HomeMy WebLinkAbout05.D- Parks, Recreation & Community Services i
RESOLUTION (ID # 2551) DOC ID: 2551 A S�
CITY OF SAN BERNARDINO—REQUEST FOR COUNCIL ACTION
Agreement/Contract
From: Brandon Mims M/CC Meeting Date: 07/15/2013
Prepared by: Harriet Myers, (909) 384-5233
Dept: Parks, Recreation& Community Ward(s): All
Services
Subject:
Resolution of the Mayor and Common Council of the City of San Bernardino Ratifying the City
Mananger's Execution of a Contract with the County of San Bernardino Department of Aging
and Adult Services (DAAS), Accepting the Proposal Grant Amount of$210,122 for the Period
of July 1, 2013 through June 30, 2014 for the Senior Nutrition Program as Part of a 3-Year Grant
Allocation Contract with DAAS, and Authorizing the Finance Director to Issue Annual Purchase
Orders in an Amount Not to Exceed $85,000 in the Aggregate to Sysco Foods, Merit Day, and
FS Dairy Distributor through Fy 2013-14. (#2551)
Current Business Registration Certificate: Not Applicable
Financial Impact:
Account Budgeted Amount: _$340,299
Balance as of: _July 1, 2013
Balance after approval of this item: _$340,299
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 13/14 is $210,122. There is no General Fund cash
match required; the City's in-kind contribution is budgeted at $83,728 for FY 13/14, which is a
39.85% contribution. The minimum in-kind matching contribution requirement by Contract for
FY 13/14 is 11.11%. This is met through a percentage of personnel,building, and utility costs,
which are funded in the Parks, Recreation and Community Services operating budget (001-380-
0075-xxxx). The program's revenue goal includes collecting $46,449 in `Program Income' or
meal recipient to support meal service,which is approximately 75% of the suggested donation
rate per meal recipient of$1.75.
Motion: Adopt the Resolution.
Synopsis of Previous Council Action:
March 4, 2013 - Resolution No. 2013-42, Amendment No. 5 to County Contract 10-318 A-5 to
accept increase contract amount to $277,294 and authorize change orders to increase annual food
purchase orders.
May 21, 2012 - Resolution No. 2012-87, Amendment No. 4 to County Contract 10-318 A-4 to
increase contract amount to $233,732.
March 19, 2012 - Resolution No. 2012-47. Amendment No. 3 to County Contract 10-318 A-3 to
increase annual food vendor purchase orders.
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Updated: 7/11/2013 by Georgeann"Gigi" Hanna A
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2551
May 16, 2011 - Resolution No. 2011-105 Amendment No. 2 to County Contract 10-318 A-2 to
execute FY 2011-2012 Budget for Senior Nutrition Program.
April 4, 2011 - Resolution No. 2011-81 Amendment No. 1 to County Contract 10-318 A-1 to
increase budget to $259,462 (increase of $82,502) for FY 2011-2012 for Senior Nutrition
Program and increase annual food vendor purchase o ders through FY 2012-13.
October 4, 2010 - Resolution No. 2010-332 issuance of annual purchase orders in aggregate to
Sysco Foods,Merit Day and Ross Swiss for the Senior Nutrition Program not to exceed$73,082.
May 17, 2010 - Resolution No. 2010-109 to execute the Contract 10-318 for FY 2010-2011
Senior Nutrition Program as part of 3-year grant allocation contract with County DAAS.
Background:
The Financial Accounting System 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, 2013 through June 30, 2014. During the last full year of meal services in FY
11/12, the Senior Nutrition Program served 47,335 total meals for a daily average of 189 meals
or 250 individual clients at six (6) nutrition sites: th Street Senior Center, Perris Hill Senior
Center, New Hope Family Life Center, Hernandez Community Center, Lytle Creek Community
Center, and Highland Senior Center.
The previous 3-year grant cycle contract ends Jun 30, 2013, and FY 13/14 Senior Nutrition
meal services contract begins July 1, 3013. This contract for Senior Nutrition Services covers
the first year of a 3-year grant cycle with Fiscal Year 2013/14. Attached is the FAS Standard
Contract,with contract number to be assigned by the County once executed by the City.
The FY 13/14 requested contract amount is $210,122,with the program expecting to serve 47,000
congregate meals at six meal sites accumulatively, although the County Contract requires 36,166
meals be served and approves a meal rate for compensation of $5.81 per meal. This year's
proposed allocation from the County is approximately $65,000 less than the Application request.
The County has experienced delays in awarding con act amounts due to Federal sequestration of
funds this year but does anticipate a tentative award date in late June, 2013 and anticipates the
City's award in the amount as proposed. The Sequestration is also the reason that all senior
nutrition food service providers have seen budget reductions this year. Furthermore, One-Time-
Only (OTO) funds at mid-year are also not anticip ted for both the 2013-2014 and 2014-2015
fiscal years. The City may need to limit the number of daily meals it provides to seniors as a
result of these reduced allocations.
In conformance with the provisions of the grant, the proposed action is to execute a new three-
year agreement and to issue annual purchase orders for the food vendors Sysco Foods, Merit
Day, and
FS Dairy Distributor, exercising the first of two sin le-year renewals, to provide these meals in
an aggregate amount of$85,000 for the term of one year having begun on July 1, 2013. As the
City progresses through the bankruptcy process, and as the budgeted costs for these food items
are likely to fluctuate during the next three fiscal years, the first-year renewal option is
determined to be the best approach. The approval of this recommended action will allow the
Senior Nutrition Program to continue the delivery of nutrition services uninterrupted to the
City's senior population.
Updated: 7/11/2013 by Georgeann"Gigi"Hanna A Packet Pg. 111
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City Attorney Review:
Supporting Documents:
reso 2551 (PDF)
RESO DAAS Senior Nutrition Grant 2013 PDF (PDF)
CON-DAAS-061813 City of SB (2) (PDF)
DAAS Contract 070113 063014 (PDF)
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Updated: 7/11/2013 by Georgeann"Gigi"Hanna A Packet Pg. 112
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ions' 1 RESOLUTION NO.
2 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SA
BERNARDINO RATIFYING THE CITY MANANGER'S EXECUTION OF
3 CONTRACT WITH THE COUNTY OF SAN BERNARDINO DEPARTMENT O
AGING AND ADULT SERVICES (DAAS), ACCEPTING THE PROPOSAL GRAN
4 AMOUNT OF $210,122 FOR THE PERIOD OF JULY 1,2013 THROUGH JUNE 30,2014
FOR THE SENIOR NUTRITION PROGRAM AS PART OF A 3-YEAR GRAN
5 ALLOCATION CONTRACT WITH DAAS, AND AUTHORIZING THE FINANC
DIRECTOR TO ISSUE ANNUAL PURCHASE ORDERS IN AN AMOUNT NOT T
6 EXCEED $85,000 IN THE AGGREGATE TO SYSCO FOODS, MERIT DAY, AND F
DAIRY DISTRIBUTOR THROUGH FY 2013-14.
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BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CIT
8 OF SAN BERNARDINO AS FOLLOWS: a
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9 SECTION 1. The Mayor and Common Council herby ratify the City Manager's M
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10 execution of a FAS Standard Agreement with the County of San Bernardino, accepting a grant i a
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11 the amount of$210,122 for a one-year period, beginning July 1, 2013 through June 30, 2014, a r
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12 copy of which is attached hereto, marked Exhibit "A" and incorporated herein by reference as o
13 fully as though set forth at length; and u?
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14 SECTION 2. The Director of Finance or his designee is hereby authorized to issue
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15 annual purchase orders to Sysco Foods, Merit Day, and FS Dairy Distributor for food services N LO
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16 and consumable supplies in an aggregate amount not to exceed $85,000 for FY 2013-2014 pet
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17 the second year of 3-year Vendor Service Agreements. E
18 SECTION 3. The authorization granted hereunder shall expire and be void and of no r
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19 further effect if the Standard Agreement is not executed by both parties and returned to the
20 Office of the City Clerk within one hundred and twenty days (120) days following effective date
21 of the Resolution.
22
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EPajcket Pg. 113
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I RESOLUTION NO.
2 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SA
BERNARDINO RATIFYING THE CITY MANANGER'S EXECUTION OF
3 CONTRACT WITH THE COUNTY OF SAN BERNARDINO DEPARTMENT O
AGING AND ADULT SERVICES (DAAS), ACCEPTING THE PROPOSAL GRAN
4 AMOUNT OF$210,122 FOR THE PERIOD OF JULY 1,2013 THROUGH JUNE 30,201
FOR THE SENIOR NUTRITION PROGRAM AS PART OF A 3-YEAR GRAN
5 ALLOCATION CONTRACT WITH DAAS, AND AUTHORIZING THE FINANC
DIRECTOR TO ISSUE ANNUAL PURCHASE ORDERS IN AN AMOUNT NOT T
6 EXCEED $85,000 IN THE AGGREGATE TO SYSCO FOODS, MERIT DAY, AND F
DAIRY DISTRIBUTOR THROUGH FY 2013-14.
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I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the Mayor an N
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Common Council of the City of San Bernardino at a meeting thereof, held on
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the day of , 2013, by the following vote,to wit: o
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Council Members: AYES NAYS ABSTAIN ABSENT o
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MARQUEZ z
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JENKINS c
13 in
VALDIVIA
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SHORETT
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KELLEY o
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JOHNSON :.
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MC CAMMACK
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19 Georgeann Hanna, City Clerk
20 The foregoing resolution is hereby approved this day of ,2013.
21
22 Patrick J. Morris,Mayor
City of San Bernardino
23 Approved as to Form:
JAMES F. PENMAN, City Attorney
24
By:
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FOR COUNTY USE ONLY
X New FAS Vendor Code Dept. Contract Number
ED JARDINO
Change CITYOFS772 SC OOA
Cancel
ePro Vendor Number ePro Contract Number
00003036
County Department Dept. Orgn. Contractor's License No.
Department of Aging and Adult Services OOA 210
County Department Contract Representative Telephone Total Contract Amount
County of San Bernardino Wendy Everett (909)387-2917 $210,122
Contract Type
FAS ❑ 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 1 July 2013 June 30, 2014 $210,122 in
Fund Dept. Organization Appr. Obj/Rev Source GRC/PROJ/JOB No. Amount Q
AAF OOA 210 300 3357 $167,182 0
AAF OOA 211 300 3357 $17,115 E
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AAF OOA 235 300 3357 $25,825 c
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Project Name Estimated Payment Total by Fiscal Year o
Elderly Nutrition Program FY Amount I/D FY Amount I/D
13/14 $210,122 1 z
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THIS CONTRACT is entered into in the State of California by and between the County of San Bernardino, LO
^-partment of Aging and Adult Services, hereinafter called the County, and N
.,pry of San Bernardino hereinafter called Contractor N
Address O
300 North D Street r
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San Bernardino, CA 92418 T-
00
Telephone r
Federal ID No./Social Security No. C
(909)384-5434 ,
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IT IS HEREBY AGREED AS FOLLOWS: a
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WHEREAS, The County desires to provide nutrition programs for the elderly; and Z
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WHEREAS, the Older Americans Act of 1965 provides assistance to State and local agencies to develop nutrition L)
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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 a
services according to the specific terms and conditions provided by the Contract;
NOW THEREFORE, County and Contractor mutually agree to the following terms and conditions:
AUditor/Controller/Treasurer Tax Collector Use Only
• Contract Database • FAS
Input Date Keyed By
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TABLE OF CONTENTS
I. DEFINITIONS .................................................................................................................................................................3
II. CONTRACTOR SERVICE RESPONSIBILITIES...........................................................................................................3
III. CONTRACTOR GENERAL RESPONSIBILITIES.........................................................................................................5
IV. COUNTY RESPONSIBILITIES.....................................................................................................................................17
V. FISCAL PROVISIONS..................................................................................................................................................17 N
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VI. RIGHT TO MONITOR AND AUDIT..............................................................................................................................20 p
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VII. CORRECTION OF PERFORMANCE DEFICIENCIES f°
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VIII. TERM L
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IX. EARLY TERMINATION 0
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X. GENERAL PROVISIONS.............................................................................................................................................23 z
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XI. CONCLUSION..............................................................................................................................................................26 r-
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ATTACHMENTS N
ATTACHMENT A - SCOPE OF WORK
ATTACHMENT B - CLIENT COMPLAINT AND GRIEVANCE PROCEDURES Co
ATTACHMENT C - ASSURANCE OF COMPLIANCE -
ATTACHMENT D - CONTRACTOR/VENDOR CONFIDENTIALITY STATEMENT r
ATTACHMENT E - SECURITY INCIDENT REPORT
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ATTACHMENT F - DISCLOSURE OF LOBBYING ACTIVITIES Co
ATTACHMENT G INFORMATION SHEET c
ATTACHMENT H - COMMUNITY FOCAL POINTS LIST Q
ATTACHMENT I - PROGRAM BUDGET o
ATTACHMENT J - MONTHLY INVOICE (REQUEST FOR REIMBURSEMENT) z
ATTACHMENT K - QUARTERLY EXPENDITURE REPORT
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ATTACHMENT L - BUDGET MATCHING FUNDS NARRATIVE STATEMENT
ATTACHMENT M - REQUEST TO PURCHASE PROPERTY/EQUIPMENT/PROPERTY BID
FORM
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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.
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E. CFDA—Catalog of Federal Domestic Assistance a
F. CFR—Code of Federal Regulations
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G. Congregate Nutrition Services(C-1)— Meals provided in a congregate setting for older individuals in an a,
atmosphere that is pleasant and encourages socialization. a
H. Contract—The cover sheet, terms and conditions, attachments, addendums, and amendments, unless o
otherwise specified.
I. Contractor— The entity (Contractor/ProviderNendor) to which funds are awarded under this Contract z
and which is accountable to DAAS for use of these funds and is responsible for executing its provisions o
and services.
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J. CRFC — California Retail Food Code (Section 113700 et seq., California Health and Safety Code);
replaces California Uniform Retail Food Facilities Law(CURFFL).
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10 K. DAAS — Department of Aging and Adult Services, and the designated Area Agency on Aging in San
Bernardino County.
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L. DHS—California State Department of Health Services m
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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 0
areas of major life activity:
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1. Self-care c
2. Receptive and expressive language a
3. Learning a
4. Mobility
5. Self-direction Z
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6. Capacity for independent living v
7. Economic self-sufficiency
8. Cognitive functioning E
9. Emotional adjustment
N. Elderly—Any individual who is sixty (60)years of age or older, also under"older individual." Q
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.
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R. General Program Income — Meal income received in the form of contributions or donations made by
the elderly for services rendered under this Contract.
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 in
dispensing of a food. a
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. o
6. Establishing and maintaining a recordkeeping system to verify adherence to a HACCP plan. a
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. Z
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V. Home Delivered Nutrition Services(C-2)—Meals provided to older individuals who are homebound.
W. HS — Human Services —A system of integrated services, where the programs and resources of eight N
County departments come together to provide a rich, more complete array of services to the citizens of ,
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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 N
and information which will promote improved food selection, eating habits, nutrition, health promotion, o
and disease prevention practices.
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Z. Nutrition Services—The procurement, preparation, transport, and service of meals, nutrition education, M
nutrition screening, and nutrition counseling, to eligible individuals at congregate sites or in their Go
homes. o
AA. OAA — Older Americans Act — Provides comprehensive, coordinated, community-based systems of a
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. p
CC. OMB—Office of Management and Budget.
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DD. Program Income — Revenue generated by the Contractor or subcontractor from contract-supported E
activities. Program income is:
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1. Voluntary contributions received from a participant or responsible party as a result of services. a
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:
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4.D.b
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.
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 I I I —Title I I I of the Older Americans Act
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LL. USC—United States Code Q
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MM. USDA— United States Department of Agriculture E
NN. Volunteer — An individual who provides services without pay, but may receive reimbursement for a,
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expenses. a
00. W & I —California Welfare and Institutions Code o
II. CONTRACTOR SERVICE RESPONSIBILITIES
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Contractor shall provide all services as outlined in Scope of Work(Attachment A). 00
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III. CONTRACTOR GENERAL RESPONSIBILITIES
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A. In the performance of this Contract, Contractor, its agents and employees, shall act in an independent N
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, m
declared ineligible, or voluntarily excluded from participation in this transaction by any federal w
department or agency as required by Executive Order 12549 and implemented as 45 Code of Federal 0
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Regulations part 76. v
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B. Without the prior written consent of the Assistant Executive Officer for Human Services, this Contract is o
not assignable by Contractor either in whole or in part. c
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C. Contractor agrees to provide or has already provided information on former County of San Bernardino a
administrative officials (as defined below) who are employed by or represent Contractor. The o
information provided includes a list of former County administrative officials who terminated County z
employment within the last five years and who are now officers, principals, partners, associates or u
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, Chief Executive Officer of the County or member of
such officer's staff, County department or group head, assistant department or group head, or any M
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 agrees not to enter into any subcontracts for work contemplated under this Contract without
first obtaining written approval from the Director of DAAS or designee. Any subcontractor shall be
subject to the same provisions as Contractor. Contractor shall be fully responsible for the performance
of any subcontractor.
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4.D.b
F. 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. County shall have the right upon reasonable notice
and at reasonable hours of business to examine and inspect such records and books.
Records, should include, but are not limited to, monthly summary sheets, sign-in sheets, and other
primary source documents. Fiscal records shal 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 appr priate 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 a
maintain acceptable records per the precedin requirements shall be considered grounds for o
withholding of payments for billings submitted and for termination of the Contract. E
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G. Contractor shall notify County in writing of any hange in mailing address and/or physical location a
within ten (10) days of the change, and shall imm adiately notify County of changes in telephone or fax =
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numbers.
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H. Contractor shall notify County of any continuing vacancies and any positions that become vacant z
during the term of this Contract that will result in reduction of services to be provided under this o
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. Vacancies and associated
problems shall be reported to County on each periodically required report for the duration of said
to
vacancies and/or problems. N
I. 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 N
(1) or more workdays. Contractor or designee must respond to County inquiries within two (2) County o
business days.
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J. Contractor shall provide a system, approved by he County, through which recipients of service shall
have the opportunity to express and have consid red their views and complaints regarding the delivery
of services. The procedure, Client Complaint nd Grievance Procedures (Attachment B), must be u�
posted in clear view of all recipients. a
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K. Contractor shall notify the County of all upco ing meetings of the Board of Directors or other z
governing party and shall keep the County apprised of any and all actions taken by its Board of Ov
Directors which may impact on the Contract. AlZritative ard of Directors' minutes shall be submitted to the c
County upon request. Further, a County repr shall have the option of attending Board d
meetings during the term of this Contract.
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L. Contractor shall protect from unauthorized use or disclosure names and other identifying information a
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. This provision Will remain in force even after the termination of the
Contract.
M. 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 a iy services. Contractor shall immediately notify the
County of any suspected or actual breach of confidential information as further detailed in the
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requirements. These requirements specified at http://hss.sbcounty.gov/Privacy are hereby
incorporated by this reference.
N. 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, which requires a DOJ clearance, 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 a
volunteer services. a
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O. Contractor shall notify the County of any staff member, paid intern or volunteer who is knowingly or E
negligently employed who has been convicted of any crime of violence or of any sexual crime. o
Contractor shall investigate all incidents where an applicant, employee, intern or volunteer has been a
arrested and/or convicted for any crime listed in Penal Code Section 11105.3 and shall notify the o
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 z
volunteer services. °-
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Contractor shall immediately notify the County concerning the arrest and/or conviction, for other N
than minor traffic offenses, of any paid employee, agent, consultant, intern, or volunteer staff, when LO
such information becomes known to Contractor. LO
P. Contractor shall make every reasonable effort to prevent employees, consultants or members of its
governing bodies from using their positions for purposes that are or give the appearance of being cm»
motivated by a desire for private gain for themselves or others, such as those with whom they have o
family, business, or other ties. In the event County determines a conflict of interest exists, any increase w
in costs associated with the conflict of interest may be disallowed by County and such conflict may M
constitute grounds for termination of the Contract. This provision shall not be construed to prohibit -
employment of persons with whom Contractor's officers, agents, or employees have family, business
or other ties so long as the employment of such persons does not result in increased costs over those vi
associated with the employment of any other equally qualified applicants and such persons have a
successfully competed for employment with other applicants on a merit basis. o
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Q. Contractor agrees to and shall comply with the following indemnification and insurance requirements: U
1. Indemnification — The Contractor agrees to indemnify, defend (with counsel reasonably E
approved by County) and hold harmless the County, the California Department of Aging
(CDA), the State of California, and its authorized officers, employees, agents and volunteers o
from any and all claims, actions, losses, damages, and/or liability arising out of this contract a
from any cause whatsoever, including the acts, 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
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4.D,b
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 in
all rights of subrogation against the County. a
0
4. Policies Primary and Non-Contributory — All policies required herein are to be primary and E
non-contributory with any insurance or self-insurance programs carried or administered by o
the County. a
_
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 z
or between the County and any other insured or additional insured under the policy. o
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6. Proof of Coverage — The Contractor shall furnish Certificates of Insurance to the County U)
Department administering the contract evidencing the insurance coverage, including
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endorsements, as required, prior to the commencement of performance of services LO
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 N-
maintain such insurance from the time Contractor commences performance of services co
hereunder until the completion of such services. Within fifteen (15) days of the lo-
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.
T
7. Acceptability of Insurance Carrier — Unless otherwise approved by Risk Management, 9
insurance shall be written by insurers authorized to do business in the State of California a
and with a minimum "Best" Insurance Guide rating of"A-VII". o
z
8. Deductibles and Self-Insured Retention - Any and all deductibles or self-insured retentions 0
in excess of$10,000 shall be declared to and approved by Risk Management.
d
9. Failure to Procure Coverage — In the event that any policy of insurance required under this E
contract does not comply with the requirements, is not procured, or is canceled and not w
replaced, the County has the right but not the obligation or duty to cancel the contract or a
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
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
Page 8 of 27
Packet Pg. 122
4.C1.b
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. u�
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11. The Contractor agrees to provide insurance set forth in accordance with the requirements o
herein. If the Contractor uses existing coverage to comply with these requirements and that E
coverage does not meet the specified requirements, the Contractor agrees to amend, o
supplement or endorse the existing coverage to do so. The type(s) of insurance required is a
determined by the scope of the contract services. o
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 z
insurance with limits as shown: o
d
a. Workers' Compensation/Employers Liability — A program of Workers' Compensation �!?
insurance or a state-approved, self-insurance program in an amount and form to
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meet all applicable requirements of the Labor Code of the State of California, N
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.
0
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" U
under the Labor Code and the requirement for Workers' Compensation coverage will C
be waived by the County's Director of Risk Management.
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With respect to Contractors that are non-profit corporations organized under a
California or Federal law, volunteers for such entities are required to be covered by o
Workers' Compensation insurance. z
O
b. Commercial/General Liability Insurance—The Contractor shall carry General Liability r
Insurance covering all operations performed by or on behalf of the Contractor
providing coverage for bodily injury and property damage with a combined single E
limit of not less than one million dollars ($1,000,000), per occurrence. The policy Y
coverage shall include: Q
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
Page 9 of 27
Packet Pg. 1231
4.D.b
6) Contractual liability.
Q7) $2,000,000 general aggregate limit.
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 in
combined single limit of two million dollars ($2,000,000) for bodily injury and property Q
damage per occurrence. o
E
If the Contractor owns no autos, a non-owned auto endorsement to the General
Liability policy described above is acceptable. a
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d. Umbrella Liability Insurance — An umbrella (over primary) or excess policy may be 2
used to comply with limits or other primary coverage requirements. When used, the
umbrella policy shall apply to bodily injury/property damage, personal z
injury/advertising injury and shall include a "dropdown" provision providing primary o
coverage for any liability not covered by the primary policy. The coverage shall also d
apply to automobile liability. N
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e. Professional Liability— Professional Liability Insurance with limits of not less than one N
million ($1,000,000) per claim or occurrence and two million ($2,000,000) aggregate
limits N-
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or o
Errors and Omissions Liability Insurance with limits of not less than one million 6
($1,000,000) and two million ($2,000,000) aggregate limits r.
or 9
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Directors and Officers Insurance coverage with limits of not less than one million o
($1,000,000) shall be required for Contracts with charter labor committees or other z
not-for-profit organizations advisi ig or acting on behalf of the County. o
If insurance coverage is provide on a "claims made" policy, the "retroactive date" C
shall be shown and must be be ore the date of the start of the contract work. The E
claims made insurance shall be maintained or "tail" coverage provided for a
minimum of five (5) years after contract completion. Q
R. Contractor shall comply with all applicable laws, statutes, ordinances, administrative orders, rules or
regulations relating to its duties, obligations and p rformance 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.
S. Contractor shall comply with all applicable local h alth and safety clearances, including fire clearances,
for each site where services are provided under t e terms of this Contract.
Pa e 10 of 27
Packet Pg. 124
4.D.b
T. 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.
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, E
religion, gender, marital status, sexual orientation, age, political affiliation or disability. o
Information on the above rules and regulations may be obtained from the County Human a
Services Contracts Unit. c
0
2. Civil Rights Compliance: The Contractor shall develop and maintain internal policies and r
procedures to assure compliance with each factor outlined by state regulation. These Z
policies must be developed into a Civil Rights Plan, which is to be on file with the County c
Human Services Contracts Unit within 30 days of awarding of the Contract. The Plan must 'E
address prohibition of discriminatory practices, accessibility, language services, staff in
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 (Attachment C) along with their agency's Civil Rights Plan. m
w
U. Contractor agrees to comply with all applicable provisions of the Americans with Disabilities Act(ADA). 0
U
V. Contractor shall observe the mandatory standards and policies relating to energy efficiency in the State M
Energy Conservation Plan (California Code of Regulations title 20, section 1401 et seq.). oo
0
W. If the amount available to Contractor under this Contract, as specified in Section V, Paragraph A, a
exceeds $100,000, Contractor agrees to comply with the Clean Air Act (42 U.S.C. Section 7606), a
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.). p
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X. 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. E
Y. 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 a
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.
Z. Contractor shall register with 211 San Bernardino County Inland Empire United Way within 30 days of
contract effective date and follow necessary procedures to be included in the 211 database. The
contractor shall notify the 211 San Bernardino County Inland Empire United Way of any changes in
program services, location or contact information within ten (10) days of any change. Services
performed as a result of being included in the 211 database, are separate and apart from the services
Page 11 of 27
Packet Pg. 125
being performed under this Contract and payment for such services will not be the responsibility of the
County.
AA. Contractor agrees that any news releases, advertisements, public announcements or photographs
arising out of the Agreement or Vendor's relationship with County shall not be made or used without
prior written approval of the DAAS Director or their designee.
BB. IRAN CONTRACTING ACT OF 2010, Public Contract Code sections 2200 et seq. (Applicable for all
Contracts of one million dollars ($1,000,000) or more). In accordance with Public Contract Code
section 2204(a), the Contractor certifies that at the time the Contract is signed, the Contractor signing
the Contract is not identified on a list created pursuant to subdivision (b) of Public Contract Code
section 2203 as a person (as defined in Public Contract Code section 2202(e)) engaging in investment
activities in Iran described in subdivision (a) of Public Contract Code section 2202.5, or as a person Q
described in subdivision (b)of Public Contract Code section 2202.5, as applicable. o
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Contractors are cautioned that making a false certification may subject the Contractor to civil 0
penalties, termination of existing contract, and ineligibility to bid on a contract for a period of three a
(3) years in accordance with Public Contract Code section 2205. o
CC. Contract Transaction Charge(CTC) r
z
Contractor agrees to remit a Contract Transaction Charge (CTC) in the amount of one percent (1%) o
of all sales (products and/or services) occurring under this contract, not including taxes, capped at
1% of $100,000 or $1,000 per contract. Contractor agrees not to assess the transaction charge in Cn
the form of a line item in their invoices, rather it will include the CTC in its unit prices for all products
and/or services available under the contract. The CTC shall be remitted to the County Purchasing N
Department at 777 E. Rialto Avenue, San Bernardino, CA 92415, no later than thirty (30) calendar
days following the end of the calendar quarter in which sales (products and/or services) under the
contract were paid. At the end of each calendar quarter or on the termination date of the contract, N
Contractor will calculate the CTC owed to County by multiplying the dollar amount of sales o
(products and/or services) paid by County in that calendar quarter by 1%. In no event shall r
contractor remit to County more than $1,000 in total CTC payments due under the contract.
Calendar quarters shall include the months of January through March, April through June, July
through September, and October through December. Contractor's obligation to remit the CTC
survives termination of the contract. Upon termination of the contract, Contractor shall remit any i°
outstanding CTC payments due to County within thirty (30) calendar days following the latter of: 1) a
termination of contract or, 2) final payment by County (if applicable). Contractor's failure to remit o
the CTC in a timely manner may result in the County exercising any recourse available under the o
contract or as provided for by law. L)
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DD. Information Integrity and Security
1. Information Assets w
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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):
a. Information collected and/or accessed in the administration of the State programs
and services.
b. Information stored in any media form, paper or electronic.
Page 12 of 27
Packet Pg. 126
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).
3. Disclosure
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a. The Contractor shall ensure that personal, sensitive and confidential information is
protected from inappropriate or unauthorized access or disclosure in accordance o
with applicable laws, regulations and State policies. The requirement to protect E
information shall remain in force until superseded by laws, regulations or policies. 0.,
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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.
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C. "Identifying information" shall include, but not be limited to, name, identifying number, o
social security number, state driver's license or state identification number, financial
account numbers, symbol or other identifying characteristic assigned to the CO
individual, such as finger or voice print or a photograph.
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d. The Contractor shall not use such identifying information for any purpose other than
carrying out the Contractor's obligations under this agreement.
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e. The Contractor shall not, except as otherwise specifically authorized or required by o
this agreement, release any identifying information obtained under the terms of this
agreement to anyone other than DAAS and/or CDA without prior written G
authorization from DAAS or CDA, except by court order. The Contractor may be r
authorized, in writing, by a participant to disclose identifying information specific to OTO
the authorizing participant. c
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f. The Contractor may allow a participant to authorize the release of information to 0
specific entities, but shall not request or encourage any participant to give a blanket z
authorization or sign a blank release, nor shall the Contractor accept such blanket o
authorization from any participant.
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4. Training/Education E
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a. The Contractor must provide ongoing education and training, at least annually, to all a
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.
Page 13 of 27
Packet Pg. 127
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. Contractors 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. a
Contractor will make reasonable efforts to ensure that subcontractors comply with the o
privacy and security requirements of HIPAA. R
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6. Contractor Confidentiality Statement °
a.
The Contractor shall sign and return a ContractorNendor Confidentiality Statement CDA O_
1024 form (Attachment D) with this Agreement. This is to ensure that Contractors are aware r
of, and agree to comply with, their obligations to protect CDA information assets from 2
unauthorized access and disclosure. `o
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Contractor shall protect from unauthorized use or disclosure names and other identifying CO
information concerning persons receiving services pursuant to this Contract, except for
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statistical information not identifying any participant. The Contractor shall not use or N
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. 0°
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7. Security Incident Reporting
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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 o
(CDA 1025) (Attachment E) must be submitted to DAAS within five (5) business days of the a
date the incident was detected. o
8. Notification of Security Breach to Data Subjects O
l a. Notice must be given by the Contractor or subcontractor to any data subject whose
personal information could have been breached. s
b. Notice must be given in the most expedient time possible and without unreasonable a
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.
Page 14 of 27
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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.
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EE. Elder and Dependent Adult Abuse Reporting a
0
Contractor agrees to and shall comply with the County's Elder and Dependent Adult Abuse Reporting E
requirements: Under the terms of this Contract, as changes in the Elder and Dependent Adult a,
Reporting Laws are enacted, the Contractor is bound to comply with the most current regulations. a
1. Who Must Report: o
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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 Z
assures all employees, agents, consultants or volunteers who perform services under this 2
Contract and are mandated to report elder and dependent adult abuse will sign a statement cn
(SOC 341 A) at http://www.dss.cahwnet.gov/Forms/English/SOC341.pdf, upon the •-
commencement of their employment, acknowledging their reporting requirements and their
compliance with them. N.
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2. When To Report: m
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Mandated reporters are required to report all instances of known or suspected abuse of the 0
elderly and dependent adults immediately or as soon as practically possible, under the
following circumstances:
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a. When the mandated reporter has observed or has knowledge of an incident that c
reasonably appears to be physical abuse, abandonment, isolation, neglect, financial Cn
abuse, mental abuse, or sexual abuse; or a
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b. When the mandated reporter is told by an elder or dependent adult that he or she has z
experienced behavior constituting physical abuse, abandonment, isolation, neglect, U
financial abuse, mental abuse, or sexual abuse.
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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;
Page 15 of 27
Packet Pg. 129
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, Q
complete a written "Report of Suspected Dependent Adult/Elder Abuse" (SOC 341) o
form, http://www.dss.cahwnet.gov/Forms/English/SOC341.pdf. The completed form E
must be submitted to the same agency to which the incident was reported by a)
telephone. a
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FF. Conflict of Interest °
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1. The Contractor shall prevent employees, consultants, or members of governing bodies from Z
using their positions for purposes including, but not limited to, the selection of o
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 U)
County determines that a conflict of interest exists, funds may be disallowed by the County
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and such conflict may constitute grounds for termination of the Agreement. LO
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 N
the employment of such persons does not result in a conflict of interest (real or apparent) or c
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.
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GG. The Contractor, by signing this Contract, hereby certifies to the best of his or her knowledge and c
belief, that: Q
1. No federal appropriated funds have been paid or will be paid, by or on behalf of the z
Contractor, to any person for influencing or attempting to influence an officer or employee of o
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 E
agreement, and the extension, continuation, renewal, amendment, or modification of any
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federal contract, grant, loan, or cooperative agreement. a
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.
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.
Page 16 of 27
Packet Pg. 130
This certification is a material representation of fact upon which reliance was placed when
0 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.
HH. Contractor shall complete and submit Information Sheet (Attachment G) in accordance with its
instructions.
II. Per DAAS contract with CDA, Article II.A.(27), Community Focal Points List (Attachment H)
provides Contractors with additional resources for their customers.
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IV. COUNTY RESPONSIBILITIES Q
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A. The County shall monitor and evaluate the performance of the Contractor in meeting the terms of the E
Contract and the quality and effectiveness of services provided based on the criteria as determined by M
0
the County. a.
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 z
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this Contract. 0
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V. FISCAL PROVISIONS co
A. The maximum amount of funds available for payment under this Contract shall not exceed $210,122, N
0 of which $193,007 may be federally funded, and shall be subject to availability of funds to the County.
The consideration to be paid to Contractor, as provided herein, shall be in full payment for all E,
Contractor's services and expenses incurred in the performance hereof, including travel and per diem. N
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B. Contractor shall be compensated on a fee-for-service basis based on the following rates, as
specified in Scope of Work (Attachment A): cv
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Congregate Site: $5.81 per meal, up to 36,166 meals o
C. Contractor shall accept all payments from County via electronic funds transfer(EFT) directly deposited (n
into the Contractor's designated checking or other bank account. Contractor shall promptly comply a
with directions and accurately complete forms provided by County required to process EFT payments. o
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D. Costs for services under the terms of this Contract shall be incurred during the contract period except U
as approved by County. Contractor shall not use current year funds to pay prior or future year
obligations. E
E. Funds made available under this Contract shall not supplant any federal, state or any governmental w
funds intended for services of the same nature as this Contract. Contractor shall not claim a
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.
F. County is not liable for the payment of any taxes, other than applicable sales or use tax, resulting from
4iio 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.
Pa e 17 of 27
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G. 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.
H. Budget and Budget Revision
1. Contractor shall be compensated for expenses only as itemized in the approved budget that is
incorporated by reference into the Agreement as Program Budget (Attachment 1). The
Contractor shall not be entitled to payment for expenses related to this Agreement until the
budget has been reviewed and approved by County. a
2. No Budget revision may result in an increase of the maximum dollar amount stated in Section o
V, Paragraph A. The written request must specify the line item or Service Category changes E
requested, and must include justification for the request changes. For the purpose of this o
section, a
r_a. "Service Category" shall be defined as that classification of activities defined in the
Older Americans Act(OAA) that is specific to each OAA funded grant program; and
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b. "Service" shall be defined as the activities that are defined within a Service Category. `o
as
Examples of Service Categories include Supportive Services, Congregate and Home- Cn
delivered Nutrition Services, Disease Prevention/Health Promotion Services, and Family
Caregiver or Grandparent Support Services. Examples of Services include nutrition LO
education, transportation, information assistance, senior center staffing, respite care, access
assistance, and supplemental services.
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County shall notify the Contractor in writing of the status of the budget revision request o
within fourteen (14) calendar days of receipt of the Contractor's written request. The County w
reserves the right to deny the Contractor's invoice for expenditures in excess of the U
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approved budgeted line item amount.
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3. The Contractor shall submit a budget revision to the County, in advance of expenditures when: N
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a. Changes to line item expenditures are expected to exceed the amount of the approved o
budgeted line item by more than ten (10%) of the amount specified in Section V, 0
Paragraph A. U
b. New budget line items are to be added.
C. When the changes being requested involve the transfer of funds between Service =
Category.
d. When the changes being requested involve the transfer of funds among Services within a
a Service Category.
e. When otherwise requested by County.
4. The Contractor shall maintain a written record of all budget changes including line item or
service category changes. This record shall be available to the Department upon request and
shall be maintained in the same manner as all other financial records.
r, 5. The final date to submit a budget revision is March 30th of the contract period unless otherwise
specified by the County.
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4.D.b
I. The County shall not approve any request for p yment of funds until Contractor has properly filed
completed reports as required under this Contract. If Contractor is not in compliance with any 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.
J. Reports
1. Contractor, at such times and in such for s 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 a
returned to the Contractor for completion. In the event of changes in these forms, DAAS shall o
advise the Contractor via written notice ) The Contractor shall develop and implement a E
process for ensuring quality control. c
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2. Contractor shall meet the following standards for the submission of required financial reports: _
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a. Accurate, current and complete disclosure of the financial results of the program shall 3
be made in accordance with the financial reporting requirements of this Contract. The z
following reports are to be submitted to DAAS when indicated: o
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1) Monthly N
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• Monthly Invoice (Request for Reimbursement) form (Attachment J) — LO
Due to DAAS Ad Tfinistration by the 5th working day of the month
following the month of service to the address stated below:
DAAS Administration
Att ntion: Nutrition Program Staff Analyst o
686 East Mill Street
Sa Bernardino, CA 92415-0515 L)
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2) Quarterly 0o
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• Nutrition Progra Contractor Quarterly Expenditure Report °
(Attachment K) — Due to DAAS Administration by the 5th calendar day a
of October, January, March, and June for the previous quarter of o
services to the address stated in the above paragraph.
• Quarterly reports shall be based on the Program Budget (Attachment L)
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3) Annually — The following reports are due on an annual basis no later than
August 1:
Financial Close-OLit Report a
Periodic Inventory Report
• Single Audit or Financial Statement
Schedule of Expenditures of Federal Awards (SEFA)
K. If, as a result of advanced income, the proje t 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.
L. Contractor shall expend all funds received hereunder in accordance with this Contract.
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4.D.b
M. DAAS reserves the right to refuse payment to the Contractor or later disallow costs for any
AF 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.
N. 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.
O. Contractor must return any unspent funds with submittal of the final invoice.
P. 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. Q
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Q. General program income shall be used to increase the number of elderly served by a project, to 0
facilitate access to such meals, and to provide supportive services directly related to nutrition as E
defined in the Scope of Work (Attachment A). General program income shall be used within the c
program in which it was earned. a
R. Matching Contributions o
1. The Contractor shall provide in-kind matching contributions of a minimum of $18,574 for
1 2013-14, which is the Title III portion of the Contract multiplied by 11.11%. z
2. Matching contributions must be allowable costs as determined by CDA. Allowable costs 2
may include but are not limited to rent, utilities, supplies and personnel (volunteers). N
3. Uncompensated indirect expense or Contractor allocated overhead expenses may be
claimed as an in-kind matching expense if such expenses were determined on the basis of
an approved indirect cost rate plan.
4. Contractor shall provide a Matching Funds Narrative (Attachment L) to DAAS with the m
submittal of the initial budget identifying the type, rates applied and if applicable, -
source/location of allowable costs to be used as matching contributions for the period of the 0%
Contract. The identified matching contributions shall be reported to DAAS by the Contractor ti
on a monthly or quarterly basis as specified in Section V, Paragraph D. r>
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a. Services of volunteers shall be valued at rates consistent with those ordinarily paid oo
for similar work by the Contractor. If the Contractor does not have similar work, the 9
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rate shall be consistent with those in the labor market. a
b. All other in-kind contributions shall be valued at current market value. z
VI. RIGHT TO MONITOR AND AUDIT
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A. County shall have the absolute right to monitor the performance of Contractor in the delivery of d
services provided under this Contract.
B. County or any subdivision or appointee thereof, and the State of California or any subdivision or a
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
Pa e 20 of 27
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I
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 may be deducted from the following month's claim for
reimbursement.
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. a
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F. Upon County request, Contractor shall hire a licensed Certified Public Accountant, approved by the E
County, who shall prepare and file with County, within 60 days after the termination of the Contract, a c
certified fiscal audit of related expenditures during the term of the Contract and a program compliance 0-
audit. _
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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 z
the audit performed in accordance with OMB Circular A-133 shall be submitted to the County within `o
thirty (30) days of completion, but no later than nine months following the end of the Contractor's in
fiscal year.
H. The following closely related programs identified by the Catalog of Federal Domestic Assistance
(CFDA) number are to be considered as an "Other cluster' for purposes of determining major
_ programs or whether a program specific audit may be elected. The contractor shall communicate this
information to the independent auditor conducting the organization's single audit. N
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93.045 Older Americans Act Title III-Grants for State & Community Programs on Aging w
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93.053 Older Americans Act Section 311-Nutrition Services Incentive Program
VII. CORRECTION OF PERFORMANCE DEFICIENCIES °
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A. Failure by Contractor to comply with any of the provisions, covenants, requirements or conditions of o
this Contract shall be a material breach of this Contract. z
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B. In the event of a non-cured breach, County may, at its sole discretion and in addition to any other r
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 a
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
Pa e 21 of 27
Packet Pg. 135
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 a
shall provide a detailed statement of the grievance, including dates, names, places, and the o
specific remedy or action requested. The filing address is 686 East Mill Street, San E
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. o
a.
2. If Contractor is not satisfied with the DAAS Deputy Director's response, Contractor may file a c
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) z
business days of receipt of the DAAS Deputy Director's response. The filing address is 686 0
East Mill Street, San Bernardino, California, 92415-0640. The Director of DAAS shall provide a •2
written response to Contractor within fifteen (15) business days. The Director of DAAS shall in
have final authority for the decision on the grievance except as provided below.
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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
Director's response is not satisfactory, to the Assistant Executive Officer (AEO) of Human m
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 Executive Officer shall provide a written response to Contractor within fifteen (15)
business days. The Assistant Executive Officer shall have final authority for the decision on the M
grievance except as provided below. co
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VIII. TERM Q
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This Contract is effective as of July 1, 2013 and expires June 30, 2014, but may be terminated earlier in o
accordance with provisions of Section IX of the Contract. The Contract term may be extended for two p
additional one-year periods by mutual agreement of the parties.
IX. EARLY TERMINATION E
A. The County may terminate the Contract immediately in the event that funds are not available to the 2
County pursuant to Section V, Paragraph A of this contract and/or under the provisions of Section VII, a
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.
Page 22 of 27
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4.D.b
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 Q
San Bernardino, CA 92415-0515 a
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B. Nothing contained in this Contract shall be construed as creating a joint venture, partnership or m"
employment arrangement between the Parties hereto, nor shall either Party have the right, power or o
authority to create an obligation or duty, expressed or implied, on behalf of the other Party hereto. a
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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 z
value to any officer, employee or agent of the County in an attempt to secure favorable treatment o
regarding this Contract. c
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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 N
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.
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Contractor shall immediately report any attempt by a County officer, employee or agent to solicit u
(either directly or through an intermediary) improper consideration from Contractor. The report shall 0
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 M
pursue any available legal remedies. oo
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D. Property Q
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1. Unless otherwise provided for in this Section, property refers to all assets, capitalized or non- Q
capitalized, used in operation of this Contract. p
a. Property includes land, buildings, improvements, machinery, vehicles, furniture, r
tools, and intangibles, etc.
b. Property does not include consumable office supplies such as paper, pencils, toner,
file folders, etc. w
2. Property meeting all of the following criteria is subject to the capitalization requirements. a
Subject property must:
a. Have a normal useful life of at least 1 year;
b. Have a unit acquisition cost of at least $500 (a desktop or laptop setup including all
peripherals is considered a unit, if purchased as a unit); and
C. Be used to conduct business under this Contract.
3. Additions, improvements, and betterments to assets meeting all of the above conditions must
also be reported. Additions typically involve physical extensions of existing units.
Improvements and betterments typically do not increase the physical size of the asset.
Pa e 23 of 27
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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.
4. Intangibles are property which lack physical substance but give valuable rights to the owner.
Examples of intangible property include patents, copyrights, leases, and computer software.
By contrast, hardware consists of tangible equipment(e.g., computer printer, terminal, etc.).
5. All purchases of property meeting all of the following criteria above require the following:
a. If purchase of equipment is to be reimbursed by DAAS, the equipment to be purchased
must be specified in the budget previously submitted and approved by DAAS, or be
specified in a revised budget that Contractor submits to DAAS for approval. a
b. Contractor must seek bids from multiple firms in selecting a supplier of goods. "Multiple o
firms" means a minimum of three (3) separate and distinct business entities in
competition to supply the same or similar good. When selecting a bid, Contractor must o
consider such factors as type of goods/supplies needed, cost, schedule, and a
availability. o
C. Prior to any property/equipment purchases of$500 or more by Contractor the "Request r
To Purchase Property/Equipment" and "Property/Equipment Bid Form" (Attachment M) Z
must be submitted by Contractor and be approved by DAAS. I-
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6. The Contractor shall record the following information when property is acquired:
a. Date acquired; r
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b. Property description (include model number);
C. Property identification number(serial number); iz
d. Location of property;
e. Cost or other basis of valuation; °
f. Fund source; and L)
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g. Rate of depreciation (or depreciation schedule), if applicable. o
7. The Contractor shall not use DAAS funded property as collateral to obtain loans, etc. Any liens
placed against properties purchased with the funds available through this contract should be CO
reported to DAAS within five (5) days. The Contractor shall maintain and submit to DAAS o
annually with the closeout, a current inventory of property furnished or purchased by either the z
Contractor or the subcontractor with funds awarded under the terms of this Contract or any o
predecessor contracts for the same purpose. The Contractor shall use the Report of Project r
Property Furnished/Purchased with Agreement Funds (CDA 32), unless otherwise directed by E
DAAS
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8. Disposal of Property a
a. 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.
b. Contractor shall remove all confidential, sensitive, or personal information from CDA
property prior to disposal, including removal or destruction of data on computing
devices with digital memory and storage capacity. This includes, but is not limited to,
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4.D.b
magnetic tapes, flash drives, personal computers, personal digital assistants (PDAs),
cell or smart phones, multi-function printers, and laptops.
9. The Contractor shall immediately investigate, and within five (5) days fully document the loss,
destruction, or theft of such property.
10. 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.
11. 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 a
or repair of such property during the period of the project, until the Contractor has complied with a
all written instructions from DAAS regarding the final disposition of the property. °
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12. In the event of the Contractor's dissolution or upon termination of this Contract, the Contractor o
shall provide a final property inventory to DAAS. DAAS reserves the right to require the a
Contractor to transfer such property to another entity, or to DAAS. To exercise the above right, c
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.
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13. The Contractor shall use the property for the purpose for which it was intended under the o
Contract. When no longer needed for that use, the Contractor shall use it, if needed, and with in
written approval of DAAS for other purposes in the following order:
a. Another DAAS program providing the same or similar service; or N
L) zl�b. Another DAAS-funded program.
14. Contractor may share use of the property and equipment or allow use by other programs, upon m
written approval of the Director of DAAS. As a condition of the approval, DAAS may require o
reimbursement under this Contract for its use. a
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15. The Contractor or subcontractor shall not use equipment or supplies acquired under this M
Contract with federal and/or State monies for personal gain or to usurp the competitive 00
advantage of a privately owned business entity. c
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16. Contractor shall include the provision contained in this Section in all its subcontracts
awarded under this Agreement. °
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E. County shall have Power of Attorney to pay delinquent debts and unpaid wages for work provided U
under this Contract from accounts payable to Contractor in the event debts and wages have not been a
paid on a current basis. E
F. 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 a
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.
G. 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.
Pacie 25 of 27
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4.D.b
H. If any provision of the Contract is held by a court of competent jurisdiction to be unenforceable or
10, 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.
I. 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.
XI. CONCLUSION Q
A. This Contract, consisting of twenty-seven (27) and Attachments A through M, is the full and complete o
document describing services to be rendered by Contractor to County including all covenants, E
conditions and benefits. o
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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. 2
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14.D:b
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.
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(014JNTY OF SAN BERNARDINO City of San Bernardino v
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(Print or type name of corporation,company,contractor,etc.) N
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By• �+
Janice Rutherford, Chair, Board of Supervisors (Authorized signature-sign in blue ink) U
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Dated: Name: 00
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SIGNED AND CERTIFIED THAT A COPY OF THIS (Print or type name of person signing contract) o
DOCUMENT HAS BEEN DELIVERED TO THE
Title:
CHAIRMAN OF THE BOARD a
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Laura H.Welch (Print or Type) Z
Clerk of the Board of Supervisors p
of the County of San Bernardino. Dated: U
By:
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Address: 300 North D Street s
Deputy w
San Bernardino, CA 92418 a
Approved as to Legal Form Reviewed by Contract Compliance Presented to BOS for Signature
► ► Do-
Jacqueline Carey-Wilson,Deputy County Regina Dalton,HS Contracts Unit Ron Buttram,Director
Counsel
Date Date
Pa e 27 of 27
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4.D.b
ATTACH
San Bernardino County
Elderly Nutrition Program
Scope of Work
2013-14
July 1, 2013
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 ongoing 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
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Service Area: San Bernardino and Surrounding Areas °
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I. Program Description: o
A. Purpose — The purpose of the ENP is to provide nutrition services as described in the Older a
Americans Act (OAA) of 1965, as amended, and to assist older individuals in California to live o
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 c
congregate sites or in their homes. in
C. Goals — To maintain or improve the physical, psychological, and social well being of older
individuals, by providing or securing appropriate nutrition services. Ln
D. Objectives:
1. Give preference to older individuals in greatest economic or social need with particular
attention to low-income minority individuals. m
2. Serve meals that provide one-third (1/3) of the Dietary Reference Intakes (DRIs) and are ,v?
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 M
participants. oo
5. Promote or maintain coordination with other nutrition-related supportive services for older o
individuals. N
E. Target Population — The ENP Provider shall target individuals who are sixty (60) years of age or a
older, minorities, low income and living in rural areas of the County of San Bernardino. z
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II. Eligibility for Nutrition Services:
A. Congregate Meals— Individuals eligible to receive a meal at a congregate nutrition site are:
1. Any older individual 60 or older. E
2. The spouse of any older individual 60 or older.
3. A person with a disability, under age sixty (60) who resides in housing facilities occupied r
primarily by older individuals (60 or older) at which congregate nutrition services are a
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 who is 60 or older of a meal.
C. Home-Delivered Meals— Individuals eligible to receive a home-delivered meal are:
0 1. Any older individual who is frail, as defined below, and homebound by reason of illness,
disability, or isolation:
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4.D.b
ATTACH
"Frail" means that an older individual is determined to be functionally impaired because the
individual either:
Q a. Is unable to perform at least two (2) activities of daily living, including bathing,
toileting, dressing, feeding, breathing, transferring and mobility and associated
tasks, without substantial human assistance, including verbal reminding, physical
cueing or supervision.
b. Due to a cognitive or other mental impairment, requires substantial supervision
because the older individual behaves in a manner that possess 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 a
who participates in the program. o
4. Priority shall be given to older individuals in sub-section (C)(1) above.
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III. Requirements for Nutrition Services: 0-
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A. Congregate Meals: a
1. Each Congregate Meal Provider shall: c
a. Include procedures for obtaining the views of participants about the services L
received. 3
b. Not preclude the service of a meal to a participant who has failed to make a Z
reservation when food is available. °-
1) Ensure each Congregate Meal participant completes sections I and IV of N
the Client Intake Sheet(provided by DAAS) on the first day of service and
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annually thereafter. LO
2) Maintain appropriate documentation on each client. Documentation shall
be kept on file to be monitored by DAAS. iz
2. Each Congregate Meal site shall meet all of the following: m
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 0
activities are taking place.
b. Have restrooms, lighting, and ventilation, which meet the requirements of the M
California Retail Food Code (CRFC). CO
C. Have equipment, including tables and chairs that are sturdy and appropriate for o
older individuals. Tables shall be arranged to assure ease of access and Q
encourage socialization. a
B. Home-Delivered Meals: °
1. Develop and implement criteria to assess the level of need for home-delivered nutrition 0
services of each eligible participant. c)
a. An initial determination of eligibility may be accomplished by telephone. This d
initial contact with the participant shall include completion of sections I, II, III, and E
IV of the Client Intake Sheet(provided by DAAS).
b. A written assessment shall be done in the home within two (2) weeks of w
beginning meal service, and shall include an assessment of the type of meal a
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, II, 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. Instructions must be legible.
Page 2 of 16
Packet Pg. 143
ATTACHS
3. Clearly label individual meals to indicate at least the entr6e and primary protein source.
Examples: "Chicken Enchilada," "Beef Lasagna."
Q 4. 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.
5. Provide home-delivered meals in pre-packaged divided trays (hot or frozen meals).
6. 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: 36,166
1. A minimum of 95% of the total number of meals is to be provided. The Director of DAAS o
must approve requests to serve less than 95% of the total number of meals to be E
provided. All such requests must be in writing.
0
Program: C-1 (Congregate Meals Pro ram C-2 Home-Delivered Meals a
#of Days of Service: 255 #of Days of Service: N/A o
Number of Meals: 36,166 Number of Meals N/A L
Y
Sites to be Served: Areas to be Served: Z
5th Street Senior Center N/A L
O
Perris Hill Senior Center "c
Hernandez Community Center in
Lytle Creek Community Center
New Hope Family Life Center N
Highland Senior Center
v
m
0
V. Staffing: r
A. Manager or Director: U
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): co
a. Possess an associate degree in institutional food service management, or a closely c
related field, such as, but not limited to, restaurant management, plus two (2)years' a
experience as a food service supervisor, or, a
b. Demonstrate experience in food service, such as, but not limited to, cooking at a °z
restaurant, and within twelve (12) months of hire successfully complete a minimum o
of twenty (20) hours specifically related to food service management, business
administration, or personnel management at a college level. Prior to completion of a
meeting the hours, this individual's performance shall be evaluated through t
quarterly monitoring by a registered dietitian, or,
C. Two years' experience managing food services. Such experience shall be verified a
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.
0
Packet Pg. 144
i
ATTACHMENT A
B. Personnel— Paid Staff/Volunteers:
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.
4. Contractor shall complete a written work performance evaluation on all paid and
volunteer staff at least annually. d
5. All staff, paid and volunteer, that will be involved in food service operation or clean- o
up except home-delivered meal drivers must be in possession of a current San E
Bernardino County-issued Food Worker Card and Certificate. a,
6. Volunteers shall be recruited and used in any phase of the program operation 0-
where qualified. c
7. Volunteers shall be screened and selected through a formal process that assesses 0
their capabilities.
8. Volunteers shall receive the same training as paid staff. z
9. Volunteers that are paid through other job training programs are not considered o
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 U)
volunteers are recruited, screened, what topics they are taught at orientation, and
LO
Ln
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 0°
Cn
general requirements in Title 22, Division 1.8, Section 7500. c
2. The Registered Dietitian will provide the following activities to meet the mandated
requirements: v
a. At a minimum, quarterly monitor food facilities or safe food handling,
sanitation, and physical safety practices, menu fulfillment, and, if
applicable, home delivered meals processes.
b. Review and approve the content of staff training prior to presentation. a
G. Develop, or review and approve the cycle menus. o
d. Provide input, review, and approve the Nutrition Education Plan prior to 00'
presentation. L)
e. Provide technical support and assistance as needed.
c
m
VI. Staff Training Activities:
A. A yearly written Staff Training Plan shall be developed, implemented, and maintained on o
file by the ENP Provider, as required in Title 22, Division 1.8, Section 7636.7(c). a
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 July 31 of the FY it is being provided in. The
DAAS Registered Dietitian will review and approve the Staff
Packet Pg. 145
ATTACHMENT A
Training Plan and return it to the Provider. 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. Food safety, prevention of food borne illness, and Hazard Analysis Critical Control
Points(HACCP)principles.
2. Accident prevention, instruction on fire safety, first aid, choking, earthquake in
preparedness, and other emergency procedures. a
3. Elder Abuse Law and reporting procedures. o
4. CDA Security Awareness Training (annually). E
VII. Senior Participants: a�
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 z
results must be submitted to DAAS by March 7th of the FY it is being conducted o
for. a
B. Complaint Procedures: CO
1. Each Provider shall have a written Complaint Procedure. LO
2. The Complaint Procedure will be available for the participants and will provide LO
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 U)
attending the congregate site or receiving a home-delivered meal. o
C. Nutrition Education Services for Participants:
1. Nutrition Education shall be provided a minimum of four (4) times per year to U
participants in congregate and home-delivered meal programs. V_
a. Nutrition Education for congregate sites is defined as demonstrations,
presentation, lectures or small group discussions, all of which may be v
augmented with printed materials. a
b. Nutrition Education for home-delivered meal participants may consist solely o
of printed material that is in conjunction with a congregate meal Nutrition z0'
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 July31 of the fiscal year in which it is being provided. a
4. Nutrition Education sessions must be reported monthly to DAAS using the Nutrition
Education Monthly Service Unit Report.
Nutrition Education Units of Service:
Program: C-1 (Congregate Meals Pro ram: C-2 Home-Delivered Meals
#of Units to be Provided: 567 #of Units to be Provided: N/A
#of Sites to be Presented at: 6 #of Participants to be Presented to: N/A
.:. VIII. Menu Planning Guidelines/Menu Requirements:
A. Menus to cover a minimum of 3-months shall be planned and submitted to DAAS. Menu
cycles must be 4 weeks or longer.
r,,.__ Packet-Pg. 146
ATTACHMENT A
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. Menus shall be planned with guidance from the Provider's Registered Dietitian,
analyzed by either the computerized or the component method, checked for required
menu elements, and then approved as meeting requirements by the Provider's
Registered Dietitian. Upon approval they shall be forwarded to the DAAS Registered
Dietitian for certification.
E. 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. Timely
submitted 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. in
F. A copy of the certified menu must be posted in a spot conspicuous to clients at each a
congregate site. o
G. Copies of the menus shall be made available to the participants upon request. E
H. In planning the menus, the current Dietary Reference Intakes (DRI) and the Dietary
Guidelines for Americans (DGA) are to be considered. Menus shall conform to the a
following criteria referenced in the sources: c
1. Provide an average of 550-750 calories per meal. 2
2. Limit total fat to no more than 25-35% of the calories averaged for the week.
3. Choose and prepare foods with low amounts of salt, soy sauce and other high z
L
sodium items. o
4. Include good sources of dietary fiber such as whole grains and cooked dry
beans at least two times a week. N
5. Include a variety of foods and preparation methods with consideration to color,
LO
combinations, texture, size, shape, taste, and preference of the participants LO
served.
6. Dietary Reference Intake Values: v
a. Table one (1) represents the most current Dietary Reference Intakes
(DRI) values and daily compliance range for target nutrients. The values c
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.
1) The nutrients selected for this Table are based on the target c
nutrients to: a
a. Promote health and prevent disease o
b. Prevent deficiencies o
C. Indicate diet quality
d. Manage disease
a. Of these Target Nutrients, meals must supply a minimum of 33 1/3
percent of the DRIs for Calories, Protein, Vitamin A, Vitamin C, Fiber,
and Calcium. .2
w
Q
Page Packet Pg. 147
ATTACHMENT A
Table 1
Target Nutrients
Nutrient
Target Value* Daily Compliance Range
per meal
Calories(Kcal) >550 Kcal >550—700 Kcal
15 gm (in the primary proteir
Protein 15 gm source)
Fat(% of total calories) 20-35% <35%weekly average
Saturated Fat(% of total calories) <10% <10%
<0.5 CRFC Chapter 12.6 sectior in
Trans Fat g 114377** Q
> 233 tag 3 out of 5 days /wk or °
E
A(pg RAE) 233 pg out of 7 days/wk L_
M
Vitamin C(mg) 25 mg 25 mg o0.
L
Vitamin B12 0 g pg 0.8 pg (may average over o
(pg) week) c
>400 mg (may average over z
Calcium (mg) 400 mg week) .L_
E
>105 mg (may average over C'n
Magnesium (mg) 105 mg week)
Lo
<1,000 mg (over 1,000 mg plac( LO
Sodium (mg) <500-750 mg an icon on the menu)
Fiber(gm) >7 gm >7 gm (may average over a week m
1565 mg(may average over C o
Potassium (gm) 1565 mg week) y
U
Vitamin D 200 IU 200 IU (may average over
oo
week)
*Target Value: This value represents one-third of the DRI for a 1600 calorie range. The 1600 9
calorie range was chosen based on the requirements for a 70-year-old sedentary female. If a a
majority of the senior population served by the AAA ENP Program differs from the above o
example, use your ENP predominate demographic characteristics to calculate target nutrient z
O
values.
**California Retail Food Code: Commencing January 1, 2011, no food containing artificial trans- �
fat, including oil and shortening that contains artificial trans-fat for use in the deep frying of yeast E
dough or cake batter, maybe storage, distributed, served by, or used in the preparation of any
food within a food facility. a
***RAE = Retinol Activity Equivalent. 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.
I. Meal Elements — required for both computerized and component menus:
1. Protein — meat, fish, poultry, legumes, eggs, and cheese:
Paqe Packet"Pg. 148
ATTACHMENT A
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 15 grams of protein. Programs should consider the preferences of
the participants they serve.
b. Legumes may 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 servings):
a. One serving cooked or raw vegetables = 1/2 cup
b. Vegetables as a primary ingredient in soups, stews, casseroles, or other
combination dishes must total '/2 cup (cooked) per serving.
C. One serving raw leafy vegetables (salads) = 1 cup per.
3. Fruit(1 serving): in
a. A serving of fruit equals: a
1) 1 medium sized whole fruit o
2) '/2 cup fresh, chopped, cooked, frozen, or canned drained fruit E
3) '/2 cup 100%fruit juice
b. Fresh, frozen, or canned fruit should be packed in juice, light syrup, or a
without sugar. Fruit packed in high sugar content syrup must be rinsed
before using.
C. Fruit juice may be used only occasionally, as it contributes no fiber and
can raise blood sugar in those with diabetes z
4. Breads/Grains (1 ounce-equivalent serving): `o
a. One serving equals : a
1) 1 slice of bread, a medium dinner roll, or 1/2 burger bun (n
2) 1/2 cup cooked rice, barley, corn meal, or other cooked breakfast
In
cereal N
3) 1/2 cup cooked spaghetti or other pasta
b. One-half of the daily intake of grains should be from whole grains.
Grains that are processed (not whole) must be fortified. 0°
5. Milk (8 fl. oz.): o
Each meal shall contain eight(8)fluid ounces of fortified nonfat milk, 1%fat milk,
buttermilk or calcium-fortified soymilk or calcium-fortified orange juice. If a
participant's personal preference precludes the acceptance of milk with the
co
meal, an equivalent high calcium substitute must be offered.
6. Fat(Optional): v
a. Each meal may contain fat components to increase the palatability and Q
acceptability of the meal. o
b. When selecting and preparing meat, poultry, dry beans, and milk or milk o
products, make choices that are lean, low fat, or fat free. L)
C. L ess than 10% of calories should come from saturated fat, and minimize
trans fats.Keep total fat intake between 20 to 35 percent of calories, with E
most fats coming from sources of polyunsaturated and monounsaturated
fatss such as fish, nuts, and vegetable oils. 2
7. Dessert(Optional): Q
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.
Limit sweets that are high sugar, high fat, and/or high refined grains to
no more than once or twice per week.
b. When a dessert contains '/2 cup of fruit per serving, it may be counted as
a serving of fruit.
8. Condiments and Product Substitutes:
a. Sugar substitutes, pepper, herbal seasonings, lemon, vinegar, non-dairy
coffee creamer, salt, and sugar may be provided, but
Page Packet Pg. 149
ATTACHMENT A
should not be counted as fulfilling any part of the nutritive requirements.
b. Condiments such as high sodium salad dressings, ketchup, soy sauce,
mustard, and mayonnaise do not need to be counted in a menu analysis
10 if they are served "on the side" and are not combined with the food.
C. At least one low-sodium salad dressing option must be provided for leafy
green salads.
d. Oil-and-vinegar and other salad dressings served combined with salads
must be accounted for in the nutrient analysis of the menu and/or recipe.
9. Sodium:
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
Cn
traditionally have higher sodium levels. Programs that choose to provide a
culturally appropriate meals, but are concerned with the sodium content of the o
meals, may consider: E
a. Using low sodium soy sauce or diluting soy sauce with water to produce
low sodium soy sauce; °
b. Offering soy sauce as a condiment to be added by the senior; r_
C. Providing Nutrition Education on sodium; 2
r
d. Continuing to work with the sodium levels of meals, making small steps
to reduce the risk of developing kidney stones, and possibly decrease z
bone loss with age; o
e. Not providing potassium chloride salt substitutes;
f. 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
kn
icon denoting a high sodium meal; and N
g. Using low sodium versions of high sodium foods when available and
feasible with budget allowances. ='
10. Menu Item Flexibility: N
The ENP Provider has the discretion to allow occasional flexibility in planning o
meals that may not meet the meal pattern, but does meet the nutrient value Y
requirements. Fortified food products and combination dishes used in a menu v
may not match the meal pattern, but may provide for the required nutrient
co
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. °
co
Q
J. Meal Element/Nutrient Analysis: a
0
A meal element and nutrient analysis of the entire menu cycle conducted and/or z
approved by a Registered Dietitian shall be done to ensure compliance with Title 22, 0
Division 1.8, Section 7638.5. :-
1. Meal Element Analysis: Use Section "I" Requirements Above a
2. Computerized Nutrient Analysis Requirements
a. Although not required, use of computerized nutrient analysis is strongly w
recommended and will help ensure and verify the nutritional adequacy of a
meals. The goal of assessing nutrient intakes of groups is to determine
the prevalence of inadequate or excessive nutrient intakes within a
particular group of individuals.
Page packet Pg. 150
' ATTACHMENT A
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:
1) Vitamin A
2) Vitamin C
3) Protein
4) Fat
5) Sodium
6) Fiber N
b. Not all nutrient guidelines will be met with each meal. However, areas Q
that do not meet the requirements should be the focus of future menu o
revisions and nutrition education. m
C. The following nutrients should be included in the analysis when the
computerized nutrient analysis method is used: calories; protein; total fat; a
saturated fat; total fiber; Vitamins A, C, D, E, K, thiamin, riboflavin, _
niacin, B6, folate, B12, calcium, chromium, copper, iron, magnesium, 0
sodium, and zinc. In addition to meeting one-third of the DRIs, the
menus should also follow the DGA. z
2. Component Nutrient Analysis Requirements: o
a. 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. Items that provide the
following target nutrients should be identified on the menu when using a N
component meal pattern template:
1) Vitamin C — Provide one-third (1/3) of the DRI for Vitamin C
each meal — 25 mg (for a 1600-calorie menu). N
2) Vitamin A — Provide one-third (1/3) of the DRI for Vitamin c
A at least three (3) times per week, 233 µg (for a 1600-
=
calorie menu).
3) Sodium — meals that contain over 1,000 mg of sodium
must be noted on the menu as a high sodium meal.
b. Table 2 describes the elements in the California 1600-calorie meal °
pattern. Serving sizes are based on the USDA My Plate. This sample a
component meal pattern does not assure that meals meet one-third (1/3) o
of the DRI's and the DGA. Meals will require specific types of fruits and o
vegetables, whole grains, and high fiber foods in order to assure the L)
target nutrients are provided. The component meal pattern may be
deficient in Vitamin B12, requiring additional nutrition education for E
participants on the selection of foods that are good sources of this
nutrient.
C. The meal pattern in Table 2 below is based on the minimum Q
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
Page Packet Pg. 151
i
ATTACHMENT A
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 Required 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
Vegetable 1 —2 servings '/2 cup = 1 serving
Fruit 1 serving '/2 cup = 1 serving
in
Bread or Grain 1 —2 servings 1 slice Bread = 1 serving a
At least'/ whole grain '/2 cup of rice or pasta = 1 serving °
Non-fat or 1% fat milk or milk 1 serving 1 cup or equivalent measure
L
alternate
0
Fat Optional a
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. Z
(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 N
Physical Activity, from the DGA 2010.
LO
to
IX. Food Procurement:
A. Food procurement procedures shall comply with Title 22, CRFC standards, and HACCP
best practices guidelines. m
B. All food shall be of good quality and shall be obtained from sources that conform to N
w
Federal, State, and local regulatory standards for quality, sanitation, and safety. 0
C. To the extent possible, providers are encouraged to participate in group food
U
purchasing. M
D. A comparative cost analysis shall be performed either by the ENP Provider or its group co
purchasing organization on an on-going basis to obtain the highest quality food for the o
lowest price available. a
a
X. Food Storage: °
A. Food storage procedures shall comply with Title 22, CRFC standards, and HACCP best Z
O
practices guidelines. U
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 E
eating supplies.
0
w
XI. Food Production: a
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
Ar substitution must occur, the following procedure must be followed:
1. The Provider's Registered Dietitian must approve all menu substitutions.
Page Packet Pg. 152
ATTACHMENT A
A Menu Substitution Form must be completed and signed by the Provider's
Registered Dietitian.
2. The completed Menu Substitution form shall be kept on file for DAAS review.
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 and held before a
and during serving in a manner in which it is protected from potential ❑
contamination and maintains appropriate hot and cold food temperatures. E
2. Temperatures of meals shall be monitored in the following ways, at a minimum:
a. All hot, cold, and frozen potentially hazardous meal components, a
including milk, shall be checked daily immediately prior to dispatch from
the central kitchen. 2
b. All hot, cold, and frozen potentially hazardous meal components,
including milk, shall be checked at satellite congregate sites upon z
delivery and at all congregate sites immediately before meal service. o
C. The ENP Provider must have written procedures for monitoring food
temperature. U)
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 W
the issue. o
f. All completed Food Temperature Logs must be maintained on file for >
DAAS review. v
3. 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. 9
4. To maintain quality in prepared foods, holding times shall be kept to a minimum. a
Long periods of holding hot foods at required temperatures diminishes the o
nutrient content and palatability of foods. o
5. Holding time shall not exceed 2 hours between the end of production and the U
beginning of food service at the congregate site.
6. Milk and milk products shall be provided in individual, commercially filled E
containers, or shall be poured by a staff member directly from commercially
filled bulk containers into the clean glass or cup from which they are to be c
consumed. a
7. Cool water shall be offered with each meal to encourage fluid intake and lower
the risk of dehydration—a risk that is higher for older adults.
8. Single service utensils and tableware shall be used one time only and then
discarded.
Page packet Pg. 153
ATTACHMENT A 4 p b
9. 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.
10. The Provider shall have a sign posted in the congregate site stating, "Food
removed from the congregate site is consumed 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 Logs — separate logs shall be available for congregate
meals, home delivered meals, and individual meals chilling process. .
2. Cleaning Schedule in
3. Equipment Temperature Log —for all dish machines, refrigerators, and freezers. a
4. Production Schedule—applicable only if food is cooked at the site. o
5. The current Environmental Health inspection detailed report shall be available at E
the site for review.
6. Staff and volunteers who are involved in any part of food service operation or 0
clean-up except home-delivered meals drivers shall possess a current San =
Bernardino County-issued Food Worker Card and Certificate that shall be 2
available for review.
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XIII. Program Requirements: o
A. Client Intake Sheets: d
1. The ENP Provider will ensure that each participant completes the Client Intake C.n
Sheet form (provided by DAAS) to determine his or her level of nutritional risk.
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Forms shall be completed for: N
a. Congregate Meal Participants — at the beginning of service and then
annually thereafter for clients who remain on the program.
• Sections 1 and 3 are required for congregate meals.
b. Home-Delivered Participants — at the beginning of service and then o
quarterly thereafter for clients who remain on the program. r
• Sections 1, 2, and 3 are required for home-delivered meals. v
2. ENP Providers who are required to complete their own data entry into the SAMS
co
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 a
the Client Intake Sheets to DAAS for data entry into the SAMS System. o
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. s
2. ENP Providers shall develop and have handouts, brochures, and/or signs r
available in languages other than English and posted in locations such as Q
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.
Page packet°Pg. 154
ATTACHMENT A
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 in
for guests shall be posted near the contribution container at each congregate a
meal site. A guest fee shall cover all meal costs. o
4. No eligible individual shall be denied participation because of failure or inability E
to contribute.
5. The Provider shall ensure that the amount of the eligible participant's 0-
contribution is kept confidential. _
6. The ENP Provider shall establish written procedures to protect contributions and g
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fees from loss, mishandling, and theft (i.e. Contribution/Donation Procedures).
Such Procedures shall be kept on file for DAAS review. z
7. All contributions and fees shall be identified as program income and used to 0
increase the number of meals served, to facilitate access to such meals, and to
provide nutrition-related supportive services. U?
E. "No Soliciting" Sign: LO
1. The ENP Provider shall ensure that a "No Soliciting" sign is posted on the door N LO
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. 0°
F. Coordination: o
1. If applicable, develop a fair and equitable policy and procedure for referring r
participants to the appropriate transportation provider for securing public U
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., c
"Funding for this service has been provided by the San Bernardino County CO
Department of Aging and Adult Services through a grant award from the o
California Department of Aging."
3. Coordinate service with other County departments and local agencies by U
providing time for presentations or special activities that promote a community
based system of care for the participants attending nutrition sites. d
G. Reporting: t
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 Q
to DAAS by the 5 1 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.
l
Page Packet'Pg.155
ATTACHMENT A
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 30th 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
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the number of individuals attending its present sites, or by opening new sites in Q
communities not already served by the Provider. Exceptions to this requirement o
must be fully documented in writing and submitted to the Director of DAAS for E
prior approval.
8. Other Reporting Requirements: a
a. SAMS (Social Assistance Management System): _
1) The following reports are to be completed and submitted to 2
DAAS by the 5th business day of the month following the month
of service if the Provider is serving less than 500 clients per z
month: o
a) Client Intake Sheets for any new clients or any annual or
quarterly assessments completed in the month. �!?
b) Meal Rosters
2) Providers that are serving more than 500 clients shall secure the LO
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 N
support the program. These Providers shall be responsible for —
entering the following data into SAMS by the 5th business day of w
the month following the month of service:
a) Client Intake Sheets for any new clients or any annual or
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quarterly assessments completed in the month.
b) Rosters °
c) Routes (if applicable) Q
9. Nutrition Education Monthly Service Unit Report o
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 U
to participants. This report is to be completed and submitted to DAAS by the 5m r
business day of the month following the month of service. Copies of any a
handouts presented to the participants as a component of the Nutrition
Education shall be attached to the Nutrition Education Monthly Service Unit w
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.
Page packet Pg. 156
ATTACHMENT A
2. Provider shall submit a list of equipment purchased with grant funding by
location.
Quarterly Meetings
1. Provider is required to attend all Quarterly Nutrition Provider meetings hosted by
DAAS.
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Page Packet Pg. 157
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 for
is to be filed in the service recipient's case file maintained by contractor. The reverse side of this form m;
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, o
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. o
Time frame: Within 1 week of discrimination/violation/problem. E
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If resolved at this level, no further action is required. If no resolution is apparent within 15 business days, proceed with o
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Step 2. a.
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2. Forward the written complaint/grievance to the Deputy Director of Administration at the following address: o
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Department of Aging and Adult Services z
686 East Mill Street L
San Bernardino, CA 92415-0640 2
ATTN: Deputy Director N
Time frame: Within 1 week of Step 1.
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"-9solved at this level, no further action is required. If no resolution is apparent within 15 business days, proceed with
) 3. cz
3. If no solution is apparent after Steps 1-2 have been exhausted, forward copy of written grievance to: m
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Human Services Group, Contract Administrator °
150 S. Lena Road
San Bernardino, CA 92415-0515 M
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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. q
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If you believe that your civil rights have been violated, please contact: Q
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Deputy Director, Administration z
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Department of Aging and Adult Services v
686 East Mill Street c
San Bernardino, CA 92415-0640 E
s
GRIEVANCE PROCEDURE CERTIFICATION .2
This is to certify that I have read, understood, and received a copy of the Client Complaint and Grievance Procedures Q
Older Americans Act Programs.
Signature of Service Recipient Date
0
Page 1 of 2
Packet Pg.1188
ATTACHMENT B
GRIEVANCE NOTICE
Your Name:
Date of Occurrence:
Approximate Time of Occurrence:
Name of Service Provider:
Address of Service Provider:
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Pa9 Packet Pg. 159
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4.D.b
ATTACHMENT C
ASSURANCE OF COMPLIANCE
ASSURANCE OF COMPLIANCE WIT ALL APPLICABLE LAWS
RELATING T
NONDISCRIMINATION IN STATE AND FED RALLY ASSISTED PROGRAMS
COUNCIL ON AGING-ORANGE COUNTY
CONTRACTOR
HEREBY AGREES THAT it will comply with Title VI anc 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 a
11135 and California Code of Regulations (CCR) Title 22 section 98000-98413, Title 24 of the o
California Code of Regulations section 3105A(e), and other applicable federal and state laws, as well E
as their implementing regulations (including 45 CFR, Pe rts 80, 84, and 91, 7 CFR Part 15, and 28 CFR
Part 42), by ensuring that employment practices and tha administration of public assistance and social o
services programs are nondiscriminatory, to the effec that no person shall because of race, color, a
national origin, political affiliation, religion, marital status, sex, age or disability be excluded from o
participation in or be denied the benefits of, or be otherwise subject to discrimination under any r
program or activity receiving federal or state assistance; and HEREBY GIVES ASSURANCE THAT, it Z
will immediately take any measures necessary to effectuate this agreement. o
THIS ASSURANCE is given in consideration of and for he purpose of obtaining any and all federal and in
state assistance; and THE AGENCY HEREBY GIVES ASSURANCE THAT administrative
methods/procedures which have the effect of subjecting individuals to discrimination will be prohibited. N
BY ACCEPTING THIS ASSURANCE, the agency agre s to compile data, maintain records and submit
reports as required, to permit effective enforcement o�the aforementioned laws and regulations and N
permit authorized County, state and/or federal government personnel, during normal working hours, to 0
review such records, books and accounts as needed to ascertain compliance. If there are any Y
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 M
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. o
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THIS ASSURANCE is binding on the agency directly or through contract, license, or other provider o
services, as long as it receives federal or state assist nce; and shall be submitted annually with the z
required Civil Rights Plan Update. O
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DATE SIGNATURE
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ORGANIZATION
ADDRESS
Page 1 of 1
Packet Pg. 160
ATTACHMENT D
DEPARTMENT OF AGING
CONTRACTORIVENDOR 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.
CONTRACTOR/VENDOR 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 Contractor/Vendor 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. a
• activities by any individual or entity that is suspected of compromising confidential information will be reported a
to CDA by completing a Security Incident Report, CDA 1025. o
• any wrongful access, inspection, use, or disclosure of confidential information is a crime and is prohibited E
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 o
Portability and Accountability Act. a
• any wrongful access, inspection, use, disclosure, or modification of confidential information may result in o
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. Z
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• all employees/subcontractors of the Contractor/Vendor will complete the required Security Awareness g
Training module located at www.aginq.ca.gov, within 30 days of the start date of this Contract/Agreement or cn
within 30 days of the start date of any new employee or subcontractor. Contractor/Vendor may substitute
CDA's Security Awareness Training program with its Security Training provided such training meets or
LO
exceeds CDA's training requirement. LO
• all employees/subcontractors of the Contractor/Vendor 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 m
information within the scope of the Contract. T
• 1 agree to protect the following types of confidential information which include but not limited to:
- Social Security number
- Medical information v
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- Claimant and employer information
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- Driver License information
- Information about individuals that relate to their personal life or identifies or describes an individual G
- Other agencies' confidential and proprietary information Q
- Criteria used for initiating audit selection Q
- Methods agencies use to safeguard their information (computer systems, networks, server
z
configurations, etc.) O
- Any other information that is considered proprietary, a copyright or otherwise protected by law or
contract.
• 1 agree to protect confidential information by: E
- 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, a
or any non-business related reason
- Securing confidential information in approved locations
- Never removing confidential information from the work site without authorization.
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Pa9 Packet Pg.161
i
ATTACHMENT E
i
CALIFORNIA DEPARTMENT OF AGING(CDA)
SECURITY INCIDENT REPORT
CDA 1025 New 07/07)
INCIDENT INFORMATION
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
❑ UNKNOWN ❑CA Hwy PATROL ❑ATTORNEY GENERAL ❑
❑UNKNOWN OTHER: N
8. INCIDENT LOCATION: Q
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9. DESCRIPTION OF INCIDENT: 0
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10. MEDIA DEVICE TYPE, IF APPLICABLE: 11. WAS THE PORTABLE STORAGE DEVICE
ENCRYPTED? O_
[:]YES ❑NO ❑ UNKNOWN d
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12. IF NO,EXPLAIN: O
13. DESCRIBE THE COSTS ASSOCIATED WITH RESOLVING THIS INCIDENT: 14. TOTAL ESTIMATED COST OF
INCIDENT:$ Z
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15. TYPE OF PERSONALLY IDENTIFIABLE INFORMATION(CHECK ALL THAT APPLY): y
❑ NO PERSONAL INFORMATION ❑SOCIAL SECURITY NUMBER ❑ HEALTH OR MEDICAL INFORMATION ❑ N
FINANCIAL ACCOUNT NUMBER t-
❑ NAME ❑DRIVER'S LICENSE/STATE ID NUMBER ❑OTHER SPECIFY N
16. IS A PRIVACY DISCLOSURE NOTICE 17. NUMBER OF 18. DATE NOTIFICATION(S)MADE TO
REQUIRED? INDIVIDUALS THE INDIVIDUAL:
❑YES ❑NO AFFECTED: m
*IF A PRIVACY DISCLOSURE NOTICE IS O
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REQUIRED,ATTACH A SAMPLE OF THE '=
NOTIFICATION. U
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19. HAVE THOSE RESPONSIBLE FOR THE INCIDENT BEEN IDENTIFIED? co
[]YES ❑NO COMMENT: c
20. CORRECTIVE ACTIONS TAKEN TO PREVENT FUTURE OCCURRENCES:
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21. ESTIMATED COST OF CORRECTIVE 22. DATE CORRECTIVE ACTIONS WILL BE FULLY IMPLEMENTED: Z
ACTIONS: O
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SIGNATURES E
23. PRINT-AGENCY/CONTRACTOR INFORMATION SIGNATURE: DATE:
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SECURITY OFFICER: w
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24. PRINT-AGENCY/CONTRACTOR PRIVACY OFFICER: SIGNATURE: DATE:
25. PRINT-AUTHORIZED SIGNATURE/DIRECTOR: SIGNATURE: DATE:
Pa9 Packet Pg. 162
ATTACHMENT E
DEPARTMENT O AGING
SECURITY INCIDENT REPORT
INSTRUCTI NS
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 Officer's 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 t I phone number. Q
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5. Date/Time of Incident - Provide the date/time w en the incident occurred. If unknown, select
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the "Unknown" checkbox.
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6. Date Incident Detected -Provide the date the incident was discovered.
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7. Incident Reported To-Select the appropriate checkbox. If applicable, select the other checkbox o
and describe to whom the incident was reported.
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8. Incident Location - Provide the location where t e incident occurred. For example, if a laptop o
was stolen from an employee's home, sugge ted content is "Employee's Home, Roseville,
CA"; or if the incident occurred at the agency's headquarters office, suggested content is N
"Agency's Headquarters, 123 Any Street, Sacramento, CA."
9. Description of Incident-include the following in the description: N
• When the incident occurred and how it was discovered.
• The effect of the incident on the business and infrastructure of your agency. m
• The number of people (inside your agency and outside your agency) affected by this cn
incident. 0
• The effects, if any, of this incident on people, businesses or services outside of your
agency. U
• The details of any law enforcement invest gation of this incident, such as which agency
investigated it,when, and the report number.
• Any personal, confidential, or sensitive information involved/disclosed. c
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10. Media Device Type, If Applicable - Provide the type of media or device involved in the incident, a
such as paper(fax, mail, etc.)or electronic(CD�floppy drive, laptop, PDA,email, etc.). z
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11. Was the Portable Storage Device Encrypted?-Check the appropriate box. V
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12. If NO, Explain -Describe why the storage device was not encrypted.
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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 Q
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 t tal cost associated with handling the incident
as it relates only to information technology. F�r example, if a state vehicle was stolen with a
state-issued laptop in it, do not include the co t 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.
Pag Packet Pg. 163
ATTACHMENT E
16. Is a Privacy Disclosure Notice Required? - Check appropriate box. Sample — If yes, attach a
sample copy of the notification sent to the aff cted individuals. DO NOT provide a sample
that includes personally identifiable informatio .
17. Number of Individuals Affected - Identify the number of individuals whose personally
identifiable information was breached/disclose .
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 Occ rrences - Provide a detailed description of the
corrective actions taken by the agency to pr vent future occurrences of a similar incident Q
occurring again. o
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 o
purchased; new policies may need to be developed; additional training may need to be given. a
Include all related costs, such as staff time, contracting services, and hardware or software c
purchases. :0 a
22. Date Corrective Actions Will Be Fully Implemented - Provide a date when the corrective actions Z
were, or will be,fully implemented. o
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23. Print—Agency/Contractor Information Security Offs er in
24. Print — Agency/Contractor Privacy Officer - This is required only in those instances where �
personally identifiable information is involved. If personally identifiable information is N
involved and no disclosure notice is required,the Privacy Officer's signature is still required.
25. Print—Authorized Signature/Director umi
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Pag packet Pg. 164
I
3
ATTACHMENT F
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:
El a. contract E-1 a. bid/offer/application E-1 a. initial filing
b. grant b. initial award b. material change
c. cooperative agreement c. post-award
i 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:
Q
Tier , if known: Q
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Congressional District, if known: Congressional District, if known: o
6. Federal Department/Agency: 7. Federal Program Name/Description: a
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CFDA Number, if applicable: Z
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8. Federal Action Number, if known: 9. Award Amount, if known: _
ry
$ N
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)
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attach Continuation Sheets SF-LLLA,if necessary) O
11. Amount of Payment(check all that apply): 13.Type of Payment(check all that apply):
$ ❑ actual ❑ planned ❑ a. retainer v
❑ b. one-time fee
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❑ C. commission .-
12. Form of Payment(check all that apply): ❑ d. contingent fee o
❑ a.cash ❑ e. deferred
❑ b.in-kind;specify: nature
value ❑ f. other; specify: Q
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14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), p
employee(s), or Member(s) contacted, for Payment Indicated in Item 11: L?
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(attach Continuation Sheet(s)SF-LLLA,if necessary) Q
15. Continuation Sheet(s) SF-LLLA attached: ❑ Yes ❑ No
16. Information requested through this form is authorized by title 31 U.S.C. Signature:
section 1352.This disclosure of lobbying activities is a material representation of Print Name:
fact upon which reliance was placed by the tier above when this transaction was
made or entered into.This disclosure is required pursuant to 31 U.S.C.1352.This Title:
information will be reported to the Congress semi-annually and will be available for
public inspection.Any person who fails to file the required disclosure shall be Telephone No.: Date:
subject to a civil penalty of not less that$10,000 and not more than$100,000 for
each such failure.
1
Federal Use Only: Authorized for Local Reproduction
Y Standard Form LLL(Rev.7-97)
Page 1 of 2
Packet Pg. 165
i
4.D.
ATTACHMENT F
I INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
I
rhis disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a
covered Federal action,or a material change to a previous filing, pursuant to title 31 U.S.C.section 1352.The filing of a form is required for each
payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency,a
Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with a covered Federal action.
Use the SF-LLLA Continuation Sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the
initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional
information.
1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered
Federal action.
j 2. Identify the status of the covered Federal action.
N
3. Identify the appropriate classification of this report. If this is a follow up report caused by a material change to the Information previously Q
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. E
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4. Enter the full name,address, city, State and zip code of the reporting entity. Include Congressional District, if known.Check the appropriate
classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the O
subawardee,e.g.,the first subawardee of the prime is the 1st tier.Subawards include but are not limited to subcontracts, subgrants and p-
contract awards under grants. a
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5. If the organization filing the report in item 4 checks "Subawardee,"then enter the full name, address, city, State and zip code of the prime w
Federal recipient. Include Congressional District,if known. Z
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name,if L_
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 N
Assistance(CFDA)number for grants,cooperative agreements,loans,and loan commitments.
L0
8. 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."
m
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 N
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. V
M
(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, o
and Middle Initial(MI). c
11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4)to the lobbying entity(item N
;r. 10).Indicate whether the payment has been made(actual)or will be amount of payment made or planned to be made. Q
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 Z
the in-kind payment. O
13. Check the appropriate box(es).Check all boxes that apply.If other,specify nature.
b a>
14. Provide a specific and detailed description of the services that the lobbyist has performed,or will be expected to perform,and the date(s)of E
any services rendered. Include all preparatory and related activity, not just time spent in actual contact with Federal officials. Identify the v
Federal official(s)or employee(s)contacted or the officer(s),employee(s),or Member(s)of Congress that were contacted. �o
r
15. Check whether or not a SF-LLLA Continuation Sheet(s)is attached. Q
1 16. The certifying official shall sign and date the form,print his/her name,title,and telephone number.
j
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 Cor
Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of informatio
estimated to average 30 minutes per response,including time for reviewing instructions, searching existing data sources, gathering and maintaining the c
needed,and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection
information,including suggestions for reducing this burden,to the Office of Managementand Budget,Paperwork Reduction Project(0348-0046),Washings
j DC 20503.
j
Page 2 of 2
Packet Pg.166
I
4.D.b
i
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
A. SECTION L• CONTRACTOR INFORMATION
Contractor Name: _
Q
Address(including City,State and Zip Code): Phone: Q
E
Web Site: Email: Fax:
i
O
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Site Name for Services(if Different from Contractor): (L
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Address(including City,State and Zip Code): Phone:
3
Web Site: Email: Fax: Z
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Clinic Contact: Title: d
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Contract Signature Authority: �
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Name: Name: N.
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Title: Title: m
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Signature: Signature:
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Phone#: E-Mail: Phone#: E-Mail: M
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Claim Signature Authority: c
Name: Name: '
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Title: Title:
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Signature: Signature: O
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Phone#: E-Mail: Phone#: E-Mail:
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SECTION II: DAAS INFORMATION
Program Mailing Address: Program Unit: Q
San Bernardino County
Department of Aging and Adult Services
Unit Fax#: 909-891-9150
Program Unit
686 E. Mill Street
San Bernardino,CA 92415-0920
3
Page 1 of 1
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ATTACH
COUNTY OF SAN BERNARDINO NUTRITION SERVICES
PROGRAM BUDGET
Provider:City of San Bernardino Fiscal Year: FY13-14 ORIG X Amend
CONGREGATE SITES C-1 ❑X 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
rPersonnel 150,571 37,908 188,479
3 2 Staff Travel&Training Q
Equipment Non-Inventory Equipment
5 Consultants 15,500 15,500 W
6 Catered Food
7 Raw Food 77,000 77,000 d
8 Other Expenses: _
a. Consumable Supplies 8,000 8,000
L
b. Insurance
c. Repair&Maintenance 1,500 1,500 Z
d. Rent/Building Space o
e. Utilities 45,820 45,820 cn
f. Vehicle Operations 1,000 1,000
g. Miscellaneous 3,000 3,000 LO
9 Indirect Cost
10 Nutrition Education
Total Expenditures(add lines 1-10) 256,571 83,728 340,299 M
Revenue Sources: O
State funds 17,115 17,115 ,L,
Federal Funds 167,182 167,182 U
NSIP 25,825 25,825
County funds o
Program Income 46,449 46,449 Cl)
Deferred Income Q
Q
Matching Cash ❑
Matching In-Kind 83,728 83,728 O
Non-Match Cash U
Non-Match In-Kind
c
Total Revenue 340,299 340,299 1 E
t
U
Section II: Prepare this section based on estimated number of meals that will be served r
Q
multiplied by meal cost per unit.
D E f=d*e
Estimated annual number of meals Proposed meal cost per unit Annual Budget
36,166 $5.81 210,122
Submitted by: DAAS Approval:
Name Date
Signature Date
Page 1 of 1
Packet Pg. 171
ATTACH
MONTHLY INVOICE(REQUEST FOR REIMBURSEMENT)
NUTRITION PROGRAM
(Due on the Sth working day o the following month)
FY 2013-2014
CO LINTY OF SAN BERNARDINO CONTRACTOR NAME AND ADDRESS:
_.
DEPARTMENT OF AGING &ADULT SERVICES
1
CFDA#s: MONTH:
a
a
o
E
I L
CONGREGATE SITES C 1 p HOME DELIVERED MEALS C 2 ❑ °
c
O
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1
Z
L
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# of Meals Provided as Entered into SAMS 0 '^
i ( V/
(X) Reimbursable Cost Per Meal $ -
LOLO
= REQUEST FOR REIMBURSEMENT _____ $ -
._.- . _......__.__....... .
_ ...__. ___.__..._.._ -._ .. ...___ ....
.........._.--_........__.. _.._. _.._..._.._ .....--.__....... .._ m
_ ....... .............._.... ..... _....--...... ............_..j O
3
.._................. ._..........._ .... .......___................ _ .. ......._.. ............_..... .......... _ ....._...
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Prepared By:', Date: co
_ Signature * o
Approved B Date: Q
Signature
p Check this box if you sold any equipment purchased with Nutrition grant funds during o
the month being reported.
a�
E
r
IMPORTANT: a
1. Invoice must be s.i�ned by Contractor or-invoice will be turned for signature. I
2. MonthIv Invoice must be accom anied by_separate Contractor Monthly Expenditure Report.
Packet Pg. 172
ATTACH h"'
QUARTERLY EXPENDITURE REPORT
(Due 5th working day following month quarter ending) FY 2013-2014
COUNTY OF SAN BERNARDINO CONTRACTOR NAME:
DEPARTMENT OF AGING&ADULT SERVICES
r: Quarter:
THLY NUTRITION PROGRAM EXPENDITURE REPORT/REQUEST FOR REIMBURSEMENT
(due on the 5th working day of the following month)
CONGREGATE SITES C 1� HOME DELIVERED MEALS C 2 ❑ .�
Cn
A + B C 0
COST TO PROVIDER TOTAL MONTHLY
EXPENDITURES: CASH IN-KIND EXPENSE E
R
1. Personnel $ 2
2. Staff Travel c
and Trainin
3. Equipment(including One-Time-Only urchas - o
4. Consultants C
5. Catered Food
6. Raw Food E
7. Other Expenses O
a. Consumable Supplies
_ m
b. Insurance N
c. Repair&Maintenance
d. Rent/Building Space - `n
LO
e. Utilities -
f. Vehicle Operations =
. Miscellaneous
8. Indirect Costs m
N
T
9. I Total Expenditures add lines 1-8 $ - $ $ - C
A
D E F V
TOTAL M
DEDUCTIONS FROM EXPENDITURES: CASH IN-KIND DEDUCTIONS: 0D
y� o
10 Program Income income not from DAAS 0 Q
11 Deferred Income 0 Q
12 Matching Cash 0 0
13 Matching In-Kind __ 0 Z
14 Non-Match Cash _ 0 U
15 Non-Match In-Kind 0
16 Total Deductions add lines 10-15 $ __ $ $
E
REQUEST FOR REIMBURSEMENT
v
line 9 less line 16 $
PROGRAM FUNDING: For DAAS use only _ Q
E
Repayment of Advance 100 of advance if paid) $ -
NSIP
NSIP(OTO) _
Federal Funds
Federal OTO Baseline
Federal OTO(Equipment)
_Li 1.11,11.1.11,............ ...............
State Funds
State OTO
CDBG
County Funds
Repayment of funds from prior period(specify):
Otherfunding source(specify):
TOTAL REIMBURSEMENT $ -
�"" i� � Packet Pg. 173
ATTACHMENT L
COUNTY OF SAN BERNARDINO NUTRITION SERVICES
Matching Funds Narrative
Provider: City of San Bernardino Fiscal Year: FY13-14 ORIG X Amend
CONGREGATE SITES C-1 ® HOME DELIVERED MEALS C-2
Provide justification, rates, comments, descriptions, etc. for the required 11.11% of the total
proposed contract amount in matching funds whether in cash or in-kind. Matching funds may not
be fees for services, client donations or program income as defined by 45 CFR 74.41 match.
Cn
a
a
0
Line Item Rate Annual Amount Description/Justification
Personnel $8.70/hr $37,908 Senior Volunteers at the 5 Street, c
Perris Hill and Highland Senior Center a
c
O
Utilities $45,820 The City's January-December 2012
utility bills for the 5t" Street, Perris Z
Hill, Lytle Creek and Hernandez o
Center. d
LO
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ATTACH 4.D.b
SAN BERNARDINO COUNTY
DEPARTMENT OF AGING AND ADULT SERVICES
REQUEST TO PURCHASE PROPERTY/EQUIPMENT
This form is to be completed whenever a contractor is requesting to purchase property or equipment under
a California Department of Aging (CDA) grant. Contractor must obtain a minimum of three (3) bids and
attach an Equipment Bid Form for each item requested.
Date: FY:
in
a
a
Contractor Name:
Address: Contact: Phone No:
0
0
L
a.
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Q
Item(s) Requested (attach additional sheet if required): :�
L
3
QTY DESCRIPTION AMOUNT FUNDING z
L
SOURCE O
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LO
N
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Explain how requested item(s) will be used to carry out the objectives related to the funding to be
received (attach additional sheet if required): o
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a
a
Z
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Administrative Use Only: 0
r
Approved ❑ Denied ❑ Value over$5000/unit: Yes ❑ No ❑
Inventory: Yes ❑ No ❑
w
Program Review by: Name Title Date a
Director Approval : Date
Revised 10/25/11
Packet Pg. 175
ATTACH
SAN BERNARDINO COUNTY
DEPARTMENT OF AGING AND ADULT SERVICES
PROPERTY/EQUIPMENT BID FORM
Fund Source:
Contractor Name: Contact:
Address: Phone:
d
a
0
E
Item Description: ai
0
L
a.
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Date of Bid: Date of Bid: Date of Bid: L
z
Vendor: Vendor: Vendor: o
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U)
LO
LO
N
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Contact Contact Contact m
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Phone: Phone: Phone: 0
M
T
co
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Cost per unit: Cost per unit: Cost per unit: o
Number of units: Number of units: Number of units: N
a
Total Cost: Total Cost: Total Cost: o
Comments: Comments: Comments: Z
0
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Packet;Pg. 176
rvn .vUIYI r UJC VIYL/
X New FAS Vendor Code Dept, Contract Number 4.D.c
acoYplr
Sad! DIN Change SC
CITYOFS772 OOA
Cancel
ePro Vendor Number ePro Contract Number
0 00003036
County Department Dept. Orgn. Contractor's License No.
Department of Aging and Adult Services OOA 210
County Department Contract Representative Telephone Total Contract Amount
County of San Bernardino Wendy Everett (909)387-2917 $210,122
Contract Type
FAS ❑ 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
952 1 July 2013 June 30, 2014 $210,122
Fund Dept. Organization Appr. Obj/Rev Source GRCIPROJ/JOB No. Amount _
AAF OOA 210 300 3357 $167,182
a
AAF OOA 211 300 1 3357 $17,115 0
AAF OOA 235 300 3357 $25,825 E
�a
L
0 L
Project Name Estimated Payment Total by Fiscal Year a
Elderly Nutrition Program FY Amount I/D FY Amount I/D o
13/14 $210,122 1
-- z
_ L
0
THIS CONTRACT is entered into in the State of California by and between the County of San Bernardino, in
Department of Aging and Adult Services, hereinafter called the County, and
CName N
'ity of San Bernardino hereinafter called Contractor v
,address �
O
M
300 North D Street
0
CO)
San Bernardino, CA 92418
0
Telephone
Federal ID No.lSociat Security No. G
(909)384-5434
IT IS HEREBY AGREED AS FOLLOWS- o
U
WHEREAS, The County desires to provide nutrition programs for the elderly; and a
WHEREAS, the Older Americans Act of 1965 provides assistance to State and local agencies to develop nutrition o
programs for the elderly; and a:
WHEREAS, County finds Contractor qualified to provide nutrition programs for the elderly; and E
WHEREAS, County desires that such services be provided by Contractor and Contractor agrees to perform these
services according to the specific terms and conditions provided by the Contract; a
NOW THEREFORE, County and Contractor mutually agree to the following terms and conditions:
AuditorlController?reasuror Tax Collector Use OnI
❑Contract Database ❑FAS
Input Date Keyed By
Page 1 of 16
Packet Pg.177
TABLE OF CONTENTS
01. DEFINITIONS......................................... 3
VI. RIGHT TO MONITOR AND AUDIT..............................................................................................................................20
VU CORRECTION OF PERFORMANCE DEFICIENCIES................................................................................................21 ^~
Vi|i TERM ................................................ ...............................22
QL EARLY TER00|NAT|ON—.—..----.------.--.. -----.---.---.—.—.-----------32 ~^
X. GENERAL PROVISIONS..................................................... ~------------------.--~~------23
XL CONCLUSNON--.'----'---~~'_'—~—'-- -.---.---.--~—.—..----.''-----2$ ~-
ATTACHMENTS
Ln
Ln
ATTACHMENT - SCOPE OF WORK
ATTACHMENT B - CLIENT COMPLAINT AND GRIEVANCE PROCEDURES
ATTACHMENT C - ASSURANCE OF COMPLIANCOE
ATTACHMENT D - AL|TY STATEMENT
ATTACHMENT E ' SECURITY INCIDENT RE =
ATTACHMENT F - DISCLOSURE OF LOBBYING ACTIVITIES C)
ATTACHMENT G INFORMATION SHEET
ATTACHMENT M ' COMMUNITY FOCAL POINTS LIST
ATTACHMENT I - PROGRAM BUDGET �
ATTACHMENT J - MONTHLY INVOICE {]R E o
ATTACHMENT K - QUARTERLY EXPENDITURE REPORT
ATTACHMENT L - BUDGET MATCHING FUNDS NARRATIVE STATEMENT cz
ATTACHMENT M - REQUEST TO PURCHASE PROPERTY/EQUIPMENT/PROPERTY BID
FORM
Page 2 of 27
Packet Pg. 178
�
��
4.D.c
1. DEFINITIONS
A. Cash Match — Cash, other than program incom , 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, 19 0 (CRF, Chapter 8, Subchapter C, Part 1321), and
pertinent parts of 45 CFR Subtitle A, Part 74, pu lished June 3, 1980.
E. CFDA—Catalog of Federal Domestic Assistance
F. CFR—Code of Federal Regulations a
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 a
otherwise specified. o
I. Contractor— The entity (Contractor/Provider/Vendor) 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 z
and services. o
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 Servic s, and the designated Area Agency on Aging in San LO
Bernardino County.
L. DHS—California State Department of Health Se ices o
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M. Disability —A condition attributable to mental or physical impairment, or a combination of mental and ci
physical impairments, that results in substantial f nctional limitations in one (1) or more of the following M
areas of major life activity: c
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1. Self-care °
2. Receptive and expressive language
3. Learning
4. Mobility L)
5. Self-direction
6. Capacity for independent living o
7. Economic self-sufficiency
8. Cognitive functioning
9. Emotional adjustment E
N. Elderly—Any individual who is sixty (60) years of age or older, also under"older individual." c
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O. Elderly Nutrition Program — A program which provides nutrition services, as authorized by the Older Q
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 c ntractor's financial position, results of operations or
changes in net assets, and, where appropriate, c sh flows for the fiscal year audited.
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R. General Program income — Meal income received in the form of contributions or donations made by
the elderly for services rendered under this Contract.
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 Se ion 114055, Health and Safety Code.
U. HACCP Principles—The seven basic steps of HACCP which are:
1. The completion of hazard analysis ident rcation by identifying the likely hazards to consumers
presented by a specific food.
2. The determination of critical control p ints in receiving, storage, preparation, display, and
dispensing of a food.
3. The setting of measurable critical limits for each critical control point determined. a
4. Developing and maintaining monitoring practices to determine if critical limits are being met.' o
5. Developing and utilizing corrective action plans when failure to meet critical limits is detected. E
6. Establishing and maintaining a recordke ping system to verify adherence to a HACCP plan.
7. Establishing a system of audits to: o
a. Initially verify the effectiveness f the critical limits set and appropriateness of the =
determination of critical control points. g
b. Periodically verify the effectiveness of the HACCP plan. r
V. Home Delivered Nutrition Services (C-2) —Meals provided to older individuals who are homebound. Z
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W. HS — Human Services—A system of integrated services, where the programs and resources of eight
County departments come together to provide a rich, more complete array of services to the citizens of u)
San Bernardino County under one coordinated effort.
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X. MIS— Management Information System N.
Y. Nutrition Education—Informing recipients of con re ate and home-delivered meals about current facts o
and information which will promote improved fo d selection, eating habits, nutrition, health promotion,
and disease prevention practices. of
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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 c
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. 0
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BB. Older Individual—A person sixty(60)years of age or older, U)
CC. OMB—Office of Management and Budget. o
DD. Program Income — Revenue generated by the Contractor or subcontractor from contract-supported a
activities. Program income is: E
1. Voluntary contributions received from a participant or responsible party as a result of services. .2
2. Income from usage or rental fees of re I or personal property acquired with grant funds or a
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:
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4.D.c
I. 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 compe sable item.
HH. SEFA—Schedule of Expenditures of Federal Awards
Il. 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 singlp 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 q
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NN. Volunteer — An individual who provides services without pay, but may receive reimbursement for E
expenses.
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00. W& I —California Welfare and Institutions Code a
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II. CONTRACTOR SERVICE RESPONSIBILITIES
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Contractor shall provide all services as outlined in Scope of Work(Attachment A). z
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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 N
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 o
department or agency as required by Executive Order 12549 and implemented as 45 Code of Federal c
Regulations part 76. Mi
B. Without the prior written consent of the Assistant xecutive Officer for Human Services, this Contract is °
not assignable by Contractor either in whole or in part. °
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C. Contractor agrees to provide or has already provided information on former County of San Bernardino 0
administrative officials (as defined below) who are employed by or represent Contractor. The 00
information provided includes a list of former County administrative officials who terminated County Q
employment within the last five years and who are now officers, principals, partners, associates or o
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, Chief Executive Officer of the County or member of E
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. Q
D. If during the course of the administration of this Contract, the County determines that the Contractor
has made a material misstatement or misrepres ntation 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 agrees not to enter into any subcontracts for work contemplated under this Contract without
first obtaining written approval from the Director of DAAS or designee. Any subcontractor shall be
subject to the same provisions as Contractor. Contractor shall be fully responsible for the performance
of any subcontractor,
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F. 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 County shall have the right upon reasonable notice
and at reasonable hours of business to examine and inspect such records and books.
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 al 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 a
withholding of payments for billings submitted and for termination of the Contract. o
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G. 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 o
numbers. °-
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H. Contractor shall notify County of any continuing vacancies and any positions that become vacant
during the term of this Contract that will resull in reduction of services to be provided under this Z
Contract. Upon notice of vacancies, the Contractor shall apprise County of the steps being taken to 0
provide the services and to fill the position as Expeditiously as possible. Vacancies and associated 'E
problems shall be reported to County on each periodically required report for the duration of said cn
vacancies and/or problems.
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I. Contractor shall designate an individual to sente 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 2
business days. of
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J. 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 o
of services. The procedure, Client Complaint and Grievance Procedures (Attachment B), must be
posted in clear view of all recipients.
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K. Contractor shall notify the County of all upcoming meetings of the Board of Directors or other Cn
governing party and shall keep the County apprised of any and all actions taken by its Board of a
Directors which may impact on the Contract. All Board of Directors' minutes shall be submitted to the o
County upon request. Further, a County representative shall have the option of attending Board
meetings during the term of this Contract.
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L. Contractor shall protect from unauthorized use or disclosure names and other identifying information Bu
concerning persons receiving services pursuant to this Contract, except for statistical information not a
identifying any participant. The Contractor shalt 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. This provision 'll remain in force even after the termination of the
Contract.
M. 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 a y services. Contractor shall immediately notify the
County of any suspected or actual breach of confidential information as further detailed in the
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requirements. These requirements specified at http://hss.sbcounty.gov/Privacy are hereby
incorporated by this reference.
N. Contractor shall obtain from the Department of ustice (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 abla to provide documentation of prior DOJ clearance. A
copy of a license from the State of California, Which requires a DOJ clearance, 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/terninate employment or terminate internship and/or
volunteer services where the records show the person is unsuitable for employment, internship, or
volunteer services. in
0. Contractor shall notify the County of any staff ember, paid intern or volunteer who is knowingly or o
negligently employed who has been convictec of any crime of violence or of any sexual crime. E
Contractor shall investigate all incidents where in applicant, employee, intern or volunteer has been
arrested and/or convicted for any crime listed n 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 interns iip and/or volunteer services where the investigation 2
shows that the underlying conduct renders the person unsuitable for employment, internship, or
volunteer services, z
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Contractor shall immediately notify the Count concerning the arrest and/or conviction, for other
than minor traffic offenses, of any paid employ e, agent, consultant, intern, or volunteer staff, when �?
such information becomes known to Contractor.
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P. Contractor shall make every reasonable effort t prevent employees, consultants or members of its N
governing bodies from using their positions for purposes that are or give the appearance of being o
motivated by a desire for private gain for thems Ives or others, such as those with whom they have
family, business, or other ties. In the event County determines a conflict of interest exists, any increase
in costs associated with the conflict of interest may be disallowed by County and such conflict may r
constitute grounds for termination of the Contract. This provision shall not be construed to prohibit
employment of persons with whom Contractor's officers, agents, or employees have family, business °
or other ties so long as the employment of such persons does not result in increased costs over those
associated with the employment of any other qually qualified applicants and such persons have
successfully competed for employment with othe applicants on a merit basis. 0
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Q. Contractor agrees to and shall comply with the fo lowing indemnification and insurance requirements: a
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1. Indemnification — The Contractor agre s to indemnify, defend (with counsel reasonably
approved by County) and hold harmless the County, the California Department of Aging E
(CDA), the State of California, and its authorized officers, employees, agents and volunteers U
from any and all claims, actions, losses, damages, and/or liability arising out of this contract w
from any cause whatsoever, including tie acts, errors or omissions of any person and for Q
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 inderinitees. 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
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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 ounty 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 subro ation against the County, its officers, employees,
agents, volunteers, contractors and su contractors. All general or auto liability insurance
coverage provided shall not prohibit th Contractor and Contractor's employees or agents
from waiving the right of subrogation pr r to a loss or claim. The Contractor hereby waives
all rights of subrogation against the Cou ty. in
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4. Policies Primary and Non-Contributory — All policies required herein are to be primary and o
non-contributory with any insurance or self-insurance programs carried or administered by E
the County.
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5. Severability of Interests — The Contract r agrees to ensure that coverage provided to meet
these requirements is applicable separately to each insured and there will be no cross 2
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. Z
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6. Proof of Coverage — The Contractor s all furnish Certificates of Insurance to the County
Department administering the contra t evidencing the insurance coverage, including
endorsements, as required, prior to the commencement of performance of services r
hereunder, which certificates shall provide that such insurance shall not be terminated or N
expire without thirty (30) days written notice to the Department, and Contractor shall
0 maintain such insurance from the tim Contractor commences performance of services o
hereunder until the completion of such services. Within fifteen (15) days of the M
commencement of this contract, the Contractor shall furnish a copy of the Declaration page
for all applicable policies and will pro ide complete certified copies of the policies and
endorsements immediately upon reques . o
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7. Acceptability of Insurance Carrier — Lnless 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". 0
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8. Deductibles and Self-Insured Retention - Any and all deductibles or self-insured retentions a
in excess of$10,000 shall be declared to and approved by Risk Management. o
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9. Failure to Procure Coverage — In the event that any policy of insurance required under this E
contract does not comply with the req irements, is not procured, or is canceled and not
replaced, the County has the right but of the obligation or duty to cancel the contract or
obtain insurance if it deems necessa and any premiums paid by the County will be a
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
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 unreasonabl priced or unavailable types of insurance coverage
or coverage limits become reasonably priced or available, the Director of Risk Management
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4.D.c
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
ems"- such change is reasonable in light of past claims against the County, inflation, or any other
item reasonably related to the County's isk.
Any change requiring additional types 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 insu nce set forth in accordance with the requirements a
herein. If the Contractor uses existing overage to comply with these requirements and that o
coverage does not meet the specified requirements, the Contractor agrees to amend, E
supplement or endorse the existing coverage to do so. The type(s) of insurance required is 0
determined by the scope of the contract services. °
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Without in anyway affecting the inde nity herein provided and in addition thereto, the g
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Contractor shall secure and maintain hroughout the contract term the following types of
insurance with limits as shown: z
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a. Workers' Com ensation/Em to rs Liability--A program of Workers' Compensation r-
insurance or a state-approved, self-insurance program in an amount and form to N
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 N
Q volunteers providing services n behalf of the Contractor and all risks to such
persons under this contract.
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If Contractor has no employees it may certify or warrant to the County that it does
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not currently have an emplo �es or individuals who are defined as "employees"
under the Labor Code and the requirement for Workers' Compensation coverage will o
be waived by the County's Director of Risk Management. o
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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 c0
Workers' Compensation insurance. rn
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b. Commercial/General Liability Insurance—The Contractor shall carry General Liability o
Insurance covering all operations performed by or on behalf of the Contractor
providing coverage for bodily injury and property damage with a combined single E
limit of not less than one million dollars ($1,000,000), per occurrence. The policy
coverage shall include: w
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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
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4.D.c
6) Contractual liability.
7) $2,000,000 general aggregate limit.
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,M) for bodily injury and property damage, per
occurrence.
If the Contractor is transpo ing one or more non-employee passengers in
performance of contract servi es, the automobile liability policy shall have a
combined single limit of two milli n dollars ($2,000,000) for bodily injury and property N
damage per occurrence. Q
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If the Contractor owns no auto a non-owned auto endorsement to the General E
Liability policy described above is acceptable.
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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 0
umbrella policy shall apply to bodily injury/property damage, personal Z
injury/advertising injury and shall include a "dropdown" provision providing primary z
coverage for any liability not covered by the primary policy. The coverage shall also 0
apply to automobile liability.
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e. Professional Liability—Professional Liability Insurance with limits of not less than one
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million ($1,000,000) per claim or occurrence and two million ($2,000,000) aggregate N
limits
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Errors and Omissions Liability Insurance with limits of not less than one million
($1,000,000) and two million ($2,000,000) aggregate limits o
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or
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Directors and Officers Insurance coverage with limits of not less than one million 0
($1,000,000) shall be required for Contracts with charter labor committees or other U)
not-far-profit organizations advising or acting on behalf of the County. Q
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If insurance coverage is provided on a "claims made" policy, the "retroactive date"
shall be shown and must be b fore the date of the start of the contract work. The
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claims made insurance shall be maintained or "tail' coverage provided for a U
minimum of five (5) years after contract completion. r
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R. Contractor shall comply with all applicable laws statutes, ordinances, administrative orders, rules or
regulations relating to its duties, obligations and Oerformance 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 Contr ct.
S. Contractor shall comply with all applicable local h alth and safety clearances, including fire clearances,
for each site where services are provided under;terms e terms of this Contract.
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T. 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.
The Contractor shall not unlawfully fiscriminate against any employee, applicant for a
employment, or service recipient on tt e basis of race, color, national origin or ancestry, o
religion, gender, marital status, sexu I orientation, age, political affiliation or disability. E
Information on the above rules and re ulations may be obtained from the County Human
Services Contracts Unit. °
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2. Civil Rights Compliance: The Contract)r shall develop and maintain internal policies and o
procedures to assure compliance witt each factor outlined by state regulation. These
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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 Z
address prohibition of discriminatory practices, accessibility, language services, staff 2
development and training, dissemination of information, complaints of discrimination, in
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 Lo
compliance with provisions of its Civil Rights Plan. Contractor is required to submit
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Assurance of Compliance (Attachment C) along with their agency's Civil Rights Plan. lee
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U. Contractor agrees to comply with all applicable provisions of the Americans with Disabilities Act(ADA). o
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V. Contractor shall observe the mandatory standards and policies relating to energy efficiency in the State o
Energy Conservation Plan (California Code of Regulations title 20, section 1401 et seq.). c
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W. If the amount available to Contractor under th s Contract, as specified in Section V, Paragraph A,
exceeds $100,000, Contractor agrees to com ly with the Clean Air Act (42 U.S.C. Section 7606),
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section 508 of the Clean Water Act (33 U.S.C. section 1368), Executive Order 11738 and U
Environmental Protection Agency regulations(40 C.F.R. section 1.1 et seq.). a
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X. Contractor shall use recycled and recyclable pr ducts, whenever practicable, in fulfilling the terms of
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this Contract. Recycled printed products shall include a symbol identifying the recycled material.
Y. 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 Q
charged as a cost under this Contract. In the e ent 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.
Z. Contractor shall register with 211 San Bernardino County Inland Empire United Way within 30 days of
contract effective date and follow necessary pedures to be included in the 211 database. The
contractor shall notify the 211 San Bernardino County Inland Empire United Way of any changes in
program services, location or contact information within ten (10) days of any change. Services
performed as a result of being included in the 211 database, are separate and apart from the services
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being performed under this Contract and payment for such services will not be the responsibility of the
County.
AA. Contractor agrees that any news releases, ad ertisements, public announcements or photographs
arising out of the Agreement or Vendor's relationship with County shall not be made or used without
prior written approval of the DAAS Director or the r designee.
BB. IRAN CONTRACTING ACT OF 2010, Public Contract Code sections 2200 et seq. (Applicable for all
Contracts of one million dollars ($1,000,000) cr more). In accordance with Public Contract Code
section 2204(a), the Contractor certifies that at the time the Contract is signed, the Contractor signing
the Contract is not identified on a list created ursuant to subdivision (b) of Public Contract Code
section 2203 as a person (as defined in Public Contract Code section 2202(e))engaging in investment
activities in Iran described in subdivision (a) of Public Contract Code section 2202.5, or as a person �
described in subdivision (b)of Public Contract Code section 2202.5, as applicable. a
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Contractors are cautioned that making a false certification may subject the Contractor to civil E
penalties, termination of existing contract, and ineligibility to bid on a contract for a period of three m
(3) years in accordance with Public Contract Code section 2205. °
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CC. Contract Transaction Charge (CTC) 2
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Contractor agrees to remit a Contract Transaction Charge (CTC) in the amount of one percent(1%) Z
of all sales (products and/or services) occurring under this contract, not including taxes, capped at o
1% of $100,000 or $1,000 per contract. Contractor agrees not to assess the transaction charge in
the form of a line item in their invoices, rather it will include the CTC in its unit prices for all products N
and/or services available under the contract. The CTC shall be remitted to the County Purchasing
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Department at 777 E. Rialto Avenue, San Bernardino, CA 92415, no later than thirty (30) calendar N
days following the end of the calendar quarter in which sales (products and/or services) under the
contract were paid. At the end of each calendar quarter or on the termination date of the contract, o
Contractor will calculate the CTC owed to County by multiplying the dollar amount of sales
(products and/or services) paid by County in that calendar quarter by 1%. In no event shall
contractor remit to County more than $1,000 in total CTC payments due under the contract. r
Calendar quarters shall include the months o January through March, April through June, July o
through September, and October through December. Contractor's obligation to remit the CTC
survives termination of the contract. Upon ter ination of the contract, Contractor shall remit any
outstanding CTC payments due to County with.n thirty (30) calendar days following the latter of: 1)
termination of contract or, 2) final payment by County (if applicable). Contractor's failure to remit c0 0
the CTC in a timely manner may result in the 6ounty exercising any recourse available under the Q
contract or as provided for by law. a
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DD. Information Integrity and Security
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1. Information Assets
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The Contractor shall have in place opertionai policies, procedures, and practices to protect a
State information assets, i.e., public, c nfidential, 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):
a. Information collected and/or accessed in the administration of the State programs
and services.
b. Information stored in any media form, paper or electronic.
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4.D.c
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 c nfidential, sensitive, and/or personal including data
stored on portable computing devices (i cluding 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).
3. Disclosure
a. The Contractor shall ensure thai personal, sensitive and confidential information is
protected from inappropriate or unauthorized access or disclosure in accordance a
with applicable laws, regulations and State policies. The requirement to protect
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information shall remain in force Until superseded by laws, regulations or policies. E
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b. The Contractor shall protect from unauthorized disclosure names and other o
identifying information, concerning persons receiving services pursuant to this a
Agreement, except for statistical information not identifying any participant. o
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C. "Identifying information" shall include, but not be limited to, name, identifying number, Z
social security number, state driver's license or state identification number, financial o
account numbers, symbol or other identifying characteristic assigned to the
individual, such as finger or voice print or a photograph. CO
d. The Contractor shall not use such identifying information for any purpose other than LO
carrying out the Contractor's obligations under this agreement.
e. The Contractor shall not, except as otherwise specifically authorized or required by M
this agreement, release any identifying information obtained under the terms of this of
agreement to anyone other than DAAS and/or CDA without prior written cn
authorization from DAAS or CDA, except by court order. The Contractor may be c
authorized, in writing, by a participant to disclose identifying information specific to 0
the authorizing participant.
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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 U)
authorization or sign a blank release, nor shall the Contractor accept such blanket a
authorization from any participant. o
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4. Training/Education
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a. The Contractor must provide on oing education and training, at least annually, to all w
employees and subcontractors who handle personal, sensitive or confidential Q
information. Contractor employ es, 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 droup training in lieu of individual certificates. If
internet access is not available, hardcopy of the training module may be provided
to employees and/or volunteers f r their completion.
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4.D.c
b. Contractor may substitute CDA Security Awareness Training program with its own
Security Training provided s ch training meets or exceeds CDA's training
requirement. Contractors shall maintain documentation of training and education
Q provided to their staff, volunteer , 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 Accou tability 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. o
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6. Contractor Confidentiality Statement
0
The Contractor shall sign and return a ContractorNendor Confidentiality Statement CDA a
1024 form (Attachment D) with this Agreement. This is to ensure that Contractors are aware o
of, and agree to comply with, their obligations to protect CDA information assets from 15
unauthorized access and disclosure. Z
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Contractor shall protect from unauthorized use or disclosure names and other identifying
information concerning persons receiving services pursuant to this Contract, except for CO
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 L
Contractor's obligations under this Con ract, except as may be otherwise required by law.
The provision will remain in force even after the termination of the Contract.
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7. Security Incident Reporting of
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A security incident occurs when CDA information assets are accessed, modified, destroyed, o
or disclosed without proper authorization, or are lost, or stolen. The Contractor must report o
all security incidents to DAAS immediately upon detection. A Security Incident Report form 5'
(CDA 1025) (Attachment E) must be submitted to DAAS within five (5) business days of the
t date the incident was detected. o
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8. Notification of Security Breach to Data Subjects a
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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 cu
delay except when notification would impede a criminal investigation, or when a
necessary measures to restore s stem 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 pat hes and upgrades and keep virus software up-to-
date on all systems on which data c Ilected under this agreement that is confidential,
sensitive and/or personal may be used.
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10. Provisions of this Article
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The provisions contained in this Information Integrity and Security Paragraph shall be
Q included in all contracts of both the contractor and its subcontractors.
11. Contractor shall ensure that all staff, v lunteers 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.
EE. Elder and Dependent Adult Abuse Reporting
a
Contractor agrees to and shall comply with the County's Elder and Dependent Adult Abuse Reporting o
requirements: Under the terms of this Contract, as changes in the Eider and Dependent Adult E
Reporting Laws are enacted, the Contractor is bc and to comply with the most current regulations.
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1. Who Must Report: -IL
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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, consult nts or volunteers who perform services under this z
Contract and are mandated to report elder and dependent adult abuse will sign a statement `g
(SOC 341A) at http://www.dss,cahwnet.gov/Forms/English/SOC341.pdf, upon the 0
commencement of their employment, acknowledging their reporting requirements and their
compliance with them. LO
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2. When To Report:
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Mandated reporters are required to report all instances of known or suspected abuse of the o
elderly and dependent adults immediately or as soon as practically possible, under the Mi
following circumstances:
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a. When the mandated reporter has observed or has knowledge of an incident that °
reasonably appears to be physi I abuse, abandonment, isolation, neglect, financial v
abuse, mental abuse, or sexual abuse; or c
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b. When the mandated reporter is told by an elder or dependent adult that he or she has N
experienced behavior constitutin physical abuse, abandonment, isolation, neglect, o
financial abuse, mental abuse, or exual abuse.
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3. To Whom To Report: E
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Incidents of elder and dependent adult abuse must be reported to the correct agency as Q
follows:
a. If the abuse has occurred in a to g-term care facility, except a state mental hospital or
state developmental center, the eport shall be made to the local Long-Term Care
Ombudsman or local law enforcement;
b. If the abuse has occurred in a sta a mental hospital or state developmental center, the
report shall be made to the desig ated investigators of the State Department of Mental
Health or the State Departmen of Developmental Services or to the local law
enforcement;
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4.D.c
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 tae the following steps in all instances of known or
suspected abuse of the elderly and dependent adults:
a. Place an immediate telephone all 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) a
form, htt ://vvww.dss.cahwnet. v/Forms/En lish/SOC341. df, The completed form o
must be submitted to the sarne agency to which the incident was reported by E
telephone.
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FF. Conflict of Interest a
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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 5
subcontractors, that are, or give the ap earance of being, motivated by a desire for private o
gain for themselves or others, such as amily, business, or other ties. In the event that the _
County determines that a conflict of interest exists, funds may be disallowed by the County in
and such conflict may constitute ground for termination of the Agreement.
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2. This provision shall not be construed o prohibit employment of persons with whom the
Contractor's officers, agents, or employ es have family, business, or other ties, so long as
the employment of such persons does rot result in a conflict of interest (real or apparent) or M
increased costs over those associated with the employment of any other equally qualified of
applicant, and such persons have suc essfuily competed for employment with the other M
applicants on a merit basis. c
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GG. The Contractor, by signing this Contract, hereby certifies to the best of his or her knowledge and
belief, that: L
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1. No federal appropriated funds have been paid or will be paid, by or on behalf of the L)
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 wi h 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 cooperatve agreement. �g
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2. If any funds other than federal appropr aced funds have been paid or will be paid to any
person for influencing or attempting to nfluence 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.
3. The Contractor shall require that the language of this certification be included in any
subcontracts at all tiers, and that all subr cipients shall certify and disclose accordingly.
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4.D.c
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
C7 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 fo each such failure.
HH. Contractor shall complete and submit Inform tion Sheet (Attachment G) in accordance with its
instructions.
Il. Per DAAS contract with CDA, Article II.A.(27)' Community Focal Points List (Attachment H)
provides Contractors with additional resources f{or their customers.
IV. COUNTY RESPONSIBILITIES
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A. The County shall monitor and evaluate the performance of the Contractor in meeting the terms of the o
Contract and the quality and effectiveness of services provided based on the criteria as determined by E
the County.
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B. The County shall provide consultation and technical assistance in monitoring the terms of this Contract. a
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C. The County shall compensate the Contractor for approved expenses in accordance with Section V of
this Contract.
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V. FISCAL PROVISIONS .0
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A. The maximum amount of funds available for pay ent under this Contract shall not exceed $210,122,
of which $193,007 may be federally funded, and shall be subject to availability of funds to the County:
The consideration to be paid to Contractor, a provided herein, shall be in full payment for all
d Contractor's services and expenses incurred in th performance hereof, including travel and per diem.
0
B. Contractor shall be compensated on a fee-f r-service basis based on the following rates, as of
specified in Scope of Work (Attachment A): M
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Congregate Site: $5.81 per meal up to 36,166 meals o
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C. Contractor shall accept all payments from Count via electronic funds transfer(EFT) directly deposited L
into the Contractor's designated checking or other bank account. Contractor shall promptly comply
with directions and accurately complete forms provided by County required to process EFT payments. 0
U)
D. Costs for services under the terms of this Contract shall be incurred during the contract period except a
as approved by County. Contractor shall not ise current year funds to pay prior or future year °
obligations.
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E. Funds made available under this Contract shall iot supplant any federal, state or any governmental
funds intended for services of the same nati re as this Contract. Contractor shall not claim r
reimbursement or payment from County for, or a ply sums received from County with respect to that Q
portion of its obligations that have been paid by nother source of revenue. Contractor agrees that it
will not use funds received pursuant to this Contact, either directly or indirectly, as a contribution or
compensation for purposes of obtaining funds om another revenue source without prior written
approval of the County.
F. County is not liable for the payment of any taxes, they than applicable sales or use tax, resulting from
this Contract however designated, levied or impo ed, unless County would otherwise be liable for the
payment of such taxes in the course of its normal business operations.
Page 17 of 27 .
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G. 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.
H. Budget and Budget Revision
1. Contractor shall be compensated for expenses only as itemized in the approved budget that is
incorporated by reference into the Agreement as Program Budget (Attachment I). The
Contractor shall not be entitled to payment for expenses related to this Agreement until the
budget has been reviewed and approved by County.
2. No Budget revision may result in an incr ase of the maximum dollar amount stated in Section a
V, Paragraph A. The written request m st specify the line item or Service Category changes o
requested, and must include justification for the request changes. For the purpose of this E
section, 1°
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a. "Service Category" shall be defined as that classification of activities defined in the CL
Older Americans Act (OAA) that is specific to each OAA funded grant program; and o
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b. "Service" shall be defined as the activities that are defined within a Service Category. z
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Examples of Service Categories inclu e Supportive Services, Congregate and Home- 'c
delivered Nutrition Services, Disease Prevention/Health Promotion Services, and Family i
Caregiver or Grandparent Support Services. Examples of Services include nutrition
education, transportation, information assistance, senior center staffing, respite care, access N
assistance, and supplemental services. --
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County shall notify the Contractor in writing of the status of the budget revision request 2
within fourteen (14) calendar days of receipt of the Contractor's written request. The County of
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reserves the right to deny the Contractor's invoice for expenditures in excess of the
approved budgeted line item amount, o
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3. The Contractor shall submit a budget revision to the County, in advance of expenditures when:
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a. Changes to line item expenditures are expected to exceed the amount of the approved 0
budgeted line item by more tha ten (10%) of the amount specified in Section V,
Paragraph A. a
b. New budget line items are to be added. °
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C. When the changes being requested involve the transfer of funds between Service
I Category.
d. When the changes being requested involve the transfer of funds among Services within a
a Service Category.
e. When otherwise requested by County.
4. The Contractor shall maintain a written record of all budget changes including line item or
service category changes. This records all be available to the Department upon request and
shall be maintained in the same manner as all other financial records.
5. The final date to submit a budget revision is March 30`h of the contract period unless otherwise
specified by the County.
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I. The County shall not approve any request for payment of funds until Contractor has properly filed
completed reports as required under this Contra�. If Contractor is not in compliance with any 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.
J. 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 completio . (In the event of changes in these forms, DAAS shall Q
advise the Contractor via written notice.) The Contractor shall develop and implement a o
process for ensuring quality control. E
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2. Contractor shall meet the following standards for the submission of required financial reports:
a
a. Accurate, current and complete disclosure of the financial results of the program shall o
be made in accordance with the financial reporting requirements of this Contract. The Y
following reports are to be submitted to DAAS when indicated: z
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1) Monthly
a�
Monthly Invoice (I Zequest for Reimbursement) form (Attachment J)
Due to DAAS A ministration by the 5th working day of the month
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following the mont i of service to the address stated below:
D S Administration
Attention: Nutrition Program Staff Analyst
68E East Mill Street o�
Sat! Bernardino, CA 92415-0515 r
2) Quarterly ti
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• Nutrition Progra Contractor Quarterly Expenditure Report R
(Attachment I, — f ue to DAAS Administration by the 5th calendar day
of October, January, March, and June for the previous quarter of 0
services to the address stated in the above paragraph. U)
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• Quarterly reports shall be based on the Program Budget (Attachment o
3) Annually — The following reports are due on an annual basis no later than E
August 1:
• Financial Close-ou Report .2
• Periodic Inventory Report
• Single Audit or Financial Statement
• Schedule of Expenditures of Federal Awards (SEFA)
K. If, as a result of advanced income, the projea 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.
L. Contractor shall expend all funds received hereunder in accordance with this Contract.
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M. DAAS reserves the right to refuse payment to the Contractor or later disallow costs for any
expenditure determined by DAAS and/or C A 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.
N. Contractor shall return to DAAS, immediately ipon 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.
O. Contractor must return any unspent funds with ubmittal of the final invoice.
P. Contractor shall maintain accounting records tc 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.
Q. General program income shall be used to inc ease the number of elderly served by a project, to Q
facilitate access to such meals, and to provide supportive services directly related to nutrition as o
defined in the Scope of Work (Attachment A). General program income shall be used within the E
program in which it was earned.
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R. Matching Contributions a
1. The Contractor shall provide in-kind matching contributions of a minimum of $18,574 for c
2013-14, which is the Title III portion of the Contract multiplied by 11.11%.
2. Matching contributions must be allowable costs as determined by CDA. Allowable costs Z
may include but are not limited to rent, utilities, supplies and personnel (volunteers). °-
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3. Uncompensated indirect expense or ontractor allocated overhead expenses may be rn
claimed as an in-kind matching expens if such expenses were determined on the basis of r
an approved indirect cost rate plan. LO
4. Contractor shall provide a Matching Funds Narrative (Attachment Q to DAAS with the q
submittal of the initial budget identifying the type, rates applied and if applicable, M
source/location of allowable costs to be sed as matching contributions for the period of the c
I Contract. The identified matching contributions shall be reported to DAAS by the Contractor M�
on a monthly or quarterly basis as specif ed in Section V, Paragraph D.
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a. Services of volunteers shall be valued at rates consistent with those ordinarily paid
for similar work by the Contracto . If the Contractor does not have similar work, the
rate shall be consistent with those in the labor market.
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b. All other in-kind contributions sha I be valued at current market value. L)
VI. RIGHT TO MONITOR AND AUDIT a
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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 Q
I 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 iven 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 ail fiscal, statistical and management books and records
shall be available for examination and audit by county, federal and state representatives for a period of
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4.D.c
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 may be deducted from the following month's claim for
reimbursement.
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 o
County, who shall prepare and file with County, ithin 60 days after the termination of the Contract, a E
certified fiscal audit of related expenditures durin�the term of the Contract and a program compliance
audit. o
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G. Pursuant to OMB Circular A-133, Contractors xpending $500,000 or more in federal funds within o
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 Ci cular A-133 shall be submitted to the County within z
thirty (30) days of completion, but no later than nine months following the end of the Contractor's o
fiscal year. ._
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H. The following closely related programs identified by the Catalog of Federal Domestic Assistance r
(CFDA) number are to be considered as an "Other cluster" for purposes of determining major
co programs or whether a program specific audit m 3y be elected. The contractor shall communicate this
information to the independent auditor conductin the organization's single audit.
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93.045 Older Americans Act Title III-Grant for State& Community Programs on Aging of
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93.053 Older Americans Act Section 311- utrition Services Incentive Program c
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VII. CORRECTION OF PERFORMANCE DEFICIENCIES
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A. Failure by Contractor to comply with any of the provisions, covenants, requirements or conditions of o
this Contract shall be a material breach of this Contract. L)
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B. In the event of a non-cured breach, County may, at its sole discretion and in addition to any other o
remedies available at law, in equity, or otherwise specified in this Contract:
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1. Afford Contractor thereafter a time perioc within which to cure the breach, which period shall
be established at sole discretion of Coun ; and/or
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2. Discontinue reimbursement to Contracto 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 pa.agraph; 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
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4.D.c
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
1 Contractor upon demand.
C. Appeal Procedures
If Contractor disagrees with any decision or ction 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 w 'tten 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 t grievance, including dates, names, places, and the
specific remedy or action requested. The filing address is 686 East Mill Street, San o
Bernardino, California, 92415-0640. he DAAS Deputy Director shall provide a written E
response to Contractor within fifteen (15 business days of receipt of the grievance. L
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2. If Contractor is not satisfied with the DAAS Deputy Director's response, Contractor may file a a`
written grievance appeal, which shall i clude a statement by the Contractor as to why the o
DAAS Deputy Director's response is not satisfactory,to the Director of DAAS within fifteen (15)
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business days of receipt of the DAAS Deputy Director's response. The filing address is 686 3
East Mill Street, San Bernardino, California, 92415-0640. The Director of DAAS shall provide a Z
written response to Contractor within fif een (15) business days. The Director of DAAS shall •2
have final authority for the decision on thB grievance except as provided below.
3. If Contractor is not satisfied with the D S Director's response, Contractor may file a written LO
grievance appeal, which shall include statement by the Contractor as to why the DAAS
_ Director's response is not satisfactory, to the Assistant Executive Officer (AEO) of 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. c
The Assistant Executive Officer shall provide a written response to Contractor within fifteen (15) Mr
business days. The Assistant Executive Officer shall have final authority for the decision on the o
grievance except as provided below. o
Vlll. TERM
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This Contract is effective as of July 1, 2013 and expires June 30, 2014, but may be terminated earlier in L)
accordance with provisions of Section IX of the Con act. The Contract term may be extended for two a
additional one-year periods by mutual agreement of the parties. o
IX. EARLY TERMINATION
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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 oft is contract and/or under the provisions of Section VII, a
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 ounty's rights with respect to any termination of this
Contract.
B_ Contractor shall only be reimbursed for costs an I uncancelable obligations incurred prior to the date of
termination. Contractor shall not be reimbursed or costs incurred after the date of termination.
Page 22 of 27
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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 92415-051 a
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B. Nothing contained in this Contract shall be c nstrued as creating a joint venture, partnership or °
employment arrangement between the Parties iereto, 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. o
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C. Contractor shall not offer (either directly or through an intermediary) any improper consideration such o
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. z
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The County, by written notice, may immediat ly terminate any Contract if it determines that any in
improper consideration as described in the prec ding paragraph was offered to any officer, employee ..
or agent of the County with respect to the propo al and award process. This prohibition shall apply to
any amendment, extension or evaluation process once a Contract has been awarded. N
Contractor shall immediately report any attempt by a County officer, employee or agent to solicit o
(either directly or through an intermediary) improper consideration from Contractor. The report shall o
be made to the supervisor or manager charge with supervision of the employee or to the County Mi
Administrative Office. In the event of a termi ation under this provision, the County is entitled to
pursue any available legal remedies. °
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D. Property
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1. Unless otherwise provided for in this Section, property refers to all assets, capitalized or non- ci
capitalized, used in operation of this Contract. Q
a. Property includes land, buildings, improvements, machinery, vehicles, furniture, o
tools, and intangibles, etc.
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b. Property does not include consumable office supplies such as paper, pencils, toner, E
file folders, etc.
2. Property meeting all of the following criteria is subject to the capitalization requirements. a
Subject property must:
a. Have a normal useful life of at least 1 year;
b. Have a unit acquisition cost of ar least $500 (a desktop or laptop setup including all
peripherals is considered a unit, if purchased as a unit); and
C. Be used to conduct business undE r this Contract.
3. Additions, improvements, and betterments to assets meeting all of the above conditions must
also be reported. Additions typically involve physical extensions of existing units.
Improvements and betterments typically do not increase the physical size of the asset.
Page 23 of 27
Packet Pg. 199
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 sy ems.
4. Intangibles are property which lack phy ical substance but give valuable rights to the owner.
Examples of intangible property includE patents, copyrights, leases, and computer software.
By contrast, hardware consists of tangibig equipment(e.g., computer printer, terminal,etc.).
5. All purchases of property meeting all oft the following criteria above require the following:
a. If purchase of equipment is to be reimbursed by DAAS,the equipment to be purchased
must be specified in the budget previously submitted and approved by DAAS, or be
specified in a revised budget that Contractor submits to DAAS for approval.
b. Contractor must seek bids from multiple firms in selecting a supplier of goods, "Multiple Q
firms" means a minimum of tree (3) separate and distinct business entities in o
competition to supply the same or similar good. When selecting a bid, Contractor must ;_
consider such factors as type of goods/supplies needed, cost, schedule, and
availability. o
a.
G. Prior to any property/equipment purchases of$500 or more by Contractor the"Request o
To Purchase Property/Equipment" and "Property/Equipment Bid Form" (Attachment M)
must be submitted by Contractor and be approved by DAAS.
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6. The Contractor shall record the following nformation when property is acquired: o
a. Date acquired;
b. Property description (include model number);
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C. Property identification number(serial number); LO
d. Location of property;
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e. Cost or other basis of valuation;
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f. Fund source; and M
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g. Rate of depreciation (or depreciation schedule), if applicable. °
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7. The Contractor shall not use DAAS funded property as collateral to obtain loans, etc. Any liens
placed against properties purchased with the funds available through this contract should be
reported to DAAS within five (5) days. The Contractor shall maintain and submit to DAAS o
annually with the closeout, a current inventory of property furnished or purchased by either the U)
Contractor or the subcontractor with funs awarded under the terms of this Contract or any a
predecessor contracts for the same purpose. The Contractor shall use the Report of Project o
Property Furnished/Purchased with Agreement Funds (CDA 32), unless otherwise directed by
DAAS a�
8. Disposal of Property Y
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a. 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.
b. Contractor shall remove all confidential, sensitive, or personal information from CDA
property prior to disposal, including removal or destruction of data on computing
devices with digital memory and storage capacity. This includes, but is not limited to,
Page 24 of 27
Packet Pg. 200
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4.D.c
magnetic tapes, flash drives, PE rsonal computers, personal digital assistants (PDAs),
cell or smart phones, multi-function printers, and laptops.
9. The Contractor shall immediately invest gate, and within five 5 days fully docu men t the loss
destruction, or theft of such property.
10. 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.
11. 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 in
all written instructions from DAAS regarding the final disposition of the property. Q
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12. In the event of the Contractor's dissoluti n or upon termination of this Contract, the Contractor E
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. To exercise the above right, °
no later than 120 days after termination of the Contract or notification of the Contractor's r-
dissolution, DAAS will issue specific written disposition instructions to the Contractor. °
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13. The Contractor shall use the property f r the purpose for which it was intended under the z'
Contract. When no longer needed for that use, the Contractor shall use it, if needed, and with o
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. LO
14. Contractor may share use of the property and equipment or allow use by other programs, upon v
written approval of the Director of DAAS As a condition of the approval, DAAS may require M
reimbursement under this Contract for its use.
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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 o
advantage of a privately owned business entity.
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16. Contractor shall include the provision contained in this Section in all its subcontracts =
awarded under this Agreement. U
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E. County shall have Power of Attorney to pay delinquent debts and unpaid wages for work provided a
under this Contract from accounts payable to Contractor in the event debts and wages have not been
paid on a current basis, c
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F. 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 Q
delay or failure of a Party in exercising any righi under the Contract shall affect any other or future
exercise of that right or any exercise of any other light. 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.
G. Any alterations, variations, modifications, or waivers of provisions of the Contract, unless specifically
allowed in the Contract, shall be valid only when hey have been reduced to writing, duly signed and
approved by the Authorized Representatives of oth parties as an amendment to this Contract. No
oral understanding or agreement not incorporated erein shall be binding on any of the Parties hereto.
Page 25 of 27
Packet Pg. 201
H. 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.
I. 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 dispLAes arising under this Contract, to the exclusion of all
other federal and state courts.
XI. CONCLUSION
A. This Contract, consisting of twenty-seven (27) aid Attachments A through M, is the full and complete a
document describing services to be rendered, by Contractor to County including all covenants, o
conditions and benefits. E
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B. The signatures of the Parties affixed to this Contract affirm that they are duly authorized to commit and o
bind their respective institutions to the terms and conditions set forth in this document. °'
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Page 26 of 27
Packet Pg. 202
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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.
in
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OUNTY OF SAN BERNARDINO City of San Bernardino v
(Print or type name of corporation,company,contractor„etc:): o
► s �Y to
Janice Rutherford,Chair,Board of Supervisors (Authorized signature-sign in blue ink) _ ~'
Dated: Name:
SIGNED AND CERTIFIED THAT A COPY OF THIS (Print or type name of person signing contract)
DOCUMENT HAS BEEN DELIVERED TO THE Title:
CHAIRMAN OF THE BOARD
Laura H.Welch _(Print or Type) _
Clerk of the Board of Supervisors
of the County of San Bernardino. Dated: `-N ``�� c. Q
By. C �� p
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Address: 300 North D Street E
Deputy
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San Bernardino,CA 92418 a
Approved as to Legal Form Reviewed by Contract Compliance Presented to BOS for Signature
► ► ►
Jacqueline Carey-Wilson,Deputy County Regina Dalton,HS Contracts Unit Ron Buttram,Director
Counsel
hate Date
Date
Page 27 of 27
Packet Pg.203' "
ATTACH
San Bernardino County
Elderly Nutrition Program
Scope of Work
2013-14
July 1, 2013
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 ongoing monitoring and annual Program and Fiscal monitoring. It will be used to measure
the Provider's efforts towards providing quality nutrition services.
Contractor: Citv of San Bernardino
Service Area: San Bernardino and Surrounding Areas Q
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I. Program Description: E
A. Purpose — The purpose of the ENP is to provide nutrition services as described in the Older o
Americans Act (OAA) of 1965, as amende , and to assist older individuals in California to live ao
independently, by promoting better health through improved nutrition, and reduced isolation o
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 Z
congregate sites or in their homes. o
C. Goals — To maintain or improve the physical, psychological, and social well being of older
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individuals, by providing or securing appropriate nutrition services.
D. Objectives: LO
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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 Dietary Reference Intakes (DRIB) and are
safe and of good quality. o
3. Promote and maintain high food safety and sanitation standards. M�
4. Promote good health behaviors through nutrition education and nutrition screening of c
participants. ti
5. Promote or maintain coordination wi h other nutrition-reiated supportive services for older
individuals.
E. Target Population — The ENP Provider shall target individuals who are sixty (60) years of age or c
older, minorities, low income and living in rur, I areas of the County of San Bernardino.
II. Eligibility for Nutrition Services: o
A. Congregate Meals—Individuals eligible to receive a meal at a congregate nutrition site are:
1. Any older individual 60 or older.
2. The spouse of any older individual 60 or older. E
3. A person with a disability, under age sixty (60) who resides in housing facilities occupied r
primarily by older individuals (60 0 older) at which congregate nutrition services are a
provided.
4. A disabled individual who resides at iome with and accompanies an older individual who
participates in the program.
B. Volunteer Meals:
1. A volunteer under age sixty (60) may a offered a meal if doing so will not deprive an older
individual who is 60 or older of a meal
C. Home-Delivered Meals— Individuals eligible to receive a home-delivered meal are:
1. Any older individual who is frail, as cefined below, and homebound by reason of illness,
disability, or isolation:
Page 1 of 16
Packet Pg. 204
ATTACH 4.D.c
"Frail" means that an older individual is determined to be functionally impaired because the
individual either:
a. Is unable to perform at lea t two (2) activities of daily living, including bathing,
toileting, dressing, feeding,�breathing, transferring and mobility and associated
tasks, without substantial human assistance, including verbal reminding, physical
cueing or supervision.
b. Due to a cognitive or other mental impairment, requires substantial supervision
because the older individual behaves in a manner that possess 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. Q
4. Priority shall be given to older indivi uals in sub-section (C)(1) above. a
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III. Requirements for Nutrition Services: E
A. Congregate Meals: o
1. Each Congregate Meal Provider shall: a
a. Include procedures for obtaining the views of participants about the services o
received.
b. Not preclude the service of a meal to a participant who has failed to make a
reservation when food is ava lable. Z
1) 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 N
annually thereafter.
2) Maintain appropriate documentation on each client. Documentation shall
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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 M
activities at each site, and physically be on-site during the time that ENP o
activities are taking place. M�
b. Have restrooms, lighting, arid ventilation, which meet the requirements of the
California Retail Food Code (CRFC).
c. Have equipment, including tables and chairs that are sturdy and appropriate for o
older individuals. Tables shall be arranged to assure ease of access and E
encourage socialization. o
B. Home-Delivered Meals: U
1. Develop and implement criteria to a sess the level of need for home-delivered nutrition (n
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services of each eligible participant. o
a. An initial determination of a igibility may be accomplished by telephone. This w
initial contact with the participant shall include completion of sections I, II, III, and
IV of the Client Intake Sheet(provided by DAAS). E
b. A written assessment shall be done in the home within two (2) weeks of
beginning meal service, anc shall include an assessment of the type of meal d
appropriate for the participant in their living environment.
C. An older individual eligible fo receiving home-delivered meals shall be assessed
for need of nutrition-related s pportive services, and referred as necessary.
d. Re-assessment of need shall be determined quarterly. Such re-assessment
shall be done in the home o the participant at least every other quarter. Each
quarter's re-assessment shat include completion of sections I, 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 Instructions must be legible.
Page 2 of 16
Packet Pg. 205
ATTACH
3. Clearly label individual meals to inicate at least the entree and primary protein source.
Examples: "Chicken Enchilada," "Beef Lasagna."
4. 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.
5. Provide home-delivered meals in pre-packaged divided trays (hot or frozen meals).
6. 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: 36,16
1. A minimum of 95% of the total num er of meals is to be provided. The Director of DAAS F
must approve requests to serve less than 95% of the total number of meals to be a
provided. All such requests must b6 in writing. °
E
Program: C-1 (Congregate Meals) PProgram C-2 (Home-Delivered Meals) o
# of Days of Service: 255 of Days of Service: N/A a
Number of Meals: 36,166 Number of Meals N/A o
Sites to be Served: Areas to be Served:
5th Street Senior Center N/A
Perris Hill Senior Center Z
Hernandez Community Center °
Lytle Creek Community Center in
New Hope Family Life Center
Highland Senior Center LO
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V. Staffing: o
A. Manager or Director: M�
1. The ENP provider shall have a manager on staff who shall conduct the day-to-day o
management and administrative functions of the ENP, and either have (1), (2), or(3): c
a. Possess an associate degree. in institutional food service management, or a closely
related field, such as, but not imited to, restaurant management, plus two(2)years'
experience as a food service supervisor, or, o
b. Demonstrate experience in food service, such as, but not limited to, cooking at a U
restaurant, and within twelve (12) months of hire successfully complete a minimum a
of twenty (20) hours specifically related to food service management, business °
administration, or personnel anagement at a college level. Prior to completion of r
meeting the hours, this in ividual's performance shall be evaluated through �
quarterly monitoring by a registered dietitian, or,
C. Two years' experience mana ing food services. Such experience shall be verified
and approved by a registered dietitian prior to hire. a
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 irr plementation of the program requirements at the site
level. Documentation of each visit shE 11 be maintained on file for DAAS review.
Paae 3 of
Packet Pg. 206
H 1 I H1.t11VltlV I !'�
B. Personnel— Paid Staff/Volunteers:
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 p sitions in an open and competitive application
process free of discriminatory questions. Written job descriptions for all paid and
volunteer staff shall be maintained.
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 involved in food service operation or clean- a
up except home-delivered meal drivers must be in possession of a current San o
Bernardino County-issued Food Worker Card and Certificate. E
6. Volunteers shall be recruited and used in any phase of the program operation
where qualified. o
7. Volunteers shall be screened and selected through a formal process that assesses a.
their capabilities. o
8. Volunteers shall receive the same training as paid staff.
9. Volunteers that are paid through other job training programs are not considered Z
volunteers and must be paid the agrieed upon rate charged for regular paid staff. 0
10. The ENP Provider shall maintain written Volunteer Policy that describes how C
volunteers are recruited, screened, what topics they are taught at orientation, and
how often their performance is evalu ted. r
C. Registered Dietitian: M
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. M
2. The Registered Dietitian will provide the following activities to meet the mandated °!
requirements: M
a. At a minimum, quarterly m Mor food facilities or safe food handling, o
sanitation, and physical s fety practices, menu fulfillment, and, if
applicable, home delivered m als processes.
b. Review and approve the content of staff training prior to presentation.
C. Develop, or review and approve the cycle menus. o
d. Provide input, review, and approve the Nutrition Education Plan prior to N
presentation. Q
e. Provide technical support and assistance as needed. o
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VI. Staff Training Activities:
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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 Q
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 July 31 of the FY it is being provided in. The
DAAS Registered Dietitian will review and approve the Staff
Page 4 Packet Pg. 207
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4.D.c
Training Plan and return it to the Provider. The DAAS approved Staff Training Plan must
be kept on file.
E. A minimum of four (4) hours of staff training shall be provided annual) for aid and
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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. Food safety, prevention of food borne illness, and Hazard Analysis Critical Control
Points (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. Q
4. CDA Security Awareness Training (annually). ❑
VII. Senior Participants: E
A. Satisfaction Survey:
1. The ENP Provider shall conduct a Client Satisfaction Survey at least annually. o
The Survey instrument must be app Zed by DAAS prior to its use, and all findings a
from the Survey must be used to improve services. The Provider must keep the o
completed Surveys and the tabulated results on file. A copy of the tabulated w
results must be submitted to DAAS by March 7" of the FY it is being conducted z
for. o
B. Complaint Procedures: c
1. Each Provider shall have a written C)mplaint Procedure. in
2. The Complaint Procedure will be available for the participants and will provide r
them the opportunity to provide positive as well as negative feedback to the N
Program Manager.
3. The Provider shall have an assessment tool readily accessible for the seniors c
attending the congregate site or receiving a home-delivered meal.
C. Nutrition Education Services for Participants, of
1. Nutrition Education shall be provided a minimum of four (4) times per year to
participants in congregate and home delivered meal programs. o
a. Nutrition Education for congregate sites is defined as demonstrations, o
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 0
of printed material that is in conjunction with a congregate meal Nutrition N
Education presentation. Q
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2. Nutrition Education shall be based on the particular need of congregate and home- ❑
delivered meal participants. An ann al Needs Assessment shall be performed by c
the ENP Provider to make this determination. E
3. The Nutrition Education Plan and an ival Needs Assessment must be submitted to
DAAS by July31 of the fiscal year in which it is being provided. r
4. Nutrition Education sessions must be reported monthly to DAAS using the Nutrition a
Education Monthly Service Unit Report.
Nutrition Education Units of Service:
Program: C-1 (Congregate Meals) Program: C-2 Home-Delivered Meals
#of Units to be Provided: 567 #of Units to be Provided: NIA
#of Sites to be Presented at: 6 #of Participants to be Presented to: NIA
VIII. Menu Planning Guidelines/Menu Requirements•
A. Menus to cover a minimum of 3-months sh ll be planned and submitted to DAAS. Menu
cycles must be 4 weeks or longer.
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ATTACHMENT A
4.D.c
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. Menus shall be planned with guidance from the Provider's Registered Dietitian,
analyzed by either the computerized or the component method, checked for required
menu elements, and then approved as meeting requirements by the Provider's
Registered Dietitian. Upon approval they shall be forwarded to the DAAS Registered
Dietitian for certification.
E. Menus shall be submitted to the DAAS Registered Dietitian forty-five (45) days prior to
the menu start date. Allow thirty (30) da s for the menu certification process. Timely
submitted 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.
F. A copy of the certified menu must be posted in a spot conspicuous to clients at each
congregate site. a
G. Copies of the menus shall be made availa le to the participants upon request. o
H. In planning the menus, the current Dietay Reference Intakes (DRI) and the Dietary E
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 cal ries per meal. _
2. Limit total fat to no more than 25-3r,% of the calories averaged for the week.
3. Choose and prepare foods with to amounts of salt, soy sauce and other high
sodium items. Z
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4. ud
Incl a good sources of dietary fiber such as whole rains and cooked dry o
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beans at least two times a week. _
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5. Include a variety of foods and preparation methods with consideration to color, �?
combinations, texture, size, shape, taste, and preference of the participants V_
served. LO
L) 6. Dietary Reference Intake Values: v
a. Table one (1) represents tie most current Dietary Reference Intakes c
(DRI) values and daily compliance range for target nutrients. The values
provided are based on the U.S. Department of Agriculture (USDA) Food Mi
Guide calculated for one (1 meal for a woman over seventy (70) years
of age whose activity level is sedentary. This example represents a ti
majority of the older adult population served by the ENP statewide. °
1) The nutrients selected for this Table are based on the target L
nutrients to:
a. Promote health and prevent disease 0
b. Prevent deficiencies cn
C. Indicate diet c uality a
d. Manage dise se °
a. Of these Target Nutrien s, meals must supply a minimum of 33 113
percent of the DRIB for Calories, Protein, Vitamin A, Vitamin C, Fiber, E
and Calcium.
r
a
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Table 1
Target Nutrients
Nutrient Target Value* Daily Compliance Range
per meal
Calories (Kcal) >550 Kcal >550—700 Kcal
Protein 15 gm 15 gm (in the primary proteir
source)
Fat(% of total calories) 20-35% <35%weekly average
Saturated Fat(%of total calories) <10% <10%
Trans Fat <0.5g CRFC Chapter 12.6 sectior
114377**
) pg > 233 pg 3 out of 5 days/wk or 4 Q
(pg RAE) 233 out of 7 days/wk a
Vitamin C (mg) 25 mg 25 mg
0
Vitamin B12 (pg) Q g pg 0.8 pg (may average over a
week) 0
Calcium (mg) 400 mg >400 mg (may average over a
week) z
L
>105 mg (may average over a 2
Magnesium (mg) 105 mg week) in
<1,000 mg (over 1,000 mg place
Sodium (mg) <500-750 mg to
an icon on the menu)
N
Fiber(gm) >7 gm >7 gm (may average over a week)
0
Potassium (gm) 1565 mg eek) mg(may average over a of
M
r
200 IU (may average over a o
Vitamin D 200 IU week) o
*Target Value: This value represents one-third of the DR[ for a 1600 calorie range. The 1600
calorie range was chosen based on the requirements for a 70-year-old sedentary female. If a o
majority of the senior population served by the AAA ENP Program differs from the above
example, use your ENP predominate demographic characteristics to calculate target nutrient
Q
values. o
**California Retail Food Code: Commencing January 1, 2011, no food containing artificial trans-
fat, including oil and shortening that contains artificial trans-fat for use in the deep frying of yeast
dough or cake batter, maybe storage, distributed, served by, or used in the preparation of any
food within a food facility.
Y
***RAE = Retinol Activity Equivalent, NOTE: Fortified foods should be used to meet Vitamin 1312 Q
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.
I. Meal Elements —required for both computerized and component menus:
1. Protein --meat, fish, poultry, legumes, eggs, and cheese:
Page
Packet Pg.210
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 15 grams of protein. Programs should consider the preferences of
the participants they serve.
b. Legumes may 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 servings):
a. One serving cooked or raw vegetables= 1/2 cup
b. Vegetables as a primary ingredient in soups, stews, casseroles, or other
combination dishes must total '/2 cup (cooked) per serving.
C. One serving raw leafy vegetables (salads) = 1 cup per.
3. Fruit(1 serving):
a. A serving of fruit equals:
1) 1 medium sized whole fruit a
2) '/z cup fresh, chopped, cooked, frozen, or canned drained fruit o
3) '/ cup 100%fruit juice E
b. Fresh, frozen, or canned fruit should be packed in juice, light syrup, or
without sugar. Fruit packed in high sugar content syrup must be rinsed o
before using. a
C. Fruit juice may be used only occasionally, as it contributes no fiber and c
can raise blood sugar in those with diabetes r
4. Breads/Grains (1 ounce-equivalent serving): 3
Z
a. One serving equals : o
1) 1 slice of bread, a medium dinner roll, or 1/2 burger bun
2) 1/2 cup cooked rice, barley, corn meal, or other cooked breakfast
cereal
3) 1/2 cup cooked spaghetti or other pasta Ln
b. One-half of the daily intake of grains should be from whole grains.
Q Grains that are processed (not whole) must be fortified.
5. Milk (8 fl. oz.): M
Each meal shall contain eight (8)fluid ounces of fortified nonfat milk, 1%fat milk, of
buttermilk or calcium-fortified soymilk or calcium-fortified orange juice. If a r
participant's personal preference precludes the acceptance of milk with the o
meal, an equivalent high calcium substitute must be offered. o
6. Fat (Optional):
a. Each meal may contain fat components to increase the palatability and r
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. a
C. L ess than 10% of calories should come from saturated fat, and minimize o
trans fats.Keep total fat intake between 20 to 35 percent of calories, with
most fats coming from sources of polyunsaturated and monounsaturated
fatss such as fish, nuts, and vegetable oils.
7. Dessert (Optional): .2
a. Dessert may be provided as an option to satisfy the caloric requirements a
or for additional nutrients. Use fruit as a dessert as often as possible.
Limit sweets that are high sugar, high fat, and/or high refined grains to
no more than once or twice per week.
b. When a dessert contains '/ cup of fruit per serving, it may be counted as
a serving of fruit.
8. Condiments and Product Substitutes:
a. Sugar substitutes, pepper, herbal seasonings, lemon, vinegar, non-dairy
coffee creamer, salt, and sugar may be provided, but
Page 8 of 16
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4.D.c
should not be counted as fulfilling any part of the nutritive requirements.
b. Condiments such as high sodium 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.
C. At least one low-sodium salad dressing option must be provided for leafy
green salads.
d. Oil-and-vinegar and other salad dressings served combined with salads
must be accounted for in the nutrient analysis of the menu and/or recipe.
9. Sodium:
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 N
culturally appropriate meals, but are concerned with the sodium content of the a
meals, may consider: °
a. Using low sodium soy sau or diluting soy sauce with water to produce E
low sodium soy sauce;
b. Offering soy sauce as a condiment to be added by the senior; 2 0.
G. Providing Nutrition Education on sodium; _
d. 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; z
e. Not providing potassium chloride salt substitutes; o
f. 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 sodiu meal; and
LO
g. Using low sodium version of high sodium foods when available and N
feasible with budget allows ces.
10. Menu Item Flexibility: c
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 r
may not match the meal pattern, but may provide for the required nutrient
values. For example, a fortified sn ck bar as a dessert could be used to boost °
the nutrient value of a boxed lunch or special occasion meal. L
r
J. Meal Element/Nutrient Analysis: L)
A meal element and nutrient analysis of the entire menu cycle conducted and/or co
approved by a Registered Dietitian shall be done to ensure compliance with Title 22, a
Division 1.8, Section 7638.5. °
1. Meal Element Analysis: Use Section "I" Requirements Above
2. Computerized Nutrient Analysis Requirements E
a. Although not required, use of computerized nutrient analysis is strongly
recommended and will help ensure and verify the nutritional adequacy of a
meals. The goal of assessi g nutrient intakes of groups is to determine
the prevalence of inadequ to or excessive nutrient intakes within a
particular group of individual .
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AT IACHMENTA
4.D.c
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 i more difficult to meet all of the requirements
on a daily basis. ENP Provi ers should focus on:
1) Vitamin A
2) Vitamin C
3) Protein
4) Fat
5) Sodium
6) Fiber
b. Not all nutrient guidelines will be met with each meal. However, areas
that do not meet the requi ments should be the focus of future menu Q
revisions and nutrition educ tion. o
C. The following nutrients sh uid be included in the analysis when the
CO
computerized nutrient analy is method is used: calories; protein; total fat;
saturated fat; total fiber; itamins A, C, D, E, K, thiamin, riboflavin, a
niacin, B6, folate, B12, ca cium, chromium, copper, iron, magnesium, C
sodium, and zinc. In add tion to meeting one-third of the DRIs, the
menus should also follow th DGA. w
2. Component Nutrient Analysis Requ rements: z
a. The California 11600-calorie component meal pattern has been `o
developed to reflect the new DGA requirements for those programs that
are not using computerized nutrient analysis. Items that provide the
following target nutrients sh uld be identified on the menu when using a
LO
component meal pattern to plate: N
1) Vitamin C — Pro ide one-third (113) of the DR[ for Vitamin C
each meal— 5 mg (for a 1600-calorie menu). o
2) Vitamin A — rovide one-third (1/3) of the DRI for Vitamin
A at least three (3) times per week, 233 pg (for a 1600-
calorie menu),
3) Sodium — meals that contain over 1,000 mg of sodium °
must be noted on the menu as a high sodium meal. °
b. Table 2 describes the ele ents in the California 1600-calorie meal
s..
pattern. Serving sizes are ased on the USDA My Plate. This sample c
component meal pattern does not assure that meals meet one-third (1/3) v
of the DRI's and the DGA. eals will require specific types of fruits and
vegetables, whole grains, and high fiber foods in order to assure the Q
target nutrients are provided. The component meal pattern may be °.
deficient in Vitamin B12, equiring additional nutrition education for
participants on the selection of foods that are good sources of this E
nutrient.
CZ
C. The meal pattern in Ta le 2 below is based on the minimum a
requirements for a sedentary female 70 years of age. If the majority of
the population served by 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
Page 10
Packet Pg. 213
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 Required 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
Vegetable 1 -2 servings "/2 cup= 1 serving
Fruit 1 serving '/cup = 1 serving
Bread or Grain 1 —2 servings 1 slice Bread = 1 serving in
At least'/ whole grain '/2 cup of rice or pasta= 1 serving a
Non-fat or 1% fat milk or milk 1 serving 1 cup or equivalent measure o
alternate E
Fat Optional M,
0
Dessert Optional - limit sweets use Select foods high in fiber and low in =
fruit fat and sugar 2
(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 Z
using Table 3 - Estimated Caloric Requirements in Each Gender and Age Group at Three Levels of o
Physical Activity, from the DGA 2010.
co
IX. Food Procurement: LO
A. Food procurement procedures shall comply with Title 22, CRFC standards, and HACCP N LO
best practices guidelines. 21
B. All food shall be of good quality and shall be obtained from sources that conform to 0
Federal, State, and local regulatory standards for quality, sanitation, and safety.
C. To the extent possible, providers are encouraged to participate in group food Mi
purchasing. r
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. L
r
c
X. Food Storage: Q
A. Food storage procedures shall comply with Title 22, CRFC standards, and HACCP best a
practices guidelines. o
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. E
XI. Food Production: a
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.
Page 11 of 16
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A Menu Substitution Form must �e completed and signed by the Provider's
Registered Dietitian.
2. The completed Menu Substitution form shall be kept on file for DAAS review.
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 leftovei food and prevent waste.
3. Standardized recipes shall be usec 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 toe packaged and transported and held before
and during serving in a manner in which it is protected from potential a
contamination and maintains appropriate hot and cold food temperatures. 0
2. Temperatures of meals shall be monitored in the following ways, at a minimum: E
a. All hot, cold, and frozen potentially hazardous meal components,
including milk, shall be the ked daily immediately prior to dispatch from °
the central kitchen. °'
b. All hot, cold, and frozen potentially hazardous meal components, 2
r
including milk, shall be checked at satellite congregate sites upon
delivery and at all congregate sites immediately before meal service. z
C. The ENP Provider must have written procedures for monitoring food o
temperature.
d. The ENP Provider must us a form to document food temperatures daily U)
(i.e. Food Temperature Log .
to
e. The ENP Provider shall ha e a staff member review the completed Food N
Temperature Logs at ranc om a minimum of every other month. If
problems are discovered, an action plan must be developed to resolve c
the issue.
°
f. All completed Food Temperature Logs must be maintained on file for
DAAS review.
3. Meals shall be served to seniors " ffer versus serve" —meaning participants are
to be given an opportunity to decline a menu item. Food trays shall not be °
served ahead of time.
4. To maintain quality in prepared foo s, holding times shall be kept to a minimum.
Long periods of holding hot foo s at required temperatures diminishes the
nutrient content and palatability of f ods. cn
5. Holding time shall not exceed 2 hours between the end of production and the a
beginning of food service at the congregate site. °
6. Milk and milk products shall be provided in individual, commercially filled
containers, or shali be poured by a staff member directly from commercially E
filled bulk containers into the cle n glass or cup from which they are to be
consumed.
7. Cool water shall be offered with each meal to encourage fluid intake and lower a
the risk of dehydration—a risk that is higher for older adults.
8. Single service utensils and tableware shall be used one time only and then
discarded.
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9. 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.
' 10. The Provider shall have a sign osted in the congregate site stating, "Food
removed from the congregate site consumed at your own risk.'
X11. Food Service Requirements:
A. The ENP Provider shall ensure that the f�[lowing forms are available, completed daily,
and maintained at each nutrition site fora minimum of 12 months:
1. Food Temperature Logs — separate logs shall be available for congregate
meals, home delivered meals, and individual meals chilling process. .
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. Q
5. The current Environmental Health inspection detailed report shall be available at ❑
the site for review. E
6. Staff and volunteers who are invo ved in any part of food service operation or
clean-up except home-delivered trker als drivers shall possess a current San o
Bernardino County-issued Food Card and Certificate that shall be °-
available for review. o
L
X111. Program Requirements: z
A. Client Intake Sheets: o
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. U)
Forms shall be completed for:
a. Congregate Meal Participants — at the beginning of service and then N
annually thereafter for client who remain on the program.
• Sections 1 and 3 are rec uired for congregate meals. o
b. Home-Delivered Participan s — at the beginning of service and then
quarterly thereafter for clien s who remain on the program.
• Sections 1, 2, and 3 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: us
1. ENP Providers are required to p ovide outreach in the community through a
community organizations and other groups. All outreach and marketing °
activities shall be documented anc kept on file for the annual monitoring visit
conducted by DAAS. E
2. ENP Providers shall develop and have handouts, brochures, and/or signs
available in languages other than English and posted in locations such as a
churches, community service locations, and small stores serving the minority
communities.
C. Emergency Procedures:
1. ENP Providers shall have a written mergency/Disaster Plan.
2. Each nutrition site shall have al evacuation plan posted identifying the
emergency exits and assembly are s.
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3. Staff must be knowledgeable of erriergency procedures.
4. Where feasible and appropriate, NP Providers shall make arrangements for
the availability of meals to particip nts during a major disaster, as defined in 42
Q 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 receiv s 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 contributio /donation amount, the income ranges of the
older individuals in the communit and the Provider's other sources of income
shall be considered.
3. A sign indicating the suggested c ntribution for eligible individuals and the fee
for guests shall be posted near t ie contribution container at each congregate
meal site. A guest fee shall cover 311 meal costs. a
4. No eligible individual shall be den ed participation because of failure or inability o
to contribute. E
5. The Provider shall ensure tha the amount of the eligible participant's
contribution is kept confidential. 0
6, The ENP Provider shall establish written procedures to protect contributions and
fees from loss, mishandling, and heft (i.e. Contribution/Donation Procedures). °
Such Procedures shall be kept on 1 Ile for DAAS review. w
7. All contributions and fees shall be identified as program income and used to z
increase the number of meals se ed, to facilitate access to such meals, and to 0
provide nutrition-related supportive services.
E. "No Soliciting" Sign: CO
1. The ENP Provider shall ensure that a "No Soliciting" sign is posted on the door
LO
leading to the congregate nutrition site. No soliciting of any kind is permitted on N
the premises during the lunch hours for services or goods promoted by
businesses.
0
F. Coordination:
1. If applicable, develop a fair and quitable policy and procedure for referring Mi
participants to the appropriate transportation provider for securing public r
transportation to and from nutrition sites and have the policy available for review ti
by DAAS. °
2.. Include the following statement on all advertising, brochures, poster, etc., i
"Funding for this service has be n provided by the San Bernardino County =
Department of Aging and Adult Services through a grant award from the 0
California Department of Aging."
3. Coordinate service with other County departments and local agencies by Q
providing time for presentations or special activities that promote a community
based system of care for the partic pants attending nutrition sites.
G. Reporting: E
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 5th business day f the month following the month of service. a
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 re ort all known or suspected cases of elder
abuse to DAAS Adult Protective §ervice or law enforcement immediately by
telephone.
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ATTACHMENT A
4.D.c
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 s pport claimed in-kind expenditures.
5. Report expenditures funded with I eferred Income by September 30`h 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 beco a 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 in
communities not already served by the Provider. Exceptions to this requirement a
must be fully documented in writing and submitted to the Director of DAAS for °
prior approval. E
8. Other Reporting Requirements:
a. SAMS (Social Assistance Management System): °
1) The following reports are to be completed and submitted to
DAAS by the 51h bu iness day of the month following the month
of service if the Provider is serving less than 500 clients per 3
month: z
a) Client Intake Sheets for any new clients or any annual or `o
quarterly assessments completed in the month.
b) Meal Rosters U)
2) Providers that are s ruing more than 500 clients shall secure the
appropriate licensin , have a dedicated staff responsible for N LO
maintaining the client tracking software, obtain and maintain an .
Internet Service Pro ider and the appropriate hardware that can o
support the progra . These Providers shall be responsible for o
entering the following data into SAMS by the 5`h business day of
the month following the month of service: r
a) Client Intake Sheets for any new clients or any annual or °
quarterly assessments completed in the month. °
b) Rosters L
c) Routes (if applic ble)
9. Nutrition Education Monthly Service Unit Report
The Nutrition Education Monthly Service Unit Report is a tool that is used to a
report the number of Nutrition Edu ation service units that have been provided
to participants. This report is to be completed and submitted to DAAS by the 5`h °
business day of the month follo ing the month of service. Copies of any
handouts presented to the parti ipants as a component of the Nutrition E
Education shall be attached to the Nutrition Education Monthly Service Unit
Report. Q
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.
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ATTACHMENT H
4.D.c
2. Provider shall submit a list of equipment purchased with grant funding by
location.
i. Quarterly Meetings
1. Provider is required to attend all Quarterly Nutrition Provider meetings hosted by
DAAS.
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Page 1
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1
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ATTACHM
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 forr
is to be filed in the service recipient's case file maintained by contractor. The reverse side of this form ma,
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
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. Q
Time frame: Within 1 week of discrimination/violation/p oblem. o
If resolved at this level, no further action is required. If no resolut on is apparent within 15 business days, proceed with
Step 2. o
L
2. Forward the written complaint/grievance to the Deputy Director of Administration at the following address: °-
c
Department of Aging and Adult Services
686 East Mill Street
San Bernardino, CA 92415-0640 z
ATTN: Deputy Director c
Time frame: Within 1 week of Step 1. in
If resolved at this level, no further action is required. If no resolution is apparent within 15 business days, proceed with LO
LO
Step 3.
If no solution is apparent after Steps 1-2 have been exhausted, forward copy of written grievance to:
0
Human Services Group, Contract Administrator o
150 S. Lena Road M�
San Bernardino, CA 92415-0515
0
You will be contacted within 15 business days of any actions being taken. c
Please note: Each of these steps must be completed in the sequence shown.
L
If you believe that your civil rights have been violated, ple se contact: o
U
Deputy Director, Administration a
Department of Aging and Adult Services o
686 East Mill Street
San Bernardino, CA 92415-0640
E
GRIEVANCE PROCEDURE CERTIFICATION
This is to certify that I have read, understood, and received a copy of the Client Complaint and Grievance Procedures fo a
Older Americans Act Programs.
Signature of Service Recipient Date
Page 1 of 2
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A l l AUMMtN I b
GRIEVANCE NOTICE
Your Name:
Date of Occurrence:
Approximate Time of Occurrence:
Name of Service Provider:
Address of Service Provider:
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Nature of Grievance: E
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Resolution: M
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Resolved by:
Signature Date E
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Signature of Service Recipient Date
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ASSURANCE OF COMPLIANCE ATTACH
ASSURANCE OF COMPLIANCE WITH ALL APPLICABLE LAWS
RELATING TO
NONDISCRIMINATION IN AND FEDERALLY ASSISTED PROGRAMS
COUNCIL ON AGING-ORANGE COUNTY
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 in
11135 and California Code of Regulations (CCR) Title 22 section 98000-98413, Title 24 of the a
California Code of Regulations section 3105A(e), and other applicable federal and state laws, as well o
as their implementing regulations (including 45 CFR, arts 80, 84, and 91, 7 CFR Part 15, and 28 CFR E
Part 42), by ensuring that employment practices and he administration of public assistance and social
services programs are nondiscriminatory, to the effect that no person shall because of race, color, c
national origin, political affiliation, religion, marital sitatus, sex, age or disability be excluded from CL
participation in or be denied the benefits of, or be otherwise subject to discrimination under any o
program or activity receiving federal or state assistance; and HEREBY GIVES ASSURANCE THAT, it L
will immediately take any measures necessary to effectuate this agreement. Z
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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 U)
methods/procedures which have the effect of subjecting individuals to discrimination will be prohibited.
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BY ACCEPTING THIS ASSURANCE, the agency agrees to compile data, maintain records and submit N
reports as required, to permit effective enforcement of the aforementioned laws and regulations and c
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 ti
section 11135-39, or any other laws, or the issue may be referred to the appropriate federal agency for o
further compliance action and enforcement of this assurance.
THIS ASSURANCE is binding on the agency directly or through contract, license, or other provider U
services, as long as it receives federal or state assistance; and shall be submitted annually with the a
required Civil Rights Plan Update. Q
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DATE SIGNATURE
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ORGANIZATION
ADDRESS
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ATTACHMENT U
DEPARTMENT OF AGING
CONTRACTORIVENDOR 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,
CONTRACTORIVENDOR 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 Contractor/Vendor 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 in
to CDA by completing a Security Incident Report, CDA 1025. a
• any wrongful access, inspection, use, or disclosure of confidential information is a crime and is prohibited p
under State and federal laws, including but not limited to California Penal Code Section 502; California E
Government Code Section 15619, California Civil Code Section 1798.53 and 1798.55, and Health Insurance L
Portability and Accountability Act. o
any wrongful access, inspection, use, disclosure, or modification of confidential information may result in 0.
termination of this Contract/Agreement. _
0
• obligations to protect confidential information obtained under this Contract/Agreement will continue after L
termination of the Contract/Agreement with CDA. 3
• all employees/subcontractors of the Contractor/Vendor will complete the required Security Awareness Z
Training module located at www.a.gin.g.ca.gov, within 30 days of the start date of this Contract/Agreement or `o
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 N
exceeds CDA's training requirement.
• all employees/subcontractors of the Contractor/Vendor will be notified of CDA's confidentiality and data N
security requirements. 21-
• 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. °
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• I agree to protect the following types of confidential information which include but not limited to: c
Social Security number r�l
Medical information t"
Claimant and employer information °
Driver License information °
Information about individuals that relate to their personal life or identifies or describes an individual P
Other agencies'confidential and proprietary information
Criteria used for initiating audit selection v
Methods agencies use to safeguard their information (computer systems, networks, server
configurations, etc.) Q
Any other information that is considered proprietary, a copyright or otherwise protected by law or p
contract.
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• I agree to protect confidential information by:
Accessing, inspecting, using, disclosing or modifying information only for the purpose of performing E
official duties U
Never accessing, inspecting, using, disclosing, or modifying information for curiosity, personal gain, Q
or any non-business related reason
Securing confidential information in approved locations
Never removing confidential information from the work site without authorization.
Page
Packet Pg.223
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CALIFORNIA DEPARTMENT OF AGING(CDA)
SECURITY INCIDENT REPORT
CDA 1025 New 07/07)
INCIDENT INFORMATION
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
❑UNKNOWN ❑CA Hwy PATROL ❑ATTORNEY GENERAL ❑
❑UNKNOWN OTHER:
8. INCIDENT LOCATION: *
9. DESCRIPTION OF INCIDENT: Q
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10. MEDIA DEVICE TYPE, IF APPLICABLE: 11. WAS THE PORTABLE STORAGE DEVICE E
ENCRYPTED?
❑YES ❑NO ❑UNKNOWN 0
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12. IF NO,EXPLAIN: a
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13. DESCRIBE THE COSTS ASSOCIATED WITH RESOLVING THIS INCIDENT: 14. TOTAL ESTIMATED COST OF 2
INCIDENT:$
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15. TYPE OF PERSONALLY IDENTIFIABLE INFORMATION(CHECK ALL THAT APPLY):
❑ NO PERSONAL INFORMATION ❑SOCIAL SECURITY NUMBER ❑HEALTH OR MEDICAL INFORMATION ❑ c
FINANCIAL ACCOUNT NUMBER to
❑ NAME ❑DRIVER'S LICENSE/STATE 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 AFFECTED: d
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*IF A PRIVACY DISCLOSURE NOTICE IS
REQUIRED,ATTACH A SAMPLE OF THE cl
NOTIFICATION.
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19. HAVE THOSE RESPONSIBLE FOR THE INCIDENT BEEN IDENTIFIED? o
❑YES ❑NO COMMENT: v
20. CORRECTIVE ACTIONS TAKEN TO PREVENT FUTURE OCCURRENCES:
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21. ESTIMATED COST OF CORRECTIVE 22. DATE CORRECTIVE ACTIONS WILL BE FULLY IMPLEMENTED: U
ACTIONS: N Q
$ Q
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SIGNATURES
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23. PRINT-AGENCY/CONTRACTOR INFORMATION SIGNATURE: DATE: E
SECURITY OFFICER: v
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24. PRINT-AGENCY/CONTRACTOR PRIVACY OFFICER: SIGNATURE: DATE: Q
25. PRINT-AUTHORIZED SIGNATURE/DIRECTOR: SIGNATURE: DATE:
Page 1 of 3
P'adket Pg.224
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DEPARTMENT OF AGING
SECURITY INCIDENT REPORT
INSTRUCTIONS
The following instructions will assist in completing the form. All questions must be completed, even
L/ 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 Officer's 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 Q
Q
the"Unknown"checkbox.
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6. Date Incident Detected-Provide the date the in cident was discovered.
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7. Incident Reported To-Select the appropriate checkbox. If applicable,select the other checkbox 0-
and describe to whom the incident was repo .0
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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, Z
CA"; or if the incident occurred at the agency's headquarters office, suggested content is c
"Agency's Headquarters, 123 Any Street,Sacramento,CA." N
9. Description of Incident-include the following in the description: LO
• When the incident occurred and how it was discovered. Ln
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• The effect of the incident on the business and infrastructure of your agency.
(46.1 a The number of people (inside your agency and outside your agency) affected by this c
incident. M
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• The effects, if any, of this incident on p opie, businesses or services outside of your
agency.
• The details of any law enforcement inves igation of this incident, such as which agency o
investigated it,when, and the report number. o
• Any personal, confidential,or sensitive information involved/disclosed.
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10. Media Device Type, If Applicable - Provide the pe of media or device involved in the incident, o
such as paper(fax, mail,etc.)or electronic(C ,floppy drive, laptop, PDA,email,etc.). v
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11. Was the Portable Storage Device Encrypted?-Check the appropriate box. o
12. If NO, Explain -Describe why the storage device was not encrypted.
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13. Describe the Costs Associated with Resolving thiB Incident- Provide a cost estimate of resolving
the incident. Cost should include everything necessary to resolve the incident, including M,
hardware, software, staff time, contracting se ices, and any other pertinent costs that were Q
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.
Page 2 of 3
Packet Pg. 225
HI I AV ri U111GI4 1 r-
4.D.c
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 top vent future occurrences of a similar incident _
occurring again. N
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21. Estimated Cost of Corrective Actions - Provide cost estimations to implement the corrective C1
actions. For example, hardware and/or software may need to be upgraded, installed or E
purchased;new policies may need to be deve Etracting ed; additional training may need to be given.
Include all related costs, such as staff time, services, and hardware or software Q°L-
purchases.
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22. Date Corrective Actions Will Be Fully Implement d - Provide a date when the corrective actions
were,or will be,fully implemented. 0
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23. Print—Agency/Contractor Information Security Officer 0-
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24. Print — Agency/Contractor Privacy Officer - This is required only in those instances where
personally identifiable information is involved. If personally identifiable information is LO
involved and no disclosure notice is required,the Privacy Officer's signature is still required. N
25. Print—Authorized Signature/Director
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4.D.c
ATTACH
DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB
Complete this form to disclose lobbying activities pursuant to 31 U.S.C- 1352 034&0046
(See reverse for public burden disclosure.)
1.Type of Federal Action: 2.Status of Federal Action: 3.Report Type:
F7 a. contract o a. bid/offer/application a 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: N
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Congressional District, if known: Congressional District,if known:
6. Federal Department/Agency: 7. Federal Program Name/Description: o
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CFDA Number, if applicable: _
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8. Federal Action Number,if known: 9. Award Amount,if known: o
$ _
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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) U7
(last name, first name, MI) N
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(attach Continuation Sheets SF-LLLA,if necessa ) cMo
11. Amount of Payment(check all that apply): 13.Type of Payment(check all that apply): MI
$ ❑ actual ❑ planned ❑ a. retainer r
❑ b. one-time fee o
12. Form of Pa check all that a 1 ❑ c. commission
Payment o
Y ( ApY)� ❑ d. contingent fee
❑ a.cash p e. deferred
El b.in-kind;specify: nature =
value ❑ f. other; specify: 0
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14. Brief Description of Services Performed or to be Performed and Date(s)of Service, including officer(s), a
employee(s), or Member(s)contacted,for Payment Indicated in Item 11: o
t:
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(attach Continuation Sheet(s)SF-LLLA,if necessary)
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15. Continuation Sheet(s) SF-LLLA attached: ❑ Yes ❑No
16. Information requested through this form is authorized by title 31 U.S.0 Signature:
section 1352.This disclosure of lobbying activities Is a material representation of Print Name:
fact upon which reliance was placed by the tier above when this transaction was
made or entered into.This disclosure is required pursuant to 31 U.S.C.1352.This Title:
Information will be reported to the Congress semi-annually and will be available for
public inspection.Any person who fails to file the required disclosure shall he Telephone No..: Date:
subject to a civil penalty of not less that$10,000 and not more than$100,000 for
each such failure.
Authorized for Local Reproduction
[Federal:Use Only: Standard Form LLL(Rev.7-97)
Page 1 of 2
Packet Pg.227
4.D.c
ATTACH
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a
covered Federal action,or a material change to a previous filing, pursuant to title 31 U.S.C.section 1352.The filing of a form is required for each
payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency,a
Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with a covered Federal action.
Use the SF-LLLA Continuation Sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the
initial filing and material change report. Refer to the implementing guidance I ublished 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 port caused by a material change to the Information previously
reported,enter the year and quarter in which the change occurred.Eniter the date of the last previously submitted report by this reporting Q
entity for this covered Federal action. Q
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4. Enter the full name, address,city, State and zip code of the reporting entity. Include Congressional District,if known. Check the appropriate E
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 0
contract awards under grants. d
5. If the organization filing the report in item 4 checks "Subawardee,"then rater the full name,address, city, State and zip code of the prime p
Federal recipient.Include Congressional District,if known.
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6. Enter the name of the Federal agency making the award or loan commitment.include at least one organizational level below agency name, if Z
known.For example,Department of Transportation,United States Coast Guard. O
7. Enter the Federal program name or description for the covered Federal action (item 1). if known,enter the full Catalog of Federal Domestic y
Assistance(CFDA)number for grants,cooperative agreements,loans and loan commitments. U)
8. 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." N
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 c
award/loan commitment for the prime entity identified in item 4 or 5. M
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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 r,.)l
the covered Federat action. r
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(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, c
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.
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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 (n
the in-kind payment. Q
13. 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 perform, and the dates)of W
any services rendered. Include all preparatory and related activity, not just time spent in actual contact with Federal officials. Identify the E
Federal official(s)or employee(s)contacted or the officer(s),employee(s),or Member(s)of Congress that were contacted.
y
15. Check whether or not a SF-LLLA Continuation Sheet(s)is attached. Q
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 Contra
Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information i
estimated to average 30 minutes per response,including time for reviewing instructions.searching existing data sources, gathering and maintaining the dat
needed,and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection (
information,including suggestions for reducing this burden,to the Office of Managementand Budget,Paperwork Reduction Project(0348-0046),Washingtor
DC 20503.
Page 2 of 2
Packet Pg. 228
Attachmp
INFORMATION SHEET (one Information Sheetper Vendor)
CONTRACTOR SHALL COMPLETE SECTION I OF THIS FORM AND RETURN TO:
SAN BERNARDINO COUNTY
Department of Aging and Adult Services
Attn: CONTRACTS
A. '` SECTION I: CONTRA'CTOR`INFORMATION
Contractor Name:
Address fincluding City,State and Zip Code): Phone: N
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Web Site: Email: Fax: E
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Site Name for Services(if Riereni from Contractor): O
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Address(including City,Stale and Zip Code): Phone: O
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Web Site: Email: Fax: 3
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Clinic Contact: Title: _
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Contract Signature Authority:
Name: Name:
Title: Title: �
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Signature: Signature:
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Name: NO
Title:
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Signature: Signature:
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Phone Y: E-Mail: Phone✓<: E-Mail: E
:SECTIONII: DAAS INFORMATION w
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Program Mailing Address: Program Unit: Q
San Bernardino County
Department of Aging and Adult Services Unit Fax#: 909-891-9150
Program Unit
686 E. Mill Street
San Bernardino, CA 92415-0920
Page 1 of 1
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COUNTY OF SAN BERNARDINO NUTRITION SERVICES ATTACH
PROGRAM BUDGET
Provider: City of San Bernardino Fiscal Year: FY13-14 ORIG x Amend
CONGREGATE SITES C-1 FX HOME DELIVERED MEALS C-2 F
Section 1: 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 150,571 37,908 188,479
2 Staff Travel&Training
3 Equipment
4 Non-Inventory Equipment in
5 Consultants 15,500 15,500
6 Catered Food o
7 Raw Food E
77 77,000
000
8 Other Expenses: a�
0
a. Consumable Supplies 81000 8,000 �-
b. Insurance c
0
c. Repair&Maintenance 1,500 1,500
d. Rent/Building Space
e. Utilities Z
45,820 45,820 c
f. Vehicle Operations 1,000 1,000 E
g. Miscellaneous 3,000 3,000 to
9 Indirect Cost
10 Nutrition Education
LO
Total Expenditures(add lines 1-10) 256,571 83,728 340,299 EIL
v
Revenue Sources: o
State funds 17,115 (°
Federal Funds 167,182 17,115 0l
NSIP 167,182
25,825 25,825 c
County funds
0
Program Income
46,449 46,449
Deferred Income
Matching Cash c
Matching In-Kind
83,728
83,728 U
Non-Match Cash Q
Non-Match In-Kind Q
Total Revenue 340,299 340,299
E
Section II: Prepare this section based on estimated number of meals that will be served 0
multiplied by meal cost per unit. r
Q
D E f=d*e
Estimated annual number of meals Proposed meal cost per unit Annual Budget
36,166 $5.81
210,122
Submitted by: DAAS Approval:
Name Date
Signature Date
Page 1 of 1
Packet Pg.233
ATTACH
NJON THLY N�OIC (REQUCST FOR REIMBURSEMENT)
NUTRITION PROGRAM
(Due on the Sth working day of the following month)
FY 2013-2014
COUNTY OF SAN BERNARDINO CONTRACTOR NAME AND ADDRESS:
DEPARTMENT OF AGING &ADULT SERVICES
CFDA#s: MONTH:
in
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CONGREGATE SITES C 1 ❑ HOME DELIVERED MEALS C 2 ❑
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# of Meals Provided as Entered into SAMS 0 s
(X) Reimbursable Cost Per Meal $
REQUEST FOR REIMBURSEMENT $
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Prepared By: Date:
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Approved By Date: L
Signature * �
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D Check this box if you sold any equipment purchased with Nutrition grant funds during a
the month being reported. o
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IMPORTANT: Q
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.
Page 1 of 1
Packet Pg. 234
i
ATTACH 4,D.c
QUARTERLY EXPENDITURE REPORT
(Due 5th working day following month quarter ending) FY 2013-2014
COUNTY OF SAN BERNARDINO CONTRACTOR NAME:
{� DEPARTMENT OF AGING&ADULT SERVICES
CFDA#: Quarter:
MONTHLY NUTRITION PROGRAM EXPENDITURE REPORT/REQUEST FOR REIMBURSEMENT
(due on the 5th working day of the following month)
CONGREGATE SITES C 1 p HOME DELIVERED MEALS C 2 p
A + B = C N
EXPENDITURES:
COST TO PROVIDER. TOTAL MONTHLY
Q
CASH IN-KIND EXPENSE ❑
E
77 Personnel _ L
2. Staff Travel and Training _ Im
0
3. Equipment(includin One-Time-Only urchas a
4. Consultants _ 0
5. Catered Food 0
r
6. Raw Food _ 'L
7. Other E)penses r,
a. Consumable Supplies _ Z
b. Insurance 0
c. Repair&Maintenance _ y
d. Rent/BU!Iding Space
e. Utilities _ r-
f. Vehicle Operations - Ln
Q. Miscellaneous
xp 8. Indirect Costs _ et
0
9. Total Expenditures add lines 1-8 - - cMo
0
I
D E F
DEDUCTIONS FROM EXPENDITURES: TOTAL c
CASH IN-KIND DEDUCTIONS:.
0
10 Program Income income not from DAAS 0 L
11 Deferred Income p =
12 Matchin Cash 0 0
13 Matchin g In-Kind p rn
14 Non-Match Cash 0 Q
15 Non-Match In-Kind p
16 Total Deductions add lines 10-15 $ - - $ -
a>
REQUEST FOR REIMBURSEMENT E
line 9 less line 16 $ -
PROGRAM FUNDING:: For DAAS useonl m
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Repayment of Advance 100 of advance if aid) $ -
NSIP
NSIP(OTO)
Federal Funds
Federal OTO(Baseline)
Federal OTO(Equipment)
State Funds
State OTO
Cou t
County Funds
Repayment of funds from prior period(specify):
Otherfundin source(specify):
TOTAL REIMBURSEMENT $
Pae1of1
Packet Pg.235
ATTACHME
COUNTY OF SAN BERNARDINO NUTRITION SERVICES
Matching Funds Narrative
Provider: City of San Bernardino Fiscal Year: FY13-14 ORIG X Amend
CONGREGATE SITES C-1 ® HOME DELIVERED MEALS C-2
Provide justification, rates, comments, descriptions, etc. for the required 11.11% of the total
proposed contract amount in matching funds whether in cash or in-kind. Matching funds may not
be fees for services, client donations or program income as defined by 45 CFR 74.41 match.
a
Line Item Rate Annual Amount Description/Justification Q
Personnel °
$8.70/hr $37,908 Senior Volunteers at the 5 Street, E
Perris Hill and Highland Senior Center a.
0
L
Utilities $45,820 The City's January-December 2012 0
utility bills for the 5th Street, Perris w
Hill, Lytle Creek and Hernandez
Center. Z
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Page 1 of 1
Packet Pg.236
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SAN BERNARDINO COUNTY
DEPARTMENT OF AGING AND ADULT SERVICES
REQUEST TO PURCHASE PROPERTY/EQUIPMENT
This form is to be completed whenever a contractor is requesting to purchase property or equipment under
a California Department of Aging (CDA) grant. Contractor must obtain a minimum of three (3) bids and
attach an Equipment Bid Form for each item requested.
Date: FY:
Contractor Name:
a
Address: Contact: Phone No: a
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Item(s) Requested (attach additional sheet if required): Iz
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QTY DESCRIPTION AMOUNT FUNDING L
SOURCE 3
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Explain how requested item(s)will be used to carry out the objectives related to the funding to be lot
received (attach additional sheet if required):
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Page 1 o 2
Packet Pg. 237
SAN BERNARDINO COUNTY
DEPARTMENT OF AGING AND ADULT SERVICES
* PROPERTY/EQUIPMENT BID FORM
Fund Source:
Contractor Name: Contact:
Address: Phone:
a
a
Item Description: o
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Date of Bid: Date of Bid: Date of Bid: °'
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Cost per unit: Cost per unit: Cost per unit: °
Number of units: Number of units: Number of units: i
Total Cost: Total Cost: Total Cost:
Comments: Comments: Comments: v
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Page 2 of 2
Packet Pg.238