HomeMy WebLinkAbout05.Q- Park, Recreation & Community Services RESOLUTION (ID # 4553) DOC ID: 4553 B
CITY OF SAN BERNARDINO — REQUEST FOR COUNCIL ACTION
Annexation
From: Jim Tickemyer M/CC Meeting Date: 07/18/2016
Prepared by: Mitch Assumma, (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 Execution of County Contract 16-389 with the County of San Bernardino
Department of Aging and Adult Services (DAAS), Accepting the Proposed Grant
Amount of $335,000 for the Period of July 1, 2016 through June 30, 2017 for the Senior
Nutrition Program, Appropriate Grant Expenditures, and Issue Annual Food Purchase
Orders to Sysco Foods, Merit Day, and Smith Distribution through FY 2016-17. (#4553)
Current Business Registration Certificate: Yes
Financial Impact:
Account Budgeted Amount: $483,846 (Grant Award $335,000)
Account No. 123-513-0075 Grant Revenue; 001-380-0075 Grant Match
Account Description: Senior Nutrition Program
Balance as of: July 1, 2016; $483,846
Balance after approval of this item: $483,846
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 16/17 is $335,000. There is no General
Fund cash match required; the City's in-kind contribution is budgeted at $118,846 for FY
16/17, which is a 24.56% Federal contribution. The minimum in-kind matching Federal
contribution requirement by Contract for FY 16/17 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). The program's
revenue goal includes collecting $30,000 in 'Program Income' or meal recipient
donation to support meal service, which is 35% of the suggested donation rate per meal
recipient of$1.75.
Motion: Adopt the Resolution.
Synopsis of Previous Council Action
May 2, 2016 - Resolution No. 2016-86 to ratify the execution of County Contract 13-546
A-4 (Amendment 12-21-15) with the County of San Bernardino Department of Aging
and Adult Services (DAAS), accept and appropriate additional funds in the amount of
$26,010 for the period of July 1, 2015 - June 30, 2016 for the Senior Nutrition Program,
and authorize change orders and expenditures to annual P.O.'s for Sysco Foods, Merit
Day, and Smith Distribution through FY2015-2016.
r
Updated: 7/12/2016 by Georgeann "Gigi" Hanna B Packet Pg. 373
N Hi
r°
4553
September 21, 2015 - City Manager to issue an annual food purchase order to Smith
Distribution, Inc. (replace FS Dairy) in the amount of$17,555.50 through FY2015-2016.
July 6, 2016 - Resolution No. 2016-139 to authorize the execution of County Contract
13-546 A-4 (Amendment No. 4) with the County of San Bernardino Department of
Aging and Adult Services (DAAS), accept and appropriate grant funds in the amount of
$330,000 for the period of July 1, 2015 - June 30, 2016 for the Senior Nutrition
Program, and issue annual food purchase orders in the amount not to exceed $133,085
in the aggregate to Sysco Foods, Merit Day, and FS through FY 2015-2016.
January 5, 2015 - Resolution No. 2015-3 to authorize the execution of County Contract
13-546 A-3 (Amendment No. 3) with the County of San Bernardino Department of
Aging and Adult Services (DAAS), accept and appropriate additional funds in the
amount of $105,404 for a total grant award of $322,704 for the period of July 1, 2014 -
June 30, 2015 for the Senior Nutrition Program, and authorize change orders to annual
P.O.'s for Sysco Foods, Merit Day, and FS Dairy in an amount not to exceed $133,110.
July 7, 2014 - Resolution No. 2014-253 to authorize the execution of County Contract
13-546 A-2 (Amendment No. 2) with the County of San Bernardino Department of
Aging and Adult Services (DAAS), accept $217,300 for the Period of July 1, 2014
through June 30, 2015 for the Senior Nutrition Program as the 2nd Year of a 3-Year
Grant Allocation, appropriate grant expenditures, and issue Annual Food Purchase
Orders in an amount not to exceed $112,430 in the aggregate to Sysco Foods, Merit
Day, and FS Dairy through FY 2014-15.
September 16 - Resolution No. 2013-263 to execute County Contract 13-546 A-1 in the
amount of $210,122 between two Budget Periods for the FY2013-2014 Senior Nutrition
Program and authorize annual food vendor purchase orders in two Budget Periods.
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, 2016 through June 30, 2017. During the last full
year of meal services in FY 15/16, the Senior Nutrition Program served 49,653 total
meals for a daily average of 198 meals or 250 individual clients at six (6) nutrition sites:
5th Street Senior Center, Perris Hill Senior Center, New Hope Family Life Center,
Hernandez Community Center, Lytle Creek Community Center, and Highland Senior
Center.
This contract for Senior Nutrition Services is the first year of a 3-year grant cycle with
Fiscal Year 2016/17. Attached is the FAS Standard Contract No. 16-389. The FY
2016/17 requested contract amount is not to exceed $335,000 with the program
expecting to serve up to 55,833 congregate meals at six meal sites accumulatively at an
approved meal rate for compensation of$6.00 per meal.
i
Updated: 7/12/2016 by Georgeann "Gigi" Hanna B Packet Pg.374
5.Q
4553
The County of San Bernardino DAAS has approved Contract No. 16-389 for the Senior
Nutrition Program for FY2016-2017 at their June 21, 2016 regular County Board of
Supervisors meeting. In conformance with the provisions of the grant, the proposed
action is to execute the first year of a three-year agreement and to issue annual
purchase orders for the food vendors Sysco Foods, Merit Day, and Smith Distribution,
Inc. for the term of one year having begun on July 1, 2016. As the City progresses
through the bankruptcy recovery process, and as the budgeted costs for these food
items are likely to fluctuate, continuing with these three food vendors 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 into FY2016-2017.
City Attorney Review:
Supporting Documents:
RESOLUTION 2016-17 Senior Nutrition Grant Award (DOC)
Exhibit A - County Contract 16-389, FY16-17 Senior Nutrition (PDF)
Exhibit B - 2016-17 Sr Nutr Program Budget Detail (XLSX)
l
Updated: 7/12/2016 by Georgeann "Gigi" Hanna B Packet Pg.375
5.Q.a
1
RESOLUTION NO.
2 -,
3 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY M
OF SAN BERNARDINO RATIFYING THE EXECUTION OF COUNTY CONTRACT o
4 16-389 WITH THE COUNTY OF SAN BERNARDINO DEPARTMENT OF AGING =
5
AND ADULT SERVICES (DAAS), ACCEPTING THE PROPOSED GRANT
AMOUNT OF $335,000 FOR THE PERIOD OF JULY 1, 2016 THROUGH JUNE 309 Z
6 2017 FOR THE SENIOR NUTRITION PROGRAM, APPROPRIATE GRANT `o
7 EXPENDITURES, AND ISSUE ANNUAL FOOD PURCHASE ORDERS TO SYSCO N
FOODS,MERIT DAY, AND SMITH DISTRIBUTION THROUGH FY 2016-17. ti
8 0
BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE
to
9 CITY OF SAN BERNARDINO AS FOLLOWS: N
10 M
SECTION 1. That the City Manager is hereby authorized to execute FAS Standard v
11 Agreement No. 16-389 with the County of San Bernardino, for a grant in the amount of
12 $335,000 for a one-year period - July 1, 2016 through June 30, 2017, a copy of which is c
attached hereto, marked Exhibit "A" and incorporated herein by reference as fully as though 'N
13 set forth at length; and
14
SECTION 2. That the Director of Finance or his designee is hereby authorized to a
15 appropriate budget expenditures pursuant to the FY2016-2017 Program Budget Detail Sheet,
c
16 a copy of which is attached hereto, marked Exhibit `B" and incorporated herein by reference
as fully as though set forth at length, in the amount of $483,846 for FY 2016-2017 for the c
17 Senior Nutrition Program and to issue annual purchase orders to Sysco Foods, Merit Day, and
18 Smith Distribution, Inc. for food services and consumable supplies for FY 2016-2017 per the Z
19 second year of 3-year Vendor Service Agreements. c
m
y
20 SECTION 3. That the authorization granted hereunder shall expire and be void and
T
21 of no further effect if the Standard Agreement is not executed by both parties and returned to c
the Office of the City Clerk within one hundred and twenty days (120) days following z
22 effective date of the Resolution. 0
23 J 0
U)
24
25
E
26 s
w
27 a
28
1
Packet Pg. 376
1 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY
OF SAN BERNARDINO RATIFYING THE EXECUTION OF COUNTY CONTRACT
2 16-389 WITH THE COUNTY OF SAN BERNARDINO DEPARTMENT OF AGING
3 AND ADULT SERVICES (DAAS), ACCEPTING THE PROPOSED GRANT
AMOUNT OF $335,000 FOR THE PERIOD OF JULY 1, 2016 THROUGH JUNE 30, a
4 2017 FOR THE SENIOR NUTRITION PROGRAM, APPROPRIATE GRANT C:
EXPENDITURES, AND ISSUE ANNUAL FOOD PURCHASE ORDERS TO SYSCO
5 Y
FOODS,MERIT DAY,AND SMITH DISTRIBUTION THROUGH FY 2016-17. z
6 0
7 I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the Mayor cn
8 and Common Council of the City of San Bernardino at a meeting thereof, o
N
9 held on the day of , 2016,by the following vote,to wit:
0
Council Members: AYES NAYS ABSTAIN ABSENT N
10 M
LO
LO
11 MARQUEZ
12 BARRIOS _o
N
13 '
VALDIVIA
14
SHORETT 3
15 a
NICKEL L
16 0
17 RICHARD o
L
w
18 MULVIHILL Z
L
19
20 City Clerk U)
21 The foregoing resolution is hereby approved this day of 12016. o
N
22 0
H
R. Carey Davis, Mayor
23 City of San Bernardino 0
24 Approved as to Form:
Gary D. Saenz, City Attorney
25
26
By:
27 Q
28
2
Packet Pg. 377
EXHIBIT "A"
FOR COUNTY USE ONLY
New FAS Vendor Code Dept, Contract Number
Change CITIOFS772 SC OOA A
Cancel
SAN SERNARDiNO ePro Vendor Number ePro goptract�m r
COUNTY 00003036 10 1
County Department Dept. Orgn. Contractor's License No.
Department of Aging and Adult Services OOA E
County Department Contract Representative Telephone Total Contract Amount
rn
FAS Becky Giroux (909)386-8146 Not to Exceed$1,005,000 0
a
Contract Type
STANDARD CONTRACT
Revenue l7i Encumbered M Unencumbered 171 Other: - o
If not encumbered or revenue contract type,provide reason: — L
Commodity Code Contract Start Date Contract End Date Original Amount Amendment Amount Z
95200 July 1,2016 June 30,2019 $1,005,000
Fund Dept. Organization Ap t. Obi/Rev Source GRC/PROJ/JOB No Amount d
AAF OOA 210 300 3357 815 256 ti
AAF OOA 235 300 3357 189 744 N
Project Name Estimated Payment Total by Fiscal Year co
FY Amount 111) FY Amount I/D o
Elderly Nutrition Program 16117 $335000 I — C14
17/18 $335,000 I M
LO
Ln
18!19 $335,000 1
c
THIS CONTRACT is entered into in the State of California by and between the County of San Bernardino, Department of o
Aging and Adult Services, hereinafter called the County,and r
Name
Z
City of San Bernardino hereinafter called Contractor o
Address 0
d
300 North D Street to
r`
San Bernardino, CA 92418
Telephone Federal ID No.or Social Security No. >-
(909) 384-5434 U-
00
IT IS HEREBY AGREED AS FOLLOWS:
T
WHEREAS, The County desires to provide nutrition programs for the elderly; and i
WHEREAS, County has been allocated funds by the Older Americans Act of 1965 to develop nutrition programs for
ro-
the elderly; and
WHEREAS, County finds Contractor qualified to provide nutrition programs for the elderly; and o
WHEREAS, County desires that such services be provided by Contractor and Contractor agrees to perform these
services as set forth below; Q
NOW THEREFORE, County and Contractor mutually agree to the following terms and conditions:
X
w
c
m
E
t
�a
w
a
1 Page 1 of 24
Packet Pg.378
TABLE OF CONTENTS
1. DEFINITIONS .................................. ........................................................................... 3
II. CONTRACTOR SERVICE RESPONSONSIBILITIES ...............................................I............ 5
Ill. CONTRACTOR GENERAL RESPONSONSIBILITIES ......................................................... 5
E
IV. COUNTY RESPONSIBILITIES ...................................................................................... ... 15 0
CL
V. FISCAL PROVISIONS .............................................................................................. .... 15 c
0
VI. RIGHT TO MONITOR AND AUDIT .................................................................................... 18 w
VII. CORRECTION OF PERFORMANCE DEFICIENCIES ............................................................ 19 z
VIII. TERM ............................................................................... ........................................ 19 2
d
IX. EARLY TERMINATION .............................................................................................I..... 19
X. GENERAL PROVISIONS ................................................................... ......................... 19
XI. CONCLUSION .. ....... 24 0
................. N
ATTACHMENTS n
Ln
ATTACHMENT A- SCOPE OF WORK
ATTACHMENT B- CLIENT COMPLAINT AND GRIEVANCE PROCEDURES o
ATTACHMENT C- ASSURANCE OF COMPLIANCE c
ATTACHMENT D- DISCLOSURE OF LOBBYING ACTIVITIES z
ATTACHMENT E- INFORMATION SHEET
ATTACHMENT F- COMMUNITY FOCAL POINTS LIST °-
ATTACHMENT G— PAYMENTS, BUDGETS, CLOSEOUT, AND AUDITS
ATTACHMENT H— PROGRAM BUDGET ti
ATTACHMENT I— MATCHING FUNDS NARRATIVE
ATTACHMENT J— MONTHLY EXPENDITURE REPORT c°
ATTACHMENT K— REQUEST TO PURCHASE PROP ERTYIEQ UIPMENT u
ATTACHMENT L— CONTRACTORIVENDOR CONFIDENTIALITY STATEMENT a;
ATTACHMENT M— SECURITY INCIDENT REPORT M _
c�
L -
O
U
c
O
a
t
k
W
C
d
E
s
c�
Q
Page 2 of 24
Packet Pg.379
I. DEFINITIONS
A. CCR--California Code of Regulations
B. CDA—California Department of Aging
C. 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 E
pertinent parts of 45 CFR Subtitle A, Part 74, published June 3, 1980. c
L
D. CFDA—Catalog of Federal Domestic Assistance _
o '
E. CFR—Code of Federal Regulations .
L
F. Congregate Nutrition Services (C-1)—Meals provided in a congregate setting for older individuals in an z
atmosphere that is pleasant and encourages socialization. o
G. Contractor — An entity providing nutrition services. The Contractor may either be an AAA providing
nutrition services directly with Department approval in accordance with subsection 7320(c)of Title 22 ti
or an entity under contract with an AAA to provide nutrition services in accordance with Section 7352 0
N
of Title 22.
H. Cost Reimbursement — Payment method in which allowable and reasonable costs incurred by a N
contractor in the performance of the contract, which may include overhead, personnel, utilities, etc.,
LO
are reimbursed in accordance with the terms of the contract. LO
I. CRFC — California Retail Food Code (Section 113700 et seq., California Health and Safety Code);
replaces California Uniform Retail Food Facilities Law (CURFFL). 2
J. DAAS — Department of Aging and Adult Services and the designated Area Agency on Aging in San
Z
Bernardino County. I-
0
K. DHS—California State Department of Health Services
L. DOJ—Department of Justice
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 LL -
areas of major life activity: (3�
00
M ..
1. Self-care to
2. Receptive and expressive language
3. Learning w
4. Mobility o
5. Seif-direction c)
6. Capacity for independent living
7. Economic self-sufficiency o
8. Cognitive functioning
9. Emotional adjustment Q
N. Elderly—Any individual who is sixty(60)years of age or older, also referred to as"older individual."
O. Elderly Nutrition Program (ENP) —A program which provides nutrition services, as authorized by the w
Older Americans Act of 1965, as amended, and which shall be provided in accordance with the
provisions of this Act. E
P. Equipment — Tangible personal property with a useful life of more than one year and an acquisition
cost of$500 or more per unit. a
Q. Financial Statement — For non-Federal entities that expend less than $750,000 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.
Page 3 of 24
Packet Pg.380
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 E
Foods and complies with the requirements of Section 114055,Health and Safety Code.
0
L
U. HACCP Principles-The seven basic steps of HACCP which are: a
c
1. The completion of hazard analysis identification by identifying the likely hazards to consumers 0
presented by a specific food. Y
2. The determination of critical control points in receiving, storage, preparation, display, and Z
dispensing of a food. o
3. The setting of measurable critical limits for each critical control point determined. C
4. Developing and maintaining monitoring practices to determine if critical limits are being met. CO
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. N
7. Establishing a system of audits to: o
a. Initially verify the effectiveness of the critical limits set and appropriateness of the N
determination of critical control points.
Ln
b. Periodically verify the effectiveness of the HACCP plan. v
V. Home Delivered Nutrition Services (C-2)—Meals provided to older individuals who are homebound. o
W. HS — Human Services —A system of integrated services, where the programs and resources of nine
County departments come together to provide a rich, more complete array of services to the citizens of Z
San Bernardino County under one coordinated effort. o
X. Indirect Costs—Costs incurred for a common or joint purpose benefitting more than one cost objective
and not readily assignable to the cost objective specifically benefitted, without effort disproportionate to
the results achieved.
Y. Matching Contributions — The value of third-party in-kind contributions and that portion of program
and administrative costs funded,(cash or in-kind) by the Contractor, subcontractor, or other local u
CO
resources. M
1. Cash--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. Costs borne by the Contractor and cash contributions from any and
all third parties, i.e., company/private donations, vendor general fund, are considered cash 0
matching funds. w
2. In-Kind — Contributions from third parties are considered in-kind matching funds. Examples o
of in-kind match include volunteered time and use of facilities to hold meetings or conduct U
project activities. a
Z. MIS--Management Information System
AA. Non-Matching Contributions-Local funding that does not qualify as matching contributions and/or is w
not being budgeted as matching contributions (e.g., federal funds, overmatch, etc.)
d
BB. Nutrition Education— Informing recipients of congregate and home-delivered meals about current facts E
and information which will promote improved food selection, eating habits, nutrition, health promotion,
and disease prevention practices. a
CC. Nutrition Services—The procurement, preparation, transport, and service of meals, nutrition education,
and nutrition screening,to eligible individuals at congregate sites or in their homes.
Page 4 of 24
IPacket Pg.381
5.Q.b
DD. OAA — Older Americans Act — Provides comprehensive, coordinated, community-based systems of
r services to the elderly to enable them to maintain health, personal dignity, and independence.
EE. Older Individual—A person sixty(60)years of age or older.
FF. OMB—Office of Management and Budget.
GG. Program Income — Revenue generated by the Contractor or subcontractor from contract-supported
activities. Program income is: o
1. Voluntary contributions received from a participant or responsible party as a result of services.
2. Income from usage or rental fees of real or personal property acquired with grant funds or 0
funds provided under this Agreement.
3. Royalties received on patents and copyrights from contract-supported activities. z
4. Proceeds from sale of items fabricated under a contract agreement. o
'c
HH. Registered Dietitian—A person who shall be both: rn
1. Qualified as specified in Sections 2585 and 2586, Business and Professions Code and r
2. Registered by the Commission on Dietetic Registration.
11. Reimbursable Item—Allowable cost and compensable item. N
JJ. SEFA—Schedule of Expenditures of Federal Awards
KK. Single Audit Entity — Non-Federal entities that expend $750,000 or more in a fiscal year in Federal v
awards. Single Audit Entities must have a single or program-specific audit conducted for the year in
accordance with OMB Circular A-133. 0
L
Y
LL. State—State of California
z
MM. Title III—Title III of the Older Americans Act L0
.E
NN. USC—United States Code . )
00. USDA— United States Department of Agriculture
PP. Volunteer — An individual who provides services without pay, but may receive reimbursement for
U
expenses. d
0
QQ. W& l—California Welfare and Institutions Code Cl?
T
II. CONTRACTOR SERVICE RESPONSIBILITIES
L
Contactor shall provide all services as outlined in the Scope of Work(Attachment A) c
0
U
CONTRACTOR GENERAL RESPONSIBILITIES w
c
A. In the performance of this Contract, Contractor, its agents and employees, shall act in an o
independent capacity and not as officers, employees, or agents of the County of San Bernardino.
Contractor agrees to comply with the applicable federal suspension and debarment regulations, a
including, but not limited to 7 Code of Federal Regulations (CFR) Part-3017, 45 CFR 76, 40 CFR
32, or 34 CFR 85. By signing this Agreement, Contractor certifies that: x
1. Neither it nor its principals is presently debarred, suspended, proposed for debarment,
w
declared ineligible, or voluntarily excluded from participation in this transaction by any
federal department or agency;
2. Have not within a three-year period preceding this Agreement been convicted of or had a 2
judgment rendered against them for commission of fraud or a criminal offense in connection a
with obtaining, attempting to obtain, or performing a public transaction or contract under a
public transaction; or a violation of Federal or State antitrust statutes or commission of
Page 5 of 24
Packet Pg.382
embezzlement, theft, forgery, bribery, falsification, or destruction of records, making false
statements, or receiving stolen property;
3. Are not presently indicted for or otherwise criminally or civilly charged by a governmental
entity (Federal, State or local) with commission of any of the offenses enumerated in
Paragraph (A)(2) herein; and
4. Have not within a three-year period preceding this Agreement had one or more public
transactions (Federal, State or local)terminated for cause or default. °
a.
B. Without the prior written consent of the Assistant Executive Officer for Human Services, this c
Contract is not assignable by Contractor either in whole or in part.
C. Contractor agrees to. provide or has already provided information on former County of San Z
Bernardino administrative officials (as defined below)who are employed by or represent Contractor. o
The information provided includes a list of former County administrative officials who terminated .E
County employment within the last five years and who are now officers, principals, partners, rn
associates, or members of the business. The information also includes the employment with or
representation of Contractor. For purposes of this provision, "County administrative official" is N
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 2,
department or group head, or any employee in the Exempt Group, Management Unit, or Safety M
LO
Management Unit. v
D. If during the course of the administration of this Contract, the County determines that the Contractor r
has made a material misstatement or misrepresentation or that materially inaccurate information 2
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. 2
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 through the HS Contracts Unit.
Any subcontractor shall be subject to the same provisions as Contractor. Contractor shall be fully
responsible for the performance of any subcontractor.
F. Contractor shall maintain all records and books pertaining to the delivery of services under this LL
Contract and demonstrate accountability for contract performance. Said records shall be kept and
co
maintained within the County of San Bernardino, but may be negotiated. County shall have the right M -
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 c
primary source documents. Fiscal records shall be kept in accordance with Generally Accepted 0
Accounting Principles and must account for all funds, tangible assets, revenue, and expenditures.
Fiscal records must also comply with the appropriate Office of Management and Budget (OMB) o
Circulars that state the administrative requirements, cost principles and other standards for U
accountancy. Q
r
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 x
withholding of payments for billings submitted and for termination of the Contract. w
G. Contractor shall notify County in writing of any change in mailing address and/or physical location d
within ten (10) days of the change, and shall immediately notify County of changes in telephone or
fax numbers. 2
H. Contractor shall notify County of any continuing vacancies and any positions that become vacant
a
during the term of this Contract that will result in reduction of services to be provided under this
Contract. Upon notice of vacancies, the Contractor shall apprise County of the steps being taken to
Page 6 of 24
Packet Pg.383
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
vacancies and/or problems.
1. Contractor shall designate an individual to serve as the primary point of contact for the Contract.
Contractor shall notify the County when the primary contact will be unavailable/out of the office for -
one (1) or more workdays. Contractor or designee must respond to County inquiries within two (2)
County business days. o
J. Subcontracting L
0
General
•L
w
The Contractor shall have no authority to contract for, on behalf of, or incur obligations on behalf of Z
the County. o
'c
2. Awards
Cn
a. Policies and procedures used in processing and awarding the subcontracts must be: r
0
1) Organized and structured;
2) Reasonable and equitable; N
3) Documented and approved by appropriate authorities;
LO
In
4) Consistent with applicable federal, state, and local procurement :
requirements; o
5) Uniformly applied; and w
6) Open for public review and scrutiny E
`o
... b. Copies of subcontracts, memoranda andfor letters of understanding shall be on file 'c
with the Contractor and shall be made available for review at the request of the in
County.
C. A copy of the executed subcontract shall be submitted to the Director of DAAS, and
the HS Contracts Unit.
3. Financial M
cp
a. Funds for this Contract shall not be obligated in subcontracts for services beyond the '
ending date of this Contract. L
b. Contractor must ensure cost incurred by the subcontractor is verifiable from their o
records.
C. The Contractor shall review, approve, and monitor subcontractor performance,
budgets, and expenditures pertaining to the contracted service(s).
d. If applicable, the Contractor shall monitor on an ongoing basis, the subcontractor's a
use of federal and state funds through'reporting, site visits, regular contact, or other
means to provide reasonable assurance that the subcontractor administers funds in x
compliance with laws, regulations, and the provisions of contracts. (OMB Circular A- W
133.400(d)(3).
e. The maximum reimbursement amount allowable for indirect costs is 10% of E
subcontractor's direct costs, excluding in-kind contributions and nonexpendable
equipment. An indirect cost plan must have federal and DAAS approval. a
Page 7 of 24
Packet Pg.384
4. Monitoring
a. Contractor shall monitor the budget and expenditures of its subcontractors and/or
vendors.
b. Contractor shall report immediately to DAAS in writing any incidents of alleged fraud
and/or abuse by either the Contractor or subcontractor.
C. Contractor shall monitor the insurance requirements of its subcontractors and/or o
vendors. a`
d. Contractor shall monitor the performance of its subcontractors and/or vendors o
r
requiring subcontractor to maintain adequate staff.
e. Contractor shall satisfy, settle, and resolve all administrative, programmatic, and Z
fiscal aspects of the program(s), including issues that arise out of any subcontract 'o
c
agreement.
Cn
f. Contractor shall not delegate or contract the above responsibilities to any other
entity, including, but not limited to, disputes, claims, protest of award, or other N
matters of a contractual nature.
0
g. Contractor shall provide support and technical assistance to subcontractors and
respond in writing to all written request for direction, guidance, and interpretation of LO
LO
instructions to include client and service data.
5. Subcontract Termination o
Contractor shall notify DAAS in writing of termination of any subcontract within three (3)
business days of receipt of notification of intent to terminate subcontracted service(s). Z
K. Contractor shall provide a system, approved by the County, through which recipients of service
shall have the opportunity to express and have considered their views and complaints regarding the
delivery of services. The procedure must be in writing and posted in clear view of all recipients.
Contractor will ensure that staff are knowledgeable on the San Bernardino County Human Services
Complaint and Grievance Procedures (Attachment B) and ensure that any complaints by recipients T ,
are referred to the County in accordance with the procedure.
a�
L. Contractor shall notify the County of all upcoming meetings of the Board of Directors or other M _
governing party and shall keep the County apprised of any and all actions taken by its Board of
Directors, which may impact on the Contract. All Board of Directors' minutes shall be submitted to
the County with the monthly or as applicable report submitted in the month following approval of the
minutes. Further, a County representative shall have the option of attending Board meetings during cc
the term of this Contract.
w
M. Contractor shall protect from unauthorized use or disclosure names and other identifying o
information concerning persons receiving services pursuant to this Contract, except for statistical u
information not identifying any participant. The Contractor shall not use or disclose any identifying a
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. w
N. 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 E
Privacy and Security Requirements prior to providing any services. Contractor shall immediately u -
notify the County of any suspected or actual breach of confidential information as further detailed in a
the requirements. These requirements specified at http://hss.sbcounty.gov/Privacy are hereby
incorporated by this reference.
`,
Page 8 of 24
Packet Pg.385
5.Q.b
0. Contractor agrees to and shall comply with the County's Elder and Dependent Adult Abuse
Reporting requirements: Under the terms of this Contract, as changes in the Eldr and Dependent
Adult Reporting Laws are enacted, the Contractor is bound to comply with the most current
regulations. This responsibility shall include:
1. Who Must Report: In accordance with Welfare and Institutions Code (W & 1) Section 15630,
all employees of the Contractor and its subcontractors are mandated reporters of elder and
dependent adult abuse. Contractor assures all employees, agents, consultants or volunteers o
who perform services under this Contract are mandated to report elder and dependent adult It
abuse will sign a statement (SOC 341A) upon the commencement of their employment, o
acknowledging their reporting requirements and their compliance with them at L
http://www.dss.cahwnet.gov/Forms/English/SOC341.pdf. Z
2. When to Report: Mandated reporters are required to report all instances of known or o
suspected abuse of the elderly and dependent adults immediately or as soon as practically a
possible, under the following circumstances:
ti
a. When the mandated reporter has observed or has knowledge of an incident that N
reasonably appears to be physical abuse, abandonment, isolation, neglect, financial
abuse, mental abuse, or sexual abuse; or N
b. When the mandated reporter is told by an elder or dependent adult that he or she M
has experienced behavior constituting physical abuse, abandonment, isolation, 2
neglect, financial abuse, mental abuse, or sexual abuse.
c
3. To Whom to Report: Incidents of eider and dependent adult abuse must be reported to the 2
correct agency as follows:
a. If the abuse has occurred in a long-term care facility, except a state mental hospital o
or state development center, the report shall be made to the local Long-Term Care _
Ombudsman or local law enforcement; cn
b. If the abuse has occurred in a state mental hospital or state developmental center,
to
the report shall be made to the designated investigators of the State Department of
Mental Health or the State Department of Developmental Services or the local law U
enforcement; °'
co
M
C. If the abuse occurred anywhere other than a long-term care facility or State mental 6
hospital or state developmental center, the report shall be made to Adult Protective
Services (APS) or local law enforcement. ca
r
c
4. How to Report: Mandated reporters are required to take the following steps in all instances c0
of known or suspected abuse of the elderly and dependents: >%
w
a. Place an immediate telephone call to APS (1 877 565-2020) or local law o
enforcement to report the incident.
b. Within two (2) working days of making the telephonic report to the responsible a
agency, complete a written "Report of Suspected Dependent Adult/Elder Abuse" .�
(SOC 341) form, http://www.dss.cahwnet.gov/Forms/English/SOC341.pdf. The w
completed form must be submitted to the same agency to which the incident was
reported by telephone. d
P. 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 y
volunteers for all positions in which he or she would have contact with a minor, the aged, the blind, a
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
Page 9 of 24
Packet Pg.386
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 volunteer services.
Q. Contractor shall notify the County of any staff member, paid intern or volunteer who is knowingly or
negligently employed who has been convicted of any crime of violence or of any sexual crime. M
Contractor shall investigate all incidents where an applicant, employee, intern, or volunteer has o
been arrested and/or convicted for any crime listed in Penal Code section 11105.3 and shall notify a
the County. In the County's discretion, the County may instruct Contractor to take action to either o
deny/terminate employment or terminate internship and/or volunteer services where the w
investigation shows that the underlying conduct renders the person unsuitable for employment,
internship, or volunteer services, o
Contractor shall immediately notify the County concerning the arrest and/or conviction, for other 'F-
than
minor traffic offenses, of any paid employee, agent, consultant, intern, or volunteer staff, when v'
such information becomes known to Contractor.
0
R. 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 N
motivated by a desire for private gain for themselves 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 c
increase in costs associated with the conflict of interest may be disallowed by County and such
conflict may constitute grounds for termination of the Contract.This provision shall not be construed r
to prohibit employment of persons with whom Contractor's officers, agents, or employees have 2
family, business or other ties so long as the employment of such persons does not result in 3
increased costs over those associated with the employment of any other equally qualified z
applicants and such persons have successfully competed for employment with other applicants on o
a merit basis.
Cn
S. Contractor agrees to and shall comply with the following indemnification and insurance
requirements:
1. Indemnification — The Contractor agrees to indemnify, defend (with counsel reasonably U
approved by County) and hold harmless the County and its authorized officers, employees, C
agents and volunteers from any and all claims, actions, losses, damages, and/or liability C
arising out of this contract 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 w
provision shall apply regardless of the existence or degree of fault of indemnitees. The
ro-
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. 0
2. Additional Insured — All policies, except for the Workers' Compensation, Errors and a
Omissions and Professional Liability policies, shall contain endorsements naming the
County and its officers, employees, agents and volunteers as additional insureds with
respect to liabilities arising out of the performance of services hereunder. The additional w
insured endorsements shall not limit the scope of coverage for the County to vicarious c
liability but shall allow coverage for the County to the full extent provided by the policy. Such E
additional insured coverage shall be at least as broad as Additional Insured (Form 8) -
endorsement form ISO, CG 2010.11 85.
3. Waiver of Subrogation Rights — The Contractor shall require the carriers of required
a
coverages to waive all rights of subrogation against the County, its officers, employees,
agents, volunteers, contractors, and subcontractors. All general or auto liability insurance
Page 10 of 24
Packet Pg.387
1 a
coverage provided shall not prohibit the Contractor and Contractor's employees or agents
from waiving the right of subrogation prior to a loss or claim. The Contractor hereby waives
all rights of subrogation against the County.
4. Policies Primary and Non-Contributory —All policies required herein are to be primary and
non-contributory with any insurance or self-insurance programs carried or administered by
the County.
rn
5. Severability of Interests — The Contractor agrees to ensure that coverage provided to meet 2-
these requirements is applicable separately to each insured and there will be no cross
liability exclusions that preclude coverage for suits between the Contractor and the County
or between the County and any other insured or additional insured under the policy.
6. Proof of Coverage — The Contractor shall furnish Certificates of Insurance to the County ?
Department administering the contract evidencing the insurance coverage, including •_
endorsements, as required, prior to the commencement of performance of services in
hereunder, which certificates shall provide that such insurance shall not be terminated or ti
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 6
hereunder until the completion of such services. Within fifteen (15) days of the N
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 Lon
LO
endorsements immediately upon request.
7. Acceptability of Insurance Carrier — Unless otherwise approved by Risk Management, o
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." Z
8. Deductibles and Self-Insured Retention —Any and all deductibles or self-insured retentions `o
in excess of$10,000 shall be declared to and approved by Risk Management.
9. Failure to Procure Coverage — In the event that any policy of insurance required under this
contract does not comply with the requirements, is not procured, or is canceled and not CL
replaced, the County has the right but not the obligation or duty to cancel the contract or >- -
obtain insurance if it deems necessary and any premiums paid by the County will be L
promptly reimbursed by the Contractor or County payments to the Contractor will be co
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 0
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 0
or coverage limits become reasonably priced or available, the Director of Risk Management Q
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 w
item reasonably related to the County's risk. r
c
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.
a
Any failure, actual or alleged, on the part of the County to monitor or enforce compliance
10 with any of the insurance and indemnification requirements will not be deemed as a waiver
of any rights on the part of the County.
Page 11 of 24
Packet Pg.388
ens�eLL:;
11. The Contractor agrees to provide insurance set forth in accordance with the requirements
herein. If the Contractor uses existing coverage to comply with these requirements and that
coverage does not meet the specified requirements, the Contractor agrees to amend,
supplement, or endorse the existing coverage to do so. The type(s) of insurance required is
determined by the scope of the contract services.
Without in anyway affecting the indemnity herein provided and in addition thereto, the 2-
Contractor shall secure and maintain throughout the contract term the following types of c
L
insurance with limits as shown: a
a. Workers' Compensation/Employers Liability—A program of Workers' Compensation °
insurance or a state-approved, self-insurance program in an amount and form to
meet all applicable requirements of the Labor Code of the State of California, z
including Employer's Liability with $250,000 limits covering all persons including o
volunteers providing services on behalf of the Contractor and all risks to such
persons under this contract. ti
If Contractor has no employees, it may certify or warrant to the County that it does N
not currently have any employees or individuals who are defined as "employees" to
under the Labor Code and the requirement for Workers' Compensation coverage will N
be waived by the County's Director of Risk Management.
M
With respect to Contractors that are non-profit corporations organized under L
California or Federal law, volunteers for such entities are required to be covered by
Workers' Compensation insurance. o
r
b. _Commercial/General Liability Insurance —The Contractor shall carry General Liability
Insurance covering all operations performed by or on behalf of the Contractor z
providing coverage for bodily injury and property damage with a combined single o
limit of not less than one million dollars ($1,000,000), per occurrence. The policy
coverage shall include:
ti
1) Premises operations and mobile equipment.
2) Products and completed operations. U_
ai
3) Broad form property damage (including completed operations). co
4) Explosion, collapse, and underground hazards.
5) Personal injury. w
_
6) Contractual liability. °
U
7) $2,000,000 general aggregate limit. w
c
C. Automobile Liability Insurance— Primary insurance coverage shall be written on ISO 5
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 a
one million dollars ($1,000,000) for bodily injury and property damage, per
s
occurrence. X
w
If the Contractor is transporting one or more non-employee passengers in c
performance of contract services, the automobile liability policy shall have a _
combined single limit of two million dollars ($2,000,000)for bodily injury and property
damage per occurrence.
If the Contractor owns no autos, a non-owned auto endorsement to the General
a
Liability policy described above is acceptable.
Page 12 of 24
Packet Pg. 389
d. Umbrella Liability Insurance - An umbrella (over primary) or excess policy may be
used to comply with limits or other primary coverage requirements. When used, the
umbrella policy shall apply to bodily injury/property damage, personal
injury/advertising injury and shall include a "dropdown" provision providing primary
coverage for any liability not covered by the primary policy. The coverage shall also
apply to automobile liability.
L
T. Contractor shall comply with all applicable laws, statutes, ordinances, administrative orders, rules, o
or regulations relating to its duties, obligations, and performance under the terms of the Contract a`
and shall procure all licenses and pay all fees and other charges required thereby. Contractor shall c
maintain all required licenses during the term of this Contract. Failure to comply with the provisions r
L
of this section may result in immediate termination of this Contract. z
U. Contractor shall comply with all applicable local health and safety clearances, including fire `o
clearances, for each site where services are provided under the terms of this Contract. r-
V. Contractor agrees to and shall comply with the County's Equal Employment.Opportunity Program,
Employment Discrimination, and Civil Rights Compliance requirements: N
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 N
and all rules and regulations adopted pursuant thereto: Executive Orders 11246, as M
amended by Executive Order 11375, 11625, 12138, 12432, 12250; Title VII of the Civil L
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 o
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 z
recipients, including laws and regulations hereafter enacted. L
0
2. Employment Discrimination: During the term of the Contract, Contractor shall not
discriminate against any employee or applicant for employment or service recipient because N
of race, religious creed, color, national origin, ancestry, physical disability, mental disability,
medical condition, genetic information, marital status, sex, gender, gender identity, gender
expression, sexual orientation, age, or military and veteran status. Contractor shall comply U-
with Executive Orders 11246, 11375, 11625, 12138, 12432, 12250, 13672, Title VII of the c co
Civil Rights Act of 1964, the California Fair Housing and Employment Act and other M
applicable Federal, State and County laws and regulations and policies relating to equal
employment and contracting opportunities, including laws and regulations hereafter
L
enacted.
3. Civil Rights Compliance: The Contractor shall develop and maintain internal policies and U
procedures to assure compliance with each factor outlined by state regulation. These
policies must be developed into a Civil Rights Plan, which is to be on file with the County o
Human Services Contracts Unit within 30 days of awarding of the Contract. The Plan must U
address prohibition of discriminatory practices, accessibility, language services, staff a
development, and training, dissemination of information, complaints of discrimination, s
compliance review, and duties of the Civil Rights Liaison. Upon request, the County shall x
supply a sample of the Plan format. The Contractor shall be monitored by the County for w
compliance with provisions of its Civil Rights Plan. Additionally, the Contractor shall submit c
to County an Assurance of Compliance (Attachment C) with the California Department of E -.
Social Services Nondiscrimination in State and Federally Assisted Programs Statement
annually.
a
W. Contractor agrees to comply with all applicable provisions of the Americans with Disabilities Act
(ADA).
Page 13 of 24
Packet Pg.390
X. Contractor shall observe the mandatory standards and policies relating to energy efficiency in the
State Energy Conservation Plan (California Code of Regulations title 20, section 1401 et seq.).
Y. If the amount available to Contractor under this Contract, as specified in Section V, Paragraph A,
exceeds $100,000, Contractor agrees to comply with the Clean Air Act (42 U.S.C. Section 7606),
section 508 of the Clean Water Act (33 U.S.C. section 1368), Executive Order 11738 and
Environmental Protection Agency regulations (40 C.F.R. section 1.1 et seq.).
Z. Contractor shall use recycled and recyclable products, whenever practicable, in fulfilling the terms c
of this Contract. Recycled printed products shall include a symbol identifying the recycled material. .
AA. 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 shat[ not be 3
charged as a cost under this Contract. In the event of any Contract dispute hereunder, each Party z
to this Contract shall bear its own attorney's fees and costs regardless of who prevails in the ._
outcome of the dispute.
Cn
BB. Contractor shall register with 211 San Bernardino County Inland Empire United Way within 30 days T
of contract effective date and follow necessary procedures to be included in the 211 database. The N
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 N
performed as a result of being included in the 211 database, are separate and apart from the M
services, being performed under this Contract and payment for such services will not be the L
responsibility of the County.
c
CC. Contractor agrees that any news releases, advertisements, public announcements, or photographs o
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. z
DD. The Contractor, by signing this Contract, hereby certifies to the best of his or her knowledge and •_
belief, that:
ti
1. No federal appropriated funds have been paid or will be paid, by or on behalf of the
Contractor, to any person for influencing or attempting to influence an officer or employee of >-
any agency, a Member of Congress, an officer or employee of Congress, or an employee of w
a Member of Congress in connection with the awarding of any federal contract, the making c
of any federal grant, the making of any federal loan, the entering into of any cooperative
co
agreement, and the extension, continuation, renewal, amendment, or modification of any Y
federal contract, grant, loan, or cooperative agreement. L
2. If any funds other than federal appropriated funds have been paid or will be paid to any 0
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 0
Contractor shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Q
Activities"form (Attachment D), in accordance with its instructions.
3. The Contractor shall require that the language of this certification be included in any x
subcontracts at all tiers, and that all subrecipients shall certify and disclose accordingly. w
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 E
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 Q
$10,000 and not more than $100,000 for each such failure.
Page 14 of 24
Packet Pg.391
EE. 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 E
as a person described in subdivision (b) of Public Contract Code section 2202.5, as applicable.
0
Contractors are cautioned that making a false certification may subject the Contractor to civil a
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. .
L
FF. Contractors shall complete and submit Information Sheet (Attachment E) in accordance with its Z
instructions. o
GG. Department of Aging and Adult Services contract with California Department of Aging, Article 11, in
Paragraph A (23), requires DAAS to provide contractors with additional resources for their
customers called Community Focal Points List(Attachment F). N
IV. COUNTY RESPONSIBILITIES
0
County shall: N
' M
A. Monitor and evaluate the performance of the Contractor in meeting the terms of the Contract and Lu."
the quality and effectiveness of services provided based on the criteria as determined by the
County. a
B. Provide consultation and technical assistance in monitoring the terms of this Contract.
C. Compensate the Contractor for approved expenses in accordance with Section V of this contract. Z
0
V. FISCAL PROVISIONS a
Cn
A. The maximum amount of reimbursement under this Contract shall not exceed $1,005,000, of which
$880,179 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 _
Contractor's services and expenses incurred in the performance hereof, including travel and per u-
diem. Overtime and holiday make up time will not be permitted. Payments are subject to provisions o
in the Payments, Budgets, Closeout, and Audits (Attachment G).
B. Contract shall be compensated on a cost reimbursement basis, limited to the obligations and
expenditures outlined in the Program Budget (Attachment H) for fiscal years 2017-19, attached
hereto and incorporated by reference into this Contract. c0
C. Matching Contributions
1. The Contractor shall provide in-kind matching contributions of a minimum of$25,569.11 per c0
year, which is the Federal Title III portion of the Contract multiplied by 11.11%.
a
w
2. Matching contributions must be allowable costs as determined by CDA. Allowable costs
may include, but are not limited to, rent, utilities, supplies, and personnel (volunteers). w
3. Uncompensated indirect expense or Contractor allocated overhead,expenses may be 5
claimed as an in-kind matching expense if such expenses were determined on the basis of E
an approved indirect cost rate plan.
4. Contractor shall provide a Matching Funds Narrative (Attachment 1) to DAAS with the a
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
Page 15 of 24
Packet Pg. 392
Contract. The identified matching contributions shall be reported to DAAS by the Contractor
® on a monthly or quarterly basis as specified in Section V, Paragraph D.
a. Services of volunteers shall be valued at rates consistent with those ordinarily Paid for
similar work by the Contractor. If the Contractor does not have similar work, the rate shall _
be consistent with those in the tabor market. S
ca
L `
b. All other in-kind contributions shall be valued at current market value. o
CL
D. Reports o
r
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 z .
performance of services hereunder and other matters covered by this Contract. The forms o
shall be reviewed for timeliness, completeness, and correctness of the information rn
submitted, by the Program Director or his/her designee, prior to submission to DAAS.
Incomplete forms shall be returned to the Contractor for completion. (In the event of o
changes in these forms, DAAS shall advise the Contractor via written notice.) The
Contractor shall develop and implement a process for ensuring quality control. Contractor c
shall meet the following standards for the submission of required financial reports: N
M
Ln
a. Financial Reporting — Accurate, current and complete disclosure of the financial LO
results of the program shall be made in accordance with the financial reporting =
requirements of this Contract. The following reports are to be submitted to DAAS o
when indicated:
Z
1) Monthly o
a) Monthly Expenditure Report (Attachment J) (Request for (n
reimbursement) form — Due to DAAS Administration along with all
back-up documentation by the 10t"working day of the month following to
the month of services to the address stated below: >
DAAS Administration 00 _
Attention: Nutrition Program Staff Analyst W
686 East Mill Street
San Bernardino, CA 92415-4515 w
c
0
2) Annually—The following reports are due on an annual basis by no later than
August 1:
0
a) Financial Close-out Report
b) Periodic Inventory Report a
C) Single Audit or Financial Statement
d) Schedule of Expenditures of Federal Awards(SEFA) x
w
c
3) Single Audit — If Contractor is a Single Audit entity as defined in this E
Agreement, Contractor shall:
a) Communicate the Catalog of.Federal Domestic Assistance (CFDA) a
0 number to the independent auditor conducting the organization's
Page 16 of 24
Packet Pg.393
10 Single Audit. The CFDA number for the III C Services is 93-045 and
93.053.
b) Provide a copy of Contractor's Schedule of Expenditures of Federal
Awards (SEFA)to DAAS on an annual basis.
E. Under normal conditions, Contractors shall expect payment approximately 60 days after submission
of a correctly prepared invoice. a
F. Contractor shall accept all payments from County via electronic funds transfer (EFT) directly o
deposited into the Contractor's designated checking or other bank account. Contractor shall w
promptly comply with directions and accurately complete .forms provided by County required to
process EFT payments. c
G. Costs for services under the terms of this Contract shall be incurred during the contract period •E
except as approved by County. Contractor shall not use current year funds to pay prior or future
year obligations. o
H. Funds made available under this Contract shall not supplant any federal, state or any governmental
funds intended for services of the same nature as this Contract. Contractor shall not claim N
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 n
LO
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. °
I. County is not liable for the payment of any taxes, other than applicable sales or use tax, resulting z
from this Contract however designated, levied, or imposed, unless County would otherwise be o
liable for the payment of such taxes in the course of its normal business operations. _
J. Upon written demonstration of need by Contractor and at the option of County, upon to 10% of the ti
Federal Title III funds may be advanced to Contractor by County upon approval of the Director of
DAAS. Any such advance will 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 a_
remaining in the Contract term. No advance will increase the amount shown in Paragraph A of this CO
Section. `" -
K. If, as a result of advanced income, the project earns interest on funds awarded by DAAS,that
interest shall be identified as income to the program and used for program expenditures,with full
documentation on file. o
L. Contractor shall expend all funds received hereunder in accordance with this Contract. y
M. DAAS reserves the right to refuse payment to the Contractor or later disallow costs for any o
expenditure determined by DAAS and/or CDA not to be in compliance with this Contract, or U
inappropriate to such activities, or for which there is inadequate supporting documentation a
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 w
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. d
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 a
conditions of this Contract separate from any other funds administered by the Contractor.
Contractor shall maintain records in accordance with generally accepted accounting principles.
Page W of 24
Packet Pg.394
Q. General program income shall be used to increase the number of elderly served by a project, to
facilitate access to such meals, and to provide supportive services directly related to nutrition as
defined in the Scope of Work (Attachment A). General program income shall be used within the
program in which it was earned.
VI. RIGHT TO MONITOR AND AUDIT
C. County shall have the absolute right to monitor the performance of Contractor in the delivery of o
services provided under this Contract. 0-
D. County or any subdivision or appointee thereof, and the State of California or any subdivision or o
w
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 Z
shall have absolute right to monitor the performance of Contractor in the delivery of services o
provided under this Contract. Full cooperation shall be given by Contractor in any auditing or -_
m
monitoring conducted. Cn
E. Contractor shall cooperate with County in the implementation, monitoring, and evaluation of this o
Contract and comply with any and all reporting requirements established by this Contract. o
F. All records pertaining to service delivery and all fiscal, statistical and management books and N
records shall be available for examination and audit by county, federal and state representatives for
a period of three years after final payment under the Contract or until all pending county, state, and LO
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 c
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 c
reimbursement will not exceed $50 per hour (including travel time) and may be deducted from the c5
following month's claim for reimbursement.
G. 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. c
H. Upon County request, Contractor shall hire a licensed Certified Public Accountant, approved by the
County, who shall prepare and file with County, within 60 days after the termination of the Contract, y
a certified fiscal audit of related expenditures during the term of the Contract and a program L
compliance audit. o
I. Pursuant to OMB Circular A-133, Contractors expending $750,000 or more in federal funds within
the Contractor's fiscal year must have a single audit or program-specific audit performed.A copy of
the audit performed in accordance with OMB Circular A-133 shall be submitted to the County within U
thirty (30) days of completion, but no later than nine months following the end of the Contractor's ,
fiscal year. a
J. 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 w
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. d
E
US Department of Health and Human Services:
93.045 Older Americans Act Title III Grants for State .2
and Community Programs on Aging
93.053 Older Americans Act Section 311-Nutrition
Services Incentive Program
Page 18 of 24
Packet Pg.395
VI. CORRECTION OF PERFORMANCE DEFICIENCIES
A. Failure by Contractor to comply with any of the provisions, covenants, requirements, or conditions
of this Contract shall be a material breach of this Contract.
B. In the event of a non-cured breach, County may, at its sole discretion and in addition to any other
remedies available at law, in equity, or otherwise specified in this Contract: E
L
1. Afford Contractor thereafter a time period within which to cure the breach,which period shall c
L
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 o
breach, which reimbursement shall not be entitled to later recovery; and/or
3. Withhold funds pending duration of the breach; and/or o
4. Offset against any monies billed by Contractor but yet unpaid by County those monies 'E
disallowed pursuant to Item "2" of this paragraph; and/or N
ti
5. Terminate this Contract immediately and be relieved of the payment of any consideration to N
Contractor. In event of such termination, the County may proceed with the work in any
manner deemed proper by the County. The cost to the County shall be deducted from any o
sum due to the Contractor under this Contract and the balance, if any, shall be paid by the
Contractor upon demand. o
VII. TERM
_
This Contract is effective as of July 1, 2016 and expires June 30, 2019, but may be terminated earlier in o
accordance with provisions of Section IX of the Contract. w
Z
Vlll. EARLY TERMINATION L
0
A. The County may terminate the Contract immediately under the provisions of Section VII, Paragraph 'r-
B, Item 5 of the Contract. In addition, the Contract may be terminated without cause by the County N
by serving a written notice to the Contractor thirty (30) days in advance of termination. The Diretor
of DAAS for Human Services is authorized to exercise the County's rights with respect to any
termination of this Contract. UL
B. Contractor shall only be reimbursed for costs and uncancelable obligations incurred prior to the o
date of termination. Contractor shall not be reimbursed for costs incurred after the date of
termination.
IX. GENERAL PROVISIONS
A. When notices are required to be given pursuant to this Contract, the notices shall be in writing and L)
mailed to the following respective addresses listed below.
c
Contractor: City of San Bernardino 0
U
300 North D Street
San Bernardino, CA 92418 Q
r
:a
County: County of San Bernardino
Human Services
W
Attn: Contracts Unit
150 S. Lena Road
San Bernardino, CA 92415-0515
B. Nothing contained in this Contract shall be construed as creating a joint venture, partnership or a
employment arrangement between the Parties hereto, nor shall either Party have the right, power
or authority to create an obligation or duty, expressed or implied, on behalf of the other Party
hereto.
Page 19 of 24
Packet Pg. 396
C. Contractor shall not offer (either directly or through an intermediary) any improper consideration
such as, but not limited to, cash, discounts, service, the provision of travel or entertainment, or any
items of value to any officer, employee or agent of the County in an attempt to secure favorable
treatment regarding this Contract.
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, L
employee, or agent of the County with respect to the proposal and award process. This prohibition o
shall apply to any amendment, extension or evaluation process once a Contract has been awarded. at
Contractor shall immediately report any attempt by a County officer, employee or agent to solicit 2
(either directly or through an intermediary) improper consideration from Contractor. The report shall
be made to the supervisor or manager charged with supervision of the employee or to the County Z
Administrative Office. In the event of a termination under this provision, the County is entitled to 0
pursue any available legal remedies. rn
D. Property
1. Unless otherwise provided for in this Section, property refers to all assets, capitalized or non-
N
capitalized, used in operation of this Contract. o
a. Property includes land, buildings, improvements, machinery, vehicles, furniture,
tools, and intangibles, etc. L
b. Property does not include consumable office supplies such as paper, pencils, toner,
file folders, etc. o
2. Property meeting all of the following criteria is subject to the capitalization requirements.
Subject property must: Z
L.
a. Have a normal useful life of at least 1 year; c
b. Have a unit acquisition cost of at least $500 (a desktop or laptop setup including all rn
peripherals is considered a unit, if purchased as a unit); and
C. Be used to conduct business under this Contract. LL _
3. Additions, improvements, and betterments to assets meeting all of the above conditions must :3�
also be reported. Additions typically involve physical extensions of existing units. M _
Improvements and betterments typically do not increase the physical size of the asset.
Instead, improvements and betterments enhance the condition of an asset (e,g., extend life,
increase service capacity, and lower operating costs). Examples of assets that might be w
improved and bettered include roads, bridges, curbs and gutters, tunnels, parking lots, streets U
and sidewalks, drainage, and lighting systems.
4. Intangibles are property which lack physical substance but give valuable rights to the owner. o
Examples of intangible property include patents, copyrights, leases, and computer software. 01
By contrast, hardware consists of tangible equipment(e.g., computer printer,terminal,etc.). Q
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 w
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 0
firms" means a minimum of three (3) separate and distinct business entities in a
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.
Page 20 of 24
Packet Pg. 397
C. Prior to any property/equipment purchases of $500 or more by Contractor, the
"Request To Purchase Property/Equipment" (Attachment K), including the
"Property/Equipment Bid Form," must be submitted by Contractor and be approved by
DAAS.
6. The Contractor shall record the following information when property is acquired:
L
a. Date acquired; o
L
b. Property description (include model number); a
c
C. Property identification number(serial number);
L
d. Location of property; Z
L
e. Cost or other basis of valuation; g
f. Fund source; and rn
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 CS
reported to DAAS within five (5) days. The Contractor shall maintain and submit to DAAS
annually with the closeout, a current inventory of property furnished or purchased by either the L
Contractor or the subcontractor with funds awarded under the terms of this Contract or any :
predecessor contracts for the same purpose. The Contractor shall use the Report of Project o
Property Furnished/Purchased with Agreement Funds (CDA 32), unless otherwise directed by
L
DAAS
Z _
L
8. Disposal of Property °
a. Prior to disposal of any property purchased by the Contractor or the subcontractor with in cn
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 DAAS. The Contractor w
shall use the Request to Dispose of Property (CDA 248)to dispose of property.
M _
b. Contractor shall remove all confidential, sensitive, or personal information from CDA '0
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,
magnetic tapes, flash drives, personal computers, personal digital assistants (PDAs), 0
cell or smart phones, multi-function printers, and laptops. w
9. The Contractor shat( immediately investigate, and within five (5) days, fully document the loss, o
destruction, or theft of such property.
a
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.
w
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 Y
with all written instructions from DAAS regarding the final disposition of the property. a
12. In the event of the Contractor's dissolution or upon termination of this Contract, the Contractor
shall provide a final property inventory to DAAS. DAAS reserves the right to require the
Page 21 of 24
Packet Pg.398
5.Q•b
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
dissolution, DAAS will issue specific written disposition instructions to the Contractor.
13. The Contractor shall use the property for the purpose for which it was intended under the
Contract. When no longer needed for that use, the Contractor shall use it, if needed, and with E
written approval of DAAS for other purposes in the following order: o
L
a. Another DAAS program providing the same or similar service; or a.
C
0
b. Another DAAS-funded program.
L
14. Contractor may share use of the property and equipment or allow use by other programs, upon z
written approval of the Director of DAAS. As a condition of the approval, DAAS may require o
reimbursement under this Contract for its use. r-
15. The Contractor or subcontractor shall not use equipment or supplies acquired under this ti
Contract with federal and/or State monies for personal gain or to usurp the competitive c
advantage of a privately owned business entity. to
16. Contractor shall include the provision contained in this Section in all its subcontracts N
awarded under this Agreement.
E. County shall have Power of Attorney to pay delinquent debts and unpaid wages for work provided v
under this Contract from accounts payable to Contractor in the event debts and wages have not been = .
paid on a current basis. °
L
F. No waiver of any of the provisions of the Contract shall be effective unless it is made in a writing which z
refers to provisions so waived and which is executed by the Parties. No course of dealing and no 0
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 cn
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 U-
allowed in the Contract, shall be valid only when they have been reduced to writing, duly signed and co
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.
m
L
H. If any provision of the Contract is held by a court of competent jurisdiction to be unenforceable or o
contrary to law, it shall be modified where practicable to the extent necessary so as to be enforceable 0
(giving effect to the intention of the Parties) and the remaining provisions of the Contract shall not be
M
affected.
I. This Contract shall be governed by and construed in all aspects in accordance with the laws of the a
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 w
other federal and state courts.
J. Contractor shall sign and return a ContractorNendor Confidentiality Statement(Attachment Q with this
Agreement. This is to ensure that Contractors are aware of, and agree to comply with, their obligations Q
to protect CDA information assets from unauthorized access and disclosure.
K. The State and County shall have all ownership rights in software or modifications thereof and
associated documentation designed, developed, or installed with Federal financial participation.
Page 22 of 24
Packet Pg.399
The Federal Government (Department of Health and Human Services) reserves a royalty-free,
nonexclusive, and irrevocable license to reproduce, publish, or otherwise use and to authorize
others to use for Federal Government purposes, such software modification, and documentation.
Proprietary software packages that are sold or leased to the general public are not subject to the
ownership provisions.
E
L. County shall have a royalty-free, non-exclusive and irrevocable license to publish, disclose, copy,
translate, and otherwise use, copyright or patent, now and hereafter, all reports, studies, o
information, data, statistics, forms, designs, plans, procedures, systems, and any other materials or a
properties developed under the Contract including those covered by copyright, and reserves the c
right to authorize others to use or reproduce such material. All such materials developed under the L
terms of the Contract shall acknowledge San Bernardino County as the funding agency and z
Contractor as the creator of the publication. No such materials or properties produced in.whole or in o
part under the Contract shall be subject to private use, copyright or patent right by Contractor in the •_
United States or in any other country without the express written consent of County. Copies of all N
educational and training materials, curricula, audio/visual aids, printed material, and periodicals,
assembled pursuant to the Contract must be filed with County prior to publication. Contractor shall N
receive written permission from County prior to publication of said training materials.
0
M. All documents, data, products, graphics, computer programs, and reports prepared by Contractor N
pursuant to the Contract shall be considered property of the County upon payment for services (and
product, if applicable). All such items shall be delivered to County at the completion of work under L
the Contract, subject to the requirements of Section VIII, Term. Unless otherwise directed by
County, Contractor may retain copies of such items. °
r
N. Contractor shall complete the Security Incident Report (Attachment M) 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. The Security 2
Incident Report must be submitted to DAAS within five (5) business days of the date the incident was in
detected.
O. All employees/subcontractors of the Contractor will complete the required Security Awareness Training
module located at www.a in .ca. ov, within 30 days of the start date of this Contract or within 30 days LL
of the start date of any new employees or subcontractor(s). Contractor may substitute CDA's Security 0
Awareness Training program with its own Security Training provided rich training,meets or exceeds � -
CDA's training requirement. -
L
r
O
U
A
c
O
U
a
s
x
w
r
c
d
S
�a
w
a
Page 23 of 24
Packet Pg.400
.. S.Q.b
XI. CONCLUSION
A. This Contract, consisting of twenty-four (24) pages and Attachments A through M, is the full and
complete document describing services to be rendered by Contractor to County, including all
covenants, conditions, and benefits.
B. The signatures of the Parties affixed to this Contract affirm that they are duly authorized to commit
and bind their respective institutions to the terms and conditions set forth in this document. oL.L.
C. IN WITNESS WHEREOF, the Board of Supervisors of the County of San Bernardino has caused o
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. Z
L
O
CD
Cn
ti
r
O
N
co
r
O
N
Cl)
LO
to
C
O
L
Z
1 L
COUNTY OF.SA W E NARDINO City of San Bernardino ti
(Print or type name of corporation,c mpany,contractor,etc.)
r
By 1. A L
James Ramo^ hairman $Oaf J SCEpeNfSOrs (Authorized signature-sign in blue ink) cl
00
' m�� Name Mark Scott Cl)
Dated: ja '' s_ .
.4 (Print or type name of person signing contract)
SIGNED AND QERTIF}E'D'TH4:_A `O Y F THIS E
DOCUMENT FfAS PEEN DEO,PiR TO E
CHAIRMAN OF THIL bOARD' Title City Manager
"Ldura H :VL' (Print or Type)
Clerk 0 . Br of1qjervisors
_
of the Counter of, �rnardino Dated: _ "- 1 - , Lo_ _ 0
o
U
gy " Address 300 North D Street Q
D
Deputy. San Bernardino, CA 92418
s
X
W
Approved as to Legal Form Reviewed by Contract Compliance Presented to SOS for Signa re
,�I d
o v
r
J Car Wilson,Depu y County Regina Da n,Contracts Manager
Ron Buitram,Director ca
t.
C Mel
D e Date
Date
Page 24 of 24
Packet Pg.401
. j
ATTACHMEN t
San Bernardino County
Elderly Nutrition Program
Scope of Work
July 1, 2016 through June 30, 2019
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) Contractor.
The Scope of Work specifies and establishes monthly, quarterly, and annual time frames, and constitutes the primary 2
document for ongoing monitoring and annual Program and Fiscal monitoring. It will be used to measure the o
Contractor's efforts towards providing quality nutrition services. °-
0
Contractor: City of San Bernardino
z
Service Area: San Bernardino and Surrounding Areas o
I. Program Description: vh
ti
A. Purpose—The purpose of the ENP is to provide nutrition services as described in the Older Americans N
Act (OAA) of 1965, as amended, and to assist older individuals in California to live independently, by
promoting better health through improved nutrition and reduced isolation through programs N
coordinated with nutrition-related supportive services. M
B. Definition — Nutrition Services means the procurement, preparation, transport, and service of meals, L
nutrition education, and nutrition screening to eligible individuals at congregate sites or in their homes. :iw
C. Goals—To maintain or improve the physical, psychological, and social well-being of older individuals o
by providing or securing appropriate nutrition services.
D. Objectives:
1. Give preference to older individuals age 60 and older, in greatest economic and social need ?
with particular attention to low-income minority older individuals and older individuals residing in c
rural areas. cn
2. Serve meals that provide one-third (113) of the Dietary Reference Intakes (DRIB) and are safe ti
and of good quality.
3. Promote and maintain high food safety and sanitation standards.
4. Promote good health behaviors through nutrition education and nutrition screening of
participants. 00
5. Promote or maintain coordination with other nutrition-related supportive services for older t
individuals.
E. Target Population—The ENP Contractor shall target individuals who are sixty (60)years of age L
or older, minorities, low-income and living in rural areas of the County of San Bernardino. o
U
II. Eligibility for Nutrition Services:
A. Congregate Meals—Individuals eligible to receive a meal at a congregate nutrition site are: c°�
1. Any older individual 60 or older. a
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
primarily by older individuals(60 or older) at which congregate nutrition services are provided. w
4. A disabled individual who resides at home with, and accompanies, an older individual who
participates in the program.
B. Volunteer Meals:
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.- Q
C. Home-Delivered Meals—Individuals eligible to receive a home-delivered meal are:
Page 1 of 15
Packet Pg.402
ATTACHE 5.Q.b
1. Any older individual who is frail, as defined below, and homebound by reason of illness,
disability, or isolation:
a. "Frail" means that an older individual is determined to be functionally impaired because
the individual either:
1) Is unable to perform at least two (2) activities of daily living, including bathing,
toileting, dressing, feeding, breathing, transferring and mobility and
associated tasks, without substantial human assistance, including verbal
reminding, physical cueing or supervision. f°
2) Due to a cognitive or other mental impairment, requires substantial o
supervision because the older individual behaves in a manner that possesses a
a serious health or safety hazard to the individual or to others. o
2. A spouse of a person in Section 11, Paragraph C, Item 1 above, regardless of age or L
condition, if an assessment concludes that it is in the best interest of the homebound older z
individual. o
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. a
4. Priority shall be given to older individuals in Section 11, Paragraph C, Item 1 above. N
Ilt. Requirements for Nutrition Services: N
M
A. Congregate Meals: L
1. Each Congregate Meal Contractor shall: 0
a. Include procedures for obtaining the views of participants about the services
received. '
b. Not preclude the service of a meal to a participant who has failed to make a Z
reservation when food is available. °-
C. Ensure each Congregate Meal participant completes the Client Intake Sheet N
(provided by DAAS) on the first day of service and annually thereafter. ti
d. Maintain appropriate documentation on each client. Documentation shall be kept on
T
file to be monitored by DAAS. LL
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 o
activities at each site, and physically be on-site during the time that ENP activities 6
are taking place.
b. Have restrooms, lighting, and ventilation, which meet the requirements of the i
California Retail Food Code (CRFC).
C. Have equipment, including tables and chairs that are sturdy and appropriate for older 0
individuals. Tables shall be arranged to assure ease of access and encourage c
socialization. 0
0
B. Home-Delivered Meals: a
r
1. Develop and implement criteria to assess the level of need for home-delivered nutrition
services of each eligible participant. w
a. An initial determination of eligibility may be accomplished by telephone. This initial
contact with the participant shall include completion of sections 1, 2 and 3 of the _
Client Intake Sheet(provided by DAAS). _
b. A written assessment shall be done in the home within two (2) weeks of beginning
meal service, and shall include an assessment of the type of meal appropriate for a
the participant in their living environment.
Page 2 of 15
Packet Pg.403
ATTAC14ME 5.Q.b
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 every quarter. Such re-assessment
shall be done in the home of the participant at least every other quarter. Each re-
assessment shall include completion of sections 1, 2, and 3 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. c
3. Clearly label individual meals to indicate at least the entree and primary protein source. a
Examples: "Chicken Enchilada," "Beef Lasagna." `o
4. Establish a waiting list for home-delivered meals whenever the home-delivered meal
Contractors 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 Z
list, shall be based on greatest need and/or in accordance with policy established by the 2
home-delivered meal Contractor, in consultation with DAAS.
5. Provide home-delivered meals in pre-packaged divided trays (hot or frozen meals). ti
6. Maintain appropriate documentation on each client. Documentation shall be kept on file to N
be monitored by DAAS.
0
IV. Program Outcomes: N
M
LO
LO
Total Number of Meals to be served: 55,833
A minimum of 95% of the total number of meals is to be provided to receive 100% of available funding. o
The Director of DAAS must approve requests to serve less than 95% of the total number of meals to be
provided. All such requests must be in writing.
Z
L
Program: C-1 (Congregate Meals Program C-2 Home-Delivered Meals c
#of Days of Service: 250 #of Da s of Service: N/A N
Number of Meals: 55,833 Number of Meals: N/A ti
Sites to be Served: Areas to be Served: N/A
Stn St. Senior Center .
Perris Hill Senior Center
Lytle Creek Community Center
New Hope Family Life Center
Highland Senior Center
Hernandez Community Center P
c
V. Staffing: L)
c
A. Manager or Director: o
1. The ENP Contractor shall have a manager on staff who shall conduct the day-to-day
management and administrative functions of the ENP, and either have (a), (b), or(c): a
a. Possess an associate degree in institutional food service management, or a closely
related field, such as, but not limited to, restaurant management, plus two (2) years' 2
experience as a food service supervisor, or w
b. Demonstrate experience in food service, such as, but not limited to, cooking at a
restaurant, and within twelve (12) months of hire successfully complete a minimum of
twenty (20) hours specifically related to food service management, business U
administration, or personnel management at a college level. Prior to completion of 2
meeting the hours, this individual's performance shall be evaluated through quarterly a
monitoring by a registered dietitian, or
C. Two years'experience managing food services. Such experience shall be verified and
approved by a registered dietitian prior to hire.
Page 3 of 15
Packet Pg.404
Registered Dietitian will review and approve the Staff Training Plan and return it to the Contractor. 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 Contractor shall maintain documentation of each training session on file. Documentation E
includes, but is not limited to, sign-in sheets, agendas, handouts, and completed evaluations. o
H. All staff, paid and volunteer, shall be oriented and trained to perform their assigned responsibilities and a
tasks. Training, at a minimum, shall include:
1. Food safety, prevention of food borne illness, and Hazard Analysis Critical Control Points
•L
(HACCP) principles.
2. Accident prevention, instruction on fire safety.,first aid, choking, earthquake preparedness, and Z
other emergency procedures.
3. Elder Abuse Law and reporting procedures.
Cn
4. CDA Security Awareness Training (annually). r
0
N
VII. Senior Participants:" CO
CO
N
A. Satisfaction Survey:
1. The ENP Contractor shall conduct a Client Satisfaction Survey at least annually. The Surrey
LO
instrument must be approved by DAAS prior to its use, and all findings from the Survey must v
be used to improve services. The Contractor must keep the completed Surveys and the r
tabulated results on file. A copy of the tabulated results must be submitted to DAAS by March 2
70' of the FY in which it is being conducted.
B. Complaint Procedures: Z
1. Each Contractor shall have a written Complaint Procedure. o
2. The Complaint Procedure will be available for the participants and will provide them the
opportunity to provide positive as well as negative feedback to the Program Manager. ti
3. The Contractor shall have an assessment tool readily accessible for the seniors attending the
congregate site or receiving a home-delivered meal.
C. Nutrition Education Services for Participants: U
1. Nutrition Education shall be provided a minimum of four (4) times per year to participants in a
congregate and home-delivered meal programs. C
a. Nutrition Education for congregate sites is defined as demonstrations, presentation, r
lectures or small group discussions, all of which may be augmented with printed
L
materials. o
b. Nutrition Education for home-delivered meal participants may consist solely of printed U
material that is in conjunction with a congregate meal Nutrition Education presentation. w
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 Contractor to 0
make this determination. Q
3. The Nutrition Education Plan and annual Needs Assessment must be submitted to the DAAS �.
Registered Dietician and the DAAS Program Analyst by July 31 st of the fiscal year in which it is s
being provided.
4
Lu
. Nutrition Education sessions must be reported monthly to DAAS using the Nutrition Education
Monthly Service Unit Report.
E
Nutrition Education Units of Service:
Program: C-1 (Congregate Meals Program: C-2 Home-Delivered Meals a
#of Units to be Provided: 215 #of Units to be Provided: N/A
#of Sites to be Presented at: 6 #of Participants to be Presented to: NIA
Page 5 of 14
Packet;Pg.405
ATTACHMENy
VIII. Menu Planning Guidelines/Menu Requirements:
A. A minimum of a 3-month cycle shall be planned and submitted to the DAAS Registered Dietician.
B. Menu cycles shall include the availability of seasonal foods.
C. Health, cultural, ethnic, and regional dietary practices shall be considered in menu planning, food
selection, and meal preparation.
D. The menu cycle shall be approved by the Contractor's Registered Dietitian and upon approval
forwarded to the DAAS Registered Dietitian for certification. Menus shall be submitted to the DAAS to
Registered Dietitian forty-five (45) days prior to the beginning of the quarter containing the menu o
start date. Allow thirty (30) days for the menu certification process. Menus submitted in a timely a
manner will be returned to the Contractor at least fifteen (15) days prior to the menu start date. o
ENP Contractors are required to have menus certified prior to the menu start date. All signatures
on the menu shall be original signatures. Z
E. A copy of the certified menu must be posted in a spot conspicuous to clients at each congregate o
site. E
F. Copies of the menus shall be made available to the participants upon request. c�
1. When planning the menus, the current California Food Guide and the Dietary Guidelines for ,.
Americans (DGA) are to be considered. The criteria below are based on the sources N
mentioned, such as the most current DRIs and the USDA Food Guide, as well as the most
recent CDA Program Memo and other guidance published by the CDA. Menus shall N
conform to these criteria and any updates issued by CDA. Provide an average of 550 to 750
calories per meal. n
2. Limit total fat to no more than 25 to 35% of the calories averaged for the week.
3. Choose and prepare foods with low amounts of salt, soy sauce, and other high sodium o
items. '
and cooked dry beans at least
4. Include good sources of dietary fiber such as whole grains
z
four times a week.
5. Include a variety of foods and preparation methods with consideration to color, `o
combinations, texture, size, shape, taste, and preference of the participants served. in
6. Dietary Reference Intake Values: ti
a. Table one (1) represents the most current Dietary Reference Intakes (DRI) values
and daily compliance range for target nutrients. The values provided are based on r
the United States Department of Agriculture (USDA) Food Guide calculated for one U-
(1) meal for a woman over seventy (70) years of age whose activity level is 0
sedentary. This example represents a majority of the older adult population served I
by the ENP statewide.
1) The nutrients selected for this Table are based on the target nutrients to:
a) Promote health and prevent disease o
b) Prevent deficiencies v
C) Indicate diet quality
c
d) Manage disease o
U
:Q
.E .
X
W
C
d
E
V
l0
Q
Page 6 of 15
Packet Pg.406
ATTACRME 5.Q.b
Table 1
Target Nutrients
Target Value
Nutrient g Daily Compliance Range
per meal
Calories(Kcal) >550 Kcal >550 Kcal
Protein 15 gm 15 gm (in the primary protein source) 2
a�
Fat(% of total calories) 20-35% <35%weekly average °
a
Saturated Fat(% of total calories) <10% <10% o
Trans Fat <0.5g CRFC Chapter 12.6 section 114377**
>233 pg 3 out of 5 days/wk or 4 out of Z
A(pg RAE) 233 pg 7 days/wk 2
Q
Vitamin C (mg) 25 mg 25 mg
ti
Vitamin B6(mg) 0.5 mg >0.5 mg N
Vitamin B12(pg) 0.8 pg 0.8 lag (may average over a week) �
_ o
Calcium(mg) 400 mg >400 mg (may average over a week)
__ M
Magnesium (mg) 105 mg >105 mg (may average over a week) v
( g) <1,000 mg (over 1,000 mg place an c
Sodium m <500-750 mg icon an the menu)
L
.i+
Fiber(gm) >7 gm >7 gm (may average over a week) z'
Potassium (gm) 1565 mg 1565 mg(may average over a week) o
Vitamin D 200 IU 200 IU(may average over a week) in
*Target Value: This value represents one-third of the DRI for a 1600-calorie range. The 1600-calorie range was 7
chosen based on the requirements for a 70-year-old sedentary female, If a majority of the senior population }
served by the AAA ENP Program differs from the above example, use your ENP predominate demographic u-
characteristics to calculate target nutrient 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. f°
c
***RAE = Retinol Activity Equivalent. c°
a
NOTE: Fortified foods should be used to meet Vitamin B12 needs. c
A. Component Meal Pattern Requirements: °
U
1. The California 1600-calorie component meal pattern has been developed to reflect the new a
DGA requirements for those programs that are not using computerized nutrient analysis. =
2. The ENP Contractor 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 x Lu
food products and combination dishes used in a menu may not match the meal pattern but
may provide for the required nutrient values. For example, a fortified snack bar as a dessert d
could be used to boost the nutrient value of a boxed lunch or special occasion meal. E
3. items that provide the following target nutrients should be identified on the menu when using
a component meal pattern template: Q
a. Vitamin C—Provide one-third (1/3) of the DRI for vitamin C each meal—25 mg (for a
1600-calorie menu).
Page 7 of 15
Packet Pg.407
b. Vitamin A — Provide one-third (113) of the DRI for vitamin A at least three (3) times
per week, 250 µg (for a 1600-calorie menu).
C. Sodium — Meals that contain over 1,000 mg of sodium must be noted on the menu
as a high sodium meal.
d. Fiber — Provide seven grams of fiber per meal. Programs may choose to average
fiber content over a week.
4. Table 2 below describes the elements in the California 1600-calorie meal pattern, Serving E
sizes are based on the USDA My Plate initiative (htt ://WWW.ChooseM Plate. ov), which a�
replaced the Food Guide Pyramid. This sample component meal pattern does not assure o
that meals meet one-third (113) of the DRIs and the DGA. Meals will require specific types It
of fruits and vegetables, whole grains, and high fiber foods in order to assure the target o
nutrients are provided. The component meal pattern may be deficient in vitamins E, B12 L
requiring additional nutrition education for participants on the selection of foods that are z
good sources of these nutrients. `o
a. The meal pattern in Table 2 below is based on the minimum requirements for a •2
sedentary female 70 years of age. If the majority of the population served by a N
Contractor falls within another requirement range (e.g., active 60 year old men), the
serving sizes and minimum number of servings required can be adjusted to meet the N
service population. ENP Contractors should verify the population served and r
N
develop menu criteria accordingly.
M
L
LO
Table 2
California 1600-Calorie per Day Component Meal Pattern
c
Minimum Recommended Elements ---- o
Food Group *Required servings for '*Serving sizes for 1600 L
550 calories per meal calorie level z
Lean meat or beans 1 serving 2 ounces = 1 serving o
2 ounces per meal — _
Vegetable 1 —2 servings '%2 cup= 1 serving Cn
ti
Fruit 1 serving '/2 cup= 1 serving
--- U_
Bread or Grain 1 —2 servings 1 slice Bread = 1 serving d
At least 1/2 whole rain '/z cu of rice or pasta = 1 serving _ M
Low-fat milk or milk 1 serving 1 cup or equivalent measure
alternate L
***Fat Optional 7 grams
0
Dessert Optional - limit sweets use Select foods high in fiber and low in fiat and
fruit sugar _--
"The number of servings per meal estimates provision of one-third of the DRIs.
*"Caloric value (1,600 Kcal/day) based on-a 70 year-old female, "sedentary" physical activity level using Table ,
Estimated Caloric Requirements in Each Gender and Age Group at Three Levels of Physical Activity, from the a
Dietary Guidelines for Americans 2010.
***Oils and soft margarines include vegetable, nut and fish oils, and soft vegetable oil spreads that have no w
trans-fats.
c
a�
B. Meal Components—Required for both computerized and component menus: E
1. Protein—Meat, fish, poultry, legumes, eggs, and cheese:
a. A minimum of 2.0 ounces of cooked, edible portions of meat, fish, poultry, legumes, a
eggs, cheese (or a combination thereof), providing at least 15 grams of protein.
Programs should consider.the preferences of the participants they serve.
Page 8 of 15
Packet Pg.408
ATTACHMEN
b. Legumes should not be counted as both vegetable and protein. ENP Contractors
may use other protein sources to provide the occasional vegetarian meal.
2. Vegetables (1-2 1/z cup servings):
a. Vegetables as a primary ingredient in soups, stews, casseroles, or other
combination dishes should total 1/2 cup per serving.
b. Raw leafy vegetables (salads) should equal 1 cup if they are to be considered a
serving. E
3. Fruit(1 serving): o
a. A serving of fruit equals: a`
1) 1 medium sized whole fruit o
2) '/z cup fresh, chopped, cooked, frozen, or canned drained fruit
3) '/cup 100%fruit juice r
b. Fresh, frozen, or canned fruit should be packed in juice, light syrup, or without sugar. Z
Fruit packed in high sugar content syrup may be rinsed before using. o
4. Breads/Grains (1 ounce equivalent serving): _
a. One-half of the daily intake of grains should be from whole grains. Grains that are in
processed (not whole) must be fortified. Fifty-fifty mixtures of white and brown rice r
N
meet the requirement for whole grain and have demonstrated acceptance amount_
b. ENP participants. For variety, consider serving other grains such as corn, millet, o
oats, or quinoa. `"
5. Milk (8 fl. oz.):
a. Each meal shall contain eight (8) fluid ounces of fortified skim, low fat, or buttermilk.
If religious preference precludes the acceptance of milk with the meal, it may be --
omitted from the menu (however, an equivalent substitute must be used). o
6. Fat (Optional):
a. Replace solid fats with plant based oils to improve diet quality without added z
calories. o
b. Choose plant based oils which have a high percentage of beneficial -2
monounsaturated and polyunsaturated fatty acids. vi
C. The DGAs encourage using oils as they contribute essential fatty acids to the diet.
No food containing artificial trans-fat may be stored, distributed, served, or used in t6
the preparation of any food within a food facility[CRFC114377]. LL
d. Limit the consumption of solid fats. Solid fats are those that are solid at room d,
temperature and have a high concentration of trans and saturated fats. Common c�
sources of solid fats include butter, beef, chicken, port, stick margarine, and
shortening.
7. Dessert (Optional): b
a. Dessert may be provided as an option to satisfy the caloric requirements or for o
additional nutrients. Use fruit as a dessert as often as possible and limit sweets. a,
The fruit, grains, and dairy products served as dessert can count towards the fruit,
grain, or dairy requirements. Desserts that are low in fat and/or low in sugar are o
encouraged.
b. When a dessert contains 1/2 cup of fruit per serving, it may be counted as a serving of Q
fruit.
C. When a dessert contains the equivalent of 1 serving (1 ounce) starches/grains per x
serving, it may be counted as a serving of starches/grains (example: rice pudding or w
oatmeal cookie).
d. When a dessert contains the equivalent of/z cup of milk per serving, it may be
counted as '/Z serving of milk.
a
Page 9 of 15
Packet Pg.409
ATTACHMEN
S. Condiments and Product Substitutes:
a. Sugar substitutes, pepper, herbal seasonings, lemon, vinegar, non-dairy coffee
creamer, salt, and sugar may be provided, but should not be counted as fulfilling any
part of the nutritive requirements.
b. Condiments such as salad dressings, ketchup, soy sauce, mustard, and mayonnaise
do not need to be counted in a menu analysis if they are served 'on the side" and
are not combined with the food.
9. Sodium:
a. The DGAs encourage reducing daily sodium intake to 1,500 mg per day for persons c
aged 51 or older, African Americans, persons who have hypertension, diabetes, or 0-
c
chronic kidney disease.
b. The target value for sodium is 500 mg per meal. The acceptable range is 500 to 750 L
mg per meal. However, the ENP meal provides 40 to 50 percent of the nutrient z
intake for the day for more than half of its participants. This fact provided the basis o
for establishing an acceptable ENP sodium range that is slightly higher than the •OE
Q
DGAs recommend. 0
c. A potassium rich diet blunts the effect of sodium on blood pressure. Research r
suggests that the general population does not consume sufficient amounts of N
potassium and would benefit from increasing potassium intake from foods.
d. Menu planners should take steps to reduce the levels of sodium in meals over time, N
including the following: M
1) Focus on a stepwise reduction of sodium over time. �
a) Set a goal to reduce sodium content of meals each year. For
example: _
"The local ENP will reduce the sodium level of the meals by 5
percent over this Fiscal Year" or
The ENP will provide not more than two high sodium meals Z
0
per month. c
b) Maintain documentation of the reduction of sodium content of meals.
C) Place potassium rich foods on the menu consistently.
d) Provide nutrition education on the health impacts of high sodium
intake on older adults.
e) Prepare foods without adding salt in the cooking process. U_
f) Use herbal seasoning to replace salt. 00
e. Avoid potassium chloride salt substitutes. Individuals should only use these products 6
under the supervision of a healthcare professional. Encourage using oil and vinegar
as the preferred salad dressing. Provide at least one low-sodium salad dressing m
option. Use an icon, such as a salt shaker, to identify a high sodium meal or clearly c
state on the menu that this meal contains more than 1,000 mg of sodium. L)
f. ENPs should establish policies and procedures for purchasing healthful foods that c
incorporate the DGAs' sodium recommendations. 7
g. ENPs can participate in transforming the food service industry by creating a demand coy
for products that are lower in sodium and working with food purveyors to purchase a
lower sodium foods. Responsibility to reduce the amount of sodium in the diet of all
Americans falls on both the food industry and consumers. x
10. Meal Component/Nutrient Analysis: W
A meal component/nutrient analysis of the entire menu cycle conducted and/or approved by r
ure compliance with Title 22, Division 1.8
a Registered Dietitian shall be done to ens
Chapter 4, Article 5. -
a
Page 10 of 15
Packet'Pg.410
ATTACHME 5.Qb
Computerized Nutrient Analysis Requirements
a. Although not required, use of computerized nutrient analysis is strongly
recommended and will help ensure and verify the nutritional adequacy of meals.
The goal of assessing nutrient intakes of groups is to determine the prevalence of
inadequate or excessive nutrient intakes within a particular group of individuals.
While meal patterns serve as a basic framework for menu planning, Contractors 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 c
menus. As required menu elements are expanded, it is more difficult to meet all of a.
the requirements on a daily basis. ENP Contractors should focus on:
.2 o
1) Vitamin A
2) Vitamin C '
Z
3) Protein o
4) Fat
5) Sodium N
6) Fiber r
b. Not all nutrient guidelines will be met with each meal. However, areas that do not N
meet the requirements should be the focus of future menu revisions and nutrition
0
education. N
uded in the analysis when the computerized
C. The following nutrients should be incl
nutrient analysis method is used: calories; protein; carbohydrates; total fat;saturated L
fat; total fiber; vitamins A, C, D, E, K, thiamin, riboflavin, niacin, B6, folate, B12, :
calcium, chromium, copper, iron, magnesium, sodium, and zinc. In addition to 0
meeting one-third of the DRIs, the menus should also follow the DGA.
IX. Food Procurement: z
A. Food procurement procedures shall comply with Title 22, CRFC standards, and HACCP best c
practices guidelines. cn
B. All food shall be of good quality and shall be obtained from sources that conform to Federal, State,
and local regulatory standards for quality, sanitation, and safety.
C. To the extent possible, Contractors are encouraged to participate in group food purchasing.
D. A comparative cost analysis shall be performed either by the ENP Contractor or its group LL
purchasing organization on an on-going basis to obtain the highest quality food for the lowest price
available. :°-
U
X. Food Storage: r
A. Food storage procedures shall comply with Title 22, CRFC standards, and HACCP best practices 0
guidelines.
B. Adequate and suitable space free from vermin, dirt, and contamination or adulteration shall be
0
provided for the storage of food and beverages, and cooking, serving, and eating supplies. U
a
r
XI. Food Production: 7
s
A. Food production procedures shall comply with Title 22, CRFC standards, and HACCP best w
practices guidelines.
B. Food production and meal service shall be under the supervision of a trained staff in food service E
management to ensure food service. sanitation and the pract ice of hygienic food handling s
techniques are followed. This person shall function with the advice of the Contractor's Registered
Dietitian a
Page I I of 15
Packet Pg.411
ATTACHMENf 57Q.7
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 Contractor's Registered Dietitian must approve all menu substitutions.
2. A Menu Substitution Form must be completed and signed by the Contractors Registered
Dietitian.
3. The completed Menu Substitution form shall be kept on file for DAAS review.
D. Production Control: E
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 o
shall minimize the leftover food and prevent waste. a.
3. Standardized recipes shall be used to ensure consistency of quality and quantity and o
w
adherence to menu guidelines.
4. Appropriate utensils for correct and consistent portion control shall be available and used at z
each site. c
E. Meal Service/Temperature Monitoring:
1. All food for congregate sites shall be packaged and transported and held before and during Q
Cn
serving in a manner in which it is protected from potential contamination and maintains
appropriate hot and cold food temperatures. C°
2. Meals shall be served to seniors "offer versus serve" – meaning participants are to be given
an opportunity to decline a menu item. Food trays shall not be served ahead of time. N
3. Temperature checks:
b. All hot, cold, and frozen potentially hazardous meal components, including milk, shall CO,
be checked daily immediately prior to dispatch from the central kitchen. All hot, cold,
and frozen potentially hazardous meal components, including milk, shall be checked o
at satellite congregate sites upon delivery and at all congregate sites immediately
before meal service.
C. The ENP Contractor must have written procedures for monitoring food temperature. ? -
d. The ENP Contractor must use a form to document food temperatures daily, (i.e., .'2'-
g
Food Temperature Log). The ENP Contractor shall have a staff member review the in
completed Food Temperature Logs at random a minimum of every other month. If r
problems are discovered, an action plan must be developed to resolve the issue.
CL
e. All completed Food Temperature Logs must be maintained on file for DAAS review. }
4. To maintain quality in prepared foods, holding times shall be kept to a minimum. Long LL
periods of holding hot foods at required temperatures diminishes the nutrient content and
palatability of foods.
5. Holding time shall not exceed 2 hours between the end of production and the beginning of U
food service at the congregate site.
6. Milk and milk products shall be provided in individual, commercially filled containers, or shall o
be poured by a staff member directly from commercially filled bulk containers into the clean 0
glass or cup from which they are to be consumed. r
7. Cool water shall be offered with each meal to encourage fluid intake and lower the risk of o
dehydration—a risk that is higher for older adults. U
8. Single service utensils and tableware shall be used one time only and then discarded. '
9. Safety of the food after it has been served at the congregate site and then removed by the Q
participant from the congregate site is the sole responsibility of the participant and may be s
consumed by the participant as he/she deems it appropriate. W
10. The Contractor shall have a sign posted in the congregate site stating, "Food removed from c
the congregate site is consumed at your own risk." 4
s
m
w
a
Page 12 of 15
Packet Pg.412
ATTACHMEN
XII. Food Service Requirements:
A. The ENP Contractor 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.
3. Equipment Temperature Log— For all dish machines, refrigerators, and freezers. o
4. Production Schedule—Applicable only if food is cooked at the site. a
5. The current Environmental Health inspection detailed report shall be available at the site for r c
review. L
6. Staff and volunteers who are involved in any part of food service operation or clean-up, z
except home-delivered meals drivers, shall possess a current San Bernardino County- o
issued Food Worker Card, and Certificate that shall be available for review. _
d
XIII. Program Requirements: c
N
A. Client Intake Sheets: co
1. The ENP Contractor will ensure that each participant completes the Client Intake Sheet form N
(provided by DAAS) to determine his or her level'of nutritional risk. Forms shall be
completed for: L
a. Congregate Meal Participants — At the beginning of service and then annually v
thereafter for clients who remain on the program. r
1) All bold and asterisked fields are required to be filled out for congregate
r
meals.
b. Home-Delivered Participants — At the beginning of service and then quarterly ?
thereafter for clients who remain on the program. 2
1) Sections 1, 2, and 3 are required for home-delivered meals. a)
2. ENP Contractors who are required to complete their own data entry into the Social
Assistance Management System (SAMS) must enter the annual and quarterly Client Intake
Sheets into the database in a timely manner.
3. ENP Contractors who are not required to complete their awn data entry must send the
Client Intake Sheets to DAAS for data entry into the SAMS System. M
cD
B. Outreach/Marketing Activities:
1. ENP Contractors are required to provide out
in the community through community y
organizations and other groups. All outreach and marketing activities shall be documented L
and kept on file for the annual monitoring visit conducted by DAAS. c
2. ENP Contractors shall develop and have handouts, brochures, and/or signs available in 0
languages other than English and posted in locations such as churches, community service
locations, and small stores serving the minority communities. o
C. Emergency Procedures: U
1. ENP Contractors shall have a written Emergency/Disaster Plan. '
2. Each nutrition site shall have an evacuation plan posted identifying the emergency exits and Z
assembly areas. x
3. Staff must be knowledgeable of emergency procedures. w
4. Where feasible and appropriate, ENP Contractors shall make arrangements for the c
availability of meals to participants during a major disaster, as defined in 42 U.S.C., Chapter E
68, Section 5122 (2), Such arrangements shall be included in the Emergency/Disaster
Plan. a
Page 13 of 15
Packet Pg.413
ATTACHMEN
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 Contractor 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 Contractor's other sources of income shall be considered.
3. A sign indicating the suggested contribution for eligible individuals and the fee for guests
shall be posted near the contribution container at each congregate meal site. A guest fee o
a.
shall cover all meal costs. _
4. No eligible individual shall be denied participation because of failure or inability to contribute.
5. The Contractor shall ensure that the amount of the eligible participant's contribution is kept w
confidential. z
6. The ENP Contractor shall establish written procedures to protect contributions and fees `o
from loss, mishandling, and theft(i.e., Contribution/Donation Procedures). Such Procedures OE
shall be kept on file for DAAS review.
7. All contributions and fees shall be identified as program income and used to increase the
number of meals served, to facilitate access to such meals, and to provide nutrition-related N
supportive services. c
E. "No Soliciting" Sign:
1. The ENP Contractor shall ensure that a "No Soliciting" sign is posted on the door leading to r,
the congregate nutrition site. No soliciting of any kind is permitted on the premises during
LO
the lunch hours for services or goods promoted by businesses.
c
F. Coordination: O
1. If applicable, develop a fair and equitable policy and procedure for referring participants to
the appropriate transportation Contractor for securing public transportation to and from z
nutrition sites and have the policy available for review by DAAS. L
2. Include the following statement on all advertising, brochures, poster, etc., "Funding for this c
service has been provided by the San Bernardino County Department of Aging and Adult cn
Services through a grant award from the California Department of Aging." I-
3. Coordinate service with other County departments and local agencies by providing time for o
presentations or special activities that promote a community based system of care for the LL
participants attending nutrition sites. d
G. Reporting: CO
1. All fiscal and program data must be reported monthly (e.g., Request for Reimbursement, CL
Rosters, Monthly Service Unit Report, etc.). All reports are due to DAAS by the 10th U
business day of the month following the month of service. DAAS will provide training as r
needed.
2. The Contractor shall maintain support files, including, but not limited to, invoices, payroll, US
Client Intake Sheets, and any other supporting documents to substantiate monthly reports c
and expenditures. '
3. ENP Contractors are required to report all known or suspected cases of elder abuse to 0
DAAS Adult Protective Service or law enforcement immediately by telephone. A written Q
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 w
suffering or the deprivation by a care custodian of goods or services which are necessary to
avoid physical harm or mental suffering. E
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 a
being claimed.
Page 14 of 15
Packet Pg.414
..a
ATTACHMEN
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 Contractor will use the funds to increase
the number of meals being provided to participants by either increasing the number of
individuals attending its present sites, or by opening new sites in communities not already
served by the Contractor. Exceptions to this requirement must be fully documented in
writing and submitted to the Director of DAAS for prior approval. t°
rn
8. Other Reporting Requirements:
0
a. SAMS: a.
1) The following reports are to be completed and submitted to DAAS by the 10" o
L
business day of the month following the month of service if the Contractor is
serving less than 500 clients per month: 3
a) Client Intake Sheets for any new clients or any annual or quarterly o
assessments completed in the month. .E
b) Meal Rosters n
2) Contractors that are serving more than 500 clients shall secure the ti
appropriate licensing, have a dedicated staff responsible for maintaining the N
client tracking software, obtain and maintain an Internet Service Contractor (b
and the appropriate hardware that can support the program. These N
Contractors shall be responsible for entering the following data into SAMS by
the 10" business day of the month following the month of service: �
a) Client Intake Sheets for any new clients or any annual or quarterly v
assessments completed in the month. o
b) Rosters *'
c) Routes (if applicable)
9. Nutrition Education Monthly Service Unit Report Z
a. The Nutrition Education Monthly Service Unit Report is a tool that is used to report
the number of Nutrition Education service units that have been provided to
participants. This report is to be completed and submitted to DAAS by the 10th ti
business day of the month following the month of service. Copies of any handouts 7
presented to the participants as a component of the Nutrition Education shall be
attached to the Nutrition Education Monthly Service Unit Report. w
H. Disposal of Equipment: W
1. If the Contractor wishes to dispose of equipment purchased with Nutrition grant funding,
they must submit a request, in writing, to DAAS. The request shall state the equipment
description, the location of the equipment, and the reason for disposal.
2. Contractor shall submit a list of equipment purchased with grant funding by location. o
I. Mandatory Meetings U
1. Contractor is required to attend all Nutrition Contractor meetings hosted by DAAS.
0
U
a
X
w
c
m
E
c�
a
Page 15 of 15
Packet Pg. 415
ATTACHMENT
CLIENT COMPLAINT AND GRIEVANCE PROCEDURES
Older Americans Act Programs
(Instructions: The service recipient is to read, sign, and receive a copy of this form. The original of the
form is to be filed in the service recipient's case file maintained by contractor. The reverse side of this
form may be used to file a complaint or grievance with the contractor/service Contractor.)
0
If you believe you have been discriminated against, or that there has been a violation of any laws or regulations, or if r1
c
you have a problem regarding services received, you have the right to file a grievance. o
w .
•L
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 Contractor. o
Time frame. Within 1 week of discrimination/violationlproblem. in
If resolved at this level, no further action is required. If no resolution is apparent within 15 business days, proceed with
Step 2. N
Forward the written complaint/grievance to the Deputy Director of Administration at the following address: c
N
Department of Aging and Adult Services M
686 East Mill Street n
San Bernardino, CA 92415-0640
ATTN: Deputy Director o
.2
Time frame: Within 1 week of Step 1. E
If resolved at this level, no further action is required. if no resolution is apparent within 15 business days, proceed with z -
Step 3.
If no solution is apparent after Steps 1-2 have been exhausted, forward copy of written grievance to: (n
ti
Human Services Group, Contract Administrator
150 S. Lena Road } _
San Bernardino, CA 92415-0515 U-
You will be contacted within 15 business days of any actions being taken. M
Please note: Each of these steps must be completed in the sequence shown.
If you believe that your civil rights have been violated, please contact:
�a
w .
c
Deputy Director, Administration 0
U
Department of Aging and Adult Services
686 East Mill Street
0
San Bernardino, CA 92415-0640 L)
GRIEVANCE PROCEDURE CERTIFICATION a
Z
This is to certify that I have read, understood, and received a copy of the Client Complaint and Grievance Procedures w
for Older Americans Act Programs.
c
d
Signature of Service Recipient Date U
a
Page 1 of 2
Packet Pg.416
ATTACHMENT
GRIEVANCE NOTICE
Your Name:
Date of Occurrence:
Approximate Time of Occurrence: o
L
Name of Service Contractor: o
r
Address of Service Contractor:
z
L
O
Nature of Grievance:
ti
0
N
�O
r
O
N
M
O ..
S
C
O
�L
z _
L
O
Cn
Resolution:
• T
C
00
M ..
tD
a+
V
f9
L
w '
O
U
w
c
Resolved by: o
Signature Date
a
X
W
Signature of Service Recipient Date
E _
U
lC
a+
Q
Page 2of2
Packet Pg.417
ATTACHMLN I
ASSURANCE OF COMPLIANCE
ASSURANCE OF COMPLIANCE WITH ALL APPLICABLE LAWS
RELATING TO
NONDISCRIMINATION IN STATE AND FEDERALLY ASSISTED PROGRAMS
City of San Bernardino
CONTRACTOR E
ca
L
HEREBY AGREES THAT it will comply with Title VI and VII of the Civil Rights Act of o
1964, Section 504 of the Rehabilitation Act of 1973, as amended, the Age a
Discrimination Act of 1975, the Food Stamp Act of 1977- Section 272.6, The o
Americans with Disabilities Act of 1990, Government Code (GC) section 11135 and
California Code of Regulations (CCR) Title 22 section 98000-98413, Title 24 of the z
California Code of Regulations section 3105A(e), and other applicable federal and
state laws, as well as their implementing regulations (including 45 CFR, Parts 80, 84,
and 91, 7 CFR Part 15, and 28 CFR Part 42), by ensuring that employment practices
and the administration of public assistance and social services programs are
nondiscriminatory, to the effect that no person shall because of race, color, national N
origin, political affiliation, religion, marital status, sex, age or disability be excluded
from participation in or be denied the benefits of, or be otherwise subject to N
discrimination under any program or activity receiving federal or state assistance;
and HEREBY GIVES ASSURANCE THAT, it will immediately take any measures ,';
necessary to effectuate this agreement.
c
0
THIS ASSURANCE is given in consideration of and for the purpose of obtaining any
and all federal and state assistance; and THE AGENCY HEREBY GIVES
ASSURANCE THAT administrative methods/procedures which have the effect of L-
4 subjecting individuals to discrimination will be prohibited. 2
d
BY ACCEPTING THIS ASSURANCE, the agency agrees to compile data, maintain ti
records and submit reports as required, to permit effective enforcement of the
aforementioned laws and regulations and permit authorized County, state and/or >
federal government personnel, during normal working hours, to review such records, LL
books and accounts as needed to ascertain compliance. if there are any violations o
of this assurance, County shall have the right to invoke fiscal sanctions or other legal �
remedies in accordance with Welfare and Institutions Code section 10605, or
Government Code section 11135-39, or any other laws, or the issue may be referred
to the appropriate federal agency for further compliance action and enforcement of o
this assurance. U
THIS ASSURANCE is binding on the agency directly or through contract, license, or o
other Contractor services, as long as it receives federal or state assistance; and shat! 0
be submitted annually with the required Civil Rights Plan Update. Q
DATE SIGNATURE
City of San Bernardino
ORGANIZATION
300 N. D Street, San Bernardino CA 92418 a
ADDRESS
Page 1 OF 1
Packet Pg.418
ATTACHMENT D
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:
a. contract a. bid/offer/application a. initial filing
b. grant b. initial award b. material change
c. cooperative agreemen c. post-award LEa
d. loan For Material Change Only: o
e. loan guarantee I year quarter a`
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 O
❑ Prime ❑ Subawardee and Address of Prime: r
Z
Tier ,if known: c
._
ar
rn
Congressional District, if known: Congressional District, if known: r
6.Federal Department/Agency: 7. Federal Program Name/Description: c°�,l
cD
0
N
CFDA Number, if applicable: Ln
U
8.Federal Action Number,if known: 9.Award Amount, if known: _
$ o
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) Z
f (last name, first name, Ml) o
•E
d
U)
(attach Continuation Sheet(s)SF-LLLA,ifnacessary
11.Amount of Payment(check all that apply): 13.Type of Payment (check all that apply): r
$ ❑ actual ❑ planned ❑ a. retainer u
❑ b. one-time fee cl
E] c. commission 00
M .
12. Form of Payment(check all that apply): ❑ d, contingent fee
❑ a.cash ❑ e. deferred
❑ b.in-Kind;specify: nature ❑ f, other; specify:
value
c
O
14. Brief Description of Services Performed or to be Performed and Date(s)of Service, including officer(s),
employee(s),or Member(s) contacted,for Payment Indicated in Item 11:
0
U
(attach Continuation Sheet(s)SF-LLLA,if necessary) Q
15. Continuation Sheet(s) SF-LLLA attached: ❑ Yes ❑ No
x :
16.Information requested through this form is authorized by title 31 U.S.C. Signature: x
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 Title: C
made or entered into.This disclosure is required pursuant to 31 U.S.C.1352.This y
information will be reported to the Congress Semi-annually and will be available for Telephone No.: Date: E
public inspection.Any person who fads to file the required disclosure shall be
subject to a civil penatty of not less that$10.000 and not more than$1100,000 for V
Ca
each suchfatlure.
Q
Authorized for Local Reproduction
Federal Use Only: Standard Form LLL(Rev.7.97)
Page 1 of 2
Packet Pg.419
rrr..rr
AI IA1:t11Y1C14t u
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 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 E
L
of a covered Federal action. alt
O
L
2. Identify the status of the covered Federal action. CL
O
3. Identify the appropriate classification of this report. If this is a follow up report caused by a material change to the O
Information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously L
submitted report by this reporting entity for this covered Federal action. M
Z
4. Enter the full name,address,city,State and zip code of the reporting entity.Include Congressional District,if known.Check o
the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. E
Identify the tier of the subawardee,e.g.,the first subawardee of the prime is the 1 st tier. Subawards include but are not limited to y
subcontracts,subgrants and contract awards under grants.
r`
5. If the organization filing the report in item 4 checks "Subawardee,"then enter the full name, address,city,State and zip c
N
code of the prime Federal recipient.Include Congressional District,if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level N
below agency name,if known.For example,Department of Transportation,United States Coast Guard.
M
7. Enter the Federal program name or description for the covered Federal action(item 1). if known,enter the full Catalog of `n
u7
Federal Domestic Assistance(CFDA)number for grants,cooperative agreements,loans,and loan commitments.
c
8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g.,Request for O
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."
Z -
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency,enter the Federal 0
amount of the awardlloan commitment for the prime entity identified in item 4 or 5. •2
10. (a)Enter the full name, address,city,State and zip code of the lobbying entity engaged by the reporting entity identified in
O
tam 4 to influence the covered Federal action. ti
(b)Enter the full names of the individual(s)performing services, and include full address if different from 10(a). Enter Last
CL
Name,First Name,and Middle Initial(MI). ty
11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the o
lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be amount of payment made or M
co
planned to be made.
12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution,specify the L)
nature and value of the in-kind payment.
c
O
13. Check the appropriate box(es).Check all boxes that apply.If other,specify nature. U
14. Provide a specific and detailed description of the services that the lobbyist has performed, or will be expected to perform, w
and the date(s) of any services rendered. Include all preparatory and related activity, not just time spent in actual contact O
with Federal officials. Identify the Federal official(s)or employees)contacted or the off cer(s),employee(s), or Member(s) 0
of Congress that were contacted. '
Q
15. Check whether or not a SF-LLLA Continuation Sheet(s)is attached.
16. The certifying official shall sign and date the form,print his/her name,title,and telephone number. s
X
W
According to the Paperwork Reduction Act,as amended,no persons are required to respond to a coliedion of information unless It displays a valid OMB Contro C
Number. The valid OMB control number for this information collection is OMB No.034 8-0046. Public reporting burden for this collection of Information Is N
estimated to average30 minutes per response,including time for reviewing instructions,searching existing date sources,gathering and maintainingthe data E
needed,and completing and reviewing the colection of information. Send comments regarding the burden estimate o any other aspect of this collection of U
information,including suggestions for reducing this burden,to the Office of Managemenland Budget,Paperwork Reduction Project(0346-0046).Washington.
DC 20503. Q
Page 2 of 2
Packet Pg. 420
ATTACHMEN-1 a
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 o
Attn: CONTRACTS a
O
SECTION I: CONTRACTOR INFORMATION
Contractor Name: Z
L
O_
Address(inc ludingCity.Swe and VpCode): Phone:
d
Web Site: Email: Fax: r0
N
to
Site Name for Services ffDi#f ren{(rom Contractrn): p
N
Address rincludingCily.State and Zip Code): Phone: M
W)
LO
Web Site; Email: Fax:
C
O
Clinic Contact: Title:
7
0
® L
Contract Signature Authori E
Name: Name:
41
Cl)
ti
Title:
Title:
tc
Signature: Signature: LL
E-Mai]: tb
Phone#: E-Mail: Phone#: M
T '
Claim Signature Authority:
Name:
Name: +-
C
O
Title: _ Title: V
w
C
Signature:
Signature: 0
hone#:
E-Mail: P E-Mail T� Q
Phone#:
SECTION H: DAAS INFORMATION
Contracts Unit: x
Contract Mailing Address: w
r
San Bernardino County =
m
Department of Aging and Adult Services Unii Fax#: 909-891-9150 E
Contracts Unit
to
686 E.Mill Street a
San Bernardino,CA 92415-0920
Page 1 of 1
Packet Pg.421
AI IAL:FMtr-JI r
• 5.Qb_
COMMUNITY FOCAL POINTS LIST
Name Address CitylCommunity Phone
Adelanto Senior Club 11565 Cortez Avenue Adelanto,CA 92301 (760)605-0549
Apple Valley Senior Club 13188 Central Road Apple Valley, CA 92308 (760)247-3155
Barstow Senior Citizens Barstow, CA
Club 555 Melissa Avenue 92311-3031 (760)256-5023 E
c�a
Big Bear Valley Senior a
0
Center 42651 Big Bear Blvd. Big Bear Lake,CA 92315 (909)584-0323
Bloomington Senior Center 18317 Valley Blvd. Bloomington, CA 92316 (909)546-1399 0
Y
Bonnie Baker Senior w
Citizens Club 149350 Ukiah Trail Big River, CA 92242 (760)665-2667 Z
L
Chemehuevi Indian Tribal o
Center 1990 Palo Verde Havasu Lake, CA 92363 (760)858-4219 a=i
ti
Chino Senior Center 13170 Central Avenue Chino, CA 91710 (909)334-3453
Crest Forest Senior c
N
Citizens Club 24658 San Moritz Drive Crestline, CA 92325 (909)338-5036 c6
0
Delmann Heights
Senior Center 2969 N. Flores St. San Bernardino, CA 92407 (909)887-2115 M
Ln ..
LO
Dino Papavero
Senior Center 16707 Marygold Avenue Fontana,CA 92335 (909)350 0575
_
,
El Mirage, CA 92301 (760)559-7683 0
El Mirage Senior Club 1488 Milton 9 L
Fontana Community
854-5151 Z
Senior Center 16710 Ceres Avenue Fontana,CA 92335 (909) o
Ft. Mohave Tribal Senior
Nutrition Program 700 Harrison Street
Needles,CA 92363 (760)629-2371 °'
ti
George M. Gibson r
Senior Center 250 N.Third Avenue Upland,CA 91786 (909)981-4501 6
George White
8565 Nuevo Avenue/8572 U-
Senior Center Sierra Ave.(Main Ofc) Fontana, CA 92335 (909}822 4493 a;
ao
M -
Grand Terrace to
Senior Center 22627 Grand Terrace Road Grand Terrace, CA 92313 (909)824-1491
Helendale Senior Center 15350 Riverview Rd., Bldg.2 Helendsle, CA 92342 (760)243-5690
c
Hesperia Leisure League 9122 Third Avenue Hesperia, CA 92345 (760)244-3223 0
U
Percy Baaker Community 9333 "E"Avenue/PO Box
1040.55 Hesperia, CA 92340 (760)244-5488
Center o
Highland Senior Center 3102 E. Highland Avenue Patton,CA 92369 (909)862-8104 L a.)
Hinkley Community and =
Senior Center 760 253-4677 �
35997 Mountain View Road Hinkley,CA 92347 ( )
Hutton Senior Center 660 Colton Avenue Colton,CA 92324 (909)370-6168 w
James L. Brulte Rancho Cucamonga,CA
909 477-2780
Senior Center 11200 Baseline Road 91701 ( ) E
s
Joshua Tree Community
Center 6171 Sunburst Joshua Tree, CA 92252 (760)366-2471 a
Page 1 of 2
Packet Pg.422
ATTACHMENT r 5.Q.b
iV ►ne Address Cityl.Community Phone
Joslyn Senior Center 21 Grant Street Redlands, CA 92373 (909)798-7550
Loma Linda Senior Center 25571 Barton Road Loma Linda, CA 92354 (909)799-2820
Lucerne Valley Senior Club 10431 Allen Way Lucerne Valley, CA 92356 (760)248-2248
Luque Senior Center 292 East"0" Street Colton,CA 92324 (909)370-5087 _
P.O. Box 182/14082 Center E
ca
Lytle Creek Senior Center Road Lytle Creek, CA 92358 (909)880-8659 0
Mentone Senior Center 1331 Opal Avenue Mentone, CA 92359 (909)794-5280 .
Montclair Senior Center 5111 Benito Street Montclair, CA 91763 (909)625.9483
o '
L
d.d
Morongo Basin Senior
Support Center 57121 Sunnyslope Drive Yucca Valley,CA 92284 (760)365-9661 Z
0
Mountain Communities r-
675 Center 675 Grandview Road Twin Peaks, CA 92391 (909)337-1824
ti
Needles Senior Center 1699 Bailey Avenue Needles,CA 92363 (760)326-4789 c
N
Newberry Springs SeRier cc
Family Center 33383 Newberry Road Newberry Springs, CA 92365 (760)257-3284 c
N
Ontario Senior Center 225 East"B"Street Ontario,CA 91764 (909)395-2021
LO
Perris Hill Senior Center 780 E. 21st Street San Bernardino, CA 92404 (909) 384-5436
Phelan Senior Club 4128 Warbler Rd.#A Phelan,CA 92371 (760)868-8067 =
0
r
Pinon Hills Senior Club 10433 Mountain Road Pinon Hills,CA 92372 (760) 868-8637
Redlands Community Senior Z
Center 111 W. Lugonia Redlands, CA 92374 (909)798-7579 `o
Rialto Senior Center 1411 S. Riverside Avenue Rialto, CA 92376 (909)877-9706 in
ti
San Bernardino 5th St Senior
Center 600 W 5th Street San Bernardino, CA 92410 (909)-384-5430
San Moritz Lodge 24658 San Moritz Dr Crestline, CA 92325 (909)-338-5036
U-
Trona Community Senior M -
Center 13187 Market Street Trona, CA 93562 (760)372-5889
Twenty Nine Palms Senior Twenty Nine Palms, CA
Center
6539 Adobe Road 92277 (760) 367-3891 ca
Victorville Senior Center 14874 Mojave Road Victorville, CA 92392 (760)245-5018 0
U
Wrightwood Community
Center 1543 Barbara Street Wrightwood, CA 92397 (760)249-3205 0
U
Yucaipa Senior Center 12202 First Street Yucaipa, CA 92399 (909)797-1177 ,
Q
Yucca Valley Senior Center�570�8829 P alms Highway Yucca Valley,CA 92284 (760)228-5453
s
X
w
c
a�
E -
c�
a
Page 2 of 2
Packet Pg.423
ATTACHIVIEN�
Payments, Budgets, Closeout, and Audits
July 1, 2016 through June 30, 2019
I. FUNDS
A. Expenditure of Funds
1. Contractor shall expend all funds received hereunder in accordance with this E
Agreement.
0
2. Any reimbursement for authorized travel and per diem shall be at rates not to exceed a
those amounts paid by the State in accordance with California Department of Human o
Resources' rules and regulations. This is not to be construed as limiting Contractor from r
paying any differences in costs between the rates specified above and any rates the
Contractor is obligated to pay under other contractual agreements from funds other than Z
those provided pursuant to this Agreement. c
3. No travel outside the State of California shall be reimbursed unless prior written cn
authorization is obtained from County. r
0
4. Contractor agrees to include these requirements in all contracts it enters into with
subcontractors or vendors to provide services pursuant to this Agreement. N
5. County reserves the right to refuse payment to Contractor or disallow costs for any M
LO
expenditure, when determined by the County to be out of compliance with this
Agreement, unrelated or inappropriate to the contract activities, when adequate
supporting documentation is not presented, or where prior approval was required but o
was either not requested or not granted. L
Y
B. Accountability for Funds z
1. Contractor shall maintain accounting records for funds received under the terms and c
conditions of this Agreement. These records shall be separate from those for any other in
funds administered by Contractor, and shall be maintained in accordance with Generally ti
Acceptable Accounting Principles and Procedures, and the Office of Management and
Budget's Uniform Administrative Requirements,Cost Principles, and Audit Requirements _
U-
for Federal Awards.
co
2. Contractor shall promptly forward payroll taxes, insurances and contributions, including
State Disability Insurance, Unemployment Insurance, Old Age Survivors Disability r
Insurance, and Federal and State income taxes withheld, to designated governmental
L
agencies. _
3. Adequate source documentation of each transaction shall be maintained relative to the U
allow ability of expenditures reimbursed by DAAS under this Contract. If the allow ability
of expenditures cannot be determined because records or documentation of Contractor o
are nonexistent or inadequate according to Generally Accepted Accounting Principles V
and Procedures,the expenditures may be disallowed by DAAS. Q
Y
4. Financial Management Systems .2 -
Contractor shall meet the following standards for its financial management systems, as W
stipulated in 45 CFR Section 92.20 (governmental) or 45 CFR Section 74.21 (not for
profit organizations): E
s
a. Financial Reporting
Y
Y
b. Accounting Records a
® C. Internal Control
Page 1 of 7
Packet Pg.424
5.Q.b
ATTACHME
d. Budgetary Control
e, Allowable Costs
f. Source Documentation
g. Cash Management _
C. Unexpended Funds E
Upon termination, cancellation, or expiration of this Agreement, or dissolution of the entity, the o
Contractor shall return to County immediately upon written demand, any funds provided under a`
this Agreement, which are not payable for goods or services delivered prior to the termination, o
cancellation or expiration of this Agreement or dissolution of the entity. L
D. Availability of Funds z
L
1. It is understood by the parties that this Agreement may have been written before 2
ascertaining the availability or appropriation of funds, for the mutual benefit of bath rn
parties, in order to avoid program and fiscal delays that would occur of this Agreement
were executed after that determination was made. N
2. This Agreement is valid and enforceable only if sufficient funds are made available to the o
County by the United States Government or State of California for the fiscal years N
appropriate for the purpose of the services described herein.
LO
LO
3. Funding Reduction(s) 7t.
a. If funding for any County fiscal year is reduced or deleted for the purposes of this o
program, the County shall have the option to either:
1) Terminate the Agreement z
L
2) Amend the agreement to reflect the reduced funding that will be available. •2
m
b. In the event that County elects to offer an amendment, it shall be mutually
understood by both parties that 1) County reserves the right to determine which
contracts, if any, under this program shall be reduced; 2) some contracts may be to
reduced by a greater amount than others; 3) the County shall determine in its U-
sole discretion the amount that any or all of the contracts shall be reduced for the d
fiscal year.
T
E. Program Income
1. Program income must be reported and expended under the same terms and conditions
as the program funds from which it is generated. 0
U
2. Program Income must be used to pay for current allowable costs of the program in the w
same fiscal year that the income was earned (except as noted below). o
3. Program Income must be spent before contract funds and may reduce the amount of
contract funds payable to Contractor. a
r
4. If Program Income is earned in excess of the amount reported by County in the
Contractor's approved budget, the excess amount may be deferred for use in the first w
quarter of the following contract period, which is the last quarter of the federal fiscal year,
if approved by County.
5. If Program income is deferred for use it must be used by the last day of the federal fiscal
year and reported when used. a
6. Program Income may not be used to meet any requirements for matching contributions
specified in this Agreement.
Page 2 of 7
Packet Pg.425
ATTACHMEN
7. Program Income must be used to expand baseline services.
®
F. One Time Only (OTO) Funds:
OTO funds shall be only be used for the following purposes:
1. The purchase of equipment that enhances the delivery of services to the eligible service
population. Home and. community-based projects that are approved by County in
advance. f°
rn
2. Innovative pilot projects that are approved in advance by County, and are designed for a
the development of a comprehensive and coordinated system of care as defined in [45
CFR 1321.53(a) & (b).
L
3. OTO funds may be used to maintain or increase baseline services; however, it is z
understood by the parties that such use of OTO funds creates no expectation of service
delivery beyond the current contract period.
._
d
G. Matching Contributions ch
ti
1. Cash and/or in-kind contributions may be counted as match if such contributions are N
used to meet program requirements. d;
2. Matching contributions (cash or in-kind) must be verifiable from the records of the N
Contractor or its subcontractors. Only allowable costs as established by Office of
LO
Management and Budget (OMB) cost principles may be reported as matching LO
contributions.
3. Services of volunteers or other costs reported as "in-kind" matching contributions shall
be valued at rates consistent with those of similar work or services paid by Contractor. if
Contractor does not offer similar work or purchase similar services, rates shall be z
consistent with those in local market area.
H. Budget and Budget Revision in
1. Contractor shall be compensated for expenses only as itemized in the approved budget
that is incorporated by reference into this Agreement. The Contractor shall not be }
entitled to payment for expenses related to this Agreement until the budget has been U_
reviewed and approved by the County. M
2. No budget revision may result in an increase of the maximum dollar amount stated in to
Section V, Paragraph A. The written request must specify the line item or Service
Category changes requested, and must include justification for the requested changes. W
c
For the purposes of this section, °
U
a. "Service Category" shall be defined as that classification of activities defined in
U
the Older Americans Act (OAA) that is specific to each OAA funded grant c
program; and
b. "Service" shall be defined as the activities that are defined within a Service a
Category.
Examples of Service Categories include Supportive Services, Congregate and Home- w
delivered Nutrition Services, Disease Prevention/Health Promotion Services, and Family
Caregiver or Grandparent Support Services. Examples of services include nutrition d _
education, transportation, information assistance, senior center staffing, respite care,
access assistance, and supplemental services.
County shall notify the Contractor in writing of the status of the budget revision request
Q
within fourteen (14) calendar days of receipt of the Contractor's written request. The
Page 3 of 7
Packet Pg.426
ATTACHIVIEH
County reserves the right to deny the Contractor's invoice for expenditures in excess of
the approved budgeted line item amount.
3. Contractor shall submit a budget revision to the County, in advance of expenditures when:
a. Changes to line item expenditures are expected to exceed the amount of the approved
budgeted line item by more than ten (10%) of the amount specified in Section V,
Paragraph A.
b. New budget line items are to be added. 0
a`
C. When the changes being requested involve the transfer of funds between Service
0
Category. .
L
d. When otherwise requested by the County. Z
4. Contractor shall maintain a written record of all budget changes including line item or service o
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.
ti
5. The final date to submit to a budget revision is March 30 of the contract period unless otherwise N
specified by the County. CO
0
I. Indirect Costs
1. Indirect costs are those that have been incurred for common or joint objectives and LO
cannot be readily identified with a particular final cost objective. After direct costs have :
been determined and assigned directly to awards or other work as appropriate, indirect =
costs are those remaining to be allocated to benefiting cost objectives. A cost may not
be allocated to an award as an indirect cost if any other cost incurred for the same
purpose, in like circumstances, has been assigned to an award as a direct cost, z
2. Examples of indirect cost may include depreciation or use allowances on buildings and 2
equipment, the costs of operating and maintaining facilities, and general administration
and general expenses, such as the salaries and expenses of executive officers,
personnel administration, and accounting.
3. The maximum reimbursement amount allowable for indirect costs is ten (10) percent of U_
Contractor's direct costs, excluding in-kind contributions and non-expendable C
equipment. Indirect costs exceeding the ten (10) percent maximum may be budgeted as T
cash match and be used to meet the minimum matching contribution requirements.
4. Contractor agrees to include the above requirement in all contracts it enters into with L
subcontractors or vendors to provide services pursuant to this agreement. c
U
5. Reimbursement for indirect costs shall be on the basis of an indirect cost rate plan >%
documenting the methodology used to determine the indirect cost rate, which shall be =
submitted by Contractor to the Federal government for approval. After Federal approval 0
the plan will submitted to DAAS and be approved by DAAS. a
J. Financial Closeout
1. Contractor shall submit a final statement of expenditures and income ("Financial w
Closeout") to County within thirty days of the end of contract period, unless otherwise
specified by County.
2. Federal funds otherwise payable to Contractor by County may be reduced
proportionately by County to maintain the required matching contributions ratio if amount
of matching contributions reported by Contractor is less than minimum required Q
matching contribution amount specified in Section V, Paragraph A, Fiscal Provisions of
this Contract .
Page 4 of 7
Packet Pg. 427
ATTACHMEN
K. Subcontracts or Vendor Agreements
1. Without the prior written consent of the Director of DAAS or his/her designee through the
HS Contracts Unit, this Contract is not assignable by Contractor either in whole or in
part.
2. 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 his/her E
designee. Any subcontractor shall be subject to the same provisions as Contractor.
Contractor shall be fully responsible for the performance of any subcontractor.
a -
3. Contractor shall include language in all subcontracts that require subcontractor to a
comply with all applicable State and Federal Laws. w
4. Contractor shall have no authority to contract for, on behalf of, or incur obligations on Z
behalf of County or State. Lo
5. Copies of subcontracts, vendor agreements, Memoranda, and/or Letters of
Understanding shall be on file with the Contractor and shall be made available to DAAS
upon request. N
6. Contractor shall monitor the insurance requirements of its subcontractors and/or
0
vendors. N
7. Contractor shall ensure that the subcontractor and/or vendor will complete all reporting
LO
and expenditure documents requested by DAAS. These reporting and expenditure
documents shall be sent to Contractor in a timely manner and at intervals as determined
by DAAS.
L
8. Contractor shall monitor the budget, expenditures, and performance of it subcontractors z
and/or vendors. L
o .
9. Contractors shall provide support and technical assistance to subcontractors and
respond in writing to all written request for direction, guidance, and interpretation of h
instructions to include client and service data.
T
L. Audits U
1. Contractors that expend $750,000 or more in Federal awards shall arrange for an audit
co
the Single Audit Act of 1984, Public Law 98-502, Single
to be performed as required by M
Audit Act Amendments of 1996, Public Law 104-156, and Office of Management and
Budget [2 CFR Part 200, Subpart F Audit Requirements] [formerly OMB Circular A-133].
L
2. A copy of audit report shall be submitted to DAAS within 30 days after receipt of the o
auditor's report or nine months after the audit period, whichever occurs first, unless a v
longer period is agreed to in advance by the recognized or oversight federal agency.
3. Contractor shall ensure that State-funded expenditures are displayed discretely along o
with the related federal expenditures in the single audit report's "Schedule of
Expenditures of Federal Awards" (SEFA) under the appropriate Catalog of Federal a
Domestic Assistance (CFDA) number as referenced herein. In addition, should Z
contractor's SEFA totals be reported on the basis of a fiscal year period other than x
County's fiscal year(July 1 through June 30), a supplemental schedule shall be provided W
that reconciles Contractor's reported expenditures to County fiscal year periods.
4. For state contracts that do not have CFDA numbers, Contractor shall ensure that State-
funded expenditures are discretely identified in the SEFA by the appropriate program
name, identifying grant/contract number and as passed through the California a
0 Department of Aging.
Page 5 of 7
Packet Pg.428
ATTACHME 5.Q.b
5. The following closely related programs identified by 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. Contractor shall identify the CFDA titles and numbers to
the independent auditor conducting the organization's single audit as well to each of
Contractor's sub-recipients.
6. The Federal Grantor for the following programs is the U.S Department of Health and
Human Services,Administration on Aging:
93.044 Special Programs for the Aging - Title III, Part B = Grants for Supportive a
Services and Senior Centers Title III-B). c
93.045 Special Programs for the Aging - Title III, Part C - Nutrition Services (Title 2
III-C)
93.052 National Family Caregiver Support-Title III, Part E Z
L
91053 1 Nutrition Services Incentive Program (NSIP) .2
7. The Federal Grantor for the following program is the U.S Centers for Medicare and in
Medicaid Services: r
0
93.779 State Health Insurance Assistance Pro ram HICAP
93.071 MIPPA: MSP, LIS & Prescription Drug Enrollment Assistance through the c
Aging Network, SHIP, and ADRCs �_._ N
93.626 SHIP Options Counseling for Medicare/Medicaid (FA) n
LO
8. The Federal Grantor for the following program is the Administration. for Community
Living grants: o
93.071 1 MIPPA: Priority Area 2 AAAs _ J
® 9. Cluster of programs means a grouping of closely-related programs that share common o
compliance requirements. The types of clusters of programs are research and _
development (R&D), student financial aid (SFA) and other clusters. "Other Clusters" are
defined by the OMB in the Compliance Supplement or as designated by a State for
federal awards provided to its sub recipients that meet the definition of cluster of
programs. When designating an "other cluster", a State shall identify the federal awards
included in the cluster and advise the sub-recipients of compliance requirements a)
applicable to the cluster, consistent with S.400 (d) (1) and S.400 (d) (2), respectively. A c;
cluster of programs shall be considered as one program for determining major programs, co
as described in S.520, and with the exception of R&D as described in S.200 (c),whether
a program-specific audit may be elected. (Federal Office of Management and Budget, 2
(OMB) Circular A-133, Audits of States, Local Governments, and Non-Profit o
Corporations). )
w
10. Contractor shall perform a reconciliation of its "Financial Closeout Report"to the audited
financial statements. The reconciliation shall be maintained and be made available to 0
DAAS for review. Q
11. Contractor shall ensure that subcontractor single audit reports for Contractor meet [2
CFR Part 200, Subpart F Audit Requirements] [formerly OMB Circular A-1331
requirements, including, but not limited to: W
u
a. Performed timely - Not less frequently than annually and a report submitted
timely. The audit is required to be submitted within 30 days after receipt of the E
auditor's report or nine months after the end of the audit period, whichever
occurs first. a
b. Properly procured - Use procurement standards provided for in OMB Circular A-
133 and provide maximum opportunities to small and minority audit firms.
Page 6 of 7
Packet Pg.429
ATTACHMEN
c Performed in accordance with Generally Accepted Government Auditing
Standards - Shall be performed by an independent auditor and be organization
wide
d. All inclusive — Includes an opinion (or disclaimer of opinion) of the financial
statements; a report on internal control related to the financial statements and
major programs; an opinion (or disclaimer of opinion) on compliance with laws,
regulations, and the provisions of contracts or grant agreements; and the
schedule of findings and questioned costs. o j
e. Performed in accordance with provisions applicable to this program as identified a
in [2 CFR Part 200, Subpart F Audit Requirements] [formerly OMB Circular A-133 0
Compliance Supplement]. r
M
12. Requirements identified in the provision above shall be included by Contractor in all ?
subcontracts. 2
13.. Contractor shall include in its contract with the independent auditor that the auditor will
comply with all applicable requirements/standards, that the County shall have access to
ail audit reports and supporting work papers, and that the County shall have the option N
to perform additional work if needed.
0
14. Unless prohibited by law, the cost of audits completed in accordance with provisions of "!
the Single Audit Act Amendments of 1996 is allowable charges to Federal awards. to
Contractor may not charge to Federal awards the cost of any audit under the Single
Audit Act Amendments of 1996 not conducted in accordance with the Act. Contractor
may not charge to Federal Awards the cost of auditing a non-federal entity which has o
Federal Awards expended of less than $500,000 per year, and is thereby exempted 3
under OMB Circular A-133, Subsection_200 (d). Z
15. Contractor shall cooperate with and participate in any additional audits which may be c
required by State or County. in
ti
r
to
U_
00
M .
CD
T
V
L
t+
O
U
C
O
V
a
X .
W
C
d
E ..
s
U
a+
Q
Page 7 of 7
Packet Pg.430
ATTACHMENT H
COUNTY OF SAN BERNARDINO NUTRITION SERVICES
PROGRAM BUDGET
PROGRAM BUDGET C-1 2016-17
Contractor: City of San Bernardino Period: 711116-6130117 Original Amend ,833
HOME DELIVERED a
CONGREGATE SITES C-1 I—XI MEALS C-2 TOTAL#OF MEALS 55
Section 1: Prepare this section based on annual estimated cost to serve the meals #of Days Served 252
E
ca
Match Requirement: $25,569.11 A B C=A+B
0
Cost to Contractor for the Year a
Expenditure Category: Cash Program Income& In-kind Total =
1 Personnel
2 Staff Travel&Training — Z
L
3 Equipment — 0
_
4 Non-Inventoriable Equipment m
ti
5 Consultants r
0
6 Catered Food -- N
u;
7 Raw Food N
8 Other Expenses: —
M
a Consumable Supplies — LO
b Insurance -- v
_
c Re air&Maintenance — 0
d Rent/Building Space —
f Vehicle Operations — Z
L
0
Miscellaneous c
a�
9 Indirect Cost N
Total Expenditures(add lines 1-101 t to
Revenue Sources: DAAS Program Income& In-kind Total .
LL
State Funds $41,607 $41,607 a)
Federal Funds $230,145r T i $230,145 _ M
�� co
NSIP
$63,248 EE $63,248
�.
State Special Nutrition Funds
County Funds " 0
U
Program Income
Deferred Income
y 0
Matching Cash --
Matching In-Kind ��_
Non-Match Cash
vi I
Non-Match In-Kind "Y' {` k4= ' i '° `.v`` w
Total Revenue $335,000 $335,000
m
Submitted by: DAAS Approval: Date: E
Mitch Assumma
May 9, 2016 Q ;
Signatbre Date
Pagel of 3
Packet Pg.431
ATTACHMENT H
COUNTY OF SAN BERNARDINO NUTRITION SERVICES
PROGRAM BUDGET
® PROGRAM BUDGET C-12017-18
Contractor: City of San Bernardino Period: 7/1/17-6/30/18 Original Amend
CONGREGATE SITES C-1 � HOME DELIVERED MEALS C-2 � TOTAL#OF MEALS 55,833
Section 1:Prepare this section based on annual estimated cost to serve the meals #of Days Served Z52
rn
Match o
Requirement: $25,569.11 A B
I=C=A o_
c
Cost to Contractor for the Year o
Expenditure Category: Cash Program Income& in-kind Total r
1 Personnel L_
0
2 Staff Travel&Training .2
(D
3 Equipment Cl)
r`
4 Non-Inventoriable Equipment
0
5 Consultants — Ca
6 Catered Food -' c
N
7 Raw Food
8 Other Expenses: "''
a Consumable Supplies -
c
b Insurance
0
•L
c Repair&Maintenance -—
z
d Rent/Building Space L
0
e Vehicle Operations
f Miscellaneous W
r,
9 Indirect Cost
T
Total Expenditures(add lines 1-10) >-
DAAS Program Income& in-kind Total LL
Revenue Sources:
State Funds $41,607a i 'u,P5 $41,607 M
Federal Funds $230,145 kfu�rx � �` $230,145
Y t� 2ryag p
NSIP $63,248 3 � �' �xX $63,248
w
State Special Nutrition Funds -- o
$t F?F s
County Funds g
Program Income 4�p =
Deferred Income k v
Matching Cash Q
Matching In-Kind -
3.x r a'.�i
Non-Match Cash s+r x kak, t�, - x
Non-Match In-Kind J'•- }
Total Revenue $
335,000 $335,000
Submitted by: DAAS Approval: Date:
Mitch Assumma w
a
May 9, 2016 --
Signa Ere Date
Page 2 of 3
Packet Pg.432
ATTACHMENT H
COUNTY OF SAN BERNARDINO NUTRITION SERVICES
PROGRAM BUDGET
PROGRAM BUDGET C-12018-19
Contractor: City of San Bernardino Period: 7/1/18.6/30/19 Original Amend
CONGREGATE SITES C-1 a HOME DELIVERED MEALS C-2 TOTAL#OF MEALS 55,833
Section 1:Prepare this section based on annual estimated cost to serve the meals #of Days Served 252
E
Match
Requirement: $25,569.11 A B C=A+B -
Cost to Contractor for the Year =
0
Expenditure Category: Cash Program Income& In-kind Total ,
•L
1 Personnel
z
2 Staff Travel&Training -- o
•E
3 Equipment m
U)
4 Consultants r-
T
5 Catered Food °
N
6 Raw Food co
0
7 Other Expenses `14
a Consumable Supplies `O LO
LO
b Insurance
c Repair&Maintenance _
0
d Rent/Building Space
e Vehicle Operations -- z
f Miscellaneous -
8 Indirect Cost °7
Total Expenditures(add lines 1-10) ~
DAAS Program Income& In-kind Total C°
Revenue Sources: Nt
State Funds $41,607 $41,607
w °
Federal Funds $230,145 � » y �, ti $230,145 _ M
CD
NSIP $63,248 k, x� � $63,248 --
u �
State Special Nutrition Funds " ��
County Funds _ ' - _
Program Income
Deferred Income
0
Matching Cash .3 0
Matching In-Kind
Non-Match Cash `'
Non-Match!n-Kind t�.w ''` X
Total Revenue $335,000
$335,000 w
Date: 0
Submitted by: DAAS Approval: E
Mitch Assumma
v
n•�.h May 9, 2016
Signa ure
Date Q
Page 3 of 3
Packet Pg.433
ATTACHM 5.Q.b
COUNTY OF SAN BERNARDINO NUTRITION SERVICES
Matching Funds Narrative
Contractor: City of San Bernardino Fiscal Year-, 07101116-06130117 ORIG X Amend
CONGREGATE SITES C-1 HOME DELIVERED MEALS C-2 Q E
Provide justification, rates, comments, descriptions,etc.for the required 11.11%of the total proposed o
contract amount in matching funds whether in cash or in-kind. Matching funds may not be fees for CL
services,client donations or program income as defined by 45 CFR 74.41 match. 0
0
r
L
V
CONGREGATE MEALS C-1 Z
Line Item Annual Amount Description/Justification
Personnel $45,279 Senior volunteers are used at the 5 Street, Perris Hill and o
Highland Senior Centers that help with the preparation and a
serving of the Senior Nutrition meal.The$10.00 rate is the y
wage only paid to City Kitchen Helpers(an additional 7.5% r`
includes benefits). (Approximately 39 hours per month @ CD
$10.00 = $390 X 9 employees = $3,510 X 12 months =
$42,120 plus $3,159 in benefits]. Note: State Minimum c
Wa a increases are reflected in the totals. N
Raw Food Approximately Through annual purchase.orders with primary food vendors
$10,000 for bulk purchasing,the City receives various discounts that LO
allow them to purchase more food (and consumables). v LO
Being long-time providers,these vendors also provide food
for meals for special occasions at no cost as a donation. 0
There are between 250.350 different seniors in daily L
attendance in our Senior Nutrition Program. Also, the
Christmas dinner is donated a non-profit agency.The listed z
amount of $10,000 is a conservative estimate of the o
donations, discounts, and specials given throughout the _
ear. in
Utilities $63,567 The City of San Bernardino's utility bill for January through
December 2015 for the 6"Street Senior Center, Perris Hill
Senior Center, Lytle Creek Community Center,and }
Hernandez Community Center were used as the u_
benchmark for this in-kind contribution.The electric,gas ai
and domestic water use bills were totaled by meal site.Two M
multipliers were developed for each site:one considered
the amount of building square footage for the facilities
amenities specifically obligated to the Senior Nutrition U
Program(kitchen,dining room,restrooms,common areas, w
office,etc.),as a percentage of the total building square a
0
footage and the second was established as a percentage V
of time for the Program preparation,meal serving,and w
cleanup in comparison to each meal site total operating
time.The utilities in-kind contributions for both the New 0
Hope Family Life Center(Enterprise),and Highland Senior
Center sites were inferred from site City sites at Q
approximately$9,600 per site. (This does not include in- r
kind match for custodial services and building -
t
maintenance). x _
w
c
d
E .
a
Page 1 of 3
Packet Pg.434
5.Q.b
ATTACHMENT
COUNTY OF SAN BERNARDINO NUTRITION SERVICES
Matching Funds Narrative
Contractor: City of San Bernardino: 07/01117-06/30/18 ORIG X Amend
CONGREGATE SITES C-1 HOME DELIVERED MEALS C-2 D
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`
c
CONGREGATE MEALS C-1
Line Item Annual Amount Description/Justification
Personnel $45,279 Senior volunteers are used at the 5 Street, Perris Hill and Z
Highland Senior Centers that help with the preparation and L
serving of.the Senior Nutrition meal.The$10.00 rate is the °
wage only paid to City Kitchen Helpers (an additional 7.5% E CD
includes benefits). [Approximately 39 hours per month @ v)
$10.00 = $390 X 9 employees = $3,510 X 12 months = r
$42,120 plus $3,159 in benefits]. Note: State Minimum N
Wage increases are reflected in the totals.
Raw Food Approximately Through annual purchase orders with primary food vendors c
$10,000 for bulk purchasing,the City receives various discounts that N
allow them to purchase more food (and consumables). t�
Being long-time providers,these vendors also provide food
for meals for special occasions at no cost as a donation. v
There are between 250-350 different seniors in daily _
attendance in our Senior Nutrition Program. Also, the o
Christmas dinner is donated a non-profit agency.The listed
amount of $10,000 is a conservative estimate of the
donations, discounts, and specials given throughout the Z
ear. o
Utilities $63,567 The City of San Bernardino's utility bill for January through.
December 2015 for the 5'n Street Senior Center, Perris Hill rA
Senior Center,Lytle Creek Community Center,and
Hernandez Community Center were used as the
benchmark for this in-kind contribution.The electric, gas
and domestic water use bills were totaled by meal site.Two U.
multipliers were developed for each site:one considered
the amount of building square footage for the facilities M
amenities specifically obligated to the Senior Nutrition
Program(kitchen,dining room, restrooms,common areas,
office,etc.),as a percentage of the total building square
footage and the second was established as a percentage
of time for the Program preparation, meal serving,and °
cleanup in comparison to each meal site total operating U
time.The utilities in-kind contributions for both the New
Hope Family Life Center(Enterprise),and Highland Senior
Center sites were inferred from site City sites at °
approximately$9,600 per site.(This does not include in- U
kind match for custodial services and building a
maintenance).
X
w
c
a�
E
Z
v
a
Page 2 of 3
Packet Pg.435
ATTACH
COUNTY OF SAN BERNARDINO NUTRIT[ON SERVICES
Matching Funds Narrative
Contractor: City of San Bernardino Fiscal Year: 07/01118-06/30119 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 E
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. o
CONGREGATE MEALS C-1 0
Line Item Annual Description/Justification
Amount '
Z
Personnel $45,279 Senior volunteers are used at the 5 Street, Perris Hill and o
Highland Senior Centers that help with the preparation and .
serving of the Senior Nutrition meal.The$10.00 rate is the m
wage only paid to City Kitchen Helpers(an additional 7.5% (n
includes benefits). [Approximately 39 hours per month @ n
$10.00 = $390 X 9 employees = $3,510 X 12 months = °
N
$42,120 plus $3,159 in benefits]. Note: State Minimum
Wa a increases are reflected in the totals. o
Raw Food Approximately Through annual purchase orders with primary food vendors
N
$10,000 for bulk purchasing,the City receives various discounts that M
allow them to purchase more food (and consumables). ,`O
Being long-time providers, these vendors also provide food �?
for meals for special occasions at no cost as a donation.
There are between 250-350 different seniors in daily 0
attendance in our Senior Nutrition Program. Also, the
Christmas dinner is donated a non-profit agency.The listed z
amount of $10,000 is a conservative estimate of the
donations, discounts, and specials given throughout the o
ear. d
Utilities $63,567 The City of San Bernardino's utility bill for.January through N
December 2015 for the 51h Street Senior Center,Perris Hill
Senior Center, Lytle Creek Community Center, and co
Hernandez Community Center were used as the j
benchmark for this in-kind contribution. The electric, gas LL
and domestic water use bills were totaled by meal site.Two d
multipliers were developed for each site: one considered M
the amount of building square footage for the facilities
amenities specifically obligated to the Senior Nutrition
Program (kitchen, dining room, restrooms, common areas,
office, etc.), as a percentage of the total building square
footage and the second was established as a percentage v
of time for the Program preparation, meal serving, and
cleanup in comparison to each meal site total operating
time. The utilities in-kind contributions for both the New o
Hope Family Life Center(Enterprise), and Highland Senior V
Center sites were inferred from site City sites at
approximately $9,600 per site. (This does not include in- a
kind match for custodial services and building
maintenance). -X
X
w
c
w
E
ca
r
a
Page 3 of 3
Packet Pg.436
ATTACAM N S Q b
MONTHLY EXPENDITURE REPORT
(Due 10th working day of the following month) FY 2016-2017
COUNTY OF SAN
BERNARDINO CONTRACTOR NAME AND ADDRESS:
DEPARTMENT OF AGING &ADULT
SERVICES o
L
a
0
w
CFDA#: Month:
z
MONTHLY NUTRITION PROGRAM EXPENDITURE REPORTIREQUEST FOR REIMBURSEMENT o
(due on the 10th working day of the following month) r
HOME DELIVERED T
CONGREGATE SITES C 1 ❑ MEALS C 2 ❑ N
#of meals served t
0
A + B = C 04
COST TO CONTRACTOR TOTAL MONTHLY M Ln
EXPENDITURES: CASH IN-KIND EXPENSE 1
1. Personnel $ - - $ o
2. Staff Travel and Training $ - $ -
L
Equipment(including One-Time-Only
3. purchases) $ ' $ - z
4. Consultants $ - $ °
5. Catered Food $ $ in
6. Raw Food $ $
7. Other Expenses . t � �VI �� a � � N Q �x�
a. Consumable Supplies $ - $ -
b. Insurance $ $ o;
c. Repair& Maintenance $ $ - M -
d. Rent/Building Space $ $ - $ co
e. Utilities $ $
f. Vehicle Operations $ $ w
Miscellaneous $ $ °
8. Indirect Costs $ - _
9. Total Expenditures(add lines 1-8 $ - $
D E F c0
TOTAL
DEDUCTIONS FROM EXPENDITURES: CASH IN-KIND DEDUCTIONS: a
w
Program Income (income not from i
.E
10 DAAS $ p ``�°' $ x
11 Deferred Income
12 Matching Cash
13 Matchin In-Kind , � `a.,xti s'; �r � � •P - _
14 Non-Match Cash $ _
15 Non-Match In-Kind �=.�i 'z-•���` ' ��°�" X
16 Total Deductions (add lines 10-15) $
REQUEST FOR :. M
REIMBURSEMENT .
line 9 less line 16) $ -
Page 1 of 2
Packet Pg.437
- ATTACHMENT
PROGRAM FUND[NG: . use aril
Repayment of Advance 10%of advance if paid)$ "
NSIP
NSIP (OTO) E
Federal Funds
Federal OTO Baseline L-
Federal OTO (Equipment)c
State Funds r
�L
State OTO z
CDBG
0
County Funds C
a�
Repayment of funds from prior period s ecif N
ti
Other c
funding
source c
(specify): `.4
TOTAL REIMBURSEMENT 1 $ -
LO
Approved by: Date
0
�L
f+
Z
L
O
Cn
ti
r
rr
LL
C
00
M
r
r..
V
tD
L
O
U
c
O
O
U
Q
Z
k
W
C
O
E
t
t1
c0
Q
Page 2 of 2
Packet Pg.438
ATTACHME S.Q.b
SAN BERNARDINO COUNTY
DEPARTMENT OF AGING AND ADULT SERVICES
REQUEST TO PURCHASE PROPERTYIEQUIPMENT
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 c
attach a Property/Equipment Sid Form for each item requested. a`
c
Date: FY: o
• •L
A.+
Z
L
Contractor Name: g
Address: Contact: Phone No: d
r-
0
N
Item(s) Requested (attach additional sheet if required):
0
N
QTY DESCRIPTION AMOUNT FUNDING
Ln
SOURCE LO
c
0
•L
i+
Z
L-
.0
Explain how requested item(s)will be used to carry out the objectives related to the funding to be cn
received (attach additional sheet if required):
LL
oS
w
M
to
r
r
U
R
L
O
Administrative Use Only:
r
Appriivet(°°:[[� .. Denied (] Value over$5000/unit; Yes �] No [T' o
Inventory: Yes❑ No 0:.
Program:Review by Name' Title Date
X
W
I Director Approval . Date
E
Revises!10/25/11
a
Page l of 2
Packet Pg.439
ATTACHMENT 5.Q.b
SAN BERNARDINO COUNTY
DEPARTMENT OF AGING AND ADULT SERVICES
PROPERTY/EQUIPMENT BID
FORM
Fund Source:
a�
Contact: o
Contractor Name: a
I Phone: o
Address: Y
L
w
Z
L
_o
d
Item Description: ti
0
N
Date of Bid: Date of Bid: Date of Bid: N
LO
LO
Vendor: Vendor: Vendor:
c
0
r
L
a..
Z
toO
Contact Contact Contact in
Phone: Phone: Phone: U
co
-- M
Cost per unit: Cost per unit: Cost per unit:
Number of units: Number of units: Number of units:
Total Cost: Total Cost:
Total Cost: Comments:
Comments: Comments: 0
c
0
v
Q
x
w
c
d
E
0
ca
a
Awl..
Page 2 of 2'
Packet Pg.440
ATTACHMENT L
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.foilowing Statements.
CONTRACTORIVENDOR NAME: CONTRACT NUMBER:
City of S49 Bernardino
AUTHORIZED SIGNATURE: PRINTED NAME AND TITLE OF PERSON SIGNING: IC SC
In compliance with Government Co di 11019.9, Civil Code 1798 Et.Seq., Management Memo 06-12 and Budget iy M
Letter 06-34 the California Department of Aging (CDA) hereby requires the ContractorNendor to certify that: Mgl Lo
• confidential information shall be protected from disclosure in accordance with all applicable laws, regulations C
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 wi11 be reported z
i 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 _
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 I`
Portability and Accountability Act. C°,
• any wrongful access, inspection, use, disclosure, or modification of confidential information may result in
termination of this Contract/Agreement. N
obligations to protect confidential information obtained under this Contract/Agreement will continue after
termination of the Contract/Agreement with CDA. LO
• all employees/subcontractors of the ContractorNendor will complete the required Security Awareness LO
Training module located at www.aging.ca.aov, within 30 days of the start date of this Contract/Agreement.or
within 30 days of the start date of any new employee or subcontractor. ContractorNendor may substitute 0
CDA's Security Awareness Training program with its Security Training provided such training meets or
exceeds CDA's training requirement..
all employees/subcontractors of the ContractorNendor will be notified of CDA's confidentiality and data z
security requirements. °
CDA or its designee will be granted access by the Contractor or Vendor to any computer-based confidential
information within the scope of the Contract. rn
I agree to protect the following types of confidential information which include but not limited to:
Social Security number C°
- Medical information U_
- Claimant and employer information a;
- Driver License information 00
- Information about individuals that'relate to their personal life or identifies or describes an individual M ca
Other agencies' confidential and proprietary information r
Criteria used for initiating audit selection Ca
Methods agencies use to safeguard their information (computer systems, networks, server
°
configurations, etc.)
copyright or otherwise protected by law or U
- Any other information that is considered proprietary, a >%
contract.
I agree to protect confidential information by: °
- Accessing, inspecting, using, disclosing or modifying information only for the purpose of performing �?
official duties
- Never accessing, inspecting, using, disclosing, or modifying information for curiosity, personal gain,
or any non-business related reason
- Securing confidential information in approved locations X
w
- Never removing confidential information from the work site without authorization.
d
E
c�
Q :
Page 1 of 1
Packet Pg.441
ATTACHMENT
CALIFORNIA DEPARTMENT OF AGING(CDA)
SECURITY INCIDENT REPORT
CDA 1025 New 07107
INCIDENT INFORMATION
1. AGENCY/CONTRACTOR NAME: 2. AGENCY/CONTRACTOR INFORMATION SECURITY OFFICERS
NAME:
3. AGENCY/CONTRACTOR ADDRESS: ff AGENCY/CONTRACTOR TELEPHONE:
O
O
5. DATEITIME OF 6. DATE INCIDENT 7. INCIDENT REPORTED TO'
INCIDENT: DETECTED: ❑CALIFORNIA DEPARTMENT OF AGING El L DISTRICT a
ATTORNEY c
Fl UNKNOWN F-1 CA HWY PATROL ❑ATTORNEY GENERAL ❑ L O
❑ UNKNOWN OTHER:
8. INCIDENT LOCATION: L
` .
O
9. DESCRIPTION OF INCIDENT: E
O
10. MEDIA DEVICE TYPE,IF APPLICABLE: 11. WAS THE PORTABLE STORAGE DEVICE to
ti
ENCRYPTED? c
❑YES []NO ❑UNKNOWN N
co
12. IF NO,EXPLAIN: c
N
13. DESCRIBE THE COSTS ASSOCIATED WITH RESOLVING THIS INCIDENT: INCIDENT:�ESTIMATED COST OF M
LO
15. TYPE OF PERSONALLY IDENTIFIABLE INFORMATION(CHECK ALL THAT APPLY): a
❑NO PERSONAL INFORMATION ❑SOCIAL SECURITY NUMBER ❑HEALTH OR MEDICAL INFORMATION ❑ O
FINANCIAL ACCOUNT NUMBER
❑ NAME ❑DRIVER'S LICENSEISTATE ID NUMBER ❑OTHER(SPECIFY) Z
16. IS A PRIVACY DISCLOSURE NOTICE 17. NUMBER OF 18. DATE NOTIFICATION(S)MADE TO 0
THE INDiVkDUAt'
REQUIRED? INDIVIDUALS E
❑YES ❑NO AFFECTED: N 0
ti
*IF A PRIVACY DISCLOSURE NOTICE IS co
T
REQUIRED,ATTACH A SAMPLE OF THE }
U-
NOTIFICATION.
aS
0
19. HAVE THOSE RESPONSIBLE FOR THE INCIDENT BEEN IDENTIFIED? C?
co
❑YES ❑ No COMMENT: r
20. CORRECTIVE ACTIONS TAKEN TO PREVENT FUTURE OCCURRENCES: v
c�
L
21. ESTIMATED COST OF CORRECTIVE 22. DATE CORRECTIVE ACTIONS WILL BE FULLY IMPLEMENTED:
ACTIONS: w
O
V
SIGNATURES DATE:
23. PRINT-AGENCY/CONTRACTOR INFORMATION SIGNATURE: Q
r
SECURITY OFFICER:
DATE: K
24, PRINT-AGENCY/CONTRACTOR PRIVACY OFFICER: SIGNATURE: W
c
25. PRINT-AUTHORIZED SIGNATURE/DIRECTOR; SIGNATURE:
DATE:
v
c�
Q
Page 1 of 3
Packet Pg.442
ATTACNMEN I ivi
DEPARTMENT OF AGING
SECURITY INCIDENT REPORT
INSTRUCTIONS
The following instructions will assist in completing the form.All questions must be completed,even
when the response is a future action.
1. Agency/Contractor Name - Provide your agency, contractor, vendor, department, board,
bureau or commission's full name.
2. Agency/Contractor Information Security Officer's Name - Provide your agency's Information
Security Officer's Name.
0
L
3. Agency/Contractor Address-Provide your agencylcontractor's address. a
c
0
umber.
4. Telephone-Provide your agencylcontractor's telephone n L
.r
5. Date/Time of Incident - Provide the date/time when the incident occurred. If unknown, select z
the"Unknown"checkbox. °
E
m
6. Date Incident Detected-Provide the date the incident was discovered. rn
ti
0
7. Incident Reported To-Select the appropriate checkbox.If applicable,select the other checkbox N
and describe to whom the incident was reported.
0
N
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, ,n Cn
LO
CA"; or if the incident occurred at the agency's headquarters office, suggested content is v
"Agency's Headquarters,123 Any Street,Sacramento,CA."
0
9. Description of Incident-include the following in the description:
When the incident occurred and how it was discovered. '
The effect of the incident on the business and infrastructure of your agency. o
The number of people (inside your agency and outside your agency) affected by this E
0
incident.
The effects, if any, of this incident on people, businesses or services outside of your
agency.
uch as which agency
• The details of any law enforcement investigation of this incident, s
investigated it,when, and the report number. LL
• Any personal,confidential,or sensitive information involved/disclosed. a;oo
M
10. Media Device Type, If Applicable-Provide the type of media or device involved in the incident,
such as paper(fax,mail,etc.)or electronic(CD,floppy drive,laptop,PDA,email,etc.).
L
11. Was the Portable Storage Device Encrypted?-Check the appropriate box. o
U
12. If NO,Explain-Describe why the storage device was not encrypted.
i
13. Describe the Costs Associated with Resolving this Incident-Provide a cost estimate of resolving c
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 preparations,postage,call center activation,etc.). w
14. Total Estimated Cost of Incident- Provide the total cost associated with handling the incident m
as it relates only to information technology. For example, if a state vehicle was stolen with a E
state-issued laptop in it,do not include the cost of the state vehicle.
co
15. Type of Personally Identifiable Information - If applicable, check the appropriate type(s) of a _
personally identifiable information that applies in this incident.
Page 2 of 3
Packet Pg. 443
ATTACHMENT M
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. E
ca
19. Have Those Responsible for the Incident Been Identified? - Check the appropriate box. If c
L
applicable,add comment. a.
C
20. Corrective Actions Taken To Prevent Future Occurrences-Provide a detailed description of the °
corrective actions taken by the agency to prevent future occurrences of a similar incident
occurring again. Z
L
°
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
Cn
purchased; new policies may need to be developed;additional training may need to be given. T
Include all related costs, such as staff time, contracting services, and hardware or software N
purchases. f°
0
22. Date Corrective Actions Will Be Fully Implemented - Provide a date when the corrective actions "!
were,or will be,fully implemented. LO
LO
23. Print—Agency/Contractor Information Security Officer
0
24. Print -- Agency/Contractor Privacy Officer - This is required only in those instances where
personally identifiable information is involved. If personally identifiable information is
involved and no disclosure notice is required,the Privacy Officer's signature is still required. Z
0
25. Print—Authorized SignaturelDirector
Cn
ti
d;
U_
a;
00
M
r
V
IO
L
°
U
T
Y
°
U
Q
• .Q
t
X
W
C
d
E
t
v
ca
a
Page 3 of 3
Packet Pg.444
EXHIBIT B
sci7e
CITY OF SAN BERNARDINO, CALIFORNIA
DEPARTMENT: Parks & Recreation
PROJECT #: 0513 Sr. Nutrition Grant 2016-17
FY2016-17
BUDGET
Account Number Description ESTIMATES MATCH TOTAL
Grant Name:
Salaries _
5011 Salaries perm/fulltime 51,085 51,085
5013 Automobile allowance M
5014 Salaries temp/parttime 121,051 45,279 166,330 p
L
5015 Overtime p-
Total:Salaries 172,136 45,279 217,415 C
Benefits O
5026 PERS retirement 13,909 13,909 y
5027 Health and life insurance 7,578 7,578
Z
5028 Unemployment insurance 516 516 C
5029 Medicare 2,496 2,496 •2
Total:Benefits 24,499 - 24,499
Total:Salaries&benefits 196,635 45,279 241,914
Maintenance and Operations
5111 Material and supplies N
5112 Small tools&equip(consumables) 11,225 11,225 cG
r
5114 Raw foods 124,095 10,000 134,095 N
5122 Dues and subscriptions -
5131 Mileage M
LO
5132 Meetings and conferences U)
5133 Education and training -
5150 Utilities 63,567 63,567
5172 Equipment maintenance 3,000 3,000 Q
5174 Printing charges -
5175 Postage O
a1
5176 Copy machine charges -
5181 Other operating expense 6,000 6,000 m
5186 Civic and promotional - E
5193 Grant match
Total:Maintenance and Operations 144,320 73,567 217,887 t)
O
Contract Services `
D_
5502 Professional/contractual services
5505 Other professional services 15,500 15,500 O
Z
Total:Contractual Services 15,500 - 15,500 N
Internal Service Charges f`
5601 Garage charges 2,520 2,520
5602 Workers compensation 6,025 6,025
5603 Liability - N
5604 IT charges in-house
5605 Telephone support m
5606 Electric p
5612 Fleet charges-fuel k
Total:Internal Service Charges 8,545 8,545 W
Capital Outlay ;
5703 Communications equipment -
Total:Capital Outlay - -
Credit/billables v
5910 Credit-federal and state program funding - w
Total:Credit/billables - - - Q
Total:Non-Personnel Expenses 168,365 73,567 241,932
Grant Total 365,000 118,846 483,846
Packet`Pg.445