9.14.2.1 If this Subaward (or any part thereof) is terminated pursuant to any of the termination provisions
outlined herein or if it expires pursuant to Paragraph
4.0 (Term of Subaward), Subrecipient shall provide
a Transition Plan to County. Subrecipient shall
submit said Transition Plan to County's Contract
Manager within the timeframe designated by
County in the notice of termination or Subrecipient
shall submit it at least sixty (60) days prior to the
expiration of this Subaward as noted in Paragraph
4.0 (Term of Subaward).
9.14.2.2 County shall review Subrecipient's Transition Plan and will determine whether it meets the
requirements for County's approval. County
reserves the right to suspend/deduct payments
under this Subaward and/or under any of
Subrecipient's other contracts with County when
Subrecipient submits a Transition Plan that is not
acceptable to County. Subrecipient shall adhere to
the Transition Plan which, at a minimum, shall
include all of the elements outlined below.
9.14.3 Elements of the Transition Plan
9.14.3.1 Description of how Clients will be notified about the change in their Service provider.
9.14.3.2 Subrecipient's method to communicate with other organizations that can assist in locating alternative
Services.
9.14.3.3 Subrecipient's method to inform community referral sources of the pending termination of Services and
what alternatives, if any, exist for future referrals.
9.14.3.4 Subrecipient's method to evaluate Clients in order to assure appropriate placement that will allow
Clients to receive Services.
9.14.3.5 Subrecipient's method to transfer any confidential medical and Client records to the new subrecipient
in accordance with applicable provisions of the
Health Insurance Portability and Accountability Act
of 1996 or other Federal, State or local laws and
regulations.
9.14.3.6 Subrecipient's method to dispose of confidential records, which fall outside of the retention period
noted in Subparagraph 8.38 (Record Retention,
Inspection and Audit Settlement), in accordance
with applicable laws and regulations, and the terms
of this Subaward.
9.14.3.7 Subrecipient's plan to ensure provision of adequate staff to provide continued care through the
remaining term of this Subaward.
9.14.3.8 A fully documented inventory of all Fixed and
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Non-Fixed Assets as well as a method to dispose,
transfer or return to County all Fixed and Non-Fixed
Assets purchased with Subaward Sums during the
entire term of this Subaward.
9.14.3.9 Any additional information which may be necessary to effect a safe transition of Clients to other
community service providers.
9.14.4 Implementation of the Transition Plan
9.14.4.1 Subrecipient shall implement the Transition Plan that is approved by County. Subrecipient's failure
to provide and/or implement the Transition Plan as
prescribed herein shall mean that County will
provide Subrecipient a Transition Plan and
Subrecipient will implement the Transition Plan
provided by County. County will monitor
Subrecipient's progress in carrying out all elements
of the Transition Plan.
9.15 TRAVEL EXPENSES
9.15.1 Subrecipient shall obtain prior written approval from County's Contract Manager for any expenses under this Subaward
related to travel outside of Los Angeles County (out-of-town travel).
9.15.2 Subrecipient shall maintain written documentation evidencing that all out-of-town travel expenses are specifically related to providing Services under this Subaward, in conformity with the document retention requirements specified in Subparagraph 8.38 (Record Retention, Inspection and Audit Settlement).
9.15.3 Subrecipient shall ensure that no more than two (2) of its staff incur any out-of-town travel expenses at any time.
9.15.4 Subrecipient shall not invoice County if out-of-town travel expenses are incurred without proper documentation evidencing County's prior written approval.
9.15.5 Subrecipient's non-compliance with the requirements of this Subparagraph 9.15 will result in these costs being disallowed, payments being withheld or other remedy being applied as County shall determine to be appropriate.
9.16 DRUG-FREE WORKPLACE
9.16.1 Subrecipient and its Lower Tier Subrecipient(s) shall adhere to the requirements outlined in the California Drug-Free Workplace Act of 1990, as amended (California Government Code Section 8350 et seq.). Subrecipient and its Lower Tier Subrecipient(s) shall also adhere to the requirements outlined in the Federal Drug-Free Workplace Act of 1988, including its implementing regulations (Title 41 United States Code Section 701 et seq.).
Subrecipient and its Lower Tier Subrecipient(s) shall provide and maintain a drug-free workplace for all of their employees, and shall have a documented anti-drug policy and a drug-free awareness program. Violation of or non-compliance with these DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE SUBAWARD PERIOD JULY 2020 - JUNE 2021
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requirements by Subrecipient, its Lower Tier Subrecipient or both shall subject Subrecipient to remedies available under the terms of this Subaward. Such remedies shall include
suspending Subrecipient's payments, placing Subrecipient on probation or suspension, terminating this Subaward or other available remedies which shall be determined by County at County's sole discretion.
9.16.2 Subrecipient shall provide a written drug-free workplace policy statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and stating the specific actions that will be taken for violations.
9.16.3 The ongoing drug-free awareness program must inform employees about the following: the dangers of drug abuse; available drug counseling, rehabilitation, and employee assistance programs; penalties that may be imposed; and, that employees are to be aware that Subrecipient and its Lower Tier Subrecipient(s) operate a drug-free workplace.
9.16.4 Subrecipient shall require its employees to report in writing any conviction for a violation of a criminal drug statute occurring in the workplace. Subrecipient shall provide written notice to County's Contract Manager within ten (10) days of having received such notice from employee(s). Within thirty (30) days of receiving the notice of a conviction, Subrecipient must have taken appropriate action against the employee(s) or have required employee's participation in a drug abuse assistance or rehabilitation program.
9.17 INFORMATION TECHNOLOGY, SECURITY AND PRIVACY
REQUIREMENTS
9.17.1 In the course of completing the Work and providing Services under this Subaward, Subrecipient shall use any Information Technology Systems (ITS) as designated by County. This
Subparagraph 9.17 sets forth the requirements for the ITS which Subrecipient shall use. This Subparagraph 9.17 also sets forth the security procedures for these systems which Subrecipient shall have in place by the effective date of this Subaward and which Subrecipient shall maintain throughout the Subaward term. They present a minimum standard only. Subrecipient shall implement appropriate administrative, physical and technical measures to secure its systems and data to protect and ensure the privacy, confidentiality, integrity and availability of County Information Assets as defined in Subparagraph 9.17.5 (County Information Assets) (which consists of but is not limited to confidential County data, Personally Identifiable Information, Protected Health Information and Medical Information) against internal and external threats, vulnerabilities and risks.
Subrecipient shall also continuously review and revise those measures to address ongoing threats, vulnerabilities and risks.
9.17.2 Subrecipient's failure to comply with the minimum standards set forth herein will constitute a material, non-curable breach of this Subaward, entitling County, in addition to and cumulative of all other remedies available to it at law, in equity, or under this Subaward, to immediately terminate this Subaward.
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9.17.3 Information Technology Systems - Contract Management System-Contractor's Gateway
9.17.3.1 County has implemented use of the Contract
Management System Contractor's Gateway
("Contractor's Gateway"), an automated system
designed to electronically manage this Subaward.
Subrecipient shall use the System to perform its
administrative contracting functions as directed by
County.
9.17.3.2 County has established policies concerning the access, use and maintenance of the Contractor's
Gateway. Subrecipient shall adhere to these
policies, which are identified in Exhibit V (Contract
Management System - Contractor's Gateway Terms
and Conditions of Use), instruction guides/tutorials
provided by County, training sessions conducted by
County, etc. Subrecipient's non-compliance with
these policies may subject Subrecipient to denial of
access to the Contractor's Gateway, suspension of
payment(s), termination of this Subaward, and/or
other remedies/actions which County may take at
its sole discretion under the terms of this Subaward
and/or applicable law or regulation.
9.17.4 Information Technology Systems - Management Information System
9.17.4.1 Data Entry
9.17.4.1.1 County has implemented use of the
Management Information System
(MIS), a computerized database
system that is used to record and track
Service delivery, Program data and
Client information. Subrecipient shall
use the MIS and all other systems
identified by County, including but not
limited to State and Federal programs,
applications, software, etc., to report
Program data as outlined herein and
as directed by County.
9.17.4.1.2 Subrecipient shall ensure the accuracy
and authenticity of the number of
eligible Client Services provided each
day. Subrecipient shall track,
document and report the actual date
when Services are rendered.
Subrecipient shall complete direct data
entry of the required Program, Service
delivery and Client data (including but
not limited to, the total number of
Clients served, the type and number of
Services provided to Client and the
date(s) of Service) into the MIS on the
day when the Service(s) is provided to
Client and shall ensure that Service
recording is accurate each day (i.e., to
ensure accurate reporting,
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Subrecipient shall enter Program,
Service delivery, and Client data into
MIS on the day when the Service(s) is
provided to Client). Subrecipient shall
not back-date any data and any
attempts to do so may subject
Subrecipient to appropriate remedies
as determined by County at County's
sole discretion.
9.17.4.2 Data Records
9.17.4.2.1 Subrecipient's failure to submit the
required MIS data within the time and
manner as designated by County may
subject Subrecipient to appropriate
remedies as determined by County at
County's sole discretion. Remedies
will remain in effect until Subrecipient
becomes compliant. County will
consider Subrecipient's
non-compliance during future funding
decisions.
9.17.4.2.2 Subrecipient shall maintain all records
and reports, consistent with
Subparagraph 8.38 (Record Retention,
Inspection and Audit Settlement), and
shall make them available for audit,
assessment, or inspection by County
and any of its duly authorized
representatives (including, but not
limited to, State authorities, Federal
agencies and/or any of their duly
authorized representatives).
9.17.4.2.3 All information, records, data elements
and print-outs collected and
maintained for the operation of the
Program and pertaining to Clients
(including paper and electronic data)
must be protected from unauthorized
disclosures in accordance with
Subparagraph 7.6 (Confidentiality),
California Welfare and Institutions
Code Section 10850, Title 45 Code of
Federal Regulations Part 205.50,
California Information Practices Act of
1977, and all other applicable laws
and regulations.
9.17.4.3 MIS Personnel
9.17.4.3.1 Subrecipient shall assign an employee
to have the primary responsibility for
data entry into the MIS. This
employee shall be the primary contact
person for data issues and
problems. This employee shall also be
assigned a password to log-in and
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enter Program, Service delivery and
Client data. Subrecipient shall
designate a secondary/back-up
employee who can act on behalf of the
primary MIS employee contact in the
event of his or her absence.
Subrecipient shall ensure that its users
do not share their user identification
and password information.
9.17.4.3.2 Subrecipient shall provide the names
of Subrecipient's primary and
secondary MIS employees using
Exhibit F (Subrecipient's
Administration). Subrecipient shall
submit the completed Exhibit F
(Subrecipient's Administration) in the
time and manner as directed by
County. In the event of any changes
to the information provided in Exhibit F
(Subrecipient's Administration),
Subrecipient shall update Exhibit F
(Subrecipient's Administration) and
submit the revised document to
County within two (2) weeks of any
reassignment or substitution. Only
those Subrecipient employees who
have been designated by Subrecipient
and assigned a password by County
shall be allowed to access the MIS
system.
9.17.4.3.3 Subrecipient shall ensure that the
primary and secondary MIS
employees are properly trained to
operate the MIS and attend all MIS
training provided by County to ensure
that MIS operations are in compliance
with all applicable regulations.
9.17.5 County Information Assets
9.17.5.1 County Information Assets are public, confidential, sensitive and/or personal identifying data, records,
materials, etc. and include (but are not limited to):
9.17.5.1.1 Information that is stored in hard copy
or electronic format and may include
but is not limited to the following:
reports; notes; forms; computers,
laptops, cellphones, printers,
scanners; networks (LAN, WAN,
WIFI) servers, switches, routers;
storage media, hard drives, flash
drives, cloud storage; data,
applications, databases; etc.
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9.17.5.1.2 Information that is collected,
transmitted and/or accessed in the
administration of the Program and in
the provision of Services.
9.17.5.1.3 Personal Information as defined in
California Civil Code Section
1798.29(g).
9.17.5.1.4 Protected Health Information as
defined in Health Insurance Portability
and Accountability Act of 1996.
9.17.5.1.5 Medical Information as defined in
California Civil Code Section 56.05(j).
9.17.6 Physical and Environmental Security
9.17.6.1 Subrecipient shall take reasonable measures to ensure the physical security of its operating
location(s) that handles County Information Assets.
Work areas containing computers or source
documents should be secured from public access
unless Subrecipient's representative is present.
When unoccupied during non-operating hours,
Subrecipient's facility(ies) shall be locked.
9.17.7 Data Destruction
9.17.7.1 When Subrecipient has maintained, processed or stored County Information Assets, implied or
expressed, and such County Information Assets are
no longer required to be retained by Subrecipient
under this Subaward and applicable law, County
shall have sole authority to determine when
Subrecipient shall destroy any such County
Information Assets as described herein.
Subrecipient shall only proceed with the destruction
of County Information Assets (which may be stored
on purchased, leased or rented electronic storage
equipment (e.g., printers, hard drives, etc.) and
electronic devices (e.g., servers, workstations, etc.)
that are geographically located within Los Angeles
County or external to Los Angeles County's
boundaries) upon receiving written authorization
from County.
9.17.7.2 Subrecipient shall destroy such County Information Assets by:
9.17.7.2.1 Shredding or otherwise destroying
paper, film, disk drives or other hard
copy media so that the Personally
Identifiable Information, Protected
Health Information and Medical
Information cannot be read or
otherwise reconstructed.
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9.17.7.2.2 Clearing, purging or destroying
electronic media containing
Personally Identifiable Information,
Protected Health Information and
Medical Information consistent with
National Institute of Standards and
Technology ("NIST") Special
Publication ("SP") 800-88 (Guidelines
for Media Sanitization) which is
available on-line at:
http://csrc.nist.gov/publications/PubsD
rafts.html#SP-800-88-Rev. %201 and
United States Department of Defense
5220.22-M data sanitization and
clearing directive such that the
Personally Identifiable Information,
Protected Health Information and
Medical Information cannot be
retrieved.
9.17.7.3 Subrecipient shall have the sole responsibility to certify that the County Information Assets have
been appropriately destroyed consistent with the
requirements outlined herein.
9.17.7.4 Subrecipient shall provide County with written certification validating that any and all County
Information Assets were placed in one (1) or more
of the following stored states: unusable,
unreadable and/or indecipherable. Subrecipient
shall submit such certification to County's Contract
Manager no later than ten (10) days after the
occurrence of this event.
9.17.7.5 Lower Tier Subrecipient shall provide County with written certification validating that any and all
County Information Assets were destroyed and are
in one (1) or more of the following states: unusable,
unreadable and/or undecipherable. Lower Tier
Subrecipient shall submit such certification to
County's Contract Manager no later than ten (10)
days after the removal of any electronic storage
equipment and devices and the destruction of the
County Information Assets.
9.17.8 Encryption on Workstations and Portable Computing Devices
9.17.8.1 Subrecipient and its Lower Tier Subrecipient shall use software and/or hardware encryption methods
for confidential County Information Assets stored on
all electronic media in accordance with the following
standards:
9.17.8.1.1 Federal Information Processing
Standard Publication ("FIPS") 140-2.
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9.17.8.1.2 NIST SP 800-57 (Recommendation
for Key Management - Part 1: General
(Revision 3).
9.17.8.1.3 NIST SP 800-57 (Recommendation
for Key Management - Part 2: Best
Practices for Key Management
Organization).
9.17.8.1.4 NIST SP 800-111 (Guide to Storage
Encryption Technologies for End User
Devices).
9.17.8.1.5 At a minimum, Subrecipient shall use
Advanced Encryption Standard
("AES") with cipher strength of 256-bit
9.17.8.1.6 Prior to use of remote servers (e.g.,
cloud storage, Software-as-a-Service
(SaaS), etc.) for storage of County
Information Assets, Subrecipient shall
obtain written approval from County's
Contract Manager.
9.17.8.2 Subrecipient and its Lower Tier Subrecipient shall use software and/or hardware encryption methods
for transmitted (i.e., through network transmission)
confidential County Information Assets in
accordance with the following standards:
9.17.8.2.1 NIST SP 800-52 (Guidelines for the
Selection and Use of Transport Layer
Security Implementations).
9.17.8.2.2 NIST SP 800-57 (Recommendation
for Key Management - Part 3:
Application-Specific Key Management
Guidance).
9.17.8.3 Subrecipient and its Lower Tier Subrecipient shall have operational policies, procedures and practices
which protect County Information Assets including
those assets used to store or access Personal
Health Information (PHI), Personal Information (PI)
and any information protected under the Health
Insurance Portability and Accountability Act
(HIPAA) as specified herein and in the State
Administrative Manual Sections 5300 to 5365.3;
California Government Code Section 11019.9;
Department of General Services Management
Memo (MM 06-12); Department of Finance Budget
Letter (06-34); California Department of Aging
Program Memorandum (PM 07-18(P)); Statewide
Health Information Policy Manual; and, County's
Board of Supervisors Policy Number 5.200
(Contractor Protection of Electronic County
Information).
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9.17.8.4 Subrecipient and its Lower Tier Subrecipient shall encrypt confidential, sensitive and/or personal
County Information Assets which are stored on all
electronic media (including workstations, portable
computing devices (including, but not limited to,
workstations, servers, mobile devices, wearables,
tablets, laptops, personal digital assistants,
notebook computers, and backup media) and/or
portable electronic storage media (including, but not
limited to, discs, thumb/flash drives,
external/portable hard drives, and backup media)).
9.17.8.5 Removable Media
9.17.8.5.1 Except in the context of Subrecipient's
routine back-ups or as otherwise
specifically authorized by County in
writing, Subrecipient shall institute
strict administrative, physical and
logical security controls to prevent
transfer of County information to any
form of removable media. For
purposes of this Subaward, removable
media means portable or removable
hard disks, floppy disks, universal
serial bus (USB) memory drives, zip
disks, optical disks, CDs, DVDs, digital
film, digital cameras, memory cards
(e.g., secure digital (SD), memory
sticks (MS), compact flash (CF), smart
media (SM), multimedia card (MMC),
and xD-picture card (xD)), magnetic
tape and all other removable data
storage media.
9.17.8.6 In the event that Subrecipient will have County Information Assets on or accessed by mobile
devices, Subrecipient shall have in place, a mobile
computing policy, reviewable and audited by
County. This policy must address device recovery
and data eradication methods, the mobile device
management capabilities in place, the use of
personal devices versus Subrecipient-supplied
devices and all applications that may have access
to or render County Information Assets.
9.17.8.7 Data Control and Media Servicing
9.17.8.7.1 Subrecipient shall adhere to the
requirements for back-up data stored
by Subrecipient at off-site facilities as
provided in this Subparagraph
9.17.8.7. 9.17.8.7.2 County Information Assets shall only be made available and accessible to
those parties explicitly authorized
under this Subaward or otherwise
expressly approved by County in
writing.
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9.17.8.7.3 If transferred across the Internet, any
wireless network (e.g., cellular,
Bluetooth, 802.11x, or similar
technology), or other public or shared
networks, County Information Assets
must be protected using industry
standard encryption technology in
accordance with the NIST SP 800-52
(Guidelines for the Selection and use
of Transport Layer Security
Implementations).
9.17.8.7.4 If transferred using removable media
(as defined above), County
Information Assets must be sent via a
bonded courier or protected using
industry standard encryption
technology in accordance with NIST
SP 800-111 (Guide to Storage
Encryption Technologies for End User
Devices).
9.17.8.7.5 In the event any hardware, storage
media or removable media must be
sent off-site for servicing, Subrecipient
shall ensure that all confidential
County Information Assets, including
Personally Identifiable Information,
Protected Health Information and
Medical Information, have been
cleared, purged and/or scrubbed from
such hardware and/or media using
industry best practices in accordance
with NIST SP 800-88 (Guidelines for
Media Sanitization).
9.17.8.8 Subrecipient shall certify its compliance with the encryption standards noted herein as a condition of
executing this Subaward. Subrecipient provide
such certification by completing and submitting
Exhibit AA (Subrecipient's Compliance with
Encryption Requirements) in the form and manner
as determined by County. Subrecipient shall
maintain compliance with this policy during the term
of this Subaward and for as long as Subrecipient
maintains or is in possession of County Information
Assets. In addition to the foregoing certification,
Subrecipient shall maintain any
validation/attestation reports that the data
encryption product generates and such reports shall
be subject to audit in accordance with the
requirements outlined in Subparagraph 8.38
(Record Retention, Inspection and Audit
Settlement). In the event of Subrecipient's
non-compliance with these requirements, County
will require Subrecipient to develop and execute a
corrective action plan. Subrecipient's failure to
comply with this policy may subject Subrecipient to
suspension or termination of this Subaward, denial
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of access to County information technology
resources and/or other remedies which are deemed
appropriate by County.
9.17.9 Software Maintenance and Operational Management
9.17.9.1 Subrecipient shall deploy up-to-date anti-virus software with current definitions on all computer
systems on which County Information Assets are
stored and/or transmitted.
9.17.9.2 Subrecipient and its Lower Tier Subrecipient shall ensure that all security patches, software
updates/upgrades, etc. are applied in a timely
manner to all computer systems on which County
Information Assets are stored, accessed and/or
transmitted.
9.17.9.3 Subrecipient shall deploy adequate back-up
facilities to ensure that its essential business
information can be promptly recovered in the event
of a disaster or media failure.
9.17.9.4 Subrecipient shall ensure that its operating
procedures are adequately documented and
designed to protect information, computer media
and data from theft and unauthorized access.
9.17.10 Access Control
9.17.10.1 Subrecipient shall implement formal procedures to control access to its systems, services and data,
including, but not limited to, user account
management procedures and other controls as
outlined in this Subparagraph 9.17. Subrecipient
shall ensure that network access to both internal
and external networked services shall be controlled
through the use of properly configured firewalls,
etc. Operating systems will be used to enforce
access controls to computer resources including,
but not limited to, authentication, authorization and
event logging. Applications will include access
control to limit user access to information and
application system functions. All systems will be
monitored to detect deviation from access control
policies and identify suspicious activity.
Subrecipient shall record, review and act upon all
events in accordance with incident response
policies set forth herein.
9.17.10.2 Subrecipient shall develop, implement and
enforce/maintain a password policy which requires
users who are authorized to access confidential
County Information Assets on electronic media to:
create a strong complex password containing at
least eight (8) characters, which shall include upper
and lower case letters, digits and symbols; and,
change his/her password at a minimum every
ninety (90) days, etc.
9.17.10.3 Subrecipient shall develop, implement and
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enforce/maintain a password policy which provides
for the following system requirements: when user
changes his/her password, the system shall restrict
user from re-using any of the last six (6) passwords;
the system will lock itself after a minimum of three
(3) to a maximum of five (5) failed logon attempts
made by user within a thirty (30) minute time frame;
and, the system will either lock itself or log off user after thirty (30) minutes of inactivity.
9.17.11 Personnel and Subrecipient Protections
9.17.11.1 Subrecipient shall screen and conduct background checks on all Subrecipient personnel exposed to
confidential County Information Assets.
Subrecipient shall require its employees and Lower
Tier Subrecipient(s) to sign an appropriate written
confidentiality/non-disclosure agreement. All Lower
Tier Subawards requiring access to Subrecipient's
systems and data, including all outsourcing
arrangements and maintenance and support
agreements (including facilities maintenance), shall
specifically address security risks, controls and
procedures for information systems. Subrecipient
shall supply each of its employees with appropriate,
ongoing training regarding information security
procedures, risks, vulnerabilities and threats.
Subrecipient shall have an established set of
procedures to ensure Subrecipient employees
promptly report actual and/or suspected breaches
of security.
9.17.12 County's Security Audit
9.17.12.1 At County's sole discretion, County or its designee may annually, or more frequently, conduct a
security audit to determine Subrecipient's
adherence to the requirements outlined in this
Subparagraph 9.17.
9.17.12.2 County's security audit may include, but is not limited to, a review of the following elements, which
shall be provided by Subrecipient upon County's
request: a report on Subrecipient's encryption of all
electronic media; Subrecipient's report verifying
County's written authorization for data destruction
along with documented certification of such
destruction; and, Subrecipient's written assurance
indicating that Subrecipient enforces security
measures to control physical access (i.e., access to
premises) and electronic access (i.e., access to
electronic media) to County Information Assets.
9.17.13 Security Incident Reporting
9.17.13.1 A security incident occurs when County Information Assets are or reasonably believed to have been
accessed, modified, destroyed or disclosed without
proper authorization or are lost or stolen. A security
incident includes (but is not limited to) instances in
which Subrecipient employees access systems in
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excess of their user rights or use the systems
inappropriately, data is breached, etc. Subrecipient
and its Lower Tier Subrecipient must comply with
California Department of Aging's security incident
reporting procedure which is available online at
http://aging.ca.gov/Programsproviders/Information_
Security_and_Privacy.
9.17.13.2 Notification of Security Breach to County
9.17.13.2.1 Subrecipient must immediately report
all security incidents to County's
Program Manager but in no event shall
the report be made more than two (2)
business days after its detection.
Subrecipient shall initiate the contact
by telephone and followed by written
letter of any potential or actual security
attacks or security incidents.
9.17.13.2.2 Subrecipient's notification of the
security incident shall include the
approximate date and time of its
occurrence and a summary of the
relevant facts, including a description
of measures being taken to address
the occurrence.
9.17.13.3 Notification of Security Breach to Clients
9.17.13.3.1 Subrecipient and its Lower Tier
Subrecipient shall give written notice
to any Client or data subject whose
confidential, sensitive and/or personal
identifying information may have been
breached in accordance with HIPAA,
the Information Practices Act of 1977,
and State policy.
9.17.14 Electronic Backups
9.17.14.1 Subrecipient and its Lower Tier Subrecipient shall ensure that all electronic County Information
Assets are protected by performing regular backups
of automated files and databases, and ensure the
availability of County Information Assets for
continued business. Subrecipient and its Lower
Tier Subrecipient shall ensure that all data, files and backup files are encrypted.
9.17.15 Cloud Storage
9.17.15.1 Subrecipient and its Lower Tier Subrecipient(s) may not utilize cloud storage of County Information
Assets without the prior express written
authorization of County, after a review of the cloud
service by County or its designee(s).
9.17.16 Hardware Return
9.17.16.1 Upon termination or expiration of this Subaward or at any time upon County's request, Subrecipient will
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return all hardware provided by County or
purchased by Subrecipient using Subaward Sums.
Subrecipient shall not alter or modify such
hardware. Subrecipient shall physically seal the
hardware and return it to County via a bonded
courier or as otherwise directed by County in
accordance with Exhibit S (Purchase, Inventory and
Disposal Requirements for Fixed Assets, Non-Fixed
Assets and Supplies).
9.17.16.2 In the event that the hardware contains confidential County Information Assets and is owned by
Subrecipient or its Lower Tier Subrecipient,
Subrecipient shall send a notarized statement,
detailing the destruction method used and the data
sets involved, the date of destruction and the
company or individual who performed the
destruction to County's Program Manager within
fifteen (15) days of termination or expiration of this
Subaward or at any time upon County's request.
Subrecipient's destruction or erasure of Personal
Information, Protected Health Information and
Medical Information shall be in compliance with
industry best practices as outlined in NIST SP
800-88 (Guidelines for Media Sanitization).
9.17.17 Subrecipient shall ensure that its Lower Tier Subrecipient(s) adheres to all of the provisions included in this Subparagraph
9.17. 9.18 REMEDIES FOR NON-COMPLIANCE
9.18.1 Subrecipient agrees to comply with the requirements set forth in the entirety of this Subaward as well as the requirements contained in supporting Program legislation and all applicable directives, Program memoranda, notices, guidelines and
instructions issued by or on behalf of Federal, State or County authorities. Subrecipient's failure to comply with such requirements shall subject Subrecipient to remedies which are available under this Subaward and as provided by law. These remedies include but are not limited to the following: probation; suspension of payment(s); suspension of Services; assessment and collection of liquidated damages; de-obligation of Subaward Sums (for purposes of this Subaward, de-obligation is the partial or full removal of Subaward Sums from Subrecipient);
re-obligation of Subaward Sums (for purposes of this Subaward, re-obligation is the allocation of de-obligated Subaward Sums to another current subrecipient(s) and/or to a new
subrecipient); debarment; and/or termination of this Subaward.
County shall have the sole discretion to determine which remedy(ies) will be applied as a result of Subrecipient's non-compliance.
9.19 PAYMENT AND PERFORMANCE GUARANTIES
9.19.1 Throughout the entire term of this Subaward, including the original term and any renewals or extensions thereto, County, at its sole discretion, reserves the right to require Subrecipient to provide a Payment Guaranty, Performance Guaranty or both ("Guaranty(ies)") in the amount and form as directed by County.
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County will determine whether or not Subrecipient will be required to obtain a Guaranty(ies) when Subrecipient's
performance under this Subaward reveals potential liability to County in an aggregate amount of twenty-five thousand dollars ($25,000) or more resulting from, but not limited to, the following incidents: disallowed costs, unsubstantiated costs, non-payment of Lower Tier Subrecipients, etc. (i.e., if County determines that Subrecipient has disallowed costs, unsubstantiated costs, non-payment of Lower Tier Subrecipients, etc. which total twenty-five thousand dollars ($25,000) or more in potential liability when added together then County will require
Subrecipient to obtain a Payment Guaranty, Performance
Guaranty or both).
9.19.2 Payment Guaranty
9.19.2.1 The Payment Guaranty is Subrecipient's
surety/guarantee to County that Subrecipient shall
meet its obligations to faithfully pay its Lower Tier
Subrecipients in a manner that is timely,
satisfactory and acceptable to County, as
determined by County at its sole discretion. The
purpose of the Payment Guaranty is to provide all
Lower Tier Subrecipients who supply labor,
materials, services, etc. to Subrecipient a recourse
if they do not get paid by Subrecipient. In such
case, the Payment Guaranty allows Lower Tier
Subrecipient to file a claim with the surety company
that issued the Guaranty in the event that
Subrecipient does not reimburse the Lower Tier
Subrecipient for goods and/or services provided by
Lower Tier Subrecipient.
9.19.2.2 Subrecipient acknowledges that County may also make a determination that Subrecipient's
non-payment of its Lower Tier Subrecipients is a
violation of the terms and conditions of this
Subaward which may subject Subrecipient to obtain
both the Payment Guaranty and Performance
Guaranty.
9.19.2.3 The Payment Guaranty shall only take the form of a surety bond. More information concerning surety
bonds and companies may be obtained from the
Surety Association of America (www.surety.org),
the Surety Information Office (www.sio.org.), state
insurance departments, the U.S. Small Business
Administration and U.S. Department of the
Treasury.
9.19.2.4 The Payment Guaranty must be executed by a
corporate surety which is licensed to transact
business as a surety in the State of California. The
corporate surety must have an A.M. Best Rating of
not less than A:VII, unless otherwise approved by
County.
9.19.3 Performance Guaranty
9.19.3.1 The Performance Guaranty is Subrecipient's
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surety/guarantee to County that Subrecipient shall
meet its obligations to perform the terms and
conditions of the resulting Subaward. The purpose
of the Performance Guaranty is to provide County a
recourse to recover Subaward monies which would
otherwise be lost due to Subrecipient's negligent
actions. This Performance Guaranty shall provide
for the payment of monies to County for
transactions which are incurred by Subrecipient,
including but not limited to: liquidated damages,
late penalty payments, County's reimbursement,
etc. County's determination to require Subrecipient
to obtain the Performance Guaranty would occur
after the resolution process has been completed
and "questioned costs" have been determined to be
unsubstantiated costs, disallowed costs, etc.
9.19.3.2 The Performance Guaranty shall take any of the following forms:
9.19.3.2.1 Surety Bond: More information
concerning surety bonds and
companies may be obtained from the
Surety Association of America
(www.surety.org), the Surety
Information Office (www.sio.org.),
state insurance departments, the U.S.
Small Business Administration and
U.S. Department of the Treasury.
The performance guaranty may not
allow the bond surety to substitute
another person to perform Services.
9.19.3.2.2 Letter of Credit: Refer to Exhibit BB
(Criteria and Standards for Letters of
Credit and Certificates of Deposit) for
information.
9.19.3.2.3 Certified Check or Certificate of
Deposit: This form of Guaranty shall
list/identify County of Los Angeles as
an authorized party that can withdraw
on the account. Refer to Exhibit BB
(Criteria and Standards for Letters of
Credit and Certificates of Deposit) for
additional information on the
certificate of deposit.
9.19.3.2.4 Cash
9.19.3.3 The Performance Guaranty must be executed by a corporate surety which is licensed to transact
business as a surety in the State of California. The
corporate surety must have an A.M. Best Rating of
not less than A:VII, unless otherwise approved by
County.
9.19.4 When County determines that Subrecipient shall obtain and maintain a Guaranty(ies), County shall inform Subrecipient of DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE SUBAWARD PERIOD JULY 2020 - JUNE 2021
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this requirement and shall provide Subrecipient at least fifteen (15) days to comply with County's determination. Once
Subrecipient has obtained the required Guaranty(ies), County will re-evaluate the need for Subrecipient to continue maintaining the Guaranty(ies) for any subsequent Fiscal Year of the Subaward term.
9.19.5 The costs to obtain and maintain the Guaranty(ies) are potentially allowable and reimbursable under the terms of this Subaward. However, no additional funding will be allocated to the Subaward Sums in order for Subrecipient to pay for these costs. If Subrecipient intends to use existing Subaward Sums to offset the costs of the Guaranty(ies), this action requires a redistribution of Subaward Sums which shall be initiated through a budget modification. This budget modification shall be completed and submitted by Subrecipient for approval by County as noted in Subparagraph 9.9.2 (Budget Modifications). Prior to submitting this budget modification, Subrecipient shall ensure that it will be able to adhere to all other required tasks, performance measures and other duties of this Subaward even after the Subaward Sums are redistributed (i.e., Subrecipient shall continue to provide the required level of Services which would include the Guaranty(ies) for the same level of funding).
9.20 SUBAWARD DOCUMENT DELIVERABLES
9.20.1 Prior to the execution of this Subaward and throughout the entire term of this Subaward, Subrecipient shall obtain and maintain current and appropriate licenses, permits and certificates which are required by all applicable County, State and/or Federal laws, regulations, guidelines, Program memoranda and directives for the operation of its facility(ies) and for the provision of Services hereunder. Prior to the execution of this Subaward and annually thereafter (or as otherwise established by County), Subrecipient shall submit evidence/documentation (Subaward Document
Deliverables) of its compliance with this requirement in the form and manner that is prescribed by County. Subrecipient shall provide to County's Contract Manager, by the deadline imposed by County, current copies of these deliverables which must be complete (without missing pages) and legible, and shall include:
9.20.1.1 Subaward Compliance Documents (as described in Subparagraph 9.20.3)
9.20.1.2 Business Forms (as described in Subparagraph
9.20.4)
9.20.1.3 Reporting Documents (as described in
Subparagraph 9.20.5)
9.20.1.4 Other Documents: During the term of this
Subaward, County or its designee(s) may request
from time to time additional documents from
Subrecipient, and Subrecipient shall adhere to
County's request for such documents.
9.20.2 Subrecipient shall submit copies of all new or renewed licenses, permits, and certificates to County's Contract Manager within five (5) business days of the license, permit or certification award or DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE SUBAWARD PERIOD JULY 2020 - JUNE 2021
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renewal. Subrecipient shall immediately notify County of any lapses or expirations of these items. Subrecipient's failure to maintain and/or timely submit documents required or requested by County may result in County imposing remedies as
determined by County in its sole discretion.
9.20.3 Subaward Compliance Documents
9.20.3.1 Business License
9.20.3.1.1 When the local governing authority
requires Subrecipient's organization to
obtain a license to operate and
conduct business within its local
governing authority's jurisdiction,
Subrecipient shall obtain such license
to perform the Services outlined in this
Subaward. The local governing
authority may be either the local city
government for entities doing business
within its city limits or County of Los
Angeles for entities located outside of
city limits (i.e., unincorporated areas or
designated cities). Subrecipient shall
ensure that the license is current
throughout the entire term of this
Subaward. Subrecipient shall provide
a current copy of its license to County
annually (or upon expiration, as noted
on the license).
9.20.3.2 Certificate of Insurance
9.20.3.2.1 The certificate shall evidence
Subrecipient's compliance with the
insurance requirements outlined in
Subparagraph 8.24 (General
Provisions for all Insurance Coverage)
and Subparagraph 8.25 (Insurance
Coverage). Subrecipient shall also
provide copies of the certificate of
insurance as it relates to its Lower Tier
Subrecipient(s).
9.20.3.3 Fire Department Inspection Report
9.20.3.3.1 For each Service site that Client will
visit, Subrecipient shall obtain an
annual fire inspection of its
facility(ies). The inspection shall be
conducted by the Los Angeles County
Fire Department or by Subrecipient's
local fire department and Subrecipient
shall obtain a written report of the
inspection which shall be provided to
County annually. In the event that
violations are noted on the inspection
report, Subrecipient shall ensure that it
complies with all corrective measures
as directed by the fire department.
Subrecipient shall provide to County
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written evidence of its compliance
within five (5) days of receiving the
evidence from the fire department.
The fire inspection report shall be
current within the most recent twelve
(12) month period.
9.20.3.4 Public Health Permit
9.20.3.4.1 For every Service site where
Subrecipient provides Services that
require a Permit issued by County of
Los Angeles Department of Public
Health, Subrecipient shall provide a
current copy of such permit annually
(or upon expiration, as noted on the
permit).
9.20.3.5 Health Department Inspection Report
9.20.3.5.1 For each Service site where
Subrecipient provides Services that
require an inspection by County of Los
Angeles Department of Public Health
(such as a central kitchen, Congregate
Meal Site, etc.), Subrecipient shall
annually provide a current copy of
such inspection report (report shall be
current within the most recent twelve
(12) month period). In the event that
violations are noted on the report,
Subrecipient shall ensure that it
complies with all corrective measures
as directed by the Department of
Public Health. Subrecipient shall
provide to County written evidence of
its compliance within five (5) days of
receiving the evidence from Public
Health.
9.20.3.6 Vehicle Smog Certification
9.20.3.6.1 For each vehicle(s) purchased with the
Subaward Sum(s) under this
Subaward and/or under a Predecessor
Agreement that is used in the
operation of the Program (i.e.,
County-owned vehicle(s)),
Subrecipient shall ensure that such
vehicle(s) undergo a certified smog
inspection as required under
applicable State and Los Angeles
County laws. Subrecipient must
receive evidence of a passing
inspection (i.e., smog certificate) for
each vehicle and shall submit a copy
of the smog certificate to County's
Contract Manager on an annual basis
in the manner and timeframe
designated by County. When the
vehicle(s) is not required to undergo a
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smog inspection during any year,
Subrecipient shall provide evidence
(copy of vehicle registration, etc.)
indicating that the inspection is not
warranted for the specified year.
9.20.4 Business Forms
9.20.4.1 Articles of Incorporation
9.20.4.1.1 This document, which evidences the
legal formation of Subrecipient's
organization, shall reflect
Subrecipient's current legal name;
and, County shall use this document
as verification of Subrecipient's name.
In the event there are any
amendments or addendums to the
articles of incorporation, Subrecipient
shall provide copies of such
amendments/addendums to County
within five (5) days of said
amendments/addendums being
finalized.
9.20.4.1.2 When Subrecipient's organization is a
local government or a consortium of
local governments, Subrecipient shall
provide either a city charter or a joint
powers agreement respectively, in lieu
of the articles of incorporation.
9.20.4.2 Board of Directors' Resolution
9.20.4.2.1 A resolution from Subrecipient's Board
of Directors, which evidences
Authorized Representative's authority
to act on behalf of Subrecipient in
matters related to this Subaward
(Subparagraph 8.3.3 (Board of
Directors' Resolution)). Subrecipient
shall submit its Board of Directors'
resolution in the time and manner as
designated by County.
9.20.4.3 Board of Directors Roster
9.20.4.3.1 The roster shall include the individuals
who comprise Subrecipient's Board of
Directors. In the event that the roster
is updated, Subrecipient shall provide
an updated roster to County within five
(5) days of it being approved or
finalized.
9.20.4.4 Bylaws
9.20.4.4.1 This document shall reflect the internal
rules which govern Subrecipient's
organization. These rules are
generally concerned with the operation
of the organization, and setting out the
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form, manner or procedure in which
the organization should operate. In
the event that the bylaws are
amended, Subrecipient shall provide
such amendments to County within
five (5) days of them being approved.
9.20.4.5 Complaint Policies and Procedures
9.20.4.5.1 Subrecipient's policies and procedures
for receiving, investigating and
responding to Client complaints shall
be prepared and submitted to County
pursuant to the requirements outlined
in Subparagraph 8.5 (Complaints).
9.20.4.6 Organization Chart
9.20.4.6.1 The chart shall provide an outline of
the hierarchy, relationships and
relative ranks of Subrecipient's
organizational parts and positions/jobs
as it related to the operations of this
Subaward. In the event that
Subrecipient revises its organization
chart, a copy shall be provided to
County within five (5) days of any
change in its organization chart.
9.20.4.7 Lower Tier Subaward
9.20.4.7.1 This executed third-party agreement
(as defined in Subparagraph 8.40
(Lower Tier Subaward)) and any
amendments or addendums thereto,
shall be provided to County within five
(5) days of the execution of that
agreement, amendment and
addendum.
9.20.4.8 Tax Exempt Status Letter
9.20.4.8.1 Written documentation that is obtained
from the Internal Revenue Service as
evidence of Subrecipient's tax exempt
status. When Subrecipient is a
non-profit entity, such evidence must
reflect Subrecipient's tax exempt
status. In the event Subrecipient's tax
exempt status changes, Subrecipient
shall provide County a copy of its new
status within five (5) days of any
change in its tax exempt status.
9.20.4.9 Terms and Conditions of Use-User Agreement
9.20.4.9.1 Each employee who will access the
Contract Management System -
Contractor's Gateway shall complete
and submit this agreement. Additional
information is available in Exhibit V
(Contract Management System -
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Contractor's Gateway Terms and
Conditions of Use).
9.20.5 Reporting Documents
9.20.5.1 Cost Allocation Plan
9.20.5.1.1 This Plan shall adhere to the
requirements outlined in
Subparagraph 9.21.1 (Cost Allocation
Plan for Cost Reimbursement
Activities).
9.20.5.2 Closeout Report
9.20.5.2.1 This report shall adhere to the
requirements outlined in
Subparagraph 9.21.2 (Closeout
Reporting Requirements).
9.20.5.3 Other Reporting Documents
9.20.5.3.1 From time-to-time, County or its
designee(s) may request other
documents relating to Subrecipient's
performance, Work, and/or Services
under this Subaward. County shall not
be unreasonable in its request and
Subrecipient shall adhere to County's
request for such documents.
9.21 FISCAL REPORTING REQUIREMENTS
9.21.1 Cost Allocation Plan for Cost Reimbursement Activities
9.21.1.1 Subrecipient acknowledges that as a condition of receiving this Subaward, Subrecipient shall submit
its organization-wide Cost Allocation Plan to County
no later than sixty (60) days after the start date of
the Subaward term. This Cost Allocation Plan is
included herein by reference.
9.21.1.2 The Cost Allocation Plan shall adhere to the
requirements outlined in the following: County
directives (including but not limited to WDACS
directive CCD-18-01 (Cost Allocation and Indirect
Cost Requirements for WDACS Subawards)) which
may be obtained at
https://wdacs.lacounty.gov/doing-business-with-wda
cs/programdirectives/, Exhibit Q (Accounting,
Administration and Reporting Requirements), Title
45 Code of Federal Regulations Part 75 et seq. and
Title 2 Code of Federal Regulations Part 200 et
seq. At a minimum, the Plan shall include the
following information:
9.21.1.2.1 Description of Subrecipient's
organization (i.e., non-profit, for-profit,
public/government, etc.).
9.21.1.2.2 Description of Subrecipient's general
accounting policies, including its basis
of accounting.
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9.21.1.2.3 List of all the funded programs.
9.21.1.2.4 An organizational chart that identifies
the various services and/or functions
for each unit.
9.21.1.2.5 A detailed listing of all shared and
pooled direct and indirect costs that
will be allocated.
9.21.1.2.6 Identification of the Subaward year
term for any
information/documentation related to
the Plan.
9.21.1.2.7 A thorough description of the methods
used to allocate all shared or pooled
direct or indirect costs and the
auditable documentation for
supporting each basis for allocation.
9.21.1.3 Every cost included in the Cost Allocation Plan shall be supported by formal, documented accounting
records, and the basis for its distribution must be
calculated by actual usage (e.g., time distribution,
number of Clients served, square footage, etc.) -
arbitrary percentages or estimates are not allowed.
9.21.1.4 In order to certify the accuracy of the Cost
Allocation Plan, Subrecipient shall sign the Cost
Allocation Plan and any revisions made thereto.
9.21.1.5 By May 1 of each Subaward year after the first Subaward year in a multi-year term (or upon
extension of the term as provided in Paragraph 4.0
(Term of Subaward), Subrecipient shall submit
written confirmation that its Cost Allocation Plan
methodology described in Subparagraph 9.21.1.2.7
will remain in effect throughout the following
Subaward year. In the event that this Cost
Allocation Plan methodology must be revised for
the following Subaward year then Subrecipient shall
submit the revised methodology to County's
Compliance Manager by May 1 of the current
Subaward year. The Cost Allocation Plan
methodology may only be revised once during any
Subaward year.
9.21.1.6 In the event that the information provided in the Cost Allocation Plan as it relates to Subparagraphs
9.21.1.2.1 - 9.21.1.2.6 must be revised at any time
during the Subaward term then Subrecipient shall
submit the revisions to County's Compliance
Manager within thirty (30) days of completing the
revisions.
9.21.1.7 Upon receipt of the revisions made to
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Subrecipient's Cost Allocation Plan, County will
review these revisions. Neither Subrecipient's
submission of these revisions to its Cost Allocation
Plan nor County's receipt of these revisions to
Subrecipient's Cost Allocation Plan shall constitute
County's acceptance or approval of the Cost
Allocation Plan revisions. County reserves the right
to either accept or reject any revision(s) to the Cost
Allocation Plan that County deems is
unacceptable. County will notify Subrecipient in
writing whether the revisions are approved or
rejected. Upon rejection of the revisions,
Subrecipient shall take the required actions needed
to correct its revisions. Subrecipient's failure to
adhere to County's requirements shall subject
Subrecipient to remedies available under this
Subaward.
9.21.2 Closeout Reporting Requirements
9.21.2.1 The closeout is a process that takes place upon the expiration or termination of the period in which
Program Services are provided which includes the
end of the Subaward term, the end of the Fiscal
Year or any other period when the Subaward is
terminated. The purpose of closeout is to ensure
that final reports are received and evaluated,
allowable costs are determined and amounts due to
either County or to Subrecipient are determined and
payment arrangements made.
9.21.2.2 Subrecipient shall complete and submit a
mandatory Closeout Report in the form and manner
designated by County. The Closeout Report shall
include the reporting of expenses and accruals
incurred through the last day of the Fiscal Year or
Program Year. County will notify Subrecipient of
the deadline for submission of the Closeout Report.
9.21.2.3 Subrecipient must ensure that all invoices are submitted and finalized prior to the submission of its
Closeout Report. County will not pay invoices that
are received after Subrecipient has submitted the
Closeout Report. Once County has reviewed and
accepted Subrecipient's Closeout Report, the data
reflected on the Closeout Report will be reported to
State as final. Any subsequent revisions will
require the written signature and authorization of
Authorized Representative.
9.21.2.4 If this Subaward is terminated or cancelled prior to June 30th of any Fiscal Year, the Closeout Report
shall be for that Subaward period which ends on the
termination or cancellation date. Subrecipient shall
submit the Closeout Report after the
termination/cancellation date in the manner and
timeframe designated by County.
9.21.2.5 At the end of the funding cycle/during the closeout, Subrecipient shall ensure that all of the following
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items match:
9.21.2.5.1 The Subaward Sum allocated by line
items on Subrecipient's final approved
Budget(s), where the Subaward Sum
is the funding allocated for any Fiscal
Year under this Subaward and it is
distributed using the line items/cost
categories reflected in Subrecipient's
final approved Budget(s).
9.21.2.5.2 The Grant Share, which is allocated
by line items on Subrecipient's
Closeout Report, where the Grant
Share is the actual Subaward Sum
that Subrecipient has budgeted by
line items/cost categories on its
organization's accounting/fiscal
records (i.e., general ledgers, etc.).
9.21.2.5.3 The Amount Received by line item as
reported on Subrecipient's Closeout
Report, where the Amount Received
is the actual Subaward Sum
reimbursed to Subrecipient for its line
items.
9.21.2.6 In the event that the line item amounts reflected as the Subaward Sum on the final approved Budget(s),
the Grant Share on the Closeout, and the Amount
Received on the Closeout do not match at the time
of closeout, for purposes of the closeout only,
County shall allow a maximum of ten percent (10%)
variance between the Subaward Sum and Grant
Share (specifically, the variance between the
Subaward Sum line items reported on the final
approved Budget(s) and the Grant Share line items
reported on the Closeout Report).
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE SUBAWARD PERIOD JULY 2020 - JUNE 2021
SUBAWARD NUMBER ENP202106
9.21.2.6.1 For example, during the closeout, if
the line item, Space, reflects a
Subaward Sum of $100 on the final
approved Budget(s) then the Grant
Share amount reflected on the
Closeout Report for Space shall be
$100, and the Amount Received
reflected on the Closeout Report for
Space shall be $100. Alternatively, if
the Subaward Sum for Space is
reflected on the final approved
Budget(s) as $100 but the Grant
Share for Space is reflected on the
Closeout Report as $95 and the
Amount Received for Space is
reflected on the Closeout Report as
$95 then the $5 variance (which is
five percent (5%) of the Subaward
Sum amount for the Space line item)
is within the allowable ten percent
(10%) variance.
9.21.2.7 Subrecipient shall ensure that the total Grant Share and the total Amount Received, which are reflected
on the Closeout Report, do not exceed the total
Subaward Sum reflected on the final approved
Budget(s).
9.21.3 Program Income Requirements
9.21.3.1 Program Income includes, but is not limited to:
9.21.3.1.1 Voluntary contributions received from
Client or other party for Services
received.
9.21.3.1.2 Income from usage or rental fees of
real or personal property acquired
with Subaward Sums.
9.21.3.1.3 Royalties received on patents and
copyrights from Subaward-supported
activities.
9.21.3.1.4 Proceeds from the sale of items
created under this Subaward.
9.21.3.2 Subrecipient shall adhere to the Program Income requirements outlined herein and in Title 45 Code of
Federal Regulations Part 75 et seq. and Title 2
Code of Federal Regulations Part 200 et seq.
9.21.3.3 Subrecipient shall use Program Income to expand baseline Program Services.
9.21.3.4 Subrecipient shall report Program Income in Budget exhibit(s) and shall expend Program Income under
the same terms and conditions as the Subaward
Sums from which it is generated. The use of
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SUBAWARD NUMBER ENP202106
Program Income is restricted to the funding source
or Service that was provided and contributed
towards.
9.21.3.5 Program Income shall be used to pay for current allowable Program costs in the same Fiscal Year or
Program Year that the Program Income is earned.
If Program Income is earned in excess of the
amount reported in Budget exhibit(s) then County
shall recapture the balance of the unexpended
Program Income or pursue any other remedies
available to County under this Subaward.
9.21.3.6 Subrecipient shall not use Program Income to meet the match contribution requirement of this
Subaward.
9.21.3.7 Subrecipient shall provide a disposition of all Program Income received and expended as part of
the Closeout reporting process in the form, manner
and timeline as designated by County.
9.22 DATA UNIVERSAL NUMBERING SYSTEM (DUNS) AND SYSTEM FOR
AWARD MANAGEMENT (SAM)
9.22.1 Pursuant to the Federal Funding Accountability and Transparency Act of 2006 (Public Law 109-282) and Title 2 Code of Federal Regulations Part 25, Subrecipient shall be responsible for obtaining and maintaining a DUNS number from Dun and Bradstreet. The DUNS number is a unique nine-digit
identification number and is site-specific. Therefore, each distinct physical location of Subrecipient's organization (such as branches, divisions, and headquarters) will have its own, unique DUNS number. Subrecipient may register for a DUNS number at http://www.dnb.com/duns-number.html. Subrecipient shall comply with the requirements outlined in this Subparagraph 9.22.
9.22.2 Subrecipient shall provide a valid DUNS number using Exhibit F (Subrecipient's Administration) and shall submit the completed Exhibit F (Subrecipient's Administration) in the time and manner as directed by County. Subrecipient must register the DUNS number and maintain an "Active" status within the federal System for Award Management available online at
https://www.sam.gov/portal/SAM#1. If County cannot access or verify "Active" status for Subrecipient's DUNS information, which is related to this Subaward on the Federal Funding
Accountability and Transparency Act Subaward Reporting
System, County will notify Subrecipient and Subrecipient must immediately update the information as required.
9.22.3 Subrecipient's failure to adhere to applicable DUNS and SAM requirements may result in County imposing remedies as
determined by County in its sole discretion.
9.23 UNUSUAL OCCURRENCES AND CRIME
9.23.1 Unusual occurrences such as natural disasters (including earthquakes, floods, landslides, wildfires, extreme heat/cold), man-made emergencies (such as epidemic outbreaks,
bio-terrorism, food-borne illness, fire, major accidents, death from unnatural causes or other catastrophes), and unusual DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE SUBAWARD PERIOD JULY 2020 - JUNE 2021
SUBAWARD NUMBER ENP202106
occurrences which threaten the welfare, safety or health of Clients, Subrecipient personnel or visitors to Subrecipient's facility(ies) shall be reported by Subrecipient within twenty-four (24) hours to the local health officer by telephone and in writing, and to County by telephone and also in writing or by email.
9.23.2 Crime related occurrences, such as theft or vandalism, must be reported by Subrecipient within twenty-four (24) hours to the local police or sheriff by filing a police report and to County by telephone, and in writing or by email. Subrecipient shall also prepare and retain an incident report on file, and shall include a copy of the filed police report.
9.23.3 Subrecipient shall maintain all incident reports in a manner consistent with Subparagraph 8.38 (Record Retention,
Inspection and Audit Settlement). Subrecipient shall furnish such other pertinent information related to such occurrence as the local authorities and/or County may require.
9.24 FEMA PROVISIONS
9.24.1 In the event of an emergency (defined as a sudden, unexpected occurrence that poses a clear and imminent danger, requiring immediate action to prevent or mitigate the loss or impairment of life, health, property or essential public services) and Federal Emergency Management Agency (FEMA) funds are made
available under this Subaward, Subrecipient shall comply with all requirements outlined in Exhibit CC (FEMA Provisions).
Subrecipient shall complete the Lobbyist Certification attached to this Exhibit and submit it to County's Contract Manager in the time and manner as designated by County.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
EXHIBIT A
(STATEMENT OF WORK)
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TABLE OF CONTENTS
SECTION TITLE PAGE
SCOPE OF WORK............................................................................................... 4
ADDITION AND/OR DELETION OF FACILITIES, SPECIFIC TASKS AND/OR WORK HOURS .................................................................................................... 4 QUALITY CONTROL............................................................................................ 5 QUALITY ASSURANCE PLAN............................................................................. 6 DEFINITIONS....................................................................................................... 7 RESPONSIBILITIES............................................................................................. 7 HOURS/DAYS OF WORK.................................................................................. 24 WORK SCHEDULES ......................................................................................... 24 UNSCHEDULED WORK .................................................................................... 25 SPECIFIC WORK REQUIREMENTS................................................................. 25 GREEN INITIATIVES ......................................................................................... 72 PERFORMANCE REQUIREMENTS SUMMARY............................................... 72 DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit A (Statement of Work)
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ATTACHMENTS
Attachment 1 (Performance Requirements Summary Chart)
Attachment 2 (County Recognized Holidays)
Attachment 3 (Community Focal Points List)
Attachment 4 (Universal Intake Form)
Attachment 5 (Subaward Discrepancy Report)
Attachment 6 (Emergency and Disaster Plan Basic Requirements) Attachment 7 (Site Emergency Resource Survey)
Attachment 8 (Site Summary)
Attachment 9 (Guidelines for Developing Site Summary)
Attachment 10 (Route Summary)
Attachment 11 (Guidelines for Developing Route Summary) Attachment 12 (Home-Delivered Meal Program Telephone Reassurance Log) Attachment 13 (Home-Delivered Meal Program Priority of Service Screening Tool) Attachment 14 (Home-Delivered Meal Program Priority of Service Screening Tool Instructions)
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SCOPE OF WORK
County (herein also referred to as the Area Agency on Aging (AAA)), has established the Elderly Nutrition Program (ENP or Program), which consists primarily of Congregate Meal Services and Home-Delivered Meal Services (collectively Services). As further detailed in Section 10.0 (Specific Work Requirements), Subrecipient shall provide the appropriate Services, which will assist in maintaining and/or improving the physical, psychological, and social well-being of Older Individuals (an adult who is sixty (60) years of age or older) as follows:
Provide Services to Older Individuals in greatest economic or social need, with particular attention to low-income, minority individuals.
Serve meals that provide one-third (1/3) of the Recommended Dietary Allowances (RDAs) and are safe and of good quality.
Promote and maintain high food safety and sanitation standards.
Promote good health behaviors through nutrition education and nutrition screening of Clients.
Promote or maintain coordination with other nutrition-related supportive Services for Older Individuals.
ADDITION AND/OR DELETION OF FACILITIES, SPECIFIC TASKS AND/OR
WORK HOURS
Services must be provided in Los Angeles County geographic areas, excluding the City of Los Angeles. Prior to modifying or terminating a Congregate Meal site, Home-Delivered Meal route, Services, or revising hours of Service delivery at a previously designated location(s), and before commencing such Services at any other location, Subrecipient shall obtain written consent from County, and shall comply with Subparagraph 8.1 (Amendments) of the Subaward as applicable.
Subrecipient shall inform County in writing and receive written County approval at least sixty (60) days prior to relocation of Subrecipient’s office or site location(s).
Subrecipient must submit a written request to County a minimum of sixty (60) days prior to the date that Subrecipient intends to open a new Congregate Meal site or close any existing Congregate Meal site. Subrecipient shall not open a new site or close any existing site prior to receiving County’s written approval. In the event that opening a new site or closing an existing site is due to an emergency (defined as a sudden, unexpected occurrence that poses a clear and imminent danger, requiring immediate action to prevent or mitigate the loss or impairment of life, health, property or essential public DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit A (Statement of Work)
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services) that would prevent Subrecipient from submitting a written request to County sixty (60) days in advance, Subrecipient shall request County’s approval immediately upon occurrence of such emergency. Any new Congregate Meal site must be inspected by the Dietary Administrative Support Services (DASS) Program subrecipient and a health permit must be obtained before approval is granted by County at County’s sole discretion.
Subrecipient must submit a written request to County a minimum of sixty (60) days prior to the date that Subrecipient intends to establish a new HomeDelivered Meal route or terminate any existing Home-Delivered Meal route.
Subrecipient shall not establish a new route or terminate any existing route prior to receiving County’s written approval. In the event that establishing a new route or terminating an existing route is due to an emergency (as defined in Subsection 2.3) that would prevent Subrecipient from submitting a written request to County sixty (60) days in advance, Subrecipient shall request County’s approval immediately upon occurrence of such emergency.
Subrecipient shall provide the identity of each designated Community Focal Point as specified in OAA Section 102 (a)(21) and Title 42 United States Code Section 3026(a)(3)(A)) as directed by County’s Program Manager.
Subrecipient shall identify or update the designated Community Focal Point site locations, as needed. A complete list of Community Focal Points is provided in Attachment 3 (Community Focal Points).
Specific tasks and Work hours shall not be modified or terminated throughout the entire Subaward term. Should an emergency arise, Subrecipient’s request for Service or Work hour modifications will be reviewed by County on a case-by-case basis.
QUALITY CONTROL
Subrecipient shall establish and utilize a comprehensive Quality Control Plan to assure County a consistently high level of Service throughout the term of the Subaward. The Quality Control Plan shall be submitted to County’s Compliance Manager for review every six (6) months or more frequently as imposed by County. The plan shall include, but may not be limited to the following:
Method of monitoring to ensure that Subaward requirements are being met.
A record of all inspections conducted by Subrecipient, any corrective action taken, the time a problem was first
identified, a clear description of the problem, and the time elapsed between identification and completed corrective action, shall be provided to County upon request.
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QUALITY ASSURANCE PLAN
County maintains the unlimited right to evaluate/monitor Subrecipient’s performance under the Subaward using the quality assurance procedures as defined in Subparagraph 8.15 (County’s Quality Assurance Plan) of this Subaward. Such rights shall also extend to Federal Representatives and State Representatives with Program oversight.
Meetings
Subrecipient is mandated to attend all meetings called by County, or authorized designee. Subrecipient shall be given advance notice of all scheduled meetings with County. Subrecipient may also be required to attend emergency meetings without the above stated advance notice when necessary.
Subrecipient Staff, which include paid Employees and
Volunteers, shall regularly attend meetings that offer ways to expand knowledge of and increase efficiency in the Services provided. These meetings may be scheduled by County. At Subrecipient’s own expense, Subrecipient may elect to attend meetings outside of Los Angeles County that Subrecipient reasonably deems to be beneficial for the delivery of Client Services, as well as other meetings designated by County.
Subrecipient’s failure to attend all mandatory meetings (in-person or online) shall be considered non-compliance with the
Subaward, and may result in further action pursuant to the Subaward, Subparagraph 9.13 (Probation and Suspension), Subaward, Subparagraph 9.18 (Remedies for Non-Compliance), this Statement of Work, Attachment 1 (Performance
Requirements Summary Chart), and any other applicable
remedies.
Subaward Discrepancy Report
Subrecipient shall immediately notify County’s Compliance Manager whenever a Subaward discrepancy is identified. The problem shall be resolved within a time period mutually agreed upon in writing by County and Subrecipient.
County’s Compliance Manager will determine whether a formal Subaward Discrepancy Report shall be issued. Upon receipt of this report, Subrecipient shall respond in writing to County’s Compliance Manager within the timeframe designated by County, acknowledging the reported discrepancies or presenting contrary evidence. A plan for correction of all deficiencies identified in the report shall be submitted to County’s Compliance Manager as prescribed by County.
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County Observations
In addition to County’s contracting staff, other County personnel, State representatives, and Federal representatives may observe the performance/activities and review documents relevant to the Subaward at any time during normal business hours which are defined as five (5) days per week (Monday through Friday), eight (8) hours per day during the hours of 8:00 a.m. to 5:00 p.m., not including County recognized holidays. A list of County
recognized holidays is provided in Attachment 2 (County Recognized Holidays). However, these personnel may not
unreasonably interfere with Subrecipient’s performance.
County’s Needs Assessment
County shall conduct a needs assessment of underserved
communities within six (6) months after the commencement of the Subaward to determine whether the needs of Clients are being met.
DEFINITIONS
For a listing of definitions for this Program, refer to the Subaward, Exhibit P (Definitions).
RESPONSIBILITIES
County’s Personnel
County’s authorized agents reflected in Exhibit E (County‘s Administration) will administer this Subaward according to the Subaward, Paragraph 6.0 (Administration of Subaward –
County). Specific duties will include:
Monitoring Subrecipient’s performance in the daily
operation of this Subaward.
Providing direction to Subrecipient in areas relating
to policy, information and procedural requirements.
Preparing Amendments in accordance with the
Subaward, Subparagraph 8.1 (Amendments).
County will notify Subrecipient in writing of any change in the names or addresses shown.
Intentionally Omitted
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Subrecipient’s Personnel
Subrecipient shall assign a sufficient number of qualified Employees with the appropriate education, licensure, and experience noted below to perform the required Work. These Employees must be capable of establishing effective
communication with Clients as well as other AAA network providers. The total number of Employees shall be based on the method and level of Services provided and the size of the Service area served by Subrecipient.
Subrecipient shall operate continuously throughout the entire term of this Subaward with at least the minimum number of Staff set forth herein, as well as any other applicable staffing requirements of County necessary for Subrecipient to provide Services hereunder. Such personnel shall meet all qualifications in this Subaward, as well as those provided by County through Amendments, Administrative Directives, Change Notices,
Program Memorandums, etc.
Subrecipient shall always have a Staff member that speaks and understands English and has the authority to act on behalf of Subrecipient in every detail available during normal business hours.
Subrecipient shall be required to conduct a background check on its Employees as set forth in Subparagraph 7.5 (Background and Security Investigations) of the Subaward. Subrecipient shall also be required to conduct a background check on any Volunteer, including volunteer Home-Delivered Meal Driver(s), who has direct Client contact and has access to the Client’s personal information and/or case file.
Subrecipient shall notify County of any significant personnel change(s) and shall fill vacancies for critical positions within ten (10) days.
Project Manager
Subrecipient shall have a Project Manager or
designated alternate who will serve as
coordinator/liaison for all Services. This
requirement shall be met through the designation of
either a full-time or part-time position. County must
have access to Project Manager during all hours,
365 days per year. Subrecipient shall provide a
telephone number where Project Manager may be
reached on a twenty-four (24) hours per day basis.
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Subrecipient shall immediately notify County of any
significant change in the status of the Project
Manager position. If for any reason the position
should become vacant, Subrecipient shall
immediately fill the position with a temporary
replacement who can perform the duties of the
Project Manager and shall fill the position with a
permanent qualified person within ten (10) days.
Project Manager or his/her alternate shall have full
authority to act for Subrecipient on all matters
relating to the daily operation of the Subaward.
Project Manager will plan, organize, and direct all
administrative and Program activities related to this
Subaward. Project Manager will define the lines of
authority and will develop the roles and parameters
of responsibility for Staff consistent with established County requirements.
Project Manager will serve as the
coordinator/liaison for all Services, ensuring that
any communications related to ENP are conveyed
to the appropriate personnel. Project Manager or
his/her alternate shall oversee all the daily
Subaward activities.
Minimum Required Education, Experience and
Qualifications
Bachelor’s Degree from an
accredited university.
A minimum of five (5) years of
experience in food service or a
related field.
Demonstrable problem-solving
skills and experience.
Ability to explain administrative
goals, policies, and procedures,
and assist Staff in adjusting to
changes that occur.
Ability to evaluate the
performance of Food Service
Manager(s) and Site Manager(s)
based on established criteria.
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Expertise in the provision of social
services to Older Individuals.
Successful completion of basic
training in Hazard Analysis Critical
Control Point principles within six
(6) months of being hired.
Current certification as a Food
Protection Manager by the
National Restaurant AssociationServSafe® or other recognized organization, or certification within
six (6) months of being hired.
Ability to effectively speak, read,
and write fluently in English.
Food Service Manager
When Subrecipient operates a central kitchento
provide Client meals, Subrecipient shall employ a
Food Service Manager who shall oversee the daily
food service operations at each central kitchen,
both managerial and administrative, of the ENP
(see Subsection 10.12 (Central Kitchen/Caterer) for
central kitchen/caterer requirements).
Minimum Required Education, Experience and
Qualifications
Current certification as a Food
Protection Manager by the
National Restaurant AssociationServSafe® or other recognized organization.
Successful completion of basic
training in Hazard Analysis Critical
Control Point principles, and
within six (6) months of being
hired, shall meet one (1) of the
criteria listed below:
Associate’s
Degree in
institutional food
service
management or a
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field such as, but
not limited to,
restaurant
management, plus
two (2) years of
experience as a
food service
supervisor.
Demonstrate
experience in food
service, such as,
but not limited to,
cooking at a
restaurant, and
within twelve (12)
months of hire,
successful
completion of a
minimum of twenty
(20) hours
specifically related
to food service
management,
business
administration, or
personnel
management at
the college level.
Prior to the
completion of the
required hours,
this individual’s performance shall
be evaluated
through quarterly
monitoring by a
registered
dietitian.
Two (2) years of
experience
managing food
services. Such
experience shall
be verified by
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County prior to
hire.
Must be able to speak, read, and
write fluently in English.
Bilingual English/Spanish fluency
is desirable.
Site Manager
When Subrecipient provides Congregate Meal
Services, Subrecipient shall have a Site
Manager(s) at each Congregate Meal site to
oversee all of the daily activities. The Site Manager
shall physically remain at the site during the times
that Congregate Meal Services occur.
Minimum Required Education, Experience and
Qualifications
Certification as a Food Protection
Manager by the National
Restaurant AssociationServSafe®, or other recognized
organization within six (6) months
of being hired.
Demonstrated ability to treat
Clients and Clients’ family
members with respect and dignity.
Must be able to speak, read, and
write fluently in English.
Bilingual English/Spanish fluency
is desirable.
Home-Delivered Meal Case Worker
When Subrecipient provides Home-Delivered Meal
Services, Subrecipient shall have a HomeDelivered Meal Service Case Worker(s).
Under the direction of Project Manager, HomeDelivered Meal Service Case Worker will conduct an in-home evaluation of a Client’s needs and
identify the Activities of Daily Living, Instrumental
Activities of Daily Living, and other limitations that
impede independent living. Home-Delivered Meal
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Service Case Worker shall make recommendations
and referrals as appropriate to other service
organizations, giving priority to AAA-funded
Programs.
Minimum Required Education, Experience and
Qualifications
Bachelor’s Degree in human
services, or two (2) years of fulltime paid or volunteer experience in homecare or a related field.
Demonstrated ability to
communicate effectively with
Clients and Clients’ family
members.
Demonstrated ability to treat
Clients and Clients’ family
members with respect and dignity.
Must be able to speak, read, and
write fluently in English.
Bilingual English/Spanish fluency
is desirable.
Home-Delivered Meal Coordinator
When Subrecipient provides Home-Delivered Meal
Services, Subrecipient shall have a HomeDelivered Meal Coordinator(s) to coordinate and oversee all Home-Delivered Meal routes. HomeDelivered Meal Coordinator must attend all quarterly in-service training sessions provided by
DASS Program subrecipient’s registered dietitian.
Minimum Required Education, Experience and
Qualifications
Certification as a Food Protection
Manager by the National
Restaurant AssociationServSafe® or other recognized
organization within six (6) months
of being hired.
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Demonstrated ability to treat
Clients and Clients’ family
members with respect and dignity.
Must be able to speak, read, and
write fluently in English.
Bilingual English/Spanish fluency
is desirable.
Home-Delivered Meal Driver(s)
When Subrecipient provides Home-Delivered Meal
Services, Subrecipient shall have a HomeDelivered Meal Service Driver(s) who shall have a current, valid, and appropriate California Driver’s
License and current, valid vehicle insurance in
compliance with Subparagraph 8.24 (General
Provisions for all Insurance Coverage) and
Subparagraph 8.25 (Insurance Coverage) of the
Subaward.
Home-Delivered Meal Service Driver shall be
properly trained in food handling as described in
Subsection 10.3.6. and shall attend trainings
conducted by DASS Program subrecipient as
appropriate.
Demonstrated ability to treat Clients and Clients’
family members with respect and dignity.
Bilingual English/Spanish fluency is desirable.
Other Staff
Senior Community Service Employment
Program Title V Participants
Subrecipient shall utilize the
services of Senior Community
Service Employment Program
(SCSEP) Title V Participants at
Congregate Meal sites whenever
possible.
SCSEP Title V Participants must
be appropriately trained and
qualified for the responsibilities
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assigned prior to beginning those
responsibilities.
Subrecipient shall conduct a
background check on any SCSEP
Title V Participant that has direct
Client contact and has access to
the Client’s personal information
and/or case file. Subrecipient is
not required to conduct a
background check on SCSEP
Title V Participants who only
assist in serving meals at the
Congregate site.
Volunteers
Subrecipient shall recruit, train,
and use Volunteers in any phase
of Program operations where
qualified. Volunteers must be
appropriately trained and qualified
for the responsibilities assigned
prior to beginning those
responsibilities.
Volunteers shall be the sole
responsibility of Subrecipient and
shall report to the Project Manager
or to another Employee as
designated by the Project
Manager (if applicable).
If possible, Subrecipient shall
work in coordination with
organizations that have
experience in providing training,
placement, and stipends for
Volunteers or Clients in a
community service setting (such
as organizations carrying out
Federal service programs
administered by the Corporation
for National and Community
Service (CNCS) (see Exhibit P
(Definitions) of the Subaward).
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Subrecipient shall conduct a
background check on any
Volunteer that has direct contact
with Client and has access to the
Client’s personal information
and/or case file. Subrecipient is
not required to conduct a
background check on Volunteers
who only assist in serving meals at
the Congregate site.
Caterer
When Subrecipient will not use a central kitchen as
the sole means of preparing meals, Subrecipient
shall use a Caterer, which meets the minimum
required education, experience, and qualifications
outlined for the Food Service Manager as stated in
Subsection 6.3.8 (Food Service Manager).
Caterer’s facility must be licensed and shall be
inspected and approved by the DASS Program
subrecipient for placement on County’s list of
Approved Caterers. County must grant final
approval of County list of Approved Caterers prior
to utilization by Subrecipient.
Identification Badges
Subrecipient shall ensure that its Staff are appropriately identified as set forth in the Subaward, Subparagraph 7.4 (Subrecipient’s Staff Identification).
Materials and Equipment
The purchase of all materials/equipment to provide the needed Services is the responsibility of Subrecipient. Subrecipient shall adhere to the requirements for purchasing, inventorying, and disposing of material and equipment obtained under the
Subaward as outlined herein and in the Subaward, Exhibit S (Purchase, Inventory and Disposal Requirements for Fixed Assets, Non-Fixed Assets and Supplies). Subrecipient must obtain County approval in writing prior to the purchase of any equipment or vehicles purchased with Subaward Sums as
described in Exhibit S (Purchase, Inventory and Disposal Requirements for Fixed Assets, Non-Fixed Assets and Supplies).
Subrecipient shall use materials and equipment that are safe for the environment and safe for use by Staff.
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All Staff shall be trained in their assigned tasks and in the safe handling of equipment. All equipment shall be checked daily for safety. All Staff must wear safety and protective gear according to Occupational Health and Safety Administration (OSHA) standards.
Use of Personal Protective Equipment
In addition to using food preparation materials,
safety gear, etc., Subrecipient shall provide its Staff with personal protective equipment, which includes
but is not limited to, a fabric face covering, access
to hand sanitizer or a hand washing station for use
every thirty (30) minutes, etc.
Training
Subrecipient shall provide training programs for all new Staff and continue in-service training for all existing Staff. Training shall include, but is not limited to, the provision of an orientation to all new Staff. Subrecipient shall ensure that Staff, both existing and new, are properly trained in all areas related to providing Services.
Subrecipient shall implement an annual written internal staff training plan developed and reviewed by DASS Program
subrecipient and approved by County. The training plan shall be maintained on file by Subrecipient, and shall identify who is to be trained, who will conduct the training, training content, and date scheduled.
Subrecipient shall ensure that food service staff (including Congregate Meal and Home-Delivered Meal staff and
Volunteers) attend a minimum of four (4) hours of mandatory inservice training annually developed and provided by DASS Program subrecipient’s registered dietitian.
Training sessions conducted by Subrecipient shall be evaluated by those receiving the training.
Subrecipient shall maintain written documentation of all training, including agendas, topics, training materials, training evaluations, and attendance records/sign-in sheets, which include both a name and a signature of attendees. Upon request, Subrecipient shall make training records available for inspection by representatives from the State, County, and DASS Program subrecipient.
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Subrecipient shall ensure that all appropriate Staff attend all training sessions as required by County, held at a County facility, at another site, or online as determined by County for
Subrecipient’s benefit. Further, Subrecipient shall ensure that, at a minimum, Subrecipient’s designated Employee represents Subrecipient at each training session. At Subrecipient’s own expense, Subrecipient may elect to attend educational training opportunities outside of Los Angeles County that Subrecipient reasonably deems to be beneficial for the delivery of Services, as well as other trainings designated by County.
Subrecipient shall attend all mandatory trainings scheduled by County or authorized designee. Mandatory trainings may be held at a County facility, at another site, or online. Subrecipient shall be given advance notice of all scheduled trainings with County.
Subrecipient may also be required to attend emergency trainings without the above stated advance notice when necessary.
Subrecipient shall complete a sign-in sheet for face-to-face (inperson) trainings. County will document attendance for online trainings.
Training sessions conducted by Subrecipient shall be evaluated by those receiving the training.
Subrecipient’s failure to attend all mandatory trainings (in-person or online) shall be considered non-compliance with the
Subaward, and may result in further action pursuant to this Subaward, Subparagraph 9.13 (Probation and Suspension), Subaward, Subparagraph 9.18 (Remedies for Non-Compliance), this Statement of Work, Attachment 1 (Performance
Requirements Summary Chart), and any other applicable
remedies.
Security Awareness Training
Subrecipient shall ensure that Staff who handle
confidential, sensitive, or personal identifying
information relating to ENP complete the Security
Awareness Training module, which is available
online at www.aging.ca.gov, within thirty (30) days
of the start date of the Subaward or within thirty (30) days of the start date of any new Staff who work
under the Subaward.
Subrecipient shall maintain certificates of
completion of Security Awareness Training on file
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and provide them upon request by County or State
representatives.
Subrecipient’s Office
Subrecipient shall maintain a physical office in Los Angeles County where Subrecipient conducts business. Subrecipient’s office shall have an active telephone line. The office shall be open at a minimum during normal business hours and shall be staffed by at least one (1) Employee who can respond to inquiries and complaints which may be received about Subrecipient’s performance of the Subaward. When the office is closed during non-business hours, Subrecipient shall utilize an answering service to receive calls. Subrecipient shall respond to calls received by the answering service within forty-eight (48) hours of receipt of the call. Subrecipient shall always have an Employee with the authority to act on behalf of Subrecipient available during normal business hours.
Subrecipient shall publicly display the days and hours of operation for the provision of Services at all Subrecipient office locations/sites. Subrecipient shall ensure that availability for Services is appropriate for the demographics associated with the Service area (site or office location).
Subrecipient shall ensure that all site locations/buildings and surrounding areas are maintained in a manner consistent with applicable local, State, and Federal occupational safety and sanitation laws and regulations. The premises shall be free of any accumulation of garbage, rubbish, stagnant water, and filthy or offensive matter of any kind to ensure that the premises are maintained in a clean and wholesome condition. The physical locations shall be acceptable and accessible to the public.
Subrecipient shall comply with the Americans with Disabilities Act of 1990, as amended.
Subrecipient shall ensure that all site locations are maintained to prevent the entrance and harborage of animals, birds, and vermin, including but not limited to, rodents and insects.
Subrecipient shall utilize the services of a certified/licensed pest control company are obtained to fumigate the premises and perform pest control services on a monthly basis. Subrecipient acknowledges a licensed pest control operator is the only person that can use products/or chemicals in the facility that are deemed acceptable for a commercial kitchen/foodservice facility.
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Subrecipient shall ensure that Integrated Pest Management (IPM) practices are implemented to provide a pest free
environment. IPM practices include but are not limited to:
Keep garbage tightly covered and remove from
kitchen and dining area quickly and properly.
Properly store all food and supplies.
Check all food and supplies entering the building.
Eliminate plumbing leaks and correct other sources
of moisture.
Increase ventilation where condensation is a
problem.
Seal cracks and other openings to the outside.
Remove trash and stored items outside of the
building such as, stacks of lumber or firewood that
provide hiding places for cockroaches and rodents.
Vacuum cracks and crevices to remove food and
debris.
Ensure that surfaces where food or beverages have
been spilled are cleaned up immediately.
Keep cleaning equipment (e.g., mops, sponges,
cloths) dry and properly stored.
Keep toilets and restrooms cleaned and sanitized.
Keep break areas clean and store personal food in
closed containers.
Report building maintenance issues such as holes
in walls, torn window screens, or openings in door
jams to management/Project Manager for repair.
Use traps and baits to monitor the pest population.
When pests are discovered, Subrecipient shall ensure that the Congregate Meal site, catering site or central kitchen is fumigated upon notification of the sighting to eliminate the pests and shall begin weekly IPM pest control activities. In doing so,
Subrecipient shall ensure that:
Project Manager or his/her designee will contact the
Congregate Meal site catering site or central
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kitchen staff (park supervisor, Center Director, site
manager, etc.) and request that a certified/licensed
pest control company be contacted to fumigate the
site. Subrecipient shall work with the
certified/licensed pest control company to
determine the best method to use for each
Congregate Meal site, catering site or central
kitchen based upon the products/chemicals used
and severity of the infestation.
Project Manager or his/her designee shall notify
County’s Compliance Manager and Program
Analyst, and shall also notify the Congregate Meal
site, catering site, or central kitchen site’s
designated DASS Program subrecipient’s
registered dietitian of the pest sighting.
The Congregate Meal site kitchen, catering site
kitchen, or central kitchen site kitchen will be
immediately closed, and pre-packaged meals will
be served to all Clients until the site has been
fumigated, cleaned, sanitized, and inspected by
DASS Program subrecipient’s registered dietitian
and cleared to resume regular Congregate Meal
Services.
Subrecipient shall be responsible for ensuring that IPM weekly pest control activities are conducted at sites where pests have been observed until the site has been re-inspected and cleared by DASS Program subrecipient’s registered dietitian to resume regular meal service. Weekly IPM pest control activities are to be completed on Fridays after meal service, or Saturdays to ensure that regular meal services resume on Monday with no disruption in meal services.
If no pests are found during the re-inspection by
DASS Program subrecipient’s registered dietitian
and all repairs/conditions have been met to resume
regular meal service at the Congregate Meal site,
catering site, or central kitchen, Subrecipient may
request a waiver to resume monthly fumigation and
pest control services. However, if pests are
observed at the Congregate Meal, catering, or
central kitchen site at any time for a period of three
(3) months or ninety (90) days after the reinspection, Subrecipient shall resume weekly IPM pest control activities for a period three (3) months
or ninety (90) days after the site has had a second
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re-inspection and clearance to resume regular meal
service.
If pests are observed by DASS Program
subrecipient’s registered dietitian during the reinspection, and/or requested repairs have not been made, Subrecipient shall ensure that the site is refumigated and weekly IPM activities are conducted for a period of three (3) months or ninety (90) days
after the Congregate Meal, catering or central
kitchen site has had a second re-inspection and
clearance by DASS Program subrecipient’s
registered dietitian to resume regular meal
service. Subrecipient may ask for a waiver to
resume monthly fumigation and pest control
services after the ninety (90) day waiting period if
there are no additional pest sightings and all other
IPM activities have been met.
Congregate Meal, catering or central kitchen sites are considered to have severe infestations if they continue to have pest sightings after weekly IPM activities and two fumigations. Subrecipient shall ensure that these sites continue weekly IPM activities for a period of six (6) months or 180 days after the site has been reinspected and cleared by DASS Program subrecipient’s registered dietitian to resume regular meal service. Subrecipient may ask for a waiver to resume monthly fumigation and pest control services after the 180-day waiting period if there are no additional pest sightings and all other IPM activities have been met.
Any Congregate Meal, catering, or central kitchen site that has pest control issues shall keep a Weekly Log of their pest control activities using the IPM approach until a waiver to resume monthly fumigation and pest control services is granted.
Subrecipient shall adhere to regulations/instructions in the Los Angeles County Area Agency on Aging Foodservice Standard Operating Procedures manual. Subrecipient shall keep written Pest Control Reports and weekly pest control activity logs on file and made available for review by County and DASS Program subrecipient.
Points will be deducted by the DASS Program
subrecipient’s registered dietitian on their monthly
site audit report, whether or not the registered
dietitian is present, if pests are observed in the
following locations:
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Food preparation
Food storage
Ware washing areas
Indoor Client dining areas
Restrooms
Any area adjacent to the above
cited locations that would
compromise the food preparation
and/or storage facility
Subrecipient shall observe all applicable local, State, and Federal health and safety standards. Subrecipient shall ensure that all Clients and all Staff who are in a position not covered under the Occupational Health and Safety Act of 1970, as amended (Title 29 United States Code Section 651 et seq.), and/or the California Occupational Safety and Health Act as amended (California Labor Code Section 6300 et. Seq.), are not required or permitted to work, be trained, or receive Services under working conditions that are unsanitary, hazardous, or otherwise detrimental to a person’s health or safety.
Multilingual and Multicultural Capabilities of Subrecipient Staff Subrecipient must be committed and sensitive to the delivery of Services that are culturally and linguistically appropriate. To that end, Subrecipient must seek to hire qualified Employees who are multilingual and/or multicultural in order to better reflect the communities served.
Subrecipient and its Staff are expected to develop cultural competency and cross-cultural clinical practice skills.
Subrecipient must also develop effective linkages with various ethnic, health, and social service agencies for the benefit of Clients to reflect the ethnic and cultural needs of the community being served.
To the extent feasible, Subrecipient shall provide Services in the primary/native language of Client or in areas where a significant number of Clients do not speak English as their primary language. Subrecipient shall make efforts to employ individuals and recruit Volunteers who are bilingual or who are fluent in the dominant languages of the community. Subrecipient shall not require any Client to provide his/her own interpreter
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HOURS/DAYS OF WORK
Subrecipient shall provide Services and be available to all Clients, potential Clients, and referral sources, as well as County representatives at a minimum during normal business hours. A list of County recognized holidays is provided in Attachment 2 (County Recognized Holidays).
For any site closure, disruption of Services for any non-County recognized holidays (i.e., vacations, city shut-downs, religious holidays, etc.), or any deviation from the traditional Monday through Friday schedule of Services, days, or times, Subrecipient shall submit a written request to County’s Program Manager at least ten (10) business days in advance of the closure/deviation date. This request shall state the date and reason for the closure/deviation and shall provide an action plan to ensure that delivery of Services is not disrupted. The request and action plan must be approved by County’s Program Manager in writing prior to its implementation. The meal service must be available all weekdays and at minimum three (3) days per week at any one site.
Subrecipient must make arrangements for meals to be provided to Clients to cover all days that sites are closed during non-County recognized holidays.
Subrecipient shall also ensure that all Home-Delivered Meal Clients receive meals for days that Subrecipient is closed for non-County recognized holidays.
Subrecipient’s staff shall provide personal telephone contact with Clients, potential Clients, and County, during Subrecipient’s hours of operation.
Subrecipient shall also ensure that each office location has a telephone answering machine or voice mail system in place during non-business hours.
Subrecipient’s staff shall check and respond to all messages in a timely manner but not to exceed forty-eight (48) hours within receipt of the call.
WORK SCHEDULES
Subrecipient shall submit a work schedule for each site to County’s Program Manager within fourteen (14) days prior to starting work. Said work schedules shall be set on an annual calendar identifying all the required on-going specific tasks and task frequencies.
Subrecipient shall submit revised schedules when actual performance differs substantially from planned performance. Said revisions shall be submitted to County’s Program Manager for review and approval within fourteen (14) business days prior to scheduled time for work.
County may request, at its sole discretion, a deviation of regular work schedule to address site/task demands.
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UNSCHEDULED WORK
County’s Program Manager or his/her designee may authorize Subrecipient to perform unscheduled work, including, but not limited to, repairs and replacements when the need for such work arises out of extraordinary incidents such as vandalism, acts of nature, and third party negligence; or to add to, modify or refurbish existing facilities. In the event of an emergency, at its sole discretion, County may request that Subrecipient provide Services beyond normal business hours.
Prior to performing any unscheduled work, Subrecipient shall prepare and submit a written description of the work with an estimate of labor and materials. If the unscheduled work exceeds Subrecipient’s estimate, County’s Program Manager or his/her designee must approve the excess cost. In any case, no unscheduled work shall commence without County’s prior written authorization.
When a condition exists wherein there is imminent danger of injury to the public or damage to property, Subrecipient shall contact County’s Program Manager for approval before beginning the work. A written estimate shall be sent within twenty-four (24) hours for approval. Subrecipient shall submit an invoice to County’s Contract Manager within five (5) business days after completion of the work.
All unscheduled work shall commence on the established specified date.
Subrecipient shall proceed diligently to complete said work within the time allotted.
County reserves the right to perform unscheduled work itself or assign the work to another subrecipient.
SPECIFIC WORK REQUIREMENTS
General ENP Requirements
Subrecipient shall provide Services as described within this Statement of Work, the Subaward terms and conditions, and the following regulations:
Older Americans Act reauthorized (OAA) (Title 42
United States Code Section 3001 et seq.)
Code of Federal Regulations (45 CFR 1321 et seq.)
California Code of Regulations (CCR) Title 22
California Code of Regulations Section 7000 et seq.
Older Californians Act (OCA)
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Welfare and Institutions Code (WIC) Section 9000
et seq.
California Business and Professions Code,
Sections 2585 and 2586
California Retail Food Code (California Health and
Safety Code Section 113700 et seq.)
Los Angeles County Area Agency on Aging
Foodservice Standard Operating Procedures
manual
Subrecipient shall provide meals, meeting the criteria further described in this Section 10.0, to Clients.
Each meal shall provide a minimum of one-third
(1/3) of the current Dietary Reference Intakes
established by the Food and Nutrition Board,
Institute of Medicine, National Academy of
Sciences for the elderly population, and follow the
most recent Dietary Guidelines for Americans
published by the United States Department of
Health and Human Services and the United States
Department of Agriculture (USDA). The meal
pattern must also follow the guidelines established
by County, as updated and distributed annually.
Each meal provided by Subrecipient shall comply
with applicable provisions of State and/or local laws
regarding the safe and sanitary handling of food,
equipment, and supplies used in the storage,
preparation, service, and delivery of meals to
Clients as well as satisfy all the requirements of
Title 22 California Code of Regulations Section
7638.5 and safety standards as written in the
current California Retail Food Code (California
Health and Safety Code Section 113700 et seq.)
and all standards as identified in the Los Angeles
County Area Agency on Aging Foodservice
Standard Operating Procedures manual.
Subrecipient shall provide meals to Clients in a
sanitary manner to assure absence of
contamination. When Subrecipient provides HomeDelivered Meals to any Client, those meals shall be packaged to assure temperature control.
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Subrecipient must serve a minimum of one (1) meal per day, five (5) or more days per week. Meals must be provided a minimum of 249 days per Fiscal Year. Subrecipient must obtain prior written approval from County in order to provide meals on a reduced frequency.
Providing Services at ENP Meal Sites and Routes
Subrecipient shall provide Services for each
Congregate Meal site that is indicated in
Attachment 8 (Site Summary) as well as Exhibit X
(Mandated Program Services) of the Subaward and
each Home-Delivered Meal route that is indicated
in Attachment 10 (Route Summary) as well as
Exhibit X (Mandated Program Services) of the
Subaward.
Subrecipient shall complete Attachment 8 (Site
Summary) for the Congregate Meal Program and
shall adhere to the requirements outlined in
Attachment 9 (Guidelines for Developing Site
Summary) when completing this Attachment.
Subrecipient shall complete Attachment 10 (Route
Summary) for the Home-Delivered Meal Program
and shall adhere to the requirements outlined in
Attachment 11 (Guidelines for Developing Route
Summary) when completing this Attachment.
Subrecipient shall submit these Attachments to
County’s Program Manager in the time and manner
as indicated in Subparagraph 9.22 (Subaward
Document Deliverables) of the Subaward.
Minimum Services for Vulnerable and High-Risk Clients
Subrecipient shall determine the Nutritional Risk
Score for each Client using the factors established
in Attachment 4 (Universal Intake Form), Section 5
(Nutritional Risk Factors). For each Fiscal Year of
the Subaward, in addition to the other Work
requirements included herein, Subrecipient shall
ensure that ENP Services are provided to
Vulnerable and High-Risk Clients, as determined by
each Client’s Nutritional Risk Score, as follows:
Congregate Meal Services: No
less than fifteen percent (15%) of
those Clients receiving
Congregate Meal Services shall
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have a Nutritional Risk Score of
six (6) or above.
Home-Delivered Meal Services:
No less than sixty-five percent
(65%) of those Clients receiving
Home-Delivered Meal Services
shall have a Nutritional Risk Score
of six (6) or above.
Subrecipient shall input a record of all Services delivered including the actual number of meals served per Client per day, Telephone Reassurance contact with Clients, Initial
Assessments, Reassessments, and all other Client contacts in the Management Information System.
Subrecipient shall input a record of all non-delivered Congregate Meals in the Management Information System for the purpose of tracking unmet needs. Subrecipient shall not deny a meal to a Congregate Meal Client unless all other alternate funding options have been exhausted.
Subrecipient shall also enter into the Management Information System all information which the AAA requires (e.g. Nutrition Risk Score, Activities of Daily Living, Instrumental Activities of Daily Living, and demographic information) in order to meet its planning, coordination, evaluation and reporting requirements.
This includes requests to complete missing mandatory fields in the Management Information System.
Subrecipient shall not deny the serving of a meal to a Client who has failed to make a reservation when food is available.
Where feasible and appropriate, Subrecipient must make
arrangements for the availability of a minimum of three (3) meals to Clients during a major disaster, as defined in Title 42 United States Code Section 5122(2).
Subrecipient shall prepare a menu of the meals to be served at each Congregate Meal site. Subrecipient shall ensure that its menus:
Conform to the menu planning and nutrition
standards of County and CDA. Subrecipient shall
review, utilize, and adhere to Menu Writing
Specifications and Requirements as revised
annually by County and CDA.
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Are approved by DASS Program subrecipient’s
registered dietitian prior to submission for
certification by DASS Program subrecipient’s lead
registered dietitian and County. Menus must be
certified annually.
Are planned for a minimum of five (5) weeks.
Are posted weekly in the kitchen at each
Congregate Meal site.
Are posted monthly at each Congregate Meal site
dining room in a location easily seen by Clients.
Are legible and easy to read in English and the
language of the majority of the Clients.
Reflect cultural and ethnic dietary needs of Clients,
when feasible and appropriate.
Adhere to a low sodium content with a target of 500
mg to 750 mg sodium per meal. Catered ethnic
menus may exceed sodium target with DASS
Program subrecipient’s registered dietitian
approval.
To the maximum extent practicable, each meal may be adjusted to meet any special dietary needs of Clients. Special dietary menu variations must be approved by DASS Program
subrecipient’s registered dietitian.
Congregate Meal Services Requirements
Subrecipient shall provide Congregate Meal Services, which include the procurement, preparation, transportation, and serving of nutritious meals to Older Individuals, who meet the criteria identified in Subsection 10.2.2 (Eligibility for Congregate Meal Services), in a group setting at strategically located sites. These Services are intended to reduce hunger and food insecurity, to maintain or improve the physical and social well-being of Older Individuals, and to promote the health and well-being of Older Individuals by assisting them to gain access to nutrition and other disease prevention and health promotion services to delay the onset of adverse health conditions resulting from poor nutritional health or sedentary behavior.
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Eligibility for Congregate Meal Services
Individuals are eligible to become Clients and
receive Congregate Meal Services at a Congregate
Meal site, a location where meals are served, when
they meet at least one (1) of the following criteria:
An Older Individual.
The spouse of any Older
Individual who accompanies the
Older Individual (who participates
in the Program) to the Congregate
Meal site.
A person with a disability, under
age sixty (60), who resides in a
housing facility at which
Congregate Meal Services are
provided, and which is occupied
primarily by Older Individuals.
A disabled individual who resides
at home with and accompanies an
Older Individual (who participates
in the Program) to the Congregate
Meal site. Disability is a condition
attributable to mental or physical
impairments that result in
substantial functional limitations in
one (1) or more of the following
areas of major life activity:
Self-care
Receptive and
expressive
language
Learning
Mobility
Self-direction
Capacity for
independent living
Economic selfsufficiency
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Cognitive
functioning
Emotional
adjustment
Eligibility for Volunteer Meals
A Volunteer is a person who participates in
providing ENP Services without pay. Subrecipient
shall develop a written policy for providing and
accounting for Volunteer meals served for
Volunteers under age sixty (60). Volunteers are
eligible to receive an ENP meal under the following
criteria:
A Volunteer who is sixty (60) years
of age or older meets the age
eligibility criteria to be registered
to receive meals from a
Congregate Meal site.
A Volunteer who is under sixty
(60) years of age may be offered
a meal if doing so will not deprive
an Older Individual of a meal.
Client Assessment for Congregate Meal Services
Congregate Meal Initial Assessment
Requirements of Potential Client
Subrecipient shall complete an
Initial Assessment to determine
potential Client’s eligibility either
two (2) weeks before or two (2)
weeks after potential Client’s
Congregate Meal Services first
begin by using Attachment 4
(Universal Intake Form) as
provided annually by County.
Subrecipient shall complete the
following information on the
Universal Intake Form for the
potential Client:
Name
Address
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Date of Birth
Gender
Sexual Orientation
and Gender
Identity (SOGI)
Veteran Status
Race/Ethnicity
Relationship
Status
Type of Residence
(house,
apartment, etc.)
Living
Arrangement
(alone/not alone)
Rural
Designation/Uninc
orporated City
Receive In-Home
Supportive
Services
Income Status
(which shall be
identified as at,
above, or below
the Administration
on Community
Living (ACL)
Federal Poverty
Guidelines)
Primary Language
Spoken
Nutritional Risk
Score (utilizing the
Nutrition
Screening
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Initiative
Checklist)
Activities of Daily
Living/Instrumenta
l Activities of Daily
Living
Subrecipient shall enter the
Client’s Initial Assessment data
into the Management Information
System within two (2) weeks of the
initial contact with the client and
prior to the date that the Client
begins receiving ENP Services.
The Initial Assessment will be
considered incomplete if any of
the data listed above is missing.
Subrecipient shall assign an
Employee to have the primary
responsibility for Client data entry
into Management Information
System. This person will be the
primary contact person for Client
data issues and problems. The
individual will be assigned a
password to log-in and enter
Client information. A back-up
Employee must be designated to
act on behalf of the primary
Management Information System
contact person in the event of his
or her absence.
Subrecipient shall inform County
of the name of the Subrecipient’s
Management Information System
Employee and back-up Employee
at the start of this Contract and
within two (2) weeks of any
reassignment or substitution. Only
those Subrecipient Employees
who have been designated by
Subrecipient and assigned a
password by County shall be
allowed to access Management
Information System.
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Subrecipient shall work with the
DASS Program subrecipient
identified in the AAA Provider List
(as provided by County on an
annual basis) to refer Clients that
Subrecipient has assessed as
diabetic, and/or have a high
nutrition risk score of ten (10) or
higher, or a nutrition risk score of
six (6) to nine (9) and meet a
secondary criteria, according to
the National Screening Initiative
Checklist (refer to Subsection
10.9 (Mandatory Coordination
with Dietary Administrative
Support Services Program
Subrecipient)).
Subrecipient must include a
written record of each Client’s
Initial Assessment, any
Reassessment (as described in
Subsection 10.2.4.2 (Congregate
Meal Reassessment
Requirements)), and any other
updates in the Client's file.
Subrecipient shall assist Clients in
taking advantage of benefits
under other supportive services
programs (e.g., Title 45 Code of
Federal Regulations Section
1321.65(f)), and Subrecipient
shall provide referral(s) to these
programs as necessary.
Congregate Meal Reassessment Requirements
Subrecipient shall conduct a
Reassessment by completing a
new Attachment 4 (Universal
Intake Form) as described in
Subsection 10.2.4.1 (Congregate
Meal Initial Assessment
Requirements of Potential Client).
A Reassessment shall be
performed annually for each
Client and entered into the
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Management Information System
during the first quarter (July 1st to
September 30th) of each Fiscal
Year for all continuing Clients who
will receive services that Fiscal
Year.
Subrecipient shall enter the
Client’s Reassessment data into
the Management Information
System within two (2) weeks of
completing the Reassessment.
Meal delivery to the Congregate Meal site requires that Subrecipient:
Must ship hot food to Congregate Meal site(s) in
insulated containers, heated containers, or heated
trucks to maintain a temperature of one hundred
forty degrees Fahrenheit (140˚F) or above.
Must ship cold food to Congregate Meal site(s) in
ice chests, insulated containers, or refrigerated
trucks to maintain a temperature of forty-one
degrees Fahrenheit (41˚F) or below. Cold food
shall not come in contact with ice.
Must ship frozen food to Congregate Meal site(s) in
an ice chest with ice, ice blanket or blue ice to
maintain a solid, frozen state. Ice cream shall be at
or below temperatures of seven to ten degrees
Fahrenheit (7˚ - 10˚F).
May ship bread, whole fruits, cookies, cakes, and
other non-potentially hazardous foods to
Congregate Meal site(s) at room temperature.
Temperatures of all hot, cold, and frozen foods
must be taken upon delivery to the Congregate
Meal site and annotated on a food delivery sheet as
instructed in the Los Angeles County Area Agency
on Aging Foodservice Standard Operating
Procedures manual.
Meal Service requires that Subrecipient shall:
Maintain hot food hot, as described in Subsection
10.2.5.1, for a maximum of three (3) hours from the
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completion of cooking at the central kitchen to the
completion of service at the Congregate Meal site.
Maintain hot food hot, as described in Subsection
10.2.5.1, for a maximum of two (2) hours at the
Congregate Meal site.
Serve meals at a regularly scheduled time at each
Congregate Meal site.
Follow the provisions of “Offer Versus Serve” as
found in Title 7 Code of Federal Regulations Part
226.20(p).
Ensure each Congregate Meal site maintains a
minimum participation of at least fifteen (15) Clients
per day. Subrecipient may submit a written request
to County for a waiver to deviate from this
requirement.
Each meal shall be served in a Congregate Meal
site facility that complies with the Americans with
Disabilities Act (ADA) of 1990, as amended (Title
42 United States Code Section 12101 et seq.).
Each facility must have restrooms, lighting, and
ventilation, which meet the requirements of
California Health and Safety Code Section 113700,
et seq. Equipment, including sturdy tables and
chairs, shall be appropriate for Older Individuals.
Tables should be arranged to assure ease of
access and encourage socialization.
Subrecipient shall allow presence of Service Animals as follows:
The ADA defines service animals as dogs that are
individually trained to do work or perform tasks for
people with disabilities. Examples of such work
include guiding people who are blind, alerting
people who are deaf, pulling a wheelchair, alerting
and protecting a person who is having a seizure,
reminding a person with mental illness to take
prescribed medications, etc. Dogs whose sole
function is to provide comfort or emotional support
do not qualify as service animals under the ADA.
State and local governments, businesses, and
nonprofit organizations that serve the public
generally must allow service dogs to accompany
people with disabilities in all areas of the facility
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where the public is normally allowed to go, such as:
patient rooms in hospitals, hospital clinics, hospital
cafeterias, hospital examination rooms, etc.
Subrecipient shall allow the use of service animals
at all Congregate Meal sites. Service animal must
be harnessed, leashed, or tethered, unless these
devices interfere with the service animal's work or
the Client’s disability prevents using these devices.
In that case, Subrecipient may require that the
Client must maintain control of the service animal
through voice, signal, or other effective controls.
Subrecipient acknowledges that a Client with a
disability cannot be asked to remove their service
animal from the premises unless the service animal
is out of control and the Client does not take
effective action to control it or if the service animal is not housebroken. When there is a legitimate
reason to ask that a service animal be removed,
staff must offer the Client with the disability the
opportunity for Services without the service
animal's presence.
Subrecipient acknowledges that Subrecipient's
sites that sell or prepare food must allow service
animals in public areas even if State or local health
codes prohibit animals on the premises. This
includes Congregate Meal sites. Subrecipient Staff
are not required to provide food or care for a service
animal.
Subrecipient shall ensure that Clients with
disabilities who use service animals will not be
isolated from other Clients, treated less favorably
than other Clients, or charged fees that are not
charged to other Clients without service animals.
When it is not obvious what service a service animal
provides, only two (2) limited questions may be
asked:
Is the animal a service animal
required because of a disability?
What work or task has the service
animal been trained to perform?
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Subrecipient Staff cannot ask about a Client’s
disability, require medical documentation, require a
special identification card or training documentation
for a for a service animal, or ask that the service
animal demonstrate its ability to perform any work
or task.
Subrecipient shall ensure that Clients who attend Congregate Meal sites operating in Adult Day Programs and Elderly Housing Facilities meet the eligibility criteria specified in Subsection 10.2.2 (Eligibility for Congregate Meal Services) for Congregate Meal Services; and these sites shall meet the following criteria listed below:
Be open to the general public.
Not receive funds from another source (i.e., MediCal, private payment fees in the form of a flat/bundled rate, etc.) for the cost of the same meal, equipment or Services.
Home–Delivered Meal Services Requirements
Subrecipient shall provide Home-Delivered Meal Services, which include the procurement, preparation, service, and delivery of nutritious meals in home environments/settings to Older Individuals who are homebound by reason of illness, disability or isolation, and meet the criteria identified in Subsection 10.3.2 (Eligibility for Home-Delivered Meal Services). Home-Delivered Meal Services are intended to reduce hunger and food insecurity, maintain and/or improve the physical and social well-being of homebound Older Individuals, and to make referrals for nutrition education, nutrition counseling, and other nutrition services, as appropriate, based on the needs of these Individuals.
Eligibility for Home-Delivered Meal Services
Individuals are eligible to become Clients and
receive Home-Delivered Meal Services when they
meet at least one (1) of the following criteria:
An Older Individual who is frail and
homebound by reason of illness,
disability, or isolation. Priority shall
be given to Older Individuals
described herein. Frail, as defined
in Title 22 California Code of
Regulations Section 7119, is an
Older Individual who is
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determined to be functionally
impaired because the Older
Individual either:
Is unable to
perform at least
two (2) Activities of
Daily Living (ADL),
including:
breathing, bathing,
toileting, dressing,
feeding,
transferring and
mobility and
associated tasks,
without substantial
human
assistance,
including
supervision,
verbal reminding,
or physical cueing;
or
Due to a cognitive
or other mental
impairment,
requires
substantial
supervision
because the Older
Individual behaves
in a manner that
poses a serious
health or safety
hazard to the
Individual or to
others.
The spouse of any Older
Individual described in this
Subsection 10.3.2, regardless of
the spouse’s age or condition, if
an assessment by Subrecipient
concludes that it is in the best
interest of the frail/homebound
Older Individual.
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An individual with a disability who
resides in the home of any Older
Individual as described in this
Subsection 10.3.2, if an Initial
Assessment (defined in
Subsection 10.3.3.1 (HomeDelivered Meal Initial Assessment Requirements of Potential Client))
by Subrecipient concludes that it
is in the best interest of the
homebound Older Individual.
Client Assessment for Home-Delivered Meal Services
Home-Delivered Meal Initial Assessment
Requirements of Potential Client
Subrecipient's initial
determination of potential Client’s
eligibility for Home–Delivered
Meal Services may be
accomplished by telephone.
Subrecipient shall complete a
written Initial Assessment to
determine potential Client’s
eligibility in the potential Client’s
home either two (2) weeks before
or two (2) weeks after potential
Client’s Home-Delivered Meal
Services first begin by using
Attachment 4 (Universal Intake
Form) as provided annually by
County. Completion of written
Initial In-Home Assessment also
pertains to all potential Clients that
require placement on the HomeDelivered Meal Services Waitlist.
The Initial Assessment shall
include the type of meal
appropriate for the potential Client
in their living environment and
Subrecipient shall check to see if
the potential Client has a stove or
microwave to heat or reheat
meals. Subrecipient shall
complete the following information
on the Los Angeles County Area
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Agency on Aging Universal Intake
Form for the potential Client:
Name
Address
Date of Birth
Gender
Sexual Orientation
and Gender
Identity (SOGI)
Veteran Status
Race/Ethnicity
Relationship
Status
Type of Residence
(house,
apartment, etc.)
Living
Arrangement
(alone/not alone)
Rural Designation/
Unincorporated
City
Receive In-Home
Supportive
Services
Income Status
(which shall be
identified as at,
above, or below
the ACL Federal
Poverty
Guidelines)
Primary Language
Spoken
Nutritional Risk
Score (utilizing the
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Nutrition
Screening
Initiative
Checklist)
Activities of Daily
Living/Instrumenta
l Activities of Daily
Living
Subrecipient shall enter the
Client’s Initial Assessment data
into the Management Information
System within two (2) weeks of the
initial contact with the Client and
prior to the date that the Client
begins receiving ENP Services.
The Initial Assessment will be
considered incomplete if any of
the data listed above is missing.
Subrecipient shall assign an
Employee to have the primary
responsibility for Client data entry
into Management Information
System. This person will be the
primary contact person for Client
data issues and problems. The
individual will be assigned a
password to log-in and enter
Client information. A back-up
Employee must be designated to
act on behalf of the primary
Management Information System
contact person in the event of his
or her absence.
Subrecipient shall provide County
the name of Subrecipient’s
Management Information System
Employee and back-up Employee
at the start of this Subaward and
within two (2) weeks of any
reassignment or substitution.
Only those Subrecipient
Employees who have been
designated by Subrecipient and
assigned a password by County
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shall be allowed to access
Management Information System.
Subrecipient shall complete
Attachment 13 (Home-Delivered
Meal Program Priority of Service
Screening Tool) for all Home-
Delivered Meal Clients.
Instructions for completing the
form are provided in Attachment
14 (Home-Delivered Meal
Program Priority of Service
Screening Tool Instructions).
Home-Delivered Meal Clients
shall also be assessed to
determine their need for nutrition-
related supportive services and be
referred as necessary.
Subrecipient shall work with the
DASS Program subrecipient
identified in the AAA Provider List
(as provided by County on an
annual basis) to refer Home-
Delivered Meal Clients that
Subrecipient has assessed as
diabetic, and/or have a high
nutrition risk score of ten (10) or
higher, or a nutrition risk score of
six (6) to nine (9) and meet a
secondary criteria, according to
the National Screening Initiative
Checklist (refer to Subsection
10.9 (Mandatory Coordination
with Dietary Administrative
Support Services Program
Subrecipient)).
Subrecipient shall implement
criteria to assess the level of need for each eligible Home–Delivered Meal Service Client as outlined in
Subsection 10.3.2 (Eligibility for
Home-Delivered Meal Services),
and in the appropriate section(s)
of the most current edition of the
Los Angeles County Area Agency
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on Aging Foodservice Standard
Operating Procedures manual.
Home-Delivered Meal Reassessment
Requirements
Subrecipient shall perform a
Reassessment of a Client’s needs
a minimum of once every three (3)
months (on a quarterly basis)
during the Fiscal Year. A
minimum of one (1)
Reassessment shall be entered
into the Management Information
System during the first quarter
(July 1st to September 30th) of
each Fiscal Year for all continuing
Clients who will receive services
that Fiscal Year.
Reassessments shall be
conducted in the Client’s home at
least every other quarter.
Subrecipient may schedule
Reassessments according to the
Home-Delivered Meal routes
which is assigned to Client (i.e., all
Clients on a Home-Delivered Meal
route are assigned to receive
telephone and/or In-Home
Reassessments at the same
time). Subrecipient shall conduct
Reassessments on the following
schedule commencing three (3)
months from when the Client first
begins receiving Home-Delivered
Meal Services:
Three (3) Month
Reassessment:
Telephone the
Client to
determine if the
need for HomeDelivered Meal
Services still
exists.
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Six (6) Month
Reassessment:
Conduct an In-
Home visit to
determine if the
need for Home-
Delivered Meal
Services still
exists. The visit
may include an
evaluation of the
type of meal (i.e.
hot and/or frozen)
the Client
receives. Also,
ask the Client for
the number of
Emergency Meals
the Client has
remaining.
Nine (9) Month
Reassessment:
Telephone the
Client to
determine if the
need for Home-
Delivered Meal
Services still
exists.
Twelve (12) Month
Reassessment:
Perform a
Reassessment by
completing a new
Attachment 4
(Universal Intake
Form) as stated in
Subsection
10.3.3.1 (Home-
Delivered Meal
Initial Assessment
Requirements of
Potential Client).
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This Reassessment shall be
conducted in the Client’s home.
Subrecipient shall enter Client’s
Reassessment into the
Management Information System
within two (2) weeks of completing
the Reassessment.
Subrecipient shall thereafter
conduct a quarterly update of
Client’s needs based on the three
(3), six (6), nine (9) and twelve
(12) month schedule.
Home-Delivered Meal Waiting List
Reassessment Requirements
Subrecipient shall conduct an inhome assessment for Clients who remain on the Home-Delivered
Meal Waiting List on the third (3rd)
and ninth (9th) month after the
Initial Assessment (refer to
Subsection 10.3.4 (HomeDelivered Meal Waiting List
Requirements)).
Subrecipient shall make every
effort to ensure that HomeDelivered Meal Clients that are removed from the Program are
referred to and linked with other
nutrition-related supportive
services programs for Older
Individuals.
Home-Delivered Meal Waiting List Requirements
Subrecipient must establish and maintain a monthly
Home-Delivered Meal Waiting List in the
Management Information System when it is unable
to provide meals for all Clients who are waiting to
receive Home-Delivered Meals.
A Client’s position on the Home-Delivered Meal
Waiting List shall be prioritized based on the Client
meeting criteria for the greatest economic/social
need, being at risk for institutional placement if
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meals are not provided, and/or in accordance with
policy established by Subrecipient and approved by
the DASS Program subrecipient’s registered
dietitian.
Subrecipient shall complete Attachment 13 (HomeDelivered Meal Program Priority of Service Screening Tool) for all Clients on the HomeDelivered Meal Waiting List.
The Home-Delivered Meal Program Priority of
Service Screening Tool establishes a weight factor
to determine priority placement on the HomeDelivered Meal Waiting List. Subrecipient shall give priority of Service to Clients with the greatest need
and the highest overall score.
Subrecipient shall enter the name and demographic
information of Clients placed on the HomeDelivered Meal Waiting List into the Management Information System.
Subrecipient shall provide a Telephone
Reassurance call to Clients (age sixty (60) or older)
on the Home-Delivered Meal Waiting List each
month to ascertain whether Services are still
needed.
If Services are no longer needed due to enrollment
in the Home-Delivered Meal Program; Subrecipient
shall change the Client’s status in the Management
Information System from “waiting list” to “enrolled”
and add an end date to the waiting list. If Services
are no longer needed due to other factors such as
the Client is no longer interested, etc., Subrecipient
shall remove the Client’s name from waiting list and
enter an end date.
Existence of Home Delivered Meals Waiting List
deems justification for monitoring visits by the
County’s Contract Compliance Division.
Each Home-Delivered Meal may consist of hot, cold, and/or frozen food.
Meal delivery to Home-Delivered Meal Clients requires that Subrecipient:
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Subrecipient shall obtain County permission in
writing prior to providing Home-Delivered frozen
Meals to Clients.
Subrecipient shall set regular delivery schedules so
meals will be delivered at a consistent time each
day.
Subrecipient must provide written instructions for
handling and re-heating Home–Delivered Meals in
the language of the majority of Clients being served
Home-Delivered Meals.
Must ship hot meals to Home-Delivered Meal
Clients in insulated containers, heated containers,
or heated truck to maintain a temperature of one
hundred forty degrees Fahrenheit (140˚F) or above.
Must ship cold food to Home-Delivered Meal
Clients in ice chests, insulated containers, or
refrigerated trucks to maintain a temperature of
forty-one degrees Fahrenheit (41˚F) or below. Food
should not come in contact with ice.
Must ship frozen meals to Home-Delivered Meal
Clients in an ice chest with ice, ice blanket or blue
ice to maintain a solid, frozen state. Ice cream shall
be at or below temperatures of seven – ten degrees
Fahrenheit (7˚ - 10˚F).
May ship bread, whole fruits, cookies, cakes, and
non-potentially hazardous foods to HomeDelivered Meal Clients at room temperature.
Home-Delivered Hot Prepackaged Meals
Home–Delivered hot prepackaged meals shall be
delivered to Clients in a manner that maintains
appropriate temperatures and that protects them
from potential contamination from dust, insects,
rodents, unclean equipment and utensils, and
unnecessary handling.
Home-Delivered Meal routes must be completed in
the shortest time possible to assure absence of
contamination. Home-Delivered hot prepackaged
meals must be delivered to Clients within three (3)
hours after food has left the central kitchen.
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Subrecipient, central kitchen, or caterer must utilize
a batch production cooking schedule (producing the
product in multiple loads/batches) if the same
drivers deliver meals on two (2) routes on the same
day. Hot food may not be held for more than three
(3) total combined hours in the central kitchen and
in the delivery vehicle before delivery.
Home-Delivered Frozen Meals
Subrecipient shall obtain County permission in
writing prior to providing Home-Delivered Frozen
Meals to Clients.
Subrecipient shall conduct an assessment on a
Client’s capability to receive a Home-Delivered
Frozen Meal and ability to prepare a frozen meal
prior to implementing Home-Delivered Frozen Meal
service.
Frozen Home-Delivered Meals and any
accompanying cold and room temperature items
shall be delivered to Clients in a sanitary manner to
assure absence of contamination and shall be
packaged to assure temperature control.
Delivery of Frozen Home-Delivered Meals may
extend beyond three (3) hours provided the frozen
meals remain solidly frozen and do not rise above
twenty-nine degrees Fahrenheit (29˚), and any
accompanying cold food must maintain a
temperature of forty-one degrees Fahrenheit (41˚F)
or below.
Meals must remain frozen until the final delivery is
complete. Temperature should be no higher than
twenty-nine degrees Fahrenheit (29˚F).
Emergency Meal Services Requirements for Home-Delivered Meal Clients
Subrecipient shall provide Emergency Meal Services, which include shelf stable meals provided to Older Individuals who are homebound by reason of illness, disability or who are otherwise isolated. These Services include provision of a minimum of three (3) shelf-stable meals per Fiscal Year. These meals are to be used in the event of an emergency or natural disaster such as earthquakes, power outage, floods, or any disruption of regular DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit A (Statement of Work)
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meal service to ENP Clients who are receiving Home-Delivered Meal Services.
Eligibility for Emergency Meal Services
Individuals are eligible to become Clients and
receive Emergency Meal Services when they meet
the following criteria:
A Home-Delivered Meal Client
(age sixty (60) or older) who is frail
and homebound by reason of
illness, disability, or isolation.
Subrecipient shall have emergency shelf-stable meals available for use during a power outage or any disruption of regular service.
Subrecipient must be able to continue the provision of food to homebound Clients for a minimum of three (3) days in the event that their usual deliveries are disrupted.
Subrecipient may work with the vendor of its choice to develop the menu for Emergency Meals. This menu must be
approved/certified by DASS Program subrecipient’s Project Manager.
Each meal shall provide one-third (1/3) of the current Dietary Reference Intakes included in the current Dietary Guidelines for Americans. Meal components are detailed in the Los Angeles County Area Agency on Aging Foodservice Standard Operating Procedures manual.
All meals must have a minimum of a six (6) month shelf life from the date of purchase/issuance to the Client.
Subrecipient must provide Client with instructions on how and when to use and rotate the emergency food when meals are distributed to Client. Each Home-Delivered Meal Client must be informed of the purpose of the Emergency Meals. The Client or their designated representative must sign an acknowledgment form to indicate receipt of instructions .at the time of delivery.
Subrecipient must maintain the acknowledgement form in the Client’s files.
Emergency Meal distribution may occur during the Initial Assessment for new Home-Delivered Meal Clients or during the Reassessment for existing Home-Delivered Meal Clients.
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Subrecipient must follow-up with all Home-Delivered Meal Clients during each in-home Reassessment to see if the Client still has Emergency Meals available. If the Client no longer has the Emergency Meals, this must be annotated, and Subrecipient may provide Client with an additional three (3) Emergency Meals contingent upon the availability of Subaward funding.
Telephone Reassurance Services Requirements for Home-Delivered Meal Clients
When Subrecipient provides Home-Delivered Meal Services, Subrecipient shall also provide Telephone Reassurance
Services, which are defined as regular telephone contact and safety checks to reassure and support Home-Delivered Meal Services Clients (age sixty (60) or older) and any other Older Individual who is on a waiting list to receive Home-Delivered Meal Services.
Eligibility for Telephone Reassurance Services
Individuals are eligible to become Clients and
receive Telephone Reassurance Services when
they meet the following criteria:
An Older Individual; and
Must be either:
A Home-Delivered
Meal Client (age
sixty (60) or older).
An Older
Individual who is
on the HomeDelivered Meal
waiting list as
recorded in the
Management
Information
System (refer to
Subparagraph
9.18.4 (Information
Technology
Systems –
Management
Information
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System) of the
Subaward).
Telephone Reassurance Services shall only be
provided to Home-Delivered Meal Clients who meet
the age eligibility requirement of sixty (60) years of
age or older.
Subrecipient that delivers Telephone Reassurance Services to individuals not meeting eligibility criteria will be required to repay County for those Services.
Subrecipient shall use trained Volunteers or its Employees to provide regular telephone contact and safety checks to reassure and support Clients who are homebound as specified herein:
Telephone Reassurance Service shall be provided to all Clients receiving Home–Delivered meals (frozen or hot) and to all Clients who are on a Home-Delivered Meal Waiting List in Management Information System for a Home-Delivered meal.
Telephone Call Frequency
At a minimum, Subrecipient must call Clients who
receive Home-Delivered frozen meals one (1) day
per week.
At the discretion of Subrecipient, Clients who
receive Home–Delivered hot meals may be called
one (1) day per week.
Subrecipient shall call Clients who are on a HomeDelivered Meal Waiting List in Management Information System to receive a Home-Delivered
Meal one (1) day per month.
Subrecipient must establish and maintain a
telephone log demonstrating the frequency of calls
for hot, frozen, and wait-listed Home–Delivered
Meal Clients by using Attachment 12 (HomeDelivered Meal Program Telephone Reassurance).
Log).
Subrecipient shall speak with Clients receiving
frozen and/or hot meals and Clients who are on a
waiting list for a Home-Delivered Meal. Telephonic
attempts or leaving voicemail messages does not
qualify as Telephone Reassurance Services.
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Congregate and Home-Delivered Meals Quality Assurance Committee Subrecipient shall establish a Quality Assurance Committee for both Congregate Meal Services and Home-Delivered Meal
Services. This Committee’s purpose shall be: preventing problems and constant quality improvement to ensure that proper food preparation and meal service procedures are being
followed; that the quality of the food is consistent; and that Client satisfaction is being measured. Corrective action shall be taken for any issues identified.
The Quality Assurance Committee shall be appointed by the Subrecipient’s Project Manager and shall include: Project Manager, Site Manager(s), Home-Delivered Meal Coordinator, Food Service Manager or Caterer, Client representatives from the Congregate Meal site(s), and DASS Program subrecipient’s registered dietitians. Clients will be recruited selected and organized by Subrecipient to provide input and advice on Services and Program policies.
Meetings shall be held at least once a month or more frequently, if desired. The Food Service Manager from the Caterer or central kitchen must attend the Quality Assurance meetings.
Minutes detailing each committee meeting shall be kept on file for one (1) year, and shall include: date, time, members in attendance, and a brief summary of the month’s quality
assurance meal evaluations and Congregate Sites Daily Meal Comments as detailed in Section QA-1 of the Los Angeles County Area Agency on Aging Foodservice Standard Operating Procedures manual. Focal point of the minutes shall be the resolution of problems related to quality food production and service. Problems shall be presented, and solutions proposed, tested, and evaluated.
Records shall also be kept of individual quality assurance audits done by committee members.
Quality Assurance meetings can also be included to discuss:
Congregate Meal site audits, Home-Delivered Meal route audits, Caterer audits, central kitchen audits, menu changes, suggested donations, and problems occurring at Congregate Meal sites.
Committee members or other assigned Clients shall conduct meal evaluations at Congregate Meal sites at least once every two (2) weeks or more frequently, if desired. Problem meals or those that are outstanding may warrant unplanned, on-the-spot evaluations by committee members. These evaluations, along DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit A (Statement of Work)
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with written comments provide important data for the problemsolving process.
Two (2) times per month, Home-Delivered Meal route drivers shall complete a simple written quality assurance evaluation while recording temperatures. The quality assurance evaluation shall be completed using a quality assurance evaluation form as provided in the Los Angeles County Area Agency on Aging Foodservice Standard Operating Procedures manual. This
evaluation is to monitor the quality of the meal and to ensure that temperatures are within the required safety standards. Each time, the driver shall be assigned a different day to conduct the temperature monitor and evaluation so that all Home-Delivered Meal routes and meals are tested. An extra meal shall be included on this route and shall be evaluated after the last participant has received a meal.
Meal and Quality Assurance Evaluations
Congregate Meals shall be evaluated daily as part of quality assurance.
The Site Manager shall sample each meal and poll Clients every day to judge meal satisfaction.
On a daily basis, the Site Manager will fill out the Congregate Sites Daily Meal Comments form, which is provided in the Los Angeles County Area Agency on Aging Foodservice Standard Operating Procedures manual.
At a minimum of four (4) times per month, the Site Manager shall assign a Client(s) to complete a Quality Assurance Evaluation form, which is provided in the Los Angeles County Area Agency on Aging Foodservice Standard Operating Procedures manual.
Subrecipient shall provide these completed forms to the Quality Assurance Committee Meeting for review.
Daily Client meal evaluations shall be made available for Clients at each Congregate Meal site. Clients will use these forms to communicate positive and negative comments regarding meal quality. These forms will be reviewed monthly at the Quality Assurance Committee meeting.
On a weekly basis, the Home-Delivered Meal Coordinator shall sample a hot Home-Delivered Meal once each week and
complete the Hot Home-Delivered Meal Daily Meal Comments form, which is provided in the Los Angeles County Area Agency on Aging Foodservice Standard Operating Procedures manual.
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The Home-Delivered Meal Coordinator shall assign a driver to complete a quality assurance meal evaluation a minimum of once per month. Subrecipient shall provide these completed forms to the Quality Assurance Committee Meeting for review.
Subrecipient shall adhere to requests for Corrective Action Plan (CAP) from DASS Program subrecipient and/or County. CAP shall be prepared by Subrecipient to address performance deficiencies at site, route, or caterer/central kitchen. DASS Program Subrecipient shall review and approve plan in addition to monitor remedial action.
Nutrition Services Incentive Program
For purposes of this Subaward, Subrecipient may receive additional funding to supplement the cost for food used in meals served, which is known as the Nutrition Services Incentive Program (NSIP) under Section 311 of the OAA. The purpose of the NSIP is to provide incentives that encourage and reward effective performance by Subrecipient in the efficient delivery of nutritious meals to Clients. NSIP reimbursement may be
requested by Subrecipient for meals which:
Meet the dietary guidelines, as specified in Section
339 of the OAA (Title 42 United States Code
Section 3030g-21).
Are served to Clients, as specified in Subsections
10.2.2 (Eligibility for Congregate Meal Services)
and 10.3.2 (Eligibility for Home-Delivered Meal
Services).
Are served to Volunteers of any age pursuant to
Subsection 10.2.3 (Eligibility for Volunteer Meals).
All meals provided through the ENP that receive
NSIP funds, whether prepared on-site, frozen, nonperishable (e.g. canned goods or pasta, products that do not spoil), boxed, or catered, must comply
with the most recent DGAs and provide a minimum
of one-third (1/3) of the DRIs, and meet the
requirements outlined in Subsection 10.1 (General
ENP Meal Requirements).
Follow the provisions of “Offer Versus Serve” as
found in Title 7 Code of Federal Regulations Part
226.20(p). Congregate Meal Clients may be
permitted to decline items due to preference or
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medical reasons. NSIP funds are not affected
when a Client declines menu items.
Mandatory Coordination with Dietary Administrative Support Services Program Subrecipient
Subrecipient shall work with County’s DASS Program
subrecipient identified in the AAA Provider List (as provided by County on an annual basis). DASS Program subrecipient
provides the following services: oversight of ENP by DASS Program subrecipient’s registered dietitians; nutrition education for Congregate and Home–Delivered Meal Clients; nutrition counseling for Clients with high Nutrition Risk Scores; quality assurance reviews; monitoring of Congregate Meal sites and Home-Delivered Meal routes; in-service training for food service staff and Volunteers; menu analysis; and, technical assistance in areas such as menu development, Caterer selection, purchasing and problem-solving.
Subrecipient shall provide DASS Program subrecipient with the number of Nutrition Education materials needed for distribution to Home-Delivered Meal Clients during the Fiscal Year.
Subrecipient shall make Client referrals for Nutrition Counseling, either in person, by fax, phone or email, to DASS Program subrecipient for all Clients who are diabetic and/or have a Nutritional Risk score of ten (10) and above, or six (6) to nine (9) and meets a secondary criteria below:
Client has an illness or condition that resulted in a
change in the kind and/or amount of food that is
consumed.
Client consumes fewer than two (2) meals per day.
Client has unintentionally lost or gained ten (10)
pounds in the past six (6) months.
Subrecipient acknowledges that Subrecipient’s ENP Services will be monitored by DASS Program subrecipient on a monthly basis and shall cooperate with monitoring efforts. Subrecipient shall correct any problems noted in DASS Program subrecipient's Monitoring Reports provided to Subrecipient each month.
Subrecipient shall have fifteen (15) days from the receipt of the Monitoring Report to respond in writing to DASS Program subrecipient and County in writing with an action plan to correct the problem.
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Subrecipient shall work with DASS Program subrecipient during the Elderly Nutrition Program Annual Assessment process. This includes scheduling visits and providing all requested Client records within required timeframe.
Subrecipient shall work with DASS Program subrecipient’s registered dietitians to develop menus for ENP. All menus must be reviewed, certified, and approved by DASS Program
subrecipient. DASS Program subrecipient and Subrecipient will include input from food production staff, Caterer(s) and Subrecipient’s Quality Assurance Committee as described in Subsection 10.6 (Congregate and Home-Delivered Meals Quality Assurance Committee).
Subrecipient shall work with DASS Program subrecipient to complete the annual nutritional analysis with the designated caterer/central kitchen. Subrecipient will serve as liaison between DASS Program subrecipient and caterer/central kitchen.
Subrecipient’s project menus meeting Dietary Guidelines requirements (Section 339 of the OAA (Title 42 United States Code Section 3030g-21)) must be reviewed, approved and
certified by DASS Program subrecipient’s registered dietitians and approved by County.
Mandatory Coordination with SNAP-Ed/CalFresh Healthy Living Program Subrecipient
Subrecipient shall provide support with planning and
scheduling of SNAP-Ed/CalFresh Healthy Living sessions to County’s SNAP-Ed/CalFresh Healthy Living Program
subrecipient.
Mandatory Coordination with Disease Prevention and Health Promotion Program Subrecipient
Subrecipient shall make referrals, as needed, either in person, by fax, phone or email, to Disease Prevention and Health Promotion (DPHP) Program subrecipient (identified in the AAA Annual Nutrition Program Provider list) for Clients who would benefit from disease prevention and health promotion programs.
Subrecipient may plan and schedule appropriate Health
Promotion Clinics at Congregate Meal sites which are selected with input from Subrecipient’s Quality Assurance Committee and coordinated with the DPHP Program subrecipient.
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Central Kitchen/Caterer
Subrecipient shall use either a central kitchen or Caterer to prepare meals and shall notify County which source Subrecipient will use to obtain meals.
Central Kitchen: When utilizing this option,
Subrecipient asserts that Subrecipient will prepare
meals at a certified commercial kitchen(s).
Caterer: When utilizing this option, Subrecipient
asserts that it will procure a Caterer in accordance
with Subsection 10.13 (Procurement of Caterer)
who will prepare meals and provide them to
Subrecipient.
Subrecipient shall employ a Project Manager, Food Service Manager or a Caterer, and Site Manager who are certified Food Protection Managers by the National Restaurant AssociationServSafe® or other recognized organization. There must be a certified Food Protection Manager in-charge at each central kitchen and at each Congregate Meal site. The Project Manager and Food Service Manager/Caterer must obtain Hazard Analysis and Critical Control Points (HACCP) Program Training within six (6) months of hire.
Subrecipient shall ensure that the requirements of HACCP and quality assurance programs are enforced at all central kitchens and Congregate Meal sites, and that Caterer(s) maintains and utilizes operational HACCP and quality assurance programs.
Subrecipient shall adhere to the Program requirements outlined in Title 22 California Code of Regulations Sections 7630-7638.13 and in the most current edition of the Los Angeles County Area Agency on Aging Foodservice Standard Operating Procedures manual.
Subrecipient shall ensure that a pest control operator inspect the facility on a monthly basis. Subrecipient shall implement an integrated pest management program that provides procedures to prevent and to get rid of pests. These procedures shall include those performed both by central kitchen/catering staff and by the pest control operator. Pest Control Reports shall be kept on file and made available for review by County and DASS Program subrecipient’s registered dietitians.
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Procurement of Caterer
When Subrecipient elects to use the services of a Caterer to prepare/supply meals, Subrecipient shall procure that Caterer from a pool of caterers who are on the AAA Approved Caterer List. Such caterers have been inspected and certified by DASS Program subrecipient and have been approved by County. The AAA Approved Caterer List shall be provided by County on an annual basis.
Pursuant to Title 22 California Code of Regulations Sections 7352 – 7364, Subrecipient shall procure Caterer from the AAA Approved Caterer List using a competitive solicitation process.
Subrecipient shall release a solicitation which can only be responded to by those caterers who are on the AAA Approved Caterer List. After evaluation of all bids/proposals and upon selection of the successful Caterer, Subrecipient shall enter into a Lower Tier Subaward with the successful Caterer. In
accordance with Subparagraph 8.40 (Lower Tier Subaward) of the Subaward, Subrecipient must obtain approval from County prior to entering into the Lower Tier Subaward.
Noncompetitive awards may be made by Subrecipient when the award is infeasible for competitive bid as a result of any of the conditions outlined in Title 22 California Code of Regulations Section 7360 (Noncompetitive Awards).
Health and Fire Inspections
Subrecipient’s Congregate Meal sites, central kitchens and Caterer shall be inspected annually by the County of Los Angeles Department of Health Services (DHS). Subrecipient must
maintain a grade of “B” or better from DHS based on the inspections conducted by DHS for food services. Subrecipient shall work with DASS Program subrecipient to seek assistance in correcting any violations in accordance with the Los Angeles County Area Agency on Aging Foodservice Standard Operating Procedures manual. In accordance with Subparagraph 9.22.3 (Subaward Compliance Documents) of the Subaward,
Subrecipient must submit to County annual inspection reports from DHS for each Congregate Meal site, central kitchen and/or Caterer.
Subrecipient’s Congregate Meal sites and central kitchens shall be inspected annually by the Los Angeles County Fire
Department or Subrecipient’s local fire department. In
accordance with Subparagraph 9.22.3 (Subaward Compliance Documents) of the Subaward, Subrecipient must submit to DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit A (Statement of Work)
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County annual inspection reports from either the Los Angeles County Fire Department or Subrecipient’s local fire department for each Congregate Meal site and central kitchen.
Licenses and Certifications for Services
Subrecipient shall obtain and maintain, all appropriate licenses, permits and certificates required by all applicable County, State of California and/or Federal laws, regulations, guidelines, and directives for the operation of its facility(ies) and for the provision of ENP Services.
Prior to the execution of this Subaward, and, in cases of new staff or staff with updated licenses, permits or certifications, Subrecipient shall provide copies of all new or updated licenses, permits and certificates within ten (10) business days of the license, permit or certification award or update. Copies shall be sent to County’s Program Manager listed in Exhibit E (County’s Administration) of the Subaward.
If Subrecipient operates a central kitchen and/or engages the services of Caterer, Subrecipient must maintain current proof of the following:
Public health permit and business license.
Health Department/DHS inspection report (which
shall be current within the most recent twelve (12)
month period) for each central kitchen and/or
Congregate Meal site.
Fire Department inspection report ((which shall be
current within the most recent twelve (12) month
period) for each central kitchen and/or Congregate
Meal site).
Hazard Analysis Critical Control Point Certificate
and Food Protection Manager Certificate (ServSafe
Certificate) for Food Service Manager.
Subrecipient shall ensure that required Employees
attend ServSafe training and successfully pass
examination. Subrecipient shall absorb cost of
training for Employees that fail examination and are
required to take a remedial course.
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Contributions and Fees for Cost of Meals
Subrecipient shall develop and implement a method to enable Clients to voluntarily contribute to the cost of the Program (i.e., Client who receives a meal shall be given the opportunity to contribute to the cost of the meal).
Subrecipient shall ensure that Clients are not required to contribute to the Program when they are requesting Services.
Subrecipient’s solicitation of voluntary contributions shall not be coercive.
Subrecipient shall clearly inform Client that contributions are strictly voluntary and Subrecipient shall not pressure Client to contribute to the cost of the meal.
Subrecipient shall develop a suggested contribution with input from its Quality Assurance Committee. When developing this contribution amount, the income ranges of the Older Individuals in the community and Subrecipient’s additional sources of income shall be considered.
Subrecipient shall post a sign near the contribution container at each Congregate Meal site indicating the suggested contribution for Clients and the guest fee (amount charged to non-seniors).
The sign shall also state, “Your donation is voluntary and is not a requirement to receive a meal if you are eligible for the Elderly Nutrition Program.”
Staff at the sign-in table must be trained on the donation policy emphasizing the confidential nature of the contributions.
Home-Delivered Meal agreements may have a suggested
donation amount. The agreements shall not be coercive and shall state, “Your donation is voluntary and is not a requirement to receive a meal if you are eligible for the Elderly Nutrition Program.”
Client shall not be denied Services because of his/her failure or inability to contribute to the cost of Services.
Subrecipient shall establish procedures for soliciting donations that provide Clients with a confidential method for making donations.
Subrecipient shall ensure that Client’s decision to contribute as well as the amount of Client’s contribution is kept private and confidential.
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Guest Fees
All guests under the age of sixty (60) shall pay for
the full cost of a meal. The guest fee shall be
sufficient to cover all meal costs.
There is no provision for a guest fee to be private.
Subrecipient shall serve meals to guests only if
sufficient food is available after Clients are served.
Clients shall not be denied Services based on their inability or unwillingness to contribute. Subrecipient shall not use any of the following practices as it relates to voluntary
contributions/donations and/or share of costs:
Requesting Clients to assist in the share of cost to
the Program.
Tracking donations by accounts receivable.
Tracking donations by individual Clients.
Using pamphlets and websites stating that payment
is required for Services or stating a monetary
amount for Services.
Employing tactics, in any way, that could be viewed
as embarrassing and/or obligatory requests for
donations.
Employing tactics such as allowing Volunteers to
guard the collection boxes or having Clients sign in
and pay before receiving Services.
At the time of the Initial Assessment, compelling
Client to pledge a particular amount as an agreed
upon donation.
Using coercion to solicit voluntary contributions.
Using a donation request resembling a billing
statement or invoice.
Imposing a suggested contribution rate based on
an individual’s income.
Subrecipient shall establish and adhere to written procedures to protect contributions and fees from loss, mishandling, and theft.
Such procedures shall be kept on file at Subrecipient’s site.
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Subrecipient shall separate collected contributions
(donations/fees) from Subaward funding. All contributions shall be identified as Program Income and used to: increase the number of meals served, facilitate access to such meals, and to provide nutrition-related supportive services.
Contributions earned in excess of the amount(s) reported in the Budget(s) may be deferred for use in the first quarter of the next Fiscal Year (when County renews the Subaward term) and must be used to expand baseline Services. Such funds shall be recorded as Program Income.
All records of contributions, written procedures governing solicitation of funds, solicitation materials, or other contribution related records shall be held pursuant to record retention policies outlined in Subparagraph 8.38 (Record Retention, Inspection and Audit Settlement) of this Subaward.
Emergency and Disaster Preparedness
Notwithstanding Subrecipient’s and County’s contractual objective to provide Services to Clients, Subrecipient shall make Services available to any person impacted by a nationally or State-declared emergency event, contingent upon the availability and commitment of Federal Emergency Management Agency
(FEMA) or State Office of Emergency Services funds with which to reimburse Subrecipient for funds expended.
In the event of extraordinary incidents, unusual occurrences, natural disasters or crime, including but not limited to repairs, modifications, refurbishment, fumigation, or replacement of facility(ies), vandalism, acts of nature, and third-party negligence, Subrecipient must have an emergency plan in place to ensure that there is no disruption in Services.
Subrecipient must have a written Emergency and Disaster Plan on file describing how Services will be maintained during and following the event of a disaster or emergency. Attachment 6 (Emergency and Disaster Plan Basic Requirements) details the minimum requirements of the plan. The written plan must include the following sections:
Emergency and Disaster Plan Mission
Business Continuity Plan
Emergency Response Organization Chart
Roster of Critical Local Contacts
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Communication Plan
The Emergency and Disaster Plan must be made available to Staff and any County-approved Lower Tier Subrecipients for reference before, during, and after the emergency or disaster.
Subrecipient’s key Staff members shall have a copy of the Emergency and Disaster Plan easily accessible at all times.
Annually, Subrecipient shall update the Emergency and Disaster Plan and submit it to County’s Emergency Coordinator as indicated in Exhibit E (County’s Administration) of the Subaward.
The Emergency and Disaster Plan shall be saved on an
encrypted computer storage jump drive for easy access and transportability.
Subrecipient must maintain an updated hardcopy registry of Clients with contact information for emergency and disaster purposes. Subrecipient shall use the registry to contact Clients to assess if Client is safe, needs a referral to an evacuation center or other assistance, and has a plan to stay in a safe and healthy environment.
Subrecipient must make arrangements for the availability of a minimum of three (3) meals to Clients during a major disaster, as defined in Title 42 United States Code Section 5122(2).
Subrecipient shall complete Attachment 7 (Site Emergency Resource Survey) to help identify and assess potential resources in the community to support the Service population following a large community emergency or disaster.
Annually, on the last business day in September,
Subrecipient shall submit the completed
Attachment 7 (Site Emergency Resource Survey)
to County’s Emergency Coordinator.
Subrecipient shall also complete and submit
Attachment 7 (Site Emergency Resource Survey)
to County’s Emergency Coordinator anytime there
is a change in information.
Subrecipient shall develop and have on file a written Business Continuity Plan (BCP) that describes how Subrecipient will reduce the adverse impact of any emergency event, as
referenced in Subsection 10.17.3.1, to Clients as determined by both the scope of the event (e.g., who and what it affects, and to what extent), and also its duration (e.g., hours, days, months).
Subrecipient shall make the BCP available to its Staff and any DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit A (Statement of Work)
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County-approved Lower Tier Subrecipients for reference before, during, and after such emergency event disruption.
The BCP must include a system to track emergency expenditures and emphasize the following:
Back-up systems for data
Emergency service delivery options
Community resources
Transportation
Subrecipient shall:
Designate an Emergency Coordinator to
communicate with County’s Emergency
Coordinator or designee in the event of an
emergency or disaster and ensure that County’s
Emergency Coordinator or designee has current
contact information for Subrecipient’s Emergency
Coordinator.
Coordinate emergency plans with respective City
Emergency Plans and local Office of Emergency
Services.
Establish alternate communication systems, such
as cell phone or text messaging, in the event that
the regular communication system is interrupted.
Identify lead and support agencies for emergencies
and disasters in the local community so that
response efforts are coordinated with the
appropriate agency.
Maintain a current list of support agencies and
services (in addition to AAA subrecipients) in local
and neighboring communities to provide
Information and Assistance for Clients, their
families and representatives, and facility staff.
Maintain a current list of Subrecipient staff and
Volunteers’ telephone numbers, e-mail addresses,
and emergency contact information.
Maintain adequate emergency and disaster
supplies on site, including emergency first aid
supplies.
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Ensure that there are adequate staff and resources
to execute the emergency and disaster plan in the
event of an emergency or disaster.
Maintain a written escape plan and route for Clients
receiving on-site Services during an emergency or
disaster. The written escape plan and route shall
include a diagram that is visibly posted at the site.
Facilities must have evacuation procedures to
facilitate the safe evaluation of individuals to secure locations.
When necessary and practical, use existing cash
reserves to temporarily cover emergency and
disaster assistance costs for things such as
additional food, supplies, extra Home-Delivered
Meals, home clean-up and safety, emergency
medications, transportation, and other immediate
needs including:
Assisting Older Individuals,
disabled adults, and/or any other
persons seeking refuge by linking
them with medical or emergency
services, family, friends, and
community-based programs such
as the Red Cross or the
appropriate government
agency(ies) that can provide
assistance.
Coordinating Services for Older
Individuals and disabled adults
who may be bedbound,
dependent upon dialysis, or have
life-threatening, chronic illnesses
that require immediate emergency
intervention.
Assisting in the relocation of
homebound, high risk Clients to a
safe location, and coordinating
and arranging emergency
transportation to a predetermined
location.
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Additional Emergency and Disaster Preparedness Policies and Procedures for Home-Delivered Meal Services
The Emergency and Disaster Plan must follow the
instructions the Emergency Planning Policies and
Procedures section of the Los Angeles County Area
Agency on Aging Foodservice Standard Operating
Procedures manual.
Subrecipient shall develop a prearranged
agreement with local food vendor(s) or communitybased organization(s) to assist with the provision of food to homebound Clients for a minimum of three
(3) days in the event that their usual meal deliveries
are disrupted as stated in Subsection 10.17.5.
Food items should include water, frozen meals and
non-perishable goods.
Subrecipient shall have on file a written plan for
continuity of Service following an emergency for a
minimum duration of 72 hours or longer if Client
needing Service is frail or high risk.
Additional Emergency and Disaster Preparedness Policies and Procedures for Congregate Meal Services
The Emergency and Disaster Plan must follow the
instructions provided in the Emergency Planning
Policies and Procedures section of the Los Angeles
County Area Agency on Aging Foodservice
Standard Operating Procedures manual.
Subrecipient shall develop a prearranged
agreement with local food vendor(s) or communitybased organization(s) to assist with the provision of food on site in the event of disruption to the usual
meal service.
Subrecipient shall develop a written escape plan
and route diagram for Clients receiving Congregate
Meals. The written escape plan and route diagram
shall be visible and posted at the meal site.
Subrecipient’s Congregate Meal site(s) must have
evacuation procedures to facilitate the safe
evacuation of Clients to secure locations.
Subrecipient shall develop a plan to feed 200
people per day for at least three (3) days if the
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Congregate Meal site is designated as a Disaster
Site. Food items should include water, frozen
meals and non-perishable goods. Instructions are
provided in the Emergency Planning Policies and
Procedures section of the Los Angeles County Area
Agency on Aging Foodservice Standard Operating
Procedures manual.
Communication Procedures with County
Subrecipient must provide a status update to
County’s Emergency Coordinator or designee in
the event of an emergency or disaster. The
standard communication procedures during and
after an emergency or disaster are as follows:
County’s Emergency Coordinator
will provide information to
Subrecipient and request
feedback regarding the impact of
the emergency or disaster on
Clients, Program operations,
facilities, and where feasible, the
impact on Older Individuals, their
family caregivers, individuals with
disabilities, and any unmet needs
in Los Angeles County (via text
message, email, telephone, or
any other method that is
available).
Subrecipient will provide
information to County’s
Emergency Coordinator regarding
the impact of the emergency or
disaster and any unmet needs
resulting from the event as soon
as possible (via text message,
email, telephone, or any other
method that is available).
Information received by County’s
Emergency Coordinator will be
compiled into a report that will be
submitted to the Los Angeles
County Board of Supervisors and
CDA Disaster Preparedness
Coordinator.
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Alternative Methods of Service Delivery During an Emergency In the event of an emergency (as determined by Federal
authorities, State authorities, and/or County), County, at its sole discretion, may institute alternative methods that Subrecipient shall follow to deliver Services under this Subaward.
Collaborations
Subrecipient must collaborate with County and City of Los Angeles network of providers and other similar community organizations, Adult Protective Services agencies, law
enforcement agencies, and legal services providers in order to ensure comprehensive and coordinated Service delivery and to prevent unnecessary duplication of Services. Subrecipient is encouraged to share vital assessment information with other agencies providing Services to Client in the home. However, in sharing information with other agencies, Subrecipient must respect Client confidentiality rights, adhere to applicable confidentiality regulations, and follow appropriate protocols.
Subrecipient shall develop linkages with other community-based long-term care service providers, particularly those that see Clients at home.
Subrecipient shall establish procedures to protect all Client information consistent with the terms of this Subaward, any amendments thereto and all applicable laws, and shall not disclose Client information without written consent from County and Client.
Community Outreach
Subrecipient shall provide Community Outreach, which is defined as actively providing and disseminating Program information to the public on available Services for potential Clients. Subrecipient shall also market the Services to all ethnic groups in each Service area (i.e., Supervisorial District, Region, etc.) in which the Services are being provided by Subrecipient. Subrecipient’s outreach efforts shall include, but are not limited to, distribution of information about Services to community members; developing referral sources among providers and community based
organizations who work directly with target groups; including representatives of target groups on advisory boards; participating in groups or organizations for vulnerable adults; using culturally appropriate outreach materials; developing additional ways to access Services; utilizing media directed to targets populations; utilizing bilingual Staff; and other strategies to promote access.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit A (Statement of Work)
Rev. 06/2020 Page 70
All materials must be presented in a culturally sensitive manner by Subrecipient.
Subrecipient shall ensure that information and assistance on Services are provided to all populations including, but not limited to, homeless, veterans and Lesbian-Gay-Bisexual-Transgender individuals.
Customer Satisfaction Surveys
Subrecipient shall conduct ongoing Customer Satisfaction Surveys with Clients and retain a copy of all surveys on file and accessible to County for review. The results of the surveys will be used by Subrecipient to make quality improvements in Services provided to all Clients. Subrecipient may be asked by County to comply with and develop other outcome measures.
Subrecipient shall disseminate the Customer Satisfaction Surveys to all Clients who receive Congregate and/or HomeDelivered Meals.
Subrecipient shall collect all Customer Satisfaction Survey responses, tally them during the closeout period, and submit forms to DASS Program subrecipient annually or as specified by County.
Multipurpose Senior Centers
If Subrecipient operates a Multipurpose Senior Center as defined under Title 42 United States Code Section 3002(36),
Subrecipient must adhere to all applicable County, State and Federal guidelines and regulations, including, but not limited to, Title 22 California Code of Regulations Sections 7550 – 7562.
If Subrecipient operates a Multipurpose Senior Center,
Subrecipient shall comply with the provisions contained in the following acts:
Copeland "Anti-Kickback" Act (Title 18 United
States Code Section 874) (Title 29 Code of Federal
Regulations Part 3)
Davis-Bacon Act (Title 40 United States Code
Sections 3141-3142) (Title 29 Code of Federal
Regulations Part 5)
Contract Work Hours and Safety Standard Act (Title
40 United States Code Sections 327-332) (Title 29
Code of Federal Regulations Part 5)
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit A (Statement of Work)
Rev. 06/2020 Page 71
Executive Order 11246 of September 14, 1965
entitled “Equal Employment Opportunity” as
amended by Executive Order 11375 of October 13,
1967 as supplemented in the Department of Labor
Regulations (Title 41 Code of Federal Regulations
Part 60).
Subrecipient acknowledges that when an existing facility has been altered using Subaward Sums and is used as a
Multipurpose Senior Center, the period of time in which such facility must be used as a Multipurpose Senior Center is as follows:
Not less than three (3) years from the date when
this Subaward terminates or expires where the
Subaward Sums, including the non-federal share,
do not exceed thirty thousand dollars ($30,000).
If the Subaward Sums exceed thirty thousand
($30,000), the fixed period of time shall not be less
than three (3) years from the date when the
Subaward terminates or expires, and increased one
(1) year for each additional ten thousand dollars
($10,000), or part thereof, to a maximum
adjustment factor of seventy-five thousand dollars
($75,000).
If the Subaward Sums exceed seventy-five
thousand dollars ($75,000), the fixed period of time
shall not be less than ten (10) years from the date
when the Subaward expires or terminates.
Adult Protective Services
Subrecipient shall make referrals, as needed, to the Adult Protective Services Program (APS) via telephone (877) 477-3646 or online at https://wdacs.lacounty.gov/programs/aps/.
Subrecipient shall comply with all mandated reporting guidelines (Welfare and Institution Code (WIC) section 15630).
Los Angeles Found Program
Subrecipient shall make referrals, as needed, to the Los Angeles Found Program, a voluntary tracking system for individuals living with Alzheimer’s, dementia, autism or other cognitive
impairments. Referrals are to be initiated by calling or emailing as follows: (833) 569-7651 or [email protected].
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit A (Statement of Work)
Rev. 06/2020 Page 72
Senior Farmers’ Market Nutrition Program
Subrecipient shall participate in the annual Senior Farmers’ Market Nutrition Program (SFMNP). Subrecipient shall distribute SFMNP check booklets at all active Congregate Meal sites within the timeframe designated by County.
GREEN INITIATIVES
Subrecipient shall use reasonable efforts to initiate “green” practices for environmental and energy conservation benefits.
Subrecipient shall not use expanded polystyrene (Styrofoam) food and beverage containers in the delivery of food service for both Congregate and Home-Delivered Meals.
Subrecipient shall purchase products that minimize environmental impacts, toxins, pollution and hazards to worker and community safety to the greatest extent practicable.
Subrecipient shall purchase, to the extent possible, reusable and durable goods, biodegradable single-use products, products that include recycled content, conserve energy and water, use agricultural fibers and residues, reduce greenhouse gas emissions, use unbleached or chlorine free manufacturing processes, and use wood from sustainable harvested forests.
Subrecipient shall support strong recycling markets, reduce materials that are put into landfills, and increase the use and availability of environmentally preferable products that protect the environment.
To the extent practicable, Subrecipient shall not use cleaning or disinfecting products (i.e., for janitorial use) that contain carcinogens, mutagens, or teratogens. These include chemicals listed by the United States Environmental Protection Agency or the National Institute for Occupational Safety and Health on the Topics Release Inventory and those listed under Proposition 65 by the California Office of Environmental Health Hazard Assessment.
Subrecipient shall notify County’s Program Manager of Subrecipient’s new green initiatives seven (7) days prior to the commencement of this Subaward.
PERFORMANCE REQUIREMENTS SUMMARY
All listings of Services and requirements reflected in Attachment 1 (Performance Requirements Summary Chart) are intended to be completely consistent with this Subaward and this Statement of Work, and are not meant in any case to create, extend, revise, or expand any obligation of Subrecipient beyond this Subaward and this Statement of Work. In any case of apparent inconsistency between Services and requirements as stated in this DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit A (Statement of Work)
Rev. 06/2020 Page 73
Subaward, this Statement of Work, and the Performance Requirements Summary Chart, the meaning apparent in this Subaward and this Statement of Work will prevail. If Subrecipient initiates a request for a review and as a result, County determines any Services seems to be created in Attachment 1 (Performance Requirements Summary Chart) which is not clearly and forthrightly set forth in this Subaward and this Statement of Work then that apparent Service will be null and void and place no requirement on Subrecipient.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE ATTACHMENT 1
(PERFORMANCE REQUIREMENTS SUMMARY CHART)
The Performance Requirements Summary (PRS) Chart provides a listing of the minimum requirements that Subrecipient shall adhere to, and it reflects the performances that will be monitored during the Subaward term. The PRS Chart also lists examples of the types of documents that will be used during monitoring, as well as the standards of performance and the acceptable quality level of performance.
All listings of required services or standards used in this PRS Chart are intended to be completely consistent with the terms and conditions of this Subaward and Exhibit A (Statement of Work), and are not meant in any case to create, extend, revise or expand any obligation of Subrecipient beyond that defined in the terms and conditions of the Subaward and Exhibit A (Statement of Work). In any case of apparent inconsistency between required services or standards as stated in the terms and conditions of this Subaward, Exhibit A (Statement of Work) and this Attachment 1, the terms and conditions of the Subaward and Exhibit A (Statement of Work) will prevail in that order.
The PRS Chart reflects the areas that shall be evaluated based on the criteria outlined herein.
Performance Requirement
This is the outcome that Subrecipient shall achieve as a result of providing of Program Services to Clients. These outcomes will be analyzed by County to measure the quality and effectiveness of Subrecipient's Program Services, which may affect the availability for future Program funding (i.e., if Subrecipient does not meet an outcome and does not correct deficiency(ies), County shall remedy the non-compliance according to the method indicated as Remedy(ies) for Non-Compliance).
Reference
The document or source of information from which the Performance Requirement is derived.
Standard(s)
This is the benchmark that the Performance Requirement will be measured against and Subrecipient shall not deviate from this without providing a remedy as requested by County.
Acceptable Quality Level
This is the minimum level (measured as a percentage of the Standard(s)) that is used to compare Subrecipient's actual performance against the Standard(s). During the term of the Subaward, Subrecipient shall achieve, at a minimum, the Acceptable Quality Level (AQL) when completing the Performance Requirement. The AQL for each Performance Requirement is established by County and it provides an assurance to County that Subrecipient is satisfactorily providing Program Services. The AQL is used to determine whether Subrecipient is achieving the Performance Requirement in accordance with the Subaward and Exhibit A (Statement of Work). Any deviation from the Standard will result in non-compliance of that Performance Requirement (i.e., Subrecipient is not providing Program Services according to this Subaward).
Remedy(ies) for Non-Compliance
For non-compliance with the AQL, County, at its sole discretion, has the option to apply the remedy(ies) listed and Subrecipient shall adhere to the remedy(ies) as follows: 1) Corrective Action Plan, 2) Probation, 3) Suspend payment(s), 4) Suspend Subaward, 5) Liquidated damages, 6) Reduce and reallocate funds, 7) Terminate Subaward. and/or 8) Placement in County's Contractor Alert Reporting Database.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Performance Requirement Reference Standard(s) Acceptable Quality Level (AQL)
Food Protection Manager/Food Handler Certificates
shall be current.
California Retail Food Code Current certification as a Food Protection Manager by the National Restaurant Association -ServSafe® or other recognized organization.
Employees that are involved in preparation, storage or service in a food facility must possess a current Food Handler’s Certificate issued by an American National Standards Institute (ANSI) accredited training provider that meets ASTM International E2659-09 Standard Practice for Certificate Programs. (CFH card only required if a retail provider – exempt if only providing to senior meal programs).
100%
Caterer and Central Kitchen HACCP safety and
sanitation standards are met and are in compliance
with the requirements of the California Retail Code.
Los Angeles County Area Agency on
Aging Foodservice Standard Operating
Procedures manual
Maintain a monthly monitoring score of 90% or above. 90% Congregate Meal site(s) is in compliance with the
HACCP safety and sanitation standards outlined in
the Los Angeles County Area Agency on Aging
Foodservice Standard Operating Procedures
manual and the requirements of the California Retail
Food Code.
Los Angeles County Area Agency on
Aging Foodservice Standard Operating
Procedures manual
Maintain a monthly monitoring score of 95% or above. 95% Home-Delivered Meal route HACCP safety and
sanitation standards are met and are in compliance
with the requirements of the California Retail Code.
Los Angeles County Area Agency on
Aging Foodservice Standard Operating
Procedures manual
Maintain a minimum monthly monitoring score of 90% or above. 90% Comply with Integrated Pest Management (“IPM”)
requirements.
Exhibit A (Statement of Work),
Subsection 6.7 (Subrecipient's Office)
PM AAA-15-06 (Revised)
Maintain a minimum monthly monitoring score of 90% or above. 90% Exhibit A (Statement of Work),
Subsection 10.2.4 (Client Assessment for
Congregate Meal Services)
Assess the needs for all Congregate Meal Clients within ten (10) business days of commencement of Congregate Meal services 100%
Exhibit A (Statement of Work),
Subsection 10.3.3 (Client Assessment for
Home-Delivered Meal Services)
Conduct in-home assessment of the needs for all HomeDelivered Meal Clients within ten (10) business days of commencement of Home Delivered Meal
In-Home Assessment also required for all potential Clients that require placement on the Home-Delivered Meal Services Waitlist. 100%
Conduct required Client Assessments.
Attachment 1 (Performance Requirements Summary Chart) Page 2 DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Performance Requirement Reference Standard(s) Acceptable Quality Level (AQL)
Exhibit A (Statement of Work),
Subsection 10.2.4.2 (Congregate Meal
Reassessment Requirements)
PM AAA-17-07
Reassessment shall be conducted annually for each Congregate Meal Client.
A reassessment shall be conducted and entered into the
Management Information System during the first quarter (July 1st to September 30th) of each Fiscal Year for all continuing Clients who will receive services that Fiscal Year, regardless of when the last assessment or reassessment was completed.
100%
Exhibit A (Statement of Work),
Subsection 10.3.3.2 (Home-Delivered
Meal Reassessment Requirements)
PM AAA-17-07
Reassessment shall be conducted for every Home-Delivered Meal Client four (4) times per year on a quarterly basis (i.e., every three (3) months).
A reassessment shall be conducted and entered into the
Management Information System during first quarter (July 1st to September 30) of each Fiscal Year for all continuing Clients who will receive services that Fiscal Year, regardless of when the last assessment or reassessment was completed.
Reassessments shall be conducted in the Client’s home at least every other quarter.
100%
Exhibit A (Statement of Work),
Subsection 10.3.3.3 (Home-Delivered
Meal Waiting List Reassessment
Requirements)
Conduct an in-home reassessment for all Clients who remain on the waiting list for Home-Delivered Meals on the third (3rd) and ninth (9th) month after the initial assessment.
100%
Provide ENP Services to the most Vulnerable and
High-Risk Clients.
Exhibit A (Statement of Work),
Subsection 10.1.5 (Minimum Services for
Vulnerable and High-Risk Clients)
15% of Congregate Meal Clients and 65% of Home-Delivered Meal Clients served will have a Nutrition Risk Score of six (6) or above.
100%
Provide Emergency Meals to all Home-Delivered
Meal Services Clients.
Exhibit A (Statement of Work),
Subsection 10.4 (Emergency Meal
Services)
PM AAA-15-03
Provide a minimum of three (3) shelf-stable meals, per fiscal year, to all Home-Delivered Meal Clients.
100%
Call every Home-Delivered Meal Client, age 60 or older, receiving Home-Delivered Frozen Meals once per week.
Telephonic attempts or leaving voicemail messages does not qualify as Telephone Reassurance Services.
100%
Call every potential Home-Delivered Meal Client, age 60 or older, on Waiting List once per month. Telephonic attempts or leaving voicemail messages does not qualify as Telephone Reassurance Services.
100%
Conduct required Client Reassessments.
Provide telephone reassurance to Home-Delivered
Meal Clients.
Exhibit A (Statement of Work),
Subsection 10.5 (Telephone
Reassurance Services Requirements)
Attachment 1 (Performance Requirements Summary Chart) Page 3 DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Performance Requirement Reference Standard(s) Acceptable Quality Level (AQL)
Maintain current Home-Delivered Meals Waiting List Exhibit A (Statement of Work), Subsection 10.3.4 (Home-Delivered Meal
Wait List Requirements)
Subrecipient must establish and maintain a monthly HomeDelivered Meal Waiting List in the Management Information System.
Required completion of the Home-Delivered Meal Program
Priority of Service Screening Tool to determine priority placement on the Home-Delivered Meal Waiting List.
100%
Meals shall meet a minimum one-third (1/3) of
Dietary Reference Intakes.
Exhibit A (Statement of Work),
Subsection 10.1 (General ENP Meal
Requirements)
Each meal provided by Subrecipient shall provide a minimum of one-third (1/3) of the current Dietary Reference Intakes (DRI) established by the Food and Nutrition Board, Institute of Medicine, National Academy of Sciences for the elderly
population, and follow the most recent Dietary Guidelines for Americans published by the United States Department of Health and Human Services and the United States Department of
Agriculture (USDA).
100%
Adhere to the mandatory hours of operation. Exhibit A (Statement of Work), Section
7.0 (Hours/Days of Work)
Subrecipient’s staff shall be available to all Clients, potential Clients, referral sources, as well as County on a minimum five (5) day-a-week (Monday through Friday) basis, eight (8) hours per day for the hours of 8:00 a.m. to 5:00 p.m., (not including County recognized holidays).
100%
Attend County meetings. Exhibit A (Statement of Work),
Subsection 4.2 (Meetings)
Subrecipient shall attend all meetings called by County or its authorized designee.
100%
Ensure that Subrecipient's staff, including employees and volunteers, both existing and new, are properly trained in all areas related to providing ENP Services.
100%
Implement a yearly internal staff training plan developed by the DASS Program subrecipient and approved by County.
100%
Provide Program Services and expend Subaward
Sums.
Subaward Terms and Conditions,
Paragraph 3.0 (Work)
Subrecipient shall provide Services and expend the Subaward Sum allocated for any Fiscal Year under this Subaward as stated in: Paragraph 5.0 (Subaward Sum); Exhibit A (Statement of Work), Attachment 1 (Performance Requirements Summary
Chart); Budget(s); and Mandated Program Services(s).
95%
Submit Budget(s) and Mandated Program Services
documents by County's due date.
Subaward Terms and Conditions,
Paragraph 3.0 (Work)
At County's request, Subrecipient shall complete the Budget and Mandated Program Services documents and submit these
documents by the due date as prescribed by County.
100%
Notify County in writing of any change in name or
address of Subrecipient's Project Manager.
Subaward Terms and Conditions,
Subparagraph 7.2 (Subrecipient's Project
Manager)
Immediately notify County in writing of any change in the name or address of Subrecipient's Project Manager or provide such notification within five (5) business days after the change is effective.
100%
Maintain accurate records related to the Subaward
and Program Services.
Subaward Terms and Conditions,
Subparagraph 8.38 (Record Retention,
Inspection and Audit Settlement)
Subrecipient to maintain all required financial records; employment records; supporting Program documents; proprietary data; information related to its performance of the Subaward; the Subaward; Subaward amendments, addendums and/or
modifications; and, all applicable laws, regulations, directives, change notices and guidance.
100%
Provide training to Subrecipient's staff. Exhibit A (Statement of Work), Subsection 6.6 (Training)
Attachment 1 (Performance Requirements Summary Chart) Page 4 DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Performance Requirement Reference Standard(s) Acceptable Quality Level (AQL)
Obtain prior approval before entering into/amending
Lower Tier Subaward(s).
Subaward Terms and Conditions,
Subparagraph 8.40 (Lower Tier
Subaward)
Obtain County's advance written approval prior to entering into a Lower Tier Subaward for any Work by providing a draft copy of the proposed Lower Tier Subaward to County's Contract
Manager and allowing County up to sixty (60) days to complete the review process.
100%
Maintain current insurance certifications, inspection
reports, permits, licenses, etc. and submit to County
prior to expiration.
Subaward Terms and Conditions,
Subparagraph 8.24 (General Provisions
for all Insurance Coverage),
Subparagraph 8.25 (Insurance Coverage)
and Subparagraph 9.20.3 (Subaward
Compliance Documents)
Maintain proof of all current and required insurance coverage for Subrecipient and any Lower Tier Subrecipient(s), inspection reports, permits, and licenses.
100%
Prepare and submit corrective action plan(s). 2 CFR 200.511 WDACS Directive CCD-18-03
(Resolution Procedures)
WDACS Directive CCD-18-09
(Contractor Alert Reporting Database
Procedures)
Submit a corrective action plan(s) at the direction of County and/or County's duly authorized representatives (including, but not limited to, Federal, State and other County agents) within the prescribed timeline.
100%
Prepare and submit audit engagement letter. 2 CFR 200.501 WDACS Directive CCD-18-09
(Contractor Alert Reporting Database
Procedures)
WDACS Directive CCD-18-05 (Audit
Requirements)
Submit the audit engagement letter for the single audit by the deadline directed by County.
100%
Prepare and submit cost allocation plan. 2 CFR 200.4
WDACS Directive CCD-18-09
(Contractor Alert Reporting Database
Procedures)
WDACS Directive CCD-18-01 (Cost
Allocation and Indirect Cost
Requirements for WDACS Subawards)
Submit a cost allocation plan which adheres to the requirements outlined in WDACS directive CCD-18-01 (Cost Allocation and Indirect Cost Requirements for WDACS Subawards) within the prescribed timeline.
100%
Attachment 1 (Performance Requirements Summary Chart) Page 5 DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE ATTACHMENT 2
(COUNTY RECOGNIZED HOLIDAYS)
New Year's Day .................................................................................................. January 1 Martin Luther King Jr.'s Birthday .......................................... The third Monday in January Presidents' Day .................................................................. The third Monday in February Cesar Chavez Day…………………………………………..........The last Monday in March Memorial Day .............................................................................. The last Monday in May Independence Day ................................................................................................... July 4 Labor Day ......................................................................... The first Monday in September Indigenous Peoples Day ................................................. The second Monday in October Veteran’s Day ............................................................................................... November 11 Thanksgiving Day ......................................................... The fourth Thursday in November Friday after Thanksgiving .................................................. The fourth Friday in November Christmas ..................................................................................................... December 25
*If January 1st, July 4th, November 11th or December 25th fall on a Saturday, the preceding Friday is a holiday.
*If January 1st, July 4th, November 11th or December 25th fall on a Sunday, the following Monday is a holiday.
(Los Angeles County Code Ordinance 96-0003 Section 2, 1996) DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE ATTACHMENT 3 (COMMUNITY FOCAL POINTS LIST)
CCR Title 22, Article 3, Section 7302(a)(14), 45 CFR Section 1321.53(c), OAA 2006 306(a)
In the form below, provide the current list of designated community focal points and their addresses. This information must match the total number of focal points reported in the National Aging Program Information System (NAPIS) State Program Report (SPR), i.e., California Aging Reporting System, NAPISCare, Section III.D.
Designated Community Focal Point Address
Alhambra, City of: Joslyn Adult Center 210 North Chapel Avenue Alhambra, CA 91801
Altadena Community Center (CSS) 730 East Altadena Drive Altadena, CA 91001
Altadena Senior Center (CSS) 560 East Mariposa Street
Altadena, CA 91001
Altamed Health Service: California
Southland Chapter
Site 1:
512 South Indiana Street
Los Angeles, CA 90063
Site 2:
4421 Wilshire Boulevard Suite #400
Los Angeles, CA 90010
Armenian Relief Society 518 West Glenoaks Boulevard
Glendale, CA 91202
Antelope Valley Senior Center (CSS) 777 West Jackman Street Lancaster, CA 93534
Asian Senior Center (CSS) 14112 South Kingsley Drive
Gardena, CA 90249
Avalon Medical Development Corp: Catalina
Island Medical Center
100 Falls Canyon Road
Avalon, CA 90704
Azusa, City of: Azusa Senior Center /Azusa
Recreation & Family Service
Site 1:
740 North Dalton Avenue
Azusa, CA 91702
Site 2:
320 North Orange Place
Azusa, CA 91702
Bet Tzedek Justice for All 3250 Wilshire Boulevard 13th Floor Los Angeles, CA 90010
Burbank, City of : Joslyn Adult Center
/Tuttle Center
B Site 1:
1301 West Olive Avenue
Burbank, CA 91506
Site 2:
1731 North Ontario
Burbank, CA 91505
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Attachment 3 (Community Focal Points List) Page 2
Centro Maravilla Service Center (CSS) 4716 East Cesar East Chavez Avenue Los Angeles, CA 90022
Cerritos Senior Center 12340 South Street
Cerritos, CA 90703
Chinatown Service Center: Little Tokyo
Service Center /Korean Health Education,
Info. & Research Center
Site 1: 231 East 3rd Street Suite #
G106
Los Angeles, CA 90013
Site 2: 3727 West 6th Street Suite #230
Los Angeles, CA 90020
Site 3: 320 South Garfield Avenue
Suite#202
Alhambra, CA 91801
Claremont, City of: Joslyn Center /Blaisdell
Community Center
Site 1:
660 North Mountain Avenue
Claremont, CA 91711
Site 2:
440 South College Avenue
Claremont, CA 91711
Culver, City of: Culver City Senior Center /
Roxbury Park Community Center
Site 1:
4095 Overland Avenue
Culver City, CA 90232
Site 2:
471 South Roxbury Drive
Beverly Hills, CA 90212
East Los Angeles Senior Center (CSS) 133 North Sunol Drive Suite# 237 Los Angeles, CA 90063
East Rancho Dominquez Service Center
(CSS)
4513 East Compton Boulevard
Compton, CA 90221
El Monte, City of: Jack Crippen
Multipurpose Senior Center
3120 North Tyler Avenue
El Monte, CA 91731
Florence/Firestone Service Center (CSS) 7807 South Compton Avenue Los Angeles, CA 90001
Gardena, City of 1670 West 162th Street
Gardena, CA 90247
Glendale, City of : Adult Recreation Center /
Sparr Heights Community Center
Site 1:
201 East Colorado
Glendale, CA 91205
Site 2:
1613 Glencoe Way,
Glendale, CA 91208
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Attachment 3 (Community Focal Points List) Page 3
Grandparents As Parents, Inc. : Corporate
Office / Edelman Court Caregiver Center
Site 1:
22048 Sherman Way #217
Canoga Park, CA 01303
Site 2:
201 Center Plaza Drive – 5
th Floor
#422
Monterey Park, CA 91754
Human Services Association 6800 Florence Avenue
Bell Gardens, CA 90201
Jewish Family Service: West Hollywood
Comprehensive Service Center /Freda Mohr
Multipurpose Center
Site 1:
7377 Santa Monica Boulevard
West Hollywood, CA 90046
Site 2:
330 North Fairfax Avenue
Los Angeles, CA 90036
Just Rite Community Program 17715 Chatsworth Street, Suite 210 Granada Hills, CA 91344
Long Beach Senior Center 1150 East 4th Street
Long Beach, CA 90802
Los Nietos Senior Center (CSS) 11640 East Slauson Avenue Whittier, CA 90606
Norwalk, City of : Senior Center 14040 San Antonio Drive Norwalk, CA 90650
Office of Samoan Affairs 20715 South Avalon Boulevard Suite# 200
Carson, CA 90746
Oldtimers Foundation 3355 East Gage Avenue
Huntington Park, CA 90255
Pomona, City of: Community Service
Department
499 East Arrow Hwy
Pomona, CA 91767
Potrero Heights Park Community and
Senior Center (CSS)
8051 Arroyo Drive
Montebello, CA 90640
San Fernando, City of: Las Palmas Park 505 South Huntington Street San Fernando, CA 91340
San Gabriel Valley Service Center (CSS) 1441 Santa Anita Avenue South El Monte, CA 91733
San Gabriel Valley YWCA 943 North Grand Avenue
Covina, CA 91724
San Pedro Service Center (CSS) 769 West Third Street
San Pedro, CA 90731
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Attachment 3 (Community Focal Points List) Page 4
Santa Anita Family Service 605 South Myrtle Avenue
Morovia, CA 91016
Santa Clarita Valley Community on Aging 22900 Market Street Santa Clarita, CA 91321
Santa Clarita Valley Service Center (CSS) 24271 Main Street Newhall, CA 91321
Senior Care Action Network (SCAN) 2501 Cherry Avenue Suite# 380 Signal Hill, CA 90755
South El Monte, City of : Senior Center 1556 Central Avenue South El Monte, CA 91733
Southeast Area Social Service Funding
Authority
10400 Pioneer Boulevard Suite # 9
Santa Fe Springs, CA 90670
Special Services for Groups: Older Adult
Division
1730 West Olympic Boulevard Floor
3A Suite 100
Los Angeles, CA 90015
Torrance, City of: Community Services
Department, Bartlett Senior Center
1339 Post Avenue.
Torrance, CA 90501
Torrance South Bay Family YMCA 2900 West Sepulveda Boulevard Torrance, CA 90505
USC/LA Caregiver Resource Center 3715 McClintock Avenue Los Angeles, CA 90089
Watts Labor Community Action Committee:
Bradley Multipurpose Center
10937 South Central Avenue
Los Angeles, CA 90059
West Covina, City of 1444 West Garvey Avenue
West Covina, CA 91793
Wise & Healthy Aging 1527 4th Street, 2nd Floor
Santa Monica, CA 90401
Willowbrook Senior Center (CSS) 12915 South Jarvis Avenue Los Angeles, CA 90401
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Los Angeles County Area Agency on Aging Attachment
Agency Name: ______________________________ Client Name: ________________________Date: ____________ UIF (Revised 2018)
UNIVERSAL INTAKE FORM
Funding Identifier:
Title IIIB □ Title C1 □ Title C2 □ Title IIIE □ Title IIIE(G) □ Linkages □
IDENTIFICATION
1a Applicant Last Name First Name Middle Initial GetCare ID # Date of Birth (D.O.B.) Age Social Security # (Optional) Home Address (Number/Street) City State Zip Code
Mailing Address (If different than home address) City State Zip Code Home Phone Work Phone Cell Phone
Email Address
DEMOGRAPHICS
1b
Rural Designation
□ Rural □ Urban □ Declined to State
Unincorporated City
□ Yes □ No □ Declined to State
Sex at birth
□ Male □ Female □ Declined to State
Gender
□ Male □ Female □ Transgender Female to Male
□ Transgender Male to Female □ Genderqueer/ Gender
□ Non-binary □ Not Listed □ Declined to State
Sexual Orientation
□ Straight/Heterosexual □ Bisexual □ Gay/Lesbian/Same Gender-Loving □ Questioning/Unsure □ Not Listed □ Declined to State
Veteran □ Yes □ No □ Declined to State Spouse of Veteran □ Yes □ No □ Declined to State Race
□ White □ American Indian or Alaska Native □ Chinese □ Japanese □ Filipino □ Korean □ Vietnamese □ Asian Indian □ Laotian □ Cambodian □ Other Asian □ Black or African American □ Guamanian □ Hawaiian □ Samoan □ Other Pacific Islander □ Other Race □ Multiple Race □ Declined to State Ethnicity
□ Not Hispanic/Latino □ Hispanic/Latino □ Declined to State Relationship Status □ Single (Never Married) □ Married □ Domestic Partner □ Separated □ Divorced □ Widowed □ Declined to State
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Agency Name: ______________________________ Client Name: ________________________Date: ____________ UIF (Revised 2018) 1b Cont.
Type of Residence
□ House □ Apartment □ Hotel □ Mobile Home
□ Nursing Home □ Residential Care Home
□ Room and Board □ Homeless □ Other □ Declined to State Does the individual
□ Rent □ Own □ Other
□ Declined to State
Employment Status
□ Full-time □ Part-time □ Retired □ Unemployed □ Declined to State Living Arrangement
□ Lives alone without help □ Lives with others without help □ Lives alone with help 4 hrs/day or less
□ Lives with others with help □ Declined to State
Federal Poverty Guideline (FPG)
Is your income □ At or below 100% FPG
□ Above 100% FPG
□ Declined to State
Primary Language
□ American Sign Language □ Arabic □ Armenian □ Cambodian □ Cantonese □ Chinese □ English □ Farsi □ French □ Korean □ Laotian □ Mandarin □ Japanese □ Russian □ Spanish □ Tagalog □ Thai □ Vietnamese □ Other □ Declined to State
Translation needed □ Yes □ No □ Declined to State
EMERGENCY CONTACT
S
2 Contact Last Name First Name Middle
Initial
Address (Number/Street) City State Zip Code
Home Phone Work Phone Cell Phone Relationship
Contact Name (Last, First, Middle Initial) – Optional
Address (Number/Street) City State Zip Code
Home Phone Work Phone Cell Phone Relationship
Primary Physician Office Phone
Physician’s Address City State Zip Code
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Agency Name: _________________________ Client Name: __________________________Date: _______________ UIF (Revised 2018) BENEFITS
3 Are you currently receiving Social Security
Benefits?
□ Yes □ No □ Declined to State
Do you currently receive Supplemental Security Income
(SSI) Benefits?
□ Yes □ No □ Declined to State
Do you participate in CalFresh (Food Stamps, SNAP, EBT)? □ Yes □ No □ Declined to State
Do you have Health Insurance? □ Yes □No
□ Declined to State
Health Insurer’s Name Policy Number: (Optional)
Do you receive Medi-Cal?
□ Yes □ No □ Declined to State
Medi-Cal # (Optional)
Issue date:
Do you receive Medicare?
□ Yes □ No □ Declined to
State
Do you receive In-Home Supportive Services (IHSS)? □ Yes □ No □ Declined to State Do you receive any additional benefits? (i.e., Veterans Benefits, CAPI, etc.)
REFERRAL
INFORMATION
4 Referral Source
Last Name First Name Phone
Address City State Zip Code
Presenting Problems/Services Requested/Comments/Follow-up:
NUTRITIONAL RISK FACTORS
5 NUTRITIONAL RISK FACTORS
(Add the numbers from each checked box to determine Nutrition Risk Score) I have an illness or condition that made me change the kind and/or amount of food I eat. 2 □ Yes □ No □ Declined to State
I eat fewer than 2 meals per day. 3 □ Yes □ No □ Declined to State I eat few fruits or vegetables or milk products. 2 □ Yes □ No □ Declined to State I have 3 or more drinks of beer, liquor or wine almost every day. 2 □ Yes □ No □ Declined to State I have tooth or mouth problems that make it hard for me to eat. 2 □ Yes □ No □ Declined to State I don’t always have enough money to buy the food I need. 4 □ Yes □ No □ Declined to State I eat alone most of the time. 1 □ Yes □ No □ Declined to State I take 3 or more different prescribed or over-the-counter drugs a day. 1 □ Yes □ No □ Declined to State Without wanting to, I have lost or gained 10 pounds in the last 6 months. 2 □ Yes □ No □ Declined to State
I am not always physically able to shop, cook and/or feed myself. 2 □ Yes □ No □ Declined to State Total Nutritional Risk Score (If total is 6 or more, participant is at High Nutritional Risk)
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Agency Name: __________________________ Client Name: __________________________Date: _______________ UIF (Revised 2018) ADL/IADL RISK FACTORS & DISABILITY FACTORS 6 ACTIVITIES OF DAILY LIVING (ADL)/INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL) RISK FACTORS & DISABILITY FACTORS (Excluding Title IIIE Caregiver Program) Activities of Daily Living (ADL)
Independent Verbal
Assistance
Some Human
Help
Lots of Human
Help Dependent Declined to State
Eating □ □ □ □ □ □
Bathing □ □ □ □ □ □
Toileting □ □ □ □ □ □
Transferring □ □ □ □ □ □
Walking □ □ □ □ □ □
Dressing □ □ □ □ □ □
Instrumental Activities of Daily Living (IADL)
Independent Verbal
Assistance
Some Human
Help
Lots of Human
Help Dependent Declined to State
Meal
Preparation
□ □ □ □ □ □
Shopping □ □ □ □ □ □
Med. Mgmt. □ □ □ □ □ □
Money Mgmt. □ □ □ □ □ □
Using Phone □ □ □ □ □ □
Hvy. Housework □ □ □ □ □ □
Lt. Housework □ □ □ □ □ □
Transportation □ □ □ □ □ □
Disability Factors
□ Visually Impaired □ Hearing Impaired □ Speech Impaired □ Physically Impaired □ Walking Aid □ Wheelchair
□ Bedbound □ Memory Impaired □ Depression
□ Cognitively Impaired □ None □ Declined to State
Recent Hospital Discharge □Yes □ No
□ Declined to State
Date of Discharge
Date To Stop Service
Hospital
Diabetic
□ Yes □ No
□ Declined to
State
Have you been diagnosed with Alzheimer’s or a related neurological disorder? □ Yes □ No □ Declined to State
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Agency Name: __________________________ Client Name: __________________________Date: _______________ UIF (Revised 2018) TITLE IIIE CARE RECEIVER DEMOGRAPHICS 7 TITLE IIIE CARE RECEIVER DEMOGRAPHICS
Please make additional copies of Section 7 & 8 if more than one Care Receiver Caregiver
Relationship:
□ Spouse □ Domestic Partner □ Sibling □ Son/Son-in-Law □ Daughter/Daughter-in-Law □ Grandparent □Other Relative □ Non-Relative □Other □ Declined to State Care Receiver Last Name First Name Middle Initial Care Receiver GetCare ID # Address (Number & Street) City State Zip Code
Rural Designation
□ Rural □ Urban □ Declined to State
Unincorporated City
□ Yes □ No □ Declined to State
Home Phone Work Phone Cell Phone Emergency Contact Phone Date of Birth (D.O.B.) Age Gender □ Male □ Female □ Declined to State Social Security # (Optional) Email Address
Veteran
□ Yes □ No □ Declined to State
Spouse of Veteran
□ Yes □ No □ Declined to State
Race
□ White □ American Indian or Alaska Native □ Chinese □ Japanese □ Filipino □ Korean □ Vietnamese □ Asian Indian □ Laotian □ Cambodian □ Other Asian □ Black or African American □ Guamanian □ Hawaiian □ Samoan □ Other Pacific Islander □ Other Race □ Multiple Race □ Declined to State Ethnicity
□ Not Hispanic/Latino □ Hispanic/Latino □ Declined to State Relationship Status
□ Single (Never Married) □ Married □ Domestic Partner □ Separated □ Divorced □ Widowed □ Declined to State
Type of Residence
□ House □ Apartment □ Hotel □ Mobile Home
□ Nursing Home □ Residential Care Home □ Room and
Board □ Homeless □ Other □ Declined to State
Does the individual
□ Rent □ Own
□ Other
□ Declined to State
Living Arrangement
□ Alone
□ Not Alone
□ Declined to State
Receive In-Home Supportive Services (IHSS)?
□ Yes □ No
□ Declined to State
Federal Poverty Guideline (FPG)
Is your Care Receiver income
□ At or below 100% FPG
□ Above 100% FPG □ Declined to State
Have Health Insurance?
□ Yes □ No
□ Declined to State
Receive Medicare?
□ Yes □ No
□ Declined to State
Receive Social Security?
□ Yes □ No
□ Declined to State
Receive Medi-Cal?
□ Yes □ No
□ Declined to State
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Agency Name: ___________________________Client Name: __________________________Date: _______________ TITLE IIIE CARE RECEIVER ADL/IADL RISK FACTORS & DISABILITY FACTORS 8 TITLE IIIE CARE RECEIVER ACTIVITIES OF DAILY LIVING (ADL)/
INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL) RISK FACTORS & DISABILITY FACTORS Activities of Daily Living (ADL) (Grandchildren exempt) Independent Verbal
Assistance
Some Human
Help
Lots of Human
Help Dependent Declined to State
Eating □ □ □ □ □ □
Bathing □ □ □ □ □ □
Toileting □ □ □ □ □ □
Transferring □ □ □ □ □ □
Walking □ □ □ □ □ □
Dressing □ □ □ □ □ □
Instrumental Activities of Daily Living (IADL) (Grandchildren exempt) Independent Verbal
Assistance
Some Human
Help
Lots of Human
Help Dependent Declined to State
Meal
Preparation
□ □ □ □ □ □
Shopping □ □ □ □ □ □
Med. Mgmt. □ □ □ □ □ □
Money Mgmt. □ □ □ □ □ □
Using Phone □ □ □ □ □ □
Hvy. Housework □ □ □ □ □ □
Lt. Housework □ □ □ □ □ □
Transportation □ □ □ □ □ □
Disability Factors
□ Visually Impaired □ Hearing Impaired □ Speech Impaired □ Physically Impaired □ Walking Aid □ Wheelchair □ Bedbound □ Memory Impaired □ Depression □ Cognitively Impaired □ None □ Declined to State
Diabetic
□Yes □ No
□ Declined to
State
Has Care Receiver been diagnosed with Alzheimer’s or a related neurological disorder? □ Yes □ No □ Declined to State
UIF (Revised 2018)
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
ATTACHMENT 5 (SUBAWARD DISCREPANCY REPORT)
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE TO:
FROM:
Date Prepared:
Returned by Subrecipient:
Action Completed:
DISCREPANCY PROBLEMS:
Signature of County Representative Date
SUBCONTRACTOR RESPONSE (Cause and Corrective Action):
Signature of Contractor Representative Date
COUNTY EVALUATION OF SUBCONTRACTOR RESPONSE:
Signature of Contractor Representative Date
COUNTY ACTIONS:
SUBCONTRACTOR NOTIFIED OF ACTION:
County Representative's Signature and Date:
Subcontractor Representative's Signature and Date
SUBAWARD DISCREPANCY REPORT
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE ATTACHMENT 6
(EMERGENCY AND DISASTER PLAN BASIC REQUIREMENTS)
A. Emergency and Disaster Plan Mission and Introductory Statement The mission and introductory statement could be the local Office of Emergency Services (OES) statement, or an expansion of it. The mission and introductory statement should include the following elements:
• How the agency will maintain the continuity of agency services to program recipients during and following disaster and emergency events.
• How the agency will advocate on behalf of older individuals, and their family caregivers within their PSA, to assure that the special needs of older individuals are adequately met, during and following the event.
The agency’s mission and introductory statement might also include how the agency will:
• Assist older individuals and their family caregivers, who have additional needs resulting from a disaster or an emergency event.
• Provide information and assistance to stakeholders on how to be prepared to meet their own needs during and following the event.
• Focus on resuming services as quickly as possible following the event. • Collaborate with local disaster preparedness partners to coordinate services for older individuals and their family caregivers within their PSA. • Prepare for a change in both service demands and in the individual needs of clients currently being served by the agency’s network.
B. Business Continuity Plan
Develop a Business Continuity Plan (BCP) for your agency to ensure that your mission can be carried out. The BCP should:
• Provide a brief statement describing the plan for service-continuity following a disaster if normal resources are unavailable or demand exceeds capacity. • List any MOU or vendor agreements that are in place to provide emergency backup for operations or key resources.
• Have a copy of each signed agreement in an appendix to the plan and on a data-storage device, and review and revise the agreements on an annual basis to assure they remain current.
• Include a contingency plan for staff that are absent or unable to complete their assigned duties.
• Include a system to track emergency expenditures, since they may be reimbursable. • Emphasize communications, backup systems for data, emergency service delivery options, community resources, and transportation.
C. Emergency Response Organization Chart
The chart should include the name, title, and contact information of staff included in disaster and emergency related activities. Outline the relationships and responsibilities for each person responsible for each function:
• Management - who will take charge, delegate responsibilities, and provide overall direction?
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Attachment 6 (Emergency and Disaster Plan Basic Requirements) Page 2 • Operations – who will perform the actions required to get people to safety, restore services, and meet needs or help with recovery?
• Planning – who will gather information and communicate assessments about the emergency and related needs?
• Logistics – who will obtain resources that operations may require? • Finance – who will track expenditures, hours worked, and document events as they occur?
D. Roster of Critical Local Contacts in an Emergency
Include a roster of all contact/agency resources for your Planning and Service Area.
The roster should include at least the following:
• Local OES contact information for each county/city within the PSA. • First responders and law enforcement agencies (Fire, Police, Sheriff). • Hospitals in the service area.
• American Red Cross and other private relief organizations. • Community disaster preparedness groups, such as Volunteer Organizations Active in Disasters (VOAD).
• Telephone or communication tree, individuals on the Agency’s Disaster Preparedness Organizational Chart, and order of contact priority.
• Media – local news/emergency broadcast radio and television stations. • Any additional contacts as appropriate for your community (Ministerial Alliance/Council of Churches).
• Citizen-band clubs or HAM radio operators.
Roster of Critical Local Contacts in an Emergency (Sample) Agency Name: ______________ County/City: ______________ Roster Date: ______________ Agency Contact Name/Title Contact Telephone
Numbers
Contact Email
Address
Example: Local
Office of Emergency
Services
John Doe, Director of
Special Needs
Population
Work:
Cell:
Fax:
Home:
[email protected]
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Attachment 6 (Emergency and Disaster Plan Basic Requirements) Page 3 E. Communication Plan
The Communication plan should include at least the following: first responders, agency staff, service providers, community partners, media, volunteers, clients, local Office of Emergency Services, and the AAA Emergency Coordinator.
Communication Plan (Sample)
(Earthquake scenario used as an example – other scenarios can be substituted) Who How What When Where Why
Who needs to
know
How will the
message be
communicated
What
message do
you want to
convey
them
When do
they need
to know or
what is the
date/time
for the
information
Where are
the areas
affected,
providers
affected,
geographic
area,
locations of
services
Why do they
need this
information
Service
Providers
Telephone,
email, cellular
phone
Location of
elderly and
disabled
shelter
locations
Dates
shelters are
expected to
be in
operation
Address
and contact
information
for shelters
Regular
shelters are
not
available for
special
needs
victims
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE ATTACHMENT 7
(SITE EMERGENCY RESOURCE SURVEY)
Organization Name: _____________________________________________________ Organization Address: ___________________________________________________ Organization Emergency Coordinator’s Name: ________________________________ Organization Emergency Coordinator’s Phone Number: _________________________ After Hours or Cell Phone Number: ________________________________________ Organization Emergency Coordinator Email Address:___________________________
1. Given the need to shelter people (especially older individuals and individuals with disabilities) in the community following a major disaster, could your facility provide temporary shelter space for one or two days? ____Yes ___No ___Maybe (w/ training & support)
If different from the address listed above, please attach the address of each facility to this survey.
2. If you answered “Yes,” to question number 1, how many people can you accommodate? (Please check your best estimate)
___ 1 to 25 ___26 to 50 ___ 51 to 75
___76 to100 ___101 or more (please specify: )
3. In an emergency or disaster, what resources (or supplemental services) could your organization provide? Check all that apply. _____ Counseling Services _____ Emergency Power/Generator _____ Temporary Housing _____ Emergency First Aid
_____ Home/Neighborhood Cleanup _____ Volunteers
_____ Site for Food/Water _____ Kitchen/Cooking Facilities _____ Storage Distribution _____ Other (please indicate below):
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Attachment 7 (Site Emergency Resource Survey) Page 2
4. Following a major emergency or disaster, could your facility assist in transporting older individuals and individuals with disabilities to disaster services?
____ Yes (assuming the resources are not in use) ___ No If you responded “Yes”, what transportation resources does your organization have? Please enter quantity of potentially available transportation resources. ___ Passenger Sedan(s) ___ Vans (Passenger or Cargo)
___ Trucks (Including Pickups) ___ Vans with Wheelchair Lifts ___ Other (please indicate below):
5. Please indicate the support that your organization could provide with language translation, including sign language, at disaster service centers. List languages (other than English):
6. Given the community that your organization serves, would you be able to help in assessing the needs of older individuals in that community or neighborhood following an emergency or disaster?
___ Yes ___ No ___ Maybe (depending on resources at the time) Please indicate the names of the areas, neighborhoods, or communities where you would be able to assess the needs of older individuals?
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Attachment 7 (Site Emergency Resource Survey) Page 3
For organizations that provide meal services:
1. Please indicate the type of meal services that your organization provides. Check all that apply.
____ Congregate Meals ____ Home-delivered Meals
2. Given your resources, could your organization expand meal services following an emergency or disaster to meet the needs in the community? ____ Yes ___ No
If yes, provide the following information for each site that will be able to have expanded meal services:
Site Name: ___________________________________________________ Site Address:__________________________________________________ Site Number: __________________________________________________ Site Emergency Coordinator Name: ________________________________ Site Emergency Coordinator After Hours or Cell Phone Number: _________ Site Emergency Coordinator E-mail: ________________________________ After completing this survey, please send an electronic copy to Miguel Robleto, Human Services Administrator, at [email protected] or mail it to:
Miguel Robleto
3333 Wilshire Blvd., Suite #400
Los Angeles, CA 90010
*It is the responsibility of the AAA Contractor to contact the AAA Emergency Coordinator or designee if there are any changes to the survey. An updated and completed survey must be provided.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
BREAKFAS
T
[NOTE 3]
LUNCH
[NOTE 4]
DINNER
[NOTE 5]
N/A 11:30am1p.m. N/A
N/A 11:30am1p.m. N/A
N/A 11:30am1p.m. N/A
[Enter] [Enter] [Enter]
[Enter] [Enter] [Enter]
[Enter] [Enter] [Enter]
[Enter] [Enter] [Enter]
[Enter] [Enter] [Enter]
[Enter] [Enter] [Enter]
[Enter] [Enter] [Enter]
[Enter Site Name] [Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter Site Name] [Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter] [Enter Site Name] [Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Site Name] [Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Address] [Enter Number] [Enter Name]
M-Th (9am-9pm)
F-Sa (9am-5pm)
[Enter]
8185484098
[Enter Number]
[Enter Name]
[Enter Number]
Naira Unusyan
201 E. Colorado St. Anahit Margaryan 818.548.3775
Program Services:
Fiscal Year:
Subaward Number:
(2)
ADDRESS AND PUBLIC
PHONE NUMBER
8185483775
8185482187
M-F(8:00am-8:00p.m.)
Sa (8am-5p.m.)
S (8am-1p.m.)
M-T (8am-5p.m.)
W-TH (8am-6pm)
Fr (8am-3pm
TITLE III C-1 PROGRAM SERVICES (CONGREGATE MEAL SERVICES) 2020-2021
City of Glendale
(1)
NAME
(2)
PHONE NUMBER
(C)
DAYS/HOURS OF OPERATION [NOTE 1]
(2)
MEAL SERVICES
(B)
SITE MANAGER
(1)
BUSINESS
OPERATIONS
[NOTE 2]
ENP202106
I. SITE SUMMARY
(A)
CONGREGATE MEAL SITE
(3)
SITE PHONE
NUMBER
Sparr Heights Community Center
Note 4: Enter the days and hours during which the site serves meals for lunch. If the site does not provide lunch then enter “Not Applicable” or “N/A”.
Note 5: Enter the days and hours during which the site serves meals for dinner. If the site does not provide dinner then enter “Not Applicable” or “N/A”.
Note 1: Use the following information to complete this section:
Note 2: Enter the days and hours of operation during which the site is open for business. [Enter Number]
Note 3: Enter the days and hours during which the site serves meals for breakfast. If the site does not provide breakfast then enter “Not Applicable” or “N/A”. [Enter]
[Enter]
[Enter]
[Enter Site Name] [Enter Address] [Enter Number] [Enter Name] [Enter] [Enter Site Name]
[Enter Site Name]
Subrecipient's Legal Name:
818.548.2187
(1)
NAME
[Enter Number]
Adult Recreation Center
818.548.3775
[Enter Site Name] [Enter Address] [Enter Name] [Enter Number] Pacific Community Center 501 S. Pacific Ave John Garcia [Enter Address] [Enter Number]
1613 Glencoe Way
Attachment 8 (Site Summary) Page 2
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE ATTACHMENT 9
(GUIDELINES FOR DEVELOPING SITE SUMMARY)
GENERAL INFORMATION
1. Please use the following guidelines to complete the electronic version of Attachment 8 (Site Summary) which has been developed as an Excel workbook.
2. The Site Summary for the Title III C-1 Program Services workbook includes several sheets which are labeled as follows:
a. Cover Page
b. Site Summary
3. Guidelines for completing the requested information for each sheet in the workbook are included herein and these guidelines are listed in the same order as the sheets are ordered in the workbook.
4. The workbook has been protected to prevent changes to specific cells.
Subrecipient shall provide information in the cells which are not protected.
Please do not attempt to circumvent the protection that has been enabled in the workbook. County will take appropriate remedies against Subrecipient when County discovers any such attempts to alter the workbook in any manner. Such remedies may include (but are not limited to) those outlined in Subparagraph
9.18 (Remedies for Non-Compliance) of the Subaward.
5. The workbook has been configured to automatically populate certain cells such as Program Services, Fiscal Year, Subaward Number, etc. on specific sheets.
6. In order to maintain the integrity of the workbook, do not use formulas or decimals to enter information into any cell (unless expressly authorized in an instruction).
7. The information provided in Attachment 8 (Site Summary) may be used publically (e.g., directories, County’s website, brochures, etc.).
8. To enter a hard return within a cell, press “Alt” and “Enter”.
9. Subrecipient shall maintain documentation to support the information provided in this workbook. Upon request by County, Subrecipient shall make such documentation available to County within the timeframe and manner as designated by County.
COVER PAGE
1. The Cover Page provides information about Subrecipient such as its legal name, address, contacts, etc.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Attachment 9 (Guidelines for Developing Site Summary) Page 2
2. Enter all requested information that is indicated by the blue font. Please note that some of this information (i.e., Program Services, Fiscal Year, Subaward Number, etc.) will automatically populate on all other sheets of the workbook.
3. Program Services
a. The title of the Program Services is pre-populated. This workbook has been developed for Title III C-1 Program Services (“Program Services” or “Program”).
4. Fiscal Year
a. Identify the Fiscal Year for which the Program Services are being provided by using the following format: 2020-2021.
5. Subaward Number
a. Enter the Subaward number as provided by County in the funding allocation letter. If you need assistance in identifying the Subaward number, contact your agency’s assigned Contract Analyst.
6. Subrecipient’s Legal Name
a. Enter the full legal name of Subrecipient’s organization (please do not abbreviate). The name listed herein must match the name on Subrecipient’s articles of incorporation, business license, city charter or bylaws.
7. Main Administrative Office Address
a. Enter the address (street number and name, suite number, city, state and zip code) of the official representative who is authorized to sign for Subrecipient (“Authorized Representative”) on this line. County will use this information to send correspondence to Authorized Representative.
8. Mailing Address (if different from above)
a. If the main administrative office address and the mailing address are the same, enter the following language on the mailing address line: Same as Admin Office. Otherwise, if these two (2) addresses are different then enter the address (street number and name, suite number, city, state and zip code). County will use this information to send correspondence to primary/secondary contact.
9. Authorized Representative
a. Enter the name of the individual who has been authorized to sign legally binding documents on behalf of Subrecipient’s organization where such authorization has been decreed through organization’s board resolution or other authorizing document.
b. Prefix: Enter the appropriate prefix for Authorized Representative.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Attachment 9 (Guidelines for Developing Site Summary) Page 3 c. Job Title: Enter the title of Authorized Representative. Please abbreviate the job title if the title does not fit in the cell.
d. Phone Number and Ext.
i. Enter the phone number of Authorized Representative where this individual can be reached directly. When entering the phone number, enter only numbers without spaces, hyphens, parenthesis or any additional characters (i.e.,2137304414). The result will display in the correct format (i.e., (213) 730-4414).
ii. If the phone number is not a direct number then enter the extension where the individual can be reached directly. When entering the extension, enter only numbers without spaces, hyphens,
parenthesis or any additional characters (i.e., 8667).
e. E-Mail Address: Enter the e-mail address of Authorized Representative.
10.Primary/Secondary Contact for Program
a. Enter the name of the individual who is responsible for overseeing the day-to-day Program Services.
b. Prefix: Enter the appropriate prefix for primary/secondary contact. c. Job Title: Enter the title of the primary/secondary contact. Please abbreviate the job title if the title does not fit in the cell. d. Phone Number and Ext.
i. Enter the phone number of the primary/secondary contact for Program where this individual can be reached directly. When entering the phone number, enter only numbers without spaces, hyphens, parenthesis or any additional characters
(i.e.,2137304414). The result will display in the correct format (i.e., (213) 730-4414).
ii. If the phone number is not a direct number then enter the extension where the individual can be reached directly. When entering the extension, enter only numbers without spaces, hyphens,
parenthesis or any additional characters (i.e., 8667).
e. E-Mail Address: Enter the e-mail address of the primary/secondary contact.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Attachment 9 (Guidelines for Developing Site Summary) Page 4
SECTION (SITE SUMMARY)
1. This sheet provides specific information that describes the location, point of contact, hours of operation, etc. for each Congregate Meal site that Subrecipient will serve. This information is presented under the following Columns (and an explanation will be provided for each):
a. Column (A) Congregate Meal Site
b. Column (B) Site Manager
c. Column (C) Days/Hours of Operation
2. Column (A) Congregate Meal Site
a. Column (1) Name
i. Enter the site’s name.
ii. The Congregate Meal sites listed herein shall match those sites listed in Exhibit X1 (Mandated Program Services for Title III C-1 Program), Section II (Services by Month), Column (B) Site Name. b. Column (2) Address and Public Phone Number
i. Provide the address of the physical location of the Congregate Meal site.
ii. Provide the public phone number that can be used by the general public to contact the main site.
iii. Provide the site’s phone number that can be used to directly contact onsite meal staff.
3. Column (B) Site Manager
a. Column (1) Name
i. Enter the full name of the site’s manager.
b. Column (2) Phone Number
i. Enter the direct telephone number of the site’s manager.
4. Column (C) Days/Hours of Operation
a. Use the following information to complete this section:
i. Enter the day(s) as follows: Monday = M; Tuesday = T; Wednesday = W; Thursday = Th; Friday = F; Saturday = S; and Sunday = Su
ii. Enter the hours as follows: 8:00 a.m. – 10:30 a.m.
iii. Example 1: a site which provides Services on Monday, Wednesday and Friday between 11:00 a.m. to 1:00 p.m. and DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Attachment 9 (Guidelines for Developing Site Summary) Page 5 Tuesday and Thursday between 4:00 p.m. to 6:00 p.m. would enter the following information: M,W,F (11:00 a.m. – 1:00 p.m.) T,Th (4:00 p.m. – 6:00 p.m.).
a. Column (1) Business Operations
i. Enter the site’s days and hours of operation during which the site is open for business.
b. Column (2) Meal Services
ii. Breakfast: Enter the days and hours during which the site serves meals for breakfast. If the site does not provide breakfast then enter “Not Applicable” or “N/A”.
iii. Lunch: Enter the days and hours during which the site serves meals for lunch. If the site does not provide lunch then enter “Not Applicable” or “N/A”.
iv. Dinner: Enter the days and hours during which the site serves meals for dinner. If the site does not provide dinner then enter “Not Applicable” or “N/A”.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
Program Services:
Fiscal Year:
Subaward Number:
Subrecipient's Legal Name:
Note 1: Enter the day(s) and the time when the meal delivery for the route starts by using the following information:
1. Enter the day(s) of delivery: Monday = M; Tuesday = T; Wednesday = W; Thursday = Th; Friday = F; Saturday = Sa; Sunday = Su
2. Enter the delivery start time (e.g., 8:00 a.m.)
3. Example: When delivery of Services occurs on Monday, Wednesday and Friday starting at 6:00 a.m. and Tuesday and Thursday starting at 8:00 a.m., enter the following information: M,W,F (6:00 a.m.) T,Th (8:00 a.m.).
Note 2: Enter the day(s) and the time when the meal delivery for the route ends by using the following information:
1. Enter the day(s) of delivery: Monday = M; Tuesday = T; Wednesday = W; Thursday = Th; Friday = F; Saturday = Sa; Sunday = Su
2. Enter the delivery ending time (e.g., 12:00 p.m.)
3. Example: When delivery of Services occurs on Monday, Wednesday and Friday ending at 10:00 a.m. and Tuesday and Thursday ending at 12:00 p.m., enter the following information: M,W,F (10:00 a.m.) T,Th (12:00 p.m.)
(2)
STAFF DRIVER'S
NAME
(A)
HOME-DELIVERED
MEAL ROUTE NAME
(B)
LOCATION OF MEAL
PACKAGING FACILITY
(NAME AND ADDRESS)
(C)
CLIENT ZIP CODE(S)
SERVED BY ROUTE
[Enter Name} 2:00p.m. 4:00p.m.
Route 1 ( Monday) Adult Recreation Center
201 E. Colorado St. 91202-91206 2006/,GMC Savana Allison Gallaher Route 2 (Tuesday) Adult Recreation Center
201 E. Colorado St.
Allison Gallaher
91203-91205 2006/,GMC
Savana Allison Gallaher
Route 3 (Wednesday) Adult Recreation Center
201 E. Colorado St.
[Enter Route Name] [Enter Location Name and
Address] [Enter Zip Code] [EnterYear/Make/Model] [Enter Name] [Enter Name} [Enter] [Enter] [Enter Name] [Enter Name} [Enter] [Enter]
2006/,GMC
Savana
TITLE III C-2 PROGRAM SERVICES (HOME-DELIVERED MEAL SERVICES) 2020-2021
City of Glendale
(D)
VEHICLE INFORMATION
(1)
YEAR/MAKE/
MODEL
[Enter Name} 2:00p.m. 4:00p.m.
[Enter Name} 2:00p.m. 4:00p.m.
[Enter Name} 2:00p.m. 4:00pm
ENP202106
I. ROUTE SUMMARY
(E)
DELIVERY
DAY(S)/TIME(S)
(3)
VOLUNTEER
DRIVER'S NAME
(1)
START
[NOTE 1]
(2)
END
[NOTE 2]
Allison Gallaher
Adult Recreation Center
201 E. Colorado St. Route 4 (Thursday)
91201-91206
2006/,GMC
Savana 91208-91214
[Enter Route Name] [Enter Location Name and
Address] [Enter Zip Code]
[Enter Route Name] [Enter Zip Code] [Enter Name]
[EnterYear/Make/
Model]
[Enter Location Name and
Address]
[EnterYear/Make/
Model] [Enter Name} [Enter] [Enter]
Attachment 10 (Route Summary) Page 2
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE ATTACHMENT 11
(GUIDELINES FOR DEVELOPING ROUTE SUMMARY)
GENERAL INFORMATION
1. Please use the following guidelines to complete the electronic version of Attachment 10 (Route Summary) which has been developed as an Excel workbook.
2. The Route Summary for the Title III C-2 Program Services workbook includes several sheets which are labeled as follows:
a. Cover Page
b. Route Summary
3. Guidelines for completing the requested information for each sheet in the workbook are included herein and these guidelines are listed in the same order as the sheets are ordered in the workbook.
4. The workbook has been protected to prevent changes to specific cells.
Subrecipient shall provide information in the cells which are not protected.
Please do not attempt to circumvent the protection that has been enabled in the workbook. County will take appropriate remedies against Subrecipient when County discovers any such attempts to alter the workbook in any manner. Such remedies may include (but are not limited to) those outlined in Subparagraph
9.18 (Remedies for Non-Compliance) of the Subaward.
5. The workbook has been configured to automatically populate certain cells such as Program Services, Fiscal Year, Subaward Number, etc. on specific sheets.
6. In order to maintain the integrity of the workbook, do not use formulas or decimals to enter information into any cell (unless expressly authorized in an instruction).
7. The information provided in Attachment 10 (Route Summary) may be used publically (e.g., directories, County’s website, brochures, etc.).
8. To enter a hard return within a cell, press “Alt” and “Enter”.
9. Subrecipient shall maintain documentation to support the information provided in this workbook. Upon request by County, Subrecipient shall make such documentation available to County within the timeframe and manner as designated by County.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Attachment 11 (Guidelines for Developing Route Summary) Page 2
COVER PAGE
1. The Cover Page provides information about Subrecipient such as its legal name, address, contacts, etc.
2. Enter all requested information that is indicated by the blue font. Please note that some of this information (i.e., Program Services, Fiscal Year, Subaward Number, etc.) will automatically populate on all other sheets of the workbook.
3. Program Services
a. The title of the Program Services is pre-populated. This workbook has been developed for Title III C-2 Program Services (“Program Services” or “Program”).
4. Fiscal Year
a. Identify the Fiscal Year for which the Program Services are being provided by using the following format: 2020-2021.
5. Subaward Number
a. Enter the Subaward number as provided by County in the funding allocation letter. If you need assistance in identifying the Subaward number, contact your agency’s assigned Contract Analyst.
6. Subrecipient’s Legal Name
a. Enter the full legal name of Subrecipient’s organization (please do not abbreviate). The name listed herein must match the name on Subrecipient’s articles of incorporation, business license, city charter or bylaws.
7. Main Administrative Office Address
a. Enter the address (street number and name, suite number, city, state and zip code) of the official representative who is authorized to sign for Subrecipient (“Authorized Representative”) on this line. County will use this information to send correspondence to Authorized Representative.
8. Mailing Address (if different from above)
a. If the main administrative office address and the mailing address are the same, enter the following language on the mailing address line: Same as Admin Office. Otherwise, if these two (2) addresses are different then enter the address (street number and name, suite number, city, state and zip code). County will use this information to send correspondence to primary/secondary contact.
9. Authorized Representative
a. Enter the name of the individual who has been authorized to sign legally binding documents on behalf of Subrecipient’s organization where such DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Attachment 11 (Guidelines for Developing Route Summary) Page 3 authorization has been decreed through organization’s board resolution or other authorizing document.
b. Prefix: Enter the appropriate prefix for Authorized Representative. c. Job Title: Enter the title of Authorized Representative. Please abbreviate the job title if the title does not fit in the cell.
d. Phone Number and Ext.:
i. Enter the phone number of Authorized Representative where this individual can be reached directly. When entering the phone number, enter only numbers without spaces, hyphens, parenthesis or any additional characters (i.e.,2137304414). The result will display in the correct format (i.e., (213) 730-4414).
ii. If the phone number is not a direct number then enter the extension where the individual can be reached directly. When entering the extension, enter only numbers without spaces, hyphens,
parenthesis or any additional characters (i.e., 8667).
e. E-Mail Address: Enter the e-mail address of Authorized Representative.
10.Primary/Secondary Contact for Program
a. Enter the name of the individual who is responsible for overseeing the day-to-day Program Services.
b. Prefix: Enter the appropriate prefix for primary/secondary contact. c. Job Title: Enter the title of the primary/secondary contact. Please abbreviate the job title if the title does not fit in the cell. d. Phone Number and Ext.:
i. Enter the phone number of the primary/secondary contact for Program where this individual can be reached directly. When entering the phone number, enter only numbers without spaces, hyphens, parenthesis or any additional characters
(i.e.,2137304414). The result will display in the correct format (i.e., (213) 730-4414).
ii. If the phone number is not a direct number then enter the extension where the individual can be reached directly. When entering the extension, enter only numbers without spaces, hyphens,
parenthesis or any additional characters (i.e., 8667).
e. E-Mail Address: Enter the e-mail address of the primary/secondary contact.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Attachment 11 (Guidelines for Developing Route Summary) Page 4
SECTION I (ROUTE SUMMARY)
1. This sheet provides specific information that describes the location, point of contact, hours of operation, etc. for each Home-Delivered Meal route that Subrecipient will serve. This information is presented under the following Columns (and an explanation will be provided for each):
a. Column (A) Home-Delivered Meal Route Name
b. Column (B) Location of Meal Packaging Facility (Name and Address) c. Column (C) Client Zip Code(s) Served by Route
d. Column (D) Vehicle Information
e. Column (E) Delivery Day(s)/Time
2. Column (A) Home-Delivered Meal Route Name
a. Enter the route’s name.
b. The Home-Delivered Meal routes listed herein shall match those routes listed in Exhibit X2 (Mandated Program Services for Title III C-2 Program), Section II (Services by Month), Column (B) Route Name & Section III (Services by Month), Column (B) Route Name.
3. Column (B) Location of Meal Packaging Facility (Name and Address) a. Provide the name and address of the physical location of the facility where the meals are prepared and packaged.
4. Column (C) Client Zip Code(s) Served by Route
a. Provide the residence zip code for each unduplicated Client who receives Services on the route.
5. Column (D) Vehicle Information
a. Sub Column (1) Year/Make/Model
i. Enter the year, make and model of the vehicle that is being used to deliver meals to Clients on this route.
b. Sub Column (2) Staff Driver’s Name
i. Enter the first and last name of the Home-Delivered Meal Driver (as defined in Subsection 6.2.12 (Home-Delivered Meal Driver(s)) of Exhibit A (Statement of Work)) who is employed and paid by Subrecipient and is responsible for delivering the meals to Clients on this route.
c. Sub Column (3) Volunteer Driver’s Name
i. Enter the first and last name of the Home-Delivered Meal Volunteer Driver (as defined in Subsection 6.2.12 (Home-Delivered Meal DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Attachment 11 (Guidelines for Developing Route Summary) Page 5 Driver(s)) of Exhibit A (Statement of Work)) who is a Volunteer of Subrecipient and is responsible for delivering the meals to Clients on this route.
6. Column (E) Delivery Day(s)/Time(s)
a. Sub Column (1) Start
i. Enter the day(s) and the time when the meal delivery for the route starts by using the following information:
1. Enter the day(s) of delivery: e.g. Monday = M; Tuesday = T; Wednesday = W; Thursday = Th; Friday = F
2. Enter the delivery start time: e.g. 8:00 a.m.
3. Example 1: when delivery Services occur on Monday,
Wednesday and Friday starting at 6:00 a.m. and Tuesday
and Thursday starting at 8:00 a.m., enter the following information: M,W,F (6:00 a.m.) T,Th (8:00 a.m.).
b. Sub Column (2) End
i. Enter the day(s) and the time when the meal delivery for the route ends by using the following information:
1. Enter the day(s) of delivery: e.g. Monday = M; Tuesday = T; Wednesday = W; Thursday = Th; Friday = F
2. Enter the delivery ending time: e.g. 12:00 p.m.
c. Example: when delivery Services occur on Monday, Wednesday and Friday ending at 10:00 a.m. and Tuesday and Thursday ending at 12:00 p.m., enter the following information: M,W,F (10:00 a.m.) T,Th (12:00 p.m.)
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
ATTACHMENT 14
(HOME-DELIVERED MEAL PROGRAM PRIORITY OF SERVICE SCREENING TOOL
INSTRUCTIONS)
PURPOSE
All HDM Clients and Clients on the HDM Waiting List must be assessed by using the HDM Program Priority of Service Screening Tool to prioritize HDM Clients with the greatest critical needs. The initial screening establishes a weight factor to determine priority placement on the HDM Waiting List.
PROCEDURES
Each Section must be given a value which corresponds to point value established on the Universal Intake Form (UIF).
SECTION A: LIVING ARRANGEMENTS
Refer to the UIF Section number 1, Client Demographics, and Standard Operating Procedures (SOP) HDM Client In-Home Assessment, under Client, item number 4.
SECTION B: CLIENT’S INCOME IS BELOW 100% FPG
Refer to the UIF Section number 1, Client Demographics.
SECTION C: CLIENT IS ON SSI
Refer to the UIF Section number 3, Benefits.
SECTION D: NUTRITIONAL RISK FACTORS
Refer to the UIF Section number 5, Nutritional Risk.
SECTION E: ACTIVITIES OF DAILY LIVING (ADL) RISK FACTORS Refer to the UIF Section number 6, Activities of Daily Living (ADL).
SECTION F: INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL) RISK FACTORS Refer to the UIF Section number 6, Instrumental Activities of Daily Living (IADL).
SECTION G: DISABIILITY FACTORS
Refer to UIF Section number 6, ADL/IADL Risk Factors and Disability Factors.
SECTION H: CLIENT WAS RECENTLY DISCHARGED FROM THE HOSPITAL:
Refer to the SOP: Physician Certificate of Need (Form HDM-21), the HDM Client In-Home Assessment (Form HDM-22), and the Check-Up Telephone Calls to HDM Clients (Form HDM-24).
SECTION I: TOTAL SCORE
Add Points to each Section.
PRIORITY RATE
Check one box for the Priority Rate that corresponds to the total score. The priority of service will be given to the Clients with the highest total score.
SIGNATURE AND DATE
The staff that completes the form must sign, date, and check the method of the assessment in the box that applies.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
EXHIBIT B
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EXHIBIT E
(COUNTY'S ADMINISTRATION)
Effective as of: 7/1/2020
COUNTY’S DEPARTMENT HEAD
Name: Mr. Otto Solόrzano
Title: Acting Director
Address: 3175 West Sixth Street
Los Angeles, Ca 90020
Telephone: (213) 737-2617
E-Mail Address: [email protected]
COUNTY’S CONTRACT MANAGER
Name: Ms. Carol Domingo
Title: Program Manager
Address: 3175 West Sixth Street
Los Angeles, Ca 90020
Telephone: (213) 639-6339
E-Mail Address: [email protected]
COUNTY’S PROGRAM MANAGER
Name: Ms. Anna Avdalyan
Title: Program Manager
Address: 3333 Wilshire Boulevard, Room 400
Los Angeles, Ca 90010
Telephone: (213) 738-4749
E-Mail Address: [email protected]
COUNTY’S COMPLIANCE MANAGER
Name: Ms. Stephanie Maxberry
Title: Program Manager
Address: 3175 West Sixth Street
Los Angeles, Ca 90020
Telephone: (213) 738-2015
E-Mail Address: [email protected]
COUNTY’S EMERGENCY COORDINATOR
Name: Ms. Ellie Wolfe
Title: Program Manager
Address: 3175 West Sixth Street
Los Angeles, Ca 90020
Telephone: (213) 738-2681
E-Mail Address: [email protected]
Rev. 06/2020
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EXHIBIT H
(JURY SERVICE ORDINANCE)
Los Angeles County Code
Title 2 (Administration)
Chapter 2.203.010 through 2.203.090
Contractor Employee Jury Service
2.203.010 Findings.
The board of supervisors makes the following findings. The county of Los Angeles allows its permanent, full-time employees unlimited jury service at their regular pay.
Unfortunately, many businesses do not offer or are reducing or even eliminating compensation to employees who serve on juries. This creates a potential financial hardship for employees who do not receive their pay when called to jury service, and those employees often seek to be excused from having to serve. Although changes in the court rules make it more difficult to excuse a potential juror on grounds of financial hardship, potential jurors continue to be excused on this basis, especially from longer trials. This reduces the number of potential jurors and increases the burden on those employers, such as the county of Los Angeles, who pay their permanent, full-time employees while on juror duty. For these reasons, the county of Los Angeles has determined that it is appropriate to require that the businesses with which the county contracts possess reasonable jury service policies. (Ord. 2002-0015 § 1 (part), 2002)
2.203.020 Definitions.
The following definitions shall be applicable to this chapter:
A. “Contractor” means a person, partnership, corporation or other entity which has a contract with the county or a subcontract with a county contractor and has received or will receive an aggregate sum of $50,000 or more in any 12-month period under one or more such contracts or subcontracts.
B. “Employee” means any California resident who is a full-time employee of a contractor under the laws of California.
C. “Contract” means any agreement to provide goods to, or perform services for or on behalf of, the county but does not include:
1. A contract where the board finds that special circumstances exist that justify a waiver of the requirements of this chapter; or
2. A contract where federal or state law or a condition of a federal or state program mandates the use of a particular contractor; or DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit H (Jury Service Ordinance)
Rev. 09/2019 Page 2
3. A purchase made through a state or federal contract; or
4. A monopoly purchase that is exclusive and proprietary to a specific manufacturer, distributor, or reseller, and must match and inter-member with existing supplies, equipment or systems maintained by the county pursuant to the Los Angeles County Purchasing Policy and Procedures Manual, Section P-3700 or a successor provision; or
5. A revolving fund (petty cash) purchase pursuant to the Los Angeles County Fiscal Manual, Section 4.4.0 or a successor provision; or
6. A purchase card purchase pursuant to the Los Angeles County Purchasing Policy and Procedures Manual, Section P-2810 or a successor provision; or
7. A non-agreement purchase with a value of less than $5,000 pursuant to the Los Angeles County Purchasing Policy and Procedures Manual, Section A0300 or a successor provision; or
8. A bona fide emergency purchase pursuant to the Los Angeles County Purchasing Policy and Procedures Manual, Section PP-1100 or a successor provision.
D. “Full time” means 40 hours or more worked per week, or a lesser number of hours if:
1. The lesser number is a recognized industry standard as determined by the chief administrative officer, or
2. The contractor has a long-standing practice that defines the lesser number of hours as full time.
E. “County” means the county of Los Angeles or any public entities for which the board of supervisors is the governing body. (Ord. 2002-0040 § 1, 2002: Ord. 2002-0015 § 1 (part), 2002)
2.203.030 Applicability.
This chapter shall apply to contractors who enter into contracts that commence after July 11, 2002. This chapter shall also apply to contractors with existing contracts which are extended into option years that commence after July 11, 2002. Contracts that commence after May 28, 2002, but before July 11, 2002, shall be subject to the provisions of this chapter only if the solicitations for such contracts stated that the chapter would be applicable. (Ord. 2002-0040 § 2, 2002: Ord. 2002-0015 § 1 (part), 2002)
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit H (Jury Service Ordinance)
Rev. 09/2019 Page 3
2.203.040 Contractor Jury Service Policy.
A contractor shall have and adhere to a written policy that provides that its employees shall receive from the contractor, on an annual basis, no less than five days of regular pay for actual jury service. The policy may provide that employees deposit any fees received for such jury service with the contractor or that the contractor deduct from the employees’ regular pay the fees received for jury service. (Ord. 2002-0015 § 1 (part), 2002)
2.203.050 Other Provisions.
A. Administration. The chief administrative officer shall be responsible for the administration of this chapter. The chief administrative officer may, with the advice of county counsel, issue interpretations of the provisions of this chapter and shall issue written instructions on the implementation and ongoing administration of this chapter. Such instructions may provide for the delegation of functions to other county departments.
B. Compliance Certification. At the time of seeking a contract, a contractor shall certify to the county that it has and adheres to a policy consistent with this chapter or will have and adhere to such a policy prior to award of the contract. (Ord. 2002-0015 § 1 (part), 2002)
2.203.060 Enforcement and Remedies.
For a contractor’s violation of any provision of this chapter, the county department head responsible for administering the contract may do one or more of the following:
1. Recommend to the board of supervisors the termination of the contract; and/or,
2. Pursuant to chapter 2.202, seek the debarment of the contractor. (Ord. 2002-0015 § 1 (part), 2002)
2.203.070. Exceptions.
A. Other Laws. This chapter shall not be interpreted or applied to any contractor or to any employee in a manner inconsistent with the laws of the United States or California.
B. Collective Bargaining Agreements. This chapter shall be superseded by a collective bargaining agreement that expressly so provides.
C. Small Business. This chapter shall not be applied to any contractor that meets all of the following:
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit H (Jury Service Ordinance)
Rev. 09/2019 Page 4
1. Has ten or fewer employees during the contract period; and,
2. Has annual gross revenues in the preceding twelve months which, if added to the annual amount of the contract awarded, are less than $500,000; and,
3. Is not an affiliate or subsidiary of a business dominant in its field of operation.
“Dominant in its field of operation” means having more than ten employees and annual gross revenues in the preceding twelve months which, if added to the annual amount of the contract awarded, exceed $500,000.
“Affiliate or subsidiary of a business dominant in its field of operation” means a business which is at least 20 percent owned by a business dominant in its field of operation, or by partners, officers, directors, majority stockholders, or their equivalent, of a business dominant in that field of operation. (Ord. 2002-0015 § 1 (part), 2002)
2.203.090. Severability.
If any provision of this chapter is found invalid by a court of competent jurisdiction, the remaining provisions shall remain in full force and effect. (Ord. 2002-0015 § 1 (part), 2002)
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
EXHIBIT I
(SAFELY SURRENDERED BABY LAW)
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit I (Safely Surrendered Baby Law)
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DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit I (Safely Surrendered Baby Law)
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EXHIBIT N
(BUSINESS ASSOCIATE AGREEMENT UNDER THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA))
County is a Covered Entity as defined by, and subject to the requirements and prohibitions of, the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 (HIPAA), and regulations promulgated thereunder, including the Privacy, Security, Breach Notification, and Enforcement Rules at 45 Code of Federal Regulations (C.F.R.) Parts 160 and 164 (collectively, the "HIPAA Rules").
Contractor performs or provides functions, activities or services to County that require Contractor in order to provide such functions, activities or services to create, access, receive, maintain, and/or transmit information that includes or that may include Protected Health Information, as defined by the HIPAA Rules. As such, Contractor is a Business Associate, as defined by the HIPAA Rules, and is therefore subject to those provisions of the HIPAA Rules that are applicable to Business Associates.
The HIPAA Rules require a written agreement ("Business Associate Agreement") between County and Contractor in order to mandate certain protections for the privacy and security of Protected Health Information, and these HIPAA Rules prohibit the disclosure to or use of Protected Health Information by Contractor if such an agreement is not in place.
This Business Associate Agreement and its provisions are intended to protect the privacy and provide for the security of Protected Health Information disclosed to or used by Contractor in compliance with the HIPAA Rules.
Therefore, the parties agree as follows:
1. DEFINITIONS
1.1 "Breach" has the same meaning as the term "breach" at 45 C.F.R. § 164.402.
1.2 "Business Associate" has the same meaning as the term "business associate" at 45 C.F.R. § 160.103. For the convenience of the parties, a "business associate" is a person or entity, other than a member of the workforce of covered entity, who performs functions or activities on behalf of, or provides certain services to, a covered entity that involve access by the business associate to Protected Health Information. A "business associate" also is a subcontractor that creates, receives, maintains, or transmits Protected Health Information on behalf of another business associate. And in reference to the party to this Business Associate Agreement "Business Associate" shall mean Contractor.
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1.3 "Covered Entity" has the same meaning as the term “covered entity” at 45 C.F.R. § 160.103, and in reference to the party to this Business Associate Agreement, "Covered Entity" shall mean County.
1.4 "Data Aggregation" has the same meaning as the term "data aggregation" at 45 C.F.R. § 164.501.
1.5 "De-identification" refers to the de-identification standard at 45 C.F.R. § 164.514.
1.6 "Designated Record Set" has the same meaning as the term "designated record set" at 45 C.F.R. § 164.501.
1.7 "Disclose” and “Disclosure” mean, with respect to Protected Health Information, the release, transfer, provision of access to, or divulging in any other manner of Protected Health Information outside Business Associate’s internal operations or to other than its workforce. (See 45 C.F.R. § 160.103.)
1.8 "Electronic Health Record” means an electronic record of health-related information on an individual that is created, gathered, managed, and consulted by authorized health care clinicians and staff. (See 42 U.S. C. § 17921.)
1.9 “Electronic Media” has the same meaning as the term “electronic media” at 45 C.F.R. § 160.103. For the convenience of the parties, electronic media means (1) Electronic storage material on which data is or may be recorded electronically, including, for example, devices in computers (hard drives) and any removable/transportable digital memory medium, such as magnetic tape or disk, optical disk, or digital memory card; (2) Transmission media used to exchange information already in electronic storage media.
Transmission media include, for example, the Internet, extranet or intranet, leased lines, dial-up lines, private networks, and the physical movement of removable/transportable electronic storage media. Certain transmissions, including of paper, via facsimile, and of voice, via telephone, are not considered to be transmissions via electronic media if the information being exchanged did not exist in electronic form immediately before the transmission.
1.10 "Electronic Protected Health Information” has the same meaning as the term “electronic protected health information” at 45 C.F.R. § 160.103, limited to Protected Health Information created or received by Business Associate from or on behalf of Covered Entity. For the convenience of the parties, Electronic Protected Health Information means Protected Health DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit N (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA))
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Information that is (i) transmitted by electronic media; (ii) maintained in electronic media.
1.11 "Health Care Operations" has the same meaning as the term "health care operations" at 45 C.F.R. § 164.501.
1.12 "Individual” has the same meaning as the term "individual" at 45 C.F.R. § 160.103. For the convenience of the parties, Individual means the person who is the subject of Protected Health Information and shall include a person who qualifies as a personal representative in accordance with 45 C.F.R. § 164.502 (g).
1.13 "Law Enforcement Official" has the same meaning as the term "law enforcement official" at 45 C.F.R. § 164.103.
1.14 "Minimum Necessary" refers to the minimum necessary standard at 45 C.F.R. § 164.502 (b).
1.15 “Protected Health Information” has the same meaning as the term “protected health information” at 45 C.F.R. § 160.103, limited to the information created or received by Business Associate from or on behalf of Covered Entity. For the convenience of the parties, Protected Health Information includes information that (i) relates to the past, present or future physical or mental health or condition of an Individual; the provision of health care to an Individual, or the past, present or future payment for the provision of health care to an Individual; (ii) identifies the Individual (or for which there is a reasonable basis for believing that the information can be used to identify the Individual); and (iii) is created, received, maintained, or transmitted by Business Associate from or on behalf of Covered Entity, and includes Protected Health Information that is made accessible to Business Associate by Covered Entity. “Protected Health Information” includes Electronic Protected Health Information.
1.16 “Required by Law” " has the same meaning as the term "required by law" at 45 C.F.R. § 164.103.
1.17 "Secretary" has the same meaning as the term "secretary" at 45 C.F.R. § 160.103
1.18 "Security Incident” has the same meaning as the term "security incident" at 45 C.F.R. § 164.304.
1.19 "Services” means, unless otherwise specified, those functions, activities, or services in the applicable underlying Agreement, Contract, Master Agreement, Work Order, or Purchase Order or other service arrangement, DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit N (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA))
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with or without payment, that gives rise to Contractor's status as a Business Associate.
1.20 "Subcontractor" has the same meaning as the term "subcontractor" at 45 C.F.R. § 160.103.
1.21 "Unsecured Protected Health Information" has the same meaning as the term “unsecured protected health information" at 45 C.F.R. § 164.402.
1.22 “Use” or “Uses” means, with respect to Protected Health Information, the sharing, employment, application, utilization, examination or analysis of such Information within Business Associate’s internal operations. (See 45 C.F.R § 164.103.)
1.23 Terms used, but not otherwise defined in this Business Associate Agreement, have the same meaning as those terms in the HIPAA Rules.
2. PERMITTED AND REQUIRED USES AND DISCLOSURES OF PROTECTED
HEALTH INFORMATION
2.1 Business Associate may only Use and/or Disclose Protected Health Information as necessary to perform Services, and/or as necessary to comply with the obligations of this Business Associate Agreement.
2.2 Business Associate may Use Protected Health Information for deidentification of the information if de-identification of the information is required to provide Services.
2.3 Business Associate may Use or Disclose Protected Health Information as Required by Law.
2.4 Business Associate shall make Uses and Disclosures and requests for Protected Health Information consistent with the Covered Entity’s applicable Minimum Necessary policies and procedures.
2.5 Business Associate may Use Protected Health Information as necessary for the proper management and administration of its business or to carry out its legal responsibilities.
2.6 Business Associate may Disclose Protected Health Information as necessary for the proper management and administration of its business or to carry out its legal responsibilities, provided the Disclosure is Required by Law or Business Associate obtains reasonable assurances from the person to whom the Protected Health Information is disclosed (i.e., the recipient) that it will be held confidentially and Used or further Disclosed only as Required by Law or for the purposes for which it was disclosed to the DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit N (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA))
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recipient and the recipient notifies Business Associate of any instances of which it is aware in which the confidentiality of the Protected Health Information has been breached.
2.7 Business Associate may provide Data Aggregation services relating to Covered Entity's Health Care Operations if such Data Aggregation services are necessary in order to provide Services.
3. PROHIBITED USES AND DISCLOSURES OF PROTECTED HEALTH
INFORMATION
3.1 Business Associate shall not Use or Disclose Protected Health Information other than as permitted or required by this Business Associate Agreement or as Required by Law.
3.2 Business Associate shall not Use or Disclose Protected Health Information in a manner that would violate Subpart E of 45 C.F.R. Part 164 if done by Covered Entity, except for the specific Uses and Disclosures set forth in Sections 2.5 and 2.6.
3.3 Business Associate shall not Use or Disclose Protected Health Information for de-identification of the information except as set forth in section 2.2.
4. OBLIGATIONS TO SAFEGUARD PROTECTED HEALTH INFORMATION
4.1 Business Associate shall implement, use, and maintain appropriate safeguards to prevent the Use or Disclosure of Protected Health Information other than as provided for by this Business Associate Agreement.
4.2 Business Associate shall comply with Subpart C of 45 C.F.R Part 164 with respect to Electronic Protected Health Information, to prevent the Use or Disclosure of such information other than as provided for by this Business Associate Agreement.
5. REPORTING NON-PERMITTED USES OR DISCLOSURES, SECURITY
INCIDENTS, AND BREACHES OF UNSECURED PROTECTED HEALTH
INFORMATION
5.1 Business Associate shall report to Covered Entity any Use or Disclosure of Protected Health Information not permitted by this Business Associate Agreement, any Security Incident, and/ or any Breach of Unsecured Protected Health Information as further described in Sections 5.1.1, 5.1.2, and 5.1.3.
5.1.1 Business Associate shall report to Covered Entity any Use or Disclosure of Protected Health Information by Business Associate, DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit N (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA))
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its employees, representatives, agents or Subcontractors not provided for by this Agreement of which Business Associate becomes aware.
5.1.2 Business Associate shall report to Covered Entity any Security Incident of which Business Associate becomes aware.
5.1.3. Business Associate shall report to Covered Entity any Breach by Business Associate, its employees, representatives, agents, workforce members, or Subcontractors of Unsecured Protected Health Information that is known to Business Associate or, by exercising reasonable diligence, would have been known to Business Associate. Business Associate shall be deemed to have knowledge of a Breach of Unsecured Protected Health Information if the Breach is known, or by exercising reasonable diligence would have been known, to any person, other than the person committing the Breach, who is an employee, officer, or other agent of Business Associate, including a Subcontractor, as determined in accordance with the federal common law of agency.
5.2 Except as provided in Section 5.3, for any reporting required by Section 5.1, Business Associate shall provide, to the extent available, all information required by, and within the times frames specified in, Sections 5.2.1 and
5.2.2. 5.2.1 Business Associate shall make an immediate telephonic report upon discovery of the non-permitted Use or Disclosure of Protected Health Information, Security Incident or Breach of Unsecured Protected Health Information to (562) 940-3335 that minimally includes:
(a) A brief description of what happened, including the date of the non-permitted Use or Disclosure, Security Incident, or Breach and the date of Discovery of the non-permitted Use or
Disclosure, Security Incident, or Breach, if known;
(b) The number of Individuals whose Protected Health
Information is involved;
(c) A description of the specific type of Protected Health Information involved in the non-permitted Use or Disclosure, Security Incident, or Breach (such as whether full name, social security number, date of birth, home address, account
number, diagnosis, disability code or other types of
information were involved);
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(d) The name and contact information for a person highly knowledge of the facts and circumstances of the nonpermitted Use or Disclosure of PHI, Security Incident, or Breach
5.2.2 Business Associate shall make a written report without unreasonable delay and in no event later than three (3) business days from the date of discovery by Business Associate of the non-permitted Use or Disclosure of Protected Health Information, Security Incident, or Breach of Unsecured Protected Health Information and to the HIPAA Compliance Officer at: Hall of Records, County of Los Angeles, Chief Executive Office, Risk Management Branch-Office of Privacy, 320 W. Temple Street, 7th Floor, Los Angeles,
California 90012, [email protected], that includes, to the extent possible:
(a) A brief description of what happened, including the date of the non-permitted Use or Disclosure, Security Incident, or Breach and the date of Discovery of the non-permitted Use or
Disclosure, Security Incident, or Breach, if known;
(b) The number of Individuals whose Protected Health
Information is involved;
(c) A description of the specific type of Protected Health Information involved in the non-permitted Use or Disclosure, Security Incident, or Breach (such as whether full name, social security number, date of birth, home address, account
number, diagnosis, disability code or other types of
information were involved);
(d) The identification of each Individual whose Unsecured Protected Health Information has been, or is reasonably believed by Business Associate to have been, accessed,
acquired, Used, or Disclosed;
(e) Any other information necessary to conduct an assessment of whether notification to the Individual(s) under 45 C.F.R. § 164.404 is required;
(f) Any steps Business Associate believes that the Individual(s) could take to protect him or herself from potential harm from the non-permitted Use or Disclosure, Security Incident, or Breach;
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(g) A brief description of what Business Associate is doing to investigate, to mitigate harm to the Individual(s), and to protect against any further similar occurrences; and
(h) The name and contact information for a person highly knowledge of the facts and circumstances of the nonpermitted Use or Disclosure of PHI, Security Incident, or Breach.
5.2.3 If Business Associate is not able to provide the information specified in Section 5.2.1 or 5.2.2 at the time of the required report, Business Associate shall provide such information promptly thereafter as such information becomes available.
5.3 Business Associate may delay the notification required by Section 5.1.3, if a law enforcement official states to Business Associate that notification would impede a criminal investigation or cause damage to national security.
5.3.1 If the law enforcement official's statement is in writing and specifies the time for which a delay is required, Business Associate shall delay its reporting and/or notification obligation(s) for the time period specified by the official.
5.3.2 If the statement is made orally, Business Associate shall document the statement, including the identity of the official making the statement, and delay its reporting and/or notification obligation(s) temporarily and no longer than 30 days from the date of the oral statement, unless a written statement as described in Section 5.3.1 is submitted during that time.
6. WRITTEN ASSURANCES OF SUBCONTRACTORS
6.1 In accordance with 45 C.F.R. § 164.502 (e)(1)(ii) and § 164.308 (b)(2), if applicable, Business Associate shall ensure that any Subcontractor that creates, receives, maintains, or transmits Protected Health Information on behalf of Business Associate is made aware of its status as a Business Associate with respect to such information and that Subcontractor agrees in writing to the same restrictions, conditions, and requirements that apply to Business Associate with respect to such information.
6.2 Business Associate shall take reasonable steps to cure any material breach or violation by Subcontractor of the agreement required by Section 6.1.
6.3 If the steps required by Section 6.2 do not cure the breach or end the violation, Contractor shall terminate, if feasible, any arrangement with DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit N (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA))
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Subcontractor by which Subcontractor creates, receives, maintains, or transmits Protected Health Information on behalf of Business Associate.
6.4 If neither cure nor termination as set forth in Sections 6.2 and 6.3 is feasible, Business Associate shall immediately notify County.
6.5 Without limiting the requirements of Section 6.1, the agreement required by Section 6.1 (Subcontractor Business Associate Agreement) shall require Subcontractor to contemporaneously notify Covered Entity in the event of a Breach of Unsecured Protected Health Information.
6.6 Without limiting the requirements of Section 6.1, agreement required by Section 6.1 (Subcontractor Business Associate Agreement) shall include a provision requiring Subcontractor to destroy, or in the alternative to return to Business Associate, any Protected Health Information created, received, maintained, or transmitted by Subcontractor on behalf of Business Associate so as to enable Business Associate to comply with the provisions of Section 18.4.
6.7 Business Associate shall provide to Covered Entity, at Covered Entity's request, a copy of any and all Subcontractor Business Associate Agreements required by Section 6.1.
6.8 Sections 6.1 and 6.7 are not intended by the parties to limit in any way the scope of Business Associate's obligations related to Subcontracts or Subcontracting in the applicable underlying Agreement, Contract, Master Agreement, Work Order, Purchase Order, or other services arrangement, with or without payment, that gives rise to Contractor's status as a Business Associate.
7. ACCESS TO PROTECTED HEALTH INFORMATION
7.1 To the extent Covered Entity determines that Protected Health Information is maintained by Business Associate or its agents or Subcontractors in a Designated Record Set, Business Associate shall, within two (2) business days after receipt of a request from Covered Entity, make the Protected Health Information specified by Covered Entity available to the Individual(s) identified by Covered Entity as being entitled to access and shall provide such Individuals(s) or other person(s) designated by Covered Entity with a copy the specified Protected Health Information, in order for Covered Entity to meet the requirements of 45 C.F.R. § 164.524.
7.2 If any Individual requests access to Protected Health Information directly from Business Associate or its agents or Subcontractors, Business Associate shall notify Covered Entity in writing within two (2) days of the DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit N (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA))
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receipt of the request. Whether access shall be provided or denied shall be determined by Covered Entity.
7.3 To the extent that Business Associate maintains Protected Health Information that is subject to access as set forth above in one or more Designated Record Sets electronically and if the Individual requests an electronic copy of such information, Business Associate shall provide the Individual with access to the Protected Health Information in the electronic form and format requested by the Individual, if it is readily producible in such form and format; or, if not, in a readable electronic form and format as agreed to by Covered Entity and the Individual.
8. AMENDMENT OF PROTECTED HEALTH INFORMATION
8.1 To the extent Covered Entity determines that any Protected Health Information is maintained by Business Associate or its agents or Subcontractors in a Designated Record Set, Business Associate shall, within ten (10) business days after receipt of a written request from Covered Entity, make any amendments to such Protected Health Information that are requested by Covered Entity, in order for Covered Entity to meet the requirements of 45 C.F.R. § 164.526.
8.2 If any Individual requests an amendment to Protected Health Information directly from Business Associate or its agents or Subcontractors, Business Associate shall notify Covered Entity in writing within five (5) days of the receipt of the request. Whether an amendment shall be granted or denied shall be determined by Covered Entity.
9. ACCOUNTING OF DISCLOSURES OF PROTECTED HEALTH INFORMATION
9.1 Business Associate shall maintain an accounting of each Disclosure of Protected Health Information made by Business Associate or its employees, agents, representatives or Subcontractors, as is determined by Covered Entity to be necessary in order to permit Covered Entity to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 C.F.R. § 164.528.
9.1.1 Any accounting of disclosures provided by Business Associate under Section 9.1 shall include:
(a) The date of the Disclosure;
(b) The name, and address if known, of the entity or person who received the Protected Health Information;
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(c) A brief description of the Protected Health Information Disclosed; and
(d) A brief statement of the purpose of the Disclosure.
9.1.2 For each Disclosure that could require an accounting under Section
9.1, Business Associate shall document the information specified in Section 9.1.1, and shall maintain the information for six (6) years from the date of the Disclosure.
9.2 Business Associate shall provide to Covered Entity, within ten (10) business days after receipt of a written request from Covered Entity, information collected in accordance with Section 9.1.1 to permit Covered Entity to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 C.F.R. § 164.528
9.3 If any Individual requests an accounting of disclosures directly from Business Associate or its agents or Subcontractors, Business Associate shall notify Covered Entity in writing within five (5) days of the receipt of the request, and shall provide the requested accounting of disclosures to the Individual(s) within 30 days. The information provided in the accounting shall be in accordance with 45 C.F.R. § 164.528.
10. COMPLIANCE WITH APPLICABLE HIPAA RULES
10.1 To the extent Business Associate is to carry out one or more of Covered Entity's obligation(s) under Subpart E of 45 C.F.R. Part 164, Business Associate shall comply with the requirements of Subpart E that apply to Covered Entity's performance of such obligation(s).
10.2 Business Associate shall comply with all HIPAA Rules applicable to Business Associate in the performance of Services.
11. AVAILABILITY OF RECORDS
11.1 Business Associate shall make its internal practices, books, and records relating to the Use and Disclosure of Protected Health Information received from, or created or received by Business Associate on behalf of Covered Entity available to the Secretary for purposes of determining Covered Entity’s compliance with the Privacy and Security Regulations.
11.2 Unless prohibited by the Secretary, Business Associate shall immediately notify Covered Entity of any requests made by the Secretary and provide Covered Entity with copies of any documents produced in response to such request.
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12. MITIGATION OF HARMFUL EFFECTS
12.1 Business Associate shall mitigate, to the extent practicable, any harmful effect of a Use or Disclosure of Protected Health Information by Business Associate in violation of the requirements of this Business Associate Agreement that is known to Business Associate.
13. BREACH NOTIFICATION TO INDIVIDUALS
13.1 Business Associate shall, to the extent Covered Entity determines that there has been a Breach of Unsecured Protected Health Information by Business Associate, its employees, representatives, agents or Subcontractors, provide breach notification to the Individual in a manner that permits Covered Entity to comply with its obligations under 45 C.F.R. § 164.404.
13.1.1 Business Associate shall notify, subject to the review and approval of Covered Entity, each Individual whose Unsecured Protected Health Information has been, or is reasonably believed to have been, accessed, acquired, Used, or Disclosed as a result of any such Breach.
13.1.2 The notification provided by Business Associate shall be written in plain language, shall be subject to review and approval by Covered Entity, and shall include, to the extent possible:
(a) A brief description of what happened, including the date of the Breach and the date of the Discovery of the Breach, if known; (b) A description of the types of Unsecured Protected Health Information that were involved in the Breach (such as whether full name, social security number, date of birth, home address, account number, diagnosis, disability code, or other types of information were involved);
(c) Any steps the Individual should take to protect him or herself from potential harm resulting from the Breach;
(d) A brief description of what Business Associate is doing to investigate the Breach, to mitigate harm to Individual(s), and to protect against any further Breaches; and
(e) Contact procedures for Individual(s) to ask questions or learn additional information, which shall include a toll-free telephone number, an e-mail address, Web site, or postal address.
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13.2 Covered Entity, in its sole discretion, may elect to provide the notification required by Section 13.1 and/or to establish the contact procedures described in Section 13.1.2.
13.3 Business Associate shall reimburse Covered Entity any and all costs incurred by Covered Entity, in complying with Subpart D of 45 C.F.R. Part 164, including but not limited to costs of notification, internet posting, or media publication, as a result of Business Associate's Breach of Unsecured Protected Health Information; Covered Entity shall not be responsible for any costs incurred by Business Associate in providing the notification required by 13.1 or in establishing the contact procedures required by Section 13.1.2.
14. INDEMNIFICATION
14.1 Business Associate shall indemnify, defend, and hold harmless Covered Entity, its Special Districts, elected and appointed officers, employees, and agents from and against any and all liability, including but not limited to demands, claims, actions, fees, costs, expenses (including attorney and expert witness fees), and penalties and/or fines (including regulatory penalties and/or fines), arising from or connected with Business Associate's acts and/or omissions arising from and/or relating to this Business Associate Agreement, including, but not limited to, compliance and/or enforcement actions and/or activities, whether formal or informal, by the Secretary or by the Attorney General of the State of California.
14.2 Section 14.1 is not intended by the parties to limit in any way the scope of Business Associate's obligations related to Insurance and/or Indemnification in the applicable underlying Agreement, Contract, Master Agreement, Work Order, Purchase Order, or other services arrangement, with or without payment, that gives rise to Contractor's status as a Business Associate.
15. OBLIGATIONS OF COVERED ENTITY
15.1 Covered Entity shall notify Business Associate of any current or future restrictions or limitations on the Use or Disclosure of Protected Health Information that would affect Business Associate’s performance of the Services, and Business Associate shall thereafter restrict or limit its own Uses and Disclosures accordingly.
15.2 Covered Entity shall not request Business Associate to Use or Disclose Protected Health Information in any manner that would not be permissible under Subpart E of 45 C.F.R. Part 164 if done by Covered Entity, except to DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit N (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA))
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the extent that Business Associate may Use or Disclose Protected Health Information as provided in Sections 2.3, 2.5, and 2.6.
16. TERM
16.1 Unless sooner terminated as set forth in Section 17, the term of this Business Associate Agreement shall be the same as the term of the applicable underlying Agreement, Contract, Master Agreement, Work Order, Purchase Order, or other service arrangement, with or without payment, that gives rise to Contractor's status as a Business Associate.
16.2 Notwithstanding Section 16.1, Business Associate’s obligations under Sections 11, 14, and 18 shall survive the termination or expiration of this Business Associate Agreement.
17. TERMINATION FOR CAUSE
17.1 In addition to and notwithstanding the termination provisions set forth in the applicable underlying Agreement, Contract, Master Agreement, Work Order, Purchase Order, or other services arrangement, with or without payment, that gives rise to Contractor's status as a Business Associate, if either party determines that the other party has violated a material term of this Business Associate Agreement, and the breaching party has not cured the breach or ended the violation within the time specified by the nonbreaching party, which shall be reasonable given the nature of the breach and/or violation, the non-breaching party may terminate this Business Associate Agreement.
17.2 In addition to and notwithstanding the termination provisions set forth in the applicable underlying Agreement, Contract, Master Agreement, Work Order, Purchase Order, or other services arrangement, with or without payment, that gives rise to Contractor's status as a Business Associate, if either party determines that the other party has violated a material term of this Business Associate Agreement, and cure is not feasible, the nonbreaching party may terminate this Business Associate Agreement immediately.
18. DISPOSITION OF PROTECTED HEALTH INFORMATION UPON
TERMINATION OR EXPIRATION
18.1 Except as provided in Section 18.3, upon termination for any reason or expiration of this Business Associate Agreement, Business Associate shall return or, if agreed to by Covered entity, shall destroy as provided for in Section 18.2, all Protected Health Information received from Covered Entity, or created, maintained, or received by Business Associate on behalf of DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit N (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA))
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Covered Entity, that Business Associate, including any Subcontractor, still maintains in any form. Business Associate shall retain no copies of the Protected Health Information.
18.2 Destruction for purposes of Section 18.2 and Section 6.6 shall mean that media on which the Protected Health Information is stored or recorded has been destroyed and/or electronic media have been cleared, purged, or destroyed in accordance with the use of a technology or methodology specified by the Secretary in guidance for rendering Protected Health Information unusable, unreadable, or indecipherable to unauthorized individuals.
18.3 Notwithstanding Section 18.1, in the event that return or destruction of Protected Health Information is not feasible or Business Associate determines that any such Protected Health Information is necessary for Business Associate to continue its proper management and administration or to carry out its legal responsibilities, Business Associate may retain that Protected Health Information for which destruction or return is infeasible or that Protected Health Information which is necessary for Business Associate to continue its proper management and administration or to carry out its legal responsibilities and shall return or destroy all other Protected Health Information.
18.3.1 Business Associate shall extend the protections of this Business Associate Agreement to such Protected Health Information, including continuing to use appropriate safeguards and continuing to comply with Subpart C of 45 C.F.R Part 164 with respect to Electronic Protected Health Information, to prevent the Use or Disclosure of such information other than as provided for in Sections 2.5 and 2.6 for so long as such Protected Health Information is retained, and Business Associate shall not Use or Disclose such Protected Health Information other than for the purposes for which such Protected Health Information was retained.
18.3.2 Business Associate shall return or, if agreed to by Covered entity, destroy the Protected Health Information retained by Business Associate when it is no longer needed by Business Associate for Business Associate's proper management and administration or to carry out its legal responsibilities.
18.4 Business Associate shall ensure that all Protected Health Information created, maintained, or received by Subcontractors is returned or, if agreed to by Covered entity, destroyed as provided for in Section 18.2.
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19. AUDIT, INSPECTION, AND EXAMINATION
19.1 Covered Entity reserves the right to conduct a reasonable inspection of the facilities, systems, information systems, books, records, agreements, and policies and procedures relating to the Use or Disclosure of Protected Health Information for the purpose determining whether Business Associate is in compliance with the terms of this Business Associate Agreement and any non-compliance may be a basis for termination of this Business Associate Agreement and the applicable underlying Agreement, Contract, Master Agreement, Work Order, Purchase Order or other services arrangement, with or without payment, that gives rise to Contractor's status as a Business Associate, as provided for in section 17.
19.2 Covered Entity and Business Associate shall mutually agree in advance upon the scope, timing, and location of any such inspection.
19.3 At Business Associate's request, and to the extent permitted by law, Covered Entity shall execute a nondisclosure agreement, upon terms and conditions mutually agreed to by the parties.
19.4 That Covered Entity inspects, fails to inspect, or has the right to inspect as provided for in Section 19.1 does not relieve Business Associate of its responsibility to comply with this Business Associate Agreement and/or the HIPAA Rules or impose on Covered Entity any responsibility for Business Associate's compliance with any applicable HIPAA Rules.
19.5 Covered Entity's failure to detect, its detection but failure to notify Business Associate, or its detection but failure to require remediation by Business Associate of an unsatisfactory practice by Business Associate, shall not constitute acceptance of such practice or a waiver of Covered Entity's enforcement rights under this Business Associate Agreement or the applicable underlying Agreement, Contract, Master Agreement, Work Order, Purchase Order or other services arrangement, with or without payment, that gives rise to Contractor's status as a Business Associate.
19.6 Section 19.1 is not intended by the parties to limit in any way the scope of Business Associate's obligations related to Inspection and/or Audit and/or similar review in the applicable underlying Agreement, Contract, Master Agreement, Work Order, Purchase Order, or other services arrangement, with or without payment, that gives rise to Contractor's status as a Business Associate.
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20. MISCELLANEOUS PROVISIONS
20.1 Disclaimer. Covered Entity makes no warranty or representation that compliance by Business Associate with the terms and conditions of this Business Associate Agreement will be adequate or satisfactory to meet the business needs or legal obligations of Business Associate.
20.2 HIPAA Requirements. The Parties agree that the provisions under HIPAA Rules that are required by law to be incorporated into this Amendment are hereby incorporated into this Agreement.
20.3 No Third Party Beneficiaries. Nothing in this Business Associate Agreement shall confer upon any person other than the parties and their respective successors or assigns, any rights, remedies, obligations, or liabilities whatsoever.
20.4 Construction. In the event that a provision of this Business Associate Agreement is contrary to a provision of the applicable underlying Agreement, Contract, Master Agreement, Work Order, Purchase Order, or other services arrangement, with or without payment, that gives rise to Contractor's status as a Business Associate, the provision of this Business Associate Agreement shall control. Otherwise, this Business Associate Agreement shall be construed under, and in accordance with, the terms of the applicable underlying Agreement, Contract, Master Agreement, Work Order, Purchase Order or other services arrangement, with or without payment, that gives rise to Contractor's status as a Business Associate.
20.5 Regulatory References. A reference in this Business Associate Agreement to a section in the HIPAA Rules means the section as in effect or as amended.
20.6 Interpretation. Any ambiguity in this Business Associate Agreement shall be resolved in favor of a meaning that permits the parties to comply with the HIPAA Rules.
20.7 Amendment. The parties agree to take such action as is necessary to amend this Business Associate Agreement from time to time as is necessary for Covered Entity or Business Associate to comply with the requirements of the HIPAA Rules and any other privacy laws governing Protected Health Information.
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EXHIBIT P
(DEFINITIONS)
I. STANDARD TERMS
Activities of Daily Living (ADLs): Activities usually performed for oneself in the course of a normal day including bathing, dressing, grooming, eating, walking, using the telephone, taking medications, and other personal care activities.
Administration for Community Living (ACL): The principal agency of the United States Department of Health and Human Services (formerly known as the Administration on Aging) designated to carry out the provisions of the Older Americans Act of 1965 (OAA), as amended (Title 42 United States Code Section 3001 et seq.). It is dedicated to policy development, planning, and the delivery of supportive home and community-based services to older persons and their caregivers.
Adult Protective Services (APS): Those preventive and remedial activities performed on behalf of elders and dependent adults who are unable to protect their own interest, harmed or threatened with harm, caused physical or mental injury due to the action or inaction of another person or their own action as a result of ignorance, illiteracy, incompetence, mental limitation, substance abuse or poor health, lacking in adequate food, shelter or clothing, exploited of their income and resources, or deprived of entitlement due them (Welfare and Institutions Code Section 15610.10).
Americans with Disabilities Act: Federal remedial statute designed to eliminate discrimination against individuals with disabilities and to integrate individuals with disabilities in all areas of society.
Area Agency on Aging (AAA): A public or private non-profit agency or organization that has been designated by a State under the authority of the Older Americans Act of 1965 (OAA), as amended (Title 42 United States Code Section 3001 et seq.) to perform functions within the planning and service area established by the State. Such functions include identifying community and social service needs, addressing the concerns of older Americans at the local level and assuring that social and nutritional supports are made available to older people in communities where they live. For purposes of the solicitation and resulting Subaward, references to the AAA shall mean County of Los Angeles AAA, which has been designated by the State of California Department of Aging to serve Planning and Service Area 19.
Attachment: A document(s) that is included with the Statement of Work as an addition/supplement to the Statement of Work and it forms a part of the Statement of Work (e.g., Attachment 1 (Performance Requirements Summary Chart)).
Authorized Representative: The individual who has been given written authorization through a resolution, order, or motion from Subrecipient’s governing body to act on behalf of Subrecipient and bind Subrecipient to the Subaward.
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Board of Supervisors: The governing body of the County of Los Angeles, which is comprised of five (5) Board members. Created by the State legislature in 1852, the Board has executive, legislative and quasi-judicial roles. Its members are elected by voters in their respective supervisorial districts and they’re eligible to serve on the Board for up to three (3) four-year terms (i.e., Board members can serve for a maximum term of twelve (12) years).
Budget: A document that provides a detailed representation of Program costs/expenses and funding/revenues. Costs are identified by line items such as personnel, space, travel, etc. Funding is identified by sources such as the Subaward Sums, match contributions, non-match contributions, etc. Therefore the total budgeted costs represent the total cost to operate the Program and the total funding represents the anticipated revenues that will be used to pay for those Program costs.
California Department of Aging (CDA): The principal agency within the State of California government which is responsible for administering programs that serve older adults, adults with disabilities, family caregivers, and residents in long-term care facilities throughout the State. CDA administers funds allocated under the federal Older Americans Act, the Older Californians Act, and through the Medi-Cal program.
Client: An individual who meets the eligibility requirements outlined in the Statement of Work, receives Program Services and is counted only once (unduplicated) when determining the total number of Unduplicated Clients.
Closeout Report: A written summary of Subrecipient’s expenses and accruals incurred through the last day of the Fiscal Year. Subrecipient shall complete and submit this Report in the form and manner as designated by County.
Community Based Organization: An organization of demonstrated effectiveness that is representative of a community or significant segments of a community. The organization must provide social or supportive services to individuals in the community.
Community Focal Point: An agency within the community which has a proven record of providing comprehensive services to older individuals (i.e., multi-purpose senior center). A list of Community Focal Points is provided as part of the Subaward.
County: Unless otherwise specified, it shall mean the County of Los Angeles Workforce Development, Aging and Community Services, which is the County department that has been authorized by the Board of Supervisors to enter into this Subaward on behalf of the County of Los Angeles with Subrecipient.
County Information Assets: Public, confidential, sensitive and/or personal data, records, materials, etc. and include (but are not limited to):
1) Information that is stored in any media form, paper or electronic.
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2) Information that is collected, transmitted and/or accessed in the administration of the Program and in the provision of Services.
3) Personally Identifiable Information (PII) as defined in California Civil Code Section 1798.29(g)
4) Protected Health Information (PHI) as defined in Health Insurance Portability and Accountability Act of 1996
5) Medical Information (MI) as defined in California Civil Code Section 56.05(j) County’s Business Hours: The time period during which County’s operations are open to conduct business; this time period is designated as 8:00 a.m. to 5:00 p.m., Monday through Friday (excluding County recognized holidays).
County’s Compliance Manager: The individual designated by County who is responsible for ensuring that Subrecipient is in compliance with the requirements of the Subaward.
County’s Department Head: The individual designated by the Board of Supervisors as the Director of Community and Senior Services who is responsible for overseeing this County of Los Angeles department and who has delegated authority to act on behalf of County of Los Angeles for Subaward-related matters.
County’s Contract Manager: The individual designated by County who is responsible for providing direction to Subrecipient (at Subrecipient’s request) in areas relating to County policy, information requirements, and procedural requirements; making revisions which do not materially affect the terms and conditions of the Subaward; and, approving Lower Tier Subawards and Lower Tier Subrecipient’s employees working on this Subaward.
County’s Program Manager: The individual designated by County who is responsible for meeting with Subrecipient’s Project Manager on a regular basis and inspecting all tasks, deliverables, goods, Services, and other work provided by Subrecipient.
Day(s): Unless otherwise specified, references to a numerical number of days shall mean calendar days which includes the seven (7) days of the week (e.g., Monday through Sunday) as opposed to business days which includes the traditional five-day work week (e.g., Monday-Friday), excluding weekends and holidays.
Disability: A condition, or conditions, attributable to mental or physical impairments that result in substantial functional limitations in one (1) or more of the following areas of major life activity:
1. Self-care
2. Receptive and expressive language
3. Learning
4. Mobility
5. Self-direction
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6. Capacity for independent living
7. Economic self-sufficiency
8. Cognitive functioning
9. Emotional adjustment
Elder Abuse: Elder abuse is a term referring to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult. The specificity of laws varies from state to state, but broadly defined, abuse may be physical, financial/fiduciary, psychological/emotional, sexual, exploitation, neglect, self-neglect, and abandonment.
Employee: An individual who is hired and paid by Subrecipient to provide Program Services under the requirements of this Subaward.
Exhibit: A document(s) that is included with this Subaward as an addition/supplement to this Subaward and it forms a part of this Subaward (e.g., Exhibit A (Statement of Work) is an exhibit to the Subaward).
Fiscal Year (FY): The twelve (12) month period beginning July 1st of the year and ending June 30th of the following year.
Frail: An older individual determined to be functionally impaired because the individual either:
• Is unable to perform at least two 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; or
• Due to a cognitive or other mental impairment, requires substantial supervision because the older individual behaves in a manner that poses a serious health or safety hazard to the individual or to others.
Functionally Impaired: A person who meets at least one of the following conditions:
• Impairment in one or more activities of daily living (ADLs); • Impairment in two or more instrumental activities of daily living (IADLs) or; • Inability to manage own affairs due to emotional and/or cognitive impairment.
Greatest Economic Need: The need resulting from an income level at or below the poverty guideline.
Greatest Social Need: The need caused by non-economic factors which include (a) physical and mental disabilities; (b) language barriers; and (c) cultural, geographic isolation, including isolation caused by racial or ethnic status that restricts the ability of an individual to perform daily tasks or threatens the capacity of the individual to live independently.
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Health: Activities such as health screening, physical fitness, therapy, and hospice to assist older individuals to improve or maintain physical health and secure necessary medical, preventive health, or health maintenance services. Health screening, therapy, and hospice must be provided by a licensed health professional or by a paraprofessional supervised by a licensed health professional. Does not include services covered by Medicare, Medi-Cal, or other health insurance.
Indirect Costs: Costs incurred for a common or joint purpose benefiting more than one cost objective and not readily assignable to the cost objective specifically benefited, without effort disproportionate to the results achieved.
Individual with a disability: An individual with a disability, as defined in Section 3 of the Americans with Disabilities Act of 1990 (42 U.S.C. 12102), who is not less than age 18 and not more than age 59. [OAA § 372(a)(2)]
In-Home Supportive Services: The In-Home Supportive Services (IHSS) program provides financial assistance to low-income aged, blind, and disabled individuals who are unable to remain safely in their homes without help from caregivers. The program is administered by the Department of Public Social Services (DPSS) and its purpose is to prevent nursing home placement. IHSS achieves this objective by paying or subsidizing the salaries of caregivers that the IHSS recipients choose.
Instrumental Activities of Daily Living (IADLs): Activities important for daily life, involving cognitive and physical ability. These include: light and heavy housework, shopping, ability to access transportation, meal preparation, using the telephone, managing medications, and managing money.
Lower Tier Subaward (Subcontract): The written and legally binding agreement that is executed between Subrecipient and a third-party vendor (where the vendor is a thirdparty to this Subaward). It sets forth the terms and conditions for the issuance and performance of any element of the Statement of Work. Such agreement shall be preapproved by County prior to its execution between the parties.
Lower Tier Subrecipient (Subcontractor): A third-party vendor who is properly procured by Subrecipient for the purpose of completing the Work/providing Services in accordance with this Subaward.
Mandated Program Services (MPS): A document that identifies the specific Service Categories and Units of Service that Subrecipient shall provide and the Unit Rate (where applicable) that County will reimburse Subrecipient upon successful delivery of these Services.
Management Information System (MIS): Provides information that organizations need to manage themselves efficiently and effectively.
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Maximum Subaward Sum: The combined total of all Subaward Sums to be allocated during the term of this Subaward (where such term may include extensions). This money is contingent upon availability of Federal, State, County, and local funding.
Medi-Cal: California's Medicaid, the federal and state program of medical assistance for needy and low-income people.
Medicare: A federal health insurance program administered by the Centers for Medicare and Medicaid Services (CMS) in the Department of Health and Human Services that is available regardless of income. Most people 65 years of age or older and certain disabled or blind people, regardless of age, are covered.
Modified Total Direct Costs (MTDC): Direct costs including Subaward Sums and other cash contributions but excluding any in-kind contributions and nonexpendable equipment.
Normal Business Hours: The time period which is designated as five (5) days per week (Monday through Friday), eight (8) hours per day during the hours of 8:00 a.m. to 5:00 p.m., not including County recognized holidays. A list of County recognized holidays is provided as an Attachment to the Statement of Work.
Older Adult Advisory Commission (OAAC): The Commission serves as an advocate group in the California Commission on Aging on behalf of older individuals, including, but not limited to, advisory participation in the consideration of all legislation and regulations made by state and federal departments and agencies relating to programs and services that affect older individuals.
Older Americans Act (OAA): A law enacted by the United States Congress in 1965 in response to concern by policymakers about a lack of community social services for older persons. The original legislation established authority for grants to States for community planning and social services, research and development projects, and personnel training in the field of aging. References to OAA shall mean the Older Americans Act of 1965 (OAA), as amended (Title 42 United States Code Section 3001 et seq.).
Older Individual (Older Adult): A person who is sixty (60) years of age or older.
Outcome Measures: Determination and evaluation of the results of Program Services and their comparison with the intended Program goals to determine the effectiveness of these Services.
Outreach: Actively providing information to the public/potential Clients on the Services and benefits of the Program. A contact initiated by Subrecipient for the purpose of identifying potential clients, from underserved populations within each Supervisorial District served, in order to generate referrals to the Program.
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Performance Requirements Summary Chart: An attachment to the Statement of Work, which lists the minimum requirements that Subrecipient shall adhere to, and it reflects some of the performances that will be monitored during the Subaward term.
This Chart also lists examples of the types of documents that will be used during monitoring, the standards of performance, the acceptable quality level of performance, and remedies for non-compliance.
Planning and Service Area (PSA): The geographic division of the State as authorized by the Older Americans Act of 1965 (OAA), as amended (Title 42 United States Code Section 3001 et seq.) for the purpose of implementing the objectives of the OAA (which includes planning and providing a broad range of supportive services, nutrition services, adult protective services and long-term care services within such planning and service areas). As such, the geographic boundaries of Los Angeles County (excluding the City of Los Angeles) have been designated by the State as Planning and Service Area 19 (PSA 19).
Poverty: Persons considered to be in poverty are those whose income is at or below the official poverty guideline (as defined each year by the Office of Management and Budget, and adjusted by the Secretary (DHHS) in accordance with subsection 673 (2) of the Community Services Block Grant Act (Title 42 United States Code Section 9902 (2)).
Program: A system of providing Services, which is designed to meet a social need.
For purposes of this Subaward, unless otherwise specified, the Program shall refer to Services and operations reflected in Exhibit A (Statement of Work) for which Subrecipient receives funds under the terms of this Subaward and agrees to provide Services in accordance with relevant Federal, State, and County laws, regulations, and guidelines during the term of this Subaward.
Program Income: Revenue that is generated by Subrecipient and/or Lower Tier Subrecipient from Subaward-supported activities and includes, but is not limited to:
• Voluntary contributions received from Client or other party for Program Services received.
• Income from usage or rental fees of real or personal property acquired with Subaward Sums.
• Royalties received on patents and copyrights from Subaward-supported activities.
• Proceeds from the sale of items created under the Subaward.
Program Service(s): The specific tasks to be provided (or the Work to be performed) by Subrecipient under the terms of this Subaward as described in Exhibit A (Statement of Work).
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Project Manager: The individual designated by Subrecipient who is responsible for Subrecipient’s day-to-day activities as related to this Subaward. This individual shall meet with County’s Program Manager, County’s Contract Manager and County’s Compliance Manager to ensure that the objectives of this Subaward are met.
Quality Control Plan: A written policy that outlines the actions/methods for monitoring or inspecting the delivery of Services under the Subaward to ensure Subrecipient provides a consistently high level of Service.
Responsible Other: A person designating by the Client to act on behalf of a Client.
Rural: Pursuant to the Administration for Community Living (ACL) (formerly known as the Administration on Aging (AoA)), rural includes any area that is not defined as urban where urban areas comprise: (1) urbanized areas (a central place and its adjacent densely settled territories with a combined minimum population of 50,000) and (2) an incorporated place or a census designated place with 20,000 or more inhabitants.
Senior Centers: A vital link in the service delivery network which older persons may avail themselves of, senior centers are functioning as meal sites, screening clinics, recreational centers, social service agency branch offices, mental health counseling clinics, older worker employment agencies, volunteer coordinating centers, and community meeting halls. The significance of senior centers cannot be underestimated for they provide a sense of belonging, offer the opportunity to meet old acquaintances and make new friends, and encourage individuals to pursue activities of personal interest and involvement in the community.
Service(s): The specific tasks to be provided (or the Work to be performed) by Subrecipient under the terms of this Subaward as described in the Statement of Work.
Service Category: The specific type or kind of benefit/assistance to be provided to Client in accordance with the Statement of Work. This benefit/assistance is the basis of reimbursement that County will provide to Subrecipient upon Subrecipient’s satisfactory deliverance of it.
Service Delivery: Includes those activities associated with the direct provision of a Service which meets the needs of Client.
Social Services: Social service program refers to a program administered by the federal, state, or local government using government funding designed to provide social services directed at reducing poverty, improving opportunities for low-income adults or children, self-sufficiency, rehabilitation, or other services directed toward vulnerable citizens.
Staff: Unless otherwise specified, it is an individual or a group of individuals who are Subrecipient’s Employee(s) and Volunteers who provide Services under the requirements of this Subaward.
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State: Unless other specified, it shall mean the State of California Department of Aging (CDA).
Statement of Work: The directions, provisions, and requirements provided herein and special provisions pertaining to the method, frequency, manner and place of performing Subaward Services.
Subaward (Contract): The written and legally binding agreement that is executed between County and Subrecipient. It sets forth the terms and conditions for the issuance and performance of all tasks, deliverables, Services, and other work. Included are all supplemental agreements amending or extending the Services to be performed.
Subaward Document Deliverable(s): An Exhibit, Attachment, form, certificate, license, etc. that is provided by Subrecipient as part of the contracting process.
Subaward Sum(s): Monies that awarded/allocated on an annual basis and reimbursed to Subrecipient in exchange for Subrecipient’s provision of Program Services (i.e., the total amount of grant funds that County will provide to Subrecipient and Subrecipient will use these funds, in addition to Subrecipient’s own resources, to pay for the total Program operating costs). These monies are contingent upon availability of Federal, State, County, and local funding.
Subrecipient (Contractor): The person or persons, sole proprietor, partnership, joint venture, corporation, or other legal entity that has entered into this Subaward with County to perform and execute the Work and Services covered by this Subaward.
Unduplicated Client: An individual who meets the eligibility requirements outlined in the Statement of Work and such individual is counted only once when determining the total number of unduplicated Clients.
Unit of Measurement: The standard representation for which a quantity is accounted of how each unit is expressed by the Service(s) provided to the Client.
Unit Rate: The amount that is reimbursable by the Program for each Unit of Measurement provided by the Subrecipient.
Unit of Service: The representation of the quantity of services provided to a Client.
Volunteer: An individual who performs hours of service for civic, charitable, or humanitarian reasons without promise, expectation, or receipt of compensation for services rendered. For purposes of this Subaward, Volunteer’s time may qualify to be used to meet the match contributions requirement (where applicable).
Work: The specific tasks to be performed (or the Services to be provided) by Subrecipient under the terms of this Subaward as described in the Statement of Work.
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II. PROGRAM SPECIFIC TERMS
Assessment: A comprehensive and functionally oriented evaluation of the situation and needs of an individual who is potentially eligible to become a client.
California Retail Food Code (CRFC): A uniform statewide health and sanitation standard for food facilities found in California Health and Safety Code Section 113700 et seq.
Congregate Meal Site: A location such as a senior center, recreation center, multipurpose center, etc. where Congregate Meals are served to Clients by Subrecipient.
Such sites are approved for use by County prior to being used for Program Services.
Congregate Meals: Nutritionally balanced food that is prepared according to the requirements outlined in the Statement of Work and is provided to Clients as part of the Congregate Meal Services. These meals which include American and Ethnic meals are served without charge or at a low cost to mobile older adults (sixty (60) years of age or older) who congregate in a group setting at a central location. These nutritionally sound meals are served five (5) days a week in easily accessible locations.
Dietary Guidelines for Americans: The authoritative advice jointly issued and updated every five (5) years by the United States Department of Agriculture (USDA) and the Department of Health and Human Services (HHS) concerning consuming fewer calories, making informed food choices and being physically active to attain and maintain a healthy weight, reduce risk of chronic disease, and promote overall health. These Guidelines are intended for Americans two (2) years of age and over, including those at increased risk of chronic disease. These Guidelines encourage Americans to focus on eating a healthful diet — one that focuses on foods and beverages that help achieve and maintain a healthy weight, promote health and prevent disease.
Elderly Nutrition Program (ENP): An Area Agency on Aging Program administered by County of Los Angeles Workforce Development, Aging and Community Services (County) which provides nutrition services in accordance with the provisions of Title III C (Nutrition Service) of the Older Americans Act of 1965 (OAA), as amended (Title 42 United States Code Section 3001 et seq.).
Emergency Meals: Meals provided to Older Individuals, sixty (60) years of age or older who are homebound by reason of illness, disability or who are otherwise isolated.
These Services include provision of a minimum of three (3) shelf-stable meals per fiscal year. These meals are to be used in the event of an emergency or natural disaster such as earthquakes, power outage, floods, or any disruption of regular meal service to ENP Clients who are receiving Home-Delivered Meal Services.
Food Handler’s Certificate: Employees that prepare and/or serve food must possess a Food Handler’s Certificate issued by an American National Standards Institute (ANSI) accredited training provider that meets ASTM International E2659-09 Standard Practice for Certificate Programs. (Only if a retail provider – exempt if only providing to senior meal programs).
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Hazard Analysis Critical Control Point (HACCP): A systematic preventive approach to food safety which addresses the biological, chemical and physical hazards in production processes (including raw material production, procurement and handling) that can cause the manufacturing, distribution and consumption of the finished product to be unsafe. It also designs measurements to reduce these risks to a safe level. In this manner, HACCP is referred as the prevention of hazards rather than finished product inspection.
Hazard Analysis Critical Control Point (HACCP) Plan: A written document that delineates the formal procedures for following the HACCP principles that were developed by the National Advisory Committee on Microbiological Criteria for Foods and complies with the requirements of the Health and Safety Code Section 114055.
Hazard Analysis Critical Control Point (HACCP) Principles: The seven (7) basic steps of HACCP which are:
1) The completion of hazard analysis identification by identifying the likely hazards to consumers presented by a specific food.
2) The determination of critical control points in receiving, storage, preparation, display, and dispensing of a food.
3) The setting of measurable critical limits for each critical control point determined. 4) Developing and maintaining monitoring practices to determine if critical limits are being met.
5) Developing and utilizing corrective action plans when failure to meet critical limits is detected.
6) Establishing and maintaining a recordkeeping system to verify adherence to a HACCP plan.
7) Establishing a system of audits to:
a) Initially verify the effectiveness of the critical limits set and appropriateness of the determination of critical control points.
b) Periodically verify the effectiveness of the HACCP plan.
Home-Delivered Meals: Nutritionally balanced food that is prepared according to the requirements outlined in the Statement of Work and is delivered to Clients as part of the Home-Delivered Meal Services (it’s also commonly known as “Meals-on-Wheels”).
These meals include Hot, Frozen and Emergency meals which are delivered to individuals who are sixty (60) years of age or older and are homebound by reason of illness, disability or are otherwise isolated. Additionally, the Home-Delivered Meal Services includes a component of Services for Telephone Reassurance that provides regular contact and safety checks by phone calls to reassure and support HomeDelivered Meal Clients or Older Individuals who are on a waiting list to receive HomeDelivered Meals.
Home-Delivered Meals Priority of Service Screening Tool: Subrecipient is required to complete tool for all Home-Delivered Meals clients on current HDM waiting list, prior to updating the AAA Management Information System (MIS).
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Home-Delivered Meals Route: A geographical route that is used by Subrecipient to deliver Home-Delivered Meals to Clients living along that route. Such routes are approved for delivery by County prior to being used for Program Services.
Home-Delivered Meals Waiting List: Subrecipient is required to maintain an HDM Waiting List that includes all eligible HDM Clients that Subrecipient cannot provide meals to. Their position on the list is prioritized based on Older Individuals meeting criteria for greatest socioeconomic needs and level of risk of institutional placement if meals are not provided.
Non-delivered Meals: Meals that Service Providers are unable to serve due to limited financial resources. It is essential for ENP Service Providers to record the daily number of non-delivered meals in the AAA Management Information System (MIS) In order to track unmet needs.
Nutrition Counseling: Provision of individualized advice and guidance by a registered dietician in accordance with Business and Professions Code Sections 2585 and 2586 to individuals who are at nutritional risk because of their health or nutritional history, dietary intake, medications use, or chronic illnesses whereby options and methods for improving their nutritional status are addressed.
Nutrition Education: Informing Clients who receive Elderly Nutrition Program Services about current facts and information which will promote improved food selection, eating habits, nutrition, health promotion, and disease prevention practices.
Nutrition Intervention Follow-Up Services: Telephonic or in person contact with Client by a registered dietician to encourage and foster responsibility for an individualized plan of action in order to correct negative eating patterns and habits to treat an existing condition and promote health.
Nutrition-related Supportive Services: Outreach, transportation, food shopping assistance, and escort of Client to nutrition sites.
Nutritional Risk Score: A numerical representation of Client’s level of general nutritional health as determined by the Nutrition Screening Index checklist.
Nutrition Screening: Completion of a Nutrition Screening Checklist for eligible individuals to determine if they are at nutritional risk.
Nutrition Screening Checklist: A federal public information collection requirement in the National Aging Program Information System (NAPIS) found in the Federal Register Volume 59 Number 188 (September 29, 1994).
Nutrition Screening Index: A tool used to identify elderly persons who are malnourished or at risk of malnutrition.
Nutrition Services: The procurement, preparation, transport, and serving of meals, nutrition education, nutrition screening, and nutrition counseling, to Clients at Congregate Meal sites or in their homes.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit P (Definitions)
Rev. 03/2020 Page 13
Reassessment: A formalized method of documenting and analyzing changes to Client during the period since the previous Nutrition Assessment and assuring the Services provided by Subrecipient are reducing Client’s nutritional risk.
Registered Dietician: A person who shall be both:
• Qualified as specified in the Business and Professions Code Sections 2885 and 2586
• Registered by the Commission on Dietetic Registration Senior Community Service Employment Program (SCSEP): A community service and work-based job training program for older Americans. Authorized by the Older Americans Act, the program provides training for low-income, unemployed seniors.
ServSafe®: A food and beverage safety training and certificate program administered by the National Restaurant Association. The program is accredited by ANSI and the Conference for Food Protection.
Vulnerable and High-Risk Client: An individual that is assessed with a Nutritional Risk Score of six (6) or higher, that may also be affected by factors such as an illness or condition that resulted in a change in the kind and/or amount of food that is consumed, consumes fewer than two (2) meals per day, or has unintentionally lost or gained ten (10) pounds in the past six (6) months.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
EXHIBIT Q
(ACCOUNTING, ADMINISTRATION AND REPORTING REQUIREMENTS) The purpose of this Exhibit Q is to establish required accounting, financial reporting, and internal control standards for Subrecipient.
The accounting, financial reporting and internal control standards described in this Exhibit Q are minimums. These standards are not intended to be all inclusive or replace acceptable existing procedures or preclude the use of more sophisticated methods.
Instead, this Exhibit Q represents the minimum required procedures and controls that must be incorporated into Subrecipient’s accounting and financial reporting systems.
Subrecipient certifies that throughout the entirety of this Subaward, it shall maintain the required level of staffing as outlined in this Subaward. Therefore, the internal control standards described herein are those that apply to Subrecipient’s organization and Subrecipient shall comply with the intent of these standards and implement internal control systems in its performance of the Work hereunder. Subrecipient’s subcontractors must also follow these standards unless otherwise stated in this Subaward.
A. ACCOUNTING AND FINANCIAL REPORTING
1.0 Basis of Accounting
Subrecipient shall maintain written financial and accounting procedures which incorporate Generally Accepted Accounting Principles and Subrecipient shall adhere to the requirements set forth therein.
Subrecipient may elect to use either the accrual basis or cash basis of accounting during the Fiscal Year for recording financial transactions.
Monthly invoices must be prepared on the same basis that is used for recording financial transactions. All financial reports required by County shall be prepared by Subrecipient using accrual information and shall be submitted as directed by County.
1.1 County recommends the use of the accrual basis for recording financial transactions.
Accrual Basis
Under the accrual basis for recording financial transactions, revenues are recorded in the accounting period in which they are earned (rather than when cash is received). Expenditures are recorded in the accounting period in which they are incurred (rather than when cash is disbursed).
Accruals
Accruals shall be recorded observing the following:
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Recorded accruals must be reversed in the subsequent accounting period.
1.2 If Subrecipient elects to use the cash basis for recording financial transactions during the Fiscal Year:
Necessary adjustments must be made to record the accruals at the beginning and the end of the Fiscal Year.
All computations, supporting records, and explanatory notes used in converting from the cash basis to the accrual basis must be retained.
1.3 Prepaid Expenses
Prepaid expenses (e.g., insurance, service agreements, lease agreements, etc.) should only be expensed during a given Subaward Fiscal Year to the extent goods and Services are received or are applicable to that Fiscal Year.
2.0 Accounting System
Subrecipient shall maintain a double entry accounting system (utilizing debits and credits) with a General Journal, a Cash Receipts Journal, a General Ledger, and a Cash Disbursements Journal. Subrecipient shall also maintain a Payroll Register. Postings to the General Ledger and Journals shall be made at least on a monthly basis. Subrecipient shall maintain a separate Cost Center(s), which clearly identifies funds received and expended on Services provided.
2.1 General Journal
A General Journal shall be maintained for recording adjusting entries, reversing entries, closing entries, and other financial transactions not normally recorded in the Cash Receipts Journal or Cash Disbursements Journal. Entries in the General Journal must be adequately documented, and entered in chronological order with sufficient explanatory notations.
Example: DR CR
Rent Expense 100
Rent Payable 100
To record accrued rent to March 31, 20XX
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2.2 Cash Receipts Journal
A Cash Receipts Journal shall be maintained for recording all cash receipts (e.g., County warrants, contributions, interest income, etc.). The Cash Receipts Journal shall contain the following column headings (minimum requirements):
Date
Receipt Number
Cash Debit columns
Income Credit columns for the following accounts:
- County payments (one per funding source)
- Contributions
- Other Income (grants, sales of supplies/services, rental income, miscellaneous revenue, fees, etc.)
Description (entries in the description column must specify the source of cash receipts)
2.3 Cash Disbursements Journal
A Cash Disbursements Journal shall be maintained for recording all cash disbursements (e.g., rent, utilities, maintenance, etc.) The Cash Disbursements Journal shall contain the following column headings (minimum requirements):
Date
Check Number
Cash (Credit) column
Expense Account name
Description
Note (1) Separate cost columns are required for salary expense and other recurring cost classifications for each Program.
Note (2) Entries in the description column must specify the nature of the cost and the corresponding cost classification if not included in the column heading.
Note (3) Checks should not be written to employees (other than payroll, mileage, travel, and petty cash custodian checks).
A Check Register may be substituted for the Cash Disbursements Journal, but this is not recommended. If used, the Check Register must contain the same cost classifications and description information required when a Cash Disbursements Journal is used.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 03/2020 Page 4
Disbursements without supporting documentation will be disallowed upon audit. Cancelled checks and credit card statements (VISA, AMEX, department store, etc.) will not constitute acceptable support. See Subsections A.3.2 (Supporting Documentation) and B.2.4 (Credit Cards) for additional guidance on expense documentation requirements.
2.4 General Ledger
A General Ledger shall be maintained with accounts for all assets, liabilities, fund balances, expenditures, and revenues. Separate accounts must be maintained for the expenses and revenues of each of Subrecipient’s programs (both County and non-County programs).
2.5 Chart of Accounts
A Chart of Accounts shall be maintained:
County recommends that Subrecipient use the expense account titles on the monthly invoice submitted to County.
If Subrecipient uses account titles which differ from the account titles on the monthly invoice, each account title must clearly identify the nature of the transaction(s) posted to the account.
Subrecipient must consistently post transactions that are of a similar nature to the same account. For example, all expenses for travel shall be posted to the account titled "travel" or "travel expense" and not intermixed with other expense accounts.
2.6 Payroll Register
County recommends that a Payroll Register be maintained for recording all payroll transactions. The Register should contain the following:
Name
Position
Social Security Number (at a minimum last four digits of the SSN) Salary (hourly wage)
Payment Record including:
- Accrual Period
- Gross Pay
- Itemized Payroll Deductions
- Net Pay Amount
- Check Number
If a Payroll Register is not used, the information discussed above must be recorded in the Cash Disbursements Journal.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 03/2020 Page 5
Subrecipient will ensure compliance with all applicable Federal and State requirements for withholding payroll taxes (e.g., FIT, FICA, FUTA, SIT, SIU, etc.), reporting, filing (e.g., 941, DE-7, W-2, W-4 and 1099s), and all applicable tax deposits.
Subrecipient will ensure compliance with Internal Revenue Service guidelines in properly classifying employees and independent contractors.
2.7 Subrecipient Invoices
Subrecipient shall present an invoice to County each calendar month to report the prior month’s financial activity of the Program. In addition, if advanced funding is involved, an invoice shall be presented at the beginning of the Fiscal Year. An invoice shall be provided to County as required in this Subaward. At the discretion of County, Subrecipient will be required to submit all invoices and supporting documentation through County's Contract Management System - Contractor's Gateway or any other electronic System to be determined by County.
3.0 Records
Adequate care shall be exercised to safeguard the accounting records and supporting documentation. Any destruction or theft of Subrecipient’s accounting records or supporting documentation shall be immediately reported to County pursuant to the requirements outlined in Exhibit S (Purchase, Inventory and Disposal Requirements for Fixed and Non-Fixed Assets and Supplies), Section III.C (Loss, Destruction or Theft of Assets).
Subrecipient shall report, to the local law enforcement agency having jurisdiction, any act(s), which may reasonably be thought to constitute a crime, and/or which appear to have resulted in the destruction, damage or alteration of any record subject to the provisions of this Exhibit Q.
Subrecipient shall prepare a report and submit it to the local law enforcement agency within twenty-four hours after becoming aware of the acts which have resulted in the destruction, damage, or alteration of the record.
A copy of the resulting crime/incident report must be retained by Subrecipient for a period of time under which the underlying records were destroyed, or damaged were required to be retained plus an additional four (4) years, and shall be retained for a longer period in the case of unresolved litigation or audit.
To the extent that automated accounting records contain confidential information including but not limited to the names and addresses of individuals, Social Security Numbers, etc., the computer files containing this information must be adequately encrypted using the most current DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 03/2020 Page 6
encryption standards to prevent unauthorized access and use. If the allowability of expenditures cannot be determined because Subrecipient’s records or documentation are non-existent or inadequate according to Generally Accepted Accounting Principles set forth in Title 2 Code of Federal Regulations Part 200.302 (for Workforce Innovation and Opportunities Programs and all Other Programs) or Title 2 Code of Federal Regulations Part 200.302 and Title 45 Code of Federal Regulations Part
75.302 (for Area Agency on Aging Programs), the expenditures will be questioned during an audit/monitoring review and may be disallowed at the sole discretion of County or its Authorized Representative.
3.1 Retention
All accounting records (e.g., journals, ledgers, etc.), financial records and supporting documentation (e.g., invoices, receipts, checks, etc.) must be retained pursuant to the authorized retention period outlined in Subparagraph 8.38 (Record Retention, Inspection and Audit Settlement) of this Subaward.
3.2 Supporting Documentation
All revenues and expenditures shall be supported by original vouchers, invoices, receipts, or other documentation and shall be maintained in the manner described herein.
Invoices, receipts, canceled checks, and other documentation, including electronic documentation clearly establishing the nature of the expenditure and its relevance to for the Program shall be required to support an outlay of Subaward Sums. Unsupported disbursements will be disallowed upon audit. Subrecipient will be required to repay County for all dollar for dollar disallowed costs. Photocopied (including scanned images) of invoices or receipts, any internally generated documents (e.g., vouchers, request for check forms, requisitions, canceled checks, etc.), and account statements do not constitute supporting documentation for purchases. To the extent that the source for electronic documentation is an original hardcopy document (e.g., PDF scans of original vendor invoices) Subrecipient shall retain the original source document for inspection by County. County at its sole discretion may accept photocopies of supporting documentation in preference to the original documents.
Supporting documentation is required for various types of expenditures.
Subrecipients shall provide acceptable supporting documentation for all expenditures, and, with regard to the following categories of expenditures, acceptable supporting documentation shall consist solely of the documentation listed for each expenditure type. Another form of documentation may be used, in lieu of the listed types of acceptable DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 03/2020 Page 7
supporting documentation, provided Subrecipient obtains prior written approval of County to use a specific type of alternative documentation.
Payroll – timecards and attendance records signed by an employee and approved in writing by a supervisor; time distribution records by Program accounting for total work time on a daily basis for all employees; records showing actual expenditures for Social Security and unemployment insurance; State and Federal quarterly tax returns; Federal W-2 forms; and Federal W-4 forms. Personnel records shall also be maintained documenting employee pay rates. Personnel records shall also contain documentation confirming that educational and practical experience requirements of an employee’s position have been met. Where licensure is a requirement of an employee’s position, Subrecipient’s personnel file shall contain proof that employees have the required licenses/certifications.
Consultant Services – Subawards (detailing the nature and scope of services to be provided), time and attendance records, billing rates, travel vouchers (detailing purpose, time and location of travel), purchase orders and invoices for supplies and invoices or other supporting documentation detailing the nature of services provided. Subrecipient shall also maintain copies of all completed federal form 1099s, establishing that all payments to all consultants were reported in a timely fashion to federal and State taxing agencies.
Travel – prior, written approval from County’s Contract Manager for travel expenses related to providing Services under this Subaward; written travel policies of Subrecipient; travel expense vouchers showing location, date and time of travel, purpose of trip, benefit(s) to the Program and rates claimed; vehicle mileage logs showing dates, destination and headquarters, purpose of trip, and beginning and ending odometer readings and the resulting mileage. Vehicle mileage logs must clearly identify business versus non-business, or personal travel. For travel related to conferences, Subrecipient shall at a minimum retain conference literature, including but not necessarily limited to, agendas and handouts detailing the purpose of the conference, as part of Subrecipient’s documentation of the propriety of the travel expenditure, and its applicability to the Work performed by Subrecipient hereunder.
Reimbursement rates for mileage shall not exceed the lesser of County’s rate (which County shall provide to Subrecipient annually) and State's mileage rate (which is available online at:
http://www.calhr.ca.gov/employees/Pages/travel-personal-vehicle.aspx).
Reimbursement for actual receipts or per diem rates for meal expenses shall not exceed the maximum County's reimbursement rate for employees.
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Receipts shall be required for lodging for approved out-of-town travel.
Maximum reimbursable lodging amount is County’s maximum reimbursement rate for employees for a single occupancy hotel accommodation. Receipts shall also be required for airfare, car rentals, ground transportation and parking.
Operating Expenses (e.g., utilities, office supplies, equipment rentals, etc.) – bona fide subawards or lease agreements, if any, and invoices and receipts detailing the cost and items purchased will constitute the primary supporting documentation. For internal control purposes, Subrecipient shall maintain vouchers, purchase orders, requisitions, stock received reports, bills of lading, etc. Subrecipient shall also maintain documentation acknowledging the receipt of the specific goods and services for the expenditure (e.g., stock received reports, packing slip signed by the receiving employee, etc.). For internal control purposes, Subrecipient may also maintain vouchers, purchase orders, requisitions, etc.
Vehicle Expenses – A vehicle mileage log must be maintained which established the extent to which company owned vehicles are used for business, versus non-business purposes. For all business-related trips, the log shall identify trip dates, the origin and destination of the trip along with beginning and ending odometer readings and the resulting mileage. For other vehicle expenses such as gasoline and maintenance, invoices/receipts must be maintained which reflect the vehicle license number, or vehicle identification number of the vehicle being serviced or fueled. The record maintenance requirements for company-owned vehicles, also applies to personal vehicles used for business purposes.
Outside Meals - receipts and/or invoices for all meals, a record of the nature and business purpose of each meal, and identification of the Client(s).
Loans from Employees/Related Parties – Loans to Subrecipient by employees and/or related parties shall be supported by a written loan agreement and records documenting that the lent funds were deposited into Subrecipient bank account. Subrecipient shall also maintain documentation showing that the loan proceeds were actually used for the Program. To the extent that the loan agreement provides for the payment of interest, the interest may not be an allowable expense under this Subaward. If the payment of interest is allowable, interest shall not be accrued at a rate which exceeds the most current available County Treasury Rate plus one percent.
3.3 Payments to Affiliated Organizations or Persons
Prior to making payments to affiliated organizations or persons (i.e., related party transactions), Subrecipient shall complete a disclosure statement DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 03/2020 Page 9
identifying the nature of the affiliated, or related organization/ persons.
Subrecipient shall not make payments to affiliated organizations or persons for Program expenses (e.g., salaries, services, rent, etc.) that exceed the lesser of actual cost or the reasonable cost for such expenses. A reasonable cost shall be the price that would be paid by one party to another when the parties are dealing at arm's length (fair market price).
Organizations or persons (related parties) related to Subrecipient or its members by blood, marriage, or through a legal organization (corporation, partnership, association, etc.) will be considered affiliated for purposes of this Subaward. County shall be solely responsible for determining affiliation unless otherwise allowed and approved by the State or Federal agencies.
Payments to affiliated organizations or persons will be disallowed upon audit to the extent the payments exceed the lower of actual costs or the reasonable costs (fair market value) for such items.
3.4 Filing
All relevant supporting documentation for reported Program expenditures and revenues shall be filed in a systematic and consistent manner. It is recommended that supporting documents be filed as follows:
Checks – Numerically
Invoices – Vendor name and date
Vouchers – Numerically
Receipts – Chronologically
Timecards – Pay period and alphabetically
3.5 Referencing
Accounting transactions posted to Subrecipient’s books shall be appropriately cross-referenced to supporting documentation. It is recommended that expenditure transactions on Subrecipient’s books be cross-referenced to the supporting documentation as follows:
Invoices – Vender name and date
Checks – Number
Vouchers –Number
Revenue – Receipt number
Supporting documentation for non-payroll expenditures (i.e., operating expenditures) should be cross-referenced to the corresponding check issued for payment. If multiple invoices are paid with one (1) check, all related invoices should be bound together and cross-referenced to the check issued for payment.
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4.0 Donations and Other Sources of Revenue
Restricted donations and other sources of revenue earmarked specifically for this Subaward must be utilized on allowable Subaward expenditures.
Similarly, income from investments (e.g., interest or dividends), where the source of the amount invested is County program funds, shall be deemed restricted revenue that must be utilized on allowable expenditures, or returned to County.
5.0 Audits
For routine audits and inspections, Subrecipient will make available County and any of its duly Authorized Representatives (including State authorities, Federal agencies (including, but not limited to, Comptroller of the United States, Office of the Inspector General and General Accounting Office) and/or any of their duly authorized representatives), upon request, during County’s hours of operation, throughout the duration of this Subaward and for the authorized retention period outlined in Subparagraph 8.38 (Record Retention, Inspection and Audit Settlement) of this Subaward, all of its books and records, including but not limited to those which relate to its operation of each project or business activity which is funded in whole or part with governmental monies, whether or not such monies are received through County. All such books and records shall be maintained at a location within Los Angeles County.
In general, audits will normally be performed during normal business hours, Monday through Friday. However, County retains the right to inspect and conduct investigations of Subrecipient’s fiscal operations and subaward compliance at any time, without prior notice to Subrecipient seven days a week, when County has information which it, in its sole discretion, deems justifies such an unannounced visit, inspection, audit or investigations.
B. INTERNAL CONTROLS
Internal controls safeguard Subrecipient’s assets from misappropriations, misstatements or misuse. Subrecipient shall prepare necessary written procedures establishing internal controls for its staff. Subrecipient shall instruct all of its staff in these procedures and continuously monitor operations to ensure compliance with them.
1.0 Cash Receipts
1.1. Separate Bank Account or Cost Center
All Subaward Sums shall be maintained in a bank account. Subaward Sums shall be used exclusively for Services funded under this Subaward and shall not be commingled with any other monies of Subrecipient. If revenues from other sources are maintained in the same bank account, revenues for each source must be clearly identifiable on DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 03/2020 Page 11
the accounting records through the use of cost centers or separate bank accounts.
1.2 Deposits
When collections are received by mail, two employees should be assigned to open the mail and list all collections received on a check remittance log.
All checks shall be restrictively endorsed upon receipt. Cash received shall be recorded on pre-numbered receipts and the receipts/check remittance log shall be reconciled to the amount being deposited.
Voided receipts shall be retained and the sequences of receipts issued/ voided shall be periodically accounted for.
Cash receipts (i.e., cash and checks) totaling $500 or more shall be deposited within one (1) day of receipt. Collections of less than $500 may be held, and shall be secured and deposited weekly or when the total reaches $500, whichever occurs first. If Subrecipient can establish that a larger limit is warranted, Subrecipient may request authorization from County to increase the limit to an amount greater than $500.
Duplicate deposit slips shall be retained and filed chronologically, and shall contain sufficient reference information for comparison to the Cash Receipts Journal (and individual receipts, if applicable). Subrecipient shall retain photocopies of County warrants reflected on each deposit slip, or record the individual warrant numbers onto the deposit slip.
1.3 Separation of Duties
An employee who does not handle cash shall record all cash or check receipts in Subrecipient’s accounting records.
1.4 Bank Reconciliations
Bank statements should be received and reconciled by someone with no cash handling, or check writing responsibilities.
Monthly bank reconciliations should be prepared within thirty (30) days of the bank statement date and reviewed by management for appropriateness and accuracy. The bank reconciliations should be signed and dated by both the preparer and the reviewer. Reconciling items should be resolved timely.
2.0 Disbursements
2.1 General
All disbursements (other than those made for petty cash, purchases) shall DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 03/2020 Page 12
be made using Subrecipient’s check, electronic funds transfer, or debit/credit card.
Blank check stock shall be secured and accounted for to preclude unauthorized use.
Checks shall not be payable to "cash" or signed in advance. Similarly, electronic debits to “cash” shall not be made. Checks written to employees for reimbursement of out-of-pocket costs must be supported by receipts and invoices.
A second signature is recommended on all checks over $500, unless otherwise authorized by County in writing. In instances where the payee is also a signor on the check, the disbursement shall be reviewed and approved by a higher level employee, or Board member who shall also sign the check.
Voided checks shall be marked void with the signature block cut out. The voided checks must be filed with the cancelled checks.
Unclaimed or undelivered checks shall be cancelled periodically.
All supporting documentation shall be referenced to check numbers and marked "paid" or otherwise canceled to prevent duplicate payments or reuse.
Disbursements without adequate supporting documentation will be disallowed upon audit.
2.2 Approvals and Separation of Duties
Employees responsible for approving cash disbursements and/or signing checks shall examine all supporting documentation at the time the checks are approved and signed.
All disbursements, excluding petty cash purchases, shall be approved by persons independent of check preparation and bookkeeping activities.
2.3 Petty Cash
A petty cash fund up to $500 may be maintained for payment of small incidental expenses incurred by Subrecipient (e.g., postage due, small purchases of office supply items, etc.). Subrecipient must obtain prior written approval from County’s Contract Manager to establish a petty cash fund greater than $500.
Petty cash disbursements must be supported by original invoices, store receipts or other external authenticating documents indicating the item DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 03/2020 Page 13
purchased and the employee making the purchase. In the event that outside (external) supporting documentation is not obtainable for minor disbursements (under $10), such as parking meters, fee, etc., then some written documentation shall be maintained and approved by a supervisory employee not associated with the transaction. Petty cash disbursements should not be used as a substitute for normal purchasing and disbursement practices (i.e., payment by check).
The petty cash fund shall be maintained on an imprest basis. A check should be drawn to set up the fund and to make periodic reimbursements.
Receipts, vouchers, etc., supporting each fund replenishment must be bound together, filed chronologically and cross referenced to the reimbursement check.
2.4 Credit Cards
The use of credit cards, both Subrecipient issued credit cards and an employee's personal credit card used on behalf of Subrecipient, should be limited to purchases where established purchasing and disbursement practices are not suitable.
Credit cards issued in Subrecipient’s name must be adequately safeguarded and usage monitored to ensure that only authorized and necessary items are purchased.
Credit card purchases should be pre-approved by Subrecipient management to ensure that they are reasonable and necessary.
All credit card disbursements must be supported by original invoices, store receipts or other external authenticating documents indicating the item purchased the employee making the purchase, and the justification for the purchase. Credit card statements are not sufficient support for credit card purchases.
3.0 Timekeeping
3.1 Timecards
Timecards or time reports must be prepared for each pay period.
Timecards or time reports must indicate total hours worked each day by program and total hours charged to each of Subrecipient’s programs. Time estimates do not qualify as support for payroll expenditures and will be disallowed upon audit.
All timecards and time reports must be signed in ink by the employee and the employee's supervisor to certify the accuracy of the reported time. To the extent Subrecipient utilizes electronic timecards and time reports, DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 03/2020 Page 14
Subrecipient must ensure that both the employee and supervisor certify time reported using electronic signatures. Where electronic timecards and time reports are used, Subrecipient’s reporting system must be able to electronically record the date/time the timecard was prepared/reviewed.
Subrecipient’s electronic time reporting system must also have sufficient controls to prevent unauthorized alteration/changes to electronic time records and reports.
3.2 Personnel and Payroll Records
Adequate security must be maintained over personnel and payroll records with access restricted to authorized individuals. Any automated personnel and payroll records which contain confidential information such as employee addresses, medical condition information, etc. should be adequately encrypted to prevent unauthorized access and use using the latest encryption standards. Subrecipient shall develop, maintain and adhere to its written personnel policies and procedures, wherein such procedures shall incorporate due process protection according to standard personnel practices.
Personnel and payroll records shall include, but are not limited to, the following:
Employee’s authorized salary rate
Employee information sheet (e.g., employee contact information, emergency contact information, etc.)
Resume and/or application
Proof of qualifications for the position, if required (e.g., notarized copy or original diploma, license(s), etc.)
Performance evaluations
Criminal record clearance (if required)
Citizenship status
Benefit balances (e.g., sick time, vacation, etc.)
Health Clearances (if required)
3.3 Benefit Balances
Employee benefit balances (e.g., sick time, vacation, personal time, etc.) should be maintained on at least a monthly basis. Benefit balances should be increased when benefit hours are earned and decreased as hours are used.
3.4 Limitations on Positions and Salaries
Subrecipient shall not pay any salaries which are higher than those authorized in this Subaward, or the Exhibits thereto, including this Exhibit Q.
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When this Subaward is for Workforce Innovation and Opportunity Act Program Services, Subrecipient shall adhere to Public Law 109-234, as provided by the Employment Development Department (EDD) through its issuance of a directive. Subrecipient shall obtain the most current version of EDD’s directive on salary and bonus limitations on-line using the following Website address:
http://www.edd.ca.gov/jobs and training/Active Directives.htm For purposes of establishing a reasonable level of compensation for Subrecipient’s employees, County may refer to the applicable Child Welfare League of America (CWLA) Salary Study.
If an employee serves in the same or dual capacities under more than one subaward or program, time charged to the subawards or programs taken as a whole may not exceed 100% of the employee’s actual time worked.
Salaried employees shall be paid a salary that corresponds with the employee’s work schedule. For example, a ½-time salaried employee performing the same or similar work should be paid proportionately less than a full-time salaried employee.
The salary expense of salaried employees working on more than one (1) subaward or program shall be allocated to each program based on the ratio of the number of hours worked on each program during the pay period to the total number hours worked during the pay period.
Subrecipient shall not make retroactive salary adjustments for any employee without prior written approval from County’s Contract Manager.
3.5 Separation of Duties
Payroll checks should be distributed by persons not involved in timekeeping, preparing of payroll transaction, or reconciling bank accounts.
All employee hires, terminations or pay rate changes shall be approved in writing by authorized persons independent of payroll responsibilities.
4.0 Bonding – All officers, employees, and subrecipients who handle cash or have access to Subrecipient’s funds (e.g., prepare checks, etc.) shall be bonded pursuant to Subparagraph 8.25 (Insurance Coverage) of this Subaward.
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C. COST PRINCIPLES
1. 0 P o l i c y
It is the intent of County to provide funds to Subrecipient for the purpose of providing Services required by this Subaward. Subrecipient shall use these Subaward Sums on actual expenses in an economical and efficient manner and shall ensure that these expenditures are reasonable, proper, and necessary costs of providing Services and are allowable in accordance with the following Administrative requirements, procurement standards, and cost principles (Administrative Requirements):
Area Agency on Aging (AAA) Programs:
o Title 2 Code of Federal Regulations Part 200 et seq. and o Title 45 Code of Federal Regulations Part 75 et seq.
Workforce Innovation and Opportunity Act (WIOA) Programs:
o Title 2 Code of Federal Regulations Part 200 et seq. and o Title 2 Code of Federal Regulations Part 2900 et seq. All Other Programs:
o Title 2 Code of Federal Regulations Part 200 et seq.
1.1 Subrecipient is responsible for obtaining the Administrative Requirements noted above, which are available on-line as follows:
Title 2 Code of Federal Regulations Part 200 et seq.
(http://www.ecfr.gov/cgi-bin/textidx?tpl=/ecfrbrowse/Title02/2cfr200 main 02.tpl.) Title 45 Code of Federal Regulations Part 75 et seq.
http://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75
Title 2 Code of Federal Regulation Part 2900 et seq.
https://www.ecfr.gov/cgibin/searchECFR?idno=2&q1=2900&rgn1=PARTNBR&op2=and&q2=&rgn 2=Part
1.2 Limitations on Expenditures of Subaward Sums
Subrecipient shall comply with this Subaward and Administrative Requirements. The Administrative Requirements define direct and indirect costs, discuss allowable cost allocation procedures and the development of Indirect Cost Rates, and specifically address the allowability of a variety of different costs.
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If Subrecipient is unsure of the allowability of any particular type of cost or individual cost, Subrecipient should request advance written approval from County’s Program Manager prior to incurring the cost. Any conflict or inconsistency between or among the requirements outlined within this Subaward, Exhibit A (Statement of Work), this Exhibit Q, and Administrative Requirements shall be resolved by giving precedence as follows:
Administrative Requirements
Subaward
• Exhibit A (Statement of Work)
Exhibit Q (Accounting, Administration and Reporting Requirements)
1.3 Expenses Incurred Outside the Subaward Period
Expenses charged against Subaward Sums may not be incurred prior to the effective date of this Subaward, or subsequent to this Subaward’s expiration or termination date. Similarly, current period expenses related to events or activities that occurred prior to the effective date of the Subaward may not be allowable. For example, legal costs incurred while prosecuting or defending a lawsuit stemming from events which occurred during a period not covered by a valid Subaward between Subrecipient and County are not allowable. Expenses charged against Subaward Sums during any Fiscal Year period may not be incurred outside of that Fiscal Year period.
1.4 Budget Limitation
Expenses may not exceed the maximum limits shown on the Budget(s).
1.5 Unspent Funds
Subrecipient shall return any unspent Subaward Sums to County unless otherwise permitted by this Subaward. In addition, County will determine the disposition of unspent Subaward Sums upon expiration or termination of this Subaward and at the end of each Fiscal Year period.
1.6 Necessary, Proper and Reasonable
Only those expenditures that are necessary, proper and reasonable to carry out the purposes and activities of the Program are allowable. These expenditures must clearly evidence a benefit(s) to the Program.
2.0 Allocable Expenses
When Subrecipient provides services in addition to the Services required under this Subaward, Subrecipient shall allocate expenditures that benefit DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 03/2020 Page 18
programs or funding sources on an equitable basis.
In accordance with Administrative Requirements, Subrecipient shall define its allocable expenses as either direct or indirect costs (as defined in Subsections C.2.1 (Direct Costs) and C.2.2 (Indirect Costs) below) and shall allocate each cost using the basis that is most appropriate and feasible.
Subrecipient shall maintain documentation or allocated expenses (e.g., timecards, time summaries, square footage measurements, number of employees, etc.).
Under no circumstances shall allocated expenses be charged to an extent greater than 100% of actual expenses or the same expense be charged both directly and indirectly.
2.1 Direct Costs
Unless otherwise set forth in this Subaward, or required by the funding source(s), direct costs are defined as those costs that can be identified specifically with a particular final cost objective (i.e., a particular program, service, or other direct activity of Subrecipient’s organization). Examples of direct costs include salaries and benefits of employees working on the Program, supplies and other items purchased specifically for the Program, costs related to space used by employees working on the Program, etc.
For all employees, other than those employed in general or administrative positions, the hours spent on each program (activity) should be recorded on the employees' timecards and the payroll expenses should be treated as direct charges and distributed on the basis of recorded hours spent on each program.
Joint costs (i.e., costs that benefit more than one (1) program or activity) which can be distributed in reasonable proportion to the benefits received may also be direct costs.
Examples of bases for allocating joint costs as direct costs:
Number of direct hours spent on each program
Number of employees working in each program
Square footage occupied by each program
Other relevant and equitable methods of allocation
2.2 Indirect Costs
Indirect costs are those costs that have been incurred for common or joint purposes and cannot be readily identified with a particular final cost objective. Examples of indirect costs include salaries, employee benefits, DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 03/2020 Page 19
Example
Agency-wide indirect costs $250,000
Less: Capital Expenditures 10,000
Allocable indirect costs 240,000
Total Agency-wide indirect salaries $1,000,000
Indirect cost rate ($240,000/$1,000,000) 24%
Program direct salaries $100,000
Program indirect costs (24% x $100,000) $24,000
supplies, and other costs related to general administration of Subrecipient’s organization, and the salaries and expenses of executive officers, personnel administration, and accounting staff.
Examples of bases for allocating indirect costs:
Total direct salaries and wages
Total direct costs (excluding capital expenditures and other distorting items such as significant one-time expenses, or Lower Tier Subrecipient payments)
2.3 Acceptable Indirect Cost Allocation Methods
Administrative Requirements describe the following allowable methods for allocating indirect costs:
Simplified allocation method
Direct allocation method
Multiple allocation base method
Negotiated indirect cost rate
Simplified Allocation Method
This method can be used when Subrecipient’s major functions benefit from its indirect costs to approximately the same degree. Using this method, all allocable costs are considered indirect costs and an indirect cost rate is determined by dividing total allowable indirect costs by an equitable distribution base.
Direct Allocation Method
This method can also be used when Subrecipient’s major functions benefit from its indirect costs to approximately the same degree. Using this method, all costs except general administration and general expenses are DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 03/2020 Page 20
treated as direct costs. Joint costs for rentals, facilities maintenance, telephone, and other similar expenses are prorated individually to each direct activity on a basis appropriate for that type of cost.
The remaining costs, which consist exclusively of general administration and general expenses are then allocated using the simplified allocation method previously discussed.
Multiple Base Allocation Method
This method can be used when Subrecipient’s major functions benefit from its indirect costs in varying degrees. Using this method, indirect costs are grouped to permit allocation of each grouping on the basis of the benefits provided to the major functions. Each grouping is then allocated individually using the basis most appropriate for the grouping being allocated.
Negotiated Indirect Cost Rates
Subrecipient has the option of negotiating an indirect cost rate or rates for use on all its Federal programs. Subrecipient must submit a Cost Allocation Plan to the Federal agency providing the majority of funds to Subrecipient’s organization. The approved indirect cost rate is then applied to the total approved direct cost base.
When Subrecipient has an approved indirect cost rate accepted by all Federal awarding agencies, Subrecipient shall submit a copy of the approval letter to County’s Compliance Manager upon request.
D. UNALLOWABLE COSTS
The allowability of a variety of different costs are addressed in the following:
AAA Program: Title 2 Code of Federal Regulations Part 200.421 et seq. and Title 45 Code of Federal Regulations Part 75.421 et seq. WIOA and all Other Programs: Title 2 Code of Federal Regulations Part 200.421 et seq.
For all costs, there are certain restrictions and limitations; however, the following costs are not allowable under any circumstances:
Bad debts
Contingency provisions (exceptions may include self-insurance, pension funds and reserves for normal severance pay)
Contributions and donations rendered
Fines and penalties (e.g., including but not limited to NSF Check Fees, Traffic Citation Fees)
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Lobbying and fundraising activities
Interest expense (unless expressly allowed by Federal guidelines) Losses on other awards
Capital expenditures
Advertising and public relations
Entertainment/alcoholic beverages
Additionally, Subrecipient shall not use Subaward Sums to repay disallowed costs.
E. REPORTING FRAUD, ABUSE, MISCONDUCT OR NON-COMPLIANCE
1.0 Subrecipient shall report suspected fraud (including welfare fraud), abuse, waste, or misuse of public monies, and misconduct of County personnel to the Los Angeles County Fraud Hotline. Subrecipient shall also report suspected fraud, abuse, waste, or misuse of public monies, and misconduct committed by its employees, volunteers, and any Lower Tier Subrecipients when that fraud affects its Subaward with County.
Reportable conditions of fraud include, but are not limited to:
Requests for bribes/kickbacks/gratuities by County personnel Favoritism/nepotism in the awarding of County contracts, selection of vendors or hiring of Subrecipient’s employees
Theft or misuse of any funds, resources or equipment
Falsification of records
Violation of conflict of interest requirements; etc.
2.0 Failure to report the types of fraud/misconduct discussed above may be grounds for termination of this Subaward as solely determined by County.
3.0 Reports can be made anonymously to the Los Angeles County Department of Auditor-Controller, Office of County Investigations as follows:
Website: www.lacountyfraud.org
E-Mail Address: [email protected]
Fraud Hotline: (800) 544-6861
Fax: (213) 633-0991
Mail: Office of County Investigations
500 W. Temple St., Room 515
Los Angeles, CA 90012
4.0 User Complaint Report
4.1 County’s staff shall complete the User Complaint Report (UCR) to report Subrecipient’s non-compliance with the requirements of this Subaward.
Areas of Subrecipient’s non-compliance include, but are not limited to, the following:
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Subrecipient’s Project Manager or other staff not responding to messages/requests from County staff.
Subrecipient’s Project Manager or other staff does not attend trainings/meetings required by County.
Subrecipient staff changes without prior notification to County. Illegal or inappropriate behavior by Subrecipient’s staff. Subrecipient not submitting reports/documents or maintaining records as required.
Subrecipient not complying with the quality assurance requirements as specified in this Subaward.
4.2 County’s Compliance Manager shall maintain the UCR, and it will be used to evaluate Subrecipient’s performance of the requirements of this Subaward in addition to being used as the basis for placing Subrecipient on probation, suspending payment, suspending this Subaward, terminating this Subaward or any other remedies that are available in this Subaward. The UCR may also be used during County’s solicitation process to evaluate Subrecipient's past performance on this Subaward in addition to being used when Subrecipient requests a reference from County for purposes of applying for other grants.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE FY 2020-2021
EXHIBIT R
(JOINT FUNDING REVENUE DISCLOSURE)
List all revenue provided to Subrecipient on an annual basis (including the Subaward Sums, foundation grants, donations, etc.). Use additional pages as necessary.
Revenue Source (Agency or Organization
Name, Contact Name and Phone Number)
Funding Amount Funding Period
Start Date End Date
LA County WDACS Elderly Nutrition Program $291,000 7/1/2020 6/30/2021 City of Glendale General Fund $84,577 7/1/2020 6/30/2021 Congregate/Home Delivered Meals Donations $40,700 7/1/2020 6/30/2021 Meals on Wheel America COVID Response
Fund $90,000 4/24/2020 8/21/2021
LA County WDACS Supportive Services
Program $49,000 7/1/2020 6/30/2021
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GRAND TOTAL OF ALL PAGES $555,277
City of Glendale ENP202106
Subrecipient’s Legal Name Subaward Number
Aylin Isayan 6/16/2020
Name of Preparer (Print) Date Prepared
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
EXHIBIT S
(PURCHASE, INVENTORY AND DISPOSAL REQUIREMENTS
FOR FIXED ASSETS, NON-FIXED ASSETS AND SUPPLIES)
I. GOVERNING REGULATIONS AND POLICIES
A. If this Subaward indicates that Subrecipient may purchase Fixed Assets, Non-Fixed Assets and Supplies using Subaward Sums, pursuant to Subparagraph 9.5 (Fixed Assets, Non-Fixed Assets and Supplies) of the Subaward, Subrecipient shall adhere to all Federal, State and County purchasing and fiscal policies, procedures and requirements. Regardless of the source of the Subaward Sums (i.e., Federal, State or County/local monies), Subrecipient shall adhere to these purchasing, inventory and disposal requirements for all Fixed Assets, Non-Fixed Assets and Supplies which are defined in Section II (Fixed Asset, Non-Fixed Asset and Supplies), herein. Such requirements include, but are not limited to, the following:
1.0 Area Agency on Aging (AAA) Programs:
1.1 The requirements of this Exhibit S.
1.2 Administrative requirements, procurement standards
and cost principles (Administrative Requirements)
outlined in Title 2 Code of Federal Regulations Part
200 et seq. and Title 45 Code of Federal
Regulations Part 75 et seq.
1.3 Additional requirements which may be communicated
to Subrecipient through County memorandum,
directives, Change Notices, Subaward Amendments,
etc.
2.0 Workforce Innovation and Opportunity Act (WIOA) Programs:
2.1 The requirements of this Exhibit S.
2.2 Administrative requirements, procurement standards
and cost principles (Administrative Requirements)
outlined in Title 2 Code of Federal Regulations Part
200 et seq. and Title 2 Code of Federal Regulations
Part 2900 et seq.
2.3 Additional requirements which may be communicated
to Subrecipient through County memorandum,
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directives, Change Notices, Subaward Amendments,
etc.
3.0 All Other Programs:
3.1 The requirements of this Exhibit S.
3.2 Administrative requirements, procurement
standards and cost principles (Administrative
Requirements) outlined in Title 2 Code of Federal
Regulations Part 200 et seq.
3.3 Additional requirements which may be communicated to Subrecipient through County memorandum, directives,
Change Notices, Subaward Amendments, etc.
B. Throughout this Exhibit S, references will be made to the Administrative Requirements. These references shall mean that Subrecipient shall follow Administrative Requirements that apply to Subrecipient based on the type of Program being funded through this Subaward (e.g., Area Agency on Aging Programs, Workforce Innovation and Opportunity Act Programs, etc.) and the type of entity that best describes Subrecipient’s organization (e.g., non-profit, local government, educational institution, etc.).
C. The requirements outlined in this Section I, herein, are applicable to Fixed Assets and Non-Fixed Assets. When specific requirements related to Supplies are not addressed, Subrecipient shall exercise the same due diligence and care required for the purchase, inventory and disposal of Fixed Assets and Non-Fixed Assets when Subrecipient uses Subaward Sums to purchase Supplies.
D. In the event of any conflict or inconsistency between the requirements established in this Exhibit S and any of the governing Administrative Requirements, the conflict shall be resolved by giving precedence to the governing Administrative Requirements.
II. FIXED ASSET, NON-FIXED ASSET AND SUPPLIES
A. Fixed Asset
1.0 A Fixed Asset is an item which has all of the following attributes:
1.1 Includes, but is not limited to, property, plant,
equipment, land, buildings, additions, attachments,
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improvements, betterments, machinery, vehicles,
furniture, tools, intangibles, mineral resources, etc.
used to conduct business under this Subaward and are
not consumed/sold during the normal course of
Subrecipient’s business under this Subaward. Such
asset must provide a direct benefit to the Program and
Services.
1.2 Has a normal useful life of at least one (1) year and has a unit acquisition cost that is $5,000 or more.
1.2.1 For purposes of determining how to classify
items as either a Fixed Asset or a Non-Fixed
Asset, a unit is defined as either one (1) item or
a group of individual items which are purchased
together as a bundle in order to be used
together. As an example, a desktop computer
system which includes a tower along with other
peripheral items such as a monitor and/or
printer or a laptop system which also includes
additional peripherals are considered one (1)
unit when each of these systems are purchased
as a unit.
1.2.2 The unit acquisition cost is the net invoice price of a unit, which includes shipping costs and
sales taxes, any applicable credits and
discounts as well as the cost of any
modifications, attachments, accessories, or
auxiliary apparatus which are necessary to
make this unit usable for the purpose for which
it is acquired.
1.2.3 To determine the unit acquisition cost of an
asset, consider the following example: four (4)
identical pieces of equipment, which cost $3,000
each, totaling $12,000 would not meet the
$5,000 unit acquisition cost threshold.
1.3 Is either purchased with Subaward Sums and/or was
acquired by Subrecipient under a Predecessor
Agreement(s) for the same/similar purpose as this
Subaward. Such purchases must be allowable and
allocable under the requirements of this Subaward.
For purposes of this Subaward, a Predecessor
Agreement(s) shall mean a subaward between County
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and Subrecipient that was executed prior to this
Subaward for the same/similar Program Services as
this Subaward, and such subaward has expired or
terminated.
2.0 Must be ordered or purchased no later than May 31st of the Fiscal Year.
B. Non-Fixed Asset
1.0 A Non-Fixed Asset is an item which has all of the following attributes:
1.1 Does not meet all of the requirements for a Fixed
Asset, which are outlined above in Subsection II.A
(Fixed Asset), herein, and includes, but is not limited to, computers, laptops, copier machines, printers, etc.
used to conduct business under this Subaward. Such
asset must provide a direct benefit to the Program and
Services.
1.2 Has a normal useful life of over one (1) year and has a unit acquisition cost that is less than $5,000 but is at least $500.
1.2.1 For purposes of determining how to classify
items as either a Fixed Asset or a Non-Fixed
Asset, a unit is defined as either one (1) item or
a group of individual items which are purchased
together as a bundle in order to be used
together. As an example, a desktop computer
system which includes a tower along with other
peripheral items such as a monitor and/or printer
or a laptop system which also includes additional
peripherals are considered one (1) unit when
each of these systems are purchased as a unit.
1.2.2 The unit acquisition cost is the net invoice price of a unit, which includes shipping costs and
sales taxes, any applicable credits and
discounts as well as the cost of any
modifications, attachments, accessories, or
auxiliary apparatus which are necessary to
make this unit usable for the purpose for which it
is acquired.
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1.2.3 To determine the unit acquisition cost of an
asset, consider the following example: four (4)
identical pieces of equipment, which cost $3,000
each, totaling $12,000 would meet the
requirements for the unit acquisition cost
described herein.
1.3 All computing devices, regardless of cost (including but not limited to, workstations, servers, laptops, personal digital assistants, notebook computers, tablets,
smartphones and cellphones).
1.4 All Portable electronic storage media, regardless of cost (including but not limited to, thumb/flash drives and portable hard drives).
1.5 Is either purchased with Subaward Sums and/or was
acquired by Subrecipient under a Predecessor
Agreement(s). Such purchases must be allowable and
allocable under the requirements of this Subaward.
1.6 Must be ordered or purchased no later than May 31st of the Fiscal Year.
2.0 Whatever amount is approved for the equipment must be the same amount that’s reflected on the Budget.
3.0 You must submit a minimum of three (3) bids when
requesting approval for equipment.
C. Usage of the Term “Assets”
1.0 Throughout the entirety of this Exhibit S, references will be made to items that are classified as either Fixed Assets or Non-Fixed Assets. The use of these classifications is based on whether the item meets the requirements outlined in
Subsection II.A (Fixed Asset), herein, and Subsection II.B (Non-Fixed Asset), herein. In some instances where a specific type of asset is being discussed or addressed, the
appropriate term will be used to identify that asset as either a Fixed Asset or a Non-Fixed Asset. Otherwise, any usage of the specific term “Assets” shall mean that the requirements apply to both Fixed Assets and Non-Fixed Assets, collectively (hereafter “Assets”).
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D. Types of Assets
1.0 Additions and Attachments are products that typically involve physical extensions of existing units that are necessary to make these units usable for the purposes for which they are acquired, but do not involve renovations.
1.1 An Addition or an Attachment is considered a Fixed
Asset when its cost, combined with the cost of the unit it is attached to, along with its other characteristics, meet the definition of a Fixed Asset as set forth
herein.
1.2 Examples of Additions and Attachments include new
rooms, new roof, new heating, ventilation and air
conditioning (HVAC) system added to an existing
building, etc.
2.0 Improvements and Betterments are products that typically do not increase the physical size of the unit.
2.1 Requirements for AAA Programs, WIOA Programs and
all Other Programs
2.1.1 Improvements and Betterments enhance the
condition of a unit (e.g., extend life, increase
service capacity, lower operating costs, etc.).
2.1.2 An Improvement or a Betterment is considered
a Fixed Asset when the final cost of the unit
being improved or bettered along with its other
characteristics, meet the definition of a Fixed
Asset as set forth in Subsection II.A (Fixed
Asset), herein.
2.1.3 Examples of Fixed Assets that might be
improved or bettered include roads, bridges,
curbs and gutters, tunnels, parking lots, streets
and sidewalks, drainage and lighting systems,
etc.
3.0 Intangible Property is an item which lacks physical substance but gives valuable rights to the owner; and, such item can be either a Fixed Asset or a Non-Fixed Asset.
3.1 The acquisition cost of the Intangible Property
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includes all amounts incurred to acquire and to ready
the Asset for its intended use. Typical Intangible
Property costs include the purchase price, legal fees,
and other costs incurred to obtain title to the Asset.
3.2 Examples of Intangible Property include patents,
copyrights, leases, computer software, etc.
4.0 Hardware consists of tangible equipment including
computers, printers, terminals, etc.; and, such item can be either a Fixed Asset or a Non-Fixed Asset.
E. Supplies
1.0 Supplies are items which have all of the following attributes:
1.1 Are goods, materials or other items which are
consumed during the normal course of business and
may include, but are not limited to, paper, pencils,
printer cartridges, file folders, etc. (i.e., Supplies are items which are used in such a way that once used,
they cannot be re-used or recovered afterward).
1.2 Have a unit acquisition cost that is less than $500.
1.3 Are necessary for Subrecipient to effectively and
efficiently carry out the objectives, tasks and activities of the Program and provide Services hereunder.
1.4 Are either purchased with Subaward Sums and/or were acquired by Subrecipient under a Predecessor
Agreement(s).
III. GENERAL REQUIREMENTS FOR ASSETS AND SUPPLIES
A. The following requirements are applicable to both Assets and Supplies. In some areas, the requirements are only applicable to Assets; however, Subrecipient shall exercise due diligence in the use and maintenance of Supplies when specific requirements related to Supplies are not addressed.
B. Management of Assets and Supplies
1.0 To prevent misuse, destruction or theft, Subrecipient shall exercise due diligence in its care, use, maintenance,
protection and preservation of all Assets and Supplies.
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2.0 During the entire term of this Subaward, Subrecipient is responsible for the replacement or repair of Assets until Subrecipient has complied with all written instructions from County regarding the final disposition of the Assets as detailed in Section X (Disposal Requirements for Assets and Supplies) herein.
3.0 Subrecipient shall not use Assets or Supplies for personal gain or to usurp the competitive advantage of a privatelyowned business entity.
4.0 Subrecipient shall use Assets and Supplies for the purpose for which they are intended under this Subaward. When no longer needed for that purpose, Subrecipient shall treat them as prescribed in Section X (Disposal Requirements for Assets and Supplies), herein.
5.0 Subrecipient may share use of Assets or allow use by other programs upon prior written approval of County. As a
condition of approval, County may require payment under this Subaward for that use.
C. Loss, Destruction or Theft of Assets
1.0 Subrecipient shall promptly investigate, fully document and report the loss, destruction or theft of Assets. Subrecipient shall report such loss, destruction or theft as follows:
1.1 Subrecipient shall notify the local law enforcement agency with jurisdiction over the location where the
crime occurred by telephone (and confirmed in writing
by filing a police report) within twenty-four (24) hours of occurrence or discovery of such incident.
1.2 Subrecipient shall notify County’s Contract Manager by telephone (and confirmed in writing) or by e-mail within five (5) business days of occurrence or discovery of
such crime. Subrecipient shall prepare an Incident
Report, as described below, which shall be provided to
County’s Contract Manager.
1.3 Incident Report
1.3.1 At a minimum, Subrecipient’s Incident Report of
such loss shall contain the following elements:
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1.3.1.1 Identification of the Asset(s)
1.3.1.2 Recorded value(s) of each Asset
1.3.1.3 Facts relating to the crime
1.3.1.4 A copy of the police report, where
appropriate
1.3.2 Subrecipient shall retain the Incident Report
pursuant to the record retention requirements
outlined in Subparagraph 8.38 (Record
Retention, Inspection and Audit Settlement) of
the Subaward.
2.0 Subrecipient agrees to indemnify County for any loss resulting from the use of any Assets.
IV. DEPRECIATION, USE ALLOWANCE AND CAPITALIZATION POLICY
FOR ASSETS
A. Any Asset purchased with the Federal portion of Subaward Sums, if any, and/or with Subrecipient’s required matching contributions may not be depreciated or capitalized.
B. Any Asset purchased with the non-Federal portion of Subaward Sums, if any, may be capitalized and/or depreciated over the estimated useful lives of these Assets pursuant to Subrecipient’s acquisition policies.
C. Unless otherwise approved by County, compensation for the use of buildings and other capital improvements may be made through depreciation, or a use allowance:
1.0 The computation of depreciation/use allowance is based on the acquisition cost of the asset(s).
2.0 The computation should exclude the cost of land, buildings, and equipment donated by federal, State or County
governments and the cost of buildings and land contributed by Subrecipient to satisfy funding matching requirements.
3.0 For depreciation, an appropriate useful life must be established for the asset(s) which considers factors such as the nature of the asset used, susceptibility to technological obsolescence, etc.
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4.0 A use allowance is computed as an annual rate that may not exceed an annual rate of two-percent (2%) of the acquisition cost if the asset is a building or improvement. A use
allowance in excess of the ceiling percentage must be justified by Subrecipient.
V. TITLE TO ASSETS
A. Assets Purchased with Subaward Sums
1.0 Unless otherwise required by Federal or State laws or regulations, or as agreed upon in writing by the parties, Assets remain the property of County until such time as County approves the final disposition of the Assets (i.e., County retains title to all Assets used in the performance of this Subaward).
B. Assets Purchased Under a Predecessor Agreement(s)
1.0 Unless otherwise required by Federal or State laws or regulations or as agreed upon in writing by the parties, Assets purchased under a Predecessor Agreement(s) remain the property of County until such time as County approves the final disposition of these Assets (i.e., County retains title to all Assets purchased under a Predecessor Agreement(s)).
C. Title to Vehicles
1.0 County retains title to vehicles that are purchased with Subaward Sums. County also retains title to vehicles
purchased with funds from a Predecessor Agreement(s),
when such vehicles are currently in the possession of
Subrecipient.
2.0 Vehicles shall be registered only in the name of Subrecipient.
Such registration applies to all vehicles which are purchased with Subaward Sums as well as those purchased under a
Predecessor Agreement(s), when such vehicles are currently in the possession of Subrecipient.
3.0 For each vehicle(s) purchased with the Subaward Sum(s) under this Subaward and/or under a Predecessor Agreement that is used in the operation of the Program (i.e., Countyowned vehicle(s)), Subrecipient shall ensure that such vehicle(s) undergo a certified smog inspection as required under applicable State and Los Angeles County laws.
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Subrecipient must receive evidence of a passing inspection (i.e., smog certificate) for each vehicle and shall submit a copy of the smog certificate to County’s Compliance Manager on an annual basis in the manner and timeframe designated by
County. When the vehicle(s) is not required to undergo a smog inspection during any year, Subrecipient shall provide evidence (copy of vehicle registration, etc.) indicating that the inspection is not warranted for the specified year.
D. Throughout the entire term of this Subaward, Subrecipient shall adhere to the following:
1.0 Subrecipient shall provide current, ongoing and adequate insurance covering all vehicle drivers pursuant to
Subparagraph 8.24 (General Provisions for all Insurance Coverage) and Paragraph 8.25 (Insurance Coverage) of the Subaward.
2.0 Subrecipient shall ensure that each vehicle driver has a current, valid California driver's license.
VI. APPROVAL REQUIREMENTS FOR PURCHASING ASSETS
A. Necessary Prior Approval to Purchase Assets for Area Agency on Aging Programs
1.0 Prior to purchasing or acquiring any Assets, Subrecipient must receive written approval from County authorizing the purchase when Subrecipient will use any amount of Subaward Sums to purchase the Asset. Prior approval is also required for the following:
1.1 All computing devices, regardless of cost (including but not limited to, workstations, servers, laptops, personal digital assistants, notebook computers, tablets,
smartphones and cellphones).
1.2 All Portable electronic storage media, regardless of cost (including but not limited to, thumb/flash drives and portable hard drives).
2.0 Prior approval is not required for the purchase of Supplies.
However, Subrecipient shall adhere to all of the other
procurement policies governing the purchase of Supplies as outlined herein and in accordance with Administrative
Requirements.
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3.0 Subrecipient shall submit a written request to County’s Contract Manager to request authorization to purchase such Asset. Subrecipient shall submit this written request at least thirty (30) days in advance of the date/time that Subrecipient intends to purchase the Asset.
3.1 For WIOA Programs, Subrecipient shall submit a
written request to County’s Contract Manager following
the instructions provided in WIOA Directive number DDWA-04-024/D-YTH-04-08 (dated August 24, 2004).
Copies of this Directive are available on the Work
Source California website, which may be accessed
using the following address:
http://www.worksourcecalifornia.com/information/directi ves.htm
4.0 Upon receiving written approval from County, Subrecipient shall ensure that all Asset purchases are also approved in writing by Subrecipient’s Board of Directors or its Authorized Representative, before the Asset is purchased.
5.0 County’s approval of Subrecipient’s Budget does not constitute approval for Subrecipient to purchase the Asset.
Once all written approvals have been received, Subrecipient shall then include the Asset in its Budget and proceed with the purchase.
6.0 Examples
6.1 If Subrecipient intends to purchase an item which costs $475 and Subrecipient will use $475 of Subaward
Sums to purchase this item, prior approval is not
required.
6.2 If Subrecipient intends to purchase an item, which costs $550 and Subrecipient will use $500 of Subaward
Sums to purchase this item, prior written approval is
required.
VII. APPROVAL REQUIREMENTS FOR DISPOSING OF ASSETS
A. Necessary Prior Approval to Dispose of Assets for AAA Programs:
1.0 Subrecipient shall obtain prior written approval from County (and State) in order to sell, trade-in, discard, or transfer to another entity any Asset with a unit acquisition cost of at least DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit S (Purchase, Inventory and Disposal Requirements for Fixed Assets, Non-Fixed Assets and Supplies)
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$500 and/or any item which meets the standards outlined in the Subaward pertaining to Information Technology.
Subrecipient shall not dispose of any Asset or Information Technology product unless/until Subrecipient receives such written approval.
2.0 Subrecipient shall contact County’s Contract Manager to obtain specific instructions on how to request prior approval, and Subrecipient shall adhere to all County and State
requirements for the disposal of these Assets/Information Technology product.
3.0 Prior to the sale, trade-in, discard or transfer of any Asset consisting of electronic equipment with digital memory or storage capability, Subrecipient shall send a written
notification to County’s Contract Manager attesting that the device’s memory and/or any information stored in the memory is permanently removed, erased and cleared of all Subaward, Program and Client related records and information (or any information that would compromise Subrecipient’s ability to adhere to the confidentiality requirements of this Subaward, including Subparagraph 7.6 (Confidentiality) of the Subaward, Exhibit G1 (Subrecipient Acknowledgement and
Confidentiality Agreement), and Exhibit N (Business
Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA)) – if/when Exhibit N (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA)) is included with this Subaward.
4.0 Upon receipt of written approval from County, Subrecipient shall follow all guidelines to dispose of Assets and Supplies pursuant to Section X (Disposal Requirements for Assets and Supplies), herein.
B. Necessary Prior Approval to Dispose of Assets for WIOA Programs
1.0 Subrecipient shall obtain prior written approval from County in order to sell, trade-in, discard or transfer to another entity any Asset with a unit acquisition cost of at least $500.
Subrecipient shall not dispose of any Asset unless/until Subrecipient receives such written approval.
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2.0 Subrecipient shall contact County’s Contract Manager to obtain specific instructions on how to request prior approval from County, and Subrecipient shall adhere to all County requirements for the disposal of these Assets.
3.0 Prior to the sale, transfer, donation or other disposal of any Asset consisting of electronic equipment with digital memory or storage capability, Subrecipient shall send a written notification to County’s Contract Manager attesting that the device’s memory and/or any information stored in the
memory is permanently removed, erased and cleared of all Subaward, Program and Client related records and
information (or any information that would compromise
Subrecipient’s ability to adhere to the confidentiality requirements of this Subaward, including Subparagraph 7.6 (Confidentiality) of the Subaward, Exhibit G1 (Subrecipient Acknowledgement and Confidentiality Agreement) and
Exhibit N (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996
(HIPAA)) – if/when Exhibit N (Business Associate
Agreement Under the Health Insurance Portability and
Accountability Act of 1996 (HIPAA)) is included with this Subaward.
4.0 Upon receipt of written approval from County, Subrecipient shall follow all guidelines to dispose of Assets and Supplies pursuant to Section X (Disposal Requirements for Assets and Supplies), herein.
C. Necessary Prior Approval to Dispose of Assets for all Other Programs:
1.0 Subrecipient shall obtain prior written approval from County in order to sell, trade-in, discard or transfer to another entity any Asset with a unit acquisition cost of at least $500, or $300 if purchased under a Predecessor Agreement(s) (regardless of the residual or current fair market value of the Asset).
Subrecipient shall not dispose of any Asset unless/until Subrecipient receives such written approval.
2.0 Subrecipient shall contact County’s Contract Manager to obtain specific instructions on how to request prior approval from County, and Subrecipient shall adhere to all County requirements for the disposal of these Assets.
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3.0 Prior to the sale, transfer, donation or other disposal of any Asset consisting of electronic equipment with digital memory or storage capability, Subrecipient shall send a written notification to County’s Contract Manager attesting that the device’s memory and/or any information stored in the
memory is permanently removed, erased and cleared of all Subaward, Program and Client related records and
information (or any information that would compromise
Subrecipient’s ability to adhere to the confidentiality requirements of this Subaward, including Subparagraph 7.6 (Confidentiality), Exhibit G1 (Subrecipient
Acknowledgement and Confidentiality Agreement), and
Exhibit N (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996
(HIPAA)) – if/when Exhibit N (Business Associate
Agreement Under the Health Insurance Portability and
Accountability Act of 1996 (HIPAA)) is included with this Subaward.
4.0 Upon receipt of written approval from County, Subrecipient shall follow all guidelines to dispose of Assets and Supplies pursuant to Section X (Disposal Requirements for Assets and Supplies), herein.
D. Necessary Prior Approval to Use Program Income from Sales Revenue
1.0 Subrecipient shall obtain prior written approval from County in order to use Program Income derived from revenue earned after the sale of Assets pursuant to Exhibit Q (Accounting, Administration and Reporting Requirements).
4.0 Subrecipient shall contact County’s Program Manager to obtain specific instructions on how to request prior approval from County, and Subrecipient shall adhere to all County requirements for the use of such Program Income.
VIII. PURCHASE REQUIREMENTS FOR ASSETS
A. The following requirements are applicable only to Assets.
However, Subrecipient shall exercise due diligence in the purchase of Supplies when specific requirements related to Supplies are not addressed.
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B. Cost Requirements
1.0 Subrecipient shall perform a cost or price analysis prior to the purchase of an Asset.
1.1 A cost analysis includes the review and evaluation of each element of cost to determine its reasonableness,
allocability and allowability. Subrecipient shall ensure that the cost of the Assets are allowable and allocable pursuant to the cost principles outlined in
Administrative Requirements.
1.2 A price analysis includes the comparison of price
quotations submitted, market prices, and similar
indicia, together with discounts.
2.0 Subrecipient shall conduct an analysis of lease and purchase alternatives to determine the most economical and practical procurement method.
3.0 Subrecipient shall avoid purchasing unnecessary or
duplicative items. Subrecipient shall ensure that the costs for Assets are reasonable and proper and that the Assets are necessary to carry out the purposes and activities of the Program (or are necessary and reasonable for the proper and efficient accomplishment of Program objectives).
4.0 Subrecipient shall ensure that all costs associated with the purchase of an Asset are included in the Asset’s true actual cost (i.e., the true actual cost of the Asset should include all amounts to be incurred to acquire and to ready the Asset for its intended use). The true actual cost shall also include any deductions for discounts, refunds, adjustments, rebates and allowances received by Subrecipient as well as any charges for taxes, delivery/shipping, etc.
5.0 Subrecipient shall only charge the true actual cost of the Asset to this Subaward. If the true actual cost of the Asset is allocable to multiple funding sources, the share of costs charged to this Subaward shall not be charged by
Subrecipient to another grant, program or contract.
C. Competitive Procurement
1.0 Subrecipient shall conduct all procurements for Assets in a manner that provides full, open and free competition
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consistent with the procurement standards outlined in
Administrative Requirements.
2.0 Subrecipient shall ensure that it obtains and thoroughly evaluates a minimum of three (3) written competitive bids from the best known sources prior to purchasing the Asset.
3.0 Subrecipient shall avoid organizational conflicts of interest and non-competitive practices among vendors that may
restrict or eliminate competition or otherwise restrain trade.
4.0 Subrecipient or Subrecipient’s agent who develops or drafts specifications, requirements, statements of work, invitation for bids and/or request for proposals for the procurement of Assets shall be excluded from competing for such
procurements.
5.0 Subrecipient shall select the most responsible vendor whose bid is most responsive to the requirements outlined in the solicitation.
6.0 Sole Source Procurement (Non-competitive Procurement)
6.1 Sole source procurement is the solicitation of a
proposal from only one (1) source or after solicitation from a number of sources, competition is determined
inadequate.
6.2 Sole source procurement may only be used when the
procurement is not feasible under the small purchase
procedures, sealed bids or competitive proposals (as
defined in Administrative Requirements and at least
one (1) of the following applies:
6.2.1 The Asset is available only from a single
source/vendor.
6.2.2 Public exigency or emergency for the Asset will
not permit a delay resulting from a competitive
solicitation.
6.2.3 County provides written authorization for noncompetitive procurement of the Asset.
6.2.4 After solicitation of a number of sources, and
with written approval from County, competition
is determined inadequate.
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6.3 The sole source procurement must be documented,
and such documentation shall include a full
justification providing an explanation as to why this
non-competitive procurement method was used.
7.0 Subrecipient shall ensure that solicitations for Assets provide:
7.1 Clear and accurate description of the technical
requirements for the Asset to be procured and such
description shall not contain features which unduly
restrict competition.
7.2 Requirements which the bidder must fulfill and all
other factors to be used in evaluating bids.
7.3 Description of the functions to be performed (i.e., performance required), including the minimum
acceptable standards.
7.4 Description of specific features of “brand name”
products or an equivalent that bidders are required to
meet when such items are included in the solicitation.
7.5 Acceptance, to the extent possible and as
economically feasible, of Assets dimensioned in the
metric system of measurement.
7.6 Preference, to the extent possible and as
economically feasible, for Assets that conserve
natural resources, protect the environment and are
energy efficient.
8.0 Subrecipient shall make an effort to utilize small businesses, minority-owned firms and women’s business enterprises
whenever possible, pursuant to the procurement procedures outlined in the applicable Administrative Requirements.
D. Procurement Instrument
1.0 Subrecipient shall determine the type of procuring or contracting instrument to be used for the purchase. Such instrument may include purchase orders, fixed price
subawards, cost reimbursable subawards, etc.
2.0 Subrecipient shall determine and use the most appropriate instrument for the particular procurement and such
instrument shall promote the best interests of the Program.
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3.0 “Cost-plus-a-percentage-of-cost” or “percentage of
construction cost” methods of contracting shall not be used.
E. Documentation Requirements
1.0 Subrecipient shall maintain proper forms of documentation to demonstrate the significant history of the procurement for all Assets (e.g., requisitions, purchase orders, receipts, price quotes/vendor bids, etc.).
2.0 Subrecipient shall have written internal procurement procedures in place (including processes for vendor
selection, requisition approval, etc.).
3.0 Subrecipient shall maintain documentation of its cost/price analysis and any sole source procurement.
4.0 Subrecipient’s Budget
4.1 Subrecipient shall report Assets purchased with
Subaward Sums on the Budget. Prior to reporting
Assets on the Budget, Subrecipient shall receive
written approval from County in order to purchase
Assets as detailed in Section VI (Approval
Requirements for Purchasing Assets), herein.
4.2 Assets purchased by Subrecipient shall match the
Assets reported on the Budget.
4.3 The total cost of Assets purchased shall not exceed the amounts reported on the Budget. Subrecipient
shall be liable for the cost of any Asset when that cost exceeds the amount approved by County for the
purchase of the Asset.
4.4 In the event that the actual purchase price is less than the cost reported on the Budget, Subrecipient shall
submit a Budget Modification to County’s Contract
Manager before the end of the Fiscal Year pursuant to
Subparagraph 9.9 (Modifications) of the Subaward.
5.0 Additional Documentation Requirements for Area Agency on Aging Programs
5.1 In addition to the documentation requirements
outlined above, the following requirements shall also
apply to AAA Programs:
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5.1.1 Subrecipient shall submit supporting
documents including, but not limited to,
receipts, purchase orders, invoices, etc. for all
Assets.
5.1.2 The supporting documents shall be submitted
to County’s Contract Manager at the same time
that Subrecipient submits its invoice to County
for the Asset.
F. Assets must be physically received prior to the end of the Fiscal Year during which they are purchased.
G. Assets purchased either wholly with the Federal share of Subaward Sums and/or with any required Subrecipient matching contribution shall be charged directly to the Program.
IX. INVENTORY REQUIREMENTS FOR ASSETS
A. The following requirements are applicable only to Assets.
However, Subrecipient shall exercise reasonable care in the maintenance and tracking of Supplies.
B. Asset Bar Code Identification Tags
1.0 Subrecipient shall ensure that all Assets are properly identified with Asset Bar Code Identification tags. These tags include a unique identifier which is used to track the Asset until its final disposition.
2.0 Subrecipient shall notify County’s Contract Manager to obtain the Asset Bar Code Identification tags and County is
responsible for ensuring that all Assets are tagged. As such, Subrecipient shall provide County full access to these Assets so that County can affix the tags on each Asset.
C. Inventory Tracking
1.0 Every two (2) years, or more frequently as requested by County, Subrecipient shall conduct a physical inventory of all Assets and shall document its activities. Subrecipient shall reconcile the results with Subrecipient’s Asset accounting and inventory records.
2.0 Subrecipient shall investigate any difference(s) between quantities determined by the physical inspection and those DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit S (Purchase, Inventory and Disposal Requirements for Fixed Assets, Non-Fixed Assets and Supplies)
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shown in the accounting and inventory records to determine the causes of the difference(s).
3.0 As part of its inventory tracking, Subrecipient shall verify the existence, current utilization and continued need for Assets.
4.0 Subrecipient shall inventory these Assets until the final disposition procedures have been completed for the Assets.
Upon final disposition of the Assets, Subrecipient shall remove these Assets from its accounting and inventory
records. Subrecipient shall continue to maintain the
disposition records in accordance with the record retention requirements outlined in Subparagraph 8.38 (Record
Retention, Inspection and Audit Settlement) of the Subaward.
D. Reporting Current Fiscal Year
1.0 As part of the annual Closeout process which is conducted at the end of each Fiscal Year, Subrecipient shall complete its report of all Assets purchased during that Fiscal Year.
2.0 Subrecipient shall maintain supporting records for all Assets.
3.0 County may require Subrecipient to submit such supporting records upon request.
4.0 Subrecipient shall ensure that the information on the supporting records match the information reflected on
County’s inventory records.
X. DISPOSAL REQUIREMENTS FOR ASSETS AND SUPPLIES
A. The following requirements are applicable to both Assets and Supplies. Additionally, Subrecipient shall exercise due diligence to dispose of Supplies when specific requirements related to Supplies are not addressed. Subrecipient shall ensure that it obtains prior written approval from County in order to dispose of Assets pursuant to Section VII (Approval Requirements for Disposing of Assets), herein.
B. Consistent with Federal and State regulations, Subrecipient may dispose of Assets and Supplies pursuant to the guidelines reflected in this Exhibit S as well as in the Administrative Requirements.
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C. For purposes of this Exhibit S, disposal shall include the sale, discard, transfer, donation, trade-in or other disposal of Assets.
D. Only Assets that are considered Salvage or Surplus may be sold, transferred, donated or otherwise disposed of.
1.0 Salvage items include Assets which are obsolete, broken or irreparable.
2.0 Surplus items are Assets which are no longer needed for the Program due to expiration or termination of this Subaward, termination of the Program, dissolution of Subrecipient’s operations, or other similar circumstances.
3.0 Subrecipient may sell, transfer, donate or otherwise dispose of Assets when these conditions are met:
3.1 Only after the Assets have first been offered to and declined in writing by County.
3.2 The sale, transfer, donation or other disposal does not create a conflict of interest for County or
Subrecipient. For purposes of this Exhibit S, a
conflict of interest may exist when the disposal of
Assets involves certain individuals or entities who
become the recipients of these Assets. These
individuals and entities may include the
following: Subrecipient employees; Subrecipient
employees' family members; entities that conduct
business or have a relationship with Subrecipient;
Clients; etc.
E. Disposition of Assets upon Dissolution of Subrecipient’s Operations, Expiration or Termination of Subaward or Termination of Program
1.0 County reserves the right to determine the final disposition of the Assets when any of the following occurs:
1.1 After dissolution of Subrecipient’s operations
1.2 Upon expiration or termination of this Subaward
1.3 When the Program, for which Assets were purchased,
has ended
2.0 Disposition may include, but is not limited to, County taking possession of and acquiring the Assets.
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3.0 Subrecipient shall prepare a final Inventory Control Form reflecting the Assets to be provided to County, and shall submit it to County’s Contract Manager within the timeframe designated by County.
4.0 County reserves the right to require Subrecipient to transfer such Assets to another entity, including, but not limited to, State, County or another subrecipient.
5.0 To exercise the right referenced in Subsection X.E.4.0, herein, County will issue specific written disposition
instructions to Subrecipient no later than ninety (90) days after expiration or termination of this Subaward, notification of Subrecipient's dissolution or termination of the Program.
F. Supplies
1.0 Subrecipient shall compensate County for its share of the residual inventory of unused Supplies if the residual or current fair market value of the inventory exceeds $500 or more in the aggregate when the items are no longer needed for either the Program or another Federally-funded program.
2.0 The aggregate value in this case is the total value of all remaining unused Supplies.
G. Current Fair Market Value
1.0 Subrecipient shall determine the current fair market value of all Assets being sold, transferred, disposed of or donated.
2.0 Subrecipient shall use one (1) or more of the following methods/resources to determine the current fair market value of an Asset:
2.1 Orion Computer Blue Book
2.2 Professional or expert appraisal
2.3 Public advertisement
2.4 Industry quotation
2.5 Other similar methods/resources
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H. Sale of Assets
1.0 After receiving written approval from County for this action, Subrecipient may sell Assets, which meet the requirements outlined in Subsections X.D.1.0 – X.D.3.0, herein, as a method of disposing those Assets.
2.0 Subrecipient shall have proper sales procedures in place in order to sell Assets. These procedures shall provide for competition to the extent practicable and shall result in the highest possible return.
3.0 Subrecipient shall record all sales revenue information relating to the sale or disposition of the Assets. Revenue from the sale of Assets becomes Program Income and
Subrecipient may be required to reimburse County for the revenue that is earned pursuant to Exhibit Q (Accounting, Administration and Reporting Requirements).
4.0 After the sale of an Asset, Subrecipient shall prepare an updated Inventory Control Form and submit it to County’s Contract Manager within the timeframe to be specified by County. The updated Inventory Control Form shall reflect information on the Assets sold.
5.0 Subrecipient shall obtain receipts from the recipient of the sale item(s) acknowledging receipt of the sale item(s) and shall forward copies of the receipts to County’s Contract Manager along with the completed Inventory Control Form.
I. Transfer of Assets
1.0 After receiving written approval from County to transfer Assets, which meet the requirements outlined in Subsections X.D.1.0 – X.D.3.0, herein, Subrecipient may proceed with this action as a method of disposing those Assets.
2.0 Subrecipient shall transfer Assets according to this order:
2.1 To another program providing the same or similar
service as that provided under this Subaward.
2.2 To a Federally or State-funded program.
3.0 After the transfer of an Asset, Subrecipient shall prepare an updated Inventory Control Form and shall submit it to County’s Contract Manager within the timeframe to be
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specified by County. The updated Inventory Control Form shall reflect information for the Assets transferred.
4.0 Subrecipient shall obtain receipts from the recipient of the transferred item(s) acknowledging receipt of the transferred item(s). Subrecipient shall forward copies of these receipts to County’s Contract Manager along with the completed
Inventory Control Form.
J. Donation of Assets
1.0 After receiving written approval from County to donate Assets, which meet the requirements outlined in
Subsections X.D.1.0 – X.D.3.0, herein, Subrecipient may proceed with this action as a method of disposing those Assets.
2.0 To donate Assets, Subrecipient shall:
2.1 Prepare an updated Inventory Control Form and
submit it to County’s Contract Manager within the
timeframe to be specified by County. The updated
Inventory Control Form shall reflect information for the Assets donated.
2.2 Obtain receipts from the recipient of the donated
item(s) acknowledging receipt of the donated item(s)
and shall forward copies of the receipts to County’s
Contract Manager along with the completed Inventory
Control Form.
2.3 Obtain liability waiver(s) for donated items.
Subrecipient shall be responsible for developing its
own liability waiver, which should provide the
following information, at a minimum:
2.3.1 Names and addresses of Subrecipient and
recipient organization.
2.3.2 Complete description of the Asset(s) being
donated including, but not limited to, Asset Bar
Code Identification tag number, Asset name
and make/model, serial number, quantity and
condition.
2.3.3 Date when donation was received by recipient
organization.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit S (Purchase, Inventory and Disposal Requirements for Fixed Assets, Non-Fixed Assets and Supplies)
Rev. 03/2020 Page 26
2.3.4 Certification statement to be attested to by
recipient organization releasing Subrecipient
from all liability for the donated Asset(s).
2.3.5 Name, signature and title of the recipient
organization’s authorized representative.
XI. NON-COMPLIANCE WITH PURCHASE, INVENTORY AND DISPOSAL
REQUIREMENTS
A. Subrecipient shall be under a continuing obligation throughout the entire term of this Subaward to comply with the purchase, inventory and disposal requirements outlined in this Exhibit S and in Administrative Requirements.
B. Subrecipient’s non-compliance with these requirements shall subject Subrecipient to remedies which will be determined by County at County’s sole discretion. Such remedies may include, but are not limited to, those actions noted in Subparagraph 9.19 (Remedies for Non-Compliance) of the Subaward. County may also impose the following remedies as warranted by the noncompliance:
1.0 Disallow the cost for Assets purchased without prior written approval
2.0 Require Subrecipient to remit payment for Assets which are not properly disposed or inventoried
3.0 Remove those Assets from Subrecipient which are not properly maintained pursuant to the requirements outlined herein.
XII. RECORDKEEPING
A. Subrecipient shall retain all Inventory Control Forms and all supporting records (including but not limited to invoices, receipts, purchase orders, etc.) for Assets and Supplies pursuant to Subparagraph 8.38 (Record Retention, Inspection and Audit Settlement) of the Subaward.
B. Subrecipient shall make these documents available for collection and/or viewing by Federal, State and County authorities upon request.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
EXHIBIT T
(INTENTIONALLY OMITTED)
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
EXHIBIT V
(CONTRACT MANAGEMENT SYSTEM –
CONTRACTOR’S GATEWAY TERMS AND CONDITIONS OF USE)
1.0 County has developed the Contract Management System – Contractor’s Gateway (hereafter “System”), an automated system designed to electronically manage this Subaward. County has implemented the System and Subrecipient shall use the System to perform its administrative contracting functions as directed by County.
2.0 County has established policies concerning the access, use and maintenance of the System. Subrecipient shall adhere to these policies, which include this Exhibit V (hereafter “Terms and Conditions of Use”), the Contract Management SystemContractor’s Gateway User Acknowledgement Agreement (“User Acknowledgement Agreement”), instruction guides/tutorials provided by County, training sessions conducted by County, etc. Subrecipient’s non-compliance with these policies may subject Subrecipient to denial of access to the System, suspension of payment(s), termination of this Subaward, and/or other actions which County may take at its sole discretion.
3.0 System Access and Control
3.1. Subrecipient shall access the System using the following Uniform Resource Locator (URL) link:
https://gateway.css.lacounty.gov:4443/OA HTML/AppsLogin (please note there is an underscore between “OA” and “HTML” in the URL).
3.2. Subrecipient shall ensure that data that is accessed using County information technology resources must be used for County authorized purposes and must not be disclosed to others without County’s prior written authorization or unless required by Federal, State or Program regulations.
3.3. Unauthorized access by Subrecipient to any County information technology resource, including the System, network, software application programs, data files, and restricted work areas is prohibited.
3.4. Accessing the System During Non-Business Hours
3.4.1. County recommends that Subrecipient does not access the System during non-business hours in order to allow County to provide technical assistance when requested from Users (who are defined in Section 5.0 (User Accounts), herein).
3.4.2. For purposes of this Terms and Conditions of Use, non-business hours are defined as the days and times that are outside of the traditional work week (where the traditional work week is DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit V (Contract Management System – Contractor’s Gateway Terms and Conditions of Use)
Rev. 10/2019 Page 2
recognized as Monday – Friday, 8:00 a.m. to 5:00 p.m.). The traditional work week does not include County-recognized holidays.
3.4.3. Generally, County-recognized holidays are the same as Federallyrecognized holidays such as January 1st, July 4th, December 25th ,
etc. of each year. Subrecipient may obtain a current list of Countyrecognized holidays from County’s Contract Manager or designee.
4.0 System Protocols and Security
4.1. Digital communications that occur between Subrecipient and County within the System are conducted over a secure network, which has been established by County using Secure Socket Layer technology, one of the most robust encryption platforms available.
4.2. The System’s URL provides an assurance to County and Subrecipient that accessing and using the System are done securely. A Web browser in secure mode will display a URL address beginning with “https://” rather than the standard “http://”, where the “s” in “https://” stands for “secure”.
4.3. County has established these secure, standard protocols which encrypt data across publicly used Internet connections.
4.4. County will make every effort to provide standard Internet-level performance while Users utilize the System. Subrecipient shall contact County when it experiences any disruptions in services by following the guidelines established in Sub-section 8.2, herein.
5.0 User Accounts
5.1. Designation of Users
5.1.1. Subrecipient shall designate Subrecipient Employees (Users) who shall be responsible for operating the System on Subrecipient’s behalf.
5.1.2. For purposes of this Terms and Conditions of Use, a Subrecipient Employee is defined as a staff member on Subrecipient’s payroll who works on this Subaward.
5.1.3. Subrecipient shall obtain prior approval from County to designate an account for each User who accesses the System. Subrecipient shall follow the instruction guides/tutorials provided by County and the general guidelines outlined in Sub-section 5.5 (Requesting User Accounts), herein, for requesting, creating and designating User accounts.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit V (Contract Management System – Contractor’s Gateway Terms and Conditions of Use)
Rev. 10/2019 Page 3
5.2. User Account Classification
5.2.1. User accounts are classified as either View-Only or Administrative.
Subrecipient shall designate a classification for each User when requesting approval for a User account.
5.2.2. There are two (2) types of User account classifications:
5.2.2.1. View-Only User: A User who can access the System to view all Subaward documents and agency
information.
5.2.2.2. Administrative User: A User who can access the System to view all Subaward documents and agency
information, submit Subaward documents to County,
update Subrecipient’s administrative information,
receive automated System alerts/notices (when
designated as the contact person for this responsibility), and perform other functions as defined by County.
5.3. Active and Inactive User Accounts
5.3.1. An active User account is defined as a User who has an approved, current, valid account, which does not have an inactive or termination date in the System. This User can access the System and perform functions based on his/her account classification (as defined in Sub-section 5.2 (User Account Classification), herein).
5.3.2. An inactive User account is defined as a User whose account profile has been assigned an inactive or termination date and User can no longer access the System.
5.4. Subrecipient shall designate and maintain a minimum of two (2) active Users (up to a maximum of four (4) active Users) at all times as follows:
5.4.1. Subrecipient shall designate at least one (1) Administrative User at the level of Subrecipient’s Project Manager.
5.4.2. Subrecipient shall designate at least one (1) User who has delegated authority to execute this Subaward. This User shall be at the level of the Executive Director and may be classified as either a ViewOnly User or an Administrative User.
5.4.3. One of the two Users shall be designated as the responsible contact who shall receive and respond to System generated alerts/notices pertaining to Subaward Document Deliverables (e.g., insurance certificates, business licenses, permits, etc.).
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit V (Contract Management System – Contractor’s Gateway Terms and Conditions of Use)
Rev. 10/2019 Page 4
5.5. Requesting User Accounts
5.5.1. Subrecipient shall obtain prior approval from County in order to establish User accounts in the System. Subrecipient shall follow these general guidelines to obtain County’s approval:
5.5.1.1. Subrecipient shall review its Employees, assess each of their responsibilities, and determine which
Employee(s) should have a User account in the System.
5.5.1.2. Subrecipient shall provide the Employee with the User Acknowledgement Agreement, and the Employee shall
read and complete the form. Subrecipient’s Authorized
Representative shall review and sign the form.
Subrecipient shall ensure that the User
Acknowledgement Agreement is completed for each
Employee that will receive a User account.
5.5.1.3. Subrecipient shall ensure that the completed User Acknowledgement Agreement is attached/saved in the
System as a Subaward Document Deliverable (on the
General Page of the Administration tab) prior to
requesting and being granted access to the System by
County.
5.5.1.4. Subrecipient shall create a profile for each User in the System.
5.5.1.5. Upon County’s receipt of the User profile submitted by Subrecipient, County will review User’s profile and
Employee’s completed User Acknowledgement
Agreement.
5.5.1.6. County will inform Subrecipient whether the User account has been approved or rejected.
5.5.2. Approved and Rejected User Accounts
5.5.2.1. Upon approval of Subrecipient’s request for a User account, County will provide User with a unique User
Name (logon/System identifier) and a default
password.
5.5.2.1.1. User shall be responsible for changing
his/her password when prompted by the
System.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit V (Contract Management System – Contractor’s Gateway Terms and Conditions of Use)
Rev. 10/2019 Page 5
5.5.2.1.2. User may begin accessing the System
immediately.
5.5.2.2. Upon rejection of Subrecipient’s request for a User account, County will follow-up with Subrecipient to
discuss the reason(s) for rejecting Subrecipient’s
request for a User account.
5.5.3. Subrecipient’s Assurances Upon Creating User Accounts
5.5.3.1. Subrecipient is responsible for the conduct of all Users who access and utilize the System. Subrecipient shall
ensure that Subrecipient and its Users adhere to this
Terms and Conditions of Use, the User
Acknowledgement Agreement, instruction
guides/tutorials provided by County, training sessions
conducted by County, etc. which establish the policies
under which the Users shall operate the System.
5.5.3.2. Subrecipient shall ensure that each User’s copy of the User Acknowledgement Agreement forms are saved in
the System as a Subaward Document Deliverable.
Subrecipient shall not delete any User
Acknowledgement Agreement forms from the System
without County’s written prior approval.
5.5.3.3. Subrecipient shall ensure that all Users receive and maintain current copies of all instruction guides/tutorials for using the System, which are developed by County
and provided to Subrecipient.
5.6. User Name and Password
5.6.1. Subrecipient shall ensure that its Users do not share their unique User Name and password with any other person.
5.6.2. County recommends that Users change their passwords every three (3) months to ensure additional password security.
5.6.3. Subrecipient shall ensure that all Users maintain valid, secure e-mail accounts, which shall be used for self-service maintenance of User Name and password information. In the event that Users forget their User Name or password, User shall adhere to the instruction guides/tutorials provided by County for resetting the User Name or password.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit V (Contract Management System – Contractor’s Gateway Terms and Conditions of Use)
Rev. 10/2019 Page 6
5.6.4. Repeated changes to a User’s password outside of the recommended three-month period, as noted in Sub-section 5.6.2, herein, shall be monitored and investigated by County and may result in County suspending User’s access.
5.7. Change in User’s Status
5.7.1. When a User’s status changes (e.g., he/she is no longer employed by Subrecipient or User’s responsibilities change), Subrecipient’s Authorized Representative shall take immediate action to update the User’s account profile. Updates to User account profiles shall be approved by County.
5.7.2. Subrecipient shall update User account profiles in the System by removing a User’s account once that User is no longer an Employee on this Subaward.
5.7.3. New Employees/Users
5.7.3.1. When Subrecipient determines that a new Employee shall receive a User account, Subrecipient shall adhere to the guidelines established in Sub-section 5.5
(Requesting User Accounts), herein, to create an
account in the System.
5.7.3.2. Prior to requesting a new User account, Subrecipient shall ensure that it continues to maintain at least two (2) active Users and does not exceed the maximum of
four (4) Users (pursuant to Sub-section 5.4, herein).
5.7.4. Subrecipient shall regularly review all User account information to ensure accuracy and completeness. Subrecipient shall ensure that updates are completed whenever administrative changes occur.
5.7.5. If County determines at its own discretion that Subrecipient is creating or removing User accounts too frequently then County shall take appropriate measures to investigate and remedy these occurrences. Upon County’s request, Subrecipient shall provide sufficient justification for these frequent User account updates.
6.0 General Policies for Use
6.1. County information technology resources are to be used solely for County business purposes.
6.2. County may periodically update this Terms and Conditions of Use and the User Acknowledgement Agreement policies. County may also implement future enhancements to the System. Subrecipient shall ensure that DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit V (Contract Management System – Contractor’s Gateway Terms and Conditions of Use)
Rev. 10/2019 Page 7
Subrecipient and Users adhere to all policy updates as well as any new procedures for using System enhancements.
6.3. Data Integrity
6.3.1. Subrecipient shall ensure that Users maintain the integrity of data they enter in the System, and do not save, store or attach electronic files in the System which do not meet the following requirements:
6.3.1.1. File types must be Word, Excel or Portable Data Format (PDF) documents. Files such as pictures, videos,
music, PowerPoint presentations, or other files as
determined by County are not acceptable types of
documents.
6.3.1.2. File types must be compatible with standard/common national brands, including Microsoft Office 2003
products or later version (Word, Excel, etc.), Adobe
Reader 9.0 (or later version) or their equivalent.
6.3.1.3. Files shall not be corrupted (i.e., documents shall be free of viruses).
6.3.1.4. The size limit of each file shall not exceed ten (10) megabytes (10 MB).
6.3.2. Subrecipient’s non-compliance with the data requirements outlined herein will be remedied at County’s sole discretion.
6.4. E-Mail Alerts and Notices
6.4.1. The System generates automatic e-mail alerts and notices based on the occurrence of certain events. These events may include, but are not limited to, confirmation of executed Subaward (or Amendments), request for Subaward Document Deliverables, notification of expired Subaward Compliance Document
Deliverables, etc.
6.4.2. Subrecipient shall ensure that its Users adhere to all alerts and notices generated by the System. These alerts and notices shall convey and have the same effect and importance as alerts and notices sent by County’s Administration (or their designees) as defined in Paragraph 6.0 (Administration of Subaward-County) in this Subaward and Exhibit E (County’s Administration). Subrecipient shall appropriately respond to all requests for documentation, promptly adhere to due dates/deadline requirements and diligently follow all instructions indicated in the alert/notice.
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit V (Contract Management System – Contractor’s Gateway Terms and Conditions of Use)
Rev. 10/2019 Page 8
6.5. Administrative Changes
6.5.1. Pursuant to Paragraph 7.0 (Administration of SubawardSubrecipient) and Paragraph 8.34 (Notices) of this Subaward, Subrecipient shall designate its authorized staff by using Exhibit F (Subrecipient’s Administration). Further, Subrecipient shall initiate any changes in its staff, including those listed on Exhibit F (Subrecipient’s Administration), by giving written notice to County.
6.5.2. When changes to Subrecipient’s staff, address or other items requiring written notice are necessary, Subrecipient shall:
6.5.2.1. Adhere to the requirements outlined in Paragraph 8.34 (Notices) of this Subaward.
6.5.2.2. Upon providing the required written notice to County, update the administrative data in the System, including all User account profile information.
6.5.3. Implementation and use of the System shall not excuse Subrecipient from adhering to the requirements for providing proper written notice to County when changes occur in Subrecipient’s administration.
7.0 Monitoring
7.1. All County information technology resources are subject to audit and periodic, unannounced review by County.
7.2. County reserves the right to administer, monitor, audit and/or investigate Subrecipient’s access to and use of County’s information technology resources (i.e., System, e-mails, Subrecipient-generated data files, etc.). If evidence of abuse or negligence is identified, County will take the appropriate actions to remedy any areas of Subrecipient’s non-compliance.
7.3. During County’s monitoring of User activities, unusual practices will be investigated and reported to County’s Administration. County will take the necessary steps to remedy Subrecipient’s inappropriate use of the System.
Unusual practices may include, but are not limited to, the following:
7.3.1. Users frequently accessing the System during non-business hours (pursuant to Sub-section 3.4 (Accessing the System During NonBusiness Hours), herein).
7.3.2. Subrecipient not maintaining the minimum and/or exceeding the maximum number of Users at any point in time (pursuant to Subsection 5.4, herein).
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Exhibit V (Contract Management System – Contractor’s Gateway Terms and Conditions of Use)
Rev. 10/2019 Page 9
7.3.3. Users changing their passwords more than the recommended limit (pursuant to Sub-section 5.6.4, herein).
7.3.4. Subrecipient frequently changing its Users (pursuant to Subsection 5.7.5, herein).
8.0 System Maintenance and Technical Assistance
8.1. To ensure proper operation of the System, County will periodically perform routine System maintenance activities. Since these activities will impact the ability of Users to access the System, County will notify Users when they attempt to login that System maintenance is occurring and County will indicate the time when the System will become available. Generally, System maintenance activities will occur during non-business hours (e.g., weekends, late evenings, County-recognized holidays, etc.) to limit the impact to Users.
8.2. County will provide assistance to Users in the event of technical difficulties that may occur while utilizing the System. Technical assistance will be provided as follows:
8.2.1. Monday through Friday, 8:00 a.m. to 5:00 p.m. (excluding Countyrecognized holidays).
8.2.2. County’s Administrators
8.2.2.1. Ms. Tsotso Odamtten may be reached by phone or email, respectively, as follows: (213) 738-2663 or [email protected].
8.2.2.2. Ms. Lynn Tran may be reached by phone or e-mail, respectively, as follows: (323) 513-4214 or
[email protected].
8.2.3. County will follow-up on requests for assistance from Subrecipient within at least two (2) business days during the traditional work week (pursuant to Sub-sections 3.4.2 and 8.2.1, herein).
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
Program Services:
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District:
Subaward Number:
Amendment Number:
Subrecipient's Legal Name:
N/A
Five (5)
ENP202106
N/A Modification Number: N/A
City of Glendale
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
I. BUDGET DETAIL - PERSONNEL
DIRECT
Project Manager ( CSP Supervisor) 25% $ 7,775 12 $ 23,324 $ 23,324 $ 23,324 $0 Older Americans Act (OAA) Title III C-1 Congregate Meal Services 2020-2021
Baseline Funding
(A)
POSITION TITLE (1)
(B)
% OF TIME
ON
PROGRAM
(2)
(C)
MONTHLY
SALARY
(D)
NO. OF
MONTHS
(E)
TOTAL COSTS
(F)
SSY1
SF (J)
TOTAL
FUNDING
AMOUNT
(K)
VARIANCE
(G)
MATCH
(H)
NON-MATCH
(I)
PROGRAM
INCOME
(B*C*D) (1)
CASH OTHER
(1)
CASH
(2)
IN-KIND
(1)
CASH
(2)
IN-KIND
(1)
CASH
(F+G+H+I) (E - J)
$ 42,204 $0
Meal Site Manager (Sparr Hourly City
Worker) 100% $ 1,560 $ 18,720
$ 10,401 $0
12 $ 18,720 $ 18,720
$ 7,956 $ 7,956 $ 7,956 $0
12 $ 9,360
$0
Food Service Manager( Community
Services Specialist) 100% $ 3,517 12 $ 42,204 $ 42,204
Meal Site Manager (ARC Hourly City
Worker) 25% $ 3,467 12 $ 10,401 $ 10,401
Driver ( Hourly City Worker) 50% $ 1,560 $0
Meal Site Manager( Pacific- Hourly City
Worker) 100% $ 663 12
$ 9,360 $ 9,360
[Enter title]
Exhibit W1 (Budget) Page 2
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
Program Services:
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District:
Subaward Number:
Amendment Number:
Subrecipient's Legal Name:
N/A
Five (5)
ENP202106
N/A Modification Number: N/A
City of Glendale
IX. BUDGET DETAIL - OTHER COSTS
Older Americans Act (OAA) Title III C-1 Congregate Meal Services 2020-2021
Baseline Funding
(A)
DESCRIPTION (1)
(B)
UNIT COST
(C)
NO. OF
UNITS
(D)
NO. OF
MONTHS
(E)
TOTAL COSTS
(F)
SSY1
SF (J)
TOTAL
FUNDING
(K)
VARIANCE
(G)
MATCH
(H)
NON-MATCH
(I)
PROGRAM
INCOME
(B*C*D) (1)
CASH
OTHER
(1)
CASH
(2)
IN-KIND
(1)
CASH
(2)
IN-KIND
(1)
CASH
(F+G+H+I) (E - J)
$ 16,706 $0
DIRECT
Maintenance and Repairs (2 CFR 200.452 & 45 CFR
75.452) $ 1,392.17 1 12 $ 16,706 $ 16,706
6,059$ $ 6,059 $0
1 2 $ 3,293 3,293$ $ 3,293 $0
Select Description (2) (3) (4) (5)
Materials and Supplies (2 CFR 200.453 & 45 CFR 75.453) $ 1,514.75 1 4 $ 6,059 Lease (Equipment) (2 CFR 200.465 & 45 CFR 75.465) (3) $ 1,646.50 Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Exhibit W1 (Budget) Page 11
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
Program Services:
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District:
Subaward Number:
Amendment Number:
Subrecipient's Legal Name:
(2)
Amer.
Meals
Unit Rate
(3)
Ethnic
Meals
(Cam)
Unit Rate
(4)
Ethnic
Meals
(Chi) Unit
Rate
(5)
Ethnic
Meals
(Ind)
Unit Rate
(6)
Ethnic
Meals
(Kos) Unit
Rate
(2)
Amer.
Meals
Unit Rate
(3)
Ethnic
Meals
(Cam)
Unit Rate
(4)
Ethnic
Meals
(Chi) Unit
Rate
(5)
Ethnic
Meals
(Ind)
Unit Rate
(6)
Ethnic
Meals
(Kos) Unit
Rate
$ 3.51 [Enter] [Enter] [Enter] [Enter] $ 5.50 [Enter] [Enter] [Enter] [Enter] $ 0.80 [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] $ 0.71 [Enter] [Enter] [Enter] [Enter] 2 [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] 1.80$ [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
1.99$ [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
0.71$ [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
2.78$ [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] 1.51$ [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] 2020-2021
Baseline Funding
N/A
Five (5)
ENP202106
N/A Modification Number: N/A
City of Glendale
Older Americans Act (OAA) Title III C-1 Congregate Meal Services In-Kind (SF)
$ 57,970
$ -
$ -
$ -
$ -
Cash (SF)
3 Raw Food
Space In-Kind (SF)
Non-Match
-$
$ -
Cash Other
(SSY1)
$ -
5 Cash (SF)
$ -
In-Kind (SF)
7 $ -
3 Volunteer Expenses
Cash Other
(SSY1) $ -
Cash (SF)
$ -
In-Kind (SF)
$ -
$ 239,000
$ 107,101
$ 76,569
Cash NSIP
(SSY1) $ 27,325 In-Kind (SF)
Cash Other
(SSY1)
-$
Cash (SF)
$ -
6.21$ -$
SSY1
$ 69,291
1 (A)
COST CATEGORIES
4 (B)
COSTS (1)
$ -
2 Subtotal
Cash Other
(SSY1)
Cash NSIP
(SSY1)
$ 211,675
$ 27,325
DIRECT
$ 135,106
$ -
$ 30,602
Personnel
Lower Tier Subawards for Catered Food
In-Kind (SF)
Cash Other
(SSY1)
Cash (SF)
In-Kind (SF)
Volunteers
Lower Tier Subawards
In-Kind (SF)
-$
Cash Other
(SSY1)
In-Kind (SF)
$ -
Cash (SF)
$ -
Cash (SF)
$ -
Cash Other
(SSY1)
Cash NSIP
(SSY1)
X. BUDGET SUMMARY
1 6
(1)
Total Budgeted
Costs
(1)
Total Budgeted
Costs
(C)
FUNDING CATEGORIES
$ -
(D)
FUNDING (1)
Match
Cash (SF)
Exhibit W1 (Budget) Page 13
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE (2)
Amer.
Meals
Unit Rate
(3)
Ethnic
Meals
(Cam)
Unit Rate
(4)
Ethnic
Meals
(Chi) Unit
Rate
(5)
Ethnic
Meals
(Ind)
Unit Rate
(6)
Ethnic
Meals
(Kos) Unit
Rate
(2)
Amer.
Meals
Unit Rate
(3)
Ethnic
Meals
(Cam)
Unit Rate
(4)
Ethnic
Meals
(Chi) Unit
Rate
(5)
Ethnic
Meals
(Ind)
Unit Rate
(6)
Ethnic
Meals
(Kos) Unit
Rate
(A)
COST CATEGORIES
(B)
COSTS (1)
X. BUDGET SUMMARY
(1)
Total Budgeted
Costs
(1)
Total Budgeted
Costs
(C)
FUNDING CATEGORIES
(D)
FUNDING (1)
[Enter] [Enter] [Enter] [Enter] [Enter] $ 0.95 [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] $ 0.68 [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] $ 5.50 $ - $ - $ - $ - $ 5.50 $ - $ - $ - $ -
$ 0.71 $ - $ - $ - $ - $ 0.71 $ - $ - $ - $ -
$ 4.26 $ - $ - $ - $ - $ 4.26 $ - $ - $ - $ -
$ - $ - $ - $ - $ - $ - $ - $ - $ - $ -
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] 12 [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] [Enter] $ -
$ -
$ 211,675
$ 163,761
$ -
$ 27,325
INDIRECT
Cash (SF)
10 Cash (SF)
$ -
5 Subtotal Funding for
Direct Costs
Cash Other
(SSY1)
Cash (SF)
In-Kind (SF)
Cash NSIP
(SSY1)
$ -
8 9
$ 163,761
$ -
$ 211,675
$ -
Cash (SF)
Cash NSIP
(SSY1) $ 27,325
$ 26,058
Cash Other
(SSY1)
Cash Other
(SSY1)
In-Kind (SF)
Equipment
Other Costs
Subtotal Direct Costs
$ -
Cash Other
(SSY1)
In-Kind (SF)
Cash Other
(SSY1)
In-Kind (SF)
$ -
6 13 Volunteer Expenses
Cash Other
(SSY1) $ -
Cash (SF)
$ -
In-Kind (SF)
$ -
11 Personnel
Cash Other
(SSY1)
Volunteers In-Kind (SF)
Cash (SF)
$ -
In-Kind (SF)
$ -
Cash (SF)
$ -
Match
$ -
7 SSY1
$ -
In-Kind (SF)
4 Program Income Cash (SF) $ 36,500
Variance (Costs-Funding)
Cash Other
(SSY1) $ -
Cash
In-Kind
$ -
In-Kind (SF)
$ -
Cash (SF)
15 Lower Tier Subawards for Catered Food
Cash Other
(SSY1)
$ -
Cash (SF)
$ -
In-Kind (SF)
$ -
14 Lower Tier Subawards
Exhibit W1 (Budget) Page 14
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
Program Services: HOME-DELIVERED MEAL SERVICES
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District
Subaward Number:
Amendment Number:
Subrecipient's Legal Name:
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
I. BUDGET DETAIL - PERSONNEL
N/A Modification Number: N/A
City of Glendale
2020-2021
Baseline Funding
N/A
Five
ENP202106
(A)
POSITION TITLE (1)
(B)
% OF TIME
ON
PROGRAM
(2)
(C)
MONTHLY
SALARY
(D)
NO. OF
MONTHS
(E)
TOTAL COSTS
(F)
SSY1
SF (J)
TOTAL
FUNDING
AMOUNT
(K)
VARIANCE
(G)
MATCH
(H)
NON-MATCH
(I)
PROGRAM
INCOME
(B*C*D) (1)
CASH OTHER
(1)
CASH
(2)
IN-KIND
(1)
CASH
(2)
IN-KIND
(1)
CASH
(F+G+H+I) (E - J)
DIRECT
$ 22,775
HDM Case Worker (Community Services
Specialist) 50% $ 3,796 12 $ 22,775 $ 22,775 $ 22,775 $0 $ 22,775 $0
Project Manager ( CSP Supervisor) 25% $ 7,775 $ 23,324
$ 8,829 $0
12 $ 23,324 $ 775 $ 22,549 $0
HDM Meal Coordinator(Community
Services Specialist) 50% $ 3,796 12 $ 22,775
Driver (Hourly City Worker) 45% $ 1,635 12 $ 8,829 $ 8,829 [Enter title]
[Enter title]
[Enter title]
Exhibit W2 (Budget) Page 2
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
Program Services: HOME-DELIVERED MEAL SERVICES
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District
Subaward Number:
Amendment Number:
Subrecipient's Legal Name:
IX. BUDGET DETAIL - OTHER COSTS
2020-2021
Baseline Funding
N/A
Five
ENP202106
N/A Modification Number: N/A
City of Glendale
(A)
DESCRIPTION (1)
(B)
UNIT COST
(C)
NO. OF
UNITS
(D)
NO. OF
MONTHS
(E)
TOTAL COSTS
(F)
SSY1
SF (J)
TOTAL
FUNDING
(K)
VARIANCE
(G)
MATCH
(H)
NON-MATCH
(I)
PROGRAM
INCOME
(B*C*D) (1)
CASH
OTHER
(1)
CASH
(2)
IN-KIND
(1)
CASH
(2)
IN-KIND
(1)
CASH
(F+G+H+I) (E - J)
$ 4,502 $0
DIRECT
Materials and Supplies (2 CFR 200.453 & 45 CFR
75.453) 1,125.50$ 1 4 $ 4,502 4,502$
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Exhibit W2 (Budget) Page 11
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
Program Services: HOME-DELIVERED MEAL SERVICES
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District
Subaward Number:
Amendment Number:
Subrecipient's Legal Name:
(2)
Hot
Meals
Unit Rate
(3)
Frozen Meals
Unit Rate
(4)
Emergency
Meals
Unit Rate
(2)
Hot
Meals
Unit Rate
(3)
Frozen Meals
Unit Rate
(4)
Emergency
Meals
Unit Rate
[Enter] $ 1.62 [Enter] [Enter] $ 5.50 $ 7.44
[Enter] $ 11.58 [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] $ 0.71 [Enter]
2 [Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter]
[Enter] [Enter] [Enter]
[Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] $ 0.67 $ 5.58
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] $ 3.88 [Enter] [Enter] [Enter] [Enter]
[Enter] $ 0.71 [Enter] [Enter] [Enter] [Enter]
[Enter] $ 0.88 [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] $ 7.44 [Enter] $ 11.83 [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] $ 5.58 [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
2020-2021
Baseline Funding
N/A
Five
ENP202106
N/A
City of Glendale
Modification Number: N/A
In-Kind (SF)
$ 93,326
$ -
$ -
Non-Match
Cash Other
(SSY1)
In-Kind (SF)
$ 2,000
Cash (SF)
$ 1,500
Cash (SF)
$ -
Cash Other
(SSY1)
Cash NSIP
(SSY1) $ -
$ -
Cash Other
(SSY1)
$ -
5 Cash (SF)
$ -
In-Kind (SF)
7 $ -
3 Volunteer Expenses
Cash Other
(SSY1) $ -
Cash (SF)
$ -
In-Kind (SF)
$ -
$ 51,000
$ 6,925
$ 30,652
Cash NSIP
(SSY1) $ 5,602 In-Kind (SF)
Cash Other
(SSY1)
$ 6.21
Cash (SF)
$ -
-$ $ 7.44
SSY1
$ 6,777
1 $ -
$ 91,376
Personnel
Lower Tier Subawards for
Catered Food
In-Kind (SF)
Cash Other
(SSY1)
Cash (SF)
In-Kind (SF)
Volunteers
Lower Tier Subawards
In-Kind (SF)
Raw Food
Space In-Kind (SF)
$ -
X. BUDGET SUMMARY
1 6
(1)
Total Budgeted
Costs
(1)
Total Budgeted
Costs
(C)
FUNDING CATEGORIES
$ -
(D)
FUNDING (1)
Match
Cash (SF)
Cash (SF)
3 (A)
COST CATEGORIES
4 (B)
COSTS (1)
$ -
2 Subtotal
Cash Other
(SSY1)
Cash NSIP
(SSY1)
$ 45,398
$ 5,602
DIRECT
$ 12,746
Exhibit W2 (Budget) Page 13
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE (2)
Hot
Meals
Unit Rate
(3)
Frozen Meals
Unit Rate
(4)
Emergency
Meals
Unit Rate
(2)
Hot
Meals
Unit Rate
(3)
Frozen Meals
Unit Rate
(4)
Emergency
Meals
Unit Rate
X. BUDGET SUMMARY
(1)
Total Budgeted
Costs
(1)
Total Budgeted
Costs
(C)
FUNDING CATEGORIES
(D)
FUNDING (1)
(A)
COST CATEGORIES
(B)
COSTS (1)
[Enter] [Enter] [Enter] [Enter] $ 0.53 [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] $ 0.57 [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
$ - $ 5.50 $ 7.44 $ - $ 5.50 $ 7.44
$ - $ 0.71 $ - $ - $ 0.71 $ -
$ - $ 13.03 $ 5.58 $ - $ 13.03 $ 5.58
$ - $ - $ - $ - $ - $ -
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
12 [Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
[Enter] [Enter] [Enter] [Enter] [Enter] [Enter]
$ -
$ -
$ 45,398
$ 104,303
$ -
$ 5,602
INDIRECT
8 9
$ 104,303
$ -
$ 45,398
$ -
$ -
Cash (SF)
Cash Other
(SSY1)
In-Kind (SF)
Cash NSIP
(SSY1)
Cash Other
(SSY1)
In-Kind (SF)
Equipment
Other Costs
Subtotal Direct Costs
In-Kind (SF)
$ 5,602
Cash (SF)
$ -
$ 4,502
Cash Other
(SSY1)
5 Subtotal Funding for
Direct Costs
Cash Other
(SSY1)
Cash (SF)
In-Kind (SF)
Cash NSIP
(SSY1)
11 Personnel
Cash Other
(SSY1)
Volunteers In-Kind (SF)
$ -
Cash (SF)
$ -
6 10
Cash Other
(SSY1)
13 Volunteer Expenses
Cash Other
(SSY1) $ -
Cash (SF)
$ -
In-Kind (SF)
$ -
Cash (SF) $ -
17 Space
Cash Other
(SSY1) $ -
In-Kind (SF) $ -
16 Raw Food
Cash Other
(SSY1) $ -
8 $ -
In-Kind (SF)
$ -
Cash (SF)
15 Cash (SF)
$ -
In-Kind (SF)
$ -
Cash (SF)
$ -
In-Kind (SF)
$ -
Cash (SF)
$ -
In-Kind (SF)
$ -
Cash (SF)
$ -
Non-Match
Match
$ -
7 SSY1
$ -
In-Kind (SF)
4 Program Income Cash (SF) $ 4,200
Variance (Costs-Funding)
Cash Other
(SSY1) $ -
Cash
In-Kind
Lower Tier Subawards for
Catered Food
Cash Other
(SSY1)
$ -
Cash (SF)
$ -
In-Kind (SF)
$ -
14 Lower Tier Subawards
Exhibit W2 (Budget) Page 14
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
Program Services:
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District:
Subaward Number:
Amendment Number: Modification Number:
Subrecipient's Legal Name:
[Enter title]
I. BUDGET DETAIL - PERSONNEL
N/A
2020-2021
Baseline Funding
[Enter title]
(A)
POSITION TITLE (1)
(B)
% OF TIME
ON
PROGRAM
(2)
(C)
MONTHLY
SALARY
(D)
NO. OF
MONTHS
(E)
TOTAL COSTS
(F)
SSY1
SF (J)
TOTAL
FUNDING
AMOUNT
(K)
VARIANCE
(G)
MATCH
(H)
NON-MATCH
(I)
PROGRAM
INCOME
(B*C*D) (1)
CASH OTHER
(1)
CASH
(2)
IN-KIND
(1)
CASH
(2)
IN-KIND
(1)
CASH
(F+G+H+I) (E - J)
DIRECT
Hourly City Worker 5% $ 1,635 12 $ 981 $ 981 $ 981 $0
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
N/A
TELEPHONE REASSURANCE SERVICES
Five
ENP202106
N/A
City of Glendale
Exhibit W3 (Budget) Page 2
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
Program Services:
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District:
Subaward Number:
Amendment Number:
Subrecipient's Legal Name:
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
IV. BUDGET DETAIL - OTHER COSTS
TELEPHONE REASSURANCE SERVICES
2020-2021
Baseline Funding
N/A
Five
ENP202106
N/A Modification Number: N/A
City of Glendale
(A)
DESCRIPTION (1)
(B)
UNIT COST
(C)
NO. OF
UNITS
(D)
NO. OF
MONTHS
(E)
TOTAL COSTS
(F)
SSY1
SF (J)
TOTAL
FUNDING
(K)
VARIANCE
(G)
MATCH
(H)
NON-MATCH
(I)
PROGRAM
INCOME
(B*C*D) (1)
CASH
OTHER
(1)
CASH
(2)
IN-KIND
(1)
CASH
(2)
IN-KIND
(1)
CASH
(F+G+H+I) (E - J)
DIRECT
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
Exhibit W3 (Budget) Page 6
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
Program Services:
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District:
Subaward Number:
Amendment Number:
Subrecipient's Legal Name:
2 DIRECT
1 Personnel
Cash Other
(SSY1) $ 1,000 $ 0.68
1 SSY1 Cash Other (SSY1)
$ 1,000 $ 0.68
Cash (SF) $ 279 $ 0.19
In-Kind (SF) $ - [Enter]
V. BUDGET SUMMARY
(A)
COST CATEGORIES
(B)
COSTS (1)
(C)
FUNDING CATEGORIES
(D)
FUNDING (2)
(1)
Total Budgeted
Costs
(2)
Telephone Calls
Unit Rate
(1)
Total Budgeted
Costs
(2)
Telephone
Calls Unit Rate
Cash (SF) $ - [Enter]
$ 0.19
[Enter]
Volunteers In-Kind (SF) $ - [Enter] 2 MatchCash (SF) $ 279 Program Income Cash (SF)
In-Kind (SF)
$ - [Enter]
Cash (SF) $ -
3 Volunteer Expenses
Cash Other
(SSY1) $ - [Enter] In-Kind (SF) $ -
$ - [Enter] In-Kind (SF) $ -
[Enter]
Cash (SF) $ - [Enter] 3 Non-Match
5 Subtotal Direct Costs
Cash Other
(SSY1) $ 1,000 $ 0.68
4 [Enter]
In-Kind (SF) $ - [Enter]
Cash Other
(SSY1) $ - [Enter]
4 Other Costs
$ 1,000 $ 0.68
Cash (SF) $ 279 $ 0.19Cash (SF) $ 279 $ 0.19
In-Kind (SF) $ - $ -In-Kind (SF) $ - $ -
5 Subtotal Funding for
Direct Costs
Cash Other
(SSY1)
Variance (Costs-Funding)
Cash Other
(SSY1)
Cash (SF)
In-Kind (SF)
TELEPHONE REASSURANCE SERVICES
2020-2021
Baseline Funding
N/A
Five
ENP202106
N/A Modification Number: N/A
City of Glendale
Exhibit W3 (Budget) Page 8
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
Program Services:
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District:
Subaward Number:
Amendment Number:
[Enter]
Ext.
[Enter]
Phone Number Ext.
[Enter]
Phone Number Ext.
City
Congregate Meal Services
2020-2021
Baseline Funding
N/A
Five
ENP202106
City of Glendale
N/A Modification Number: N/A
Budget Analyst Job Title E-Mail Address
[Enter City] CA [Enter Zip]
Accountant I 818-550-3060 [email protected]
Mailing Address (if different from above) City State Zip Code Prefix Authorized Representative Job Title
EXHIBIT X1 (MANDATED PROGRAM SERVICES)
Subrecipient's Legal Name:
[Enter Address]
Director, Community Services and Parks [email protected] State Zip Code
613 E. Broadway Street Room 120 Glendale CA 91206
Main Administrative Office Address
E-Mail Address
Mr. Onnig Bulanikian 818-548-2000
Phone Number
Senior Community Services Supervisor [email protected] Prefix Project Manager Job Title E-Mail Address
Mr. Maggie Kavarian 818-548-3715
Mr. Hanre Chang
Prefix
MPS Reviewed and Approved by: Sheri Stanton Date: 7/22/2020
COUNTY USE ONLY
Assigned Program Analyst: Sheri Stanton
Assigned Contract Analyst: Irma Panosian
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Program Services:
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District:
Subaward Number:
Amendment Number:
SSY1
(Cash NSIP)
[Enter Units]
[Enter Units]
I. UNITS OF SERVICE SUMMARY
500
American Meals
Subrecipient's Legal Name:
Congregate Meal Services
2020-2021
Baseline Funding
N/A
Five
ENP202106
City of Glendale
Ethnic Meals
Total (4)
SSY1 (6)
(Cash Other)
SF (7)
(Cash and In-Kind)
[Enter Total
Unduplicated
Units]
[Enter Units]
[Enter Unit Rate]
N/A Modification Number: N/A
(F)
NO. OF UNDUPLICATED
CLIENTS (1)
(C)
UNITS OF
SERVICE (3)
(D)
UNIT RATE (2)
SSY1 (6)
(Cash Other)
$ -
[Enter Unit Rate]
38,486
38,486
38,486
[Enter Unit Rate]
$ -
$ 211,675
$ 10.47 $ 402,761
$ 0.71 $ 27,325
[Enter Total
Unduplicated
Units]
$ 6.21 $ 239,000
$ 5.50
$ 4.26 $ 163,761
Subtotal SSY1
(Cash Other and Cash NSIP)
Total (4)
SSY1
(Cash NSIP)
Subtotal SSY1
(Cash Other and Cash NSIP)
(E)
FUNDING AMOUNT (5)
(A)
SERVICE CATEGORY
(B)
FUNDING SOURCE
[Select Ethnic
Meal Style]
SF (7)
(Cash and In-Kind)
Exhibit X1 (Mandated Program Services) Page 2
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE (F)
NO. OF UNDUPLICATED
CLIENTS (1)
(C)
UNITS OF
SERVICE (3)
(D)
UNIT RATE (2)
(E)
FUNDING AMOUNT (5)
(A)
SERVICE CATEGORY
(B)
FUNDING SOURCE
Equipment (Other) (9)
(5) Thet Total and Grand Total amounts under column (E) Funding Amount shall match the Total and Grand Total amounts reflected in the Budget (cover page) column (F) Total Funding.
(9) Enter the amount of equipment (other) that is reflected on the Budget. (6) SSY1: Subaward Sum Year 1
(7) SF: Subrecipient's Funds
(8) Enter the approved amount of equipment purchase(s) that is reflected on the Budget.
Equipment (Purchases) (8) [Enter Approved
Amount]
(2) Please Enter the Unit Rates: a) for SSY1 (Cash Other) and for SSY1 (Cash NSIP) (i.e., approved rate to be reimbursed by County as reflected in the funding allocation letter) and b) for SF (amount of Match, Non-Match, and Program Income - reflected as a rate - that will be funded by Subrecipient for the Services). (3) Please enter the number of Units for each Service Category to be provided using SSY1 (Cash Other), SSY1 (Cash NSIP), and SF. (4) The Total Unduplicated Units for each Service Category under column (C) Units of Service shall match the corresponding Total Units reflected in Sections II, III, and IV (Services by Month) column (P) Total.
NOTE:
(1) Please Enter the total number of unduplicated clients that will be served by your agency. Unduplicated clients are individuals who meet the eligibility requirements outlined in Exhibit A (Statement of Work). These individuals are counted only once within a FY for reporting purposes. [Enter Amount]
Total (4)
[Enter Total
Unduplicated
Units]
[Enter Unit Rate]
SSY1
(Cash NSIP) [Enter Unit Rate]
$ - $ -
GRAND TOTAL SERVICES/FUNDING 500
SSY1 (6)
(Cash Other)
Subtotal SSY1
(Cash Other and Cash NSIP)
-
SF (7)
(Cash and In-Kind)
$ 402,761
[Enter Unit Rate]
[Select Ethnic
Meal Style] Ethnic Meals
[Enter Units]
[Enter Units]
[Enter Units]
Exhibit X1 (Mandated Program Services) Page 3
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Program Services:
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District:
Subaward Number:
Amendment Number:
(A)
LINE
NO.
(C)
NO. OF
UNDUP.
CLIENTS
(D)
JUL
(E)
AUG
(F)
SEP
(G)
OCT
(H)
NOV
(I)
DEC
(J)
JAN
(K)
FEB
(L)
MAR
(M)
APR
(N)
MAY
(O)
JUN
(P)
TOTAL (1)
1 300 3,000 3,000 3,000 2,700 2,700 2,700 2,520 2,500 2,500 2,500 2,500 2,541 32,161 2 175 400 400 400 400 400 400 400 400 400 400 400 441 4,841 3 25 0 0 0 0 0 0 243 240 240 240 240 281 1,484
4 0
5 0
6 0
7 0
8 0
9 0
10 0
11 0
12 0
13 0
14 0
15 0
500 3,400 3,400 3,400 3,100 3,100 3,100 3,163 3,140 3,140 3,140 3,140 3,263 38,486 NOTE:
(1) The Grand Total Units under column (P) Total shall match the Total reflected in Section I (Units of Service Summary) column (C) Units of Service Total.
Subrecipient's Legal Name: City of Glendale
N/A Modification Number: N/A
ENP202106
Congregate Meal Services
2020-2021
Baseline Funding
N/A
Five
II. SERVICES BY MONTH - AMERICAN MEALS
(B)
SITE NAME
Adult Recreation Center
Sparr Heights Community Center
Pacific Community Center
Grand Total
Exhibit X1 (Mandated Program Services) Page 4
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Program Services:
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District:
Subaward Number:
Amendment Number:
(A)
LINE
NO.
(C)
NO. OF
UNDUP.
CLIENTS
(D)
JUL
(E)
AUG
(F)
SEP
(G)
OCT
(H)
NOV
(I)
DEC
(J)
JAN
(K)
FEB
(L)
MAR
(M)
APR
(N)
MAY
(O)
JUN
(P)
TOTAL (1)
1 0
2 0
3 0
4 0
5 0
6 0
7 0
8 0
9 0
10 0
11 0
12 0
13 0
14 0
15 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
(1) The Grand Total Units under column (P) Total shall match the Total reflected in Section I (Units of Service Summary) column (C) Units of Service Total.
Subrecipient's Legal Name: City of Glendale
[Select Ethnic Meal Style] III. SERVICES BY MONTH - ETHNIC MEALS (B)
SITE NAME
NOTE:
Grand Total
ENP202106
N/A Modification Number:
Congregate Meal Services
2020-2021
Baseline Funding
N/A
Five
N/A
Exhibit X1 (Mandated Program Services) Page 5
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Program Services:
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District:
Subaward Number:
Amendment Number:
(A)
LINE
NO.
(C)
NO. OF
UNDUP.
CLIENTS
(D)
JUL
(E)
AUG
(F)
SEP
(G)
OCT
(H)
NOV
(I)
DEC
(J)
JAN
(K)
FEB
(L)
MAR
(M)
APR
(N)
MAY
(O)
JUN
(P)
TOTAL (1)
1 0
2 0
3 0
4 0
5 0
6 0
7 0
8 0
9 0
10 0
11 0
12 0
13 0
14 0
15 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
(1) The Grand Total Units under column (P) Total shall match the Total reflected in Section I (Units of Service Summary) column (C) Units of Service Total.
NOTE:
(B)
SITE NAME
Grand Total
Congregate Meal Services
2020-2021
Baseline Funding
N/A
Five
ENP202106
N/A Modification Number:
IV. SERVICES BY MONTH - ETHNIC MEALS [Select Ethnic Meal Style] N/A
Subrecipient's Legal Name: City of Glendale
Exhibit X1 (Mandated Program Services) Page 6
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Program Services:
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District:
Subaward Number:
Amendment Number:
Subrecipient's Legal Name:
[Enter]
Ext.
[Enter]
Phone Number Ext.
[Enter]
Phone Number Ext.
N/A Modification Number:
ENP202106
N/A
City of Glendale
Five
N/A
Baseline Funding
2020-2021
HOME DELIVERED MEAL SERVICES
MPS Reviewed and Approved by: Sheri Stanton Date: 7/22/2020
COUNTY USE ONLY
Assigned Program Analyst: Sheri Stanton
Assigned Contract Analyst: Irma Panosian
Senior Community Services Supervisor [email protected] Prefix Project Manager Job Title E-Mail Address
Ms. Maggie Kavarian 818-548-3715
Mr. Hanre Chang
[Enter Address]
Director, Community Services and Parks [email protected] Prefix Authorized Representative Job Title E-Mail Address Mr. Onnig Bulanikian 818-548-2000
Phone Number
State Zip Code
EXHIBIT X2 (MANDATED PROGRAM SERVICES)
Prefix Budget Analyst Job Title E-Mail Address
[Enter City] CA [Enter Zip]
Accountant I 818-548-3060 [email protected]
Mailing Address (if different from above) City
State Zip Code
613 E. Broadway Street Room 120 Glendale CA 91206
Main Administrative Office Address City
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Program Services:
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District:
Subaward Number:
Amendment Number:
Subrecipient's Legal Name:
Hot Meals
Subtotal SSY1
(Cash Other and Cash NSIP)
SSY1 (6)
(Cash Other)
SF (7)
(Cash and In-Kind)
SSY1 (6)
(Cash Other)
Frozen Meals
7,890
Total (4)
SF (7)
(Cash and In-Kind)
[Enter Total
Unduplicated
Units]
[Enter Unit Rate]
[Enter Total
Unduplicated
Units]
$ -
HOME DELIVERED MEAL SERVICES
2020-2021
Baseline Funding
N/A
Five
ENP202106
(F)
NO. OF UNDUPLICATED
CLIENTS (1)
(C)
UNITS OF
SERVICE (3)
(D)
UNIT RATE (2)
N/A
City of Glendale
Modification Number: N/A
(B)
FUNDING SOURCE
(A)
SERVICE CATEGORY
(E)
FUNDING AMOUNT (5)
$ -
[Enter Unit Rate]
[Enter Unit Rate]
[Enter Units]
[Enter Units]
[Enter Units]
Total (4)
SSY1
(Cash NSIP)
Subtotal SSY1
(Cash Other and Cash NSIP)
$ 151,803
$ 102,803
$ 49,000
$ 5.50
$ 19.24
$ 5,602
$ 6.21
$ 43,398
$ 0.71 SSY1
(Cash NSIP)
7,890
7,890
I. UNITS OF SERVICE SUMMARY
52 $ 13.03
Exhibit X2 (Mandated Program Services) Page 2
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE (F)
NO. OF UNDUPLICATED
CLIENTS (1)
(C)
UNITS OF
SERVICE (3)
(D)
UNIT RATE (2)
(B)
FUNDING SOURCE
(A)
SERVICE CATEGORY
(E)
FUNDING AMOUNT (5)
Equipment (Other) (9)
Emergency Meals
269
269 SF (7)
(Cash and In-Kind)
Total (4)
[Enter Total
Unduplicated
Units]
$ 13.02 $ 3,500
$ 7.44 $ 2,000
SSY1
(Cash NSIP) $ - $ -
$ 7.44 $ 2,000
GRAND TOTAL SERVICES/FUNDING 52
SSY1 (6)
(Cash Other)
Subtotal SSY1
(Cash Other and Cash NSIP)
- $ 155,303
[Enter Amount]
(5) Thet Total and Grand Total amounts under column (E) Funding Amount shall match the Total and Grand Total amounts reflected in the Budget (cover page) column (F) Total Funding.
(9) Enter the amount of equipment (other) that is reflected on the Budget. (6) SSY1: Subaward Sum Year 1
(7) SF: Subrecipient's Funds
(8) Enter the approved amount of equipment purchase(s) that is reflected on the Budget.
Equipment (Purchases) (8) [Enter Approved
Amount]
(2) Please Enter the Unit Rates: a) for SSY1 (Cash Other) and for SSY1 (Cash NSIP) (i.e., approved rate to be reimbursed by County as reflected in the funding allocation letter) and b) for SF (amount of Match, Non-Match, and Program Income - reflected as a rate - that will be funded by Subrecipient for the Services). (3) Please enter the number of Units for each Service Category to be provided using SSY1 (Cash Other), SSY1 (Cash NSIP), and SF. (4) The Total Unduplicated Units for each Service Category under column (C) Units of Service shall match the corresponding Total Units reflected in Sections II, III, and IV (Services by Month) column (P) Total.
NOTE:
(1) Please Enter the total number of unduplicated clients that will be served by your agency. Unduplicated clients are individuals who meet the eligibility requirements outlined in Exhibit A (Statement of Work). These individuals are counted only once within a FY for reporting purposes. $ 5.58 $ 1,500
Exhibit X2 (Mandated Program Services) Page 3
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Program Services:
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District:
Subaward Number:
Amendment Number:
Subrecipient's Legal Name:
(A)
LINE
NO.
(C)
NO. OF
UNDUP.
CLIENTS
(D)
JUL
(E)
AUG
(F)
SEP
(G)
OCT
(H)
NOV
(I)
DEC
(J)
JAN
(K)
FEB
(L)
MAR
(M)
APR
(N)
MAY
(O)
JUN
(P)
TOTAL
(1)
1 0
2 0
3 0
4 0
5 0
6 0
7 0
8 0
9 0
10 0
11 0
12 0
13 0
14 0
15 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
(1) Grand Total Units under column (P) Total shall match the Total reflected in Section I (Units of Service Summary) column (C) Units of Service Total Grand Total
NOTE:
II. SERVICES BY MONTH - HOT MEALS
(B)
ROUTE NAME
HOME DELIVERED MEAL SERVICES
2020-2021
Baseline Funding
City of Glendale
N/A Modification Number: N/A
N/A
Five
ENP202106
Exhibit X2 (Mandated Program Services) Page 4
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Program Services:
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District:
Subaward Number:
Amendment Number:
Subrecipient's Legal Name:
(A)
LINE
NO.
(C)
NO. OF
UNDUP.
CLIENTS
(D)
JUL
(E)
AUG
(F)
SEP
(G)
OCT
(H)
NOV
(I)
DEC
(J)
JAN
(K)
FEB
(L)
MAR
(M)
APR
(N)
MAY
(O)
JUN
(P)
TOTAL
(1)
1 13 164 164 164 164 164 164 164 164 164 164 164 172 1976 2 13 164 164 164 164 164 164 164 164 164 164 164 172 1976 3 13 164 164 164 164 164 164 164 164 164 164 164 173 1977 4 13 164 164 164 164 164 164 164 160 160 160 160 173 1961 5 0
6 0
7 0
8 0
9 0
10 0
11 0
12 0
13 0
14 0
15 0
52 656 656 656 656 656 656 656 652 652 652 652 690 7890 (1) Grand Total Units under column (P) Total shall match the Total reflected in Section I (Units of Service Summary) column (C) Units of Service Total Grand Total
NOTE:
Route 2
Route 3
Route 4
Route 1
III. SERVICES BY MONTH - FROZEN MEALS
(B)
ROUTE NAME
HOME DELIVERED MEAL SERVICES
2020-2021
Baseline Funding
City of Glendale
N/A
Five
ENP202106
N/A Modification Number: N/A
Exhibit X2 (Mandated Program Services) Page 5
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Program Services:
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District:
Subaward Number:
Amendment Number:
Subrecipient's Legal Name:
Hot Frozen Hot Frozen Hot Frozen Hot Frozen Hot Frozen Hot Frozen Hot Frozen Hot Frozen Hot Frozen Hot Frozen Hot Frozen Hot Frozen Hot Frozen 1 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
(1) Grand Total Units under column (P) Total shall match the Total reflected in Section I (Units of Service Summary) column (C) Units of Service Total ENP202106
N/A Modification Number: N/A
City of Glendale
NOTE:
Grand Total
(K)
FEB
(L)
MAR
(I)
DEC
(J)
JAN
IV. SERVICES BY MONTH - HOT & FROZEN MEALS ROUTES
(A)
LINE
NO.
(B)
ROUTE NAME
(C)
NO. OF
UNDUP.
CLIENTS
(D)
JUL
(E)
AUG
(F)
SEP
(G)
OCT
(H)
NOV
(P)
TOTAL (1)
(M)
APR
(N)
MAY
(O)
JUN
N/A
Five
HOME DELIVERED MEAL SERVICES
2020-2021
Baseline Funding
Exhibit X2 (Mandated Program Services) Page 6
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE Program Services:
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District:
Subaward Number:
Amendment Number:
Subrecipient's Legal Name:
(A)
LINE
NO.
(C)
NO. OF
UNDUP.
CLIENTS
(D)
JUL
(E)
AUG
(F)
SEP
(G)
OCT
(H)
NOV
(I)
DEC
(J)
JAN
(K)
FEB
(L)
MAR
(M)
APR
(N)
MAY
(O)
JUN
(P)
TOTAL
(1)
1 13 9 9 9 9 9 9 0 9 9 9 81
2 13 9 9 9 0 9 0 9 9 0 9 9 72
3 13 9 9 9 9 9 9 0 0 9 0 9 72
4 13 9 0 9 9 0 9 0 0 8 44
5 0
6 0
7 0
8 0
9 0
10 0
11 0
12 0
13 0
14 0
15 0
52 36 27 36 18 36 18 9 18 18 18 27 8 269
(1) Grand Total Units under column (P) Total shall match the Total reflected in Section I (Units of Service Summary) column (C) Units of Service Total Grand Total
NOTE:
Route 2
Route 3
Route 4
Route 1
V. SERVICES BY MONTH - EMERGENCY MEALS
(B)
ROUTE NAME
HOME DELIVERED MEAL SERVICES
2020-2021
Baseline Funding
City of Glendale
N/A
Five
ENP202106
N/A Modification Number: N/A
Exhibit X2 (Mandated Program Services) Page 7
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
TELEPHONE REASSURANCE SERVICES
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District:
Subaward Number:
Amendment Number:
[Enter]
Ext.
[Enter]
Phone Number Ext.
[Enter]
Phone Number Ext.
COUNTY USE ONLY
Assigned Program Analyst:
Assigned Contract Analyst:
MPS Reviewed and Approved by:
Sheri Stanton
Irma Panosian
Sheri Stanton Date: 7/22/2020
Prefix Project Manager Job Title E-Mail Address
Mr. Hanre Chang Accountant I 818-548-3060 [email protected] Prefix Budget Analyst Job Title E-Mail Address
Ms. Maggie Kavarian Senior Community Services and Parks 818-548-3715 [email protected] Mailing Address (if different from above) City State Zip Code Prefix
Mr. Onnig Bulanikian Director, Community Services and Parks 818-548-2000 [email protected] Authorized Representative Job Title Phone Number E-Mail Address EXHIBIT X3 (MANDATED PROGRAM SERVICES)
2020-2021
Baseline Funding
N/A
Subrecipient's Legal Name: City of Glendale
Five
Program Services:
ENP202106
N/A Modification Number: N/A
[Enter Address] [Enter City]
613 E. Broadway Street Room 120 Glendale CA 91206
CA
City State Zip Code
[Enter Zip]
Main Administrative Office Address
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
TELEPHONE REASSURANCE SERVICES
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District:
Subaward Number:
Amendment Number:
Subrecipient's Legal Name: City of Glendale
I. UNITS OF SERVICE SUMMARY
(A)
SERVICE CATEGORY
(B)
FUNDING SOURCE
SSY1 (6)
(Cash Other) $ 1,000
(F)
NO. OF UNDUPLICATED
CLIENTS (1)
(C)
UNITS OF
SERVICE (3)
(D)
UNIT RATE (2)
(E)
FUNDING AMOUNT (5)
52 Total
SF (7)
(Cash and In-Kind)
1,471
Telephone Calls 1,471
$ 0.87 $ 1,279
Program Services:
2020-2021
Baseline Funding
Modification Number: N/A
N/A
Five
ENP202106
N/A
$ 0.68
$ 0.19 $ 279
NOTE:
GRAND TOTAL SERVICES/FUNDING (4) - $ 1,279 52
(6) SSY1: Subaward Sum Year 1
(7) SF: Subrecipient's Funds
(2) Please Enter the Unit Rate for both the SSY1 (i.e., approved rate to be reimbursed by County as reflected in the funding allocation letter) and SF (amount of Match, Non-Match, and Program Income - reflected as a rate - that will be funded by Subrecipient for the Services). (1) Please Enter the total number of unduplicated clients that will be served by your agency. Unduplicated clients are individuals who meet the eligibility requirements outlined in Exhibit A (Statement of Work), Subsection 1.4 (Client Eligibility Criteria). These individuals are counted only once within a FY for reporting purposes.
(3) Please enter the number of Units for each Service Category to be provided using SSY1, NSIP, and SF. If SSY1 and SF will both be used to provide the same Units then enter the number of Units for SSY1 only. If additional Units will be provided using SF then enter the number of SF Units. (4) The Total Units for each Service Category under column (C) Units of Service shall match the Total Units reflected in Section II (Services by Month) column (P) Total.
(5) The Grand Total Funding Amount under column (E) Total shall match the Grand Total Funding Amount reflected in the Budget (cover page) column (G) Total Funding.
Exhibit X3 (Mandated Program Services) Page 2
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
TELEPHONE REASSURANCE SERVICES
Fiscal Year:
Funding Type:
Los Angeles County Region:
Supervisorial District:
Subaward Number:
Amendment Number:
(A)
LINE
NO.
(C)
NO. OF
UNDUP.
CLIENTS
(D)
JUL
(E)
AUG
(F)
SEP
(G)
OCT
(H)
NOV
(I)
DEC
(J)
JAN
(K)
FEB
(L)
MAR
(M)
APR
(N)
MAY
(O)
JUN
(P)
TOTAL (1)
1 12 31 31 30 31 29 31 31 29 31 31 31 31 367
2 14 31 31 31 31 29 31 31 29 31 31 31 31 368
3 12 31 31 31 31 29 31 31 29 31 31 31 31 368
4 14 31 31 31 31 29 31 31 29 31 31 31 31 368
5 0
6 0
7 0
8 0
9 0
10 0
11 0
12 0
13 0
14 0
15 0
52 124 124 123 124 116 124 124 116 124 124 124 124 1471 NOTE:
(1) Grand Total Units under column (P) Total shall match the Total reflected in Section I (Units of Service Summary) column (C) Units of Service Total ENP202106
N/A
Subrecipient's Legal Name: City of Glendale
N/A Modification Number:
II. SERVICES BY MONTH - TELEPHONE CALLS
Thursday Route Calls
(B)
ROUTE NAME
Monday Route Calls
Tuesday Route Calls
Wednesday Route Calls
Grand Total
Program Services:
2020-2021
Baseline Funding
N/A
Five
Exhibit X3 (Mandated Program Services) Page 3
DocuSign Envelope ID: 8FB56A48-20D0-4175-B0D0-4E5093D54FDE
EXHIBIT Y (LIST OF LOWER TIER SUBAWARDS)
Subrecipient’s Legal Name: City of Glendale
Select the certification below that is applicable to Subrecipient’s use of Lower Tier Subrecipient(s)/Lower Tier Subaward(s):
☒ Subrecipient intends to use Lower Tier Subrecipient(s)/Lower Tier Subaward(s) to provide Program Services (details are provided in the chart below).
☐ Subrecipient will not use Lower Tier Subrecipient(s)/Lower Tier Subaward(s) to provide Program Services.
Lower Tier Subrecipient Description of Services
to be Performed Legal Name Address Contact Person’s Name and Phone Number
BATEMAN
COMMUNITY
LIVING/LLC. Dba TRIO
COMMUNITY MEALS
101 Pine Park Drive
Lafayette, CA 70508
Magi Brettler
☒ Congregate Meal Services (American Meals)
☐ Congregate Meal Services (Ethnic Meals)
☐ Home-Delivered Meal Services (Hot Meals)
☒ Home-Delivered Meal Services (Frozen Meals)
☐ Home-Delivered Meal Services (Emergency
Meals)
☐ Other (if applicable): Click here to enter text.
337-593-0433 X3
If you need to report additional Lower Tier Subrecipients, use this Exhibit Y and include page numbers on each completed Exhibit Y as follows: Page 1 of X, Page 2 of X, Page 3 of X, etc. (where ‘X’ represents the total number of completed forms).