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HomeMy WebLinkAboutCC Resolution 13221 (Tobacco, Alcohol and Drug Use Prevention; COM)RESOLUTION NO. 13221 RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN RAFAEL APPROVING AND AUTHORIZING THE CITY MANAGER TO EXECUTE A PROFESSIONAL SERVICES AGREEMENT BETWEEN THE CITY OF SAN RAFAEL AND THE COUNTY OF MARIN FOR FISCAL YEAR 2011/2012 FOR SERVICES COORDINATING THE SAN RAFAEL COMMUNITY COALITION FOR THE PREVENTION OF ALCOHOL, TOBACCO AND OTHER DRUG USE, AND ACCEPTING GRANT FUNDS WHEREAS, the County of Marin has granted the City of San Rafael funds with which to pay costs associated with coordinating a community coalition to identify and address specific issues relating to substance use and abuse within the City of San Rafael; and WHEREAS, during fiscal year 2010/2011 the Police Department used the grant funds to begin the formation and coordination of a community coalition within the City of San Rafael ("the San Rafael Community Coalition"); and WHEREAS, the City Council must approve a Professional Services Agreement between the City of San Rafael and the County of Marin in order to receive grant funding to continue the process of formulating and coordinating the San Rafael Community Coalition during fiscal year 2011/2012. NOW, THEREFORE BE IT RESOLVED, that the City Council approves and authorizes the City Manager to execute a Professional Services Agreement between the City of San Rafael and the County of Marin for fiscal year 2011/2012 for services coordinating the San Rafael Community Coalition for the prevention of alcohol, tobacco and other drug use, in the form attached hereto as Exhibit "A" and incorporated herein, and accepts $75,000.00 in Community Coalition Grant funds for fiscal year 2011/2012. I, Esther Beirne, Clerk of the City of San Rafael, hereby certify that the foregoing resolution was duly and regularly introduced and adopted at a regular meeting of the San Rafael City Council held on the 15th day of August, 2011 by the following vote, to wit: AYES: COUNCILMEMBERS: Brockbank, Connolly, Heller, Levine & Mayor Baro NOES: COUNCILMEMBERS: None ABSENT: COUNCILMEMBERS: None ESTHER BEIRNE, City Clerk CAO Contract Log # COUNTY OF MARIN Dept. Contract Log #ADTP-AD-522.11.12 - PROFESSIONAL SERVICES CONTRACT 2010 - Edition 2 THIS AGREEMENT is made and entered into this day July 1, 2011 by and between the COUNTY OF MARIN, hereinafter referred to as "County" and City of San Rafael, hereinafter referred to as "Contractor." RECITALS: WHEREAS, County desires to retain a person or firm to provide the following services: Community Prevention Coalition; and WHEREAS, Contractor warrants that it is qualified and competent to render the aforesaid services; NOW, THEREFORE, for and in consideration of the agreement made, and the payments to be made by County, the parties agree to the following: 1. SCOPE OF SERVICES: Contractor agrees to provide all of the services described in Exhibit A attached hereto and by this reference made a part hereof. 2. FURNISHED SERVICES: The County agrees to: A. Guarantee access to and make provisions for the Contractor to enter upon public and private lands as required to perform their work. B. Make available all pertinent data and records for review. C. Provide general bid and contract forms and special provisions format when needed. 3. FEES AND PAYMENT SCHEDULE: The fees and payment schedule for furnishing services under this Contract shall be based on the rate schedule which is attached hereto as Exhibit B and by this reference incorporated herein. Said fees shall remain in effect for the entire term of the Contract. Contractor shall provide County with his/her/its Federal Tax I.D. number prior to submitting the first invoice. 4. MAXIMUM COST TO COUNTY: In no event will the cost to County for the services to be provided herein exceed the maximum sum of $93,617.00 including direct non - salary expenses. As set forth In paragraph 14 of this Contract, should the funding source for this Contract be reduced, Contractor agrees that this maximum cost to County may be amended by written notice from County to reflect that reduction. 5. TIME OF AGREEMENT: This Agreement shall commence on July 1, 2011, and shall terminate on June 30, 2012. Certificate(s) of Insurance must be current on day Contract commences and if scheduled to lapse prior to termination date, must be automatically updated before final payment may be made to Contractor. The final invoice must be submitted within 30 days of completion of the stated scope of services. 6. INSURANCE: The Contractor shall maintain a commercial general liability insurance policy in the amount of $1,000,000 ($2,000,000 aggregate), Where the services to be provided under this Contract involve or require the use of any type of vehicle by Contractor in order to perform said services, Contractor shall also provide comprehensive business or commercial automobile liability coverage including non -owned and hired automobile liability in the amount of $300,000.00. Said policies shall remain in force through the life of this Contract and shall be payable on a "per occurrence" basis unless County specifically consents to a "claims made" basis. The County shall be named as an additional insured on the commercial general liability policy. The insurer shall supply a certificate of insurance with endorsements signed by the insurer evidencing such insurance to County prier to commencement of work. Should any of the required insurance policies in this Contract be cancelled or non-rencwed, it is the Contractor's duty to notify the County immediately upon receipt of the notice of cancellation or ncn-renewal. By initialing in the space provided, Contractor warrants that the services to be provided under this Contract do not require the use of any type of vehicle by Contractor. The Contractor acknow:edges the State of Cal.fornla requires every employer to be insured against liability for wo,Kers' compensation or to undertake self-insurance in accordance with the prov;slons of the Labor Code. if Contractor has emp.oyees, a copy of the certificate ev;dercing such insurance or a copy of the Certificate of Consent to Self -insure shall be provided to County prior to commencement of work. Page 1 of 13 Rev.20103428 Ir., addition, Contractor may be required to carry errors and omissions, professional liability or malpractice insurance. If such insurance is required, the coverage limits and deductibles shall be set forth on Exhibit C attached hereto. Nothing herein shall be construed as a limitation of Contractor's liability, and Contractor shall indemnify and hold the County harmless and defend the County against any and all claims, damages, losses and expense that may arise by reason of the Contractor's negligent actions or omissions. County agrees to timely notify Contractor of any negligence claim, Failure to provide and maintain the insurance required by this Contract will constitute a material breach of the agreement. In addition to any other available remedies, County may suspend payment to the Contractor for any services provided during any time that insurance was not in effect and until such time as the Contractor provides adequate evidence that Contractor has obtained the required coverage. 7. ANTI DISCRIMINATION AND ANTI HARASSMENT: Contractor and/or any subcontractor shall not unlawfully discriminate against or harass any individual including, but not limited to, any employee or volunteer of the County of Marin based on race, color, religion, nationality, sex, sexual orientation, age or condition of disability. Contractor and/or any subcontractor understands and agrees that Contractor and/or any subcontractor is bound by and will comply with the anti discrimination and anti harassment mandates of all Federal, State and local statutes, regulations and ordinances including, but not limited to, County of Marin Personnel Management Regulation (PMR) 21, 8. SUBCONTRACTING: The Contractor shall not subcontract nor assign any portion of the work required by this Contract without prior written approval of the County except for any subcontract work identified herein. If Contractor hires a subcontractor under this Agreement, Contractor shall require subcontractor to provide and maintain insurance coverage(s) identical to what is required of Contractor under this Agreement and shall require subcontractor to name Contractor as additional insured under this Agreement, It shall be Contractor's responsibility to collect and maintain current evidence of insurance provided by its subcontractors and shall forward to the County evidence of same. 9. ASSIGNMENT: The rights, responsibilities and duties under this Contract are personal to the Contractor and may not be transferred or assigned without the express prior written consent of the County. 10. LICENSING AND PERMITS: The Contractor shall maintain the appropriate licenses throughout the life of this Contract, Contractor shall also obtain any and all permits which might be required by the work to be performed herein. 11. BOOKS OF RECORD AND AUDIT PROVISION: Contractor shall maintain on a current basis complete books and records relating to this Contract. Such records shall include, but not be limited to, documents supporting all bids, all income and all expenditures, The books and records shall be original entry books with a general ledger itemizing all debits and credits for the work on this Contract. In addition, Contractor shall maintain detailed payroll records including all subsistence, travel and field expenses, and canceled checks, receipts and Invoices for all items. These documents and records shall be retained for at least five years from the completion of this Contract. Contractor will permit County to audit all books, accounts or records relating to this Contract or all books, accounts or records of any business entities controlled by Contractor who participated in this Contract in any way. Any audit may be conducted on Contractor's premises or, at County's option, Contractor shall provide all books and records within a maximum of fifteen (15) days upon receipt of written notice from County, Contractor shall refund any monies erroneously charged, 12, WORK PRODUCT/PRE-EXISTING WORK PRODUCT OF CONSULTANT: Any and all work product resulting from this agreement is commissioned by the County of Marin as a work for hire. The County of Marin shall be considered, for all purposes, the author of the work product and shall have all rights of authorship to the work, including, but not limited to, the exclusive right to use, publish, reproduce, copy and make derivative use of, the work product or otherwise grant others limited rights to use the work product. To the extent Consultant incorporates into the work product any pre-existing work product owned by Consultant, Consultant hereby ac4nowledges and agrees that ownership of such wcrk product shai', be transferred to the County of Morin, 13. TERMINATION: A. if the Contractor falls to provide in any manner the services required under tNs Contract or otherwise fails to comply with the terms of this Contract or violates any ordinance, regulation or other law which applies to its performance here'n, the County ray term,nate this Contract by g'o'ng five (5) calendar days written notice to the party involved. B. The Contractor shall be excused for fai'ure to pe�form serJices herein if such services are preve:ited by acts of God, s°r:kes, 'abor disputes cr other forces o,>er wh'ch the Contractor has no control. C. Either party hereto may terminate this Contract for any reason by giving th'rty (30) calendar days w-;tten ncti.^e to the other parties. Notice of terminat'.on shat' be by written notice to the other parties and be sent by registered mai'. Pngo 2 of 13 Rev.NIA422 D. In the event of termination not the fault of the Contractor, the Contractor shall be paid for services performed to the date of termination in accordance with the terms of this Contract so long as proof of required insurance is provided for the periods covered in the Contract or Amendment(s). 14. APPROPRIATIONS: The County's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Marin County Board of Supervisors, the State of California or other third party. Should the funds not be appropriated County may terminate this agreement with respect to those payments for which such funds are not appropriated. County will give Contractor thirty (30) days' written notice of such termination. All obligations of County to make payments after the termination date will cease. Where the funding source for this Agreement is contingent upon an annual appropriation or grant from the Marin County Board of Supervisors, the State of California or other third party, County's performance and obligation to pay under this Agreement is limited by the availability of those funds. Should the funding source for this Agreement be eliminated or reduced, upon written notice to Contractor, County may reduce the Maximum Cost to County identified in Paragraph 4 to reflect that elimination or reduction. 15. RELATIONSHIP BETWEEN THE PARTIES: It is expressly understood that in the performances of the services herein, the Contractor, and the agents and employees thereof, shall act in an independent capacity and as an independent contractor and not as officers, employees or agents of the County. Contractor shall be solely responsible to pay all required taxes, including but not limited to, all withholding social security, and workers' compensation. 16. AMENDMENT: This Contract may be amended or modified only by written agreement of all parties. 17. ASSIGNMENT OF PERSONNEL: The Contractor shall not substitute any personnel for those specifically named in its proposal unless personnel with substantially equal or better qualifications and experience are provided, acceptable to County, as is evidenced in writing. 18. JURISDICTION AND VENUE: This Contract shall be construed in accordance with the laws of the State of California and the parties hereto agree that venue shall be in Marin County, California. 19. INDEMNIFICATION: Contractor agrees to indemnify, defend, and hold County, its employees, officers, and agents, harmless from any and all liabilities including, but not limited to, litigation costs and attorney's fees arising from any and all claims and losses to anyone who may be injured or damaged by reason of Contractor's negligence, recklessness or willful misconduct in the performance of this Contract. 20. COMPLIANCE WITH APPLICABLE LAWS: The Contractor shall comply with any and all Federal, State and local laws and resolutions (including, but not limited to the County of Marin Nuclear Free Zone, Living Wage Ordinance, and Resolution #2005-97 of the Board of Supervisors prohibiting the off -shoring of professional services involving employee/retiree medical and financial data) affecting services covered by this Contract. Copies of any of the above -referenced local laws and resolutions may be secured from the County's contact person referenced in paragraph 21. NOTICES below. Rzge 3 of 13 Rev.201GGA28 21. NOTICES: This Contract shall be managed and administered on County's behalf by the Department Contract Manager named below. All invoices shall be submitted and approved by this Department and all notices shall be given to County at the following location: Contract Manager: Gary Najarian County of Marin Dept./Location: Prevention Hub Address: 899 Northgate Drive, Suite 415 City, State, ZIP: San Rafael, CA 94903 Telephone No.: 415.473.4230 Notices shall be given to Contractor at the following address: Mr. Carl Huber Contractor: City of San Rafael Address: 1400 Fifth Avenue City, State ZIP: San Rafael, CA 94901 Telephone No.: 415.485.3000 22. ACKNOWLEDGEMENT OF EXHIBITS Check applicable Exhibits CONTRACTOR'S INITIALS EXHIBIT A. X Scope of Services EXHIBIT B. X Fees and Payment EXHIBIT C. Insurance Reduction/Waiver OTHER REQUIRED X Exhibit D Business Associate Agreement EXHIBITS (HHS X Exhibit I Alcohol, Drug and Tobacco Programs USE ONLY) IN WITNESS WHEREOF, the parties have executed this Contract on the date first above written. APPROVED BY COUNTY OF MARIN: 0 CONTRACTOR: By: 1 f-. b f 41! at c trTi:3�i Na -,,e: �v_.Q.v�.Y h�.4GtCLf t Telephone No.: Y/-< 55-3391� .a.a...ai.aiiii.ai.if.siaiail:iaaii.uiii ii a...is........ai.i.Iiiii.iiiia.si..isitis..... Ali ... iaaiii.ii—ii.i... 4.ba.... iii ... i ... a... i.isi.... Guia.sii.....: •iaYlad COUNTY COUNSEL REVIEW AND APPROVAL (Only required if any of the noted reason(s) applies) REASON{S} REVIEW: ❑ Standard Short Form Content Has Been Modified ❑ Optional Review by County Counsel at Department's Request County Counsel: Date: Page 4 of 13 RCv.201C0428 EXHIBIT "A" SCOPE OF SERVICES (required) Page 5 of 13 EXHIBIT "B" FEES AND PAYMENT SCHEDULE (required) EXHIBIT B BUDGET DETAIL July 1, 2011 - June 30, 2012 Contractor: City of San Rafael Program Name: San Rafael Community Coalition 1116: Community II Service Modality Il Service Modalityll Total Based Process (Salaries, Wages & Benefits 'I staff time ($88.24 per hour x 600 hrsj $52,944 ( 11 ( I 1 1 I I I I I I I ' Sub -Total Employee Benefits (Total of Salaries & Benefits (Services & Supplies 10ftice Supplies Iprinting/Copying 1postage (Repairs & Maintenance Rent Utilities ISecurity (Communications dvertis ing; Recruiting Consultants - AectglOther Intern Stipends lEducational Materials linsurance IVehicle Expense lConsultants - Medical (Lab Tests & Urinalysis IMedical Supplies 11'raining Travel (Computer Services & Suprhes Total Services & Supplies Ilndirect Costs Ilndirect Costs i7 \ I TOTAL EXPENSE $52,944 1 "$?2,944 II $2,500 $500 ( I I I 1$10,673 1 1$2,000 1 1$500 1 1 $10.000 I S-, 17' Fr? CI IIS93,617 j$51944 11 "$'2,944 (I ( I1 11 11S33.I-3 G I� I� IIS93,617 $52,944 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $01 1 $2,500 $500 $0 $t} $0 $0 $0 $0 $0 $10,673 $0 $2,000 $0 $500 $0 $0 $0 S 1 ti,00t} EXHIBIT "D" BUSINESS ASSOCIATE AGREEMENT TERMS AND CONDITIONS To the extent Contractor is a business associate as defined under the Federal Health Insurance Portability and Accountability Act (HIPAA) and the HITECH Act, Contractor shall comply with the additional terms and conditions set forth in this Exhibit ("V) to the Professional Services Agreement. This Business Associate Agreement Exhibit "D" supplements and is made a part of the Professional Services Agreement ("Agreemenf') by and between the County of Marin, referred to herein as Covered Entity ("CE"), and City of San Rafael, referred to herein as Business Associate ("BA"), to which this Exhibit "D" is an incorporated attachment. RECITALS CE and BA have entered into a business relationship through which BA may receive Protected Health Information ("PHP`) (defined below) from CE or create, collect, transmit, retain, process or otherwise use PHI on behalf of CE pursuant to the terms of the Agreement CE and BA intend to protect the privacy and provide for the security of PHI disclosed to, created by, or in any manner used by, BA pursuant to the Agreement in compliance with the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 ("HIPAA"), the Health Information Technology for Economic and Clinical Health Act, Public Law 111-005 ("the HITECH Act"), and regulations promulgated thereunder by the U,S. Department of Health and Human Services (the "HIPAA Regulations") and other applicable laws. As part of the HIPAA Regulations, the Privacy Rule and the Security Rule (defined below) require CE to enter into a contract containing specific requirements with BA prior to the disclosure of PHI, as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the Code of Federal Regulations ("C.F.R.") and contained in this Exhibit "D". In consideration of the mutual promises below and the exchange of information pursuant to this Exhibit "D", the parties agree as follows: 1. Definitions a. Breach shall have the meaning given to such term under the HITECH Act (42 U.S.C. Section 179211. b. Business Associate shall have the meaning given to such term under the Privacy Rule, the Security Rule, and the HITECH Act, including but not limited to, 42 U.S.C. Section 17938 and 45 C.F.R. Section 160.103. For purposes of this Exhibit "D", use of the term Business Associate includes all Contractor agents, employees, contractors or other associates providing services or assistance to Contractor under the Agreement. c. Covered Entity shall have the meaning given to such term under the Privacy Rule and the Security Rule, including, but not limited to, 45 C.F.R. Section 160.103. For purposes of this Agreement, this term is intended to mean the County of Marin. d. Data Aggregation shall have the meaning given to such term under the Privacy Rule, including, but not limited to, 45 C.F.R. Section 164.501. e. Designated Record Set shall have the meaning given to such term under the Privacy Rule, including, but not limited to, 45 C,F.R. Section 164.501. f. DHHS Secretary shall mean the Secretary of the U.S. Department of Health and Human Services. g. Electronic Health Record shall have the meaning given to such term in the HITECH Act, including, but not limited to, 42 U,S.C. Section 17921. h. Electronic Protected Health Information means Protected Health Information that is maintained in or transmitted by electronic media. I. Health Care Operations sha,l have the meaning given to such term under the Privacy Rule, including, but rot limited to, 45 C.F.R. Section 164.501. j. Individual shall have the rreaning given to such term under the Privacy Rule and the Security Rule, including, but not limited to, 45 C.F.R. Section 160.103. k. Privacy Rule sha:l r-ean the HIPAA Regulation that is codified at 45 C.F.R. Parts 160 and 164, Subparts A and E. 1. Protected Health Information or PHI means any information, whether oral or recorded in any form or medium: 6) tnat relates to the past, present or future physical or frontal condition of an Individual; the provision cf health care to an Individual; or the past, present or future payrrrent for the prov'sion of heath care to an individual; and (ii) that Identif es the !rdividual or ,with respect to which there is a reasonable basis to believe the information can be used to identify the !rdividual, and shall have the meaning given to such term under the Privacy Rule, including, but not limited to, 45 C.F.R. Section 164.501. Protected Health Information includes Electronic Protected Health information (45 C.F.R. Sections 160.103, 164.5011. Page 7 of 13 m. Protected Information shall mean PHI provided by CE to BA or created or received by BA on CE's behalf. n. Security Rule shall mean the HIPAA Regulation that is codified at 45 C.F.R. Parts 160 and 164, Subparts A and C. o. Unsecured PHI shall have the meaning given to such term under the HITECH Act and any guidance issued pursuant to such Act including, but not limited to, 42 U.S.C. Section 17932(h). 2. Obligations of Business Associate a. Permitted Uses. BA shall not use Protected Information except for the purpose of performing BA's obligations under the Agreement and as permitted under the Agreement and this Exhibit "D". Further, and notwithstanding anything to the contrary above, BA shall not use Protected Information in any manner that would constitute a violation of the Privacy Rule or the HITECH Act if so used by CE. However, BA may use Protected Information (i) for the proper management and administration of BA, (ii) to carry out the legal responsibilities of BA, or (iii) for Data Aggregation purposes for the Health Care Operations of CE [45 C.F.R. Sections 164.504(e)(2)(ii)(A) and 164.504(e)(4)(1)]. b. Permitted Disclosures. BA shall not disclose Protected Information except for the purpose of performing BA's obligations under the Agreement and as permitted under the Agreement and this Exhibit "D". Further, and notwithstanding anything to the contrary above, BA shall not disclose Protected Information in any manner that would constitute a violation of the Privacy Rule or the HITECH Act if so disclosed by CE. However, BA may disclose Protected Information (i) for the proper management and administration of BA; (ii) to carry out the legal responsibilities of BA; (iii) as required by law; or (iv) for Data Aggregation purposes for the Health Care Operations of CE. If BA discloses Protected Information to a third party, BA must obtain, prior to making any such disclosure, (1) reasonable written assurances from such third party that such Protected Information will be held confidential as provided pursuant to this Exhibit "D" and only disclosed as required by law or for the purposes for which it was disclosed to such third party, and (ii) a written agreement from such third party to immediately notify BA of any breaches of confidentiality of the Protected Information, to the extent it has obtained knowledge of such breach [42 U.S.C. Section 17932; 45 C.F.R. Sections 164.504(e)(2)(i), 164.504(e)(2)(i)(B), 164,504(e)(2)(ii)(A) and 164.504(e)(4)(ii)]. c. Prohibited Uses and Disclosures. BA shall not use or disclose Protected Information for fundraising or marketing purposes. BA shall not disclose Protected Information to a health plan for payment or health care operations purposes if the patient has requested this special restriction, and has paid out of pocket in full for the health care item or service to which the PHI solely relates 42 U.S.C. Section 17935(a). BA shall not directly or indirectly receive remuneration in exchange for Protected Information, except with the prior written consent of CE and as permitted by the HITECH Act, 42 U.S.C. section 17935(d)(2); however, this prohibition shall not affect payment by CE to BA for services provided pursuant to the Agreement. d. Appropriate Safeguards. BA shall implement appropriate administrative, physical and technical safeguards as are necessary to prevent the use or disclosure of Protected Information otherwise than as permitted by the Agreement that reasonably and appropriately protect the confidentiality, integrity and availability of the Protected Information, in accordance with 45 C.F.R. Sections 164.308, 164.310, and 164.312. [45 C.F.R. Section 164.504(e)(2)(ii)(B); 45 C.F,R. Section 164.308(b)]. BA shall comply with the policies and procedures and documentation requirements of the HIPAA Security Rule, including, but not limited to, 45 C.F.R. Section 164.316. [42 U.S.C. Section 17931 e. Reporting of Improper Access, Use or Disclosure. Unless stricter reporting requirements apply in accordance with federal or state laws or regulations, other provisions of the Agreement, or this Exhibit "D", BA shall report to CE in writing of any access, use or disclosure of Protected Information not permitted by the Agreement and this Exhibit "D", and any Breach of Unsecured PHI of which it becomes aware without unreasonable delay and in no case later than 5 business days after discovery [42 U.S.C. Section 17921; 45 C.F.R. Section 164.504(e)(2)(ii)(C); 45 C.F.R. Section 164.308(b)]. f. Business Associate's Agents. BA shall ensure that any agents, including subcontractors, to whom it provides Protected Information, agree in writing to the same restrictions and conditions that apply to BA with respect to such PHI and implement the safeguards required by paragraph d above with respect to PHI [45 G.F.R. Section 164.504(e)(2)(ii)(D); 45 C.F.R. Section 164.308(b)]. BA shall implement and maintain sanctions against agents and subcontractors that violate such restrictions and conditions and shall mitigate the effects of any such violation (see 45 C,F.R. Sections 164.530(f) and 164.530(e)(1)). g. Access to Protected Information. BA shall make Protected Information maintained by BA or its agents or subcontractors in Designated Record Sets available to CE for inspection and copy'ng within ten (10) business days of a request by CE to enable CE to fulfill its abl;gatons under the Privacy Rule, including, but not Cm!ted to, 45 C.F.R. Section 164.524 [45 CF.R. Section 164.504(e)(2)(il)(E)1. If BA maintains an Electronic Health Record, BA shall prov do such information in electronic format to enable CE to fulfill its obligations under the HITECH Act, including, but not i'mited to, 42 U.S.C. Section 17935(e). if any Individual requests access to Protection information directly from BA or Its agents or subcontractors, BA shall further conform with and meet all of the requirements of 45 C.F.R. Section 164.524 and other appl'cable laws, Including the HITECH Act and related regulations. h. Amendment of PHI. Wit`iin ten ('0) business days of receipt of a rocuest from CE for an amendment of Protected Information or a record about an Individual contained in a Designated Record Set, BA or is agents or subcontractors shall make such Protected Information available to CE for amendment and incorporate any such amendment to enable CE to fulfill its obligations under the Privacy Rule, including, but not limited to, 45 C.F.R. Section 164.526, if any Individual requests an amendment of Protected Information directly from BA or its agents or subcontractors, BA must notify CE in writing w'thin five (5) business days Page 8 of 13 of the request. Any approval or denial of amendment of Protected Information maintained by BAmits agents orsubcontractors shall be the responsibility of CE [45 C,F.R. Section 164.504(e)(2)(h)(F)J. I. Accounting Rights. Within ten (10) business days o/notice byCEofmrequest for onaccounting ofdisclosures ofProtected Information, BA and its agents or subcontractors shall make available to CE the Information required to provide an accounting of disclosures to enable CE to fulfill its obligations under the Privacy Rule, including, but not limited to, 45 C.F.R. Section 184.528.and the H|TECHAct, including but not limited 0o42U.8.C.Section 17835(o).amdetermined byCE. @Aagrees bz implement a process that allows for an accounting to be collected and maintained by BA and Its agents or subcontractors for at least six (6)years prior bothe request. However, accounting nfdisclosures from mnElectronic Health Record for beatmant payment orhealth oamopmxoUonmpu mquimdhubeooUoc<adand maintained for on�thnm(3)yeamphorhsthe ` mh, qu�ot.andon|ydnooxtentWnotBAmainhainmanBm eotnioHealth Record and iusubject !othis requirement, Atamin�um Uhe|nfonnaUonuo||eobedandma|ntainedeheUino|udo:(|)Unadatmofdioo|oeum;(U)themameoftheent|tyorpommnwhu~' ' received Protected Information and, Kknown, the address cfthe entity or person; (|U)abriefnfPm�ded |nfnnnaVnnd�dooedand Uv)obdefstatement ofpu o ofth disclosure that reasonably -- s the Individual of the basis for the disclosure, or a copy of the Individuals' authorization, or a copy of the written request for disclosure, In the event that the request for ~'' accounting .~ delivered directly "'B°v/its agents v,subcontractors, u*shall within five (5)business days of orequest forward ith»OEinwriting, However, bshall beBA's|bi| ' any such accounting requested and hoduuuinaccordance with law. BAshall not disclose any Protected |n8unnabon»m*taooat[oUhinSecbono 2.b.ofthis Exhibit ^D"(45CF.R.Sections 1G4.5U4(e)(2)(i|)(G) and 105.520. ' J. Governmental Access to Records. BA shall make Its internal practices, books and records relating to the use, disclosure and privacy protection of Protected Information available to CE and to the DHHS Secretary for purposes of determining BA's compliance with the Privacy Rule N5C.F.R.Section 104.5D4(e)(2)(|i)(H)].BAshall provide k/CEmcopy ofany Protected Information that BA provides to the DHHS Secretary concurrently with providing such Protected Information to the DHHS Secretary, k Minimum Necessary. BA and its agents or subcontractors shall request, use and disclose only the minimum amount of Protected Information necessary to accomplish the purpose of the request, use, or disclosure, [42 U.S.C. Section 17935(b); 45 C.F.R. Section 164.514(d)(3)] BA understands and agrees that the definition of "minimum necessary" is in flux and shall keep itself informed of guidance issued by the DHHS Secretary with respect to what constitutes "minimum necessary." L Data Ownership. BA acknowledges that BA has no ownership rights with respect to the Protected Information. m. Notification of Breach, Unless stricter reporting requirements apply /n accordance with federal or state |uwm or regulations, other provisions of the Agmemant, or this Exhibit ^D^. BA shall nuUh, CE within twenty-four (24) hours of any suspected or actual breach of security, intrusion or unauthorized use or d|on/oou,e of PHI of which 8A becomes aware and/or any actual or suspected use or disclosure of data in violation of any applicable federal or state laws or regulations. Unless CE provides BA with written notice that /twill undertake such obligations on behalf of BABAh Utk ` prompt corrective action tocure any such deficiencies and (|}) any action porta|ning to such unauthorized disclosure required ^y applicable �federal and state laws and regulations. The parties agree that CE has the sole discretion to determine whether it will undertake such obligations on behalf of BA and that, if it does, CE has the right to require BA to pay for any or all costs associated therewith. n. Breach Pattern mPractice by Covered Entity. Pursuant to 42 U,8.0Section 17934(N,ifthe 8Aknows ofapattern of activity orpractice o/the CEthat constitutes amaterial breach uvviolation ofthe CE'a~aUonoundnr8mAgmamontorthis Exhibit ^Crorother an�� ang*mon�.#he��mutokamouonab|ostnpataoumUhebmoohoendthevioh$km.|f the steps are unsuccessful, the BA must terminate the Agreement or other arrangement if feasible, or if termination is not feasible, report the problem tothe DHHSSecretary. BA shall provide written notice to CE of any pattern of activity or practice of the CE that BA believes constitutes omaterial breach orviolation of the CE's obligations under the Agreement or this Exhibit ^D''orother arrangement within five (5) business days of discovery and shall meet with CE to discuss and attempt to resolve the problem as one ofthe reasonable steps 8zcure the breach orend the violation. u Audits, Inspection and Enforcement. Within ten (1U)days ofawritten request byCE, BAand its agents ursubcontractors shall allow OEtoconduct a reasonable inspection of the facilities, systems, books, records, agreements, policies and procedures relating to the use or disclosure of Protected Information pursuant to this Exhibit "D" for the purpose ofdabsnnining whether BA has complied with this Exhibit; provided, however, that (1) BA and CE shall mutually agree in advanceupon the scope, timing and |ocaMopofsuch aninspection, (iVprotect proprietary in6onnuUonofBA&xwhich CEhas access duhngthe coumemlsuch inopeoUon;and (iU)CEaha|/execute '-nondisclosure agreement, upon terms mutua1y agreed upon by the parties, f requestod by BA, The fact that CEinspects, orfalls ho|napao|nr has the right h/�nmpecL.BA's tadUUea.ay�emn.booxo.records, agreements, poUoiosand pnoxadumudoes not mUaveBAoy�its responsibility to comply with this Exh;bIt `D", nor does CE's (V failure to detect or (F) detection, but failure to notify BA or require BA's remed'ation of any unsatisfactory practices, constitute acceptance of such practice or a waiver of CE's enforcem ont rights under the Agreement orthis Exhibit ^O''. BA shal; notify CEw!thin ten (10) bus'ness days of learning that BA has become the' subjectl o�anuu�nomp|ionccrov|mw.nroomp/ointinveeUgotionbythoOfUoafo,Chi|Rig�,Jm. pogeeof 13 3. Termination of Agreement a. Material Breach. A breach by BA of any provision of this Exhibit "D", as determined by CE, shall constitute a material breach of the Agreement and shall provide grounds for immediate termination of the Agreement, any provision in the Agreement to the contrary notwithstanding. [45 C.F.R. Section 164.504(e)(2)(iii)]. b. Judicial or Administrative Proceedings. Notwithstanding any provision in the Agreement to the contrary, CE may terminate the Agreement, effective immediately, if (i) BA is named as a defendant in a criminal proceeding for a violation of HIPAA, the HITECH Act, the HIPAA Regulations or other security or privacy laws or (ii) a finding or stipulation that the BA has violated any standard or requirement of HIPAA, the HITECH Act, the HIPAA Regulations or other security or privacy laws is made in any administrative or civil proceeding in which the party has been joined. c. Effect of Termination. Upon termination of the Agreement for any reason, BA shall, at the option of CE, return or destroy all Protected Information that BA or its agents or subcontractors still maintain in any form, and shall retain no copies of such Protected Information. If return or destruction is not feasible, as determined by CE, BA shall continue to extend the protections of Section 2 of this Exhibit "D" to such information, and limit further use of such PHI to those purposes that make the return or destruction of such PHI infeasible. [45 C.F.R. Section 164.504(e)(ii)(2(I)]. If CE elects destruction of the PHI, BA shall certify in writing to CE that such PHI has been destroyed. 4. Indemnification In addition to any other indemnification and defense obligation under the Agreement, BA has a separate and additional obligation to indemnify and defend CE against any claims or suits arising from BA's breach of its obligations under the terms and conditions of this Exhibit "D". 5. Limitation of Liability Notwithstanding any limitation of liability provision that may exist in the Agreement or this Exhibit "D", BA is solely liable for any damages related to a breach of the BA's privacy or security obligations under the terms of this Exhibit "D". 6. Disclaimer CE makes no warranty or representation that compliance by BA with this Exhibit "D", HIPAA, the HITECH Act, or the HIPAA Regulations will be adequate or satisfactory for BA's own purposes. BA is solely responsible for all decisions made by BA regarding the safeguarding of PHI. 7. Certification To the extent that CE determines that such examination is necessary to comply with CE's legal obligations pursuant to HIPAA relating to certification of its security practices, CE or its authorized agents or contractors, may, at CE's expense, examine BA's facilities, systems, procedures and records as may be necessary for such agents or contractors to certify to CE the extent to which BA's security safeguards comply with HIPAA, the HITECH Act, the HIPAA Regulations or this Addendum. 8. Amendment a. Amendment to Comply with Law. The parties acknowledge that state and federal laws relating to data security and privacy are rapidly evolving and that amendment of the Agreement or this Exhibit "D" may be required to provide for procedures to ensure compliance with such developments. The parties specifically agree to take such action as is necessary to implement the standards and requirements of HIPAA, the HITECH Act, the Privacy Rule, the Security Rule and other applicable laws relating to the security or confidentiality of PHI. The parties understand and agree that CE must receive satisfactory written assurance from BA that BA will adequately safeguard all Protected Information. Upon the request of either party, the other party agrees to promptly enter into negotiations concerning the terms of an amendment to this Exhibit "D" embodying written assurances consistent with the standards and requirements of HIPAA, the HITECH Act, the Privacy Rule, the Security Rule or other applicable laws. CE may terminate the Agreement upon thirty (30) days written notice in the event (i) BA does not promptly enter into negotiations to amend the Agreement or this Exhibit °D" when requested by CE pursuant to this Section or (ii) BA does not enter not enter into an amendment to the Agreement or this Exhib t "D" providing assurances regarding the safeguard'ng of PHI that CE, in its sole discretion, deems sufficient to satisfy the standards and requirements of appicable laws. b. Amendment of Exhibit "D". T his Exhibit "D" may be modif ed or amended at any t'me without amendment of the Agreement, but only by written agreement of the parties. 9. Assistance in Litigation of Administrative Proceedings BA shall make ;tself, and any subcontractors, employees or agents ass sting BA in the performance of its obligations u^der the Agreement, available to CE, at no cost to CE, to testify as witnesses, or otnerwise, in the event of litigation or adrriristrative proceedings being commenced against CE, its directors, officers or employees based upon a claimed v oiaticn of HIPAA, the HITECH Act, the Privacy Rule, the Security Rule, or other laws relating to security and privacy, except where BA or its subcontractor, employee or agent is a named adverse party. Page 10 of 13 10. No Third -Party Beneficiaries Nothing express or implied in the Agreement or this Exhibit "D" is intended to confer, nor shall anything herein confer, upon any person other than CE, BA and their respective successors or assigns, any rights, remedies, obligations or liabilities whatsoever. 11. Effect on Agreement Except as specifically required to implement the purposes of this Exhibit "D", or to the extent inconsistent with this Exhibit "D", all other terms of the Agreement shall remain in force and effect. 12. Interpretation The provisions of this Exhibit "D" shall prevail over any provisions in the Agreement that may conflict or appear inconsistent with any provision in this Exhibit "D". This Exhibit "D" and the Agreement shall be interpreted as broadly as necessary to implement and comply with HIPAA, the HITECH Act, the Privacy Rule and the Security Rule. The parties agree that any ambiguity in this Exhibit "D" shall be resolved in favor of a meaning that complies and is consistent with HIPAA, the HITECH Act, the Privacy Rule and the Security Rule. 13. Survival of Provisions Excepting only the provisions regarding BA's use or disclosure of Protected Information for the purpose of performing BA's obligations under the Agreement, the terms of this Exhibit "D" shall survive the termination of the Agreement so long as PHI obtained or generated during the term of the Agreement is retained by BA. Page 11 Cf 13 ALCOHOL, DRUG AND TOBACCO PROGRAMS 1. Services to be Performed: 1.1 Services and work provided by Contractor at the County's request under this Agreement will be performed in a timely manner, and in accordance with applicable federal and state statutes and regulations, including, but not limited to, sections 96.126, 96.127, 96.128, 96.131, and 96.132, and all references therefrom, of the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) Reauthorization Act, Public Law 106-310, the State of California Alcohol and/or Other Drug Program Certification Standards, and any and all guidelines promulgated by the State Department of Alcohol and Drug Programs and the Marin County Department of Health and Human Services to serve special populations and groups, as applicable, County laws, ordinances, regulations and resolutions; and in a manner in accordance with the standards and obligations of Contractor's profession. Contractor shall devote such time to the performance of services pursuant to this Agreement as may be reasonably necessary for the satisfactory performance of Contractor's obligations. The County shall maintain copies of all statutes, regulations, and guidelines for Contractor's use. 2. Program Evaluation: 2.1 Contractor shall maintain books, records, files, documents and other evidence directly pertinent to all work under this Agreement in sufficient detail to make possible an evaluation of services provided and compliance with State Department of Alcohol and Drug Programs Regulations, as applicable, and in accordance with accepted professional practice and accounting procedures for a minimum of four (4) years after the termination of the Agreement. Contractor agrees to extend to the State Department of Alcohol and Drug Programs and to the County and their designees the right to review and investigate records, programs, and procedures, as well as overall operation of Contractor's program with reasonable notice. 2.2 Formal evaluation of the program shall be made annually through a Provider Self -Audit and on-site visit. This evaluation shall result in a written report to the Contractor within fifteen (15) working days of the site visit. Any report that results from a site visit shall be submitted to the Contractor within fifteen (15) working days. Contractor shall submit a written response within thirty (30) working days of receipt of such report, and such response shall be part of the official written report provided for in this section. 2.3 Contractor shall meet the requirements of and participate in the management information system of the County Alcohol and Drug Program Office, and maintain fiscal, administrative, and programmatic records and such other data as may be required by the Chief of Alcohol and Drug Programs for program evaluation and research requirements. 3. Records: 3.1 Contractor and County mutually agree to maintain the confidentiality of Contractor's participant records, including billings, pursuant to Sections 11812(c) and 11879, Health and Safety Code, and Federal Regulations for Confidentiality of Alcohol and Drug Abuse Patient Records, dated June 9, 1987, the federal Health Insurance Portability and Accountability Act, and all other applicable State and Federal laws and any amendments. Contractor shall inform all its officers, employees, and agents of the confidentiality provisions of said regulations, and provide all necessary policies and procedures and training to ensure compliance. 4. Applicable Fee: 4.1 Contractor shall charge participant fees. No one shall be denied services based solely on ability or inability to pay. 4.2 Contractor shall perform eligibility and financial determinations in accordance with a fee schedule approved by the Chief of Alcohol and Drug Programs for this purpose. Individual income, expenses, and number of dependents shall be considered in formulating the fee schedule and in its utilization. 4.3 Contractor shall conduct community -centered fundraising activities, as appropriate. 5. Consideration: 5.1 Upon Contractor's completion of services under this Agreement to County's sat;sfaction, payment to Contractor shall be made monthly in accordance with the procedures set forth in Exhibits B and D, after receipt by County of bill,ngs made by Contractor on Provider Claim and Seriice Level Report forms. Format or other changes -nay be made by County to billing and report forms from time to time as needed and shall be furnished to Contractor for bluing and report:ng purposes. All billings and reports shall cieary reflect and in reasonable detail give information regarding the services for which the claim is be ng made, it is understood and agreed that Ccunty may withhold payment until receipt of billings and reports in the prescribed detail and format. Bil Ings and reports shalt be made and forwarded to Cou7,ty promptly at the end of each calendar month in order to reach the Division of Alcohol, Drug & Tobacco Programs, 10 N. San Pedro Rd., # 1013, San Rafael, CA 94903, not later than the 10th day of the month following the month in which the services for which b .ling is made were rendered. Payments received after that date -nay result in a delay in payment until the next monthly billing cyce. The payment for the month of September may be withheld pending receipt of the preceding year's Cost Report on conti^uing services contracts, Fage 12 of 13 5.2 Contractor shall provide County with an annual Cost Report no later than ninety (90) days after the termination of this Agreement. In addition to the annual Cost Report, Contractor shall furnish County, within one hundred and eighty (180) days of close of Contractor fiscal year, a certified copy of an Audit Report from an independent CPA firm. This Audit Report shall cover Contractor's fiscal year which most nearly coincides with County's fiscal year. Contractors receiving federal funds shall comply with Office of Management and Budget (OMB) Circular Number A-133, Uniform Administrative Requirements for Grants and Other Agreements with Institutions of Higher Education, Hospitals, and other Nonprofit Organizations. Cost Report settlements shall be made when a proper Cost Report has been submitted to the County. The findings of the annual Cost Report shall be subject to an audit by County and State. The State of California may make such audits as it deems necessary for the purpose of determining reimbursement due to the County. 6. Nondiscrimination: 6.1 Contractor shall develop and implement policies and procedures that ensure: nondiscrimination in the provision of services based on a diagnosis of Acquired Immune Deficiency Syndrome (AIDS) or AIDS-related Complex (ARC), or upon testing positive for Human immunodeficiency Virus (HIV); the prohibition of the use of HIV antibody testing as a screening criterion for program participation; training of all staff and all participants In AIDS-related problems, issues, and special recovery needs; provision of information to all participants regarding high-risk behaviors, safer sex practices, and perinatal transmission of HIV infection; and development of procedures for addressing the special needs and problems of those individuals who test positive for antibodies to HIV. No individual shall be required to disclose his or her HIV status. Assignability: 7.1 Except as otherwise provided in this section, Contractor shall not subcontract any portion of the performance contemplated and provided for herein without prior written approval of County. Any subcontractor(s), independent Contractor(s) or any type of agent(s) or employees performing or hired to perform any term or condition of this Agreement on behalf of Contractor, (hereinafter referred to as the "Secondary Parties"), as may be allowed by this Agreement, shall comply with and be bound by each term and condition of this Agreement. Furthermore, Contractor shall be responsible for the Secondary Parties acts and satisfactory, performance of the terms and conditions of this Aqreement. 8. Nondiscrimination: 8.1 Contractor and/or any permitted subcontractor, shall not unlawfully discriminate against any individual based on race, religious creed, color, national origin, ancestry, medical condition, marital status, sex, sexual orientation, age; condition of disability, or any statutorily protected status. Contractor and/or any permitted subcontractor understands and agrees that Contractor and/or any permitted subcontractor is bound by and will comply with the nondiscrimination mandates of all Federal, State and local statutes, regulations and ordinances. In the performance of the terms of this Agreement, Contractor shall not discriminate against any employee or applicant for employment, or against anv applicant for or beneficiary of services. because of race. sex, sexual orientation. HIV status, color, religion, ancestrv. national oriain. aae. disability. or anv other statutorily protected status. Contractor shall take affirmative action to ensure that applicants are employed and that employees are treated fairly during employment without regard to their race, sex, sexual orientation, HIV status, color, religion, ancestry, national origin, age, or disability. Such action shall include, but not be limited to, employment, upgrading, demotion or transfer, recruitment or recruitment advertising, lay-off or termination, rates of pay or other forms of compensation, and selection for training, Including apprenticeship. Contractor shall post in conspicuous places, available to employees and applicants for employment, notices setting forth Fair Employment Practices outlined in this section. Contractor shall permit access to its records of employment, employment advertisements, application forms, and other pertinent data and records by the State Fair Employment Practice Commission, or any other agency of the State of California designated by the awarding authority, for the purpose of investigation to ascertain compliance with the Fair Employment Practices section of this Agreement. CONTRACTOR'S COMPLIANCE WITH PROVISIONS OF STATE CONTRACT 9.1 The County receives funding from the California Department of Alcohol and Drug Programs pursuant to an annual contracting arrangement (hereinafter "State Contract"). The State Contract contains certain requirements pertaining to the privacy and security of personally identifiable information (hereinafter "Pll") and/or protected health information (hereinafter "PHI") and requires that the County contractually obligate any of its subcontractors to also comply with these requirements. Contractor hereby agrees to be bound by, and comply with, any and all terms and conditions of the State Contract pertaining to the privacy and/or security of PII and/or PHI, a copy of which is attached to this Agreement as Attachment One, 9.2 Additionally, in the event the State Contract requires the County to notify the State of a breach of privacy and/or security of Fill and/or PHi, Contractor shall, immediately upon discovery of a breach of privacy andior security of Pil andror PHI by Contractor, rnotfy County of such breach by telephone and email or facsimile. Contractor further agrees that it shall notify County of any such breaches prior to the time County is required to notify the State pursuant to the State Contract. 9.3 In the event the State Contract requires the County to pay any costs associated with a breach of privacy and,`or security of PIE and/or PHI, including but not limited to the costs of notification, Contractor shall pay on County's behalf any and all such costs arising out of a breach of privacy and/or security of PII andlor PHi by Contractor. Page 13of'3 COUNTY OF MARIN DIVISION OF ALCOHOL, DRUG & TOBACCO PROGRAMS SIGNATURE AUTHORIZATION FORM FISCAL YEAR 2011/12 AGENCY NAME: Citv of San Rafael EXECUTIVE DIRECTOR: Nancv Mackie (City Mana4er) CHAIRPERSON, BOARD OF DIRECTORS: NAME: (Print or Type) Actinz Chief of Police Jeff Franzini Captain Dave Starnes Lieutenant Ralph Pata Corporal Carl Huber 4ignature) (Print or Type) (Signature) SIGNATURE- - J, This form supersedes and voids all other authorization forms for the agenc} identified above. The EXccuti� e Director or the Chairperson of the Hoard of Directors are the only indi\ iduals authorized to sian contracts between the identified a,enc\ and the Count} of 'Marin. Other indix iduals designated abo\ e are authorized to sign agency invoices on behalf of the Exectititie Director. ASSURANCES REGARDING THE NO UNLAWFUL USE OF DRUGS or ALCOHOL Consistent with the requirements of California Health and Safety Code, Division 10.5, Sections 11999 through 11999.3 (SB 1377), Statutes of 1989, Chapter 1429, and on behalf of the San Rafael Communitv Coalition the undersigned person does hereby assure that: 1. He or she understands the requirements of Section 11 999.2 which states: (a) Notwithstanding any other provision of law, commencing July 1, 1990, no state funds shall be encumbered by a state agency for allocation to any entity, whether public or private, for a drug or alcohol-related program, unless the drug- or alcohol-related program contains a component that clearly explains in written materials that there shall be no unlawful use of drugs or alcohol. No aspect of a drug- or alcohol-related program shall include any message on the responsible use, if the use is unlawful of drugs or alcohol. (b) All aspects of a drug- or alcohol-related program shall be consistent with the "no unlawful use" message, including, but not limited to, program standards, curricula, materials, and teachings. These materials and programs may include information regarding the health hazards of use of illegal drugs and alcohol, concepts promoting the well-being of the whole person, risk reduction, the addictive personality, development of positive concepts consistent with the "no unlawful use" of drugs and alcohol message. (c) The "no unlawful use" of drugs and alcohol message contained in drug- or alcohol- related programs shall apply to the use of drugs and alcohol prohibited by law. (d) This section does not apply to any programs funded by the state that provides education and prevention outreach to intravenous drug users with AIDS or AIDS-related conditions, or persons at risk of HIV -infection through intravenous drug use. 2. He or she has reviewed those aspects of the program to which Section 11999.2 applies, and 3. Those aspects of the program to which Section 11999.2 applies meet the requirements of Section 11999.2 Printed Name: Nancy Maekle Original ;Signature' Citv Manager '.2 Z-// Title Date Note: This form must be signed bx the person responsible for operating a dru- or alcohol-related program. CERTIFICATION OF SMOKING PROHIBITIONS FISCAL YEAR 2011112 City of San Rafael The grantee named above hereby agrees to comply, and require that any subcontractors comply, with Public Law 103-227, also known as the Pro -Children Act of 1994, which requires that smoking not be permitted in any portion of any indoor facility owned or leased or contracted for by an entity and used routinely or regularly for the provision of health, day care, early childhood development services, education, or library services to children under the age of 18 if the services are funded by federal programs either directly or through state or local governments, by federal grant, contract, loan, or loan guarantee. CERTIFICATION I, Nancy Mackle, hereby swear that I am duly authorized legally to bind the contractor or grant recipient to the above described certification. I am fully aware that this certification, executed on the date below, is made under penalty of perjury under the laws of the State of California. Director of Agency or Authorized Signatory: Signature Date Print Name and Title ACKNOWLEDGEMENT OF CONTRACT COMPLIANCE POLICY FISCAL YEAR 2011/12 City of San Rafael As the duly authorized representative of the agency/organization named above, I acknowledge that I have read and understood the Contract Compliance Policy for the Marin County Division of Alcohol, Drug and Tobacco Programs (ADTP). Further, I understand that failure to comply with pny of the reporting requirements will result in a delay of payment, as outlined in the Contract Compliance Policy. It is the provider's responsibility to ensure that all documents are received by ADTP in the timeframe and format prescribed by the County, as outlined in the Provider Reporting Requirements documents. SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE City Manager AGENCY/ORGANIZATION DATE City of San Rafael CERTIFICATION OF COMPLIANCE WITH STRATEGIC PREVENTION FRAMEWORK City of San Rafael The grantee named above hereby agrees to comply, and require that any subcontractors comply, with Prevention Business Practices, as outlined in the California Department of Alcohol and Drug Program's Net Negotiated Amount Contract with the County of Marin, and set forth below. Prevention is defined as strategies, programs and initiatives which reduce both direct and indirect adverse personal, social, health, and economic consequences resulting from problematic alcohol, tobacco, and other drug (ATOD) availability, manufacture, distribution, promotion, sales, and use. The desired result is to promote safe and healthy behaviors and environments for individuals, families, and communities. Not less than 20 percent of the Substance Abuse Prevention and Treatment (SAPT) Block Grant must be spent on "primary prevention" for individuals who do not require treatment for substance abuse as described in the SAPT Block Grant requirements. Inappropriate use of these funds for non -primary prevention services will require repayment of SAPT Block Grant fiends. Contracts will meet data reporting requirements for capacity, process, and outcome as required by federal grant requirements. The data will use the Institute of Medicine prevention categories of universal, selective, and indicated. 1. Universal prevention strategies address an entire population (national, local community, school, workplace, neighborhood), to prevention or delay ATOD use and/or abuse. 2. Selective prevention strategies address an entire subset of the total population that is at higher risk for ATOD use and/or abuse. Indicated prevention strategies are designed to prevent'delay the onset of and.'or reduce severity of substance abuse in individuals who are exhibiting early- signs of substance abuse and associated problem behaviors. Contractor agrees to comply with the follo,,ging prevention business practices in its prei ention acti-\ ities funded under this Contract, and protide evidence of compliance with these practices if requested by State: Assessment of Needs ivith Data: Through the use of data relc\ ant to specific communities, identify at risk and under -served populations and their environmental risks related to alcohol and other drugs. 2. Prioritize and Commit to Purpose: Through local or regional advisory bodies (coalitions), establish prevention priorities for the assessed needs. Provide a sound validation for the selection of priorities; identify the benefits. Provide evidence that identified priorities and desired outcomes are culturally relevant to priority populations. 3. Determine Outcome Objectives and Measurements: Establish the desired goal/desired outcome, objectives, and actions using well-defined terms. Determine the "who, what, where, when and how" that will attain these. Specify how prevention actions will be measured to monitor interim and final results. 4. Proven Prevention Strategies: Select prevention activities/services based on identified theories or practices supported by evaluation/research evidence that substantiates these actions are, or promise to be, effective for attaining the desired outcome. Select or adapt actions to assure they are culturally relevant to the intended populations and communities. Evaluate Measured Results and Improve: Use goal and objective measurements to assess steps toward achieving the desired outcome as well as the final results. Apply this data to continuously refine, strengthen, and sustain the prevention effects. CERTIFICATION I, Nancy Mackle, hereby swear that I am duly authorized legally to bind the contractor or grant recipient to the above described certification. I am fully aware that this certification, executed on the date below, is made under penalty of perjury under the laws of the State of California. Director of Agency or Authorized Signatory: `= _--<_ /V4AI--CY M.46" C. Ac4rv4&;-XX Signature Date Print Name and Title CERTIFICATION OF NON-ACCEPTANCE OF TOBACCO FUNDS FISCAL YEAR 2011/12 City of San Rafael The applicant named above hereby certifies that it will not accept funding from nor have an affiliation or contractual relationship with a tobacco company, and of its subsidiaries or parent company during the term of the grant from the Marin County Office of Alcohol, Drug and Tobacco Programs, CERTIFICATION 1, Nancy Mackle, hereby swear that I am duly authorized legally to bind the contractor or grant recipient to the above described certification. I am fully aware that this certification, executed on the date below, is made under penalty of perjury Linder the laws of the State of California. Director of Agency or Authorized Signatory: Ao'AWC- -/ Al Ar 1<1-,-r e-f'rY AAA"Z:-f4 Signature Date Print Name and Title MARIN COUNTY LIVING WAGE ORDINANCE DE'CLARATION What the Ordinance does. For new, continued, extended or otherwise amended contracts beginning January 1, 2008, the Living Wage Ordinance (L\N'O) requires County contractors and subcontractors to provide the following to their employees covered by the Ordinance on County contracts and Subcontracts for direct services: (I ) wages of at least S 10.05 per hour with health benefits; or (2) the payment of at least SI 1.55 per hour if no health benefits are provided. For in-home support services (IHSS) providers, a living wage of no less than S9.50 per hour with health benefits eligibility applies. These rates will be adjusted annually, effective the I" of each January, to reflect the increase during the preceding year in the Consumer Price Index for all urban consumers in the Sari Francisco -Oakland -San Jose area, as published in October by the U.S. Department of Labor, Bureau of Labor Statistics. New, continued, extended or otherwise amended contracts are required to incorporate the living wage in effect at the time of the contract change. The LWO applies only if you have in excess of $25,000 in cumulative annual business with a County department or departments. The County may require contractors to submit reports on the number of employees affected by the LWO, and may require at any time that contractors furnish to the County far services rendered a certification(s), tinder penalty of perjury, that the contractor and any subcontractor is in full compliance with the provisions of the LWO. Effect on County contracting. For contracts and amendments signed on or after July 1, 2002, the LWO has the following effect: • In each contract, the contractor will agree to abide by the LWO and to provide its employees the minimum benefits the LWO requires, and to require its subcontractors subject to LWO to do the same. • If a contractor does not provide the LWO's minimum benefits, the County can award a contract to that contractor only if the contract is exempt under the LWO, or if the contract has received an approved waiver. The contract will not contain the agreement to abide by the LWO if there is an exemption or waiver on file. What this form does. If you can assure the County that, beginning with the first County contract or amendment you receive after January 1, 2008, and until further notice, you will provide the minimum benefit levels specified in the LWO to your covered employees, and will ensure that your subcontractors also subject to the LWO do the same, this will help the County's contracting process. For more information, (1) see Our Website, including the complete text of tile ordinance: http:/./www.co.mai,in.ca.tis. (2) e-mail us at: deilerman Caco.marin.cams or (3) phone Lis at (415) 499-6358. Routing. Return this form to the County department that sent it to you. Declaration In order to be a certified vendor with the County of Marin, this company will provide, if applicable, the minimum benefit levels specified in the I-VOto our Covered Employees, and will ensure that our subcontractors also subject to the LWO do the same, until further notice. I declare tinder penalty of perjury tinder the laws of the State of California that the above is true and correct. 1")atc r i r t i i n e Compam S* .4,V 1'lhonc 'Y/S"- Fede. a! Fmplon cr ID-- LWO Declaration (01-01-08) San Rafael Community Coalition Staff Member List San Rafael Police Department Employees: Lieutenant Ralph Pata- San Rafael Community Coalition Manager Corporal Carl Huber- San Rafael Community Coalition Coordinator CITY OF SAN RAFAEL NKTM*70' SRRA / SRCC AGENDA ITEM NO DATE OF MEETING: 08-15-11 FROM: Actino Chief Jeff Franzini DEPARTMENT: Police Department DATE: 08-11-11 TITLE OF DOCUMENT: qpptrapt.Service Agree,ment - for.fiscal-near 2011/2012 ' " between.the.Citv of, San.Rafael and"the County=of Mariryfor'the purpose of coordinafina the San Rafael Community Coalition.` CONSIDERATION OF A RESOLUTION APPROVING AND AUTHORIZING THE CITY MANAGER TO EXECUTE A PROFESSIONAL SERVICES AGREEMENT BETWEEN THE COUNTY OF MARIN AND THE CITY OF SAN RAFAEL FOR FISCAL YEAR 2011/2012 FOR SERVICES COORDINATING THE SAN RAFAEL COMMUNITY COALITION FOR THE PREVENTION OF ALCOHOL, TOBACCO, AND OTHER DRUG USE, AND ACCEPTING GRANT FUNDS. Department Head (signature) APPROVED AS COUNCIL / AGENCY AGENDA ITEM: City Manager (signature) APPROVED AS TO FORM: 'j City Attorney (signaturb)