City Council / Housing Authority
October 20, 2025

Designated Community Focal Point Address
Burbank, City of : Joslyn Adult Center /Tuttle
Center
Site 1:
1301 West Olive Avenue
Burbank, CA 91506
Site 2:
1731 North Ontario Street
Burbank, CA 91505
Centro Maravilla Service Center (AD) 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 (AD) 133 North Sunol Drive Suite# 237 Los Angeles, CA 90063
East Rancho Dominquez Service Center (AD) 4513 East Compton Boulevard Compton, CA 90221
El Monte, City of: Jack Crippen Multipurpose
Senior Center
3120 North Tyler Avenue
El Monte, CA 91731
ATTACHMENT NO. 2
Attachment 3 (Community Focal Points List)
Rev. 9/2024

Designated Community Focal Point Address
Florence/Firestone Service Center (AD) 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 Street
Glendale, CA 91205
Site 2:
1613 Glencoe Way,
Glendale, CA 91208
Grandparents As Parents, Inc. : Corporate Office
/ Edelman Court Caregiver Center
Site 1:
22048 Sherman Way #217
Canoga Park, CA 91303
Site 2:
201 Center Plaza Drive – 5th Floor #422
Monterey Park, CA 91754
Human Services Association 6800 Florence Avenue
Bell Gardens, CA 90201
Jewish Family Services: 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 (AD) 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
Pomona, City of: Community Service Department 499 East Arrow Hwy Pomona, CA 91767
Potrero Heights Park Community and Senior
Center (AD)
8051 Arroyo Drive
Montebello, CA 90640
ATTACHMENT NO. 2
Attachment 3 (Community Focal Points List)
Rev. 9/2024

Designated Community Focal Point Address
San Fernando, City of: Las Palmas Park 505 South Huntington Street San Fernando, CA 91340
San Gabriel Valley Service Center (AD) 1441 Santa Anita Avenue South El Monte, CA 91733
San Gabriel Valley YWCA 943 North Grand Avenue
Covina, CA 91724
San Pedro Service Center (AD) 769 West Third Street
San Pedro, CA 90731
Santa Anita Family Service 605 South Myrtle Avenue
Monrovia, CA 91016
Santa Clarita Valley Committee on Aging 27180 Golden Valley Road Santa Clarita, CA 91351
Santa Clarita Valley Service Center (AD) 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
515 Columbia Avenue #100
Los Angeles, CA 90017
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 (AD) 12915 South Jarvis Avenue Los Angeles, CA 90401

ATTACHMENT NO. 2
Los Angeles County Area Agency on Aging Attachment 4 Age
ncy Name: ______________________________ Client Name: ________________________Date: ____________

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 Name 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 Please Specify: _________
□ Declined to State
Sexual Orientation
□ Straight/Heterosexual □ Bisexual □ Gay/Lesbian/Same Gender-Loving □ Questioning/Unsure □ Not Listed – Please Specify: _________ □ Declined to State Veteran □ Yes □ No □ Declined to State □ Spouse □ Legal Partner □ Parent □ Child of a Person □ Active Military Personnel □ Declined to State
□ Client consents to this agency and the California Department of Aging transmitting Client’s name, email address, mai
ling address, and mobile telephone number to the California Department of Veterans Affairs (CalVet) only for the purpose of receiving additional information on veterans benefits for which Client may be eligible. Client understands that this consent is valid for 12 months.

Contact the CalVet to determine eligibility for services and supports at www.calvet.ca.gov or 1-800-952-5626.

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 □ 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 St ate
ATTACHMENT NO. 2

Agency Name: ______________________________ Client Name: ________________________Date: ____________

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
□ Alone □ Not Alone □ 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 CONTACTS
2 Contact Last Name First Name Middle
Name
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
ATTACHMENT NO. 2
Agency Name: _________________________ Client Name: __________________________Date: _______________

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, if total is 6 or more, participant is at High Nutritional Risk) )
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 do not 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
Client is High Risk: □ Yes □ No
□ Decline to State
ATTACHMENT NO. 2
Agency Name: __________________________ Client Name: __________________________Date: _______________

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
ATTACHMENT NO. 2
Agency Name: __________________________ Client Name: __________________________Date: _______________ TITLE IIIE CARE RECEIVER CAREGIVERS’ DEMOGRAPHICS
7 TITLE IIIE CARE RECEIVER / CAREGIVER DEMOGRAPHICS
Please make additional copies of Section 7 & 8 if more than one Care Receiver Caregiver
Relationship:
□ Husband □ Wife □ Domestic Partner □ Son/Son-in-Law □ Daughter/Daughter-in-Law □ Grandparent □Other Relative □Sister □Brother □Parent/Parent-in-Law □ Non- Relative
□ Declined to State
Care Receiver Last Name

First Name

Middle
Name
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 □ 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
ATTACHMENT NO. 2
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

ATTACHMENT NO. 2
Agency Name: __________________________ Client Name: __________________________Date: _______________

CERTIFICATION

9 CERTIFICATION
(To be completed by Interviewer and signed by Client)

I certify that the information on this form, provided to me by the client, is accurate and true to the best of my abilities. I also certify that I have informed the Client that this information may be shared with other providers for the purpose of providing services. Client signature establishes agreement to services.

Completed by (Print Name)

Phone

Signature

Date

Client Name (Print)

Client Signature

Date

UIF (Revised July 2024)

DISENROLLMENT
10 REASON FOR DISENROLLMENT Date of disenrollment:
□ Deceased □ Moved Out of Service Area □ No Longer Desires Services □ No Longer SNF Certifiable □ No Longer Medi-Cal Eligible □ Institutionalization □ High Cost of Services □ Won’t Follow Care Plan □ On Hold □ Service No Longer Needed □ Past Active □ On Waiting List □ Other Reason

NOTES:

Thank you for completing the Universal Intake Form (UIF). As the aging population grows and funding remains limited, it is vital to capture this critical information to reinforce and substantiate the increased demand for older adult services. This information will assist the Los Angeles County Area Agency on Aging (AAA) in identifying unmet needs, effectively developing plans, and better coordinate services to meet your needs.

ATTACHMENT NO. 2
ATTACHMENT 5
Attachment 5 Elderly Nutrition Program (ENP) SOW Page 1 of 3 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 statemen t might also include how the agency will:
 Assist older individuals and their family caregivers, who may 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 c
an 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 back- up 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.

ATTACHMENT NO. 2
ATTACHMENT 5
Attachment 5 Elderly Nutrition Program (ENP) SOW Page 2 of 3 C. Emergency Response Organization Chart
The chart should include the name, title, and contact information of staff involved 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?
 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
Joe Cool, Director
of Special Needs
Populations
Work:

Cell:

Fax:

Home:
[email protected]
ATTACHMENT NO. 2
ATTACHMENT 5
Attachement 5 Elderly Nutrition Program (ENP) SOW Page 3 of 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 to
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
ATTACHMENT NO. 2
ATTACHMENT 6

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):

ATTACHMENT NO. 2

Attachment 6 (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?

ATTACHMENT NO. 2

Attachment 6 (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 Michael Gavigan, AAA Emergency Coordinator, at [email protected]

*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.

ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Subaward Number:

Subrecipient's Legal Name:
[Enter Site Name] [Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Number] [Enter] [Enter] [Enter] TITLE III C-1 PROGRAM SERVICES (CONGREGATE MEAL SERVICES) 2025-26
ENP252607
City of Pomona
ATTACHMENT 7 (SITE SUMMARY)
[Enter Site Name] [Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Number] [Enter] [Enter] [Enter] Authorized Representative
2052
Ext.
909-62-3211
Phone Number
City Manager
Job Title
Community Services Manager/Recreation
Coordinator
91767
499 E Arrow Hwy
Main Administrative Office Address
PO Box 660
Pomona
City
Pomona
91767
Zip Code
CA
State
Ca
Prefix
(2)

ADDRESS AND PUBLIC

PHONE NUMBER
(3)

SITE PHONE
NUMBER
(A)

CONGREGATE MEAL SITE
(1)
NAME
Mr./Ms.

Zip Code
[email protected] Gutierrez
Mailing Address (if different from above) City
Prefix E-Mail Address
Mr./Ms.

Job Title
[email protected]/[email protected]
Primary/Secondary Contact for Program
Adrian Valdez/Aura Lopez 909-620-2056
Phone Number
2056
Ext. E-Mail Address
State
N/A 12:00pm499 E Arrow Hwy, Pomona CA
91767 909-620-2324
[Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Number] [Enter] [Enter Number] [Enter Number] [Enter] [Enter]
[Enter]
N/A 12:00pm
Palomares Park
Washington Park
(C)
DAYS/HOURS OF OPERATION [NOTE 1]
(2)
PHONE
NUMBER
[Enter]
(1)
NAME
(B)

SITE MANAGER
LUNCH
[NOTE 4]

BREAKFAST
[NOTE 3]
(1)

BUSINESS

OPERATIONS
[NOTE 2]
(2)

MEAL SERVICES
DINNER
[NOTE 5]
[Enter Address] [Enter Number] [Enter Name]
N/A
865 E Grand Avenue, Pomona
CA 91766 909-620-2305 Olinda Lytle 909-802-7732 Monday-Friday 10:00am-2:00pm
Marilyn Martinez-Santos 909-620-2324 Monday-Friday
10:00am-2:00pm
N/A
[Enter][Enter Site Name]
[Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Number] [Enter] [Enter] [Enter][Enter Site Name] [Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Number] [Enter] [Enter] [Enter]
[Enter Site Name]
[Enter Site Name]
[Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Number] [Enter] [Enter] [Enter][Enter Site Name] [Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Number] [Enter] [Enter] [Enter][Enter Site Name] [Enter]
[Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Address] [Enter Number] [Enter Name]
[Enter Number] [Enter] [Enter] [Enter]
[Enter Site Name]
[Enter Site Name]
[Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Number] [Enter] [Enter] [Enter Number] [Enter Number] [Enter] [Enter]
[Enter][Enter Site Name]
[Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Number] [Enter] [Enter] [Enter][Enter Site Name] [Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Number] [Enter] [Enter] [Enter][Enter Site Name] [Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Number] [Enter] [Enter] [Enter][Enter Site Name] [Enter]
[Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Number] [Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter] [Enter] [Enter]
[Enter Site Name]
[Enter Site Name]
[Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Number] [Enter] [Enter] [Enter Number] [Enter] [Enter]
[Enter][Enter Site Name]
[Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Number] [Enter] [Enter] [Enter][Enter Site Name] [Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Number] [Enter] [Enter] [Enter][Enter Site Name] [Enter]
[Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Address] [Enter Number] [Enter Name]
[Enter Number] [Enter] [Enter] [Enter]
[Enter Site Name]
[Enter Site Name]
[Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Number] [Enter] [Enter] [Enter Number] [Enter Number] [Enter] [Enter]
[Enter][Enter Site Name]
[Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Number] [Enter] [Enter] [Enter][Enter Site Name] [Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Number] [Enter] [Enter] [Enter][Enter Site Name] 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.

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”.

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”. [Enter] [Enter] [Enter][Enter Address] [Enter Number] [Enter Name] [Enter Number] [Enter Number][Enter Site Name] ATTACHMENT NO. 2
Attachment 9

(HDM-25)

(HOME -DELIVERED MEAL (HDM) PROGRAM

TELEPHONE REASSURANCE LOG )

SUBRECIPIENT : STAFF/VOLUNTEER :

MONTH:

DATE OF
CALL

DATE OF
LAST

CONTACT

NAME OF CLIENT TELEPHONE
NUMBER
HDM
ROUTE
#
MEAL

STATUS OUTCOME
COMMENTS Hot (H)
Frozen (F)
Waiting
List (WL)
Contact (C)
No Contact (NC)
Left Message
(LM)

ATTACHMENT NO. 2
Attachment 10

HOME-DELIVERED MEAL PROGRAM

PRIORITY OF SERVICE SCREENING TOOL

Direction: Please use the tool below to determine priority of service for Home -Delivered Meals (HDM) Clients. Existing Clients must be reassessed in-home every six (6) months. HDM Waiting List Clients must be reassessed on a monthly basis by phone and in-home during the 3rd and 9th month of initial assessment.

CLIENT: PHONE:

OTHER CONTACT: PHONE:

RELATIONSHIP TO CLIENT:

CLIENT STATUS: ☐ Active Client ☐ On HDM Waiting List TOOL

SECTION
UIF

SECTION RISK FACTOR POINTS
A 1 Living Arrangements
Client lives alone without help – 3 pts.

Client lives with others without help – 2 pts.

Client lives with others with help – 1 pt.

Client lives alone with help 4 hours/day or less – 1 pt.

B 1 Client’s income is at or below 100% FPG – 1pt.

C 3 Client is on SSI – 1 pt.

D 5 Nutritional Risk Factors (total nutritional risk score on UIF) E 6 ADL Risk Factors (1 pt. each activity requiring assistance, 6 pts. max.) F 6 IADL Risk Factors (1 pt. each activity requiring assistance, 6 pts. max.) G 6 Disability Factors
Visually impaired – 1 pt.

Hearing impaired 1 pt.

Speech impaired- 1 pt.

Physical impairment – 1 pt.

Client uses walking aids- 1 pt.

Client is in wheelchair – 2 pts.

Client is bedbound – 3 pts
Memory impaired – 1 pt.

Depression – 1 pt.

Cognitively impaired – 2 pts.

H 6 Client was recently discharged from the hospital – 2 pts.

Hospital:

Date of Discharge: Date to Stop Service:

I TOTAL SCORE:

In case of HDM Waiting Lists, clients with greatest need (priority rate 1) are served first.

PRIORITY RATE
(Check one that applies)

TOTAL SCORE
☐ 1 High 10+
☐ 2 Average 6-9
☐ 3 Low Less than 6

Completed by: ____________________________________________ Date: _______________________ Method of Assessments (Check One): ☐ In-Home Assessment ☐ Telephone ATTACHMENT NO. 2
Attachment 10

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 mu
st 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 (HDM-3), 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 Certification of Need (Form HDM-23), the HDM Client In-Home Assessment (Form HDM- 24), Telephone Reassurance Calls Script (Form HDM- 26), and HDM Telephone Reassurance Call Log (Form HDM-27).

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.

ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Supervisorial District:

Subaward Number:

Amendment Number:
(5) Funding Amount for Equipment (Other) reflected as SF must match the Equipment (Other) Funding Amount reflected in Exhibit C1.1 (Mandated Program Services), Section I (Units of Service Summary). (6) Grand Total Funding Amount under Column (F) Total Funding Amount must match Grand Total Funding Amount reflected in Exhibit C1.1 (Mandated Program Services), Section I (Units of Service Summary), Column (E) Funding Amount.
[Enter] -$
- $ - $

COUNTY USE ONLY
Assigned Program Analyst:

Assigned Contract Analyst:

Jorge Pena Equipment Purchase(s) Approved by: N/A
Lynn Tran
[Enter]
NOTE:
(1) The SSY1 for each Service Category must match the SSY1 Cash Other reflected in Exhibit C1.1 (Mandated Program Services), Section I (Units of Service Summary) for each Service Category. (2) The SF for each Service Category must match the SF reflected in Exhibit C1.1 (Mandated Program Services), Section I (Units of Service Summary) for each Service Category. (4) Funding Amount for Equipment (Purchase(s)) reflected under SSY1 and SF must match the Equipment (Purchase(s)) Funding Amount reflected in Exhibit C1.1 (Mandated Program Services), Section I (Units of Service Summary).

Grand Total (6)
[Enter]
39,107$ 384,500 $ - $
Equipment (Purchases) (4)
99-620-2311
Phone Number
Community Services Manager
(2)

IN-KIND
Phone Number
533,611$
(F)
TOTAL

FUNDING
(B+C+D+E)
[Enter]
(2)

IN-KIND
Project Manager
Mr.

Stephanie Carbajal
Prefix Budget Analyst Job Title
Ms.
(1)
CASH
Job Title
(A)

SERVICE CATEGORY
(B)

SUBAWARD SUM
YEAR 1
(SSY1) (1)
(1)
CASH
OTHER
(2)
CASH
NSIP
384,500 $
(1)
CASH
[Enter]
SUBRECIPIENT'S FUNDS (SF) (2)
(C)
MATCH (3)
(D)

NON-MATCH
(E)

PROGRAM
INCOME
Modification Number: N/A
[email protected] 2039
2052 [email protected]
Prefix
Anita Scott
Ext. E-Mail AddressAuthorized Representative
City Manager
Job Title
Ms.

Mike Osoff
E-Mail AddressExt.Prefix
All Congregate Meals N/A
-$
Management Analyst 909-620-2005
(3)
TOTAL

FUNDING

3.92$
(1)
SSY1

10.10$ 110,004$
2005 [email protected]
Phone Number Ext. E-Mail Address

PROGRAM FUNDING SUMMARY
[Enter] [Enter] 14.02$
Older Americans Act Title III C-1
One (1)
EXHIBIT B1.1 (BUDGET)
Ca 91766
Zip CodeState
State
CA 91767

CONGREGATE MEAL SERVICES
2025-2026
Select Region
City of Pomona
ENP252607
Subrecipient's Legal Name:
505 S Garey Ave
Main Administrative Office Address
Pomona
Mailing Address (if different from above) City Zip Code N/A
(3) The minimum required total mach is twelve percent (12%) of SSY1.

ALL COSTS REPORTED ON THIS BUDGET MUST BE ALLOWABLE, NECESSARY, AND REASONABLE FOR THE PROGRAM SERVICES TO BE PROVIDED.

Lynn Tran Date: 9/30/2025
[Enter] N/A
Budget Reviewed and Approved by:

Equipment (Other) (5)
(G)

UNIT RATE
City
P.O Box 660 Pomona
(2)
SF
- $ 110,004$ 533,611$
(1)
CASH
39,107$
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Subaward Number:

Amendment Number:

Subrecipient's Legal Name:

Community Service Specialist I 100% 1,292$ 12 15,500$ $015,500$ 15,500$ 22,200$ 22,200$
21,000$ - $ - $ 21,000$ 12 22,200$
$0
Recreation Supervisor 10% 9,211$ 12 11,053$ - $ Recreation Coordinator 20% 6,482$ 12 15,556$
$0
Site Manager-Community Service
Specialist II 100% 1,850$
Site Manager-Community Service
Specialist II 100% 1,833$ 12 22,000$ $022,000$ 22,000$ 11,053$ 11,053$ $0
Community Service Specialist III 100% 2,042$ 24,510$ $015,556$ - $ 15,556$
12 24,510$ 24,510$

CONGREGATE MEAL SERVICES
2025-2026
Older Americans Act Title III C-1
(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)
I. BUDGET DETAIL - PERSONNEL
DIRECT
Community Service Manager-Project
Manager 2% 20,834$ 12 5,000$ $05,000$ 5,000$ Community Service Specialist I 100% 1,750$ 12 21,000$ [Enter title]
Community Service Specialist I 100% 1,675$ 12 20,100$ 24,000$
Community Service Specialist I 100% 1,750$ 12 21,000$ 21,000$ - $ 20,100$ $0
Office Assitant I 100% 2,000$ 12
[Enter title]
- $
20,100$ - $
24,000$
Select Region
ENP252607
N/A Modification Number: N/A
24,000$ $0
$0
21,000$ $0
City of Pomona
Exhibit B1.1 (Budget) Page 2
ATTACHMENT NO. 2
(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)
I. BUDGET DETAIL - PERSONNEL
(2): If an individual's time is allocated to multiple Program Services, that individual's time must not exceed 100% when his/her time is totaled for Congregate Meal Services, Home-Delivered Meal Services, and Telephone Reassurance Services.
[Complete as
needed]
[Complete as
needed]
[Complete as
needed] -$
Do indirect costs exceed the fifteen percent (15%) maximum? (5): The maximum reimbursable amount allowable for indirect costs is fifteen percent (15%) of Subrecipient's modified total direct cost reflected under Column F (SSY1 Cash Other). Indirect costs in excess of the fifteen percent (15%) maximum may be budgeted as a match in-kind contribution and used to meet the match requirement (subject to County's prior written approval). 212,015$ $0
NOTE:
(1): Enter the title of each position. List all mandatory staffing positions noted in Exhibit A (Statement of Work and Attachments). If a mandatory position is performed by staff under a different position/payroll title then list both the position title noted in Exhibit A (Statement of Work and Attachments) and the payroll title (e.g., Project Director/Recreation Director). (3): Enter the amount of funding that Subrecipient will use to fund any portion of the total cost for taxes. (4): Enter the amount of funding that Subrecipient will use to fund any portion of the total cost for benefits.

GRAND TOTAL
GRAND TOTAL PERSONNEL 212,014$ 90,405$ 110,004$ - $ - $ - $ 11,606$ Indirect Costs (Personnel)
[Complete as
needed] (5)
[Complete as
needed]
[Complete as
needed]
201,919$ $0
- $ - $ 11,606$ 212,015$ $0

INDIRECT
(4) (4) 553$ 10,096$ $0
TOTAL DIRECT PERSONNEL 212,014$ 90,405$ 110,004$ 10,096$ 4,305$ 5,238$ (4) Taxes [Enter Rate] (3) (3)
SUBTOTAL DIRECT PERSONNEL 201,919$ 86,100$ 104,766$ - $ (3) (3) (3) (3)
- $ - $ 11,053$
[Enter title]
- $
Benefits 5.00%
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
Exhibit B1.1 (Budget) Page 3
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Subaward Number:

Amendment Number:

Subrecipient's Legal Name:

NOTE:
(1): When using volunteer services as an in-kind match to meet the minimum required match, this in-kind match must not exceed more than fifty percent (50%) of the minimum required match. For example, if volunteer services total $2,000 and the minimum required match is $1,500 then a maximum of $750 of volunteer services will count toward meeting the minimum required match. Additionally, Subrecipient does not have to change the amount of volunteer services reflected as in-kind match since only a portion of it may be counted toward meeting the minimum required match. Using the previous example, Subrecipient may reflect $2,000 (as opposed to $750) as in-kind match for volunteer services but only $750 of this amount will be counted toward meeting the minimum required match.

GRAND TOTAL
GRAND TOTAL VOLUNTEERS - $ - $ - $ - $ $0

INDIRECT
Indirect Costs (Volunteers)
[Complete
as needed]
[Complete as
needed]
[Complete as
needed]
TOTAL DIRECT VOLUNTEERS - $ - $ - $ - $ $0 [Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
(G)
MATCH (1)
(H)

NON-MATCH
DIRECT
City of Pomona
[Enter title]
[Enter title]

CONGREGATE MEAL SERVICES
N/A Modification Number:
2025-2026
(B*C*D*E) (1)

IN-KIND
(1)

IN-KIND
(G + H) (F - I)
II. BUDGET DETAIL - VOLUNTEERS
(A)

POSITION TITLE
(B)
NUMBER
OF

POSITIONS
(C)
% OF TIME

ON PROGRAM
(D)

MONTHLY
SALARY

EQUIVALENT
(E)
NO. OF
MONTHS
(F)
TOTAL
SALARY

EQUIVALENT
SF (I)
TOTAL

IN-KIND
Older Americans Act Title III C-1
Select Region
ENP252607
N/A
(J)

VARIANCE
Exhibit B1.1 (Budget) Page 4
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Subaward Number:

Amendment Number:

Subrecipient's Legal Name:
(1) Effective January 1, 2025, County’s approved mileage rate is $0.66 per mile and State's mileage rate is available online at: http://www.calhr.ca.gov/employees/Pages/travel-reimbursements.aspx. Reimbursement for mileage must not exceed the lesser of County's rate and State's rate. (2): The maximum reimbursable amount allowable for indirect costs is fifteen percent (15%) of Subrecipient's modified total direct cost reflected under Column F (SSY1 Cash Other). Indirect costs in excess of the fifteen percent (15%) maximum may be budgeted as a match in-kind contribution and used to meet the match requirement (subject to County's prior written approval). - $ - $ - $ - $ $0 NOTE:

Do indirect costs exceed the fifteen percent (15%) maximum?

GRAND TOTAL

GRAND TOTAL VOLUNTEER
EXPENSES - $ - $ - $ - $ [Complete as
needed]
[Complete as
needed]
[Complete as
needed]
[Complete as
needed]
[Complete as
needed] Indirect Costs (Volunteer Expenses) (2)
- $ - $ - $ - $ $0

INDIRECT

TOTAL DIRECT VOLUNTEER
EXPENSES - $ - $ - $ - $ [Enter description of other expenses]
[Enter description of other expenses]
[Enter description of other expenses]
[Enter description of other expenses]
[Enter description of other expenses]
[Enter description of other expenses]
DIRECT
Training
Mileage (Cost/Mile) (1)
(A)

DESCRIPTION
(B)

UNIT COST
(C)

NUMBER 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)
ENP252607
N/A Modification Number: N/A
City of Pomona
III. BUDGET DETAIL - VOLUNTEER EXPENSES

CONGREGATE MEAL SERVICES
2025-2026
Older Americans Act Title III C-1
Select Region
Exhibit B1.1 (Budget) Page 5
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Subaward Number:

Amendment Number:

Subrecipient's Legal Name:

IV. BUDGET DETAIL - SUBAWARD(S)/SUBCONTRACT(S) FOR CATERED FOOD (A)

LOWER TIER

SUBRECIPIENT'S/SUBCONTRACTOR(S)
NAME (1)
(C)

UNIT COST
(D)
NO. OF
UNITS
(E)
NO. OF
MONTHS
(C*D*E) (F - K)
All Congregate Meals 4.91 $ 4,991 294,095$ 294,095$ $012 (J)

PROGRAM
INCOME
(1)
CASH
(B)

SERVICE CATEGORY
(G)
SSY1
SF(F)

TOTAL COSTS
(K)

TOTAL FUNDING
(L)

VARIANCE
- $ - $
[Complete as
needed]
294,095$ - $ 294,095$ - $ - $ - $ - $ - $ - $ - $

INDIRECT
294,095$ 294,095$
(1): Use this Budget Detail to report Lower Tier Subaward(s)/Subcontract(s) with caterers by entering the name of the caterer. The information provided herein must be included in Exhibit T (List of Lower Tier Subawards). Subrecipient must obtain prior written approval from County before executing Subaward(s).
(2): The maximum reimbursable amount allowable for indirect costs is fifteen percent (15%) of Subrecipient's modified total direct cost reflected under Column G (SSY1 Cash Other). Indirect costs in excess of the fifteen percent (15%) maximum may be budgeted as a match in-kind contribution and used to meet the match requirement (subject to County's prior written approval).

Do indirect costs exceed the fifteen percent (15%) maximum? Indirect Costs
(Lower Tier Subaward(s)/Subcontract(s) for Catered Food)

TOTAL DIRECT LOWER TIER
SUBAWARD(S)/SUBCONTRACT(S) FOR CATERED FOOD - $

GRAND TOTAL LOWER TIER

SUBAWARD(S)/SUBCONTRACT(S) FOR CATERED FOOD
[Complete as
needed]
[Complete as
needed]
[Complete as
needed]
[Complete as
needed]

GRAND TOTAL
(2)
NOTE:
294,095$ $0- $
294,095$ $0
(1)
CASH
(2)

IN-KIND
(1)
CASH
(2)

IN-KIND
(2)
CASH
NSIP
(G+H+I+J)
(I)

NON-MATCH
(1)
CASH
OTHER
(H)
MATCH
Select Description
Select Description
[Enter caterer's name] Select Description
[Enter caterer's name]
[Enter caterer's name]
Select Description

CONGREGATE MEAL SERVICES
Trio Community Meals
[Enter caterer's name] Select Description
[Enter caterer's name]
[Enter caterer's name] Select Description
294,095$
DIRECT
2025-2026
Older Americans Act Title III C-1
ENP252607
N/A Modification Number: N/A
City of Pomona
Exhibit B1.1 (Budget) Page 6
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Subaward Number:

Amendment Number:

Subrecipient's Legal Name:

NOTE:

Do indirect costs exceed the fifteen percent (15%) maximum? (1)
- $ TOTAL DIRECT RAW FOOD
DIRECT
All Congregate Meals
(1): The maximum reimbursable amount allowable for indirect costs is fifteen percent (15%) of Subrecipient's modified total direct cost reflected under Column F (SSY1 Cash Other). Indirect costs in excess of the fifteen percent (15%) maximum may be budgeted as a match in-kind contribution and used to meet the match requirement (subject to County's prior written approval).

INDIRECT

GRAND TOTAL
Indirect Costs (Raw Food)
$0GRAND TOTAL RAW FOOD -$ - $ - $ - $ - $ - $ - $ - $ -$ [Complete as
needed]
-$ $0
[Complete as
needed]
[Complete as
needed]
[Complete as
needed]
-$ - $ - $ - $ - $ - $ - $ [Complete as
needed]

CONGREGATE MEAL SERVICES
(2)

IN-KIND
(1)
CASH
(F+G+H+I) (E - J)
V. BUDGET DETAIL - RAW FOOD
(A)

SERVICE CATEGORY
(B)

UNIT COST
(C)
NO. OF
UNITS
(D)
NO. OF
MONTHS
(2)

IN-KIND
(1)
CASH
(G)
MATCH
(H)

NON-MATCH
(I)

PROGRAM
INCOME
(E)

TOTAL COSTS
SF(F)
SSY1
(J)

TOTAL FUNDING
(K)

VARIANCE
(B*C*D) (1)
CASH
OTHER
(2)
CASH
NSIP
(1)
CASH
2025-2026
Older Americans Act Title III C-1
Select Region
ENP252607
N/A Modification Number: N/A
City of Pomona
Exhibit B1.1 (Budget) Page 7
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Subaward Number:

Amendment Number:

Subrecipient's Legal Name:
[Enter name and description]
[Enter name and description]
(1): Please submit supporting documentation with this Budget for any unit cost, which exceeds $2.00 per square foot, that will be supported by the SSY1. (2): The maximum reimbursable amount allowable for indirect costs is fifteen percent (15%) of Subrecipient's modified total direct cost reflected under Column F (SSY1 Cash Other). Indirect costs in excess of the fifteen percent (15%) maximum may be budgeted as a match in-kind contribution and used to meet the match requirement (subject to County's prior written approval). - $ - $ - $ - $ $0 NOTE:

Do indirect costs exceed the fifteen percent (15%) maximum?

GRAND TOTAL
GRAND TOTAL SPACE - $ - $ - $ - $ [Complete as
needed]
[Complete as
needed]
[Complete as
needed]
[Complete as
needed]
[Complete as
needed] Indirect Costs (Space) (2)
- $ - $ - $ - $ $0

INDIRECT
TOTAL DIRECT SPACE - $ - $ - $ - $ [Enter name and description]
[Enter name and description]
[Enter name and description]
[Enter name and description]
[Enter name and description]
[Enter name and description]
DIRECT
(A)

NAME OF LOCATION AND DESCRIPTION
(B)

UNIT COST
(1)
(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)
N/A Modification Number: N/A
City of Pomona
VI. BUDGET DETAIL - SPACE

CONGREGATE MEAL SERVICES
2025-2026
Older Americans Act Title III C-1
Select Region
ENP252607
Exhibit B1.1 (Budget) Page 8
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Subaward Number:

Amendment Number:

Subrecipient's Legal Name:

NOTE:
- $ $0

GRAND TOTAL
TOTAL DIRECT EQUIPMENT - $ - $ - $ - $ - $ - $ - $ [Enter description] Select
[Enter description] Select
[Enter description] Select
[Enter description] Select
[Enter description] Select
Select

CONGREGATE MEAL SERVICES
(A)
DESCRIPTION (1)
(B)

EQUIPMENT
TYPE
(2) or (3)
(C)

UNIT COST
(D)
NO. OF
UNITS
(E)

TOTAL COSTS
(F)
SSY1
SF (J)
TOTAL

FUNDING
(G)
MATCH
(H)

NON-MATCH
(I)

PROGRAM
INCOME
(C*D) (1)
CASH
OTHER
(1)
CASH
(2)

IN-KIND
(1)
CASH
(2)

IN-KIND
(1)
CASH
(F+G+H+I)
(1) County's approval of Subrecipient's Budget does not constitute approval for Subrecipient to purchase the Equipment/Asset. Prior approval is needed for all computing devices, regardless of cost (including but not limited to, workstations, servers, laptops, personal digital assistants, notebook computers, tablets, smartphones and cellphones) as well as all portable electronic storage media, regardless of cost (including but not limited to, thumb/flash drives and portable hard drives), and/or when Subrecipient will use $500 or more of the SSY1 to purchase the Equipment/Asset.

Subrecipient shall obtain prior written approval from County at least thirty (30) days in advance of the date/time that Subrecipient intends to purchase the Equipment using CSY2 and no later than March 31st of the Fiscal Year.

Equipment must be ordered or purchased no later than May 31st of the Fiscal Year.

Subrecipient must submit a minimum of three (3) bids when requesting approval for Equipment that is $500 or more.

Subrecipient must ensure that the description and amount of the Equipment purchase(s) on the Budget are the same as the actual item(s) purchased.

The Grand Total Equipment purchase amount reflected under column (F) CSY2 shall match the total equipment amount reflected in the Mandated Program Services, Section I (Service Unit Summary). (2) Purchase includes any equipment that Subrecipient intends to purchase. Subreciept must report this using any combination of SSY1, Match Cash, and Non-match Cash. (3) Other includes any equipment (except for leased equipment) which is not purchased by Subrecipient (e.g. donated items). Subrecipient must report this using any combination of Match In-kind and/or Non-match In-kind. 2025-2026
Older Americans Act Title III C-1
Select Region
ENP252607
N/A Modification Number: N/A
City of Pomona
VII. BUDGET DETAIL - EQUIPMENT
(K)

VARIANCE
(E - J)
DIRECT
[Enter description] Select
[Enter description]
Exhibit B1.1 (Budget) Page 9
ATTACHMENT NO. 2
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)
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)
Materials and Supplies (2 CFR 200.453 & 45 CFR 75.453) 50.00 $ 100 1 5,000$ $05,000 $ 5,000$ Professional Services (2 CFR 200.459 & 45 CFR 75.459) 83.33 $ 1 12 1,000$ $01,000 $ 1,000$ 5,851 $ 5,851$ $0
Maintenance and Repairs (2 CFR 200.452 & 45 CFR

75.452) 487.58 $ 1 12 5,851$
2,000 $ 2,000$ $0
Materials and Supplies (2 CFR 200.453 & 45 CFR 75.453) 708.33 $ 1 12 8,500$ $08,500 $ 8,500$ 101 12 800$
Materials and Supplies (2 CFR 200.453 & 45 CFR 75.453) 166.67 $ 1 12 2,000$ Memberships, Subscriptions and Professional Activities (2 CFR 200.454 & 45 CFR 75.454) 800.00 $ 2 1 1,600$
Travel (Mileage) (2 CFR 200.474 & 45 CFR 75.474) (4) 0.66 $ $01,600 $ 1,600$
800$ 800$ $0
2,750 $ 2,750$ $0
DIRECT
Publication and Printing (2 CFR 200.461 & 45 CFR 75.461) 916.67 $ 1 3 2,750$ (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)
Select Region
One (1)
ENP252607
N/A Modification Number: N/A
City of Pomona
VIII. BUDGET DETAIL - OTHER COSTS

CONGREGATE MEAL SERVICES
2025-2026
Older Americans Act Title III C-1
Exhibit B1.1 (Budget) Page 10
ATTACHMENT NO. 2
(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): Effective January 1, 2025, County’s approved mileage rate is $0.66 per mile and State's mileage rate is available online at: http://www.calhr.ca.gov/employees/Pages/travel-reimbursements.aspx. Reimbursement for mileage must not exceed the lesser of County's rate and State's rate. (5): Subrecipient must obtain prior written approval from County if utilizing SSY1 for Travel (Other).(6): Subrecipient must contact their assigned Contract Analyst if there is a cost(s) that Subrecipient would like to add that is not included in the drop down list. Subrecipient must provide detailed explanation of the cost to County review.
(7): The maximum reimbursable amount allowable for indirect costs is fifteen percent (15%) of Subrecipient's modified total direct cost reflected under Column F (SSY1 Cash Other). Indirect costs in excess of the fifteen percent (15%) maximum may be budgeted as a match in-kind contribution and used to meet the match requirement (subject to County's prior written approval). (6)
[Complete
as needed]
[Complete
as needed]
[Complete
as needed]
[Complete as
needed] Indirect Costs (Other Costs)
NOTE:
(6)
(6)
(6)
Select Description (2) (3) (4) (5)
Select Description (2) (3) (4) (5)
(1): Allowable costs are identified in accordance with Title 2 Code of Federal Regulations (CFR) Part 200 and Title 45 Code of Federal Regulations (CFR) Part 75. (2): Subrecipient must obtain prior written approval from County if utilizing SSY1 for Conferences. (3): Subrecipient must provide the following information to your assigned Contract Analyst: (a) Kind of equipment, (b) Indicate whether the equipment lease is program specific or a shared cost, (c) If a shared cost, provide the cost distribution methodology for County review and (d) Length of the lease. - $ - $ 27,501 $ 27,501$ $0
Do indirect costs exceed the fifteen percent (15%) maximum?

GRAND TOTAL
GRAND TOTAL OTHER COSTS 27,501$ - $ - $ - $ [Complete
as needed] (7)
- $ - $ 27,501 $ 27,501$ $0

INDIRECT
TOTAL DIRECT OTHER COSTS 27,501$ - $ - $ - $ Exhibit B1.1 (Budget) Page 11
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Subaward Number:

Amendment Number:

Subrecipient's Legal Name:
2 CONGREGATE MEAL SERVICES
2025-2026
Older Americans Act Title III C-1
Select Region
ENP252607
N/A Modification Number: N/A
City of Pomona
IX. BUDGET SUMMARY
(A)

COST CATEGORIES
(B)
COSTS (1)
(C)

FUNDING CATEGORIES
(D)
FUNDING (1)
(1)
Total Budgeted Costs
Cash NSIP
(SSY1) -$
(1)
Total Budgeted Costs
DIRECT
1 Personnel
Cash Other
(SSY1) 90,405$
1 SSY1
Cash Other
(SSY1) 384,500$
Volunteers In-Kind (SF)
-$
3 Volunteer Expenses
Cash (SF)
121,610$
In-Kind (SF)
-$
Cash (SF)
-$
In-Kind (SF)
-$
2 Subtotal 384,500$
4 Lower Tier Subaward(s)/Subcontract(s) for
Catered Food
Cash Other
(SSY1) 294,095$
Cash NSIP
(SSY1) -$
Cash (SF)
-$
Match
In-Kind (SF)
-$
Cash (SF) 110,004$
-$ In-Kind (SF)
Cash Other
(SSY1) -$
5 Raw Food
Cash Other
(SSY1) -$
3 Non-Match
6 Space
Cash Other
(SSY1) -$
In-Kind (SF) -$ Cash (SF)
-$
In-Kind (SF)
-$
Cash (SF) -$
Cash NSIP
(SSY1) -$
Cash (SF)
-$
In-Kind (SF)
-$
7 Equipment
Cash Other
(SSY1) -$
4 Program Income
8 Other Costs
In-Kind (SF)
-$
Cash (SF) 39,107$
Cash (SF)
-$
In-Kind (SF)
-$
Cash Other
(SSY1) -$
Cash (SF)
27,501$
Cash Other
(SSY1) 384,500$
Cash NSIP
(SSY1) -$
Cash NSIP
(SSY1) -$ 9 Subtotal Direct Costs Cash Other
(SSY1) 384,500$
5 Subtotal Funding for
Direct Costs
Cash (SF)
149,111$
Variance (Costs-Funding)
Cash
In-Kind
Cash (SF)
149,111$
In-Kind (SF)
-$
In-Kind (SF)
-$
Exhibit B1.1 (Budget) Page 12
ATTACHMENT NO. 2
IX. BUDGET SUMMARY
(A)

COST CATEGORIES
(B)
COSTS (1)
(C)

FUNDING CATEGORIES
(D)
FUNDING (1)
(1)
Total Budgeted Costs
(1)
Total Budgeted Costs
11 21 12

INDIRECT
10 Personnel
Cash Other
(SSY1) -$
6 SSY1Volunteers
12 Volunteer Expenses Cash (SF)
Match
-$
In-Kind (SF)
-$
Cash Other
(SSY1) -$
Cash (SF)
-$
In-Kind (SF)
-$
In-Kind (SF)
-$
Cash Other
(SSY1) -$
In-Kind (SF) -$
Cash (SF) -$
13 Lower Tier Subaward(s)/Subcontract(s) for
Catered Food
Cash Other
(SSY1) -$
Cash (SF)
-$
In-Kind (SF)
-$
7 14 Raw Food
Cash Other
(SSY1) -$
8 Non-Match
15 Space
Cash Other
(SSY1) -$
In-Kind (SF) -$ Cash (SF)
-$
In-Kind (SF)
-$
Cash (SF) -$ Cash (SF)
-$
In-Kind (SF)
-$
Cash (SF) -$ Cash (SF)
-$
In-Kind (SF)
-$
16 Other Costs
Cash Other
(SSY1) -$
9 Program Income
Cash Other
(SSY1) -$
Cash (SF)
-$
Cash (SF)
-$
17 Subtotal Indirect Costs
Cash Other
(SSY1) -$
10 Subtotal Funding for
Indirect Costs
In-Kind (SF)
-$
Subrecipeint meets minimum match requirement. Match Met NOTE:
(1): Costs and Funding must match.

In-Kind (SF)
-$
In-Kind (SF)
-$

GRAND TOTAL COSTS
533,611$

GRAND TOTAL FUNDING
533,611$
20 Total Costs
Cash Other
(SSY1) 384,500$
11 Total Funding
Cash Other
(SSY1) 384,500$
Cash NSIP
(SSY1)
Variance (Costs-Funding) $0
-$
Cash NSIP
(SSY1) -$
Cash (SF)
149,111$
Cash (SF)
149,111$

GRAND TOTAL
In-Kind (SF)
-$
Variance (Costs-Funding)
Cash
In-Kind
Exhibit B1.1 (Budget) Page 13
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Supervisorial District:

Subaward Number:

Amendment Number:
(3) Match is optional and is not required for MOCA funding.

ALL COSTS REPORTED ON THIS BUDGET MUST BE ALLOWABLE, NECESSARY, AND REASONABLE FOR THE PROGRAM SERVICES TO BE PROVIDED.

Lynn Tran Date: 9/30/2025
[Enter] N/A
Budget Reviewed and Approved by:

Equipment (Other) (5)
(G)

UNIT RATE
City
P.O. Box 660 Pomona
(2)
SF
- $ - $ 78,000$
(1)
CASH
[Enter]
Modernizing Older Californians Act (MOCA)
One (1)
EXHIBIT B1.2 (BUDGET)
CA 91766
Zip CodeState
State
CA 91769

CONGREGATE MEAL SERVICES
2025-2026
N/A
City of Pomona
ENP252607
Subrecipient's Legal Name:
505 S Garey Ave
Main Administrative Office Address
Pomona
Mailing Address (if different from above) City Zip Code N/A
E-Mail AddressExt.Prefix
All Congregate Meals N/A
-$
Management Analyst 909-620-2005
(3)
TOTAL

FUNDING
[Enter]
(1)
SSY1

10.10$ [Enter]
2005 [email protected]
Phone Number Ext. E-Mail Address

PROGRAM FUNDING SUMMARY
[Enter] [Enter] 10.10$
Modification Number: N/A
[email protected] 2039
2052 [email protected]
Prefix
Anita Scott
Ext. E-Mail AddressAuthorized Representative
City Manager
Job Title
Ms.

Mike Osoff
78,000 $
(1)
CASH
[Enter]
SUBRECIPIENT'S FUNDS (SF) (2)
(C)
OPTIONAL MATCH (3)
(D)

NON-MATCH
(E)

PROGRAM
INCOME
Project Manager
Mr.

Stephanie Carbajal
Prefix Budget Analyst Job Title
Ms.
(1)
CASH
Job Title
(A)

SERVICE CATEGORY
(B)

SUBAWARD SUM
YEAR 1
(SSY1) (1)
(1)
CASH
OTHER
(2)
CASH
NSIP
[Enter]
- $ 78,000 $ - $
Equipment (Purchases) (4)
[Enter Number]
Phone Number
Community Service Manager
(2)

IN-KIND
Phone Number
78,000$
(F)
TOTAL

FUNDING
(B+C+D+E)
[Enter]
(2)

IN-KIND
(5) Funding Amount for Equipment (Other) reflected as SF must match the Equipment (Other) Funding Amount reflected in Exhibit C1.2 (Mandated Program Services), Section I (Units of Service Summary). (6) Grand Total Funding Amount under Column (F) Total Funding Amount must match Grand Total Funding Amount reflected in Exhibit C1.2 (Mandated Program Services), Section I (Units of Service Summary), Column (E) Funding Amount.
[Enter] -$
- $ - $

COUNTY USE ONLY
Assigned Program Analyst:

Assigned Contract Analyst:

Jorge Pena Equipment Purchase(s) Approved by: N/A
Lynn Tran
[Enter]
NOTE:
(1) The SSY1 for each Service Category must match the SSY1 Cash Other reflected in Exhibit C1.2 (Mandated Program Services), Section I (Units of Service Summary) for each Service Category. (2) The SF for each Service Category must match the SF reflected in Exhibit C1.2 (Mandated Program Services), Section I (Units of Service Summary) for each Service Category. (4) Funding Amount for Equipment (Purchase(s)) reflected under SSY1 and SF must match the Equipment (Purchase(s)) Funding Amount reflected in Exhibit C1.2 (Mandated Program Services), Section I (Units of Service Summary).

Grand Total (6)
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Supervisorial District:

Subaward Number:

Amendment Number:

Subrecipient's Legal Name:

N/A
One (1)
ENP252607
N/A Modification Number: N/A
City of Pomona
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
I. BUDGET DETAIL - PERSONNEL
DIRECT
See Exhibit "B1.1"

CONGREGATE MEAL SERVICES
2025-2026
Modernizing Older Californians Act (MOCA)
(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)
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
Exhibit B1.2 (Budget) Page 2
ATTACHMENT NO. 2
I. BUDGET DETAIL - PERSONNEL
(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)
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
SUBTOTAL DIRECT PERSONNEL -$ -$ - $ - $ (3) (3) (3) (3)
- $ - $ - $
[Enter title]
- $
Benefits [Enter Rate] (4) (4) (4)
Taxes [Enter Rate] (3) (3)
Indirect Costs (Personnel)
[Complete as
needed] (5)
[Complete as
needed]
[Complete as
needed]
-$ $0
- $ - $ - $ -$ $0

INDIRECT
(4) (4) (4)
TOTAL DIRECT PERSONNEL -$ -$ - $ (2): If an individual's time is allocated to multiple Program Services, that individual's time must not exceed 100% when his/her time is totaled for Congregate Meal Services, Home-Delivered Meal Services, and Telephone Reassurance Services.
[Complete as
needed]
[Complete as
needed]
[Complete as
needed] -$
Do indirect costs exceed the fifteen percent (15%) maximum? (5): The maximum reimbursable amount allowable for indirect costs is fifteen percent (15%) of Subrecipient's modified total direct cost reflected under Column F (SSY1 Cash Other). Indirect costs in excess of the fifteen percent (15%) maximum may be budgeted as a match in-kind contribution and used to meet the match requirement (subject to County's prior written approval). -$ $0
NOTE:
(1): Enter the title of each position. List all mandatory staffing positions noted in Exhibit A (Statement of Work and Attachments). If a mandatory position is performed by staff under a different position/payroll title then list both the position title noted in Exhibit A (Statement of Work and Attachments) and the payroll title (e.g., Project Director/Recreation Director). (3): Enter the amount of funding that Subrecipient will use to fund any portion of the total cost for taxes. (4): Enter the amount of funding that Subrecipient will use to fund any portion of the total cost for benefits.

GRAND TOTAL
GRAND TOTAL PERSONNEL -$ -$ - $ - $ - $ - $ - $ Exhibit B1.2 (Budget) Page 3
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Supervisorial District:

Subaward Number:

Amendment Number:

Subrecipient's Legal Name:

CONGREGATE MEAL SERVICES
N/A Modification Number:
2025-2026
(B*C*D*E) (1)

IN-KIND
(1)

IN-KIND
(G + H) (F - I)
II. BUDGET DETAIL - VOLUNTEERS
(A)

POSITION TITLE
(B)
NUMBER
OF

POSITIONS
(C)
% OF TIME

ON PROGRAM
(D)

MONTHLY
SALARY

EQUIVALENT
(E)
NO. OF
MONTHS
(F)
TOTAL
SALARY

EQUIVALENT
SF (I)
TOTAL

IN-KIND
Modernizing Older Californians Act (MOCA)
N/A
One (1)
ENP252607
N/A
(J)

VARIANCE
(G)
MATCH (1)
(H)

NON-MATCH
DIRECT
City of Pomona
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]
[Enter title]

INDIRECT
Indirect Costs (Volunteers)
[Complete
as needed]
[Complete as
needed]
[Complete as
needed]
TOTAL DIRECT VOLUNTEERS - $ - $ - $ - $ $0 NOTE:
(1): When using volunteer services as an in-kind match to meet the minimum required match, this in-kind match must not exceed more than fifty percent (50%) of the minimum required match. For example, if volunteer services total $2,000 and the minimum required match is $1,500 then a maximum of $750 of volunteer services will count toward meeting the minimum required match. Additionally, Subrecipient does not have to change the amount of volunteer services reflected as in-kind match since only a portion of it may be counted toward meeting the minimum required match. Using the previous example, Subrecipient may reflect $2,000 (as opposed to $750) as in-kind match for volunteer services but only $750 of this amount will be counted toward meeting the minimum required match.

GRAND TOTAL
GRAND TOTAL VOLUNTEERS - $ - $ - $ - $ $0 Exhibit B1.2 (Budget) Page 4
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Supervisorial District:

Subaward Number:

Amendment Number:

Subrecipient's Legal Name:

ENP252607
N/A Modification Number: N/A
City of Pomona
III. BUDGET DETAIL - VOLUNTEER EXPENSES

CONGREGATE MEAL SERVICES
2025-2026
Modernizing Older Californians Act (MOCA)
N/A
One (1)
(A)

DESCRIPTION
(B)

UNIT COST
(C)

NUMBER 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
Training
Mileage (Cost/Mile) (1)
[Enter description of other expenses]
[Enter description of other expenses]
[Enter description of other expenses]
[Enter description of other expenses]
[Enter description of other expenses]
- $ $0

INDIRECT

TOTAL DIRECT VOLUNTEER
EXPENSES - $ - $ - $ - $ [Enter description of other expenses]
Indirect Costs (Volunteer Expenses) (2)
- $ - $ - $
(1) Effective January 1, 2025, County’s approved mileage rate is $0.66 per mile and State's mileage rate is available online at: http://www.calhr.ca.gov/employees/Pages/travel-reimbursements.aspx. Reimbursement for mileage must not exceed the lesser of County's rate and State's rate. (2): The maximum reimbursable amount allowable for indirect costs is fifteen percent (15%) of Subrecipient's modified total direct cost reflected under Column F (SSY1 Cash Other). Indirect costs in excess of the fifteen percent (15%) maximum may be budgeted as a match in-kind contribution and used to meet the match requirement (subject to County's prior written approval). - $ - $ - $ - $ $0 NOTE:

Do indirect costs exceed the fifteen percent (15%) maximum?

GRAND TOTAL

GRAND TOTAL VOLUNTEER
EXPENSES - $ - $ - $ - $ [Complete as
needed]
[Complete as
needed]
[Complete as
needed]
[Complete as
needed]
[Complete as
needed]
Exhibit B1.2 (Budget) Page 5
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Supervisorial District:

Subaward Number:

Amendment Number:

Subrecipient's Legal Name:
2025-2026
Modernizing Older Californians Act (MOCA)
N/A
One (1)
ENP252607
N/A Modification Number: N/A
City of Pomona

CONGREGATE MEAL SERVICES
Trio Community Meals
[Enter caterer's name] Select Description
[Enter caterer's name]
[Enter caterer's name] Select Description
78,000$
DIRECT
[Enter caterer's name] Select Description
[Enter caterer's name]
[Enter caterer's name]
Select Description
Select Description
Select Description
(1)
CASH
(2)

IN-KIND
(1)
CASH
(2)

IN-KIND
(G+H+I+J)
(I)

NON-MATCH
(1)
CASH
OTHER
(H)
MATCH
(1): Use this Budget Detail to report Lower Tier Subaward(s)/Subcontract(s) with caterers by entering the name of the caterer. The information provided herein must be included in Exhibit T (List of Lower Tier Subawards). Subrecipient must obtain prior written approval from County before executing Subaward(s). (2): The maximum reimbursable amount allowable for indirect costs is fifteen percent (15%) of Subrecipient's modified total direct cost reflected under Column G (SSY1 Cash Other). Indirect costs in excess of the fifteen percent (15%) maximum may be budgeted as a match in-kind contribution and used to meet the match requirement (subject to County's prior written approval).

Do indirect costs exceed the fifteen percent (15%) maximum? Indirect Costs
(Lower Tier Subaward(s)/Subcontract(s) for Catered Food)

TOTAL DIRECT LOWER TIER
SUBAWARD(S)/SUBCONTRACT(S) FOR CATERED FOOD - $

GRAND TOTAL LOWER TIER

SUBAWARD(S)/SUBCONTRACT(S) FOR CATERED FOOD
[Complete as
needed]
[Complete as
needed]
[Complete as
needed]
[Complete as
needed]

GRAND TOTAL
(2)
NOTE:
78,000$ $0- $
78,000$ $0- $
[Complete as
needed]
78,000$ - $ 78,000$ - $ - $ - $ - $ - $ - $

INDIRECT
78,000$ 78,000$
IV. BUDGET DETAIL - SUBAWARD(S)/SUBCONTRACT(S) FOR CATERED FOOD (A)

LOWER TIER

SUBRECIPIENT'S/SUBCONTRACTOR(S)
NAME (1)
(C)

UNIT COST
(D)
NO. OF
UNITS
(E)
NO. OF
MONTHS
(C*D*E) (F - K)
All Congregate Meals 4.91 $ 1,324 78,000$ 78,000$ $012 (J)

PROGRAM
INCOME
(1)
CASH
(B)

SERVICE CATEGORY
(G)
SSY1
SF(F)

TOTAL COSTS
(K)

TOTAL FUNDING
(L)

VARIANCE
Exhibit B1.2 (Budget) Page 6
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Supervisorial District:

Subaward Number:

Amendment Number:

Subrecipient's Legal Name:

NOTE:
2025-2026
Modernizing Older Californians Act (MOCA)
N/A
One (1)
ENP252607
N/A Modification Number: N/A
City of Pomona
V. BUDGET DETAIL - RAW FOOD
(A)

SERVICE CATEGORY
(B)

UNIT COST
(C)
NO. OF
UNITS
(D)
NO. OF
MONTHS
(2)

IN-KIND
(1)
CASH
(G)
MATCH
(H)

NON-MATCH
(I)

PROGRAM
INCOME
(E)

TOTAL COSTS
SF(F)
SSY1
(J)

TOTAL FUNDING
(K)

VARIANCE
(B*C*D) (1)
CASH
OTHER
(1)
CASH

CONGREGATE MEAL SERVICES
(2)

IN-KIND
(1)
CASH
(F+G+H+I) (E - J)
-$ $0
[Complete as
needed]
[Complete as
needed]
[Complete as
needed]
-$ - $ - $ - $ - $ - $ [Complete as
needed]
DIRECT
All Congregate Meals
(1): The maximum reimbursable amount allowable for indirect costs is fifteen percent (15%) of Subrecipient's modified total direct cost reflected under Column F (SSY1 Cash Other). Indirect costs in excess of the fifteen percent (15%) maximum may be budgeted as a match in-kind contribution and used to meet the match requirement (subject to County's prior written approval).

INDIRECT

GRAND TOTAL
Indirect Costs (Raw Food)
$0GRAND TOTAL RAW FOOD -$ - $ - $ - $ - $ - $ - $ -$ [Complete as
needed]
Do indirect costs exceed the fifteen percent (15%) maximum? (1)
- $ TOTAL DIRECT RAW FOOD
Exhibit B1.2 (Budget) Page 7
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Supervisorial District:

Subaward Number:

Amendment Number:

Subrecipient's Legal Name:

N/A Modification Number: N/A
City of Pomona
VI. BUDGET DETAIL - SPACE

CONGREGATE MEAL SERVICES
2025-2026
Modernizing Older Californians Act (MOCA)
N/A
One (1)
ENP252607
(A)

NAME OF LOCATION AND DESCRIPTION
(B)

UNIT COST
(1)
(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)
[Enter name and description]
[Enter name and description]
DIRECT
[Enter name and description]
[Enter name and description]
[Enter name and description]
$0

INDIRECT
TOTAL DIRECT SPACE - $ - $ - $ - $ [Enter name and description]
[Complete
as needed] Indirect Costs (Space) (2)
- $ - $ - $ - $
[Enter name and description]
[Enter name and description]
(1): Please submit supporting documentation with this Budget for any unit cost, which exceeds $2.00 per square foot, that will be supported by the SSY1. (2): The maximum reimbursable amount allowable for indirect costs is fifteen percent (15%) of Subrecipient's modified total direct cost reflected under Column F (SSY1 Cash Other). Indirect costs in excess of the fifteen percent (15%) maximum may be budgeted as a match in-kind contribution and used to meet the match requirement (subject to County's prior written approval). - $ - $ - $ - $ $0 NOTE:

Do indirect costs exceed the fifteen percent (15%) maximum?

GRAND TOTAL
GRAND TOTAL SPACE - $ - $ - $ - $ [Complete
as needed]
[Complete
as needed]
[Complete
as needed]
[Complete
as needed]
Exhibit B1.2 (Budget) Page 8
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Supervisorial District:

Subaward Number:

Amendment Number:

Subrecipient's Legal Name:
(1) County's approval of Subrecipient's Budget does not constitute approval for Subrecipient to purchase the Equipment/Asset. Prior approval is needed for all computing devices, regardless of cost (including but not limited to, workstations, servers, laptops, personal digital assistants, notebook computers, tablets, smartphones and cellphones) as well as all portable electronic storage media, regardless of cost (including but not limited to, thumb/flash drives and portable hard drives), and/or when Subrecipient will use $500 or more of the SSY1 to purchase the Equipment/Asset.

Subrecipient shall obtain prior written approval from County at least thirty (30) days in advance of the date/time that Subrecipient intends to purchase the Equipment using CSY2 and no later than March 31st of the Fiscal Year.

Equipment must be ordered or purchased no later than May 31st of the Fiscal Year.

Subrecipient must submit a minimum of three (3) bids when requesting approval for Equipment that is $500 or more.

Subrecipient must ensure that the description and amount of the Equipment purchase(s) on the Budget are the same as the actual item(s) purchased.

The Grand Total Equipment purchase amount reflected under column (F) CSY2 shall match the total equipment amount reflected in the Mandated Program Services, Section I (Service Unit Summary). (2) Purchase includes any equipment that Subrecipient intends to purchase. Subreciept must report this using any combination of SSY1, Match Cash, and Non-match Cash. (3) Other includes any equipment (except for leased equipment) which is not purchased by Subrecipient (e.g. donated items). Subrecipient must report this using any combination of Match In-kind and/or Non-match In-kind. 2025-2026
Modernizing Older Californians Act (MOCA)
N/A
One (1)
ENP252607
N/A Modification Number: N/A
City of Pomona
VII. BUDGET DETAIL - EQUIPMENT
(K)

VARIANCE
(E - J)
DIRECT
[Enter description] Select
[Enter description]
(J)
TOTAL

FUNDING
(G)
MATCH
(H)

NON-MATCH
(I)

PROGRAM
INCOME
(C*D) (1)
CASH
OTHER
(1)
CASH
(2)

IN-KIND
(1)
CASH
(2)

IN-KIND
(1)
CASH
(F+G+H+I)

CONGREGATE MEAL SERVICES
(A)
DESCRIPTION (1)
(B)

EQUIPMENT
TYPE
(2) or (3)
(C)

UNIT COST
(D)
NO. OF
UNITS
(E)

TOTAL COSTS
(F)
SSY1
SF
[Enter description] Select
Select
[Enter description] Select
[Enter description] Select
[Enter description] Select
NOTE:
- $ $0

GRAND TOTAL
TOTAL DIRECT EQUIPMENT - $ - $ - $ - $ - $ - $ - $ [Enter description] Select
Exhibit B1.2 (Budget) Page 9
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Supervisorial District:

Subaward Number:

Amendment Number:

Subrecipient's Legal Name:

N/A
One (1)
ENP252607
N/A Modification Number: N/A
City of Pomona
VIII. BUDGET DETAIL - OTHER COSTS

CONGREGATE MEAL SERVICES
2025-2026
Modernizing Older Californians Act (MOCA)
(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)
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 B1.2 (Budget) Page 10
ATTACHMENT NO. 2
(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)
- $ - $ - $ - $ $0

INDIRECT
TOTAL DIRECT OTHER COSTS - $ - $ - $ - $ (1): Allowable costs are identified in accordance with Title 2 Code of Federal Regulations (CFR) Part 200 and Title 45 Code of Federal Regulations (CFR) Part 75. (2): Subrecipient must obtain prior written approval from County if utilizing SSY1 for Conferences. (3): Subrecipient must provide the following information to your assigned Contract Analyst: (a) Kind of equipment, (b) Indicate whether the equipment lease is program specific or a shared cost, (c) If a shared cost, provide the cost distribution methodology for County review and (d) Length of the lease. - $ - $ - $ - $ $0 Do indirect costs exceed the fifteen percent (15%) maximum?

GRAND TOTAL
GRAND TOTAL OTHER COSTS - $ - $ - $ - $ [Complete
as needed] (7)
Select Description (2) (3) (4) (5)
(6)
Select Description (2) (3) (4) (5)
(6)
(6)
(4): Effective January 1, 2025, County’s approved mileage rate is $0.66 per mile and State's mileage rate is available online at: http://www.calhr.ca.gov/employees/Pages/travel-reimbursements.aspx. Reimbursement for mileage must not exceed the lesser of County's rate and State's rate. (5): Subrecipient must obtain prior written approval from County if utilizing SSY1 for Travel (Other).(6): Subrecipient must contact their assigned Contract Analyst if there is a cost(s) that Subrecipient would like to add that is not included in the drop down list. Subrecipient must provide detailed explanation of the cost to County review.
(7): The maximum reimbursable amount allowable for indirect costs is fifteen percent (15%) of Subrecipient's modified total direct cost reflected under Column F (SSY1 Cash Other). Indirect costs in excess of the fifteen percent (15%) maximum may be budgeted as a match in-kind contribution and used to meet the match requirement (subject to County's prior written approval). (6)
[Complete
as needed]
[Complete
as needed]
[Complete
as needed]
[Complete as
needed] Indirect Costs (Other Costs)
NOTE:

Exhibit B1.2 (Budget) Page 11
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Supervisorial District:

Subaward Number:

Amendment Number:

Subrecipient's Legal Name:
2 Variance (Costs-Funding)
Cash
In-Kind
Cash (SF)
-$
In-Kind (SF)
-$
In-Kind (SF)
-$
Cash Other
(SSY1) 78,000$
Cash NSIP
(SSY1) -$
Cash NSIP
(SSY1) -$ 9 Subtotal Direct Costs Cash Other
(SSY1) 78,000$
5 Subtotal Funding for
Direct Costs
Cash (SF)
-$
Cash (SF) -$
Cash (SF)
-$
In-Kind (SF)
-$
Cash Other
(SSY1) -$
Cash (SF)
-$
7 Equipment
Cash Other
(SSY1) -$
4 Program Income
8 Other Costs
In-Kind (SF)
-$
In-Kind (SF) -$ Cash (SF)
-$
In-Kind (SF)
-$
Cash (SF) -$
Cash NSIP
(SSY1) -$
Cash (SF)
-$
In-Kind (SF)
-$
5 Raw Food
Cash Other
(SSY1) -$
3 Non-Match
6 Space
Cash Other
(SSY1) -$
2 Subtotal 78,000$
4 Lower Tier Subaward(s)/Subcontract(s)
for Catered Food
Cash Other
(SSY1) 78,000$
Cash NSIP
(SSY1) -$
Cash (SF)
-$
Match
In-Kind (SF)
-$
Cash (SF) -$
-$ In-Kind (SF)
Cash Other
(SSY1) -$
Cash (SF)
-$
In-Kind (SF)
-$
Cash (SF)
-$
In-Kind (SF)
-$
City of Pomona
IX. BUDGET SUMMARY
(A)

COST CATEGORIES
(B)
COSTS (1)
(C)

FUNDING CATEGORIES
(D)
FUNDING (1)
(1)
Total Budgeted Costs
Cash NSIP
(SSY1) -$
(1)
Total Budgeted Costs
DIRECT
1 Personnel
Cash Other
(SSY1) -$
1 SSY1
Cash Other
(SSY1) 78,000$
Volunteers In-Kind (SF)
-$
3 Volunteer Expenses

CONGREGATE MEAL SERVICES
2025-2026
Modernizing Older Californians Act (MOCA)
One (1)
ENP252607
N/A Modification Number: N/A
Exhibit B1.2 (Budget) Page 12
ATTACHMENT NO. 2
IX. BUDGET SUMMARY
(A)

COST CATEGORIES
(B)
COSTS (1)
(C)

FUNDING CATEGORIES
(D)
FUNDING (1)
(1)
Total Budgeted Costs
(1)
Total Budgeted Costs
11 21 12
Cash NSIP
(SSY1) -$
Cash (SF)
-$
Cash (SF)
-$

GRAND TOTAL
In-Kind (SF)
-$
Variance (Costs-Funding)
Cash
In-Kind
NOTE:
(1): Costs and Funding must match.

In-Kind (SF)
-$
In-Kind (SF)
-$

GRAND TOTAL COSTS
78,000$

GRAND TOTAL FUNDING
78,000$
20 Total Costs
Cash Other
(SSY1) 78,000$
11 Total Funding
Cash Other
(SSY1) 78,000$
Cash NSIP
(SSY1)
Variance (Costs-Funding) $0
-$
Cash Other
(SSY1) -$
Cash (SF)
-$
Cash (SF)
-$
17 Subtotal Indirect Costs
Cash Other
(SSY1) -$
10 Subtotal Funding for
Indirect Costs
In-Kind (SF)
-$
Cash (SF) -$ Cash (SF)
-$
In-Kind (SF)
-$
16 Other Costs
Cash Other
(SSY1) -$
9 Program Income
In-Kind (SF) -$ Cash (SF)
-$
In-Kind (SF)
-$
Cash (SF) -$ Cash (SF)
-$
In-Kind (SF)
-$
14 Raw Food
Cash Other
(SSY1) -$
8 Non-Match
15 Space
Cash Other
(SSY1) -$
13 Lower Tier Subaward(s)/Subcontract(s)
for Catered Food
Cash Other
(SSY1) -$
Cash (SF)
-$
In-Kind (SF)
-$
7 Match
-$
In-Kind (SF)
-$
Cash Other
(SSY1) -$
Cash (SF)
-$
In-Kind (SF)
-$
In-Kind (SF)
-$
Cash Other
(SSY1) -$
In-Kind (SF) -$
Cash (SF) -$
10 Personnel
Cash Other
(SSY1) -$
6 SSY1Volunteers
12 Volunteer Expenses Cash (SF)

INDIRECT
Exhibit B1.2 (Budget) Page 13
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Supervisorial District:

Subaward Number:

Amendment Number:
2052
Ext.
2039
Phone Number Ext.
2005
Phone Number Ext.

City
Congregate Meal Services
2025-26
Older Americans Act Title III C-1
Select Region
ENP252607
City of Pomona
N/A N/AModification Number:

One (1)
Budget Analyst Job Title E-Mail Address
Pomona CA 91769
Management Analyst 909-620-2005 [email protected] Mailing Address (if different from above) City State Zip Code Prefix Authorized Representative Job Title
EXHIBIT C1.1 (MANDATED PROGRAM SERVICES)
Subrecipient's Legal Name:

P.O. Box 660
City Manager [email protected]
State Zip Code
505 S Garey Ave Pomona CA 91766
Main Administrative Office Address
E-Mail Address
Ms. Anita Scott 909-620-2311
Phone Number
Community Services Manager [email protected]
Prefix Project Manager Job Title E-Mail Address
Mr. Mike Osoff 909-620-2039
Ms. Stephanie Carbajal
Prefix
MPS Reviewed and Approved by: Jorge Pena Date: 9/30/2025

COUNTY USE ONLY
Assigned Program Analyst: Jorge Pena
Assigned Contract Analyst: Lynn Tran
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Supervisorial District:

Subaward Number:

Amendment Number:

Equipment (Other) (9)
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 and Attachments). These individuals are counted only once within a FY for reporting purposes.

All Congregate Meals
[Enter Approved
Amount]
38,069
38,069
384,500$

14.02$
138
GRAND TOTAL SERVICES/FUNDING 138 38,069 533,611$ SF (7)
(Cash and In-Kind)
Total (4)
(5) The Total and Grand Total amounts under column (E) Funding Amount must match the Total and Grand Total amounts reflected in Exhibit B1.1 (Budget) (cover page) column (F) Total Funding.
(9) Enter the amount of equipment (other) that is reflected in Exhibit B1.1 (Budget).

I. UNITS OF SERVICE SUMMARY
(6) SSY1: Subaward Sum Year 1
(7) SF: Subrecipient's Funds
(8) Enter the approved amount of equipment purchase(s) that is reflected in Exhibit B1.1 (Budget).

Equipment (Purchases) (8) [Enter Approved
Amount]
(2) Please Enter the Unit Rates: a) for SSY1 (Cash Other) (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 the Service Category to be provided using SSY1 (Cash Other) and SF. (4) The Total Unduplicated Units for the Service Category under column (C) Units of Service must match the corresponding Total Units reflected in Section II, (Services by Month) column (P) Total.

Modification Number: N/AN/A
(E)
FUNDING AMOUNT (5)
(F)
NO. OF UNDUPLICATED
CLIENTS (1)
(C)

UNITS OF
SERVICE (3)
(D)
UNIT RATE (2)
(A)

SERVICE CATEGORY
(B)

FUNDING SOURCE
Subrecipient's Legal Name: City of Pomona
Congregate Meal Services
2025-26
Older Americans Act Title III C-1
Select Region
ENP252607
One (1)
SSY1 (6)
(Cash Other)
38,069 533,611$

10.10$

3.92$ 149,111$
Exhibit C1.1 (Mandated Program Services)

ATTACHMENT NO. 2
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)
1 138 3,172 3,172 3,172 3,172 3,172 3,172 3,172 3,172 3,172 3,172 3,172 3,172 38,069 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
138 3,172 3,172 3,172 3,172 3,172 3,172 3,172 3,172 3,172 3,172 3,172 3,172 38,069 NOTE:
(1) The Grand Total Units under column (P) Total must match the Total reflected in Section I (Units of Service Summary) column (C) Units of Service Total.

Subrecipient's Legal Name: City of Pomona
Modification Number:N/A N/A
ENP252607
Congregate Meal Services
2025-26
Older Americans Act Title III C-1
Select Region
One (1)
II. SERVICES BY MONTH - ALL CONGREGATE MEALS
(B)

SITE NAME
All Congregate Meals
Grand Total
Exhibit C1.1 (Mandated Program Services)

ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Supervisorial District:

Subaward Number:

Amendment Number:
2052
Ext.
2039
Phone Number Ext.
2005
Phone Number Ext.

MPS Reviewed and Approved by: Jorge Pena Date: 9/30/2025

COUNTY USE ONLY
Assigned Program Analyst: Jorge Pena
Assigned Contract Analyst: Lynn Tran
Community Service Manager [email protected]
Prefix Project Manager Job Title E-Mail Address
Mr. Mike Osoff 909-620-2039
Ms. Stephanie Carbajal
Prefix
E-Mail Address
Ms. Anita Scott 909-620-2311
Phone Number
EXHIBIT C1.2 (MANDATED PROGRAM SERVICES)
Subrecipient's Legal Name:

P.O. Box 660
City Manager [email protected]
State Zip Code
505 S Garey Ave Pomona CA 91767
Main Administrative Office Address
Budget Analyst Job Title E-Mail Address
Pomona CA 91769
Management Analyst 909-620-2005 [email protected] Mailing Address (if different from above) City State Zip Code Prefix Authorized Representative Job Title
City
Congregate Meal Services
2025-2026
Modernization of Older Californians Act (MOCA)
Select Region
ENP252607
City of Pomona
N/A N/AModification Number:

One (1)
ATTACHMENT NO. 2
Program Services:

Fiscal Year:

Funding Type:

Los Angeles County Region:

Supervisorial District:

Subaward Number:

Amendment Number:

Equipment (Other) (9)
Total (4)
SSY1 (6)
(Cash Other)
SF (7)
(Cash and In-Kind)
7,723 10.10$
Congregate Meal Services
2025-2026
Modernization of Older Californians Act (MOCA)
Select Region
ENP252607
One (1)
Modification Number: N/AN/A
(E)
FUNDING AMOUNT (5)
(F)
NO. OF UNDUPLICATED
CLIENTS (1)
(C)

UNITS OF
SERVICE (3)
(D)
UNIT RATE (2)
(A)

SERVICE CATEGORY
(B)

FUNDING SOURCE
Subrecipient's Legal Name: City of Pomona
(5) The Total and Grand Total amounts under column (E) Funding Amount must match the Total and Grand Total amounts reflected in Exhibit B1.2 (Budget) (cover page) column (F) Total Funding.
(9) Enter the amount of equipment (other) that is reflected in Exhibit B1.2 (Budget).

I. UNITS OF SERVICE SUMMARY
(6) SSY1: Subaward Sum Year 1
(7) SF: Subrecipient's Funds
(8) Enter the approved amount of equipment purchase(s) that is reflected in Exhibit B1.2 (Budget).

Equipment (Purchases) (8) [Enter Approved
Amount]
(2) Please Enter the Unit Rates: a) for SSY1 (Cash Other) (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) and SF. (4) The Total Unduplicated Units for each Service Category under column (C) Units of Service must match the corresponding Total Units reflected in Section II (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 and Attachments). These individuals are counted only once within a FY for reporting purposes.

All Congregate Meals
[Enter Approved
Amount]
7,723
[Enter Units]
78,000$
28 GRAND TOTAL SERVICES/FUNDING 28 7,723 78,000$ 78,000$

10.10$
[Enter Unit Rate]
Exhibit C1.2 (Mandated Program Services)

ATTACHMENT NO. 2
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 28 644 644 644 644 644 644 644 644 644 644 644 644 7,723 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
28 644 644 644 644 644 644 644 644 644 644 644 644 7,723 NOTE:
(1) The Grand Total Units under column (P) Total must match the Total reflected in Section I (Units of Service Summary) column (C) Units of Service Total.

N/A Modification Number: N/A
Congregate Meal Services
2025-2026
Modernization of Older Californians Act (MOCA)
Select Region
ENP252607
One (1)
Subrecipient's Legal Name: City of Pomona
II. SERVICES BY MONTH - ALL CONGREGATE MEALS
(B)

SITE NAME
All Congragate Meals
Grand Total
Exhibit C1.2 (Mandated Program Services)

ATTACHMENT NO. 2

EXHIBIT D
(COUNTY'S ADMINISTRATION)

FISCAL YEAR: 2025-26

COUNTY’S DEPARTMENT HEAD

Name: Dr. Laura Trejo
Title: Executive Director
Address: 510 South Vermont Avenue
Los Angeles, Ca 90020
Telephone: (213) 291-0028
E-Mail Address: [email protected]

COUNTY’S CONTRACT MANAGER

Name: Mr. Mike Tsao
Title: Program Manager
Address: 510 South Vermont Avenue
Los Angeles, Ca 90020
Telephone: (213) 662-4432
E-Mail Address: [email protected]

COUNTY’S PROGRAM MANAGER

Name: Mr. Miguel Robleto
Title: Program Manager
Address: 510 South Vermont Avenue
Los Angeles, Ca 90020
Telephone: (213) 738-2737
E-Mail Address: [email protected]

COUNTY’S COMPLIANCE MANAGER

Name: Ms. Susana Ortega
Title: Program Manager
Address: 510 South Vermont Avenue
Los Angeles, Ca 90020
Telephone: (323) 459-9141
E-Mail Address: [email protected]

COUNTY’S EMERGENCY COORDINATOR
Name: Mr. Henry Lopez
Title: Program Manager
Address: 510 South Vermont Avenue
Los Angeles, Ca 90020
Telephone: (213) 738­-2337
E-Mail Address: [email protected]
ATTACHMENT NO. 2
ATTACHMENT NO. 2
ATTACHMENT NO. 2
ATTACHMENT NO. 2
ATTACHMENT NO. 2
ATTACHMENT NO. 2
ATTACHMENT NO. 2

EXHIBIT G
(SAFELY SURRENDER BABY LAW)

ATTACHMENT NO. 2
Exhibit G (Safely Surrender Baby Law)
Rev. 06/2022 Page 2

ATTACHMENT NO. 2
Exhibit G (Safely Surrender Baby Law)
Rev. 06/2022 Page 3

ATTACHMENT NO. 2

EXHIBIT H
(INTENTIONALLY OMITTED)
ATTACHMENT NO. 2

EXHIBIT I
(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 ser vices 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 Rul es. 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 Ag reement") 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 a greement 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.

ATTACHMENT NO. 2
Exhibit I (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”))
Rev. 06/2022 Page 2

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 immedi ately 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 Information that is (i) transmitted by electronic media; (ii) maintained in electronic media.

ATTACHMENT NO. 2
Exhibit I (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”))
Rev. 06/2022 Page 3

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 su bject 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 informa tion 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 C overed 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 "secretar y" 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 Agreem ent, Contract, Master Agreement, Work Order, or Purchase Order or other service arrangement, with or without payment, that gives rise to Contractor's status as a Business Associate.

ATTACHMENT NO. 2
Exhibit I (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”))
Rev. 06/2022 Page 4

1.20 "Subcontractor" has the same meaning as the term "subcontractor" at 4 5 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, emp loyment, 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 de - identification 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 a s 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 recipient and the recipient notifies Business Associate of any i nstances of which it is aware in which the confidentiality of the Protected Health Information has been breached.

ATTACHMENT NO. 2
Exhibit I (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”))
Rev. 06/2022 Page 5

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 Ag reement 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 UNSEC URED 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, its employees, representatives, agen ts or Subcontractors not provided for by this Agreement of which Business Associate becomes aware.

ATTACHMENT NO. 2
Exhibit I (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”))
Rev. 06/2022 Page 6

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 repo rt 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 tha n 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, disab ility code or other types of
information were involved);
(d) The name and contact information for a person highly knowledge of the facts and circumstances of the non -
permitted Use or Disclosure of PHI, Security Incident, or Breach
ATTACHMENT NO. 2
Exhibit I (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”))
Rev. 06/2022 Page 7

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 t he 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 Di sclosure, 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 Uns ecured 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;
(g) A brief description of what Busin ess 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 non -
ATTACHMENT NO. 2
Exhibit I (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”))
Rev. 06/2022 Page 8

permitted Us e 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 o ral 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 ens ure 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 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.

ATTACHMENT NO. 2
Exhibit I (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”))
Rev. 06/2022 Page 9

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 S ection 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 Covere d 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 Subcontractor s, Business Associate shall notify Covered Entity in writing within two (2) days of the 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 Hea lth 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 ATTACHMENT NO. 2
Exhibit I (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”))
Rev. 06/2022 Page 10

Individual with access to the Prot ected 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 reque sts 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;
(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.

ATTACHMENT NO. 2
Exhibit I (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”))
Rev. 06/2022 Page 11

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 disclosu res 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 ob ligation(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 Busin ess 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.

12. MITIGATION OF HARMFUL EFFECTS

12.1 Business Associate shall mitigate, to the extent practicable, any harmful effect of a U se 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 ATTACHMENT NO. 2
Exhibit I (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”))
Rev. 06/2022 Page 12

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 informatio n, which shall include a toll -free telephone number, an e -mail address, Web site, or postal address.

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 ATTACHMENT NO. 2
Exhibit I (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”))
Rev. 06/2022 Page 13

required by 13.1 or in establishing the contact proc edures 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 omiss ions 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 reque st 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 the extent that Business Associate may Use or Disclose Protected He alth 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 Agree ment, Work Order, Purchase Order, or other service arrangement, with or without payment, that gives rise to Contractor's status as a Business Associate.

ATTACHMENT NO. 2
Exhibit I (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”))
Rev. 06/2022 Page 14

16.2 Notwithstanding Section 16.1, Business Associate’s obligations under Sections 11, 14, and 18 shall surv ive 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 non - breaching 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 Contracto r'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 non - breaching 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 Cov ered 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 Covered Entity, that Business Associate, including any Subcont ractor, 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 inde cipherable to unauthorized individuals.

ATTACHMENT NO. 2
Exhibit I (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”))
Rev. 06/2022 Page 15

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 Informatio n 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 protection s 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 th e 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 Associa te 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.

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 termin ation 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.

ATTACHMENT NO. 2
Exhibit I (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”))
Rev. 06/2022 Page 16

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 e xecute 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 O rder, or other services arrangement, with or without payment, that gives rise to Contractor's status as a Business Associate.

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 Associat e Agreement shall confer upon any person other than the parties and their respective successors or assigns, any rights, remedies, obligations, or liabilities whatsoever.

ATTACHMENT NO. 2
Exhibit I (Business Associate Agreement Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”))
Rev. 06/2022 Page 17

20.4 Construction. In the event that a provision of this Business Associate Agreement is c ontrary 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 oth er 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 Bu siness 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.

ATTACHMENT NO. 2
ATTACHMENT NO. 2

EXHIBIT K
(INFORMATION SECURITY AND PRIVACY REQUIREMENTS)
The County of Los Angeles (“County”) is committed to safeguarding the Integrity of the County systems, Data, Information and protecting the privacy rights of the individuals that it serves. This Information Security and Privacy Requirements Exhibit (“Exhibit”) sets forth the County and the Subrecipient’s commitment and agreement to fulfill each of their obligations under applicable state or federal laws, rules, or regulations, as well as applicable industry standards concerning privacy, Data protections, Information Security, Confidentiality, Availability, and Integrity of such Information. The Information Security and privacy requirements and procedures in this Exhibit are to be established by the Subrecipient before the Effective Date of the Subaward and maintained throughout the term of the Subaward.

These requirements and procedures are a minimum standard and are in addition to the requirements of the underlying base agreement between the County and Subrecipient (the “ Subaward”) and any other agreements between the parties. However, it is the Subrecipient's sole obligation to: (i) implement appropriate and reasonable measures to secure and protect its systems and all County Information against internal and external Threats and Risks; and (ii) continuously review and revise those measures to address ongoing Threats and Risks. Failure to comply with the minimum requirements and procedures set forth in this Exhibit will constitute a material, non -curable breach of Subaward by the Subrecipient, entitling the County, in addition to the cumulative of all other remedies available to it at law, in equity, or under the Subaward, to immediately terminate the Subaward. To the extent there are conflicts between this Exhibit and the Subaward, this Exhibit will prevail unless stated otherwise.

1. DEFINITIONS
Unless otherwise defined in the Subaward, the definitions herein contained are specific to the uses within this exhibit.

a. Availability: the condition of Information being accessible and usable upon demand by an authorized entity (Workforce Member or process).
b. Confidentiality: the condition that Information is not disclosed to system entities (users, processes, devices) unless they have been authorized to access the Information.
c. County Information: all Data and Information belonging to the County. d. Data: a subset of Information comprised of qualitative or quantitative values. e. Incident: a suspected, attempted, successful, or imminent Threat of unauthorized electronic and/or physical access, use, disclosure, breach, modification, or destruction of information; interference with Information Technology operations; or significant violation of County policy.

ATTACHMENT NO. 2
Exhibit K (Information Security and Privacy Requirements) Rev. 12/2024 Page 2
f. Information: any communication or representation of knowledge or understanding such as facts, Data, or opinions in any medium or form, including electronic, textual, numerical, graphic, cartographic, narrative, or audiovisual. g. Information Security Policy: high level statements of intention and direction of an organization used to create an organization’s Information Security Program as formally expressed by its top management.
h. Information Security Program: formalized and implemented Information Security Policies, standards and procedures that are documented describing the program management safeguards and common controls in place or those planned for meeting the County’s information security requirements.
i. Information Technology: any equipment or interconnected system or subsystem of equipment that is used in the automatic acquisition, storage, manipulation, management, movement, control, display, switching, interchange, transmission, or reception of Data or Information.
j. Integrity: the condition whereby Data or Information has not been improperly modified or destroyed and authenticity of the Data or Information can be ensured. k. Mobile Device Management (MDM): software that allows Information Technology administrators to control, secure, and enforce policies on smartphones, tablets, and other endpoints.
l. Privacy Policy: high level statements of intention and direction of an organization used to create an organization’s Privacy Program as formally expressed by its top management.
m. Privacy Program: A formal document that provides an overview of an organization’s privacy program, including a description of the structure of the privacy program, the resources dedicated to the privacy program, the role of the organization’s privacy official and other staff, the strategic goals and objectives of the Privacy Program, and the program management controls and common controls in place or planned for meeting applicable privacy requirements and managing privacy risks. n. Risk: a measure of the extent to which the County is threatened by a potential circumstance or event, Risk is typically a function of: (i) the adverse impacts that would arise if the circumstance or event occurs; and (ii) the likelihood of occurrence. o. Threat: any circumstance or event with the potential to adversely impact County operations (including mission, functions, image, or reputation), organizational assets, individuals, or other organizations through an Information System via unauthorized access, destruction, disclosure, modification of Information, and/or denial of service. p. Vulnerability: a weakness in a system, application, network or process that is subject to exploitation or misuse.
q. Workforce Member: employees, volunteers, and other persons whose conduct, in the performance of work for Los Angeles County, is under the direct control of Los Angeles County, whether or not they are paid by Los Angeles County. This includes, but may not be limited to, full and part time elected or appointed officials, employees, ATTACHMENT NO. 2
Exhibit K (Information Security and Privacy Requirements) Rev. 12/2024 Page 3
affiliates, associates, students, volunteers, and staff from third party entities who provide service to the County.

2. INFORMATION SECURITY AND PRIVACY PROGRAMS
a. Information Security Program. The Subrecipient must maintain a company -wide Information Security Program designed to evaluate Risks to the Confidentiality, Availability, and Integrity of the County Information covered under this Subaward.

Subrecipient’s Information Security Program must include the creation and maintenance of Information Security Policies, standards, and procedures. Information Security Policies, standards, and procedures will be communicated to all Subrecipient employees in a relevant, accessible, and understandable form and will be regularly reviewed and evaluated to ensure operational effectiveness, compliance with all applicable laws and regulations, and addresses new and emerging Threats and Risks.

The Subrecipient must exercise the same degree of care in safeguarding and protecting County Information that the Subrecipient exercises with respect to its own Information and Data, but in no event less than a reasonable degree of care. The Subrecipient will implement, maintain, and use appropriate administrative, technical, and physical security measures to preserve the Confidentiality, Integrity, and Availability of County Information.

The Subrecipient’s Information Security Program must:

• Protect the Confidentiality, Integrity, and Availability of County Information in the Subrecipient’s possession or control;
• Protect against any anticipated Threats or hazards to the Confidentiality, Integrity, and Availability of County Information;
• Protect against unauthorized or unlawful access, use, disclosure, alteration, or destruction of County Information;
• Protect against accidental loss or destruction of, or damage to, County Information; and
• Safeguard County Information in compliance with any applicable laws and regulations which apply to the Subrecipient.
b. Privacy Program. The Subrecipient must establish and maintain a company -wide Privacy Program designed to incorporate Privacy Policies and practices in its business operations to provide safeguards for Information, including County Information. The Subrecipient’s Privacy Program must include the development of, and ongoing reviews and updates to Privacy Policies, guidelines, procedures and appropriate workforce privacy training within its organization. These Privacy Policies, guidelines, procedures, and appropriate training will be provided to all Subrecipient employees, agents, and volunteers. The Subrecipient’s Privacy Policies, guidelines, and procedures must be continuously reviewed and updated for effectiveness and compliance with applicable laws and regulations, and to appropriately respond to new ATTACHMENT NO. 2
Exhibit K (Information Security and Privacy Requirements) Rev. 12/2024 Page 4
and emerging Threats and Risks. The Subrecipient’s Privacy Program must perform ongoing monitoring and audits of operations to identify and mitigate privacy Threats.

The Subrecipient must exercise the same degree of care in safeguarding the privacy of County Information that the Subrecipient exercises with respect to its own Information, but in no event less than a reasonable degree of care. The Subrecipient will implement, maintain, and use appropriate privacy practices and protocols to preserve the Confidentiality of County Information.

The Subrecipient’s Privacy Program must include:
• A Privacy Program framework that identifies and ensures that the Subrecipient complies with all applicable laws and regulations;
• External Privacy Policies, and internal privacy policies, procedures and controls to support the privacy program;
• Protections against unauthorized or unlawful access, use, disclosure, alteration, or destruction of County Information;
• A training program that covers Privacy Policies, protocols and awareness; • A response plan to address privacy Incidents and privacy breaches; and • Ongoing privacy assessments and audits.

3. PROPERTY RIGHTS TO COUNTY INFORMATION
All County Information is deemed property of the County, and the County will retain exclusive rights and ownership thereto. County Information must not be used by the Subrecipient for any purpose other than as required under this Subaward, nor will such or any part of such be disclosed, sold, assigned, leased, or otherwise disposed of, to third parties by the Subrecipient, or commercially exploited or otherwise used by, or on behalf of, the Subrecipient, its officers, directors, employees, or agents. The Subrecipient may assert no lien on or right to withhold from the County, any County Information it receives from, receives addressed to, or stores on behalf of, the County. Notwithstanding the foregoing, the Subrecipient may aggregate, compile, and use County Information in order to improve, develop or enhance the System Software and/or other services offered, or to be offered, by the Subrecipient, provided that (i) no County Information in such aggregated or compiled pool is identifiable as originating from, or can be traced back to the County, and (ii) such Data or Information cannot be associated or matched with the identity of an individual alone, or linkable to a specific individual. The Subrecipient specifically consents to the County's access to such County Information held, stored, or maintained on any and all devices Subrecipient owns, leases or possesses.

4. SUBRECIPIENT’S USE OF COUNTY INFORMATION
The Subrecipient may use County Information only as necessary to carry out its obligations under this Subaward. The Subrecipient must collect, maintain, or use County Information only for the purposes specified in the Subaward and, in all cases, in compliance with all applicable local, state, and federal laws and regulations governing the collection, maintenance, transmission, dissemination, storage, use, and destruction of County Information, including, but not limited to, (i) any state and federal law governing ATTACHMENT NO. 2
Exhibit K (Information Security and Privacy Requirements) Rev. 12/2024 Page 5
the protection of personal Information, (ii) any state and federal security breach notification laws, and (iii) the rules, regulations and directives of the Federal Trade Commission, as amended from time to time.

5. SHARING COUNTY INFORMATION AND DATA
The Subrecipient must not share, release, disclose, disseminate, make available, transfer, or otherwise communicate orally, in writing, or by electronic or other means, County Information to a third party for monetary or other valuable consideration.

6. CONFIDENTIALITY
a. Confidentiality of County Information. The Subrecipient agrees that all County Information is Confidential and proprietary to the County regardless of whether such Information was disclosed intentionally or unintentionally or marked as "confidential". b. Disclosure of County Information. The Subrecipient may disclose County Information only as necessary to carry out its obligations under this Subaward, or as required by law, and is prohibited from using County Information for any other purpose without the prior express written approval of the County’s Contract Administrator in consultation with the County’s Chief Information Security Officer and/or Chief Privacy Officer. If required by a court of competent jurisdiction or an administrative body to disclose County Information, the Subrecipient must notify the County’s Contract Administrator immediately and prior to any such disclosure, to provide the County an opportunity to oppose or otherwise respond to such disclosure, unless prohibited by law from doing so.
c. Disclosure Restrictions of Non -Public Information. While performing work under the Subaward, the Subrecipient may encounter County Non-public Information (“NPI”) in the course of performing this Subaward, including, but not limited to, licensed technology, drawings, schematics, manuals, sealed court records, and other materials described and/or identified as “Internal Use”, “Confidential” or “Restricted” as defined in Board of Supervisors Policy 6.104 – Information Classification Policy as NPI. The Subrecipient must not disclose or publish any County NPI and material received or used in performance of this Subaward. This obligation is perpetual. d. Individual Requests. The Subrecipient must acknowledge any request or instructions from the County regarding the exercise of any individual’s privacy rights provided under applicable federal or state laws. The Subrecipient must have in place appropriate policies and procedures to promptly respond to such requests and comply with any request or instructions from the County within seven (7) calendar days. If an individual makes a request directly to the Subrecipient involving County Information, the Subrecipient must notify the County within five (5) calendar days and the County will coordinate an appropriate response, which may include instructing the Subrecipient to assist in fulfilling the request. Similarly, if the Subrecipient receives a privacy or security complaint from an individual regarding County Information, the Subrecipient must notify the County as described in Section 14 SECURITY AND PRIVACY INCIDENTS, and the County will coordinate an appropriate response.

ATTACHMENT NO. 2
Exhibit K (Information Security and Privacy Requirements) Rev. 12/2024 Page 6
e. Retention of County Information. The Subrecipient must not retain any County Information for any period longer than necessary for the Subrecipient to fulfill its obligations under the Subaward and applicable law, whichever is longest.

7. SUBRECIPIENT EMPLOYEES
The Subrecipient must perform background and security investigation procedures in the manner prescribed in this section unless the Subaward prescribes procedures for conducting background and security investigations and those procedures are no less stringent than the procedures described in this section.

To the extent permitted by applicable law, the Subrecipient must screen and conduct background investigations on all Subrecipient employees and Lower Tier Subrecipients as appropriate to their role, with access to County Information for potential security Risks.

Such background investigations must be obtained through fingerprints submitted to the California Department of Justice to include State, local, and federal -level review and conducted in accordance with the law, may include criminal and financial his tory to the extent permitted under the law, and will be repeated on a regular basis. The fees associated with the background investigation will be at the expense of the Subrecipient, regardless of whether the member of the Subrecipient’s staff passes or fails the background investigation. The Subrecipient, in compliance with its legal obligations, must conduct an individualized assessment of their employees, agents, and volunteers regarding the nature and gravity of a criminal offense or conduct; the time that has passed since a criminal offense or conduct and completion of the sentence; and the nature of the access to County Information to ensure that no individual accesses County In formation whose past criminal conduct poses a risk or threat to County Information.

The Subrecipient must require all employees, agents, and volunteers to abide by the requirements in this Exhibit, as set forth in the Subaward, and sign an appropriate written Confidentiality/non-disclosure agreement with the Subrecipient.

The Subrecipient must supply each of its employees with appropriate, annual training regarding Information Security procedures, Risks, and Threats. The Subrecipient agrees that training will cover, but may not be limited to the following topics:

a) Secure Authentication: The importance of utilizing secure authentication, including proper management of authentication credentials (login name and password) and multi-factor authentication.
b) Social Engineering Attacks: Identifying different forms of social engineering including, but not limited to, phishing, phone scams, and impersonation calls. c) Handling of County Information: The proper identification, storage, transfer, archiving, and destruction of County Information.
d) Causes of Unintentional Information Exposure: Provide awareness of causes of unintentional exposure of Information such as lost mobile devices, emailing Information to inappropriate recipients, etc.

ATTACHMENT NO. 2
Exhibit K (Information Security and Privacy Requirements) Rev. 12/2024 Page 7
e) Identifying and Reporting Incidents: Awareness of the most common indicators of an Incident and how such indicators should be reported within the organization. f) Privacy: The Subrecipient’s Privacy Policies and procedures as described in Section 2b. Privacy Program.

The Subrecipient must have an established set of procedures to ensure the Subrecipient’s employees promptly report actual and/or suspected breaches of security.

8. LOWER TIER SUBRECIPIENTS AND THIRD PARTIES
The County acknowledges that in the course of performing its services, the Subrecipient may desire or require the use of goods, services, and/or assistance of Lower Tier Subrecipients or other third parties or suppliers. The terms of this Exhibit will also apply to all Lower Tier Subrecipients and third parties. The Subrecipient or third party will be subject to the following terms and conditions: (i) each Lower Tier Subrecipient and third party must agree in writing to comply with and be bound by the applicable terms and conditions of this Exhibit, both for itself and to enable the Subrecipient to be and remain in compliance with its obligations hereunder, including those provisions relating to Confidentiality, Integrity, Availability, disclosures, security, and such other terms and conditions as may be reasonably necessary to effectuate the Subaward including this Exhibit; and (ii) the Subrecipient will be and remain fully liable for the acts and omissions of each Lower Tier Subrecipient and third party, and fully responsible for the due and proper performance of all Subrecipient obligations under this Subaward.

The Subrecipient must obtain advanced approval from the County’s Chief Information Security Officer and/or Chief Privacy Officer prior to subcontracting services subject to this Exhibit.

9. STORAGE AND TRANSMISSION OF COUNTY INFORMATION
All County Information must be rendered unusable, unreadable, or indecipherable to unauthorized individuals. Without limiting the generality of the foregoing, the Subrecipient will encrypt all workstations, portable devices (such as mobile, wearables, tablets,) and removable media (such as portable or removable hard disks, floppy disks, USB memory drives, CDs, DVDs, magnetic tape, and all other removable storage media) that sto re County Information in accordance with Federal Information Processing Standard (FIPS) 140-2 or otherwise approved by the County’s Chief Information Security Officer.

The Subrecipient will encrypt County Information transmitted on networks outside of the Subrecipient’s control with Transport Layer Security (TLS) or Internet Protocol Security (IPSec), at a minimum cipher strength of 128 bit or an equivalent secure transmission protocol or method approved by County’s Chief Information Security Officer.

In addition, the Subrecipient must not store County Information in the cloud or in any other online storage provider without written authorization from the County’s Chief Information Security Officer. All mobile devices storing County Information must be managed by a Mobile Device Management system. Such system must provide provisions to enforce a password/passcode on enrolled mobile devices. All workstations/Personal Computers ATTACHMENT NO. 2
Exhibit K (Information Security and Privacy Requirements) Rev. 12/2024 Page 8
(including laptops, 2-in-1s, and tablets) will maintain the latest operating system security patches, and the latest virus definitions. Virus scans must be performed at least monthly.

Request for less frequent scanning must be approved in writing by the Co unty’s Chief Information Security Officer.

10. RETURN OR DESTRUCTION OF COUNTY INFORMATION
The Subrecipient must return or destroy County Information in the manner prescribed in this section unless the Subaward prescribes procedures for returning or destroying County Information and those procedures are no less stringent than the procedures described in this section.

a. Return or Destruction. Upon County’s written request, or upon expiration or termination of this Subaward for any reason, Subrecipient must (i) promptly return or destroy, at the County’s option, all originals and copies of all documents and materials it has received containing County Information; or (ii) if return or destruction is not permissible under applicable law, continue to protect such Information in accordance with the terms of this Subaward; and (iii) deliver or destroy, at the County’s option, all originals and copies of all summaries, records, descriptions, modifications, negatives, drawings, adoptions and other documents or materials, whether in writing or in machine-readable form, prepared by the Subrecipient, prepared under its direction, or at its request, from the documents and materials referred to in Subsection (i) of this Section. For all documents or materials referred to in Subsections (i) and (ii) of this Section that the County requests be returned to the County, the Subrecipient must provide a written attestation on company letterhead certifying that all documents and materials have been delivered to the County. For documents or materials referred to in Subsections (i) and (ii) of this Section that the County requests be destroyed, the Subrecipient must provide an attestation on company letterhead and certified documentation from a media destruction firm consistent with subdivision b of this Section. Upon termination or expiration of the Subaward or at any time upon the County’s request, the Subrecipient must return all hardware, if any, provided by the County to the Subrecipient. The hardware should be physically sealed and returned via a bonded courier, or as otherwise directed by the County. b. Method of Destruction. The Subrecipient must destroy all originals and copies by (i) cross-cut shredding paper, film, or other hard copy media so that the Information cannot be read or otherwise reconstructed; and (ii) purging or destroying electronic media containing County Information consistent with NIST Special Publication 800 - 88, “Guidelines for Media Sanitization” such that the County Information cannot be retrieved. The Subrecipient will provide an attestation on company letterhead and certified documentation from a media destruction firm, det ailing the destruction method used and the County Information involved, the date of destruction, and the company or individual who performed the destruction. Such statement will be sent to the designated County’s Contract Manager within ten (10) days of termination or expiration of the Subaward or at any time upon the County’s request. On termination or expiration of this Subaward, the County will return or destroy all Subrecipient’s Information marked as confidential (excluding items licensed to the County hereunder, or that provided to the County by the Subrecipient hereunder), at the County’s option.

ATTACHMENT NO. 2
Exhibit K (Information Security and Privacy Requirements) Rev. 12/2024 Page 9

11. PHYSICAL AND ENVIRONMENTAL SECURITY
All Subrecipient facilities that process County Information will be located in secure areas and protected by perimeter security such as barrier access controls (e.g., the use of guards and entry badges) that provide a physically secure environment from unauthorized access, damage, and interference.

All Subrecipient facilities that process County Information will be maintained with physical and environmental controls (temperature and humidity) that meet or exceed hardware manufacturer’s specifications.

12. OPERATIONAL MANAGEMENT, BUSINESS CONTINUITY, AND DISASTER

RECOVERY
The Subrecipient must: (i) monitor and manage all of its Information processing facilities, including, without limitation, implementing operational procedures, change management, and Incident response procedures consistent with Section 14 SECURITY AND PRIVACY INCIDENTS; and (ii) deploy adequate anti -malware software and adequate back -up systems to ensure essential business Information can be promptly recovered in the event of a disaster or media failure; and (iii) ensure its operating procedures are adequately documented and designed to protect Information and computer media from theft and unauthorized access.

The Subrecipient must have business continuity and disaster recovery plans. These plans must include a geographically separate back -up data center and a formal framework by which an unplanned event will be managed to minimize the loss of County Information and services. T he formal framework includes a defined back -up policy and associated procedures, including documented policies and procedures designed to: (i) perform back- up of data to a remote back-up data center in a scheduled and timely manner; (ii) provide effective controls to safeguard backed-up data; (iii) securely transfer County Information to and from back -up location; (iv) fully restore applications and operating systems; and (v) demonstrate periodic testing of restoration from back -up location. If the Subrecipient makes backups to removable media (as described in Section 9 STORAGE AND TRANSMISSION OF COUNTY INFORMATION), all such backups must be encrypted in compliance with the encryption requirements noted above in Section 9 STORAGE AND TRANSMISSION OF COUNTY INFORMATION.

13. ACCESS CONTROL
Subject to and without limiting the requirements under Section 9 STORAGE AND TRANSMISSION OF COUNTY INFORMATION, County Information (i) may only be made available and accessible to those parties explicitly authorized under the Subaward or otherwise expressly approved by the County’s Contract Manager or Program Manager in writing; and (ii) if transferred using removable media (as described in Section 9 STORAGE AND TRANSMISSION OF COUNTY INFORMATION ) must be sent via a bonded courier and protected using encryption technology designated by the Subrecipient and approved by the County’s Chief Information Security Officer in writing.

ATTACHMENT NO. 2
Exhibit K (Information Security and Privacy Requirements) Rev. 12/2024 Page 10
The foregoing requirements will apply to back-up media stored by the Subrecipient at off- site facilities.

The Subrecipient must implement formal procedures to control access to County systems, services, and/or Information, including, but not limited to, user account management procedures and the following controls:

a. Network access to both internal and external networked services must be controlled, including, but not limited to, the use of industry standard and properly configured firewalls;
b. Operating systems will be used to enforce access controls to computer resources including, but not limited to, multi-factor authentication, use of virtual private networks (VPN), authorization, and event logging;
c. The Subrecipient will conduct regular, no less often than semi -annually, user access reviews to ensure that unnecessary and/or unused access to County Information is removed in a timely manner;
d. Applications will include access control to limit user access to County Information and application system functions;
e. All systems will be monitored to detect deviation from access control policies and identify suspicious activity. The Subrecipient must record, review and act upon all events in accordance with Incident response policies set forth in Section 14 SECURITY AND PRIVACY INCIDENTS; and
f. In the event any hardware, storage media, or removable media (as described in Section 9 STORAGE AND TRANSMISSION OF COUNTY INFORMATION ) must be disposed of or sent off -site for servicing, the Subrecipient must ensure all County Information, has been eradicated from such hardware and/or media using industry best practices as discussed in Section 9 STORAGE AND TRANSMISSION OF COUNTY INFORMATION.

14. SECURITY AND PRIVACY INCIDENTS
In the event of a Security or Privacy Incident, the Subrecipient must:

a. Promptly notify the County’s Chief Information Security Officer, the Departmental Information Security Officer, and the County’s Chief Privacy Officer of any Incidents involving County Information, within twenty-four (24) hours of detection of the Incident.

All notifications must be submitted via encrypted email and telephone.

ATTACHMENT NO. 2
Exhibit K (Information Security and Privacy Requirements) Rev. 12/2024 Page 11
County Chief Information Security Officer and Chief Privacy Officer email [email protected]

Chief Information Security Officer:

Jeffrey Aguilar
Chief Information Security Officer
320 West Temple Street, 7th Floor
Los Angeles, CA 90012
(213) 253-5659

Chief Privacy Officer:

Chris Paltao
Deputy Information Security Officer
320 West Temple Street, 7th Floor
Los Angeles, CA 90012
(213) 253-5637

Departmental Information Security Officer:

Ivan Pacheco
Departmental Chief Information Officer
510 South Vermont Avenue, 11th Floor
Los Angeles, CA 90020
(323) 356-4672
[email protected]
b. Include the following Information in all notices:
i. The date and time of discovery of the Incident,
ii. The approximate date and time of the Incident,
iii. A description of the type of County Information involved in the reported Incident, and
iv. A summary of the relevant facts, including a description of measures being taken to respond to and remediate the Incident, and any planned corrective actions as they are identified.
v. The name and contact information for the organizations official representative(s), with relevant business and technical information relating to the incident.
c. Cooperate with the County to investigate the Incident and seek to identify the specific County Information involved in the Incident upon the County’s written request, without charge, unless the Incident was caused by the acts or omissions of the County. As Information about the Incident is collected or otherwise becomes available to the Subrecipient, and unless prohibited by law, the Subrecipient must provide Information regarding the nature and consequences of the Incident that are reasonably requested by the County to allow the County to notify affected individuals, government agencies, and/or credit bureaus.

ATTACHMENT NO. 2
Exhibit K (Information Security and Privacy Requirements) Rev. 12/2024 Page 12
d. Immediately initiate the appropriate portions of their Business Continuity and/or Disaster Recovery plans in the event of an Incident causing an interference with Information Technology operations.
e. Assist and cooperate with forensic investigators, the County, law firms, and and/or law enforcement agencies at the direction of the County to help determine the nature, extent, and source of any Incident, and reasonably assist and cooperate with the County on any additional disclosures that the County is required to make as a result of the Incident.
f. Allow the County or its third-party designee at the County’s election to perform audits and tests of the Subrecipient's environment that may include, but are not limited to, interviews of relevant employees, review of documentation, or technical inspection of systems, as they relate to the receipt, maintenance, use, retention, and authorized destruction of County Information.

Notwithstanding any other provisions in this Subaward and Exhibit, The Subrecipient will be (i) liable for all damages and fines, (ii) responsible for all corrective action, and (iii) responsible for all notifications arising from an Incident involving County Information caused by the Subrecipient’s weaknesses, negligence, errors, or lack of Information Security or privacy controls or provisions.

15. NON-EXCLUSIVE EQUITABLE REMEDY
The Subrecipient acknowledges and agrees that due to the unique nature of County Information there can be no adequate remedy at law for any breach of its obligations hereunder, that any such breach may result in irreparable harm to the County, and therefore, that upon any such breach, the County will be entitled to appropriate equitable remedies, and may seek injunctive relief from a court of competent jurisdiction without the necessity of proving actual loss, in addition to whatever remedies are available within law or equity. Any breach of Section 6 CONFIDENTIALITY will constitute a material breach of this Subaward and be grounds for immediate termination of this Subaward in the exclusive discretion of the County.

16. AUDIT AND INSPECTION
a. Self-Audits. The Subrecipient must periodically conduct audits, assessments, testing of the system of controls, and testing of Information Security and privacy procedures, including penetration testing, intrusion detection, and firewall configuration reviews.

These periodic audits will be conducted by staff certified to perform the specific audit in question at Subrecipient’s sole cost and expense through either (i) an internal independent audit function, (ii) a nationally recognized, external, independent auditor, or (iii) another independent auditor approved by the County.

The Subrecipient must have a process for correcting control deficiencies that have been identified in the periodic audit, including follow up documentation providing evidence of such corrections. The Subrecipient must provide the audit results and any corrective action documentation to the County promptly upon its completion at the County’s request. With respect to any other report, certification, or audit or test results prepared or received by the Subrecipient that contains any County ATTACHMENT NO. 2
Exhibit K (Information Security and Privacy Requirements) Rev. 12/2024 Page 13
Information, the Subrecipient must promptly provide the County with copies of the same upon the County’s reasonable request, including identification of any failure or exception in the Subrecipient’s Information systems, products, and services, and the corresponding steps taken by the Subrecipient to mitigate such failure or exception.

Any reports and related materials provided to the County pursuant to this Section must be provided at no additional charge to the County.

b. County Requested Audits. At its own expense, the County, or an independent third- party auditor commissioned by the County, will have the right to audit the Subrecipient’s infrastructure, security and privacy practices, Data center, services and/or systems storing or processing County Information via an onsite inspection at least once a year. Upon the County’s request the Subrecipient must complete a questionnaire regarding Subrecipient’s Information Security and/or program. The County will pay for the County requested audit unless the auditor finds that the Subrecipient has materially breached this Exhibit, in which case the Subrecipient must bear all costs of the audit ; and if the audit reveals material non -compliance with this Exhibit, the County may exercise its termination rights underneath the Subaward.

Such audit will be conducted during the Subrecipient’s normal business hours with reasonable advance notice, in a manner that does not materially disrupt or otherwise unreasonably and adversely affect the Subrecipient’s normal business operations.

The County's request for the audit will specify the scope and areas (e.g., Administrative, Physical, and Technical) that are subject to the audit and may include, but are not limited to physical controls inspection, process reviews, policy reviews, evidence of external and internal Vulnerability scans, penetration test results, evidence of code reviews, and evidence of system configuration and audit log reviews. It is understood that the results may be filtered to remove the specific Information of other Subrecipient customers such as IP address, server names, etc.

The Subrecipient must cooperate with the County in the development of the scope and methodology for the audit, and the timing and implementation of the audit. This right of access will extend to any regulators with oversight of the County. The Subrecipient agrees to comply with all reasonable recommendations that result from such inspections, tests, and audits within reasonable timeframes.

When not prohibited by regulation, the Subrecipient will provide to the County a summary of: (i) the results of any security audits, security reviews, or other relevant audits, conducted by the Subrecipient or a third party; and (ii) corrective actions or modifications, if any, the Subrecipient will implement in response to such audits.

17. CYBER LIABILITY INSURANCE
Subrecipient must secure and maintain cyber liability insurance coverage in the manner prescribed in this Section unless the Contract prescribes cyber liability insurance coverage provisions, and those provisions are no less stringent than those described in this Section.

Subrecipient must secure and maintain cyber liability insurance coverage with limits of at least $3,000,000 (3 million) per occurrence and in the aggregate during the term of the Subaward, including coverage for: network security liability; privacy liability; ATTACHMENT NO. 2
Exhibit K (Information Security and Privacy Requirements) Rev. 12/2024 Page 14
privacy regulatory proceeding defense, response, expenses and fines; technology professional liability (errors and omissions); privacy breach expense reimbursement (liability arising from the loss or disclosure of County Information no matter how it occurs); system breach; denial or loss of service; introduction, implantation, or spread of malicious software code; unauthorized access to or use of computer systems; and Data/Information loss and business interruption; any other liability or risk that arises out of the Subaward. Subrecipient must add County as an additional insured to its cyber liability insurance policy and provide to County certificates of insurance evidencing the foregoing upon County’s request. The procuring of the insurance described herein, or delivery of the certificates of insurance described herein, must not be construed as a limitation upon Subrecipient’s liability or as full performance of its indemnification obligations hereunder. No exclusion/restriction for unencrypted portable devices/media may be on the policy.

18. PRIVACY AND SECURITY INDEMNIFICATION
In addition to the indemnification provisions in the Subaward, the Subrecipient agrees to indemnify, defend, and hold harmless the County, its Special Districts, elected and appointed officers, agents, employees, and volunteers from and against any and all claims, demands liabilities, damages, judgments, awards, losses, costs, expenses or fees including reasonable attorneys’ fees, accounting and other expert, consulting or professional fees, and amounts paid in any settlement arising from, connected with, o r relating to:

• The Subrecipient’s violation of any federal and state laws in connection with its accessing, collecting, processing, storing, disclosing, or otherwise using County Information;
• The Subrecipient’s failure to perform or comply with any terms and conditions of this Subaward or related agreements with the County; and/or, • Any Information loss, breach of Confidentiality, or Incident involving any County Information that occurs on the Subrecipient’s systems or networks (including all costs and expenses incurred by the County to remedy the effects of such loss, breach of Confidentiality, or Incident, which may include (i) providing appropriate notice to individuals and governmental authorities, (ii) responding to individuals’ and governmental authorities’ inquiries, (iii) providing credit monitoring to individuals, and (iv) con ducting litigation and settlements with individuals and governmental authorities).

Notwithstanding the preceding sentences, the County will have the right to participate in any such defense at its sole cost and expense, except that in the event Subrecipient fails to provide County with a full and adequate defense, as determined by County in its sole judgment, County will be entitled to retain its own counsel, including, without limitation, County Counsel, and to reimbursement from Subrecipient for all such costs and expenses incurred by County in doing so. Subrecipient will not have the right to enter into any settlement, agree to any injunction or other equitable relief, or make any admission, in each case, on behalf of County without County’s prior written approval.

ATTACHMENT NO. 2
ATTACHMENT NO. 2
Exhibit M (FEMA Provisions) Page 1

EXHIBIT M
(FEMA PROVISIONS)

A. CLEAN AIR AND WATER REQUIREMENTS. [Applicable to all subawards (that is “contracts”) and lower tier subawards (that is, “ subcontracts”) in excess $150,000, including indefinite quantities where the amount is expected to exceed $150,000 in any year)

1. Subrecipient (that is, “Contractor”) agrees to comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act, as amended, 42 U.S.C. 7401 et seq., and the Federal Water Pollution Control Act, as amended, 33 U.S.C. 1251 et seq.

2. The Contractor agrees to report each violation to County and understand and agrees that the County will, in turn, report each violation as required to assure notification to the Federal Emergency Management Agency (FEMA), and the Regional Office of the Environmental Protection Agency (EPA).

3. Contractor agrees to include these requirements in each subcontract exceeding $150,000 financed in whole or in part with Federal assistance provided by FEMA.

B. DEBARMENT AND SUSPENSION CLAUSE.

1. This Agreement is a covered transaction for purposes of 2 C.F.R. pt. 180 and 2 C.F.R. pt. 3000. As such , the Contractor is required to verify that none of Contractor's principals (defined at 2 C.F.R. § 180.9 05), or its affiliates (defined at 2 C.F.R. § 180.905) are excluded (defined at 2 C.F.R. § 180.940) or disqualified (defined at 2 C.F.R. § 180.935).

2. Contractor must com ply with 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000, subpart C and must include a requirement to comply with these regulations in any lower tier covered transaction it enters into.

3. This certification is a material representation of fact relied up on by the County. If it is later determined that the Contractor did not comply with 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000, subpart C, in addition to remedies available to the County, the Federal Government may pursue available remedies, including but not limited to suspension and/or debarment.

4. The bidder or proposer agrees to comply with the requirements of 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000, subpart C while this offer is valid and throughout the period of any contract that may arise from this offer. The bidder or proposer further agrees to include a provision requiring such compliance in its lower tier covered transactions.

ATTACHMENT NO. 2
Exhibit M (FEMA Provisions) Page 2

C. BYRD ANTI-LOBBYING AMENDMENT, 31 U.S.C. § 1352 (AS AMENDED).

1. Contractor shall not use or pay any funds received under this Agreement to influence or attempt to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with obtaining any Federal contrac t, grant, or any other award covered by 31 U.S.C. § 1352.

2. Contractor agrees to the provisions of Attachment 1, Certification Regarding Lobbying, attached hereto and incorporated herein.

3. Contractor agrees to include paragraphs 1 and 2 above in each thir d party subcontract financed in whole or in part with Federal assistance provided by FEMA. It is further agreed that the clause shall not be modified, except to identify the lower tier subrecipient (that is, “ subcontractor”) who will be subject to its provisions.

D. PROCUREMENT OF RECOVERED MATERIALS (2 CFR 200.322).

1. In the performance of this Agreement, the Contractor shall make maximum use of products containing recovered materials that are EPA-designated items unless the product cannot be acquired—
• Competitively within a timeframe providing for compliance with the contract performance schedule;
• Meeting contract performance requirements; or
• At a reasonable price.

2. Information about this requirement, along with the list of EPA-designated items, is available at EPA’s Comprehensive Procurement Guidelines web site, https://www.epa.gov/smm/comprehensive- procurement-guideline-cpg-program.

3. Contractor also agrees to comply with all other applicable requirements of Section 6002 of the Solid Waste Disposal Act.

E. ACCESS TO RECORDS.

The following access to records requirements apply to this Agreement:

1. Contractor agrees to provide the County, the FEMA Administrator, the Comptroller General of the United States, or any of their authorized representatives access to any books, documents, papers, and records of the Vendor which are directly pertinent to this Agreement for the purposes of making audits, examinations, excerpts, and transcriptions.

2. Contractor agrees to permit any of the foregoin g parties to reproduce by any means whatsoever or to copy excerpts and transcriptions as reasonably needed.

ATTACHMENT NO. 2
Exhibit M (FEMA Provisions) Page 3

3. Contractor agrees to provide the FEMA Administrator or his or her authorized representatives access to construction or other work sites pertaining t o the work being completed under the Agreement.

4. In compliance with the Disaster Recovery Act of 2018, the County and the Contractor acknowledge and agree that no language in this contract is intended to prohibit audits or internal reviews by the FEMA Admi nistrator or the Comptroller General of the United States.

F. DEPARTMENT OF HOMELAND SECURITY SEAL, LOGO, AND FLAGS.

Contractor shall not use the Department of Homeland Security (DHS) seal(s), logos, crests, or reproductions of flags or likenesses of DHS agency officials without specific FEMA prior e-approval.

G. COMPLIANCE WITH FEDERAL LAW, REGULATIONS, AND EXECUTIVE ORDERS.

This is an acknowledgement that FEMA financial assistance will be used to fund all or a portion of the contract. The Vendor will comply with all applicable Federal law, regulations, executive orders, FEMA policies, procedures, and directives.

H. NO OBLIGATION BY FEDERAL GOVERNMENT.

The Federal Government is not a party to this Agreement and is not subject to any obligations or liabil ities to the non -Federal entity, contractor, or any other party pertaining to any matter resulting from the Agreement.

I. PROGRAM FRAUD AND FALSE OR FRAUDULENT STATEMENTS OR RELATED ACTS.

Contractor acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims and Statements) applies to the Contractor’s actions pertaining to this Agreement.

ATTACHMENT NO. 2
Exhibit M (FEMA Provisions) Page 4

APPENDIX A, 44 C.F.R. PART 18 – CERTIFICATION REGARDING LOBBYING Certification for Contracts, Grants, Loans, and Cooperative Agreements

The undersigned certifies, to the best of his or her knowledge and belief, that:

1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions.

3. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code.

Any person who fails to file the required c ertification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

The Contractor, _______________, certifies or affirms the truthfulness and accuracy of each statement of its certification and disc losure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. Chap. 38, Administrative Remedies for False Claims and Statements, apply to this certification and disclosure, if any.

_____________________________________
Signature of Contractor’s Authorized Official

______________________________________
Name and Title of Contractor’s Authorized Official

______________________
Date

TO BE COMPLETED BY SURECIPIENT ONLY WHEN DIRECTED BY COUNTY ATTACHMENT NO. 2

EXHIBIT N
(CRITERIA AND STANDARDS FOR LETTERS OF CREDIT

AND CERTIFICATES OF DEPOSIT)

1. The Letters of Credit (LOC) or Certificates of Deposit (CD) shall be drawn by or on a financial institution that meets at least one (1) of the ratings from the table below:

Deposits Rating Agency
Moody’s(a) Standard
& Poor’s
Bauer
Financial
The
Street.
com(b)
If the term of the CD is
less than three (3) years,
the minimum ratings are:

A2 or
better

A or
better

4 stars or
better

B or better
If the term of the CD is
three (3) years or greater
and the total assets of
the financial institution
are less than $150
billion, the minimum
ratings are:

Aa1 or
better

AA+ or
better

4 stars or
better

B or better
If the t erm of the CD is
three (3) years or greater
and the total assets of
the institution are $150
billion or more, the
minimum ratings are:

Aa3 or
better

AA- or
better

4 stars or
better

B or better

a. Bank Financial Strength (only for Moody’s, a subcategory of the overall rating standard) should be B or better. Bank Financial Strength is a rating standard that must be met if the financial institution’s total assets are less than $1.5 billion and Moody’s rates that institution.

b. Formerly Weiss Ratings, Inc.

2. If the financial institution is rated by all four (4) of the rating agencies, the rating that is considered in the analysis will be the lower rating of Moody’s or Standard & Poor’s.

However, if the financial institution receives ratings from Bauer F inancial and TheStreet.com, only the higher of the two (2) ratings will be considered.

3. All deposits shall be insured through either the Federal Deposit Insurance Corporation (“FDIC”) or National Credit Union Administration (“NCUA”) at their maximum standard rate.

ATTACHMENT NO. 2

4. The CD or LOC shall be irrevocable and in County’s name or pledged to County.

5. As directed by County, the CD or LOC shall be issued for an amount that is sufficient to support the terms of the performance agreement, unless otherwise stated in the Contract.

6. The CD or LOC shall mature at a definite time, which, unless otherwise stated in the Contract, may not be prior to direction by County, or the expiration of the performance agreement or other provisions thereof.

7. The CD shall meet the minimum criteria and standards at the time the funds are placed with the financial institution. However, a liquidation of the placement is not required should the financial institution’s ratings fall below the minimum criteria and standards during the term of the placement. At the placement’s expiration or maturity, the funds should be placed with a different financial institution that meets the minimum criteria and standards.

Exhibit N (Criteria and Standards for Letters of Credit and Certificates of Deposit) Rev. 06/2022 Page 2
ATTACHMENT NO. 2
ATTACHMENT NO. 2

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)).

ATTACHMENT NO. 2

Exhibit P (Definitions)
Rev. 1/2025 Page 2
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.

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.

Child: An individual who is not more than 18 years of age.

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 Aging and Disabilities Department, 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.

ATTACHMENT NO. 2

Exhibit P (Definitions)
Rev. 1/2025 Page 3

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. 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 affe ct 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 include 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:

ATTACHMENT NO. 2

Exhibit P (Definitions)
Rev. 1/2025 Page 4

1. Self-care

2. Receptive and expressive language

3. Learning

4. Mobility

5. Self-direction

6. Capacity for independent living

7. Economic self-sufficiency

8. Cognitive functioning

9. Emotional adjustment

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.

ATTACHMENT NO. 2

Exhibit P (Definitions)
Rev. 1/2025 Page 5

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 per form daily tasks or threatens the capacity of the individual to live independently.

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 third - party to this Subaward). It sets forth the terms and conditions for the issuance and performance of any element of the Statement of Work. Such an agreement shall be pre- approved 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 ATTACHMENT NO. 2

Exhibit P (Definitions)
Rev. 1/2025 Page 6
applicable) that County will reimburse Subrecipient upon successful delivery of these Services.

Management Information System (MIS) : Data system utilized by Contractor to record client information and services.  This system is also utilized for invoicing.

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.

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 department s 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.

ATTACHMENT NO. 2

Exhibit P (Definitions)
Rev. 1/2025 Page 7

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 document s 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).

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 ATTACHMENT NO. 2

Exhibit P (Definitions)
Rev. 1/2025 Page 8
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 designated by the Client to act on behalf of the 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 m ake 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.

State: Unless other specified, it shall mean the State of California Department of Aging (CDA).

ATTACHMENT NO. 2

Exhibit P (Definitions)
Rev. 1/2025 Page 9

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.

ATTACHMENT NO. 2

Exhibit P (Definitions)
Rev. 1/2025 Page 10
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.

Certified Professional Food Safety (CP -FS) Certificate – A certificate for passing an exam that integrates food microbiology, HACCP principles and regulatory requirements into questions that test problem solving skills and knowledge. The Certified Professional Food Safety Certificate is for food safety professio nals and is designed for individuals within the public and private sectors whose primary responsibility is the protection and safety of food.

Congregate Meal Site: A location such as a senior center, recreation center, multi - purpose 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.

Dietary Reference Intakes (DRI) – A system of nutrition recommendations from the Institute of Medicine (IOM) of the National Academies (United States). The DRI is used in North America by the medical, dietary and food production sectors.

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 ATTACHMENT NO. 2

Exhibit P (Definitions)
Rev. 1/2025 Page 11
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).

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 consumpti on 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, F rozen 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 ATTACHMENT NO. 2

Exhibit P (Definitions)
Rev. 1/2025 Page 12
Services includes a component of Services for Telephone Reassurance that provides regular contact and safety checks by phone calls to reassure and support Home - Delivered Meal Clients or Older Individuals who are on a waiting list to receive Home - Delivered 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).

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.

Modernizing Older Californians Act (MOCA): California legislation enacted to provide funding for selected Area Agency on Aging programs.

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 Services Incentive Program (NSIP): 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.

Nutrition-related Supportive Services: Outreach, transportation, food shopping assistance, and escort of Client to nutrition sites.

ATTACHMENT NO. 2

Exhibit P (Definitions)
Rev. 1/2025 Page 13
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.

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.

ATTACHMENT NO. 2

EXHIBIT Q
(ACCOUNTING, ADMINISTRATION AND REPORTING REQUIREMENTS)

The purpose of this Exhibit Q is to establish required accounting, financial reporting, internal control, and contract administration 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, or supersede any laws or requirements imposed by the applicable funding sources (i.e., federal and State agencies) that may be more restrictive and/or stringent. 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 must 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. Unless otherwise specified by the funding source, 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 C ounty 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).

Recorded accruals (e.g., to estimate expenditures) shall be reversed in the subsequent accounting period or when deemed appropriate in accordance with Generally Accepted Accounting Principles (GAAP).

1.2 Cash Basis
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 each Fiscal Year, and at the end of the Subaward.

ATTACHMENT NO. 2
Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 7/2025

• 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.) must be expensed during the appropriate Subaward Fiscal Year to the extent goods and Services are received or are applicable to that Fiscal Year.

2.0 Accounting System
Subrecipient must 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 must also maintain a Payroll Register (see Section A2.6). Postings to the General Ledger and Journals shall be made at least on a monthly basis. Subrecipient must 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

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
ATTACHMENT NO. 2
Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 7/2025

• Check Number
• Cash (Credit) column
• Expense Account
• 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 clearly 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.

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 Sub- sections A.3.3 (Supporting Documentation) and B.2.4 (Credit Cards) for additional guidance on expense documentation requirements.

2.4 General Ledger
A General Ledger must be maintained with accounts for all assets, liabilities, fund balances, expenditures, and revenues. Separate accounts or cost centers must be maintained for the revenues (e.g., donations, grants, rental income, miscellaneous revenue) and expenditures of each of Subrecipient’s programs and activities (both County and non-County programs).

2.5 Chart of Accounts
A Chart of Accounts must 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:

ATTACHMENT NO. 2
Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 7/2025

• Name
• Position
• Unique code identifying each employee (e.g., employee number/ID) • Salary or hourly wage
• Payment Record including:
o Accrual Period
o Gross Pay
o Itemized Payroll Deductions
o Net Pay Amount
o Check Number

If a Payroll Register is not used, the information discussed above must be recorded in the Cash Disbursements Journal.

Subrecipient will ensure compliance with all applicable Federal and State requirements for withholding payroll taxes (e.g., FIT, FICA, FUTA, SIT, SIU), 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 Invoices/Billings
Subrecipient must submit an invoice/billing at least monthly to report to County the financial activity of the Program(s) as required in the 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 must be exercised to safeguard the accounting records and supporting documentation. Any destruction or theft of Subrecipient’s accounting records or supporting documentation must 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 must 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 must 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 three (3 ) years and must 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 ATTACHMENT NO. 2
Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 7/2025

Numbers, etc., the computer files containing this information must be adequately encrypted using the most current 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 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 must be retained (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 Encryption
Subrecipient must employ sufficient security measures to safeguard all County non-public information (e.g., confidential information including, but not limited to, the names and addresses of individuals, Social Security numbers, credit card information) that is electronically stored, used, and transmitted. Encryption standards must, at a minimum, be developed and implemented in accordance with the requirements prescribed by the County Agreement and County Board Policy

5.200.

3.3 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 must 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 supporting documentation, provided ATTACHMENT NO. 2
Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 7/2025

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 an employee’s supervisor (in ink or electronically) certifying the accuracy and approval of the reported time. 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 must not exceed the maximum County's reimbursement rate for employees.

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.

ATTACHMENT NO. 2
Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 7/2025

Operating Expenses (e.g., utilities, office supplies, equipment rentals, etc.) – bona fide subawards or lease agreements, if applicable. I nvoices and receipts detailing the cost and items purchased will constitute the primary supporting documentation. Subrecipient must maintain documentation acknowledging the receipt of the specific goods and services for the expenditure (e.g., itemized delivery confirmations, 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.

3.4 Payments to Affiliated Organizations or Persons
Prior to making payments to affiliated organizations or persons (i.e., related party transactions), Subrecipient must complete a disclosure statement identifying the nature of the affiliated, or related organization/ persons. Subrecipient must 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 of the affiliated or related ATTACHMENT NO. 2
Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 7/2025

organizations/persons or the reasonable costs (fair market value) for services rendered or items purchased.

Documentation must be maintained to support the actual costs of the affiliated or related organizations/persons and the reasonable costs for services rendered or items purchased, and shall include, but not be limited to:

• Financial records (e.g., general ledgers, payroll registers, labor distributions, invoices/receipts) of the affiliated or related organizations/persons. • Price and rate quotations for the same services/goods from an adequate number of independent and qualified sources.
• Cost and price analysis.
• Vendor selection analysis.

3.5 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

3.6 References
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.

4.0 Donations and Other Sources of Revenue
For Subrecipients that use donations and/or other sources of revenue (e.g., grants, sales of supplies/services, rental income, miscellaneous revenue, fees) to pay for expenditures related to County service, Subrecipient must maintain accounting records that clearly identify the specific expenditures that were paid for with the other source(s) 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 ATTACHMENT NO. 2
Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 7/2025

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 Inspec tor 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 prio r 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.

6.0 Single Audit Requirements
The Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance), “Audit Requirements” states that certain organizations receiving federal awards, including pass-through awards, have annual single audits. Details are contained in the Uniform Guidance.

7.0 Lower Tier Subawards
Subrecipient must not subcontract services without the prior written consent of the County.

Subrecipient must provide County with copies of all executed Lower Tier Subawards and must be responsible for the performance of their Lower Tier Subrecipients. At the sole discretion of County, Subrecipient may submit an electronic copy of executed Lower Tier Subawards in preference to a hardcopy.

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 ATTACHMENT NO. 2
Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 7/2025

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 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 Su brecipient 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 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.

ATTACHMENT NO. 2
Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 7/2025

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
Petty cash must NOT be used as a substitute for normal purchasing and disbursement practices (i.e., payment by check).

Subrecipient may establish a petty cash fund up to $500 to pay for small incidental expenditures incurred (e.g., postage due, parking meters, small purchases of office supplies) and may establish multiple petty cash funds when appropriate (i.e., petty cash fund for each location where services are rendered). Subrecipient must obtain written approval from County to establish a single pett y cash fund greater than $500.

Petty cash disbursements must be supported by original invoices, store receipts or other external authenticating documents indicating the item 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.

The petty cash fund must be maintained on an imprest (fixed) basis. A check should be drawn to set up the fund and to periodically replenish the fund up to the imprest amount. Receipts, vouchers, etc., supporting each fund replenishment must be bound together, filed chronologically and cross referenced to the reimbursement check.

ATTACHMENT NO. 2
Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 7/2025

A petty cash log shall be maintained for each petty cash fund to track the usage and replenishment of petty cash. Petty cash logs should be reviewed on a monthly basis by a higher -level employee not having responsibilities over the respective petty cash fund to ensure petty cash funds are being used for their intended purposes.

There should be a separate petty cash fund custodian assigned for each petty cash fund established. The petty cash fund custodian should not have any other cash handling responsibilities (i.e., sign checks).

The petty cash fund custodian will be responsible for maintaining and disbursing the petty cash funds and requesting replenishment of the fund up to its imprest amount when necessary.

Each day the petty cash fund is used, the petty cash fund custodian should reconcile the petty cash fund amount to the cash- on-hand, receipts/invoices for which replenishment has not yet been requested, and replenishment requests in process, but not yet received.

Petty cash must be secured at all times in a locked safe, file cabinet, or cash drawer. Access to the petty cash fund should be limited to the petty cash fund custodian and one other employee in case of absence or emergency.

Surprise cash counts of each petty cash fund shall be conducted periodically, but no less than quarterly, to ensure the petty cash fund is being maintained as required. The cash counts should be conducted by a higher -level employee not having cash handling responsibilities over the specific fund being counted.

Documentation should be maintained to support each cash count conducted and should be signed and dated by the employee conducting the cash count.

2.4 Credit Cards
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.

The use of an employee’s personal credit card on behalf of Subrecipient for authorized and necessary items 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.

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.

ATTACHMENT NO. 2
Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 7/2025

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, 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
• E mployee information sheet (e.g., employee contact information, emergency contact information, etc.)
• R esume and/or application
• Proof of qualifications for the position, if required (e.g., notarized copy or original diploma, license(s), etc.)
• P erformance evaluations
• C riminal record clearance (if required)
• C itizenship status
• B enefit balances (e.g., sick time, vacation, etc.)
• H ealth Clearances (if required)

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.

3.3 Incentive Compensation
Incentive compensation paid to employees should be reasonable, based on a measurable performance metric (e.g., cost reduction, efficient performance, ATTACHMENT NO. 2
Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 7/2025

suggestion awards, safety awards), and in accordance with Subrecipient’s established policy or agreement with employees. Subrecipient must maintain documentation to support incentive compensation payments to employees.

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. 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.

5.0 Investments
County program funds may not be utilized for investments where there is a risk of loss.

C. COST PRINCIPLES

1.0 Policy
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 ATTACHMENT NO. 2
Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 7/2025

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.
• 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.
• Title 45 Code of Federal Regulations Part 75 et seq.

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.

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 and Attachments)
• 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
ATTACHMENT NO. 2
Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 7/2025

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 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 Sub- sections 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 based on recorded hours spent on each program or using another equitable basis based on actual conditions.

Shared 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 shared costs as direct costs:
• Number of direct hours spent on each program
• Full-time equivalents for 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 and benefits of executive officers and ATTACHMENT NO. 2
Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 7/2025

administrative personnel (e.g., accounting, human resources, information technology), depreciation and use allowances for administrative buildings, and other costs related to the general administration of the organization. Only expenditures that are allowable in accordance with the applicable sections of the Uniform Guidance and any other applicable funding source(s) (i.e., federal and State agencies) shall be included as indirect costs and allocated to County program(s).

Examples of bases for allocating indirect costs:
• Total direct salaries and wages
• Total direct costs , excluding unallowable costs that do not represent an activity of Subrecipient (e.g., fines, penalties, bad debts), capital expenditures, and other distorting items such as significant one -time expenditures, 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
• De minimis rate
Subrecipient must ensure the indirect cost allocation methodology chosen is clearly described in their Cost Allocation Plan and is used consistently to allocate indirect costs.

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.

Example
Agency-wide indirect costs $ 250,000
Less: Capital Expenditures $ 10,000

Allocable indirect costs $ 240,000
Total Agency-wide direct 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

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 treated as direct costs.

ATTACHMENT NO. 2
Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 7/2025

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 based on 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.

De Minimis Rate
Subrecipient that does not have a current negotiated (including provisional) rate may elect to charge indirect costs based on a de minimis rate of 15% of modified total indirect costs. If elected, this rate may be used indefinitely, but must be used consistently to charge indirect costs to all programs and activities.

Modified total direct costs includes all direct salaries and wages, applicable fringe benefits, materials and supplies, services, travel, and up to the first $25,000 of each subaward (regardless of the period of performance of the subawards under the award). It excludes equipment, capital expenditures, charges for patient care, rental costs, tui tion remission, scholarships and fellowships, participant support costs, and the portion of each subaward in excess of $25,000.

2.4 Indirect Cost Limitations
Subrecipient must ensure indirect costs charged to the County program are within any maximum limitations established by statutory requirements. Any amounts charged in excess of maximum limitations will be disallowed upon audit unless otherwise allowed and approved by the applicable County , State, or federal agency.

2.5 Cost Allocation Plan
Subrecipient must submit an annual Agency-wide Cost Allocation Plan as required by the Subaward and when requested by County. The Cost Allocation Plan must be prepared in accordance with County instructions and the applicable sections of the Administrative Requirements, and include the following information:

ATTACHMENT NO. 2
Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 7/2025

1. Subrecipient general accounting policies:

• Basis of accounting
• Fiscal year
• Method for allocating indirect costs (e.g., simplified, direct, multiple, negotiated rate, de minimis rate)
• Indirect cost rate allocation base (e.g., direct salaries and wages, direct costs)

2. Identify Subrecipient ’s direct, shared, and indirect costs (by category) and describe the cost allocation methodology for each category.

3. Signature of Subrecipient management certifying the accuracy of the plan.

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. • 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 (except ions 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 NSP Check Fees, Traffic Citation Fees)
• 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:

ATTACHMENT NO. 2
Exhibit Q (Accounting, Administration and Reporting Requirements) Rev. 7/2025