of the previous month. Under normal
conditions, Contractor shall expect payment approximately 30 days after submission of a correctly
prepared invoice.
O. Contractor shall accept all payments from County via electronic funds transfer (EFT) directly
deposited into the Contractor's designated checking or other bank account. Contractor shall
Page 18 of 25
promptly comply with directions and accurately complete forms provided by County required to
process EFT payments.
P. Costs for services under the terms of this Contract shall be incurred during the contract period
except as approved by County. Contractor shall not use current year funds to pay prior or future
year obligations.
Q. Funds made available under this Contract shall not supplant any federal, state or any governmental
funds intended for services of the same nature as this Contract. Contractor shall not claim
reimbursement or payment from County for, or apply sums received from County with respect to
that portion of its obligations that have been paid by another source of revenue. Contractor agrees
that it will not use funds received pursuant to this Contract, either directly or indirectly, as a
contribution or compensation for purposes of obtaining funds from another revenue source without
prior written approval of the County.
R. County is not liable for the payment of any taxes, other than applicable sales or use tax, resulting
from this Contract however designated, levied or imposed, unless County would otherwise be liable
for the payment of such taxes in the course of its normal business operations.
S. The Contractor shall request a budget amendment, in writing, submitted to the Director of DAAS, in
advance of expenditures: 1) when aggregate expenditures are expected to exceed an approved
budgeted line item by more than fifteen (15%) percent; or 2) to add a new budget line item. No
budget revision may result in an increase of the maximum dollar amount stated in Paragraph A, of
this Section. The written request must specify the changes requested, by line item and amount,
and must include justification. Prior to implementation of a budget revision, the County shall
approve (or deny) the budget revision request. The County has the authority to approve line item
budget changes to the budget herein, as long as these changes do not exceed the total contract
amount. County shall notify the Contractor in writing of the status of the budget revision request
within fourteen (14) calendar days of receipt of the Contractor's written request. The County
reserves the right to deny the Contractor's invoice for expenditures in excess of the approved
budgeted line item amount.
VI. RIGHT TO MONITOR AND AUDIT
A. County shall have the absolute right to monitor the performance of Contractor in the delivery of
services provided under this Contract.
B. County or any subdivision or appointee thereof, and the State of California or any subdivision or
appointee thereof, including the Auditor General, shall have absolute right to review and audit all
records, books, papers, documents, corporate minutes, and other pertinent items as requested,
and shall have absolute right to monitor the performance of Contractor in the delivery of services
provided under this Contract. Full cooperation shall be given by Contractor in any auditing or
monitoring conducted.
C. Contractor shall cooperate with County in the implementation, monitoring and evaluation of this
Contract and comply with any and all reporting requirements established by this Contract.
D. All records pertaining to service delivery and all fiscal, statistical and management books and records
shall be available for examination and audit by county, federal and state representatives for a period
of three years after final payment under the Contract or until all pending county, state, and federal
audits are completed, whichever is later. Records of the Contractor which do not pertain to the
services under this Contract may be subject to review or audit unless provided in this or another
Contract. Technical program data shall be retained locally and made available upon the County's
reasonable advance written notice or turned over to County. If said records are not made available at
the scheduled monitoring visit, Contractor may, at County's option, be required to reimburse County
for expenses incurred due to required rescheduling of monitoring visit(s). Such reimbursement will
not exceed $50 per hour (including travel time) and be deducted from the following month's claim for
reimbursement.
Page 19 of 25
E. Contractor shall provide all reasonable facilities and assistance for the safety and convenience of
County's 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 of the Contractor.
F. Upon County request, Contractor shall hire a licensed Certified Public Accountant, approved by the
County, who shall prepare and file with County, within 60 days after the termination of the Contract,
a certified fiscal audit of related expenditures during the term of the Contract and a program
compliance audit.
G. Pursuant to OMB Circular A-133, Contractors expending $500,000 or more in federal funds within
the Contractor's fiscal year must have a single audit or program-specific audit performed. A copy
of the audit performed in accordance with OMB Circular A-133 shall be submitted to the County
within thirty (30) days of completion, but no later than nine months following the end of the
Contractor's fiscal year.
VII. CORRECTION OF PERFORMANCE DEFICIENCIES
A. Failure by Contractor to comply with any of the provisions, covenants, requirements or conditions of
this Contract shall be a material breach of this Contract.
B. In the event of a non-cured breach, County may, at its sole discretion and in addition to any other
remedies available at law, in equity, or otherwise specified in this Contract:
1. Afford Contractor thereafter a time period within which to cure the breach, which period shall
be established at sole discretion of County; and/or
2. Discontinue reimbursement to Contractor for and during the period in which Contractor is in
breach, which reimbursement shall not be entitled to later recovery; and/or
3. Withhold funds pending duration of the breach; and/or
4. Offset against any monies billed by Contractor but yet unpaid by County those monies
disallowed pursuant to Item "2"of this paragraph; and/or
5. Terminate this Contract immediately and be relieved of the payment of any consideration to
Contractor. In event of such termination, the County may proceed with the work in any
manner deemed proper by the County. The cost to the County shall be deducted from any
sum due to the Contractor under this Contract and the balance, if any, shall be paid by the
Contractor upon demand.
C. Appeal Procedures
If Contractor disagrees with any decision or action taken by the County or DAAS related to this
Contract, Contractor may choose to file a formal grievance by following the procedures below:
1. The Contractor shall file a formal written grievance with the DAAS Deputy Director of
Administrative Services ("DAAS Deputy Director") within fifteen (15) business days after the
Contractor is aware of the factors or conditions precipitating the contract dispute. The written
grievance shall set forth the subject of the grievance, identify the specific clause in dispute and
shall provide a detailed statement of the grievance, including dates, names, places, and the
specific remedy or action requested. The filing address is 686 East Mill Street, San
Bernardino, California, 92415-0640. The DAAS Deputy Director shall provide a written
response to Contractor within fifteen (15) business days of receipt of the grievance.
2. If Contractor is not satisfied with the DAAS Deputy Director's response, Contractor may file a
written grievance appeal, which shall include a statement by the Contractor as to why the
DAAS Deputy Director's response is not satisfactory, to the Director of DAAS within fifteen
(15) business days of receipt of the DAAS Deputy Director's response. The filing address is
686 East Mill Street, San Bernardino, California, 92415-0640. The Director of DAAS shall
provide a written response to Contractor within fifteen (15) business days. The Director of
DAAS shall have final authority for the decision on the grievance except as provided below.
Paae 20 of 25
3. If Contractor is not satisfied with the DAAS Director's response, Contractor may file a written
grievance appeal, which shall include a statement by the Contractor as to why the DAAS
Directors response is not satisfactory, to the Assistant County Administrator (ACA) of the
Human Services within fifteen (15) business days of receipt of the DAAS Director's response.
The filing address is 385 North Arrowhead Avenue, Fifth Floor, San Bernardino, California,
92415-0128. The Assistant County Administrator shall provide a written response to
Contractor within fifteen (15) business days. The Assistant County Administrator shall have
final authority for the decision on the grievance except as provided below.
4. For those appeals which involve CDA programmatic policies and directives issued to the
County and contained within this Contract, the following applies. If Contractor is not satisfied
with the ACA's decision, the written grievance may be registered in writing with the CDA, Case
Management Branch, 1300 National Drive, Suite 200, Sacramento, California, 95834, within
fifteen (15) business days following receipt of the Director of DAAS' decision. Contractor shall
submit to CDA the original written grievance along with a copy of the DAAS Deputy Director's
written response, the Contractor's appeal to the Director of DAAS, the Director of DAAS'
decision, the Contractors appeal to the Assistant County Administrator, and the Assistant
County Administrators' decision. CDA shall have final authority for the decision on the
grievance
VIII. TERM
This Contract is effective as of July 1, 2010 and expires June 30, 2011 but may be terminated earlier in
accordance with provisions of Section IX of the Contract. The Contract term may be extended for two
additional one-year periods by mutual agreement of the parties.
IX. EARLY TERMINATION
A. The County may terminate the Contract immediately in the event that funds are not available to the
County pursuant to Section V, Paragraph A of this contract and/or under the provisions of Section VII,
Paragraph B, Item 5 of the Contract. In addition, the Contract may be terminated without cause by
the County by serving a written notice to the Contractor thirty (30) days in advance of termination.
The Director of DAAS is authorized to exercise the County's rights with respect to any termination of
this Contract.
B. Contractor shall only be reimbursed for costs and uncancelable obligations incurred prior to the date
of termination. Contractor shall not be reimbursed for costs incurred after the date of termination.
X. GENERAL PROVISIONS
A. When notices are required to be given pursuant to this Contract, the notices shall be in writing and
mailed to the following respective addresses listed below.
Contractor: City of San Bernardino
300 North D Street
San Bernardino, CA 92418
County: County of San Bernardino
Human Services
Attn: Contracts Unit
150 S. Lena Road
San Bernardino, CA 92415-0515
B. Nothing contained in this Contract shall be construed as creating a joint venture, partnership or
employment arrangement between the Parties hereto, nor shall either Party have the right, power
or authority to create an obligation or duty, expressed or implied, on behalf of the other Party
hereto.
C. Contractor shall not offer (either directly or through an intermediary) any improper consideration
such as, but not limited to, cash, discounts, service, the provision of travel or entertainment, or any
Paae 21 of 25
i
items of value to any officer, employee or agent of the County in an attempt to secure favorable
treatment regarding this Contract.
The County, by written notice, may immediately terminate any Contract if it determines that any
improper consideration as described in the preceding paragraph was offered to any officer, employee
or agent of the County with respect to the proposal and award process. This prohibition shall apply to
any amendment, extension or evaluation process once a Contract has been awarded.
Contractor shall immediately report any attempt by a County officer, employee or agent to solicit
(either directly or through an intermediary) improper consideration from Contractor. The report
shall be made to the supervisor or manager charged with supervision of the employee or to the
County Administrative Office. In the event of a termination under this provision, the County is
entitled to pursue any available legal remedies.
D. Property
1. Unless otherwise provided for in this Section, property refers to all assets, capitalized or non-
capitalized, used in operation of this Contract.
a. Property includes land, buildings, improvements, machinery, vehicles, furniture,
tools, and intangibles, etc.
b. Property does not include consumable office supplies such as paper, pencils, typing
ribbons, file folders, etc.
2. Property meeting all of the following criteria is subject to the capitalization requirements.
Subject property must:
a. Have a normal useful life of at least 1 year;
b. Have a unit acquisition cost of at least $5000 (e.g., four identical assets which cost
$3000 each, for a$12,000 total would not meet this capitalization requirement), and
C. Be used to conduct business under this Contract.
3. Non-capitalized properties are those items that do not meet all three requirements in Section
X, Paragraph D, Item 2, above.
4. Additions, improvements, and betterments to assets meeting all of the conditions in Section X,
Paragraph D, Item 2 above must be capitalized. Additions typically involve physical
extensions of existing units. Improvements and betterments typically do not increase the
physical size of the asset. Instead, improvements and betterments enhance the condition of
an asset (e.g., extend life, increase service capacity, and lower operating costs). Examples of
assets that might be improved and bettered include roads, bridges, curbs and gutters, tunnels,
parking lots, streets and sidewalks, drainage, and lighting systems.
5. Intangibles are property which lack physical substance but give valuable rights to the owner
and can be capitalized or non-capitalized. Examples of intangible property include patents,
copyrights, leases, and computer software. By contrast, hardware consists of tangible
equipment (e.g., computer printer, terminal, etc.).
Costs include all amounts incurred to acquire and to ready the intangible asset for its intended
use. Typical intangible property costs include the purchase price, legal fees, and other costs
incurred to obtain title to the asset.
6. The Contractor shall record the following information when property is acquired:
a. Date acquired;
b. Property description (include model number);
C. Property identification number(serial number);
d. Location of property;
e. Cost or other basis of valuation;
Page 22 cf 25
I
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f. Fund source; and
g. Rate of depreciation (or depreciation schedule), if applicable.
The Contractor shall keep track of property purchased with Contract funds, whether
capitalized or not. The Contractor shall maintain and submit to DAAS annually with the
closeout, a current inventory of property furnished or purchased by either the Contractor or
the subcontractor with funds awarded under the terms of this Contract or any predecessor
contracts for the same purpose. The Contractor shall use the Report of Project Property
Furnished/Purchased with Agreement Funds (CDA 32), unless otherwise directed by DAAS.
7. Prior to disposal of any property purchased by the Contractor or the subcontractor with funds
from this Contract, the Contractor must obtain approval from DAAS regardless of the
acquisition value. Disposition, which includes sale, trade-in, discarding, or transfer to another
agency may not occur until approval is received from the Department. The Contractor shall
use the Request to Dispose of Property (CDA 248) to dispose of property.
8. The Contractor shall immediately investigate, and within five (5) days fully document the loss,
destruction, or theft of such property.
9. DAAS reserves title to all DAAS-purchased or financed property not fully consumed in the
performance of this Contract, unless otherwise required by federal law or regulations or as
otherwise agreed by the parties.
10. Contractor shall exercise due care in the use, maintenance, protection, and preservation of
such property during the period of the project, and shall assume responsibility for replacement
or repair of such property during the period of the project, until the Contractor has complied
with all written instructions from DAAS regarding the final disposition of the property.
11. In the event of the Contractor's dissolution or upon termination of this Contract, the Contractor
shall provide a final property inventory to DAAS. DAAS reserves the right to require the
Contractor to transfer such property to another entity, or to DAAS.
12. To exercise the above right, no later than 120 days after termination of the Contract or
notification of the Contractor's dissolution, DAAS will issue specific written disposition
instructions to the Contractor.
13. The Contractor shall use the property for the purpose for which it was intended under the
Contract. When no longer needed for that use, the Contractor shall use it, if needed, and with
written approval of DAAS for other purposes in the following order:
a. Another DAAS program providing the same or similar service; or
b. Another DAAS -funded program.
14. Contractor may share use of the property and equipment or allow use by other programs,
upon written approval of the Director of DAAS. As a condition of the approval, DAAS may
require reimbursement under this Contract for its use.
15. The Contractor or subcontractor shall not use equipment or supplies acquired under this
Contract with federal and/or State monies for personal gain or to usurp the competitive
advantage of a privately owned business entity.
16. If purchase of equipment is a reimbursable item, the equipment to be purchased will be
specified in the budget.
17. All equipment purchases of $500.00 or more require the written approval of the Director of
DAAS or his/her designee prior to purchase.
E. The state and County shall have all ownership rights in software or modifications thereof and
associated documentation designed, developed or installed with Federal financial participation. The
Federal Government (Department of Health and Human Services) reserves a royalty-free,
nonexclusive, and irrevocable license to reproduce, publish or otherwise use and to authorize others
to use for Federal Government purposes, such software modification, and documentation.
Paae 23 of 25
Proprietary software packages that are sold or leased to the general public are not subject to the
ownership provisions.
F. County shall have Power of Attorney to pay delinquent debts and unpaid wages for work provided
under this Contract from accounts payable to Contractor in the event debts and wages have not been
paid on a current basis.
G. No waiver of any of the provisions of the Contract shall be effective unless it is made in a writing
which refers to provisions so waived and which is executed by the Parties. No course of dealing
and no delay or failure of a Party in exercising any right under the Contract shall affect any other or
future exercise of that right or any exercise of any other right. A Party shall not be precluded from
exercising a right by its having partially exercised that right or its having previously abandoned or
discontinued steps to enforce that right.
H. Any alterations, variations, modifications, or waivers of provisions of the Contract, unless
specifically allowed in the Contract, shall be valid only when they have been reduced to writing, duly
signed and approved by the Authorized Representatives of both parties as an amendment to this
Contract. No oral understanding or agreement not incorporated herein shall be binding on any of
the Parties hereto.
I. If any provision of the Contract is held by a court of competent jurisdiction to be unenforceable or
contrary to law, it shall be modified where practicable to the extent necessary so as to be enforceable
(giving effect to the intention of the Parties) and the remaining provisions of the Contract shall not be
affected.
J. This Contract shall be governed by and construed in all aspects in accordance with the laws of the
State of California without regard to principles of conflicts of laws. The Parties agree to the exclusive
jurisdiction of the federal court located in the County of Riverside and the state court located in the
County of San Bernardino, for any and all disputes arising under this Contract, to the exclusion of all
other federal and state courts.
Paae 24 of 25
City of San Bernardino
Exhibit A 2010-109
XI. CONCLUSION
A. This Contract, consisting of twenty-five (25) pages and Attachments A through L, is the full and
complete document describing services to be rendered by Contractor to County including all
covenants, conditions and benefits.
B. The signatures of the Parties affixed to this Contract affirm that they are duly authorized to commit
and bind their respective institutions to the terms and conditions set forth in this document.
C. IN WITNESS WHEREOF, the Board of Supervisors of the County of San Bernardino has caused
this Contract to be subscribed to by the Clerk thereof, and Contractor has caused this Contract to
be subscribed in its behalf by its duly authorized officers, the day, month and year written.
i
i
E
COUNTY OF SAN BERNARDINO City of San Bernardino
(Print or r name f corporeti ,comps y contractor, etc.)
By � ��
Gary Ovitt, Chairman, Board of Supervisors Autno zed signet re-si blue ink)
Dated Name -46#-R seri-- C Lh2L /le+V�ld�
(Print or type name of person signing contract) 1
SIGNED AND CERTIFIED THAT A COPY OF THIS
DOCUMENT HAS BEEN DELIVERED TO THE Title
CHAIRMAN OF THE BOARD (Print or Type)
Laura Welch /,
Clerk of the Board of Supervisors Dated °r /7 iy
of the County of San Bernardino.
By Address 300 North D Street
Deputy
San Bernardino, CA 92418
Approved as to Legal form Reviewed by Contract Compliance Presented to BOS for Signature
0. 11�
Jacqueline Carey-Wilson,Deputy County Counsel Lory Klopfer, HS Contracts Unit Collen Krygier,Director
Date Dale Date
Page 25 of 25
ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
This Scope of Work contains the measurable objectives mandated by the Department of Aging and Adult
Services (DAAS) and the California Department of Aging (CDA) required of the Elderly Nutrition Program
(ENP) Provider. The Scope of Work specifies and establishes monthly, quarterly, and annual time frames
and constitutes the primary document for on-going monitoring and annual Program and Fiscal monitoring.
It will be used to measure the Provider's efforts towards providing quality nutrition services.
Contractor: City of San Bernardino
Service Area: San Bernardino and Surrounding Areas
s
I. Program Description:
A. Purpose — The purpose of the ENP is to provide nutrition services as described in the Older
Americans Act (OAA) of 1965, as amended, and to assist older individuals in California to live
independently, by promoting better health through improved nutrition, and reduced isolation
through programs coordinated with nutrition-related supportive services.
B. Definition — Nutrition Services means the procurement, preparation, transport, and service of
meals, nutrition education, nutrition screening, and nutrition counseling, to eligible individuals at
congregate sites or in their homes.
C. Goals — to maintain or improve the physical, psychological, and social well being of older
individuals, by providing or securing appropriate nutrition services.
D. Objectives:
1. Give preference to older individuals in greatest economic or social need with particular
attention to low-income minority individuals.
2. Serve meals that provide one-third (1/3) of the Recommended Dietary Allowances (RDA's)
and are safe and of good quality.
3. Promote and maintain high food safety and sanitation standards.
4. Promote good health behaviors through nutrition education and nutrition screening of
participants.
5. Promote or maintain coordination with other nutrition-related supportive services for older
individuals.
E. Target Population — The ENP Provider shall target individuals who are sixty (60) years of age
or older, minorities, low income and living in rural areas of the County of San Bernardino.
II. Eligibility for Nutrition Services:
A. Congregate Meals—Individuals eligible to receive a meal at a congregate nutrition site are-
1. Any older individual.
2. The spouse of any older individual.
3. A person with a disability, under age sixty (60) who resides in housing facilities occupied
primarily by older individuals at which congregate nutrition services are provided.
4. A disabled individual who resides at home with and accompanies an older individual who
participates in the program.
B. Volunteer Meals:
1. A volunteer under age sixty (60) may be offered a meal if doing so will not deprive an older
individual of a meal.
C. Home-Delivered Meals—Individuals eligible to receive a home-delivered meal are:
1. Any older individual who is frail, as defined below, and homebound by reason of illness,
disability, or isolation:
a) "Frail" means that an older individual is determined to be functionally impaired because
the individual either:
(1) Is unable to perform at least two (2) activities of daily living, including bathing,
toileting, dressing, feeding, breathing, transferring and mobility and associated
Page 1 of 14
ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
tasks, without substantial human assistance. including verbal reminding, physical
cueing or supervision.
(2) Due to a cognitive or other mental impairment, requires substantial supervision
because the older individual behaves in a manner that posses a serious health or
safety hazard to the individual or to others.
2. A spouse of a person in sub-section (C)(1) above, regardless of age or condition, if an
assessment concludes that it is in the best interest of the homebound older individual.
3. An individual with a disability who resides at home with older individuals if an assessment
concludes that it is in the best interest of the homebound older individual who participates
in the program.
4. Priority shall be given to older individuals in sub-section (C)(1) above.
Requirements for Nutrition Services:
A. Congregate Meals:
1. Each Congregate Meal Provider shall:
a) Include procedures for obtain the views of participants about the services received.
b) Not preclude the service of a meal to a participant who has failed to make a
reservation when food is available.
c) Ensure each Congregate Meal participant completes sections I and IV of the Client
Intake Sheet (provided by DAAS) on the first day of service and annually thereafter.
d) Maintain appropriate documentation on each client. Documentation shall be kept on
file to be monitored by DAAS.
2. Each Congregate Meal site shall meet all of the following:
a) Have a paid staff or volunteer designated to be responsible for the day-to-day
activities at each site, and physically be on-site during the time that ENP activities are
taking place.
b) Have restrooms, lighting, and ventilation, which meet the requirements of CURFFL.
c) Have equipment, including tables and chairs that are sturdy and appropriate for older
individuals. Tables shall be arranged to assure ease of access and encourage
socialization.
B. Home-Delivered Meals:
1. Develop and implement criteria to assess the level of need for home-delivered nutrition
services of each eligible participant.
a) An initial determination of eligibility may be accomplished by telephone. This initial
contact with the participant shall include completion of sections 1, 11, 111, and IV of the
Client Intake Sheet (provided by DAAS).
b) A written assessment shall be done in the home within two (2) weeks of beginning
meal service, and shall include an assessment of the type of meal appropriate for the
participant in their living environment.
c) An older individual eligible for receiving home-delivered meals shall be assessed for
need of nutrition-related supportive services, and referred as necessary.
d) Re-assessment of need shall be determined quarterly, Such re-assessment shall be
done in the home of the participant at least every other quarter. Each quarter's re-
assessment shall include completion of sections 1, 11, 111, and IV of the Client Intake
Sheet (provided by DAAS).
2. Provide written instructions, in the language of the majority of the participants, for
handling and re-heating of the meals.
3. Establish a waiting list for home-delivered meals whenever the home-delivered meal
providers are unable to provide meals to all eligible individuals. The decision to place
eligible recipients of a home-delivered meal on a waiting list, and their position on such a
list, shall be based on greatest need and-or in accordance with policy established by the
home-delivered meal provider, in consultation with DAAS.
Page 2 of 14
ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
4. Provide home-delivered meals in pre-packaged divided trays (hot or frozen meals).
5. Maintain appropriate documentation on each client. Documentation shall be kept on file
to be monitored by DAAS.
IV. Program Outcomes:
A. Total Number of Meals to be Served: 32,000
1. A minimum of 95% of the total number of meals is to be provided. The Director of DAAS
must approve requests to serve less than 95% of the total number of meals to be
provided. All such requests must be in writing.
Program: C-1 (Congregate Meals Program C-2 Home-Delivered Meals
# of Days of Service: 255 # of Days of Service:
Number of Meals: 32,000 Number of Meals:
Sites to be Served: Areas to be Served:
5' Street Senior Center
Perris Hill Senior Center
Hernandez Community Center
Lytle Creek Community Center
New Hope Family Life Center
Highland Senior Center
V. Staffing:
A. Manager or Director:
1. The ENP provider shall have a manager on staff who shall conduct the day-to-day
management and administrative functions of the ENP, and either have (1), (2), or(3):
a) Possess an associate degree in institutional food service management, or a closely
related field, such as, but not limited to, restaurant management, plus two (2) years
experience as a food service supervisor, or,
b) Demonstrate experience in food service, such as, but not limited to, cooking at a
restaurant, and within twelve (12) months of hire successfully complete a minimum of
twenty (20) hours specifically related to food service management, business
administration, or personnel management at a college level. Prior to completion of
meeting the hours, this individual's performance shall be evaluated through quarterly
monitoring by a registered dietitian, or,
c) Two years experience managing food services. Such experience shall be verified and
approved by a registered dietitian prior to hire.
2. The ENP Provider shall maintain documentation on file of the qualifications of the Program
Manager or staff.
3. If the Provider has more than one site, the Manager/Director shall monitor the sites on a bi-
monthly basis. The bi-monthly visit shall be for the purpose of monitoring the food service
practices of the employees and the implementation of the program requirements at the site
level. Documentation of each visit shall be maintained on file for DAAS review.
B. Personnel—Paid StaffNolunteers:
1. There shall be sufficient qualified paid staff or volunteer staff with the appropriate education
and experience to carry out the requirements of the ENP. The total number of staff should
be based on the method and level of services provided and size of the service area.
2. Contractor is encouraged to hire multi-lingual/multi-cultural staff to increase low-income and
ethnic minority program participation in accordance with federal mandates.
3. Contractor shall recruit for vacant positions in an open and competitive application process
free of discriminatory questions. Written job descriptions for all paid and volunteer staff
shall be maintained.
Page 3 of 14
ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
4. Contractor shall complete a written work performance evaluation on all paid and volunteer
staff at least annually.
5. All staff, paid and volunteer, that will be handling food must be in possession of a current
Food Handlers Card.
'.l 6. Volunteers shall be recruited and used in any phase of the program operation where
qualified.
7. Volunteers shall be screened and selected through a formal process that assesses their
capabilities.
8. Volunteers shall receive the same training as paid staff.
9. Volunteers that are paid through other job training programs are not considered volunteers
and must be paid the agreed upon rate charged for regular paid staff.
10. The ENP Provider shall maintain a written Volunteer Policy that describes how volunteers
are recruited, screened, what topics they are taught at orientation, and how often their
performance is evaluated.
C. Registered Dietitian:
1. Each ENP Provider shall establish and administer nutrition services with the advice of a
Registered Dietitian in accordance with Section 339 of the OAA, and follow the general
requirements in Title 22, Division 1.8, Section 7500.
2. The Registered Dietitian will provide the following activities to meet the mandated
requirements:
a) At a minimum, quarterly monitor for safe food handling and sanitation practices of food
i facilities.
b) Review and approve the content of staff training prior to presentation.
c) Develop, or review and approve the cycle menus.
d) Provide input, review, and approve the Nutrition Education Plan prior to presentation.
e) Provide technical support and assistance as needed.
VI. Staff Training Activities:
A. A yearly written Staff Training Plan shall be developed, implemented, and maintained on file by
the ENP Provider, as required in Title 22, Division 1.8, Section 7636.7(c).
B. The Provider's Registered Dietitian shall review and approve the content of the Plan prior to
presentation.
C. The Staff Training Plan must identify who is to be trained, who will conduct the training, content
of the training, and when it is scheduled.
D. A copy of the Staff Training Plan that has been approved by the Provider's Registered Dietitian
must be submitted to DAAS by September 1s' of the FY it is being provided in. The DAAS
Registered Dietitian will review and approve the Staff Training Plan and return it to the Provider.
1 The DAAS approved Staff Training Plan must be kept on file.
E. A minimum of four (4) hours of staff training shall be provided annually for paid and volunteer
food service staff, including congregate and home-delivered meal staff.
F. Training sessions shall be evaluated by those receiving the training.
G. The ENP Provider shall maintain documentation of each training session on file.
Documentation includes, but is not limited to, sign-in sheets, agendas, handouts, and
completed evaluations.
H. All staff, paid and volunteer, shall be oriented and trained to perform their assigned
responsibilities and tasks. Training, at a minimum, shall include:
1 1. Food safety, prevention of food bome illness, and HACCP principles.
1 2. Accident prevention, instruction on fire safety, first aid, choking, earthquake preparedness,
and other emergency procedures.
3. Elder Abuse Law and reporting procedures.
Pape 4 of 14
ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
VII. Senior Participants:
A. Satisfaction Survey:
1. The ENP Provider shall conduct a Client Satisfaction Survey at least annually. The Survey
instrument must be approved by DAAS prior to its use, and all findings from the Survey
must be used to improve services. The Provider must keep the completed Surveys and the
tabulated results on file. A copy of the tabulated results must be submitted to DAAS by
March 3b of the FY it is being conducted for.
B. Complaint Procedures:
1. Each Provider shall have a written Complaint Procedure.
2. The Complaint Procedure will be available for the participants and will provide them the
opportunity to provide positive as well as negative feedback to the Program Manager.
3. The Provider shall have an assessment tool readily accessible for the seniors attending the
congregate site or receiving a home-delivered meal.
C. Nutrition Education Services for Participants:
1. Nutrition Education shall be provided a minimum of four(4) times per year to participants in
congregate and home-delivered meal programs.
a) Nutrition Education for congregate sites is defined as demonstrations, presentation,
lectures or small group discussions, all of which may be augmented with printed
materials.
b) Nutrition Education for home-delivered meal participants may consist solely of printed
material that is in conjunction with a congregate meal Nutrition Education presentation.
2. Nutrition Education shall be based on the particular need of congregate and home-
delivered meal participants. An annual Needs Assessment shall be performed by the ENP
Provider to make this determination.
3. The Nutrition Education Plan and annual Needs Assessment must be submitted to DAAS
by September 1$'of the FY it is being provided in.
4. Nutrition Education sessions must be reported monthly to DAAS using the Nutrition
Education Monthly Service Unit Report.
Nutrition Education Units of Service:
Pro ram: C-1 Con re ate Meals Program: C-2 Home-Delivered Meals
#of Units to be Provided: 2,900 #of Units to be Provided:
#of Sites to be Presented at: 6 #of Participants to be Presented to:
Vlll. Menu Planning Guidelines/Menu Requirements:
A. A minimum of a 3-month cycle shall be planned and submitted to DAAS.
B. Menu cycles shall include the availability of seasonal foods.
C. Health, cultural, ethnic and regional dietary practices shall be considered in menu planning,
food selection, and meal preparation.
D. The menu cycle shall be approved by the Provider's Registered Dietitian and upon approval
forwarded to the DAAS Registered Dietitian for certification. Menus shall be submitted to the
DAAS Registered Dietitian forty-five (45) days prior to the menu start date. Allow thirty (30)
days for the menu certification process. Menus will be returned to the Provider at least
fifteen (15) days prior to the menu start date. ENP Providers are required to have menus
certified prior to the menu start date. All signatures on the menu shall be original signatures.
E. A copy of the certified menu must be posted in a spot conspicuous to clients at each
congregate site.
F. Copies of the menus shall be made available to the participants upon request.
G. When planning the menus, the California Daily Food Guide and the Dietary Guidelines for
Americans (DGA) are to be considered. Menus shall conform to the following criteria
referenced in the sources:
1. Provide an average of 550-750 calories per meal.
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ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
2. Limit total fat to no more than 25-30% of the calories averaged for the week.
3. Choose and prepare foods with low amounts of salt, soy sauce and other high sodium
items.
4. Include good sources of dietary fiber such as whole grains and cooked dry beans at least
four times a week.
5. Include a variety of foods and preparation methods with consideration to color,
combinations, texture, size, shape, taste, and preference of the participants served.
6. Dietary Reference Intake Values:
1. Table one (1) represents the most current Dietary Reference Intakes (DRI) values
and daily compliance range for target nutrients. The values provided are based on
the U.S. Department of Agriculture (USDA) Food Guide calculated for one (1) meal
for a woman over seventy (70) years of age whose activity level is sedentary. This
example represents a majority of the older adult population served by the ENP
statewide.
a. The nutrients selected for this Table are based on the target nutrients to:
i. Promote health and prevent disease
ii. Prevent deficiencies
i iii. Indicate diet quality
iv. Manage disease
Table 1
Target Nutrients
Nutrient Target Value Daily Compliance Range
r meal
Calories (Kcal) >550 Kcal >550—700 Kcal
Protein 14 gm 14 gm (in the entree)
Fat(% of total calories) 30% <35%weekly average
> 250 ug 3 out of 5 days /wk or 4
Vitamin A(ug) 250 ug out of 7 days/wk
Vitamin C (mg) 25 mg 25 mg
Vitamin B6 (mg) 0.5 mg >0.5 mg
Vitamin B12 (ug) "* 0.8 ug 0.8 ug "
Calcium (mg) 400 mg >400 mg
Magnesium (mg) 140 mg >140 mg
Zinc(mg) " 2.6 mg >2.6 mg '*
Sodium (mg) <800 mg <1,200 mg (over 1,000 mg place
an icon on the menu)
Fiber(gm) >7 gm >7 gm
Potassium (gm) 1565 mg 1565 mg
Vitamin D 200 IU 200 IU
Vitamin E 5 IU Provide education
"Target Value: This value represents one-third of the DRI for a 1600 calorie range. The 1600 calorie
range was chosen based on the requirements for a 70-year-old sedentary female. If a majority of the
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ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
senior population served by the AAA ENP Program differs from the above example, use your ENP
predominate demographic characteristics to calculate target nutrient values.
** If these elements are not provided to the level noted as a weekly average, the Program must educate
the participants on how to obtain these elements.
NOTE: Fortified foods should be used to meet vitamin B12 needs.
Recommended sodium content was liberalized based on the information from the Mathematical study data
which indicated that, for many participants, the ENP meal provides 40-50 percent of the participants' daily
it
intake.
7. Component Meal Pattern Requirements:
1. The California 1600-calorie component meal pattern has been developed to reflect
the new DGA requirements for those programs that are not using computerized
nutrient analysis.
2. The ENP Provider has the discretion to allow occasional flexibility in planning meals
that may not meet the meal pattern, but does meet the nutrient value requirements.
Fortified food products and combination dishes used in a menu may not match the
meal pattern, but may provide for the required nutrient values. For example, a
fortified snack bar as a dessert could be used to boost the nutrient value of a boxed
lunch or special occasion meal.
3. Items that provide the following target nutrients should be identified on the menu
when using a component meal pattern template:
a. Vitamin C — Provide one-third (1/3) of the DRI for vitamin C each meal — 25 mg
I (for a 1600-calorie menu).
b. Vitamin A— Provide one-third (1/3) of the DRI for vitamin A at least three (3) times
per week, 250 µg (for a 1600-calorie menu).
c. Sodium — meals that contain over 1,000 mg of sodium must be noted on the
menu as a high sodium meal.
4. Table two (2) descries the elements in the California 1600-calorie meal pattern.
Serving sizes are based on the USDA Food Guide Pyramid. This sample component
meal pattern does not assure that meals meet one-third (1/3) of the DRI's and the
DGA. Meals will require specific types of fruits and vegetables, whole grains, and
high fiber foods in order to assure the target nutrients are provided. The component
meal pattern may be deficient in vitamins E, B12, and Zinc, requiring additional
nutrition education for participants on the selection of foods that are good sources of
these nutrients.
a. The meal pattern in Table two (2) below is based on the minimum requirements
for a sedentary female 70 years of age. If the majority of the population served
by a provider falls within another requirement range (i.e. active 60 year old men),
the serving sizes and minimum number of servings required can be adjusted to
meet the service population. ENP Providers should verify the population served
and develop menu criteria accordingly.
Table 2
California 1600 Calorie per Day Component Meal Pattern
Minimum Recommended Elements
Food Group Required servings for Serving sizes for 1600
550 calories per meal calorie level
Lean meat or beans 1 serving 2 ounces = 1 serving
2 ounces per meal
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ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
Vegetable 1 —2 servings '/cup = 1 serving
Fruit 1 serving / cup = 1 serving
Bread or Grain 1 —2 servings 1 slice Bread = 1 serving
At least '/ whole grain /2 cup of rice or pasta = 1 serving
Low-fat milk or milk alternate 1 serving 1 cup orequivalent measure
Fat Optional
Dessert Optional - limit sweets use Select foods high in fiber and low in
fruit fat and sugar
(1) The number of servings per meal estimates provision of one-third of the DRIs.
(2) Caloric value (1,600 Kcal/day) based on a 70-year-old female, "sedentary" physical activity level
I using Table 3 - Estimated Caloric Requirements in Each Gender and Age Group at Three Levels of
Physical Activity, from the DGA 2005.
H. Meal Components — required for both computerized and component menus:
1. Protein — meat, fish, poultry, legumes, eggs, and cheese:
a) A minimum of 2.0 ounces of cooked, edible portions of meat, fish, poultry, legumes,
eggs, cheese, (or a combination thereof) providing at least 14 grams of protein.
Programs should consider the preferences of the participants they serve.
b) Legumes should not be counted as both vegetable and protein. ENP Providers may
use other protein sources to provide the occasional vegetarian meal.
2. Vegetables (1-2 Y cup servings):
a) Vegetables as a primary ingredient in soups, stews, casseroles, or other combination
dishes should total Y:cup per serving.
b) Raw leafy vegetables (salads) should equal 1-cup if they are to be considered a
serving.
3. Fruit (1 serving):
a) A serving of fruit equals:
(1) 1 medium sized whole fruit
(2) '/ cup fresh, chopped, cooked, frozen, or canned drained fruit
(3) '/2 cup 100% fruit juice
b) Fresh, frozen, or canned fruit should be packed in juice, light syrup, or without sugar.
Fruit packed in high sugar content syrup may be rinsed before using.
4. Breads/Grains (1 ounce equivalent serving):
a) One-half of the daily intake of grains should be from whole grains. Grains that are
processed (not whole) must be fortified.
5. Milk (8 fl. oz.):
a) Each meal shall contain eight (8) fluid ounces of fortified skim, low fat, or buttermilk.
If religious preference precludes the acceptance of milk with the meal, it may be
omitted from the menu (however, an equivalent substitute must be used).
6. Fat (Optional):
a) Each meal may contain fat components to increase the palatability and acceptability
of the meal.
b) When selecting and preparing meat, poultry, dry beans, and milk or milk products,
make choices that are lean, low fat, or fat free.
c) Consume less than 10% of calories from saturated fatty acids and less than 300
mg/day of cholesterol, and keep trans fatty acid consumption as low as possible.
I
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ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
d) Keep total fat intake between 20 to 35 percent of calories, with most fats coming from
sources of polyunsaturated and monounsaturated fatty acids such as fish, nuts, and
vegetable oils.
7. Dessert (Optional):
a) Dessert may be provided as an option to satisfy the caloric requirements or for
additional nutrients. Use fruit as a dessert as often as possible and limit sweets. The
fruit, grains, and dairy products served as dessert can count towards the fruit, grain,
or dairy requirements. Desserts that are low in fat and/or low in sugar are
encouraged.
b) When a dessert contains '/ cup of fruit per serving, it may be counted as a serving of
fruit.
c) When a dessert contains the equivalent of 1 serving (1 ounce) starches/grains per
serving, it may be counted as a serving of starches/grains (example: rice pudding or
oatmeal cookie).
d) When a dessert contains the equivalent of '/1 cup of milk per serving, it may be
counted as ''/:serving of milk.
8. Condiments and Product Substitutes:
a) Sugar substitutes, pepper, herbal seasonings, lemon, vinegar, non-dairy coffee
creamer, salt, and sugar may be provided, but should not be counted as fulfilling
any part of the nutritive requirements.
b) Condiments such as salad dressings, ketchup, soy sauce, mustard, and
mayonnaise do not need to be counted in a menu analysis if they are served "on
the side" and are not combined with the food.
9. Sodium:
a) The commitment to reduce sodium in the meals stems from the fact that nutrition-
related chronic diseases remain the primary cause of death among people aged
65 and older. California has a diverse population, and the ENPs in the State
provide culturally appropriate meals for many ethnicities. Asian meals traditionally
have higher sodium levels. Programs that choose to provide culturally
appropriate meals, but are concerned with the sodium content of the meals, may
consider:
(1) Using low sodium soy sauce or diluting soy sauce with water to produce low
sodium soy sauce;
(2) Offering soy sauce as a condiment to be added by the senior;
(3) Providing Nutrition Education on sodium;
(4) Continuing to work with the sodium levels of meals, making small steps to
reduce the risk of developing kidney stones, and possibly decrease bone loss
with age;
(5) Not providing potassium chloride salt substitutes;
(6) Noting meals that have more than 1000 mg of sodium on the menu as such:
"This meal contains more than 1000 mg of sodium," or using an icon denoting
a high sodium meal; and
(7) Using low sodium versions of high sodium foods when available and feasible
with budget allowances.
I. Meal Component/Nutrient Analysis:
1. A meal component/nutrient analysis of the entire menu cycle conducted and/or approved
by a Registered Dietitian shall be done to ensure compliance with Title 22, Division 1.8,
Section 7638.5.
a) Computerized Nutrient Analysis Requirements
(1) Although not required, use of computerized nutrient analysis is strongly
recommended and will help ensure and verify the nutritional adequacy of meals.
The goal of assessing nutrient intakes of groups is to determine the prevalence of
Pane 9 of 14
ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
inadequate or excessive nutrient intakes within a particular group of individuals.
While meal patterns serve as a basic framework for menu planning, providers are
encouraged to use computerized nutrient analysis because it provides specific
information on nutrients the menu may not be providing. The information that a
menu is not supplying all of the desired nutrients will guide the development of
future menus. As required menu elements are expanded, it is more difficult to
meet all of the requirements on a daily basis. ENP Providers should focus on:
(a) Vitamin A
(b) Vitamin C
(c) Protein
(d) Fat
(e) Sodium
(f) Fiber
(2) Not all nutrient guidelines will be met with each meal. However, areas that do not
meet the requirements should be the focus of future menu revisions and nutrition
education.
(3) The following nutrients should be included in the analysis when the computerized
nutrient analysis method is used: calories; protein; carbohydrates; total fat;
saturated fat; total fiber; vitamins A, C, D, E, K, thiamin, riboflavin, niacin, B6,
folate, 1312, calcium, chromium, copper, iron, magnesium, sodium, and zinc. In
addition to meeting one-third of the DRIs, the menus should also follow the DGA.
IX. Food Procurement:
A. Food procurement procedures shall comply with Title 22, CRFC standards, and HACCP best
practices guidelines.
B. All food shall be of good quality and shall be obtained from sources that conform to Federal,
State, and local regulatory standards fro quality, sanitation, and safety.
C. To the extent possible, providers are encouraged to participate in group food purchasing.
D. A comparative cost analysis shall be performed either by the ENP Provider or its group
purchasing organization on an on-going basis to obtain the highest quality food for the lowest
price available.
X. Food Storage:
A. Food storage procedures shall comply with Title 22, CRFC standards, and HACCP best
practices guidelines.
B. Adequate and suitable space free from vermin, dirt, and contamination or adulteration shall
be provided for the storage of food and beverages, and cooking, serving, and eating
supplies.
XI. Food Production:
A. Food production procedures shall comply with Title 22, CRFC standards, and HACCP best
practices guidelines.
B. Food production and meal service shall be under the supervision of a trained staff in food
service management to ensure food service sanitation and the practice of hygienic food
handling techniques are followed. This person shall function with the advice of the Provider's
Registered Dietitian.
C. Meals shall be served as indicated on the certified menus. In the event that a menu
substitution must occur, the following procedure must be followed:
1. The Provider's Registered Dietitian must approve all menu substitutions.
2. A Menu Substitution Form must be completed and signed by the Provider's Registered
Dietitian.
3. The completed Menu Substitution form shall be kept on file for DAAS review.
Pon. 1 n of 1A
ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
D. Production Control:
1. Production schedules or worksheets must be available in the food preparation area.
2. Food shall be prepared in sufficient quantities to serve all participants. Careful planning
shall minimize the leftover food and prevent waste.
3. Standardized recipes shall be used to ensure consistency of quality and quantity and
adherence to menu guidelines.
4. Appropriate utensils for correct and consistent portion control shall be available and used
at each site.
E. Meal Service/Temperature Monitoring:
1. All food for congregate sites shall be packaged and transported in a manner in which it is
protected from potential contamination and maintains appropriate hot and cold food
temperatures.
2. Meals shall be served to seniors 'offer versus serve" — meaning participants are to be
given an opportunity to decline a menu item. Food trays shall not be served ahead of
time.
3. Temperature Checks:
a) All hot, cold, and frozen potentially hazardous meal components, including milk, shall
be checked daily immediately prior to dispatch from the central kitchen.
b) All hot, cold, and frozen potentially hazardous meal components, including milk, shall
be checked at satellite congregate sites upon delivery and at all congregate sites
immediately before meal service.
c) The ENP Provider must have written procedures for monitoring food temperature.
d) The ENP Provider must use a form to document food temperatures daily (i.e. Food
Temperature Log).
e) The ENP Provider shall have a staff member review the completed Food
Temperature Logs at random a minimum of every other month. If problems are
discovered, an action plan must be developed to resolve the issue.
f) All completed Food Temperature Logs must be maintained on file for DAAS review.
4. To maintain quality in prepared foods, holding times shall be kept to a minimum. Long
periods of holding hot foods at required temperatures diminishes the nutrient content and
palatability of foods.
5. Holding time shall not exceed 2 hours between the end of production and the beginning
of food service at the congregate site.
6. Milk and milk products shall be provided in individual, commercially filled containers, or
shall be poured by a staff member directly from commercially filled bulk containers into
the glass or cup from which it is consumed.
7. Single service utensils and tableware shall be used one time only and then discarded.
8. Safety of the food after it has been served at the congregate site and then removed by
the participant from the congregate site is the sole responsibility of the participant and
may be consumed by the participant as he/she deems it appropriate.
9. The Provider shall have a sign posted in the congregate site stating, "Food removed from
the congregate site is at your own risk."
XII. Food Service Requirements:
A. The ENP Provider shall ensure that the following forms are available, completed daily, and
maintained at each nutrition site for a minimum of 12 months:
1. Food Temperature Log — one should be available for congregate meals and one for
home delivered meals if hot foods are delivered to the client.
2. Cleaning Schedule
3. Equipment Temperature Log —for all dish machines, refrigerators, and freezers.
4. Production Schedule— applicable only if food is cooked at the site.
5. The current Environmental Health inspection shall be available at the site for review.
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ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
6. Staff and volunteers who are handling food shall possess a current food handlers' card
that shall be available for review.
XIII. Program Requirements:
A. Client Intake Sheets:
1. The ENP Provider will ensure that each participant completes the Client Intake Sheet
form (provided by DAAS) to determine his or her level of nutritional risk. Forms shall be
completed for:
a) Congregate Meal Participants — at the beginning of service and then annually
thereafter for clients who remain on the program.
(1) Sections I and IV are required for congregate meals.
b) Home-Delivered Participants — at the beginning of service and then quarterly
thereafter for clients who remain on the program.
(1) Sections I, II, III, and IV are required for home-delivered meals.
2. ENP Providers who are required to complete their own data entry into the SAMS System
must enter the annual and quarterly Client Intake Sheets into the database in a timely
manner.
3. ENP Providers who are not required to complete their own data entry must send the
Client Intake Sheets to DAAS for data entry into the SAMS System.
B. Outreach/Marketing Activities:
1. ENP Providers are required to provide outreach in the community through community
organizations and other groups. All outreach and marketing activities shall be
documented and kept on file for the annual monitoring visit conducted by DAAS.
2. ENP Providers shall develop and have handouts, brochures, and/or signs available in
languages other than English and posted in locations such as churches, community
service locations, and small stores serving the minority communities.
C. Emergency Procedures:
1. ENP Providers shall have a written Emergency/Disaster Plan.
2. Each nutrition site shall have an evacuation plan posted identifying the emergency exits
and assembly areas.
3. Staff must be knowledgeable of emergency procedures.
4. Where feasible and appropriate, ENP Providers shall make arrangements for the
availability of meals to participants during a major disaster, as defined in 42 U.S.C.,
Chapter 68, Section 5122 (2). Such arrangements shall be included in the
Emergency/Disaster Plan.
D. Donations and Confidentiality:
1. An Eligible individual who receives a meal shall be given the opportunity to contribute to
the cost of the meal
2. The ENP Provider shall develop a suggested contribution/donation amount. When
developing this contribution/donation amount, the income ranges of the older individuals
in the community and the Provider's other sources of income shall be considered.
3. A sign indicating the suggested contribution for eligible individuals and the fee for guests
shall be posted near the contribution container at each congregate meal site. A guest
fee shall cover all meal costs.
4. No eligible individual shall be denied participation because of failure or inability to
contribute.
5. The Provider shall ensure that the amount of the eligible participant's contribution is kept
confidential.
6. The ENP Provider shall establish written procedures to protect contributions and fees
from loss, mishandling, and theft (i.e. Contribution/Donation Procedures). Such
Procedures shall be kept on file for DAAS review.
Paae 12 of 14
ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
7. All contributions and fees shall be identified as program income and used to increase the
number of meals served, to facilitate access to such meals, and to provide nutrition-
related supportive services.
E. "No Soliciting" Sign:
1. The ENP Provider shall ensure that a "No Soliciting' sign is posted on the door leading to
the congregate nutrition site. No soliciting of any kind is permitted on the premises
during the lunch hours for services or goods promoted by businesses.
F. Coordination:
1. If applicable, develop a fair and equitable policy and procedure for referring participants
to the appropriate transportation provider for securing public transportation to and from
nutrition sites and have the policy available for review by DAAS.
2. Include the following statement on all advertising, brochures, poster, etc., "Funding for
this service has been provided by the San Bernardino County Department of Aging
and Adult Services through a grant award from the California Department of
Aging."
3. Coordinate service with other County departments and local agencies by providing time
for presentations or special activities that promote a community based system of care for
the participants attending nutrition sites.
G. Reporting:
1. All fiscal and program data must be reported monthly (i.e. Request for Reimbursement,
Rosters, Monthly Service Unit Report, etc.). All reports are due to DAAS by the 5"
business day of the month following the month of service. DAAS will provide training as
needed.
2. The Provider shall maintain support files including, but not limited to, invoices, payroll,
Client Intake Sheets, and any other supporting documents to substantiate monthly
reports.
3. ENP Providers are required to report all known or suspected cases of elder abuse to
DAAS Adult Protective Service or law enforcement immediately by telephone. A written
report must be sent within two (2) working days. Abuse of an elder or dependent adult
means physical abuse, neglect, intimidation, cruel punishment, fiduciary abuse,
abandonment, isolation, or other treatment resulting in physical harm or pain or mental
suffering or the deprivation by a care custodian of goods or services which are necessary
to avoid physical harm or mental suffering.
4. Maintain records, by month, that support claimed in-kind expenditures.
5. Report expenditures funded with Deferred Income by September 30' of the FY in which
it is being claimed.
6. Develop and have on hand for review by DAAS, a cost allocation plan which explains the
methods used to allocate costs between congregate and home-delivered meals or any
other program funded by DAAS.
7. In the event additional funds become available, the Provider will use the funds to
increase the number of meals being provided to participants by either increasing the
number of individuals attending its present sites, or by opening new sites in communities
not already served by the Provider. Exceptions to this requirement must be fully
documented in writing and submitted to the Director of DAAS for prior approval.
S. Other Reporting Requirements:
a) SAMS (Social Assistance Management System): n
(1) The following reports are to be completed and submitted to DAAS by the 5
business day of the month following the month of service if the Provider is serving
less than 500 clients per month:
(a) Client Intake Sheets for any new clients or any annual or quarterly
assessments completed in the month.
(b) Meal Rosters
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ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
(2) Providers that are serving more than 500 clients shall secure the appropriate
licensing, have a dedicated staff responsible for maintaining the client tracking
software, obtain and maintain an Internet Service Provider and the appropriate
hardware that can support the program. These Providers shall be responsible for
entering the following data into SAMS by the 5t" business day of the month
following the month of service:
(a) Client Intake Sheets for any new clients or any annual or quarterly
assessments completed in the month.
(b) Rosters
(c) Routes (if applicable)
b) Nutrition Education Monthly Service Unit Report
(1) The Nutrition Education Monthly Service Unit Report is a tool that is used to report
the number of Nutrition Education service units that have been provided to
participants. This report is to be completed and submitted to DAAS by the 5t"
business day of the month following the month of service. Copies of any
handouts presented to the participants as a component of the Nutrition Education
shall be attached to the Nutrition Education Monthly Service Unit Report.
H. Disposal of Equipment:
1. If the Provider wishes to dispose of equipment purchased with Nutrition grant funding,
they must submit a request, in writing, to DAAS. The request shall state the equipment
description, the location of the equipment, and the reason for disposal.
2. Provider shall submit a list of equipment purchased with grant funding by location.
Pace 14 of 14
ATTACHMENT B
CLIENT COMPLAINT AND GRIEVANCE PROCEDURES
Older Americans Act Programs
(Instructions: The service recipient is to read, sign, and receive a copy of this form. The original of the form
is to be filed in the service recipient's case file maintained by contractor. The reverse side of this form may
be used to file a complaint or grievance with the contractor/service provider.)
If you believe you have been discriminated against, or that there has been a violation of any laws or regulations, or if
you have a problem regarding services received, you have the right to file a grievance.
The following procedures are to be followed when filing a grievance:
1. Identify the complaint/grievance in writing and discuss it with the contractor/service provider.
Time frame: Within 1 week of discrimination/violation/problem.
If resolved at this level, no further action is required. If no resolution is apparent within 15 business days, proceed with
Step 2.
2. Forward the written complaint/grievance to the Deputy Director of Administration at the following address:
Department of Aging and Adult Services
686 East Mill Street
San Bernardino, CA 92415-0640
ATTN: Deputy Director
Time frame: Within 1 week of Step 1.
If resolved at this level, no further action is required. If no resolution is apparent within 15 business days, proceed with
Step 3.
3. If no solution is apparent after Steps 1-2 have been exhausted, forward copy of written grievance to:
Human Services Group, Contract Administrator
150 S. Lena Road
San Bernardino, CA 92415-0515
You will be contacted within 15 business days of any actions being taken.
Please note: Each of these steps must be completed in the sequence shown.
If you believe that your civil rights have been violated, please contact:
Deputy Director, Administration
Department of Aging and Adult Services
686 East Mill Street
San Bernardino, CA 92415-0640
GRIEVANCE PROCEDURE CERTIFICATION
This is to certify that I have read, understood, and received a copy of the Client Complaint and Grievance Procedures for
Older Americans Act Programs.
Signature of Service Recipient Date
Page 1 of 2
ATTACHMENT B
GRIEVANCE NOTICE
Your Name:
Date of Occurrence:
Approximate Time of Occurrence:
Name of Service Provider:
Address of Service Provider:
Nature of Grievance:
Resolution:
Resolved by:
Signature Date
Signature of Service Recipient Date
ATTACHMENT C
DEPARTMENT OF AGING
CONTRACTORNENDOR CONFIDENTIALITY STATEMENT
CDA 1024 REV 1/07
CERTIFICATION
I hereby certify that I have reviewed this Confidentiality Statement and will comply with the following Statements.
CONTRACTORNENDOR NAME: CONTRACT NUMBER:
AUTHORIZED SIGNATURE: PRINTED NAME AND TITLE OF PERSON SIGNING:
In compliance with Government Code 11019.9, Civil Code 1798 Et. Seq., Management Memo 06-12 and Budget
Letter 06-34 the California Department of Aging (CDA) hereby requires the ContractorNendor to certify that:
• confidential information shall be protected from disclosure in accordance with all applicable laws, regulations
and policies.
• all access codes which allow access to confidential information will be properly safeguarded.
• activities by any individual or entity that is suspected of compromising confidential information will be reported
to CDA by completing a Security Incident Report, CDA 1025.
• any wrongful access, inspection, use, or disclosure of confidential information is a crime and is prohibited
under State and federal laws, including but not limited to California Penal Code Section 502; California
Government Code Section 15619, California Civil Code Section 1798.53 and 1798.55, and Health Insurance
Portability and Accountability Act.
• any wrongful access, inspection, use, disclosure, or modification of confidential information may result in
termination of this Contract/Agreement.
• obligations to protect confidential information obtained under this Contract(Agreement will continue after
termination of the Contract/Agreement with CDA.
• all employees/subcontractors of the ContractorNendorwill complete the required Security Awareness Training
module located at www.aginq.oa.gov, within 30 days of the start date of this Contract/Agreement or within 30
days of the start date of any new employee or subcontractor. ContractorNendor may substitute CDA's
Security Awareness Training program with its Security Training provided such training meets or exceeds
CDA's training requirement.
• all employees/subcontractors of the ContractorNendor will be notified of CDA's confidentiality and data
security requirements.
• CDA or its designee will be granted access by the Contractor or Vendor to any computer-based confidential
information within the scope of the Contract.
• I agree to protect the following types of confidential information which include but not limited to:
- Social Security number
- Medical information
- Claimant and employer information
- Driver License information
- Information about individuals that relate to their personal life or identifies or describes an individual
- Other agencies' confidential and proprietary information
- Criteria used for initiating audit selection
- Methods agencies use to safeguard their information (computer systems, networks, server
Configurations, etc.)
- Any other information that is considered proprietary, a copyright or otherwise protected by law or
contract.
• I agree to protect confidential information by:
- Accessing, inspecting, using, disclosing or modifying information only for the purpose of performing
official duties
- Never accessing, inspecting, using, disclosing, or modifying information for curiosity, personal gain, or
any non-business related reason
- Securing confidential information in approved locations
Never removing confidential information from the work site without authorization.
Page 1 of 1
ATTACHMENT D
CALIFORNIA DEPARTMENT OF AGING(CDA)
SECURITY INCIDENT REPORT
CDA 1025 New 07107
INCIDENT INFORMATION MOO
O ="
1. AGENCY/CONTRACTOR NAME: 2. AGENCY/CONTRACTOR INFORMATION SECURITY OFFICER'S
NAME:
3. AGENCY/CONTRACTOR ADDRESS: 4. AGENCY/CONTRACTOR TELEPHONE:
5. DATE/TIME OF 6. DATE INCIDENT 7. INCIDENT REPORTED TO
INCIDENT: DETECTED: ❑CALIFORNIA DEPARTMENT OF AGING ❑ DISTRICT
ATTORNEY
❑CA HWY PATROL ❑ATTORNEY GENERAL ❑
OTHER:
❑UNKNOWN
❑ UNKNOWN
8. INCIDENT LOCATION: "
9. DESCRIPTION OF INCIDENT:
I
10. MEDIA DEVICE TYPE, IF APPLICABLE: 11. WAS THE PORTABLE STORAGE DEVICE
ENCRYPTED?
❑YES [] No ❑ UNKNOWN
12. IF NO, EXPLAIN:
13. DESCRIBE THE COSTS ASSOCIATED WITH RESOLVING THIS INCIDENT: 14. TOTAL ESTIMATED COST OF
INCIDENTS
15. TYPE OF PERSONALLY IDENTIFIABLE INFORMATION(CHECK ALL THAT APPLY):
❑ No PERSONAL INFORMATION ❑SOCIAL SECURITY NUMBER ❑ HEALTH OR MEDICAL INFORMATION ❑
FINANCIAL ACCOUNT NUMBER
❑ NAME ❑ DRIVER'S LICENSE/STATE ID NUMBER ❑ OTHER(SPECIFY)
7 16. IS A PRIVACY DISCLOSURE NOTICE 17. NUMBER OF 18. DATE NOTIFICATION(S)MADE TO
9 REQUIRED? INDIVIDUALS THE INDIVIDUAL:
q ❑YES 0 No
1 "IF A PRIVACY DISCLOSURE NOTICE IS AFFECTED:
REQUIRED,ATTACH A SAMPLE OF THE
NOTIFICATION.
19. HAVE THOSE RESPONSIBLE FOR THE INCIDENT BEEN IDENTIFIED?
Page 1 of 3
I
ATTACHMENT D
❑YES ❑ NO COMMENT:
20, CORRECTIVE ACTIONS TAKEN TO PREVENT FUTURE OCCURRENCES:
21. ESTIMATED COST OF CORRECTIVE 22. DATE CORRECTIVE ACTIONS WILL BE FULLY IMPLEMENTED:
ACTIONS:
SIGNATURES
23. PRINT-AGENCY/CONTRACTOR INFORMATION SIGNATURE: DATE:
SECURITY OFFICER:
24. PRINT-AGENCY/CONTRACTOR PRIVACY OFFICER: SIGNATURE: DATE:
i
i
25. PRINT-AUTHORIZED SIGNATUREIDIRECTOR: SIGNATURE: DATE:
Page 1 of 3
ATTACHMENT D
DEPARTMENT OF AGING
SECURITY INCIDENT REPORT
INSTRUCTIONS
The following instructions will assist in completing the form.All questions must be completed, even when
the response is a future action.
1. Agency/Contractor Name - Provide your agency, contractor, vendor, department, board, bureau or
commission's full name.
2. Agency/Contractor Information Security Officers Name - Provide your agency's Information Security
Officer's Name.
3. Agency/Contractor Address-Provide your agency/contractor's address.
4. Telephone -Provide your agency/contractor's telephone number.
5. Date/Time of Incident - Provide the date/time when the incident occurred. If unknown, select the
"Unknown" checkbox.
6. Date Incident Detected -Provide the date the incident was discovered.
7. Incident Reported To -Select the appropriate checkbox. If applicable,select the other checkbox and
describe to whom the incident was reported.
8. Incident Location - Provide the location where the incident occurred. For example, if a laptop was
stolen from an employee's home, suggested content is "Employee's Home, Roseville, CA"; or if
the incident occurred at the agency's headquarters office, suggested content is "Agency's
Headquarters, 123 Any Street,Sacramento, CA."
9. Description of Incident- include the following in the description:
• When the incident occurred and how it was discovered.
• The effect of the incident on the business and infrastructure of your agency.
• The number of people (inside your agency and outside your agency)affected by this incident.
• The effects, if any, of this incident on people, businesses or services outside of your agency.
• The details of any law enforcement investigation of this incident, such as which agency
investigated it,when,and the report number.
• Any personal, confidential, or sensitive information involved/disclosed.
10. Media Device Type, If Applicable - Provide the type of media or device involved in the incident,such
as paper(fax, mail,etc.)or electronic(CD,floppy drive, laptop, PDA, email,etc.).
11. Was the Portable Storage Device Encrypted?-Check the appropriate box.
12. If NO, Explain -Describe why the storage device was not encrypted.
13. Describe the Costs Associated with Resolving this Incident - Provide a cost estimate of resolving the
incident. Cost should include everything necessary to resolve the incident, including hardware,
software, staff time, contracting services, and any other pertinent costs that were triggered due to
the incident. The estimate should also include costs associated with a disclosure notification
(such as preparation, postage,call center activation, etc.).
Page 2 of 3
ATTACHMENT D
14. Total Estimated Cost of Incident - Provide the total cost associated with handling the incident as it relates only to
information technology. For example, if a state vehicle was stolen with a state-issued laptop in it, do not include
the cost of the state vehicle.
15. Type of Personally Identifiable Information - If applicable, check the appropriate type(s) of personally identifiable
information that applies in this incident.
16. Is a Privacy Disclosure Notice Required? - Check appropriate box. Sample — If yes, attach a sample copy of the
notification sent to the affected individuals. DO NOT provide a sample that includes personally identifiable
information.
17. Number of Individuals Affected - Identify the number of individuals whose personally identifiable information was
breached/disclosed.
18. Date Notification(s) Made to the Individual - Provide the date that the Notification was made to the affected
individuals.
1s. Have Those Responsible for the Incident Been Identified?-Check the appropriate box. If applicable, add comment.
20. Corrective Actions Taken To Prevent Future Occurrences - Provide a detailed description of the corrective actions
taken by the agency to prevent future occurrences of a similar incident occurring again.
21. Estimated Cost of Corrective Actions - Provide cost estimations to implement the corrective actions. For example,
hardware and/or software may need to be upgraded, installed or purchased; new policies may need to be
developed; additional training may need to be given. Include all related costs, such as staff time, contracting
services, and hardware or software purchases.
22. Date Corrective Actions Will Be Fully Implemented -Provide a date when the corrective actions were, or will be,fully
implemented.
23. Print—Agency/Contractor Information Security Officer
24. Print — Agency/Contractor Privacy Officer - This is required only in those instances where personally identifiable
information is involved. If personally identifiable information is involved and no disclosure notice is required,
the Privacy Officer's signature is still required.
25. Print—Authorized Signature/Director
Page 3 of 3
ATTACHMENT
ASSURANCE OF COMPLIANCE
ASSURANCE OF COMPLIANCE WITH ALL APPLICABLE LAWS
RELATING TO
NONDISCRIMINATION IN STATE AND FEDERALLY ASSISTED PROGRAMS
CONTRACTOR
HEREBY AGREES THAT it will comply with Title VI and VII of the Civil Rights Act of 1964, Section 504 of the
Rehabilitation Act of 1973, as amended, the Age Discrimination Act of 1975, the Food Stamp Act of 1977-
Section 272.6, The Americans with Disabilities Act of 1990, Government Code (GC) Section 11135 and California
Code of Regulations (CCR) Title 22 Section 98000-98413, Title 24 of the California Code of Regulations, Section
3105A(e) and other applicable federal and state laws, as well as their implementing regulations (including 45
CFR, Parts 80, 84, and 91, 7 CFR Part 15, and 28 CFR Part 42), by ensuring that employment practices and the
administration of public assistance and social services programs are nondiscriminatory, to the effect that no
person shall because of race, color, national origin, political affiliation, religion, marital status, sex, age or
disability be excluded from participation in or be denied the benefits of, or be otherwise subject to discrimination
under any program or activity receiving federal or state assistance; and HEREBY GIVES ASSURANCE THAT, it
will immediately take any measures necessary to effectuate this agreement.
THIS ASSURANCE is given in consideration of and for the purpose of obtaining any and all federal and state
assistance; and THE AGENCY HEREBY GIVES ASSURANCE THAT administrative methods/procedures which
have the effect of subjecting individuals to discrimination will be prohibited.
BY ACCEPTING THIS ASSURANCE, the agency agrees to compile data, maintain records and submit reports
as required, to permit effective enforcement of the aforementioned laws and regulations and permit authorized
County, state and/or federal government personnel, during normal working hours, to review such records, books
and accounts as needed to ascertain compliance. If there are any violations of this assurance, County shall have
the right to invoke fiscal sanctions or other legal remedies in accordance with Welfare and Institutions Code
Section 10605, or Government Code Section 11135-39, or any other laws, or the issue may be referred to the
appropriate federal agency for further compliance action and enforcement of this assurance.
THIS ASSURANCE is binding on the agency directly or through contract, license, or other provider services, as
long as it receives federal or state assistance; and shall be submitted annually with the required Civil Rights Plan
Update.
DATE SIGNATURE
ORGANIZATION
ADDRESS
Page 1 of 1
ATTACHMENT
DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046
(See reverse for public burden disclosure.)
1.Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
0 a. contract EJ a. bid/offer/application 0 a. initial filing
b. grant b. initial award b. material change
c. cooperative agreement c. post-award
d. loan For Material Change Only:
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 a Subawardee, Enter Name
❑ Prime ❑ Subawardee and Address of Prime:
Tier , if known:
Congressional District, if known: Congressional District, if known:
6. Federal DepartmenttAgency: 7. Federal Program Name/Description:
CFDA Number, if applicable:
8. Federal Action Number,if known: 9.Award Amount,if known:
10.a. Name and Address of Lobbying Entity b. Individuals Performing Services(including address if
(if individual, last name, first name, Ml different from No. 10a)
(last name, first name, Mi)
attach Continuation Sheet(s) SF-LLLA,it necessary)
11.Amount of Payment(check all that apply): 13.Type of Payment(check all that apply):
$ ❑ actual ❑ planned ❑ a. retainer
❑ b. one-time fee
❑ c. commission
12. Form of Payment(check all that apply): ❑ d. contingent fee
❑ a.cash ❑ e. deferred
❑ b. in-kind;specify: nature ❑ f. other; specify:
value
14. Brief Description of Services Performed or to be Performed and Dates)of Service, including officer(s),
employee(s), or Member(s) contacted, for Payment Indicated in Item 11:
(attach Continuation Sheeti SF-LLLA, if necessal
15.Continuation Sheets)SF-LLLA attached: ❑ Yes ❑ No
16. Information requested through me fomr is adhoriud by tine 31 US C. Signature:
secon1352.This disclosure a lobbying activities is a material representation of Print Name:
fad upon whldt reliance was placed by the tier above when this transaction was
made or entered into This disclosure is required pureuent to 31 U.S.C.1352.This Title:
information will be reported to the Congress semi-annually and will be available Tele hone No.: Date:
for public inspection.My mean who fails to file the required discllosus shall be P
subject to a evil penalty of not less that$10,000 and not more than$1 Op000 for
each such feilu(e.
Federal Use Only: Authorized for Local Reproduction
y Standard Form LLL(Rev.7-97)
Page 1 of 2
ATTACHMENT
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 fling, pursuant to title 31 U.S.C. section 1352. The fling 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-LLLA
Continuation Sheet for additional information if the space on the form is inadequate. Complete ail items that apply for both the initial fling 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, Slate 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,subgranls and contract awards under grants.
5. If the organization filing the report in item 4 checks'Subawardee,"then enter the full name, address, city, Slate 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 (IFS) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number
assigned by the Federal agency). Include prefixes,e.g.,'RFP-DE-90-001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the
award/loan commitment for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, State and zip code of the lobbying entity engaged by the reporting 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 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.
11 Check the appropriate box(es).Check all boxes 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 perforn, 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 Members)of Congress that were contacted.
15. Check whether or not a SF-LLLA Continuation Sheet(s)is attached.
16. The certifying official shall sign and date the form,print his/her name,title,and telephone number.
According to the Paperwork Reduction Act,as amended.no persons are required to respond to a collection of information unless it displays a valid OMB Control
Number. The valid OMB control number for this information collection is OMB No. 0348-0046. 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 dal
needed,and completing and reviewing the collection of information. Send comments regarding the burden estimate 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.
DC 20503.
Page 2 of 2
ATTACHMENT G
INFORMATION SHEET (one Information Sheet per Vendor)
CONTRACTOR SHALL COMPLETE SECTION I OF THIS FORM AND RETURN TO:
SAN BERNARDINO COUNTY
Department of Aging and Adult Services
Attn: CONTRACTS
SECTION I: CONTRACTOR INFORMATION
Coturactor Name:
Address(inaudin8 City.Store and zip Code)' Phone
Web Sire: Email: Par.
Site Name for Servima(ifDifferem from Contmmor):
Address(indam'ng City,Stme and tip Code): Phone:
Web Sim: email: Faa:
Clinic Contact Title:
Contract Signature Authority:
Na.. Name:
Title: Title: _-- --
Sigimmme: Signature:
Phone#: E-Mail: Phone N: E-Mail:
Claim Signature Authority:
N. Name:
Title: Title: __-
Signature: Sigmmre:
Phone#: E-Mail: Phone q: E-Mail:
SECTION II: DAAS INFORMATION
Contract Mailing Address: Contracts Unit:
San Bernardino County
Department of Aging and Adult Services
Unit Fax k: 909-891-9150
Contracts Unit
686 E. Mill Street
San Bernardino, CA 92415-0920
Page 1 of 1
ATTACHMENT H
COMMUNITY FOCAL POINTS LIST
CCR Title 22, Article 3, Section 7302(a)(14), 45 CFR Section 1321.53(c), OAA 2006 306(a)
Adelanto Senior Center 11565 Cortez Street Adelanto 92301 (760)246-7736
Apple Valley Senior Center 14933 Wakita Road Apple Valley 92307 (760)247-3155
Baker Valley Senior Center P.O. Box 28 Baker 92309 (760)733-4485
Barstow Senior Center 555 Melissa Barstow 92311 (760)256-9111
Big Bear Valley Senior Center 42651 Big Bear Blvd. Big Bear 92314 (909) 584-0323
Bloomington Senior Center 18317 Valley Blvd. Bloomington 92316 (909)877-4310
Bonnie Baker Senior Center 149350 Ukiah Trail Big River 92242 (760)665-2667
Casa Ramona Senior Center 1524 W. 7�St. San Bernardino 92311 (909)889-0011
Chino Senior Center 13170 Central Ave. Chino 91710 (909)591-9836
Delmann Heights Senior Center 2969 North Flores San Bernardino 92405 (909) 887-2115
El Mirage Senior Club 1488 Milton El Mirage 92301 (760) 388-4429
George White Senior Center 856 S. Nuevo Ave. Fontana 92335 (909)822-4493
Gibson Senior Center 250 N. Third St. Upland 91786 (909) 981-4501
Grand Terrace Senior Center 22627 Grand Terrace Grand Terrace 92313 (909) 824-1491
Rd.
Havasu Lake Senior Center So. 17 Mile Rd. Havasu Lake 92363 (760)858-4336
Hesperia Senior Center 16292 Lime St. Hesperia 92345 (760)244-1680
Highland Senior Center 3102 E. Highland Ave. Highland 92369 (909) 862-8104
Hinkley Senior Center 35779 Mt.View Hinkley 92347 (760)253-4677
Home of Neighborly Senior Center 839 N. Mt. Vernon San Bernardino 92311 (909) 885-3491
Hootman Senior Center 2929 School Rd. Running Springs 92382 (909)867-3176
Hutton Senior Center 660 Colton Ave. Colton 92324 (909) 370-6168
James Brulte Senior Center 1120 Baseline Rd. Rancho 91730 (909)477-2780
Cucamonga
Jessie Turner Senior Center 6396 Citrus Ave. Fontana 92336 (909)428-8372
Josephine Knopf Senior Center 8384 Cypress Ave. Fontana 82335 (909)428-8376
Page 1 of 3
ATTACHMENT H
Landers Senior Center 58380 Reche Rd. Landers 92285 (760)364-3936
Leisure Shores Senior Center 24658 San Moritz Dr. Crestline 92325 (909) 338-5036
Luque Senior Center 292 East"O" Street Colton 92324 (909) 370-5087
Lucerne Valley Senior Club 10431 Allen Way Lucerne Valley 92366 (760)248-2248
Mentone Senior Center 1331 Opal Ave. Mentone 92359 (909) 794-0327
Montclair Senior Center 5111 Benito Montclair 91763 (909)625-9462
Mountain Communities Senior Center 675 Grandview Rd. Twin Peaks 92391 (909)337-1824
Needles Senior Center 1699 Bailey Needles 92363 (760) 326-5643
Newberry Springs Senior Center 3383 Newberry Rd. Newberry Springs 92365 (760)257-3284
Oldtimers Foundation Senior Center 8572 Sierra Ave. Fontana 92335 (909) 829-0364
Ontario Community Senior Center 225 East"B" St. Ontario 92764 (909)395-2021
Perris Hill Park Senior Center 760 E. 21"St. San Bernardino 92418 (909)384-5436
Phelan Senior Center 9856 Sheep Creek Rd. Phelan 92371 (760) 868-8067
Pinon Hills Senior Center 10433 Mountain Rd. Pinon Hills 92371 (760)868-8637
Red Mountain Senior Center P.O. Box 824 Red Mountain 92558 (760) 374-2201
Redlands Community Senior Center 111 W. Lugonia Redlands 92373 (909) 798-7579
Redlands Joslyn Senior Center 21 Grant St. Redlands 92373 (909)798-7550
Rialto Senior Center 14111 S. Riverside Rialto 92376 (909) 877-9706
Ave.
San Bernardino Senior Center 600 W. 5� St. San Bernardino 92410 (909)384-5430
Trona Senior Center 13187 Market St. Trona 93562 (760) 372-5889
Victorville Activity Center 15075 Hesperia Rd. Victorville 92392 (760) 245-7047
Victorville Senior Center 14874 South Mojave Victorville 92392 (760)245-5018
Dr.
Wonder Valley Senior Center 80526 %Amboy Rd. Twentynine Palms 92277 (760) 367-1678
Wrightwood Senior Center P.O. Box 607 Wrightwood 92397 (760)249-3854
Yucaipa Senior Center 12202 First St. Yucaipa 92399 (909)797-1177
Yucca Valley Senior Center 57088 29 Palms Hwy Yucca Valley 92284 (760)228-5453
Page 2 of 3
ATTACHMENT H
Following are the addresses of the Department of Aging and Adult Services offices.
city Address Zip Phone
Barstow 536 East Virginia Way 92311 (760) 256-5544
Needles 1300 Bailey Avenue 92363 (760) 326-9328
Rancho Cucamonga 9445 Fairway View Place 91730 (909) 948-6200
San Bernardino 686 E. Mill Street 92415 (909) 891-3900
Victorville 17270 Bear Valley Road, Suite 108 92395 (760)843-5100
Yucca Valley 56357 Pima Trail 92284 (760)228-5390
Page 3 of 3
ATTACHMENT
MONTHLY NUTRITION PROGRAM REQUEST FOR REIMBURSEMENT
(Due on the 5th working day of the following month)
FY 2010-2011
COUNTY OF SAN BERNARDINO CONTRACTOR NAME AND ADDRESS:
DEPARTMENT OF AGING &ADULT SERVICES
CFDA#s: MONTH: D
CONGREGATE SIrES C 1 ❑ HOME DELIVERED MEALS C 2 ❑
# of Meals Provided as Entered into SAMS
(X) Reimbursable Cost Per Meal S
= REQUEST FOR REIMBURSEMENT S
Prepared By: , Date:
Signature
Approved By: Date:
Signature
❑ Check this box if you sold any equipment purchased with Nutrition grant funds during the
the month being reported.
IMPORTANT:
1.Invoice must be signed by Contractor or invoice will be returned for signature.
2.Monthly Invoice must be accompanied by separate Contractor Monthly Expenditure Report.
Pant 1 of 1
ATTACHMENT J
NUTRITION PROGRAM Contractor Quarterly Expenditure Report.
(Submit quarterly by the 5th working day October,January,March and June for the previous quarter of service)
FY 2010-2011
COUNTY OF SAN BERNARDINO CONTRACTOR NAME AND ADDRESS:
DEPARTMENT OF AGING &ADULT SERVICES
CFDA# MONTH:
CONGREGATE SITES C 1 ❑ HOME DELIVERED MEALS C 2 ❑
A + B C
COST TO PROVIDER TOTAL MONTHLY
EXPENDITURES: CASH IN-KIND EXPENSE
1 lPersonnel $ $
2. Staff Travel and Training-
3. Equipment(including One-Time-Only purchases) -
4. Consultants -
5. Catered Food -
6. Raw Food -
7. Other Expenses
a. Consumable Supplies -
b. Insurance -
c. Repair&Maintenance -
J. Rent/Building Space -
e. Utilities -
f. Vehicle Operations -
Miscellaneous -
8. Indirect Costs -
g. Total Expenditures add lines 1-8) $
DEDUCTIONS FROM EXPENDITURES: TOTAL
CASH IN-KIND DEDUCTIONS
10 Program Income income not from DAAS $ - $ -
11 Deferred Income -
12 Matching Cash -
13 Matching In-Kind -
14 Non-Match Cash -
15 Non-Match In-Kind -
16 Total Deductions add lines 10-15 $ - $ - $ -
TOTAL EXPENDITURES LESS DEDUCTIONS line 9 less line 16
Prepared By: Date:
Signature
Approved By: Date:
Signature
❑ Check this box if you sold any equipment purchased with Nutrition grant funds during the
the month being reported.
*CONTRACTOR MUST SIGN INVOICE FOR PAYMENT,OR INVOICE WILL BE RETURNED FOR SIGNATURES!
ATTACHMENT K
NAME OF CONTRACTOR
BUDGET LINE ITEMS FOR NUTRITION SERVICES
Fiscal Year 2010/2011
CONGREGATE SITES C-1 [i] HOME DELIVERED MEALS C-2 ❑
Section I: Prepare this section based on annual estimated cost to serve the meals.
a I b C=a+b
Cost to Provider for the year
Expenditure Category: Cash In-Kind Annual Expense
1 Personnel 132,207 36,300 168,507
2 Staff Travel&Training
3 Equipment
4 Consultants 9,918 9,918
5 Catered Food
6 Raw Food 65,802 10,000 75,802
7 Other Expenses:
a. Consumable Supplies 7,280 7,280
b. Insurance
c. Repair& Maintenance 4,500 4,500
d. Rent/Building Space
e. Utilities 21,929 21,929
f. Vehicle Operations 3,000 3,000
g. Miscellaneous 1,488 1,488
8. Indirect Cost
9. Nutrition Education 785 785
Total Expenditures(add lines 1-9) 224,980 68,229 293,209
County Contract Revenue Sources:
Title IIIC 153,940 153,940
NSIP 22,235 22,235
One Time Only
CDBG-DAAS
CDBG-ECD
County Funding
Nutrition Education 785 785
Total County Contract Revenue Sources 176,960 176,960
Other Revenue Sources:
Program Income 40,000 40,000
Deferred Income
Matching Cash
Matching In-Kind 68,229 68,229
Non-Match Cash 8,020 __ 8,020
Non-Match In-Kind
Total Other Revenue Sources 116,249 116,249
Total Revenue 293,209 293,209
Section II: Prepare this section based on estimated number of meals that will be served
multiplied by meal cost per unit.
D I E f=d*e
Estimated annual number of meals Proposed meal cost per unit Annual Budget
32,000 $5.53 $175,960
ATTACHMENT L
Budget In-Kind Narrative
Provide information regarding specific in-kind to be used as match. Include site location, if applicable, descriptions, rate
and other relevant information. The Total should equal the amount of in-kind reported as match on your budget summary.
Description* Site/Location Rate Total In-Kind Match
*(Identify type of in-kind: rent, volunteer services, etc.)
DATE OF
SUBMISSION PROVIDER NAME
San Bernardino County-DAAS Form 332
Revised 01/0812001
1 RESOLUTION NO.
2 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE
CITY OF SAN BERNARDINO AUTHORIZING THE CITY MANAGER TO
3 EXECUTE A CONTRACT WITH THE COUNTY OF SAN BERNARDINO
4 DEPARTMENT OF AGING AND ADULT SERVICES (DAAS), ACCEPTING
THE PROPOSAL AMOUNT OF $176,960 FOR THE PERIOD OF JULY 1, 2010
5 THROUGH JUNE 30,2011 FOR THE SENIOR NUTRITION PROGRAM.
6 BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF
THE CITY OF SAN BERNARDINO AS FOLLOWS:
7
8 SECTION 1. That the City Manager is hereby authorized to execute a FAS
9 Standard Agreement with the County of San Bernardino, for a grant in the amount of
10 $176,960 for a one-year period - July 1, 2010 through June 30, 2011, a copy of which is
11 attached hereto, marked Exhibit "A" and incorporated herein by reference as fully as
12 though set forth at length; and
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SECTION 2. That the authorization granted hereunder shall expire and be void
14
15 and of no further effect if the Standard Agreement is not executed by both parties and
16 returned to the Office of the City Clerk within one hundred and twenty days (120) days
17 following effective date of the Resolution.
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1 RESOLUTION NO.
2 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE
CITY OF SAN BERNARDINO AUTHORIZING THE CITY MANAGER TO
3 EXECUTE A CONTRACT WITH THE COUNTY OF SAN BERNARDINO
4 DEPARTMENT OF AGING AND ADULT SERVICES (DAAS), ACCEPTING
THE PROPOSAL AMOUNT OF $176,960 FOR THE PERIOD OF JULY 1, 2010
5 THROUGH JUNE 30,2011 FOR THE SENIOR NUTRITION PROGRAM.
6 I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the
7 Mayor and Common Council of the City of San Bernardino at a meeting
8 thereof,held on the_day of 2010,by the following vote,to wit:
9
Council Members: AYES NAYS ABSTAIN ABSENT
10
MARQUEZ
11
12 DESJARDINS
13 BRINKER
14 SHORETT
15 KELLEY
16 JOHNSON
17
MC CAMMACK
18
19
20 City Clerk
21 The foregoing resolution is hereby approved this day of 2010.
22
23 Patrick J. Moms, Mayor
City of San Bernardino
24 Approved as to Form:
25 By:
26 James F. Penman, City Attorney
27
28
Exhibit A
FOR COUNTY USE ONLY
X New Vendor Code Dept. Contract Number
Change Cha
CITYOFS772 SC OOA
Cancel
County Department Dept. Orgn. Contractors License No.
Department of Aging and Adult Services
County Department Contract Representative Telephone Total Contract Amount
County of San Bernardino Jeri Quick 388-0255 $176,960
FAS
Contract Type
❑ Revenue ® Encumbered ❑ Unencumbered ❑ Other:
STANDARD CONTRACT If not encumbered or revenue contract type,provide reason
Commodity Code Contract Start Date Contract End Date Original Amount Amendment Amount
95200 July 1, 2010 June 30, 2011 $176,960
Fund Dept. Organization Appr. Obi/Rev Source GRC/PROJ/JOB No. Amount
AAF OOA 210 200 2445 $157,668
Fund Dept. Organization Appr. Obi/Rev Source GRC/PROJ/JOB No. Amount
AAF ODA 235 200 2445 $18,507
Fund Dept. Organization Appr. Obj/Rev Source GRC/PROJ/JOB No. Amount
AAF ODA 280 200 2445 $785
Project Name Estimated Payment Total by Fiscal Year
Elderly Nutrition Services FY Amount 1/D FY Amount I/D
Program 10-11 $176,960 1
THIS CONTRACT is entered into in the State of California by and between the County of San Bernardino,
Department of Aging and Adult Services, hereinafter called the County, and
Name
City of San Bernardino hereinafter called Contractor
Address
300 North D Street
San Bernardino, CA 92418
Phone Birth Date
(909) 384-5231
Federal ID No.or Social Seventy No,
95-6000772
IT IS HEREBY AGREED AS FOLLOWS:
WHEREAS the County desires to provide nutrition programs for the elderly; and
WHEREAS, the Older Americans Act of 1965 provides assistance to State and local agencies to develop nutrition
programs for the elderly; and
WHEREAS, the County has been allocated Older Americans Act funds by the California Department of Aging for the
purpose of administering nutrition programs for the elderly; and
WHEREAS, County finds Contractor qualified to provide nutrition programs for the elderly; and
WHEREAS, County desires that such services be provided by Contractor and Contractor agrees to perform these
services according to the specific terms and conditions provided by the Contract.
NOW THEREFORE, in consideration of the mutual promises contained herein, County and Contractor mutually
agree to the following terms and conditions:
t �
Exhibit A
TABLE OF CONTENTS
I. DEFINITIONS...................................................................................................................................3
II. COUNTY RESPONSIBILITIES ........................................................................................................5
III. CONTRACTOR GENERAL RESPONSIBILITIES............................................................................5
IV. COUNTY RESPONSIBILITIES ......................................................................................................16
V. FISCAL PROVISIONS ...................................................................................................................16
VI. RIGHT TO MONITOR AND AUDIT........:............................................................................................19
VII. CORRECTION OF PERFORMANCE DEFICIENCIES........................................................................20
VIII. TERM..:................................................................................................................................................21
IX. EARLY TERMINATION.......................................................................................................................21
X. GENERAL PROVISIONS....................................................................................................................21
XI. CONCLUSION.....................................................................................................................................25
ATTACHMENT A - SCOPE OF WORK
ATTACHMENT B - CLIENT COMPLAINT AND GRIEVANCE PROCEDURE
ATTACHMENT C - CONTRACTOR/VENDOR CONFIDENTIALITY STATEMENT (CDA 1024)
ATTACHMENT D - SECURITY INCIDENT REPORT FORM (CDA 1025)/SECURITY
INCIDENT REPORT INSTRUCTIONS
ATTACHMENT E - ASSURANCE OF COMPLIANCE
ATTACHMENT F - DISCLOSURE OF LOBBYING ACTIVITIES (FORM)
ATTACHMENT G INFORMATION SHEET
ATTACHMENT H - COMMUNITY FOCAL POINTS
ATTACHMENT I - MONTHLY NUTRITION PROGRAM REQUEST FOR REIMBURSEMENT
FORM
ATTACHMENT - NUTRITION PROGRAM CONTRACTOR QUARTERLY EXPENDITURE
REPORT
ATTACHMENT K - BUDGET SUMMARY
ATTACHMENT L - BUDGET IN-KIND NARRATIVE STATEMENT
Exhibit A
I. DEFINITIONS
A. Cash Match — Cash, other than program income, contributed to the project from local or State funds.
With the exception of Community Development Block Grants (CDBG), Federal funds cannot be used
as cash match.
B. CCR—California Code of Regulations
C. CDA—California Department of Aging
D. CDA PM — Title III Program Manual for Area Agencies on Aging —This manual is based on Federal
Regulations for Title III published March 31, 1980 (CRF, Chapter 8, Subchapter C, Part 1321), and
pertinent parts of 45 CFR Subtitle A, Part 74, published June 3, 1980.
E. CFDA—Catalog of Federal Domestic Assistance
F. CFR—Code of Federal Regulations
G. Congregate Nutrition Services (C-1) — Meals provided in a congregate setting for older individuals in
an atmosphere that is pleasant and encourages socialization.
H. Contract — The cover sheet, terms and conditions, attachments, addendums, and amendments,
unless otherwise specified.
I. Contractor—The entity (Contractor/ProviderNendor) to which funds are awarded under this Contract
and which is accountable to DAAS for use of these funds and is responsible for executing its
provisions and services.
J. CRFC — California Retail Food Code (Section 113700 et seq., California Health and Safety Code);
replaces California Uniform Retail Food Facilities Law(CURFFL).
K. DAAS — Department of Aging and Adult Services, and the designated Area Agency on Aging in San
Bernardino County.
L. DHS —California State Department of Health Services
M. Disability — a condition attributable to mental or physical impairment, or a combination of mental and
physical impairments, that results in substantial functional limitations in one (1) or more of the
following areas of major life activity:
1. Self-care
2. Receptive and expressive language
3. Learning
4. Mobility
5. Self-direction
6. Capacity for independent living
7. Economic self-sufficiency
8. Cognitive functioning
9. Emotional adjustment
N. Elderly—Any individual who is sixty(60)years of age or older, also under"older individual."
O. Elderly Nutrition Program — a program which provides nutrition services, as authorized by the Older
Americans Act of 1965, as amended, and which shall be provided in accordance with the provisions
of this Article.
P. Equipment — Tangible personal property with a useful life of more than one year and an acquisition
cost of$5,000 or more per unit.
Q. Financial Statement — For non-Federal entities that expend less than $500,000 in a fiscal year in
Federal awards, a statement that reflects the contractor's financial position, results of operations or
changes in net assets, and, where appropriate, cash flows for the fiscal year audited.
R. General Program Income — Meal income received in the form of contributions or donations made by
the elderly for services rendered under this Contract.
Exhibit A
S. HACCP—Hazard Analysis Critical Control Point.
T. HACCP Plan — a written document that delineates the formal procedures for following the HACCP
principles that were developed by the National Advisory Committee on Microbiological Criteria for
Foods and complies with the requirements of Section 114055, Health and Safety Code.
U. HACCP Principles—the seven basic steps of HACCP which are:
1. The completion of hazard analysis identification by identifying the likely hazards to consumers
presented by a specific food.
2. The determination of critical control points in receiving, storage, preparation, display, and
dispensing of a food.
3. The setting of measurable critical limits for each critical control point determined.
4. Developing and maintaining monitoring practices to determine if critical limits are being met.
5. Developing and utilizing corrective action plans when failure to meet critical limits is detected.
6. Establishing and maintaining a recordkeeping system to verify adherence to a HACCP plan.
7. Establishing a system of audits to:
a. Initially verify the effectiveness of the critical limits set and appropriateness of the
determination of critical control points.
b. Periodically verify the effectiveness of the HACCP plan.
V. Home Delivered Nutrition Services (C-2)—meal provided to older individuals who are homebound.
W. HS — Human Services —A system of integrated services, where the programs and resources of nine
County departments come together to provide a rich, more complete array of services to the citizens
of San Bernardino County under one coordinated effort.
X. MIS—Management Information System
Y. Nutrition Education — informing recipients of congregate and home-delivered meals about current
facts and information which will promote improved food selection, eating habits, nutrition, health
promotion, and disease prevention practices.
Z. Nutrition Services—the procurement, preparation, transport, and service of meals, nutrition education,
nutrition screening, and nutrition counseling, to eligible individuals at congregate sites or in their
homes.
AA. OAA — Older Americans Act — Provides comprehensive, coordinated, community-based systems of
services to the elderly to enable them to maintain health, personal dignity, and independence.
BB. Older Individual-A person sixty (60)years of age or older.
CC. OMB—Office of Management and Budget.
DD. Program Income — Revenue generated by the Contractor or subcontractor from contract-supported
activities. Program income is:
1. Voluntary contributions received from a participant or responsible party as a result of services.
2. Income from usage or rental fees of real or personal property acquired with grant funds or
funds provided under this Agreement.
3. Royalties received on patents and copyrights from contract-supported activities.
4. Proceeds from sale of items fabricated under a contract agreement.
EE. Provider — an entity providing nutrition services. The provider may either be an AAA providing
nutrition services directly with Department approval in accordance with subsection 7320(c) of Title 22,
or an entity under contract with an AAA to provide nutrition services in accordance with Section 7352
of Title 22.
FF. Registered Dietitian—a person who shall be both:
1. Qualified as specified in Sections 2585 and 2586, Business and Professions Code, and,
2. Registered by the Commission on Dietetic Registration.
GG. Reimbursable Item —Allowable cost and compensable item.
i
Exhibit A
HH. SEFA—Schedule of Expenditures of Federal Awards
II. Single Audit Entity — Non-Federal entities that expend $500,000 or more in a fiscal year in Federal
awards. Single Audit Entities must have a single or program-specific audit conducted for the year in
accordance with OMB Circular A-133.
JJ. State—State of California
KK. Title III —Title III of the Older Americans Act
LL. USC— United States Code
MM. USDA— United States Department of Agriculture
NN. Volunteer — an individual who provides services without pay, but may receive reimbursement for
expenses.
00. W& I —California Welfare and Institutions Code
j II. CONTRACTOR SERVICE RESPONSIBILITIES
` Contractor shall provide all services as outlined in Scope of Work(Attachment A).
III. CONTRACTOR GENERAL RESPONSIBILITIES
A. In the performance of this Contract, Contractor, its agents and employees, shall act in an
independent capacity and not as officers, employees, or agents of the County of San Bernardino.
Contractor certifies that neither it nor its principals is presently disbarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any
federal department or agency as required by Executive Order 12549 and implemented as 45 Code
of Federal Regulations part 76.
B. Without the prior written consent of the Assistant County Administrator for Human Services, this
Contract is not assignable by Contractor either in whole or in part. Contractor agrees not to enter into
any subcontracts for work contemplated under this Contract without first obtaining written approval
from the Assistant County Administrator— Human Services. Any subcontractor shall be subject to
the same provisions as Contractor. Contractor shall be fully responsible for the performance of any
subcontractor.
C. Contractor agrees to provide or has already provided information on former County of San
Bernardino administrative officials (as defined below) who are employed by or represent
Contractor. The information provided includes a list of former County administrative officials who
terminated County employment within the last five years and who are now officers, principals,
partners, associates or members of the business. The information also includes the employment
with or representation of Contractor. For purposes of this provision, "County administrative official"
is defined as a member of the Board of Supervisors or such officer's staff, County Administrative
Officer or member of such officer's staff, County department or group head, assistant department
or group head, or any employee in the Exempt Group, Management Unit or Safety Management
Unit.
D. If during the course of the administration of this Contract, the County determines that the
Contractor has made a material misstatement or misrepresentation or that materially inaccurate
information has been provided to the County, this Contract may be immediately terminated. If this
Contract is terminated according to this provision, the County is entitled to pursue any available
legal remedies.
E. Contractor shall maintain all records and books pertaining to the delivery of services under this
Contract and demonstrate accountability for contract performance.
Said records shall be kept and maintained within the County of San Bernardino or within
reasonable driving distance. County shall have the right upon reasonable notice and at reasonable
hours of business to examine and inspect such records and books.
Exhibit A
Records should include, but are not limited to, monthly summary sheets, sign-in sheets, and other
primary source documents. Fiscal records shall be kept in accordance with Generally Accepted
Accounting Principles and must account for all funds, tangible assets, revenue and expenditures.
Fiscal records must also comply with the appropriate Office of Management and Budget (OMB)
Circulars that state the administrative requirements, cost principles and other standards for
accountancy.
All records shall be complete and current and comply with all Contract requirements. Failure to
maintain acceptable records per the preceding requirements shall be considered grounds for
withholding of payments for billings submitted and for termination of the Contract.
F. Contractor shall notify County in writing of any change in mailing address and/or physical location
within ten (10) days of the change, and shall immediately notify County of changes in telephone or
fax numbers.
G. Contractor shall notify County of any continuing vacancies and any positions that become vacant
during the term of this Contract that will result in reduction of services to be provided under this
Contract. Upon notice of vacancies, the Contractor shall apprise County of the steps being taken to
provide the services and to fill the position as expeditiously as possible. All vacancies and associated
problems shall be reported to County on each periodically required report for the duration of said
vacancies and/or problems.
H. Contractor shall designate an individual to serve as the primary point of contact for the Contract.
Contractor shall notify the County when the primary contact will be unavailable/out of the office for one
(1) or more workdays. Contractor or designee must respond to County inquiries within two (2) County
business days.
I. Contractor shall provide a system, approved by the County, through which recipients of service shall
have the opportunity to express and have considered their views and complaints regarding the
delivery of services. The procedure (Attachment B) must be in writing and posted in clear view of all
recipients.
J. Contractor shall keep the County apprised of any and all actions taken by its Board of Directors which
may impact on the Contract. Further, a County representative shall have the option of attending Board
meetings during the term of this Contract.
L. Information Integrity and Security
1. Information Assets
The Contractor shall have in place operational policies, procedures, and practices to protect
State information assets, i.e., public, confidential, sensitive and/or personal information as
specified in State Administrative Manual, Section 4841.2., GC Section 11019, Department
of Finance (DOF) Management Memo 06-12, and DOF Budget Letter 06-34.
Information assets include (but are not limited to):
• Information collected and/or accessed in the administration of the State programs
and services.
• Information stored in any media form, paper or electronic.
2. Encryption on Portable Computing Devices
The Contractor is required to encrypt (or use an equally effective measure), any data
collected under this agreement that is confidential, sensitive, and/or personal including data
stored on portable computing devices (including but not limited to, laptops, personal digital
assistants, and notebook computers) and/or portable electronic storage media (including
but not limited to, discs and thumb/flash drives, portable hard drives).
Exhibit A
3. Disclosure
a. The Contractor shall ensure that personal, sensitive and confidential information is
protected from inappropriate or unauthorized access or disclosure in accordance
with applicable laws, regulations and State policies. The requirement to protect
information shall remain in force until superseded by laws, regulations or policies.
b. The Contractor shall protect from unauthorized disclosure names and other
identifying information, concerning persons receiving services pursuant to this
Agreement, except for statistical information not identifying any participant.
C. "Identifying information" shall include, but not be limited to, name, identifying
number, social security number, state driver's license or state identification number,
financial account numbers, symbol or other identifying characteristic assigned to the
individual, such as finger or voice print or a photograph.
d. The Contractor shall not use such identifying information for any purpose other than
carrying out the Contractor's obligations under this agreement.
e. The Contractor shall not, except as otherwise specifically authorized or required by
this agreement, release any identifying information obtained under the terms of this
agreement to anyone other than DAAS and/or CDA without prior written
authorization from DAAS or CDA, except by court order. The Contractor may be
authorized, in writing, by a participant to disclose identifying information specific to
the authorizing participant.
f. The Contractor may allow a participant to authorize the release of information to
specific entities, but shall not request or encourage any participant to give a blanket
authorization or sign a blank release, nor shall the Contractor accept such blanket
authorization from any participant.
4. Training/Education
a. The Contractor must provide ongoing education and training, at least annually, to all
employees and subcontractors who handle personal, sensitive or confidential
information. Contractor employees, subcontractors, and volunteers must complete
the required Security Awareness Training module located at www.aging.ca.gov
within 30 days of the start date of the Contract/Agreement or within 30 days of the
start date of any new employee, subcontractor or volunteer. The Contractor must
maintain certificates of completion on file and provide them to DAAS upon request.
Training may be provided on an individual basis or in groups. A sign-in sheet is
acceptable documentation for group training in lieu of individual certificates. If
internet access is not available, a hardcopy of the training module may be provided
to employees and/or volunteers for their completion.
b. Contractor may substitute CDA's Security Awareness Training program with its own
Security Training provided such training meets or exceeds CDA's training
requirement. ContractorsNendors shall maintain documentation of training and
education provided to their staff, volunteers, and/or subcontractors.
C. All employees and volunteers who handle personal, sensitive or confidential
information relating to CDA's programs must participate in Security Awareness
Training.
5. Health Insurance Portability and Accountability Act(HIPAA)
The Contractor agrees to comply with the privacy and security requirements of the HIPAA to
the extent applicable and to take all reasonable efforts to implement HIPAA requirements.
Contractor will make reasonable efforts to ensure that subcontractors comply with the privacy
and security requirements of HIPAA.
Exhibit A
6. Contractor Confidentiality Statement
The Contractor shall sign and return a ContractorNendor Confidentiality Statement CDA
1024 form (Attachment C) with this Agreement. This is to ensure that ContractorNendors
are aware of, and agree to comply with, their obligations to protect CDA information assets
from unauthorized access and disclosure.
Contractor shall protect from unauthorized use or disclosure names and other identifying
information concerning persons receiving services pursuant to this Contract, except for
statistical information not identifying any participant. The Contractor shall not use or
disclose any identifying information for any other purpose other than carrying out the
Contractor's obligations under this Contract, except as may be otherwise required by law.
The provision will remain in force even after the termination of the Contract.
7. Security Incident Reporting
A security incident occurs when CDA information assets are accessed, modified, destroyed,
or disclosed without proper authorization, or are lost, or stolen. The Contractor must report
all security incidents to DAAS immediately upon detection. A Security Incident Report form
(CDA 1025) (Attachments D) must be submitted to DAAS within five (5) business days of
the date the incident was detected.
8. Notification of Security Breach to Data Subjects
a. Notice must be given by the Contractor or subcontractor to any data subject whose
personal information could have been breached.
b. Notice must be given in the most expedient time possible and without unreasonable
delay except when notification would impede a criminal investigation, or when
necessary measures to restore system integrity are required.
C. Notice may be provided in writing, electronically, or by substitute notice in
accordance with State law, regulation, or policy.
9. Software Maintenance
The Contractor shall apply security patches and upgrades and keep virus software up-to-date
on all systems on which data collected under this agreement that is confidential, sensitive
and/or personal may be used.
10. Provisions of this Article
The provisions contained in this Information Integrity and Security Paragraph shall be
included in all contracts of both the contractor and its subcontractors.
11. Contractor shall ensure that all staff, volunteers and/or subcontractors performing services
under this Contract comply with the terms and conditions as set forth in the Human Services
Information Privacy and Security Requirements prior to providing any services. Contractor
shall immediately notify the County of any suspected or actual breach of confidential
information as further detailed in the requirements. These requirements specified at
http://hss.sbcounty.gov/Privacy are hereby incorporated by this reference.
M. Elder and Dependent Adult Abuse Reporting
Contractor agrees to and shall comply with the County's Elder and Dependent Adult Abuse Reporting
requirements: Under the terms of this Contract, as changes in the Elder and Dependent Adult
Reporting Laws are enacted, the Contractor is bound to comply with the most current regulations.
Exhibit A
1. Who Must Report:
In accordance with W & I Code Section 15630, all employees of the Contractor and its
subcontractors are mandated reporters of elder and dependent adult abuse. Contractor
assures all employees, agents, consultants or volunteers who perform services under this
Contract and are mandated to report elder and dependent adult abuse will sign a statement
(SOC 341A) http://www.dss.cahwnet.gov/Forms/English/SOC341.Pdf, upon the
commencement of their employment, acknowledging their reporting requirements and their
compliance with them.
2. When To Report:
Mandated reporters are required to report all instances of known or suspected abuse of the
elderly and dependent adults immediately or as soon as practically possible, under the
following circumstances:
a. When the mandated reporter has observed or has knowledge of an incident that
reasonably appears to be physical abuse, abandonment, isolation, neglect, financial
abuse, mental abuse or sexual abuse; or
b. When the mandated reporter is told by an elder or dependent adult that he or she has
experienced behavior constituting physical abuse, abandonment, isolation, neglect,
financial abuse, mental abuse or sexual abuse. .
3. To Whom To Report:
Incidents of elder and dependent adult abuse must be reported to the correct agency as
follows:
a. If the abuse has occurred in a long term care facility, except a state mental hospital
or state developmental center, the report shall be made to the local Long-Term Care
Ombudsman or local law enforcement;
b. If the abuse has occurred in a state mental hospital or state developmental center,
the report shall be made to the designated investigators of the State Department of
Mental Health or the State Department of Developmental Services or to the local law
enforcement;
C. If the abuse occurred anywhere other than a long-term care facility or State mental
hospital or State developmental center, the report shall be made to Adult Protective
Services or local law enforcement.
4. How To Report:
Mandated reporters are required to take the following steps in all instances of known or
suspected abuse of the elderly and dependent adults:
a. Place an immediate telephone call to Adult Protective services (1-877-565-2020) or
local law enforcement to report the incident.
b. Within two (2) working days of making the telephonic report to the responsible
agency, complete a written 'Report of Suspected Dependent Adult/Elder Abuse"
(SOC 341) form, http://www.dss.cahwnet.gov/Forms/English/SOC341.pdf. The
completed form must be submitted to the same agency to which the incident was
reported by telephone.
N. Contractor shall ensure that all known or suspected instances of child abuse or neglect are reported
to the appropriate law enforcement agency or to the appropriate Child Protective Services agency.
This responsibility shall include:
1. Assurance that all employees, agents, consultants or volunteers who perform services
under this Contract and are mandated by Penal Code Sections 11164 at seq. to report child
Exhibit A
abuse or neglect, sign a statement, upon the commencement of their employment,
acknowledging their reporting requirements and their compliance with them.
2. Development and implementation of procedures for employees, agents, consultants, or
volunteers who are not subject to the mandatory reporting laws for child abuse to report any
observed or suspected incidents of child abuse to a mandated reporting party, within the
program, who will ensure that the incident is reported to the appropriate agency.
3. Provision for or arrangement of training in child abuse reporting laws (Penal Code section
11164 et seq.) for all employees, agents, consultants, and volunteers, or verification that
such persons have received training in the law within thirty (30) days of
employment/volunteer activity.
O. Contractor shall obtain from the Department of Justice (DOJ) records of all convictions involving
any sex crimes, drug crimes, or crimes of violence of a person who is offered employment or
volunteers for all positions in which he or she would have contact with a minor, the aged, the blind,
the disabled or a domestic violence client, as provided for in Penal Code section 11105.3 prior to
providing any services. This includes licensed personnel who are not able to provide
documentation of prior DOJ clearance. A copy of a license from the State of California is sufficient
proof. The County must be immediately notified of any records showing a conviction. The County
may instruct Contractor to take action to deny/terminate employment or terminate internship and/or
volunteer services where the records show the person is unsuitable for employment, internship, or
volunteer services.
P. Contractor shall notify the County of any staff member, paid intern or volunteer who is knowingly or
negligently employed who has been convicted of any crime of violence or of any sexual crime.
Contractor shall investigate all incidents where an applicant, employee, intern or volunteer has
been arrested and/or convicted for any crime listed in Penal Code Section 11105.3 and shall notify
the County. In the County's discretion, the County may instruct Contractor to take action to either
deny/terminate employment or terminate internship and/or volunteer services where the
investigation shows that the underlying conduct renders the person unsuitable for employment,
internship, or volunteer services.
Contractor shall immediately notify the County concerning the arrest and/or conviction, for other
than minor traffic offenses, of any paid employee, agent, consultant, intern, or volunteer staff, when
such information becomes known to Contractor.
Q. Conflict of Interest
1. The Contractor shall prevent employees, consultants, or members of governing bodies from
using their positions for purposes including, but
not limited to, the selection of subcontractors, that are, or give the appearance of being,
motivated by a desire for private gain for themselves or others, such as family, business, or
other ties. In the event that the County determines that a conflict of interest exists, funds
may be disallowed by the County and such conflict may constitute grounds for termination
of the Agreement.
2. This provision shall not be construed to prohibit employment of persons with whom the
Contractor's officers, agents, or employees have family, business, or other ties, so long as
the employment of such persons does not result in a conflict of interest (real or apparent) or
increased costs over those associated with the employment of any other equally qualified
applicant, and such persons have successfully competed for employment with the other
applicants on a merit basis.
R. Contractor agrees to and shall comply with the following indemnification and insurance requirements:
1. Indemnification — The Contractor agrees to indemnify, defend (with counsel reasonably
approved by County) and hold harmless the County and its authorized officers, employees,
agents and volunteers (Indemnitees) from any and all claims, actions, losses, damages,
and/or liability arising out of this contract from any cause whatsoever, including the acts,
Exhibit A
errors or omissions of any person and for any costs or expenses incurred by the County on
account of any claim except where such indemnification is prohibited by law. This
indemnification provision shall apply regardless of the existence or degree of fault of
Indemnitees. The Contractor's indemnification obligation applies to the County's "active" as
well as "passive" negligence but does not apply to the County's "sole negligence" or "willful
misconduct" within the meaning of Civil Code Section 2782.
2. Additional Insured — All policies, except for the Workers' Compensation, Errors and
Omissions and Professional Liability policies, shall contain endorsements naming the
County and its officers, employees, agents and volunteers as additional insureds with
respect to liabilities arising out of the performance of services hereunder. The additional
insured endorsements shall not limit the scope of coverage for the County to vicarious
liability but shall allow coverage for the County to the full extent provided by the policy. Such
additional insured coverage shall be at least as broad as Additional Insured (Form B)
endorsement form ISO, CG 2010.11 85.
3. Waiver of Subrogation Rights — The Contractor shall require the carriers of required
coverages to waive all rights of subrogation against.the County, its officers, employees,
agents, volunteers, contractors and subcontractors. All general or auto liability insurance
coverage provided shall not prohibit the Contractor and Contractor's employees or agents
from waiving the right of subrogation prior to a loss or claim. The Contractor hereby waives
all rights of subrogation against the County.
4. Policies Primary and Non-Contributory — All policies required herein are to be primary and
non-contributory with any insurance or self-insurance programs carried or administered by
the County.
5. Severability of Interests — The Contractor agrees to ensure that coverage provided to meet
these requirements is applicable separately to each insured and there will be no cross
liability exclusions that preclude coverage for suits between the Contractor and the County
or between the County and any other insured or additional insured under the policy.
i
8. Proof of Coverage — The Contractor shall furnish Certificates of Insurance to the County
Department administering the contract evidencing the insurance coverage, including
endorsements, as required, prior to the commencement of performance of services
hereunder, which certificates shall provide that such insurance shall not be terminated or
expire without thirty (30) days written notice to the Department, and Contractor shall
maintain such insurance from the time Contractor commences performance of services
hereunder until the completion of such services. Within fifteen (15) days of the
commencement of this contract, the Contractor shall furnish a copy of the Declaration page
for all applicable policies and will provide complete certified copies of the policies and
endorsements immediately upon request.
7. Acceptability of Insurance Carrier — Unless otherwise approved by Risk Management,
insurance shall be written by insurers authorized to do business in the State of California
and with a minimum "Best" Insurance Guide rating of"A-VII".
8. Deductibles and Self-Insured Retention - Any and all deductibles or self-insured retentions
in excess of$10,000 shall be declared to and approved by Risk Management.
9. Failure to Procure Coverage — In the event that any policy of insurance required under this
contract does not comply with the requirements, is not procured, or is canceled and not
replaced, the County has the right but not the obligation or duty to cancel the contract or
obtain insurance if it deems necessary and any premiums paid by the County will be
promptly reimbursed by the Contractor or County payments to the Contractor will be
reduced to pay for County purchased insurance.
10. Insurance Review — Insurance requirements are subject to periodic review by the County.
The Director of Risk Management or designee is authorized, but not required, to reduce,
waive or suspend any insurance requirements whenever Risk Management determines that
Exhibit A
any of the required insurance is not available, is unreasonably priced, or is not needed to
protect the interests of the County. In addition, if the Department of Risk Management
determines that heretofore unreasonably priced or unavailable types of insurance coverage
or coverage limits become reasonably priced or available, the Director of Risk Management
or designee is authorized, but not required, to change the above insurance requirements to
require additional types of insurance coverage or higher coverage limits, provided that any
such change is reasonable in light of past claims against the County, inflation, or any other
item reasonably related to the County's risk.
Any change requiring additional types of insurance coverage or higher coverage limits must
be made by amendment to this contract. Contractor agrees to execute any such
amendment within thirty (30) days of receipt.
Any failure, actual or alleged, on the part of the County to monitor or enforce compliance
with any of the insurance and indemnification requirements will not be deemed as a waiver
of any rights on the part of the County.
11. The Contractor agrees to provide insurance set forth in accordance with the requirements
herein. If the Contractor uses existing coverage to comply with these requirements and that
coverage does not meet the specified requirements, the Contractor agrees to amend,
supplement or endorse the existing coverage to do so. The type(s) of insurance required is
determined by the scope of the contract services.
Without in anyway affecting the indemnity herein provided and in addition thereto, the
Contractor shall secure and maintain throughout the contract term the following types of
insurance with limits as shown:
a. Workers' Compensation/Employers Liability—A program of Workers' Compensation
insurance or a state-approved, self-insurance program in an amount and form to
meet all applicable requirements of the Labor Code of the State of California,
including Employer's Liability with $250,000 limits covering all persons including
volunteers providing services on behalf of the Contractor and all risks to such
persons under this contract.
If Contractor has no employees, it may certify or warrant to the County that it does
not currently have any employees or individuals who are defined as "employees"
under the Labor Code and the requirement for Workers' Compensation coverage will
be waived by the County's Director of Risk Management.
With respect to Contractors that are non-profit corporations organized under
California or Federal law, volunteers for such entities are required to be covered by
Workers' Compensation insurance.
b. Commercial/General Liability Insurance—The Contractor shall carry General Liability
Insurance covering all operations performed by or on behalf of the Contractor
providing coverage for bodily injury and property damage with a combined single
limit of not less than one million dollars ($1,000,000), per occurrence. The policy
coverage shall include:
1) Premises operations and mobile equipment.
2) Products and completed operations.
3) Broad form property damage (including completed operations).
4) Explosion, collapse and underground hazards.
5) Personal injury
6) Contractual liability.
7) $2,000,000 general aggregate limit.
Exhibit A
C. Automobile Liability Insurance — Primary insurance coverage shall be written on ISO
Business Auto coverage form for all owned, hired and non-owned automobiles or
symbol 1 (any auto). The policy shall have a combined single limit of not less than
one million dollars ($1,000,000) for bodily injury and property damage, per
occurrence.
If the Contractor is transporting one or more non-employee passengers in
performance of contract services, the automobile liability policy shall have a
combined single limit of two million dollars ($2,000,000) for bodily injury and property
damage per occurrence.
If the Contractor owns no autos, a non-owned auto endorsement to the General
Liability policy described above is acceptable.
d. Umbrella Liability Insurance — An umbrella (over primary) or excess policy may be
used to comply with limits or other primary coverage requirements. When used, the
umbrella policy shall apply to bodily injury/property damage, personal
injury/advertising injury and shall include a "dropdown" provision providing primary
coverage for any liability not covered by the primary policy. The coverage shall also
apply to automobile liability.
e. Professional Liability — Professional Liability Insurance with limits of not less than
one million ($1,000,000) per claim or occurrence and two million ($2,000,000)
aggregate limits
or
Errors and Omissions Liability Insurance with limits of not less than one million
($1,000,000) and two million ($2,000,000) aggregate limits
or
Directors and Officers Insurance coverage with limits of not less than one million
($1,000,000) shall be required for Contracts with charter labor committees or other
not-far-profit organizations advising or acting on behalf of the County.
If insurance coverage is provided on a "claims made" policy, the "retroactive date"
shall be shown and must be before the date of the start of the contract work. The
claims made insurance shall be maintained or "tail" coverage provided for a
minimum of five (5) years after contract completion.
S. Contractor shall comply with all applicable laws, statutes, ordinances, administrative orders, rules or
regulations relating to its duties, obligations and performance under the terms of the Contract and
shall procure all licenses and pay all fees and other charges required thereby. Contractor shall
maintain all required licenses during the term of this Contract. Failure to comply with the provisions of
this section may result in immediate termination of this Contract.
T. Contractor shall comply with all applicable local health and safety clearances, including fire
clearances, for each site where services are provided under the terms of this Contract.
U. Contractor agrees to and shall comply with the County's Equal Employment Opportunity Program
and Civil Rights Compliance requirements:
1. Equal Employment Opportunity Program: The Contractor agrees to comply with the
provisions of the Equal Employment Opportunity Program of the County of San Bernardino
and all rules and regulations adopted pursuant thereto: Executive Orders 11246, as
amended by Executive Order 11375, 11625, 12138, 12432, 12250; Title VII of the Civil
Rights Act of 1964; Division 21 of the California Department of Social Services Manual of
Policies and Procedures; California Welfare and Institutions Code section 10000, the
California Fair Employment and Housing Act; and other applicable federal, state, and county
laws, regulations and policies relating to equal employment or social services to welfare
recipients, including laws and regulations hereafter enacted.
Exhibit A
The Contractor shall not unlawfully discriminate against any employee, applicant for
employment, or service recipient on the basis of race, color, national origin or ancestry,
religion, gender, marital status, sexual orientation, age, political affiliation or disability.
Information on the above rules and regulations may be obtained from the County Human
Services Contracts Unit.
2. Civil Rights Compliance: The Contractor shall develop and maintain internal policies and
procedures to assure compliance with each factor outlined by state regulation. These
policies must be developed into a Civil Rights Plan, which is to be on file with the County
Human Services Contracts Unit within 30 days of awarding of the Contract. The Plan must
address prohibition of discriminatory practices, accessibility, language services, staff
development and training, dissemination of information, complaints of discrimination,
compliance review, and duties of the Civil Rights Liaison. Upon request, the County shall
supply a sample of the Plan format. The Contractor shall be monitored by the County for
compliance with provisions of its Civil Rights Plan. Contractor is required to submit
Assurance of Compliance statement (Attachment E) along with their agency's Civil Rights
Plan.
V. Contractor agrees to comply with all applicable provisions of the Americans with Disabilities Act
(ADA).
W. Contractor shall observe the mandatory standards and policies relating to energy efficiency in the
State Energy Conservation Plan (California Code of Regulations title 20, section 1401 et seq.).
X. If the amount available to Contractor under this Contract, as specified in Section IV, Paragraph A,
exceeds $100,000, Contractor agrees to comply with the Clean Air Act (42 U.S.C. Section 7606),
section 508 of the Clean Water Act (33 U.S.C. section 1368), Executive Order 11738 and
Environmental Protection Agency regulations (40 C.F.R. section 1.1 et seq.).
Y. Contractor shall use recycled and recyclable products, whenever practicable, in fulfilling the terms of
this Contract. Recycled printed products shall include a symbol identifying the recycled material.
Z. Contractor understands and agrees that any and all legal fees or costs associated with lawsuits
concerning this Contract against the County shall be the Contractor's sole expense and shall not be
charged as a cost under this Contract. In the event of any Contract dispute hereunder, each Party
to this Contract shall bear its own attorney's fees and costs regardless of who prevails in the
outcome of the dispute.
AA. Contractor shall report immediately to the County in writing any incidents or alleged fraud and/or
abuse by either Contractor or Contractor's subcontract(s). Contractor shall maintain any records,
documents, or other evidence of fraud and abuse until otherwise notified by the County.
BB. The Contractor, by signing this Contract, hereby 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
Contractor, to 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 the awarding of any federal contract, the making
of any federal grant, the making of any federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment, or modification of any
federal contract, grant, loan, 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, 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, loan or cooperative agreement, the
Contractor shall complete and submit Standard Form-LLL, "Disclosure of Lobbying
Activities" form (Attachment F), in accordance with its instructions.
Exhibit
3. The Contractor shall require that the language of this certification be included in any
subcontracts at all tiers, and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when
this transaction was made or entered into. 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.
CC. Contractor shall complete and submit Information Sheet (Attachment G) in accordance with its
instructions.
DD. Per DAAS contract with CDA, Article II.A.(27), Community Focal Points (Attachment H) provides
Contractors with additional resources for their customers.
EE. Contractor agrees to and shall comply with the following American Recovery and Reinvestment Act
funding requirements:
1. Use of ARRA Funds and Requirements: This Contract may be funded in whole or in part
with funds provided by the American Recovery and Reinvestment Act of 2009 ("ARRA"),
signed into law on February 17, 2009. Section 1605 of ARRA prohibits the use of recovery
funds for a project for the construction, alteration, maintenance or repair of a public building
or public work (both as defined in 2 CFR 176.140) unless all of the iron, steel and
manufactured goods (as defined in 2 CFR 176.140) used in the project are produced in the
United States. A waiver is available under three limited circumstances: (i) Iron, steel or
relevant manufactured goods are not produced in the United States in sufficient and
reasonable quantities and of a satisfactory quality; (ii) Inclusion of iron, steel or
manufactured goods produced in the United States will increase the cost of the overall
project by more than 25 percent; or (iii) Applying the domestic preference would be
inconsistent with the public interest. This is referred to as the 'Buy American" requirement.
Request for a waiver must be made to the County for an appropriate determination.
Section 1606 of ARRA requires that laborers and mechanics employed by contractors and
subcontractors on projects funded directly by or assisted in whole or in part by and through
the Federal Government pursuant to ARRA shall be paid wages at rates not less than those
prevailing on projects of a character similar in the locality as determined by the Secretary of
Labor in accordance with the Davis-Bacon Act (40 U.S.C. 31). This is referred to as the
"wage rate" requirement.
The above described provisions constitute notice under ARRA of the Buy American and
wage rate requirements. Contractor must contact the County contact if it has any questions
regarding the applicability or implementation of the ARRA Buy American and wage rate
requirements. Contractor will also be required to provide detailed information regarding
compliance with the Buy American requirements, expenditure of funds and wages paid to
employees so that the County may fulfill any reporting requirements it has under ARRA.
The information may be required as frequently as monthly or quarterly. Contractor agrees
to fully cooperate in providing information or documents as requested by the County
pursuant to this provision. Failure to do so will be deemed a default and may result in the
withholding of payments and termination of this Contract.
Contractor may also be required to register in the Central Contractor Registration (CCR)
database at htto://www.ccr.gov and may be required to have its subcontractors also register
in the same database. Contractor must contact the County with any questions regarding
registration requirements.
2. Schedule of Expenditure of Federal Awards: In addition to the requirements described in
"Use of ARRA Funds and Requirements," proper accounting and reporting of ARRA
expenditures in single audits is required. Contractor agrees to separately identify the
expenditures for each grant award funded under ARRA on the Schedule of Expenditures of
Federal Awards (SEFA) and the Data Collection Form (SF-SAC) required by the Office of
I
Exhibit A
Management and Budget Circular A-133, "Audits of States, Local Governments, and
Nonprofit Organizations." This identification on the SEFA and SF-SAC shall include the
Federal award number, the Catalog of Federal Domestic Assistance (CFDA) number, and
amount such that separate accountability and disclosure is provided for ARRA funds by
Federal award number consistent with the recipient reports required by ARRA Section 1512
(c).
In addition, Contractor agrees to separately identify to each subcontractor and document at
the time of sub-contract and at the time of disbursement of funds, the Federal award
number, any special CFDA number assigned for ARRA purposes, and amount of ARRA
funds.
Contractor may be required to provide detailed information regarding expenditures so that
the County may fulfill any reporting requirements under ARRA described in this section.
The information may be required as frequently as monthly or quarterly. Contractor agrees
to fully cooperate in providing information or documents as requested by the County
pursuant to this provision. Failure to do so will be deemed a default and may result in the
withholding of payments and termination of this Contract.
3. Contractor agree that both it and its subcontractors shall comply with Section 1553 of the
Whistleblower Protection Act-ARRA, which prohibits all non-federal Contractors, including
the State, and all contractors of the State, from discharging, demoting or otherwise
discriminating against an employee for disclosures by the employee that the employee
reasonably believes are evidence of (1) gross mismanagement of a contract relating to
ARRA funds; (2) a gross waste of ARRA funds; (3) a substantial and specific danger to
public health or safety related to the implementation or use of ARRA funds; or (4) a violation
of law, rule, or regulation related to an agency contract (including the competition for or
negotiation of a contract) awarded or issued related to ARRA funds. Contractor agrees that
it and its subcontractors shall post notice of the rights and remedies available to employees
under Section 1553 of the Title XV of Division A of the ARRA.
4. Contractor agrees both it and its subcontractors shall comply with Section 106 (g) of the
Trafficking Victims Protection Act of 2000, as amended (22 U.S.C. 7104).
IV. COUNTY RESPONSIBILITIES
A. The County shall monitor and evaluate the performance of the Contractor in meeting the terms of
the Contract and the quality and effectiveness of services provided based on the criteria as
determined by the County.
B. The County shall provide consultation and technical assistance in monitoring the terms of this
Contract.
C. The County shall compensate the Contractor for approved expenses in accordance with Section V
of this Contract.
V. FISCAL PROVISIONS
A. The maximum amount of funds available for payment under this Contract shall not exceed
$176,960, of which $163,359 may be federally funded, and shall be subject to availability of funds
to the County. The consideration to be paid to Contractor shall be in full payment for all
Contractor's services and expenses incurred in the performance hereof, including travel and per
diem.
B. Contractor shall be compensated on a fee-for-service basis based on the following rate, as
specified in Scope of Work (Attachment A):
Congregate Site: $5.53 per meal, up to 32,000 meals
C. The County shall not approve any request for payment of funds until Contractor has properly filed
completed reports as required under this Contract. If Contractor is not in compliance with any
Exhibit A
provision of this Contract, DAAS may withhold payment of any invoice submitted to DAAS by
Contractor until such time as suitable documentation is submitted to DAAS and/or Contractor is
deemed to be in compliance by DAAS.
D. Reports
1. Contractor, at such times and in such forms as DAAS may require, shall furnish statements,
records, reports, data, and information requested by DAAS pertaining to the Contractor's
performance of services hereunder and other matters covered by this Contract. The forms
shall be reviewed for timeliness, completeness, and correctness of the information
submitted, by the Program Director or his/her designee, prior to submission to DAAS.
Incomplete forms shall be returned to the Contractor for completion. (In the event of
changes in these forms, DAAS shall advise the Contractor via written notice.) The
Contractor shall develop and implement a process for ensuring quality control.
2. Contractor shall meet the following standards for the submission of required financial
reports:
a. Accurate, current and complete disclosure of the financial results of the program
shall be made in accordance with the financial reporting requirements of this
Contract. The following reports are to be submitted to DAAS when indicated:
1) Monthly
Monthly Nutrition Program Request for Reimbursement form
(Attachment 1) — Due to DAAS Administration by the 5" working day
of the month following the month of service to the address stated
below:
DAAS Administration
Attention: Nutrition Program Fiscal Clerk
686 East Mill Street
San Bernardino, CA 92415-0515
2) Quarterly
• Nutrition Program Contractor Quarterly Expenditure Report
(Attachment J) — Due to DAAS Administration by the 5U calendar day
of October, January, March, and June for the previous quarter of
services to the address stated in the above paragraph.
Quarterly reports shall be based on the Budget Summary
(Attachment K).
3) Annually — The following reports are due on an annual basis no later than
August 1:
Financial Close-out Report
• Periodic Inventory Report
• Single Audit or Financial Statement
• Schedule of Expenditures of Federal Awards (SEFA)
E. Upon written demonstration of need by Contractor and at the option of County, up to 10 % of the
Title III funds may be advanced to Contractor by County upon the approval of the Director of DAAS.
Any such advance shall cause the amounts payable to Contractor in subsequent months to be
reduced to the amount determined by dividing the balance left by the number of months remaining
in the Contract term. No advance will increase the amount shown in Section V, Paragraph A.
F. If, as a result of advanced income, the project earns interest on funds awarded by DAAS, that
interest shall be identified as income to the program and used for program expenditures, with full
documentation on file.
G. Contractor shall expend all funds received hereunder in accordance with this Contract.
7
Exhibit A
H. DAAS reserves the right to refuse payment to the Contractor or later disallow costs for any
expenditure determined by DAAS and/or CDA not to be in compliance with this Contract, or-
inappropriate to such activities, or for which there is inadequate supporting documentation
presented, or for which prior approval is required but not granted.
I. Contractor shall return to DAAS, immediately upon written demand, any funds provided under the
Contract which are not payable for goods or services delivered prior to the termination,
cancellation, or expiration of this Contract, or the dissolution of the entity.
J. Contractor must return any unspent funds with submittal of the final invoice.
K. Contractor shall maintain accounting records to account for the funds received under the terms and
conditions of this Contract separate from any other funds administered by the Contractor.
Contractor shall maintain records in accordance with generally accepted accounting principles.
L. General program income shall be used to increase the number of elderly served by a project, to
facilitate access to such meals, and to provide supportive services directly related to nutrition as
defined in the Work Plan/Scope of Work (Attachment A). General program income shall be used
within the program in which it was earned.
M. Matching contributions
1. The Contractor shall provide in-kind matching contributions of a minimum of$17,604, which
i is'the Title III portion of the Contract multiplied by 11.11%.
i 2. Allowable match shall be in compliance with the following requirements:
iii 3. Matching in-kind contributions must be for allowable costs as determined by CDA PM.
Allowable costs include but are not limited to rent, utilities, supplies, and volunteers.
4. To qualify as a matching in-kind contribution, indirect or Contractor allocated overhead
expenses must be supported by a documented cost allocation plan.
5. Matching in-kind contributions in excess of the minimum required in one service component
may be used to match another service component within the Older Americans Act. As an
example, match exceeding the minimum requirement in a transportation program may be
used to offset an under match in in-home supportive services.
6. Contractor shall provide by August 1, 2010 at Budget In-Kind Narrative statement
(Attachment L) to DAAS identifying the type, rates applied and, if applicable, source/location
of in-kind to be used as match for the period of the Contract. The identified in-kind match
shall be reported monthly on the monthly expense reports.
a. Services of volunteers shall be valued at rates consistent with those ordinarily paid
for similar work by the Contractor. If the Contractor does not have similar work, the
rate shall be consistent with those in the labor market. In either case, a reasonable
amount of employee benefits may be included.
b. All other in-kind contributions shall be valued at current market value.
7. Costs incurred by the Contractor or subcontractor must be verifiable from the records of the
Contractor or subcontractor.
8. Non-Matching Contributions are local funding that does not qualify as matching
contributions and/or is not being budgeted as matching contributions (e.g., Title V,
overmatch, etc.).
N. The County shall pay Contractor for the authorized services of the previous month. Under normal
conditions, Contractor shall expect payment approximately 30 days after submission of a correctly
prepared invoice.
O. Contractor shall accept all payments from County via electronic funds transfer (EFT) directly
deposited into the Contractor's designated checking or other bank account. ' Contractor shall
i
Exhibit A
promptly comply with directions and accurately complete forms provided by County required to
process EFT payments.
P. Costs for services under the terms of this Contract shall be incurred during the contract period
except as approved by County. Contractor shall not use current year funds to pay prior or future
year obligations.
Q. Funds made available under this Contract shall not supplant any federal, state or any governmental
funds intended for services of the same nature as this Contract. Contractor shall not claim
reimbursement or payment from County for, or apply sums received from County with respect to
that portion of its obligations that have been paid by another source of revenue. Contractor agrees
that it will not use funds received pursuant to this Contract, either directly or indirectly, as a
contribution or compensation for purposes of obtaining funds from another revenue source without
prior written approval of the County.
R. County is not liable for the payment of any taxes, other than applicable sales or use tax, resulting
from this Contract however designated, levied or imposed, unless County would otherwise be liable
for the payment of such taxes in the course of its normal business operations.
S. The Contractor shall request a budget amendment, in writing, submitted to the Director of DAAS, in
advance of expenditures: 1) when aggregate expenditures are expected to exceed an approved
budgeted line item by more than fifteen (15%) percent; or 2) to add a new budget line item. No
budget revision may result in an increase of the maximum dollar amount stated in Paragraph A, of
this Section. The written request must specify the changes requested, by line item and amount,
and must include justification. Prior to implementation of a budget revision, the County shall
approve (or deny) the budget revision request. The County has the authority to approve line item
budget changes to the budget herein, as long as these changes do not exceed the total contract
amount. County shall notify the Contractor in writing of the status of the budget revision request
within fourteen (14) calendar days of receipt of the Contractor's written request. The County
reserves the right to deny the Contractor's invoice for expenditures in excess of the approved
budgeted line item amount.
VI. RIGHT TO MONITOR AND AUDIT
A. County shall have the absolute right to monitor the performance of Contractor in the delivery of
services provided under this Contract.
B. County or any subdivision or appointee thereof, and the State of California or any subdivision or
appointee thereof, including the Auditor General, shall have absolute right to review and audit all
records, books, papers, documents, corporate minutes, and other pertinent items as requested,
and shall have absolute right to monitor the performance of Contractor in the delivery of services
provided under this Contract. Full cooperation shall be given by Contractor in any auditing or
monitoring conducted.
C. Contractor shall cooperate with County in the implementation, monitoring and evaluation of this
Contract and comply with any and all reporting requirements established by this Contract.
D. All records pertaining to service delivery and all fiscal, statistical and management books and records
shall be available for examination and audit by county, federal and state representatives for a period
of three years after final payment under the Contract or until all pending county, state, and federal
audits are completed, whichever is later. Records of the Contractor which do not pertain to the
services under this Contract may be subject to review or audit unless provided in this or another
Contract. Technical program data shall be retained locally and made available upon the County's
reasonable advance written notice or turned over to County. If said records are not made available at
the scheduled monitoring visit, Contractor may, at County's option, be required to reimburse County
for expenses incurred due to required rescheduling of monitoring visit(s). Such reimbursement will
not exceed $50 per hour (including travel time) and be deducted from the following month's claim for
reimbursement. '
Exhibit A
E. Contractor shall provide all reasonable facilities and assistance for the safety and convenience of
County's 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 of the Contractor.
F. Upon County request, Contractor shall hire a licensed Certified Public Accountant, approved by the
County, who shall prepare and file with County, within 60 days after the termination of the Contract,
a certified fiscal audit of related expenditures during the term of the Contract and a program
compliance audit.
G. Pursuant to OMB Circular A-133, Contractors expending $500,000 or more in federal funds within
the Contractor's fiscal year must have a single audit or program-specific audit performed. A copy
of the audit performed in accordance with OMB Circular A-133 shall be submitted to the County
within thirty (30) days of completion, but no later than nine months following the end of the
Contractor's fiscal year.
VII. CORRECTION OF PERFORMANCE DEFICIENCIES
A. Failure by Contractor to comply with any of the provisions, covenants, requirements or conditions of
this Contract shall be a material breach of this Contract.
B. In the event of a non-cured breach, County may, at its sole discretion and in addition to any other
remedies available at law, in equity, or otherwise specified in this Contract:
1. Afford Contractor thereafter a time period within which to cure the breach, which period shall
be established at sole discretion of County; and/or
2. Discontinue reimbursement to Contractor for and during the period in which Contractor is in
breach, which reimbursement shall not be entitled to later recovery; and/or
3. Withhold funds pending duration of the breach; and/or
4. Offset against any monies billed by Contractor but yet unpaid by County those monies
disallowed pursuant to Item "2" of this paragraph, and/or
5. Terminate this Contract immediately and be relieved of the payment of any consideration to
Contractor. In event of such termination, the County may proceed with the work in any
manner deemed proper by the County. The cost to the County shall be deducted from any
sum due to the Contractor under this Contract and the balance, if any, shall be paid by the
Contractor upon demand.
C. Appeal Procedures
If Contractor disagrees with any decision or action taken by the County or DAAS related to this
Contract, Contractor may choose to file a formal grievance by following the procedures below:
1. The Contractor shall file a formal written grievance with the DAAS Deputy Director of
Administrative Services ("DAAS Deputy Director") within fifteen (15) business days after the
i Contractor is aware of the factors or conditions precipitating the contract dispute. The written
grievance shall set forth the subject of the grievance, identify the specific clause in dispute and
shall provide a detailed statement of the grievance, including dates, names, places, and the
j specific remedy or action requested. The filing address is 686 East Mill Street, San
Bernardino, California, 92415-0640. The DAAS Deputy Director shall provide a written
i
response to Contractor within fifteen (15) business days of receipt of the grievance.
2. If Contractor is not satisfied with the DAAS Deputy Director's response, Contractor may file a
written grievance appeal, which shall include a statement by the Contractor as to why the
DAAS Deputy Director's response is not satisfactory, to the Director of DAAS within fifteen
(15) business days of receipt of the DAAS Deputy Director's response. The filing address is
686 East Mill Street, San Bernardino, California, 92415-0640. The Director of DAAS shall
provide a written response to Contractor within fifteen (15) business days. The Director of
DAAS shall have final authority for the decision on the grievance except as provided below.
i
e
Exhibit A
3. If Contractor is not satisfied with the DAAS Directors response, Contractor may file a written
grievance appeal, which shall include a statement by the Contractor as to why the DAAS
Directors response is not satisfactory, to the Assistant County Administrator (ACA) of the
Human Services within fifteen (15) business days of receipt of the DAAS Directors response.
The filing address is 385 North Arrowhead Avenue, Fifth Floor, San Bernardino, California,
92415-0128. The Assistant County Administrator shall provide a written response to
Contractor within fifteen (15) business days. The Assistant County Administrator shall have
final authority for the decision on the grievance except as provided below.
4. For those appeals which involve CDA programmatic policies and directives issued to the
County and contained within this Contract, the following applies. If Contractor is not satisfied
with the ACA's decision, the written grievance may be registered in writing with the CDA, Case
Management Branch, 1300 National Drive, Suite 200, Sacramento, California, 95834, within
fifteen (15) business days following receipt of the Director of DAAS' decision. Contractor shall
submit to CDA the original written grievance along with a copy of the DAAS Deputy Directors
written response, the Contractor's appeal to the Director of DAAS, the Director of DAAS'
decision, the Contractors appeal to the Assistant County Administrator, and the Assistant
County Administrators' decision. CDA shall have final authority for the decision on the
grievance
VIII. TERM
This Contract is effective as of July 1, 2010 and expires June 30, 2011 but may be terminated earlier in
accordance with provisions of Section IX of the Contract. The Contract term may be extended for two
additional one-year periods by mutual agreement of the parties.
IX. EARLY TERMINATION
A. The County may terminate the Contract immediately under the provisions of Section VII, Paragraph
B, Item 5 of the Contract. In addition, the Contract may be terminated without cause by the County by
serving a written notice to the Contractor thirty (30) days in advance of termination. The Director of
DAAS is authorized to exercise the County's rights with respect to any termination of this Contract.
B. Contractor shall only be reimbursed for costs and uncancelable obligations incurred pror to the date
of termination. Contractor shall not be reimbursed for costs incurred after the date of termination.
X. GENERAL PROVISIONS
A. When notices are required to be given pursuant to this Contract, the notices shall be in writing and
mailed to the following respective addresses listed below.
Contractor: City of San Bernardino
300 North D Street
San Bernardino, CA 92418
County: County of San Bernardino
Human Services
Attn: Contracts Unit
150 S. Lena Road
San Bernardino, CA 92415-0515
B. Nothing contained in this Contract shall be construed as creating a joint venture, partnership or
employment arrangement between the Parties hereto, nor shall either Party have the right, power
I or authority to create an obligation or duty, expressed or implied, on behalf of the other Party
hereto.
C. Contractor shall not offer (either directly or through an intermediary) any improper consideration
such as, but not limited to, cash, discounts, service, the provision of travel or entertainment, or any
items of value to any officer, employee or agent of the County in an attempt to secure favorable
treatment regarding this Contract.
Exhibit A
The County, by written notice, may immediately terminate any Contract if it determines that any
improper consideration as described in the preceding paragraph was offered to any officer, employee
or agent of the County with respect to the proposal and award process. This prohibition shall apply to
any amendment, extension or evaluation process once a Contract has been awarded.
Contractor shall immediately report any attempt by a County officer, employee or agent to solicit
(either directly or through an intermediary) improper consideration from Contractor. The report
shall be made to the supervisor or manager charged with supervision of the employee or to the
County Administrative Office. In the event of a termination under this provision, the County is
entitled to pursue any available legal remedies.
D. Property
1. Unless otherwise provided for in this Section, property refers to all assets, capitalized or non-
capitalized, used in operation of this Contract.
a. Property includes land, buildings, improvements, machinery, vehicles, furniture,
tools, and intangibles, etc.
b. Property does not include consumable office supplies such as paper, pencils, typing
ribbons, file folders, etc.
2. Property meeting all of the following criteria is subject to the capitalization requirements.
Subject property must:
a. Have a normal useful life of at least 1 year;
b. Have a unit acquisition cost of at least $5000 (e.g., four identical assets which cost
$3000 each, for a$12,000 total would not meet this capitalization requirement); and
C. Be used to conduct business under this Contract.
3. Non-capitalized properties are those items that do not meet all three requirements in Section
X, Paragraph D, Item 2, above.
4. Additions, improvements, and betterments to assets meeting all of the conditions in Section X,
Paragraph D, Item 2 above must be capitalized. Additions typically involve physical
extensions of existing units. Improvements and betterments typically do not increase the
physical size of the asset. Instead, improvements and betterments enhance the condition of
an asset (e.g., extend life, increase service capacity, and lower operating costs). Examples of
assets that might be improved and bettered include roads, bridges, curbs and gutters, tunnels,
parking lots, streets and sidewalks, drainage, and lighting systems.
5. Intangibles are property which lack physical substance but give valuable rights to the owner
and can be capitalized or non-capitalized. Examples of intangible property include patents,
copyrights, leases, and computer software. By contrast, hardware consists of tangible
equipment(e.g., computer printer, terminal, etc.).
Costs include all amounts incurred to acquire and to ready the intangible asset for its intended
use. Typical intangible property costs include the purchase price, legal fees, and other costs
incurred to obtain title to the asset.
6. The Contractor shall record the following information when property is acquired:
a. Date acquired;
b. Property description (include model number);
C. Property identification number(serial number);
d. Location of property;
e. Cost or other basis of valuation;
f. Fund source; and
Exhibit A
g. Rate of depreciation (or depreciation schedule), if applicable.
The Contractor shall keep track of property purchased with Contract funds, whether
capitalized or not. The Contractor shall maintain and submit to DAAS annually with the
closeout, a current inventory of property furnished or purchased by either the Contractor or
the subcontractor with funds awarded under the terms of this Contract or any predecessor
contracts for the same purpose. The Contractor shall use the Report of Project Property
Furnished/Purchased with Agreement Funds (CDA 32), unless otherwise directed by DAAS.
7. Prior to disposal of any property purchased by the Contractor or the subcontractor with funds
from this Contract, the Contractor must obtain approval from DAAS regardless of the
acquisition value. Disposition, which includes sale, trade-in, discarding, or transfer to another
agency may not occur until approval is received from the Department. The Contractor shall
use the Request to Dispose of Property (CDA 248)to dispose of property.
8. The Contractor shall immediately investigate, and within five (5) days fully document the loss,
destruction, or theft of such property.
9. DAAS reserves title to all DAAS-purchased or financed property not fully consumed in the
performance of this Contract, unless otherwise required by federal law or regulations or as
otherwise agreed by the parties.
10. Contractor shall exercise due care in the use, maintenance, protection, and preservation of
such property during the period of the project, and shall assume responsibility for replacement
or repair of such property during the period of the project, until the Contractor has complied
with all written instructions from DAAS regarding the final disposition of the property.
11. In the event of the Contractor's dissolution or upon termination of this Contract, the Contractor
shall provide a final property inventory to DAAS. DAAS reserves the right to require the
Contractor to transfer such property to another entity, or to DAAS.
12. To exercise the above right, no later than 120 days after termination of the Contract or
notification of the Contractor's dissolution, DAAS will issue specific written disposition
instructions to the Contractor.
13. The Contractor shall use the property for the purpose for which it was intended under the
Contract. When no longer needed for that use, the Contractor shall use it, if needed, and with
written approval of DAAS for other purposes in the following order:
a. Another DAAS program providing the same or similar service, or
b. Another DAAS -funded program.
14. Contractor may share use of the property and equipment or allow use by other programs,
upon written approval of the Director of DAAS. As a condition of the approval, DAAS may
require reimbursement under this Contract for its use.
15. The Contractor or subcontractor shall not use equipment or supplies acquired under this
Contract with federal and/or State monies for personal gain or to usurp the competitive
advantage of a privately owned business entity.
16. If purchase of equipment is a reimbursable item, the equipment to be purchased will be
specified in the budget.
17. All equipment purchases of $500.00 or more require the written approval of the Director of
DAAS or his/her designee prior to purchase.
F. The state and County shall have all ownership rights in software or modifications thereof and
associated documentation designed, developed or installed with Federal financial participation. The
Federal Government (Department of Health and Human Services) reserves a royalty-free,
nonexclusive, and irrevocable license to reproduce, publish or otherwise use and to authorize others
to use for Federal Government purposes, such software modification, and documentation.
Exhibit A
Proprietary software packages that are sold or leased to the general public are not subject to the
ownership provisions.
G. County shall have Power of Attorney to pay delinquent debts and unpaid wages for work provided
under this Contract from accounts payable to Contractor in the event debts and wages have not been
paid on a current basis.
H. No waiver of any of the provisions of the Contract shall be effective unless it is made in a writing
which refers to provisions so waived and which is executed by the Parties. No course of dealing
and no delay or failure of a Party in exercising any right under the Contract shall affect any other or
future exercise of that right or any exercise of any other right. A Party shall not be precluded from
exercising a right by its having partially exercised that right or its having previously abandoned or
discontinued steps to enforce that right.
I. Any alterations, variations, modifications, or waivers of provisions of the Contract, unless
specifically allowed in the Contract, shall be valid only when they have been reduced to writing, duly
signed and approved by the Authorized Representatives of both parties as an amendment to this
Contract. No oral understanding or agreement not incorporated herein shall be binding on any of
the Parties hereto.
J. If any provision of the Contract is held by a court of competent jurisdiction to be unenforceable or
contrary to law, it shall be modified where practicable to the extent necessary so as to be enforceable
(giving effect to the intention of the Parties) and the remaining provisions of the Contract shall not be
affected.
K. This Contract shall be governed by and construed in all aspects in accordance with the laws of the
State of California without regard to principles of conflicts of laws. The Parties agree to the exclusive
jurisdiction of the federal court located in the County of Riverside and the state court located in the
County of San Bernardino, for any and all disputes arising under this Contract, to the exclusion of all
other federal and state courts.
Exhibit A
XI. CONCLUSION
A. This Contract, consisting of twenty-five (25) pages and Attachments A through L, is the full and
complete document describing services to be rendered by Contractor to County including all
covenants, conditions and benefits.
B. The signatures of the Parties affixed to this Contract affirm that they are duly authorized to commit
and bind their respective institutions to the terms and conditions set forth in this document.
C. IN WITNESS WHEREOF, the Board of Supervisors of the County of San Bernardino has caused
this Contract to be subscribed to by the Clerk thereof, and Contractor has caused this Contract to
be subscribed in its behalf by its duly authorized officers, the day, month and year written.
COUNTY OF SAN BERNARDINO City of San Bernardino
(Print or type name of corporation,company, contractor,etc.)
► By ►
Gary Ovitt, Chairman, Board of Supervisors (Authorized signature-sign in blue ink)
Dated Name Jeff Eason
(Print or type name of person signing contract)
SIGNED AND CERTIFIED THAT A COPY OF THIS
DOCUMENT HAS BEEN DELIVERED TO THE Title
CHAIRMAN OF THE BOARD (Print or Type)
Laura Welch
Clerk of the Board of Supervisors Dated
of the County of San Bernardino.
By Address 300 North D Street
Deputy
San Bernardino, CA 92418
Approved as to Legal Form Reviewed by Contract Compliance Presented to BOS for Signature
► ► ►
Jacqueline Carey-Wilson,Deputy County Counsel Lory Klopfer, HS Contracts Unit Collen Krygier,Director
Date Date Dale
Exhibit A ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
This Scope of Work contains the measurable objectives mandated by the Department of Aging and Adult
Services (DAAS) and the California Department of Aging (CDA) required of the Elderly Nutrition Program
(ENP) Provider. The Scope of Work specifies and establishes monthly, quarterly, and annual time frames
and constitutes the primary document for on-going monitoring and annual Program and Fiscal monitoring.
It will be used to measure the Provider's efforts towards providing quality nutrition services.
Contractor: City of San Bernardino
Service Area: San Bernardino and Surrounding Areas
I. Program Description:
A. Purpose — The purpose of the ENP is to provide nutrition services as described in the Older
Americans Act (OAA) of 1965, as amended, and to assist older individuals in California to live
independently, by promoting better health through improved nutrition, and reduced isolation
through programs coordinated with nutrition-related supportive services.
B. Definition — Nutrition Services means the procurement, preparation, transport, and service of
meals, nutrition education, nutrition screening, and nutrition counseling, to eligible individuals at
congregate sites or in their homes.
C. Goals — to maintain or improve the physical, psychological, and social well being of older
individuals, by providing or securing appropriate nutrition services.
D. Objectives:
1. Give preference to older individuals in greatest economic or social need with particular
attention to low-income minority individuals.
2. Serve meals that provide one-third (1/3) of the Recommended Dietary Allowances (RDA's)
and are safe and of good quality.
3. Promote and maintain high food safety and sanitation standards.
4. Promote good health behaviors through nutrition education and nutrition screening of
participants.
5. Promote or maintain coordination with other nutrition-related supportive services for older
individuals.
E. Target Population — The ENP Provider shall target individuals who are sixty (60) years of age
or older, minorities, low income and living in rural areas of the County of San Bernardino.
II. Eligibility for Nutrition Services:
A. Congregate Meals— Individuals eligible to receive a meal at a congregate nutrition site are:
1. Any older individual.
2. The spouse of any older individual.
3. A person with a disability, under age sixty (60) who resides in housing facilities occupied
primarily by older individuals at which congregate nutrition services are provided.
4. A disabled individual who resides at home with and accompanies an older individual who
participates in the program.
B. Volunteer Meals:
1. A volunteer under age sixty (60) may be offered a meal if doing so will not deprive an older
individual of a meal.
C. Home-Delivered Meals—Individuals eligible to receive a home-delivered meal are:
1. Any older individual who is frail, as defined below, and homebound by reason of illness,
disability, or isolation:
a) "Frail" means that an older individual is determined to be functionally impaired because
the individual either:
(1) Is unable to perform at least two (2) activities of daily living, including bathing,
toileting, dressing, feeding, breathing, transferring and mobility and associated
Exhibit A ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
tasks, without substantial human assistance, including verbal reminding, physical
cueing or supervision.
(2) Due to a cognitive or other mental impairment, requires substantial supervision
because the older individual behaves in a manner that posses a serious health or
safety hazard to the individual or to others.
2. A spouse of a person in sub-section (C)(1) above, regardless of age or condition, if an
assessment concludes that it is in the best interest of the homebound older individual.
3. An individual with a disability who resides at home with older individuals if an assessment
concludes that it is in the best interest of the homebound older individual who participates
in the program.
4. Priority shall be given to older individuals in sub-section (C)(1) above.
III. Requirements for Nutrition Services:
A. Congregate Meals:
1. Each Congregate Meal Provider shall:
a) Include procedures for obtain the views of participants about the services received.
b) Not preclude the service of a meal to a participant who has failed to make a
reservation when food is available.
c) Ensure each Congregate Meal participant completes sections I and IV of the Client
Intake Sheet (provided by DAAS) on the first day of service and annually thereafter.
d) Maintain appropriate documentation on each client. Documentation shall be kept on
file to be monitored by DAAS.
2. Each Congregate Meal site shall meet all of the following:
a) Have a paid staff or volunteer designated to be responsible for the day-to-day
activities at each site, and physically be on-site during the time that ENP activities are
taking place.
b) Have restrooms, lighting, and ventilation, which meet the requirements of CURFFL.
c) Have equipment, including tables and chairs that are sturdy and appropriate for older
individuals. Tables shall be arranged to assure ease of access and encourage
socialization.
B. Home-Delivered Meals:
1. Develop and implement criteria to assess the level of need for home-delivered nutrition
services of each eligible participant.
a) An initial determination of eligibility may be accomplished by telephone. This initial
contact with the participant shall include completion of sections I, II, III, and IV of the
Client Intake Sheet (provided by DAAS).
b) A written assessment shall be done in the home within two (2) weeks of beginning
meal service, and shall include an assessment of the type of meal appropriate for the
participant in their living environment.
c) An older individual eligible for receiving home-delivered meals shall be assessed for
need of nutrition-related supportive services, and referred as necessary.
d) Re-assessment of need shall be determined quarterly. Such re-assessment shall be
done in the home of the participant at least every other quarter. Each quarter's re-
assessment shall include completion of sections I, 11, III, and IV of the Client Intake
Sheet (provided by DAAS).
2. Provide written instructions, in the language of the majority of the participants, for
handling and re-heating of the meals.
3. Establish a waiting list for home-delivered meals whenever the home-delivered meal
providers are unable to provide meals to all eligible individuals. The decision to place
eligible recipients of a home-delivered meal on a waiting list, and their position on such a
list, shall be based on greatest need and-or in accordance with policy established by the
home-delivered meal provider, in consultation with DAAS.
Exhibit A ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
4. Provide home-delivered meals in pre-packaged divided trays (hot or frozen meals).
5. Maintain appropriate documentation on each client. Documentation shall be kept on file
to be monitored by DAAS.
IV. Program Outcomes:
A. Total Number of Meals to be Served: 32,000"
1. A minimum of 95% of the total number of meals is to be provided. The Director of DAAS
must approve requests to serve less than 95% of the total number of meals to be
provided. All such requests must be in writing.
Program: C-1 (Congregate Meals Program C-2 Home-Delivered Meals
#of Days of Service: 255 #of Days of Service:
Number of Meals: 32,000 Number of Meals:
Sites to be Served: Areas to be Served:
5t' Street Senior Center
Perris Hill Senior Center
Hernandez Community Center
Lytle Creek Community Center
New Hope Family Life Center
Highland Senior Center
Light House for the Blind
V. Staffing:
A. Manager or Director:
1. The ENP provider shall have a manager on staff who shall conduct the day-to-day
management and administrative functions of the ENP, and either have (1), (2), or(3):
a) Possess an associate degree in institutional food service management, or a closely
related field, such as, but not limited to, restaurant management, plus two (2) years
experience as a food service supervisor, or,
b) Demonstrate experience in food service, such as, but not limited to, cooking at a
restaurant, and within twelve (12) months of hire successfully complete a minimum of
twenty (20) hours specifically related to food service management, business
administration, or personnel management at a college level. Prior to completion of
meeting the hours, this individual's performance shall be evaluated through quarterly
monitoring by a registered dietitian, or,
c) Two years experience managing food services. Such experience shall be verified and
approved by a registered dietitian prior to hire.
2. The ENP Provider shall maintain documentation on file of the qualifications of the Program
Manager or staff.
1 If the Provider has more than one site, the Manager/Director shall monitor the sites on a bi-
monthly basis. The bi-monthly visit shall be for the purpose of monitoring the food service
practices of the employees and the implementation of the program requirements at the site
level. Documentation of each visit shall be maintained on file for DAAS review.
B. Personnel—Paid StaffNolunteers:
1. There shall be sufficient qualified paid staff or volunteer staff with the appropriate education
and experience to carry out the requirements of the ENP. The total number of staff should
be based on the method and level of services provided and size of the service area.
2. Contractor is encouraged to hire multi-lingual/multi-cultural staff to increase low-income and
ethnic minority program participation in accordance with federal mandates.
3. Contractor shall recruit for vacant positions in an open and competitive application process
free of discriminatory questions. Written job descriptions for all paid and volunteer staff
shall be maintained.
Exhibit A ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
4. Contractor shall complete a written work performance evaluation on all paid and volunteer
staff at least annually.
5. All staff, paid and volunteer, that will be handling food must be in possession of a current
Food Handlers Card.
6. Volunteers shall be recruited and used in any phase of the program operation where
qualified.
7. Volunteers shall be screened and selected through a formal process that assesses their
capabilities.
8. Volunteers shall receive the same training as paid staff.
9. Volunteers that are paid through other job training programs are not considered volunteers
and must be paid the agreed upon rate charged for regular paid staff.
10. The ENP Provider shall maintain a written Volunteer Policy that describes how volunteers
are recruited, screened, what topics they are taught at orientation, and how often their
performance is evaluated.
C. Registered Dietitian:
1. Each ENP Provider shall establish and administer nutrition services with the advice of a
Registered Dietitian in accordance with Section 339 of the OAA, and follow the general
requirements in Title 22, Division 1.8, Section 7500.
2. The Registered Dietitian will provide the following activities to meet the mandated
requirements:
a) At a minimum, quarterly monitor for safe food handling and sanitation practices of food
facilities.
b) Review and approve the content of staff training prior to presentation.
c) Develop, or review and approve the cycle menus.
d) Provide input, review, and approve the Nutrition Education Plan prior to presentation.
e) Provide technical support and assistance as needed.
VI. Staff Training Activities:
A. A yearly written Staff Training Plan shall be developed, implemented, and maintained on file by
the ENP Provider, as required in Title 22, Division 1.8, Section 7636.7(c).
B. The Provider's Registered Dietitian shall review and approve the content of the Plan prior to
presentation.
C. The Staff Training Plan must identify who is to be trained, who will conduct the training, content
of the training, and when it is scheduled.
D. A copy of the Staff Training Plan that has been approved by the Provider's Registered Dietitian
must be submitted to DAAS by September 1st of the FY it is being provided in. The DAAS
Registered Dietitian will review and approve the Staff Training Plan and return it to the Provider.
1 The DAAS approved Staff Training Plan must be kept on file.
1 E. A minimum of four (4) hours of staff training shall be provided annually for paid and volunteer
1 food service staff, including congregate and home-delivered meal staff.
F. Training sessions shall be evaluated by those receiving the training.
G. The ENP Provider shall maintain documentation of each training session on file.
Documentation includes, but is not limited to, sign-in sheets, agendas, handouts, and
+ completed evaluations.
H. All staff, paid and volunteer, shall be oriented and trained to perform their assigned
responsibilities and tasks. Training, at a minimum, shall include:
i 1. Food safety, prevention of food borne illness, and HACCP principles.
2. Accident prevention, instruction on fire safety, first aid, choking, earthquake preparedness,
and other emergency procedures.
3. Elder Abuse Law and reporting procedures.
Exhibit A ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
VII. Senior Participants:
A. Satisfaction Survey:
1. The ENP Provider shall conduct a Client Satisfaction Survey at least annually. The Survey
instrument must be approved by DAAS prior to its use, and all findings from the Survey
must be used to improve services. The Provider must keep the completed Surveys and the
tabulated results on file. A copy of the tabulated results must be submitted to DAAS by
March 3itl of the FY it is being conducted for.
B. Complaint Procedures:
1. Each Provider shall have a written Complaint Procedure.
2. The Complaint Procedure will be available for the participants and will provide them the
opportunity to provide positive as well as negative feedback to the Program Manager.
3. The Provider shall have an assessment tool readily accessible for the seniors attending the
congregate site or receiving a home-delivered meal.
C. Nutrition Education Services for Participants:
1. Nutrition Education shall be provided a minimum of four (4) times per year to participants in
congregate and home-delivered meal programs.
a) Nutrition Education for congregate sites is defined as demonstrations, presentation,
lectures or small group discussions, all of which may be augmented with printed
materials.
b) Nutrition Education for home-delivered meal participants may consist solely of printed
material that is in conjunction with a congregate meal Nutrition Education presentation.
2. Nutrition Education shall be based on the particular need of congregate and home-
delivered meal participants. An annual Needs Assessment shall be performed by the ENP
Provider to make this determination.
3. The Nutrition Education Plan and annual Needs Assessment must be submitted to DAAS
j by September 1' of the FY it is being provided in.
4. Nutrition Education sessions must be reported monthly to DAAS using the Nutrition
Education Monthly Service Unit Report.
Nutrition Education Units of Service:
Pro rem: C-1 Con re ate Meals Pro ram: C-2 Home-Delivered Meals
#of Units to be Provided: 2,900 #of Units to be Provided:
#of Sites to be Presented at: 7 #of Participants to be Presented to:
VIII. Menu Planning Guidelines/Menu Requirements:
A. A minimum of a 3-month cycle shall be planned and submitted to DAAS.
B. Menu cycles shall include the availability of seasonal foods.
C. Health, cultural, ethnic and regional dietary practices shall be considered in menu planning,
food selection, and meal preparation.
D. The menu cycle shall be approved by the Provider's Registered Dietitian and upon approval
forwarded to the DAAS Registered Dietitian for certification. Menus shall be submitted to the
DAAS Registered Dietitian forty-five (45) days prior to the menu start date. Allow thirty (30)
days for the menu certification process. Menus will be returned to the Provider at least'
fifteen (15) days prior to the menu start date. ENP Providers are required to have menus
certified prior to the menu start date. All signatures on the menu shall be original signatures.
E. A copy of the certified menu must be posted in a spot conspicuous to clients at each
congregate site.
F. Copies of the menus shall be made available to the participants upon request.
G. When planning the menus, the California Daily Food Guide and the Dietary Guidelines for
III! Americans (DGA) are to be considered. Menus shall conform to the following criteria
referenced in the sources:
1. Provide an average of 550-750 calories per meal.
Exhibit A ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
2. Limit total fat to no more than 25-30% of the calories averaged for the week.
3. Choose and prepare foods with low amounts of salt, soy sauce and other high sodium
items.
4. Include good sources of dietary fiber such as whole grains and cooked dry beans at least
four times a week.
5. Include a variety of foods and preparation methods with consideration to color,
combinations, texture, size, shape, taste, and preference of the participants served.
6. Dietary Reference Intake Values:
1. Table one (1) represents the most current Dietary Reference Intakes (DRI) values
and daily compliance range for target nutrients. The values provided are based on
the U.S. Department of Agriculture (USDA) Food Guide calculated for one (1) meal
for a woman over seventy (70) years of age whose activity level is sedentary. This
example represents a majority of the older adult population served by the ENP
statewide.
a. The nutrients selected for this Table are based on the target nutrients to:
i. Promote health and prevent disease
ii. Prevent deficiencies
iii. Indicate diet quality
iv. Manage disease
Table 1
Target Nutrients
Nutrient Target Value* Daily Compliance Range
per meal
Calories (Kcal) >550 Kcal >550—700 Kcal
Protein 14 gm 14 gm (in the entree)
Fat (% of total calories) 30% <35%weekly average
> 250 ug 3 out of 5 days/wk or 4
Vitamin A(ug) 250 ug out of 7 days/wk
Vitamin C (mg) 25 mg 25 mg
Vitamin B6 (mg) 0.5 mg >0.5 mg
Vitamin B12 (ug) '* 0.8 ug 0.8 ug **
Calcium (mg) 400 mg >400 mg
Magnesium (mg) 140 mg >140 mg
Zinc(mg) ** 2.6 mg >2.6 mg**
<1,200 mg (over 1,000 mg place
Sodium (mg) <800 mg an icon on the menu)
Fiber(gm) >7 gm >7 gm
Potassium (gm)* 1565 mg 1565 mg **
Vitamin D 2001U 2001U
Vitamin E ** 5 IU Provide education**
*Target Value: This value represents one-third of the DRI for a 1600 calorie range. The 1600 calorie
range was chosen based on the requirements for a 70-year-old sedentary female. If a majority of the
Exhibit A ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
senior population served by the AAA ENP Program differs from the above example, use your ENP
predominate demographic characteristics to calculate target nutrient values.
** If these elements are not provided to the level noted as a weekly average, the Program must educate
the participants on how to obtain these elements.
NOTE: Fortified foods should be used to meet vitamin B12 needs.
Recommended sodium content was liberalized based on the information from the Mathematical study data
which indicated that, for many participants, the ENP meal provides 40-50 percent of the participants' daily
intake.
7. Component Meal Pattern Requirements:
1. The California 1600-calorie component meal pattern has been developed to reflect
the new DGA requirements for those programs that are not using computerized
nutrient analysis.
2. The ENP Provider has the discretion to allow occasional flexibility in planning meals
that may not meet the meal pattern, but does meet the nutrient value requirements.
Fortified food products and combination dishes used in a menu may not match the
meal pattern, but may provide for the required nutrient values. For example, a
fortified snack bar as a dessert could be used to boost the nutrient value of a boxed
lunch or special occasion meal.
3. Items that provide the following target nutrients should be identified on the menu
when using a component meal pattern template:
a. Vitamin C — Provide one-third (1/3) of the DRI for vitamin C each meal — 25 mg
(for a 1600-calorie menu).
b. Vitamin A— Provide one-third (1/3) of the DR[ for vitamin A at least three (3) times
per week, 250 µg (for a 1600-calorie menu).
c. Sodium — meals that contain over 1,000 mg of sodium must be noted on the
menu as a high sodium meal.
4. Table two (2) descries the elements in the California 1600-calorie meal pattern.
Serving sizes are based on the USDA Food Guide Pyramid. This sample component
meal pattern does not assure that meals meet one-third (1/3) of the DRI's and the
DGA. Meals will require specific types of fruits and vegetables, whole grains, and
high fiber foods in order to assure the target nutrients are provided. The component
meal pattern may be deficient in vitamins E, B12, and Zinc, requiring additional
nutrition education for participants on the selection of foods that are good sources of
these nutrients.
a. The meal pattern in Table two (2) below is based on the minimum requirements
for a sedentary female 70 years of age. If the majority of the population served
by a provider falls within another requirement range (i.e. active 60 year old men),
the serving sizes and minimum number of servings required can be adjusted to
meet the service population. ENP Providers should verify the population served
and develop menu criteria accordingly.
Table 2
California 1600 Calorie per Day Component Meal Pattern
Minimum Recommended Elements
Food Group Required servings for Serving sizes for 1600
550 calories per meal calorie level
Lean meat or beans 1 serving 2 ounces = 1 serving
2 ounces per meal
Exhibit A ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
Vegetable 1 —2 servings /�cup = 1 serving
Fruit 1 serving /z cup = 1 serving
Bread or Grain 1 —2 servings 1 slice Bread = 1 serving
At least'% whole grain % cup of rice or pasta = 1 serving
Low-fat milk or milk alternate 1 serving 1 cup orequivalent measure
Fat Optional
Dessert Optional - limit sweets use Select foods high in fiber and low in
fruit fat and sugar
(1) The number of servings per meal estimates provision of one-third of the DRIB.
(2) Caloric value (1,600 Kcal/day) based on a 70-year-old female, "sedentary" physical activity level
using Table 3 - Estimated Caloric Requirements in Each Gender and Age Group at Three Levels of
Physical Activity, from the DGA 2005.
H. Meal Components— required for both computerized and component menus:
1. Protein — meat, fish, poultry, legumes, eggs, and cheese:
a) A minimum of 2.0 ounces of cooked, edible portions of meat, fish, poultry, legumes,
eggs, cheese, (or a combination thereof) providing at least 14 grams of protein.
Programs should consider the preferences of the participants they serve.
b) Legumes should not be counted as both vegetable and protein. ENP Providers may
use other protein sources to provide the occasional vegetarian meal.
2. Vegetables (1-2 '% cup servings):
a) Vegetables as a primary ingredient in soups, stews, casseroles, or other combination
dishes should total '/ cup per serving.
b) Raw leafy vegetables (salads) should equal 1-cup if they are to be considered a
serving.
3. Fruit (1 serving):
a) A serving of fruit equals:
(1) 1 medium sized whole fruit
(2) '/2 cup fresh, chopped, cooked, frozen, or canned drained fruit
(3) % cup 100% fruit juice
b) Fresh, frozen, or canned fruit should be packed in juice, light syrup, or without sugar.
Fruit packed in high sugar content syrup may be rinsed before using.
4. BreadslGrains (1 ounce equivalent serving):
a) One-half of the daily intake of grains should be from whole grains. Grains that are
processed (not whole) must be fortified.
5. Milk (8 fl. oz.):
a) Each meal shall contain eight (8) fluid ounces of fortified skim, low fat, or buttermilk.
If religious preference precludes the acceptance of milk with the meal, it may be
omitted from the menu (however, an equivalent substitute must be used).
6. Fat (Optional):
a) Each meal may contain fat components to increase the palatability and acceptability
of the meal.
b) When selecting and preparing meat, poultry, dry beans, and milk or milk products,
make choices that are lean, low fat, or fat free.
c) Consume less than 10% of calories from saturated fatty acids and less than 300
mg/day of cholesterol, and keep trans fatty acid consumption as low as possible.
Exhibit A ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
d) Keep total fat intake between 20 to 35 percent of calories, with most fats coming from
sources of polyunsaturated and monounsaturated fatty acids such as fish, nuts, and
vegetable oils.
7. Dessert (Optional):
a) Dessert may be provided as an option to satisfy the caloric requirements or for
additional nutrients. Use fruit as a dessert as often as possible and limit sweets. The
fruit, grains, and dairy products served as dessert can count towards the fruit, grain,
or dairy requirements. Desserts that are low in fat and/or low in sugar are
encouraged.
b) When a dessert contains '/2 cup of fruit per serving, it may be counted as a serving of
fruit.
c) When a dessert contains the equivalent of 1 serving (1 ounce) starches/grains per
serving, it may be counted as a serving of starches/grains (example: rice pudding or
oatmeal cookie).
d) When a dessert contains the equivalent of '/2 cup of milk per serving, it may be
counted as ''/: serving of milk.
8. Condiments and Product Substitutes:
a) Sugar substitutes, pepper, herbal seasonings, lemon, vinegar, non-dairy coffee
creamer, salt, and sugar may be provided, but should not be counted as fulfilling
any part of the nutritive requirements.
b) Condiments such as salad dressings, ketchup, soy sauce, mustard, and
mayonnaise do not need to be counted in a menu analysis if they are served "on
the side° and are not combined with the food.
9. Sodium:
a) The commitment to reduce sodium in the meals stems from the fact that nutrition-
related chronic diseases remain the primary cause of death among people aged
65 and older. California has a diverse population, and the ENPs in the State
provide culturally appropriate meals for many ethnicities. Asian meals traditionally
have higher sodium levels. Programs that choose to provide culturally
appropriate meals, but are concerned with the sodium content of the meals, may
consider:
(1) Using low sodium soy sauce or diluting soy sauce with water to produce low
sodium soy sauce;
(2) Offering soy sauce as a condiment to be added by the senior;
(3) Providing Nutrition Education on sodium;
(4) Continuing to work with the sodium levels of meals, making small steps to
reduce the risk of developing kidney stones, and possibly decrease bone loss
with age;
(5) Not providing potassium chloride salt substitutes;
(6) Noting meals that have more than 1000 mg of sodium on the menu as such:
"This meal contains more than 1000 mg of sodium," or using an icon denoting
a high sodium meal; and
(7) Using low sodium versions of high sodium foods when available and feasible
with budget allowances.
I. Meal Component/Nutrient Analysis:
1. A meal component/nutrient analysis of the entire menu cycle conducted and/or approved
by a Registered Dietitian shall be done to ensure compliance with Title 22, Division 1.8,
Section 7638.5.
a) Computerized Nutrient Analysis Requirements
(1) Although not required, use of computerized nutrient analysis is strongly
recommended and will help ensure and verify the nutritional adequacy of meals.
The goal of assessing nutrient intakes of groups is to determine the prevalence of
Exhibit A ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
inadequate or excessive nutrient intakes within a particular group of individuals.
While meal patterns serve as a basic framework for menu planning, providers are
encouraged to use computerized nutrient analysis because it provides specific
information on nutrients the menu may not be providing. The information that a
menu is not supplying all of the desired nutrients will guide the development of
future menus. As required menu elements are expanded, it is more difficult to
meet all of the requirements on a daily basis. ENP Providers should focus on:
(a) Vitamin A
(b) Vitamin C
(c) Protein
(d) Fat
(e) Sodium
(f) Fiber
(2) Not all nutrient guidelines will be met with each meal. However, areas that do not
meet the requirements should be the focus of future menu revisions and nutrition
education.
(3) The following nutrients should be included in the analysis when the computerized
nutrient analysis method is used: calories; protein; carbohydrates; total fat;
saturated fat; total fiber; vitamins A, C, D, E, K, thiamin, riboflavin, niacin, 86,
folate, B12, calcium, chromium, copper, iron, magnesium, sodium, and zinc. In
addition to meeting one-third of the DRIB, the menus should also follow the DGA.
IX. Food Procurement:
A. Food procurement procedures shall comply with Title 22, CRFC standards, and HACCP best
practices guidelines.
B. All food shall be of good quality and shall be obtained from sources that conform to Federal,
State, and local regulatory standards fro quality, sanitation, and safety.
C. To the extent possible, providers are encouraged to participate in group food purchasing.
D. A comparative cost analysis shall be performed either by the ENP Provider or its group
purchasing organization on an on-going basis to obtain the highest quality food for the lowest
price available.
X. Food Storage:
A. Food storage procedures shall comply with Title 22, CRFC standards, and HACCP best
practices guidelines.
B. Adequate and suitable space free from vermin, dirt, and contamination or adulteration shall
be provided for the storage of food and beverages, and cooking, serving, and eating
supplies.
XI. Food Production:
A. Food production procedures shall comply with Title 22, CRFC standards, and HACCP best
practices guidelines.
B. Food production and meal service shall be under the supervision of a trained staff in food
service management to ensure food service sanitation and the practice of hygienic food
handling techniques are followed. This person shall function with the advice of the Provider's
Registered Dietitian.
C. Meals shall be served as indicated on the certified menus. In the event that a menu
substitution must occur, the following procedure must be followed:
1. The Provider's Registered Dietitian must approve all menu substitutions.
2. A Menu Substitution Form must be completed and signed by the Provider's Registered
Dietitian.
3. The completed Menu Substitution form shall be kept on file for DAAS review.
Exhibit A ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
D. Production Control:
1. Production schedules or worksheets must be available in the food preparation area.
2. Food shall be prepared in sufficient quantities to serve all participants. Careful planning
shall minimize the leftover food and prevent waste.
3. Standardized recipes shall be used to ensure consistency of quality and quantity and
adherence to menu guidelines.
4. Appropriate utensils for correct and consistent portion control shall be available and used
at each site.
E. Meal Service/Temperature Monitoring:
1. All food for congregate sites shall be packaged and transported in a manner in which it is
protected from potential contamination and maintains appropriate hot and cold food
temperatures.
2. Meals shall be served to seniors "offer versus serve" — meaning participants are to be
given an opportunity to decline a menu item. Food trays shall not be served ahead of
time.
3. Temperature Checks:
a) All hot, cold, and frozen potentially hazardous meal components, including milk, shall
be checked daily immediately prior to dispatch from the central kitchen.
b) All hot, cold, and frozen potentially hazardous meal components, including milk, shall
be checked at satellite congregate sites upon delivery and at all congregate sites
immediately before meal service.
c) The ENP Provider must have written procedures for monitoring food temperature.
d) The ENP Provider must use a form to document food temperatures daily (i.e. Food
Temperature Log).
e) The ENP Provider shall have a staff member review the completed Food
Temperature Logs at random a minimum of every other month. If problems are
discovered, an action plan must be developed to resolve the issue.
f) All completed Food Temperature Logs must be maintained on file for DAAS review.
4. To maintain quality in prepared foods, holding times shall be kept to a minimum. Long
periods of holding hot foods at required temperatures diminishes the nutrient content and
palatability of foods.
5. Holding time shall not exceed 2 hours between the end of production and the beginning
of food service at the congregate site.
6. Milk and milk products shall be provided in individual, commercially filled containers, or
shall be poured by a staff member directly from commercially filled bulk containers into
the glass or cup from which it is consumed.
7. Single service utensils and tableware shall be used one time only and then discarded.
8. Safety of the food after it has been served at the congregate site and then removed by
the participant from the congregate site is the sole responsibility of the participant and
may be consumed by the participant as he/she deems it appropriate.
9. The Provider shall have a sign posted in the congregate site stating, "Food removed from
the congregate site is at your own risk."
XII. Food Service Requirements:
A. The ENP Provider shall ensure that the following forms are available, completed daily, and
maintained at each nutrition site for a minimum of 12 months:
1. Food Temperature Log — one should be available for congregate meals and one for
home delivered meals if hot foods are delivered to the client.
2. Cleaning Schedule
3. Equipment Temperature Log —for all dish machines, refrigerators, and freezers:
4. Production Schedule— applicable only if food is cooked at the site.
5. The current Environmental Health inspection shall be available at the site for review.
Exh i bit A ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
6. Staff and volunteers who are handling food shall possess a current food handlers' card
that shall be available for review.
XIII. Program Requirements:
A. Client Intake Sheets:
1. The ENP Provider will ensure that each participant completes the Client Intake Sheet
form (provided by DAAS) to determine his or her level of nutritional risk. Forms shall be
completed for:
a) Congregate Meal Participants — at the beginning of service and then annually
thereafter for clients who remain on the program.
(1) Sections I and IV are required for congregate meals.
b) Home-Delivered Participants — at the beginning of service and then quarterly
thereafter for clients who remain on the program.
(1) Sections 1, Il, III, and IV are required for home-delivered meals.
2. ENP Providers who are required to complete their own data entry into the SAMS System
must enter the annual and quarterly Client Intake Sheets into the database in a timely
manner.
3. ENP Providers who are not required to complete their own data entry must send the
Client Intake Sheets to DAAS for data entry into the SAMS System.
B. Outreach/Marketing Activities:
1. ENP Providers are required to provide outreach in the community through community
organizations and other groups. All outreach and marketing activities shall be
documented and kept on file for the annual monitoring visit conducted by DAAS.
2. ENP Providers shall develop and have handouts, brochures, and/or signs available in
languages other than English and posted in locations such as churches, community
service locations, and small stores serving the minority communities.
C. Emergency Procedures:
1. ENP Providers shall have a written Emergency/Disaster Plan.
2. Each nutrition site shall have an evacuation plan posted identifying the emergency exits
and assembly areas.
3. Staff must be knowledgeable of emergency procedures.
4. Where feasible and appropriate, ENP Providers shall make arrangements for the
availability of meals to participants during a major disaster, as defined in 42 U.S.C.,
Chapter 68, Section 5122 (2). Such arrangements shall be included in the
Emergency/Disaster Plan.
D. Donations and Confidentiality:
1. An Eligible individual who receives a meal shall be given the opportunity to contribute to
the cost of the meal
2. The ENP Provider shall develop a suggested contribution/donation amount. When
developing this contribution/donation amount, the income ranges of the older individuals
in the community and the Provider's other sources of income shall be considered.
3. A sign indicating the suggested contribution for eligible individuals and the fee for guests
shall be posted near the contribution container at each congregate meal site. A guest
fee shall cover all meal costs.
4. No eligible individual shall be denied participation because of failure or inability to
contribute.
5. The Provider shall ensure that the amount of the eligible participant's contribution is kept
confidential.
6. The ENP Provider shall establish written procedures to protect contributions and fees
from loss, mishandling, and theft (i.e. Contribution/Donation Procedures). Such
Procedures shall be kept on file for DAAS review.
Exhibit A ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
7. All contributions and fees shall be identified as program income and used to increase the
number of meals served, to facilitate access to such meals, and to provide nutrition-
related supportive services.
E. "No Soliciting" Sign:
1. The ENP Provider shall ensure that a "No Soliciting" sign is posted on the door leading to
the congregate nutrition site. No soliciting of any kind is permitted on the premises
during the lunch hours for services or goods promoted by businesses.
F. Coordination:
1. If applicable, develop a fair and equitable policy and procedure for referring participants
to the appropriate transportation provider for securing public transportation to and from
nutrition sites and have the policy available for review by DAAS.
2. Include the following statement on all advertising, brochures, poster, etc., "Funding for
this service has been provided by the San Bernardino County Department of Aging
and Adult Services through a grant award from the California Department of
Aging."
3. Coordinate service with other County departments and local agencies by providing time
for presentations or special activities that promote a community based system of care for
the participants attending nutrition sites.
G. Reporting:
1. All fiscal and program data must be reported monthly (i.e. Request for Reimbursement,
Rosters, Monthly Service Unit Report, etc.). All reports are due to DAAS by the 5"
business day of the month following the month of service. DAAS will provide training as
needed.
2. The Provider shall maintain support files including, but not limited to, invoices, payroll,
Client Intake Sheets, and any other supporting documents to substantiate monthly
reports.
3. ENP Providers are required to report all known or suspected cases of elder abuse to
DAAS Adult Protective Service or law enforcement immediately by telephone. A written
report must be sent within two (2) working days. Abuse of an elder or dependent adult
means physical abuse, neglect, intimidation, cruel punishment, fiduciary abuse,
abandonment, isolation, or other treatment resulting in physical harm or pain or mental
suffering or the deprivation by a care custodian of goods or services which are necessary
to avoid physical harm or mental suffering.
4. Maintain records, by month, that support claimed in-kind expenditures.
5. Report expenditures funded with Deferred Income by September 30" of the FY in which
it is being claimed.
6. Develop and have on hand for review by DAAS, a cost allocation plan which explains the
methods used to allocate costs between congregate and home-delivered meals or any
other program funded by DAAS.
7. In the event additional funds become available, the Provider will use the funds to
increase the number of meals being provided to participants by either increasing the
number of individuals attending its present sites, or by opening new sites in communities
not already served by the Provider. Exceptions to this requirement must be fully
documented in writing and submitted to the Director of DAAS for prior approval.
8. Other Reporting Requirements:
a) SAMS (Social Assistance Management System):
(1) The following reports are to be completed and submitted to DAAS by the 51"
business day of the month following the month of service if the Provider is serving
less than 500 clients per month:
j (a) Client Intake Sheets for any new clients or any annual or -quarterly
assessments completed in the month.
(b) Meal Rosters
Exhibit A ATTACHMENT A
San Bernardino County
Elderly Nutrition Program
Scope of Work
(2) Providers that are serving more than 500 clients shall secure the appropriate
licensing, have a dedicated staff responsible for maintaining the client tracking
software, obtain and maintain an Internet Service Provider and the appropriate
hardware that can support the program. These Providers shall be responsible for
entering the following data into SAMS by the 5r" business day of the month
following the month of service:
(a) Client Intake Sheets for any new clients or any annual or quarterly
assessments completed in the month.
(b) Rosters
(c) Routes (if applicable)
b) Nutrition Education Monthly Service Unit Report
(1) The Nutrition Education Monthly Service Unit Report is a tool that is used to report
the number of Nutrition Education service units that have been provided to
participants. This report is to be completed and submitted to DAAS by the 5"
business day of the month following the month of service. Copies of any
handouts presented to the participants as a component of the Nutrition Education
shall be attached to the Nutrition Education Monthly Service Unit Report.
H. Disposal of Equipment:
1. If the Provider wishes to dispose of equipment purchased with Nutrition grant funding,
they must submit a request, in writing, to DAAS. The request shall state the equipment
description, the location of the equipment, and the reason for disposal.
2. Provider shall submit a list of equipment purchased with grant funding by location.
CLIENT COMPLAINT AND GRIEVANCE PROCEDURES
Older Americans Act Programs
(Instructions: The service recipient is to read, sign, and receive a copy of this form. The original of the form
is to be filed in the service recipient's case file maintained by contractor. The reverse side of this form may
be used to file a complaint or grievance with the contractor/service provider.)
If you believe you have been discriminated against, or that there has been a violation of any laws or regulations, or if
you have a problem regarding services received, you have the right to file a grievance.
The following procedures are to be followed when filing a grievance:
1. Identify the complaint/grievance in writing and discuss it with the contractor/service provider.
Time frame: Within 1 week of discrimination/violation/problem.
If resolved at this level, no further action is required. If no resolution is apparent within 15 business days, proceed with
Step 2.
2. Forward the written complaint/grievance to the Deputy Director of Administration at the following address:
Department of Aging and Adult Services
686 East Mill Street
San Bernardino, CA 92415-0640
ATTN: Deputy Director
Time frame: Within 1 week of Step 1.
If resolved at this level, no further action is required. if no resolution is apparent within 15 business days, proceed with
Step 3.
3. If no solution is apparent after Steps 1-2 have been exhausted, forward copy of written grievance to:
Human Services Group, Contract Administrator
Exhibit A ATTACHMENT B
150 S. Lena Road
San Bernardino, CA 92415-0515
You will be contacted within 15 business days of any actions being taken.
Please note: Each of these steps must be completed in the sequence shown.
If you believe that your civil rights have been violated, please contact:
Deputy Director, Administration
Department of Aging and Adult Services
686 East Mill Street
San Bernardino, CA 92415-0640
GRIEVANCE PROCEDURE CERTIFICATION
This is to certify that I have read, understood, and received a copy of the Client Complaint and Grievance Procedures for
Older Americans Act Programs.
Signature of Service Recipient' Date
GRIEVANCE NOTICE
Your Name:
Date of Occurrence:
Approximate Time of Occurrence:
Name of Service Provider:
Address of Service Provider:
Nature of Grievance:
Resolution:
Page 1 of 2
Exhibit A ATTACHMENT B
Resolved by:
Signature Date
Signature of Service Recipient Date
DEPARTMENT OF AGING
CONTRACTORIVENDOR CONFIDENTIALITY STATEMENT
CDA 1024 REV 1107
CERTIFICATION
hereby certify that I have reviewed this Confidentiality Statement and will comply with the following Statements.
CONTRACTORIVENDOR NAME: CONTRACT NUMBER:
AUTHORIZED SIGNATURE: PRINTED NAME AND TITLE OF PERSON SIGNING:
Exhibit A ATTACHMENT C
In compliance with Government Code 11019.9, Civil Code 1798 Et. Seq., Management Memo 06-12 and Budget
Letter 06-34 the California Department of Aging (CDA) hereby requires the ContractorNendor to certify that:
• confidential information shall be protected from disclosure in accordance with all applicable laws, regulations
and policies.
• all access codes which allow access to confidential information will be properly safeguarded.
• activities by any individual or entity that is suspected of compromising confidential information will be reported
to CDA by completing a Security Incident Report, CDA 1025.
• any wrongful access, inspection, use, or disclosure of confidential information is a crime and is prohibited
under State and federal laws, including but not limited to California Penal Code Section 502; California
Government Code Section 15619, California Civil Code Section 1798.53 and 1798.55, and Health Insurance
Portability and Accountability Act.
• any wrongful access, inspection, use, disclosure, or modification of confidential information may result in
termination of this Contract/Agreement.
• obligations to protect confidential information obtained under this Contract/Agreement will continue after
termination of the Contract/Agreement with CDA.
• all employees/subcontractors of the ContractorNendor will complete the required Security Awareness Training
module located at www.agina.ca.00y, within 30 days of the start date of this Contract/Agreement or within 30
days of the start date of any new employee or subcontractor. ContractorNendor may substitute CDA's
Security Awareness Training program with its Security Training provided such training meets or exceeds
CDA's training requirement.
• all employees/subcontractors of the ContractorNendor will be notified of CDA's confidentiality and data
security requirements.
• CDA or its designee will be granted access by the Contractor or Vendor to any computer-based confidential
information within the scope of the Contract.
• I agree to protect the following types of confidential information which include but not limited to:
- Social Security number
- Medical information
- Claimant and employer information
- Driver License information
- Information about individuals that relate to their personal life or identifies or describes an individual
Other agencies'confidential and proprietary information
- Criteria used for initiating audit selection
- Methods agencies use to safeguard their information (computer systems, networks, server
configurations, etc.)
- Any other information that is considered proprietary, a copyright or otherwise protected by law or
contract.
• I agree to protect confidential information by:
Accessing, inspecting, using, disclosing or modifying information only for the purpose of performing
official duties
Never accessing, inspecting, using, disclosing, or modifying information for curiosity, personal gain, or
any non-business related reason
Securing confidential information in approved locations
Never removing confidential information from the work site without authorization.
CALIFORNIA DEPARTMENT OFAGING(CDA)
SECURITY INCIDENT REPORT
CDA 1025 New 07107
INCIDENT INFORMATION
1. AGENCY/CONTRACTOR NAME: 2. AGENCY/CONTRACTOR INFORMATION SECURITY OFFICER'S
NAME:
3. AGENCY/CONTRACTOR ADDRESS: 14. AGENCY/CONTRACTOR TELEPHONE:
Page 1 of 1
Exhibit A ATTACHMENT D
5. DATETM 6. DATE INCIDENT 7. INCIDENT REPORTED TO:
INCIDENT: DETECTED: ❑CALIFORNIA DEPARTMENT OF AGING ❑DISTRICT
ATTORNEY
❑CA HWY PATROL ❑ATTORNEY GENERAL ❑
OTHER:
❑UNKNOWN
❑ UNKNOWN
8. INCIDENT LOCATION:
9. DESCRIPTION OF INCIDENT: -
10. MEDIA DEVICE TYPE, IF APPLICABLE: 11. WAS THE PORTABLE STORAGE DEVICE
ENCRYPTED?
El YES LINO El UNKNOWN
12. IF NO, EXPLAIN:
13. DESCRIBE THE COSTS ASSOCIATED WITH RESOLVING THIS INCIDENT: 14. TOTAL ESTIMATED COST OF
INCIDENT:$
15. TYPE OF PERSONALLY IDENTIFIABLE INFORMATION(CHECK ALL THAT APPLY):
❑ NO PERSONAL INFORMATION ❑SOCIAL SECURITY NUMBER ❑HEALTH OR MEDICAL INFORMATION ❑
FINANCIAL ACCOUNT NUMBER
❑NAME ❑ DRIVER'S LICENSEISTATE ID NUMBER ❑OTHER(SPECIFY)
16. IS A PRIVACY DISCLOSURE NOTICE 17. NUMBER OF 18. DATE NOTIFICATION(S)MADE TO
REQUIRED? INDIVIDUALS THE INDIVIDUAL:
[:]YES ❑ No
'IF A PRIVACY DISCLOSURE NOTICE IS AFFECTED:
REQUIRED,ATTACH A SAMPLE OF THE
NOTIFICATION.
19. HAVE THOSE RESPONSIBLE FOR THE INCIDENT BEEN IDENTIFIED?
[]YES ❑ No COMMENT:
20. CORRECTIVE ACTIONS TAKEN TO PREVENT FUTURE OCCURRENCES:
Page 1 of 3
Exhibit A ATTACHMENT D
21. ESTIMATED COST OF CORRECTIVE 22. DATE CORRECTIVE ACTIONS WILL BE FULLY IMPLEMENTED:
ACTIONS:
SIGNATURES
23. PRINT-AGENCY/CONTRACTOR INFORMATION SIGNATURE: DATE:
SECURITY OFFICER:
24. PRINT-AGENCY/CONTRACTOR PRIVACY OFFICER: SIGNATURE: DATE:
25. PRINT-AUTHORIZED SIGNATURE/DIRECTOR: SIGNATURE: DATE:
DEPARTMENT OF AGING
SECURITY INCIDENT REPORT
INSTRUCTIONS
The following instructions will assist in completing the form.All questions must be completed, even when
the response is a future action.
1. Agency/Contractor Name - Provide your agency, contractor, vendor, department, board, bureau or
commission's full name.
2. Agency/Contractor Information Security Officers Name - Provide your agency's Information Security
Officer's Name.
3. Agency/Contractor Address-Provide your agency/contractor's address.
4. Telephone-Provide your agency/contractor's telephone number.
5. Date/Time of Incident - Provide the date/time when the incident occurred. If unknown, select the
"Unknown" checkbox.
6. Date Incident Detected -Provide the date the incident was discovered.
7. Incident Reported To -Select the appropriate checkbox. If applicable,select the other checkbox and
describe to whom the incident was reported.
8. Incident Location - Provide the location where the incident occurred. For example, if a laptop was
stolen from an employee's home, suggested content is "Employee's Home, Roseville, CA'; or if
the incident occurred at the agency's headquarters office, suggested content is "Agency's
Headquarters, 123 Any Street,Sacramento,CA."
Page 1 of 3
Exhibit A ATTACHMENT D
9. Description of Incident- include the following in the description:
• When the incident occurred and how it was discovered.
• The effect of the incident on the business and infrastructure of your agency.
• The number of people(inside your agency and outside your agency) affected by this incident.
• The effects, if any, of this incident on people, businesses or services outside of your agency.
• The details of any law enforcement investigation of this incident, such as which agency
investigated it,when,and the report number.
• Any personal, confidential,or sensitive information involved/disclosed.
10. Media Device Type, If Applicable-Provide the type of media or device involved in the incident,such
as paper(fax, mail, etc.) or electronic(CD,floppy drive, laptop, PDA,email,etc.).
11. Was the Portable Storage Device Encrypted?-Check the appropriate box.
12. If NO, Explain -Describe why the storage device was not encrypted.
13. Describe the Costs Associated with Resolving this Incident - Provide a cost estimate of resolving the
incident. Cost should include everything necessary to resolve the incident, including hardware,
software, staff time, contracting services, and any other pertinent costs that were triggered due to
the incident. The estimate should also include costs associated with a disclosure notification
(such as preparation, postage,call center activation,etc.).
14. Total Estimated Cost of Incident - Provide the total cost associated with handling the incident as it relates only to
information technology. For example, if a state vehicle was stolen with a state-issued laptop in it,do not include
the cost of the state vehicle.
15. Type of Personally Identifiable Information - If applicable, check the appropriate type(s) of personally identifiable
information that applies in this incident.
16. Is a Privacy Disclosure Notice Required? - Check appropriate box. Sample - If yes, attach a sample copy of the
notification sent to the affected individuals. DO NOT provide a sample that includes personally identifiable
information.
17. Number of Individuals Affected - Identify the number of individuals whose personally identifiable information was
breached/disclosed.
18. Date Notification(s) Made to the Individual - Provide the date that the Notification was made to the affected
individuals.
19. Have Those Responsible for the Incident Been Identified?-Check the appropriate box. If applicable, add comment.
20. Corrective Actions Taken To Prevent Future Occurrences - Provide a detailed description of the corrective actions
taken by the agency to prevent future occurrences of a similar incident occurring again.
21. Estimated Cost of Corrective Actions - Provide cost estimations to implement the corrective actions. For example,
hardware and/or software may need to be upgraded, installed or purchased; new policies may need to be
developed; additional training may need to be given. Include all related costs, such as staff time, contracting
services,and hardware or software purchases.
22. Date Corrective Actions Will Be Fully Implemented -Provide a date when the corrective actions were,or will be,fully
implemented.
23. Print-Agency/Contractor Information Security Officer
Page 2 of 3
Exhibit A ATTACHMENT D
24. Print - Agency/Contractor Privacy Officer - This is required only in those instances where personally identifiable
information is involved. If personally identifiable information is involved and no disclosure notice is required,
the Privacy Officer's signature is still required.
25. Print-Authorized Signature/Director
ASSURANCE OF COMPLIANCE
ASSURANCE OF COMPLIANCE WITH ALL APPLICABLE LAWS
RELATING TO
NONDISCRIMINATION IN STATE AND FEDERALLY ASSISTED PROGRAMS
CONTRACTOR
HEREBY AGREES THAT it will comply with Title VI and VII of the Civil Rights Act of 1964, Section 504 of the
Rehabilitation Act of 1973, as amended, the Age Discrimination Act of 1975, the Food Stamp Act of 1977-
Section 272.6, The Americans with Disabilities Act of 1990, Government Code (GC) Section 11135 and California
Code of Regulations (CCR) Title 22 Section 98000-98413, Title 24 of the California Code of Regulations, Section
3105A(e) and other applicable federal and state laws, as well as their implementing regulations (including 45
CFR, Parts 80, 84, and 91, 7 CFR Part 15, and 28 CFR Part 42), by ensuring that employment practices and the
administration of public assistance and social services programs are nondiscriminatory, to the effect that no
person shall because of race, color, national origin, political affiliation, religion, marital status, sex, age or
disability be excluded from participation in or be denied the benefits of, or be otherwise subject to discrimination
under any program or activity receiving federal or state assistance; and HEREBY GIVES ASSURANCE THAT, it
will immediately take any measures necessary to effectuate this agreement.
THIS ASSURANCE is given in consideration of and for the purpose of obtaining any and all federal and state
assistance; and THE AGENCY HEREBY GIVES ASSURANCE THAT administrative methods/procedures which
have the effect of subjecting individuals to discrimination will be prohibited.
BY ACCEPTING THIS ASSURANCE, the agency agrees to compile data, maintain records and submit reports
as required, to permit effective enforcement of the aforementioned laws and regulations and permit authorized
County, state and/or federal government personnel, during normal working hours, to review such records, books
and accounts as needed to ascertain compliance. If there are any violations of this assurance. County shall have
the right to invoke fiscal sanctions or other legal remedies in accordance with Welfare and Institutions Code
Section 10605, or Government Code Section 11135-39, or any other laws, or the issue may be referred to the
appropriate federal agency for further compliance action and enforcement of this assurance.
THIS ASSURANCE is binding on the agency directly or through contract, license, or other provider services, as
long as it receives federal or state assistance; and shall be submitted annually with the required Civil Rights Plan
Update.
DATE SIGNATURE
ORGANIZATION
j ADDRESS
i
Pane 3 of 3
Exhibit A ATTACHMENT E
DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046
(See reverse for public burden disclosure.)
1.Type of Federal Action: 2.Status of Federal Action: 3. Report Type:
F7 a. contract 0 a. bid/offer/application a. initial filing
b. grant b. initial award b. material change
c. cooperative agreement c. post-award
d. loan For Material Change Only:
e. loan guarantee year quarter
I. loan insurance date of last report
4. Name and Address of Reporting Entity: 5. If Reporting Entity in No.4 is a Subawardee, Enter Name
❑ Prime ❑ Subawardee and Address of Prime:
Tier if known:
Congressional District, if known: Congressional District, if known:
6. Federal Department/Agency: 7. Federal Program Name/Description:
CFDA Number, if applicable:
8. Federal Action Number, if known: 9.Award Amount,if known:
10. a. Name and Address of Lobbying Entity b. Individuals Performing Services(including address if
(if individual, last name, first name, MI): different from No. 10a)
(last name, first name, MI)
attach Continuation Sheets SF-LLLA, necessarA
11.Amount of Payment(check all that apply): 13. Type of Payment(check all that apply):
$ ❑ actual ❑ planned ❑ a. retainer
❑ b. one-time fee
❑ c. commission
12. Form of Payment(check all that apply): ❑ d. contingent fee
❑ a.cash ❑ e. deferred
❑ b.in-kind;specify: nature ❑ I. other; specify:
14. Brief Description of Services Performed or to be Performed and Date(s)of Service, including officell
employee(s), or Member(s) contacted,for Payment Indicated in Item 11:
(attach Continuation Sheet(s)SF-LLLA,if necessary)
15. Continuation Sheet(s) SF-LLLA attached: ❑ Yes ❑ No
16. Infonnffilonreguest edlhleugh this farmisaulhanniby title 31US.C. Signature:
section 1352.This desdosure oflct ing adivitees is a nwleml represenmtmn of Print Name:
fed upon which ralian.was plamd by the tier above when Nea dansaclion wee
made ar entered Imo.This disdoeure is required pursuant m 31 U.Sc.1352.Thee Title:
infarmaeon will be ral o to the Congress semi-annul aM will be available
for public lnspectem."Pill who falls to file the reguered disclosure shell be Telephone No.: Date:
subject m a cavil penalty of not less that S1o,000 and had more Iran stopood far '
eam sum failure.
pane 1 of 1
Exhibit A ATTACHMENT F
Authorized Federal Use Only: Standard Foorm LLLI(Rev. on
.7-97)
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 fling, pursuant to title 31 U.S.C. section 1352. The fling 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-LLLA
Continuation Sheet for additional information if the space on the forth is inadequate. Complete all items that apply for both the initial fling 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 Distinct, 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 fling 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 zip code of the lobbying entity engaged by the reporting 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 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 ail boxes 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 details) of any
services rendered. Include all preparatory and related activity, not just time spent in actual contact with Federal officials. Identify the Federal
officials)or employees)contacted or the officer(s),employee(s),or Member(s)of Congress that were contacted.
15. Check whether or not a SF-LLLA Continuation Sheets)is attached.
16. The certifying official shall sign and date the tone,print his/her name,title,and telephone number.
Page 2 of 2
Exhibit A ATTACHMENT F
According to the Paperwork Reduction Ad,as amended,no persons are required to respond to a collection of information unless it displays a valiA OMB Control
Number. The valid OMB control number for this information collection is OMB No. 034 8-0046. Public reporting burden for this collection of information is
estimated to average30 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 estimate a any other aspect of this cdledion of
information,including suggestions for reducing this burden,to the Once of Management and Budget,Paperwork Reduction Project(034&0046).Washington,
OC 20503.
INFORMATION SHEET (one Information Sheet per Vendor)
CONTRACTOR SHALL COMPLETE SECTION I OF THIS FORM AND RETURN TO:
SAN BERNARDINO COUNTY
Department of Aging and Adult Services
Attn: CONTRACTS
SECTION I: CONTRACTOR INFORMATION
Cpntranor Name:
Address(mcWQing Cary,Stme aasd Zp Code: Phone:
Web Sim: Email: Fax:
Sim Name for Services(fDij(erem from Commmn r):
AM=(Mcl&,g City,Sane and Zip Code): Phone:
Web Sim: Email: Fac
Clinic Concoct: Tide:
Contract Signature Authority:
Name: Nance:
Title: Title:
Signsmm: Signature:
Phone N: E-Mall: Phone N: t E-11aI1.
Claim Signature Authority:
Name: Name:
Title: Title:
Signature: Sigrratime:
Phone N: E-Mail: Phone N: E-Mail:
SECTION II: DAAS INFORMATION
Contract Mailing Address: Contracts Unit:
San Bernardino County
Page 3 of 2
Exhibit A ATTACHMENT G
Department of Aging and Adult Services Unit Fax k: 909-891-9150
Contracts Unit
686 E. Mill Street
San Bernardino, CA 92415-0920
COMMUNITY FOCAL POINTS LIST
CCR Title 22, Article 3, Section 7302(a)(14), 45 CFR Section 1321.53(c), OAA 2006 306(a)
Adelanto Senior Center 11565 Cortez Street Adelanto 92301 (760)246-7736
Apple Valley Senior Center 14933 Wakita Road .Apple Valley 92307 (760)247-3155
Baker Valley Senior Center P.O. Box 28 Baker 92309 (760)733-4485
Barstow Senior Center 555 Melissa Barstow 92311 (760)256-9111
Big Bear Valley Senior Center 42651 Big Bear Blvd. Big Bear 92314 (909) 584-0323
Bloomington Senior Center 18317 Valley Blvd. Bloomington 92316 (909) 8774310
Bonnie Baker Senior Center 149350 Ukiah Trail Big River 92242 (760)665-2667
Casa Ramona Senior Center 1524 W. 7"St. San Bernardino 92311 (909)889-0011
Chino Senior Center 13170 Central Ave. Chino 91710 (909)591-9836
Delmann Heights Senior Center 2969 North Flores San Bernardino 92405 (909) 887-2115
El Mirage Senior Club 1488 Milton El Mirage 92301 (760) 388-4429
George White Senior Center 856 S. Nuevo Ave. Fontana 92335 (909)822-4493
Gibson Senior Center 250 N.Third St. Upland 91786 (909)981-4501
Grand Terrace Senior Center 22627 Grand Terrace Grand Terrace 92313 (909)824-1491
Rd.
Havasu Lake Senior Center So. 17 Mile Rd. Havasu Lake 92363 (760)8584336
Hesperia Senior Center 16292 Lime St. Hesperia 92345 (760)244-1680
Highland Senior Center 3102 E. Highland Ave. Highland 92369 (909) 862-8104
Hinkley Senior Center 35779 Mt. View Hinkley 92347 (760)253-4677
Home of Neighborly Senior Center 839 N. Mt.Vernon San Bernardino 92311 (909)885-3491
Hootman Senior Center 2929 School Rd. Running Springs 92382 (909) 867-3176
Hutton Senior Center 660 Colton Ave. Colton 92324 (909) 376-6168
Page 2 of 1
Exhibit ATTACHMENT H
James Brulte Senior Center 1120 Baseline Rd. Rancho 91730 (909)477-2780
Cucamonga
Jessie Turner Senior Center 6396 Citrus Ave. Fontana 92336 (909)428-8372
Josephine Knopf Senior Center 8384 Cypress Ave. Fontana 82335 (909)428-8376
Landers Senior Center 58380 Reche Rd. Landers 92285 (760) 364-3936
Leisure Shores Senior Center 24658 San Moritz Dr. Crestline 92325 (909) 338-5036
Luque Senior Center 292 East"0" Street Colton 92324 (909) 370-5087
Lucerne Valley Senior Club 10431 Allen Way Lucerne Valley 92356 (760)248-2248
Mentone Senior Center 1331 Opal Ave. Mentone 92359 (909)794-0327
Montclair Senior Center 5111 Benito Montclair 91763 (909)625-9462
Mountain Communities Senior Center 675 Grandview Rd. Twin Peaks 92391 (909)337-1824
Needles Senior Center 1699 Bailey Needles 92363 (760)326-5643
Newberry Springs Senior Center 3383 Newberry Rd. Newberry Springs 92365 (760)257-3284
Oldtimers Foundation Senior Center 8572 Sierra Ave. Fontana 92335 (909)829-0384
Ontario Community Senior Center 225 East"B" St. Ontario 92764 (909)395-2021
Perris Hill Park Senior Center 780 E. 21''St. San Bernardino 92418 (909)384-5436
Phelan Senior Center 9856 Sheep Creek Rd. Phelan 92371 (760) 868-8067
Pinion Hills Senior Center 10433 Mountain Rd. Pinion Hills 92371 (760)868-8637
Red Mountain Senior Center P.O. Box 824 Red Mountain 92558 (760)374-2201
Redlands Community Senior Center 111 W. Lugonia Redlands 92373 (909) 798-7579
Redlands Joslyn Senior Center 21 Grant St. Redlands 92373 (909)798-7550
Rialto Senior Center 14111 S. Riverside Rialto 92376 (909) 877-9706
Ave.
San Bernardino Senior Center 600 W. 5"St, San Bernardino 92410 (909) 384-5430
Trona Senior Center 13187 Market St. Trona 93562 (760) 372-5889
Victorville Activity Center 15075 Hesperia Rd. Victorville 92392 (760)245-7047
Victorville Senior Center 14874 South Mojave Victorville 92392 (760)245-5018
Dr.
Wonder Valley Senior Center 80526 %Amboy Rd. Twentynine Palms 92277 (760)367-1678
Wrightwood Senior Center P.O. Box 607 Wrightwood 92397 (760)249-3854
Yucaipa Senior Center 12202 First St. Yucaipa 92399 (909)797-1177
Pace 1 of 3
Exhibit A
ATTACHMENT H
—
Yucca Valley Senior Center 57088 29 Palms H Yucca Valley 92284 r(760)22
wy 6-5453
--
Following are the addresses of the Department of Aging and Adult Services offices.
city Address Zip Phone
Barstow 536 East Virginia Way 92311 (760)256-5544
Needles 1300 Bailey Avenue 92363 (760)326-9328
Rancho Cucamonga 9445 Fairway View Place 91730 (909) 948-6200
San Bernardino 686 E. Mill Street 92415 (909)891-3900
Victorville 17270 Bear Valley Road, Suite 108 92395 (760)843-5100
Yucca Valley 56357 Pima Trail 92284 (760)228-5390
P�no 7 of Z
Exhibit A ATTACHMENT I
MONTHLY NUTRITION PROGRAM REQUEST FOR REIMBURSEMENT
(Due on the Sth working day of the following month)
FY 2010-2011
COUNTY OF SAN BERNARDINO CONTRACTOR NAME AND ADDRESS:
DEPARTMENT OF AGING &ADULT SERVICES
CFDA#s: MONTH: D
CONGREGATE SITES C 1 ❑ HOME DELIVERED MEALS C2 ❑
# of Meals Provided as Entered into SAMS
(X) Reimbursable Cost Per Meal #
= REQUEST FOR REIMBURSEMENT $
Prepared By: . Date:
Signature*
Approved By: Date:
Signature*
❑ Check this box if you sold any equipment purchased with Nutrition grant funds during the
the month being reported.
IMPORTANT:
1.Invoice must be signed by Contractor or invoice will be returned for signature.
2.Monthly Invoice must be accompanied by separate Contractor Monthly Expenditure Report.
Exhibit A ATTACHMENT J
NUTRITION PROGRAM Contractor Quarterly Expenditure Report.
(Submit quarterly by the Sth working day October,January,March and June for the previous quarter of service)
FY 2010-2011
COUNTY OF SAN BERNARDINO CONTRACTOR NAME AND ADDRESS:
DEPARTMENT OF AGING &ADULT SERVICES
CFDA# O MONTH: D
CONGREGATE SITES C 1 ❑ HOME DELIVERED MEALS C 2 ❑
A + B C
EXPENDITURES: COST TO PROVIDER TOTAL MONTHLY
CASH IN-KIND EXPENSE
1. Personnel $ - $ - $ -
2. Staff Travel and Training -
3. Equipment(including One-Time-Only purchases) -
4 Consultants -
5. Catered Food -
& Raw Food -
7. Other Expenses
a. Consumable Supplies -
b. Insurance -
c. Repair&Maintenance - -
d. Rent/Building Space -
e. Utilities -
f. Vehicle Operations -
Miscellaneous -
8. Indirect Costs -
9. Total Expenditures add lines 1-8) $ - ; - $ -
DEDUCTIONS FROM EXPENDITURES: TOTAL
CASH IN-KIND DEDUCTIONS
10 Program Income income not from DAAS) $ - $ -
11 Deferred Income -
12 Matching Cash -
13 Matching In-Kind -
14 Non-Match Cash
15 Non-Match In-Kind -
16 Total Deductions add lines 10-15 $ - ; - § -
TOTAL EXPENDITURES LESS DEDUCTIONS line 9less line 16 $
Prepared By: . Date:
Signature *
Approved By: Date:
Signature *
❑ Check this box if you sold any equipment purchased with Nutrition grant funds during the
the month being reported.
Exhibit A ATTACHMENT K
NAME OF CONTRACTOR
BUDGET LINE ITEMS FOR NUTRITION SERVICES
Fiscal Year 2010/2011
CONGREGATE SITES C-1 Fx I HOME DELIVERED MEALS C-2 ❑
Section I: Prepare this section based on annual estimated cost to serve the meals.
a b C=a+b
Cost to Provider for the year
Expenditure Category: Cash In-Kind Annual Expense
1 Personnel 132,207 36,300 168,507
2 Staff Travel&Training
3 Equipment
4 Consultants 9,918 9,918
5 .Catered Food
6 Raw Food 65,802 10,000 75,802
7 Other Expenses:
a. Consumable Supplies 7,280 7,280
b. Insurance
c. Repair&Maintenance 4,500 4,500
d. Rent/Building Space
e. Utilities 21,929 21,929
f. Vehicle Operations 3,000 3,000
g. Miscellaneous 1,488 1,488
8. Indirect Cost
9. Nutrition Education 785 785
Total Expenditures(add lines 1-9) 224,980 68,229 293,209
County Contract Revenue Sources:
Title IIIC 153,940 153,940
NSIP 22,235 22,235
One Time Only
CDBG-DAAS
CDBG-ECD
County Funding
Nutrition Education 785 785
Total County Contract Revenue Sources 176,960 176,960
Other Revenue Sources:
Program Income 40,000 40,000
Deferred Income
Matching Cash
Matching In-Kind 68,229 68,229
Non-Match Cash 8,020 8,020
Non-Match In-Kind
Total Other Revenue Sources 116,249 116,249
Total Revenue 293,209 293,209
Section II: Prepare this section based on estimated number of meals that will be served
multiplied by meal cost per unit.
D E f=d*e
Estimated annual number of meals Proposed meal cost per unit Annual Budget
Exhibit A ATTACHMENT L
Budget In-Kind Narrative
Provide information regarding specific in-kind to be used as match. Include site location, if applicable, descriptions, rate
and other relevant information. The Total should equal the amount of in-kind reported as match on your budget summary.
Description' Site/Location Rate Total In-Kind Match
`(Identify type of in-kind: rent, volunteer services, etc.)
DATE OF
SUBMISSION PROVIDER NAME
San Bernardino County-DAAS Form 332
Revised 01/06/2001