Common use of Human Services Agency’s (HSA) Responsibilities Clause in Contracts

Human Services Agency’s (HSA) Responsibilities. A. Provide technical assistance and support to assist Contractor’s implementation of the County’s OBM initiative; B. Issue and review OBM Implementation Guidelines; and C. Conduct review of performance and outcome information. Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973, as Amended The undersigned (hereinafter called the "Contractor(s)") hereby agrees that it will comply with Section 504 of the Rehabilitation Act of 1973, as amended, all requirements imposed by the applicable DHHS regulation, and all guidelines and interpretations issued pursuant thereto. The Contractor(s) give/gives this assurance in consideration of and for the purpose of obtaining contracts after the date of this assurance. The Contractor(s) recognize/ recognizes and agree/agrees that contracts will be extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the Contractor(s), its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Contractor(s). The Contractor(s): (Check a or b) a. ( ) employs fewer than 15 persons. b. ( ) employs 15 or more persons and, pursuant to Section 84.7 (a) of the regulation (45 C.F.R. 84.7 (a)), has designated the following person(s) to coordinate its efforts to comply with the DHHS regulations. Name of 504 Person – Type or Print Name of Contractor(s) Type or Print Street Address or P.O. Box City State Zip Code I certify that the above information is complete and correct to the best of my knowledge *Exception: DHHS regulations state that: "If a recipient with fewer than 15 employees finds that, after consultation with a handicapped person seeking its services, there is no method of complying with (the facility accessibility regulations).other than making a significant alteration in its existing facilities, the recipient may, as an alternative, refer the handicapped person to other providers of those services that are accessible."

Human Services Agency’s (HSA) Responsibilities. A. Provide technical assistance and support to assist Contractor’s implementation of the County’s OBM initiative; B. Issue and review OBM Implementation Guidelines; and C. Conduct review of performance and outcome information. Assurance of Compliance with Section § 504 of the Rehabilitation Act of 1973, as Amended (Fee For Service Agreement) The undersigned (hereinafter called the "Contractor(s)") hereby agrees that it will comply with Section § 504 of the Rehabilitation Act of 1973, as amended, all requirements imposed by the applicable DHHS regulation, and all guidelines and interpretations issued pursuant thereto. The Contractor(s) givegives/gives give this assurance in consideration of and for the purpose of obtaining contracts after the date of this assurance. The Contractor(s) recognize/ recognizes recognizes/recognize and agreeagrees/agrees agree that contracts will be extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the Contractor(s), its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Contractor(s). The Contractor(s): (Check a or b) ) a. ( ) employs Employs fewer than 15 persons. persons b. ( ) employs Employs 15 or more persons and, pursuant to Section section 84.7 (a) of the regulation (45 C.F.R. 84.7 (a)), has designated the following person(s) to coordinate its efforts to comply with the DHHS regulations. Name of § 504 Person – - Type or Print Women's Recovery Association 0000 Xxxxxx Xxx 1st floor Burlingame, CA 94010 Name of Contractor(s) Type – type or Print Street Address or P.O. Box City State Zip Code I certify that the above information is complete and correct to the best of my knowledge knowledge. *Exception: DHHS regulations state that: "If a recipient with fewer than 15 employees finds that, after consultation with a handicapped disabled person seeking its services, there is no method of complying with (the facility accessibility regulations).other regulations)...other than making a significant alteration in its existing facilities, the recipient may, as an alternative, refer the handicapped person to other providers of those services that are accessible." A. In accordance with the Child Abuse Prevention and Reporting section of this Agreement, Contractor agrees as follows: Each applicant for employment or a volunteer position at Contractor’s program who will have a supervisory or disciplinary power over a minor or any person under his or her care will be fingerprinted in order to determine whether they have a criminal history which would compromise the safety of such minor(s) or person(s) under his or her care. (Penal Code 11105.3(a), as amended in 1990 by AB 2617). All fingerprinting will be at Contractor’s sole expense. B. The fingerprinting process will be completed and the results of the process will be obtained before any of Contractor’s employees, subcontractors, assignees or volunteers are assigned or permitted to work at the program. Alternatively, the Contractor may set a hire date prior to obtaining fingerprinting results contingent on the applicant certifying that: (1) his or her employment application truthfully and completely discloses whether he or she has ever been convicted of a felony or misdemeanor or been on parole or probation and (2) that the applicant understands that a background check will be conducted, and that he or she will be dismissed from employment immediately if he or she has failed to provide information regarding convictions, has provided incomplete information regarding convictions, has omitted information regarding conviction, or if the fingerprinting results reveal any conviction incompatible with this employment. C. Contractor will maintain, and will make available to County upon request, a written fingerprint certification for each applicant for employment or a volunteer position at the program for whom fingerprinting is required. Such certification shall state that the individual has been fingerprinted, that the process has disclosed no criminal history on the part of the individual which would compromise the safety of persons with whom that individual has contact. Fingerprint information received from the Department of Justice (DOJ) will be retained or disposed of pursuant to DOJ directive. Name (Signature) Contractor will provide the following HIV/AIDS services which are part of all Contractors basic alcohol and drug treatment program(s): A. Contractor’s program directors will attend administrator training provided jointly by the San Mateo County AIDS Program and the Human Services Agency’s Alcohol and Drug Services, or equivalent training designed specifically for administrators of alcohol and/or drug treatment programs and approved by the Alcohol and Drug Services Administrator. B. Contractor’s staff will attend a minimum of two hours of HIV update training specifically designed for counselors in alcohol and drug recovery programs. This requirement may be met by attendance at the San Mateo County AIDS Program in-service for alcohol and drug treatment staff, or equivalent training approved by the Alcohol and Drug Services Administrator. 75% of Contractor’s staff will receive this training. C. Contractor will make available to each program participant (and families as appropriate) individual HIV/AIDS as a recovery issue, risk assessment and prevention education, culturally sensitive materials and necessary knowledge and skills for attitude and behavior change. Contractor must have up-to-date information readily available for participants on HIV testing and counseling, needle exchange programs and written information on HIV/AIDS and Hepatitis A, B and C. Contractor must also make access to condoms available to all program participants. D. Contractor will consult with San Mateo County AIDS Program to determine the best way for the AIDS Program, or Contractor’s staff trained by the AIDS Program, to deliver HIV/AIDS group education to program participants. HIV/AIDS group education for participants will occur monthly for two hours, with participant attendance expected. Group education will be designed with recovery as a focus, and will include culturally sensitive materials, and necessary knowledge and skills for attitude and behavior change. E. Contractor will coordinate with the Alcohol and Drug Services Administrator, and San Mateo County AIDS Program to develop a plan for either on-site or easy access to HIV antibody testing including phlebotomy, for program participants through County AIDS Program HIV testing services. HIV antibody testing and counseling will be conducted according to California State Law including HIV testing/AIDS confidentiality laws, and California State Office of AIDS guidelines by certified HIV counselors.

Human Services Agency’s (HSA) Responsibilities. A. Provide technical assistance and support to assist Contractor’s implementation of the County’s OBM initiative; B. Issue and review OBM Implementation Guidelines; and C. Conduct review of performance and outcome information. Assurance of Compliance with Section § 504 of the Rehabilitation Act of 1973, as Amended (Fee For Service Agreement) The undersigned (hereinafter called the "Contractor(s)") hereby agrees that it will comply with Section § 504 of the Rehabilitation Act of 1973, as amended, all requirements imposed by the applicable DHHS regulation, and all guidelines and interpretations issued pursuant thereto. The Contractor(s) givegives/gives give this assurance in consideration of and for the purpose of obtaining contracts after the date of this assurance. The Contractor(s) recognize/ recognizes recognizes/recognize and agreeagrees/agrees agree that contracts will be extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the Contractor(s), its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Contractor(s). The Contractor(s): (Check a or b) ) a. ( ) employs Employs fewer than 15 persons. persons b. ( ) employs Employs 15 or more persons and, pursuant to Section section 84.7 (a) of the regulation (45 C.F.R. 84.7 (a)), has designated the following person(s) to coordinate its efforts to comply with the DHHS regulations. Name of § 504 Person – - Type or Print Sitike Counseling Center 000 Xxxxxx Xxxxxx South San Francisco, CA 94080 Name of Contractor(s) Type – type or Print Street Address or P.O. Box City State Zip Code I certify that the above information is complete and correct to the best of my knowledge knowledge. *Exception: DHHS regulations state that: "If a recipient with fewer than 15 employees finds that, after consultation with a handicapped disabled person seeking its services, there is no method of complying with (the facility accessibility regulations).other regulations)...other than making a significant alteration in its existing facilities, the recipient may, as an alternative, refer the handicapped person to other providers of those services that are accessible." A. In accordance with the Child Abuse Prevention and Reporting section of this Agreement, Contractor agrees as follows: Each applicant for employment or a volunteer position at Contractor’s program who will have a supervisory or disciplinary power over a minor or any person under his or her care will be fingerprinted in order to determine whether they have a criminal history which would compromise the safety of such minor(s) or person(s) under his or her care. (Penal Code 11105.3(a), as amended in 1990 by AB 2617). All fingerprinting will be at Contractor’s sole expense. B. The fingerprinting process will be completed and the results of the process will be obtained before any of Contractor’s employees, subcontractors, assignees or volunteers are assigned or permitted to work at the program. Alternatively, the Contractor may set a hire date prior to obtaining fingerprinting results contingent on the applicant certifying that: (1) his or her employment application truthfully and completely discloses whether he or she has ever been convicted of a felony or misdemeanor or been on parole or probation and (2) that the applicant understands that a background check will be conducted, and that he or she will be dismissed from employment immediately if he or she has failed to provide information regarding convictions, has provided incomplete information regarding convictions, has omitted information regarding conviction, or if the fingerprinting results reveal any conviction incompatible with this employment. C. Contractor will maintain, and will make available to County upon request, a written fingerprint certification for each applicant for employment or a volunteer position at the program for whom fingerprinting is required. Such certification shall state that the individual has been fingerprinted, that the process has disclosed no criminal history on the part of the individual which would compromise the safety of persons with whom that individual has contact. Fingerprint information received from the Department of Justice (DOJ) will be retained or disposed of pursuant to DOJ directive. Name (Signature) Contractor will provide the following HIV/AIDS services which are part of all Contractors basic alcohol and drug treatment program(s): A. Contractor’s program directors will attend administrator training provided jointly by the San Mateo County AIDS Program and the Human Services Agency’s Alcohol and Drug Services, or equivalent training designed specifically for administrators of alcohol and/or drug treatment programs and approved by the Alcohol and Drug Services Administrator. B. Contractor’s staff will attend a minimum of two hours of HIV update training specifically designed for counselors in alcohol and drug recovery programs. This requirement may be met by attendance at the San Mateo County AIDS Program in-service for alcohol and drug treatment staff, or equivalent training approved by the Alcohol and Drug Services Administrator. 75% of Contractor’s staff will receive this training. C. Contractor will make available to each program participant (and families as appropriate) individual HIV/AIDS as a recovery issue, risk assessment and prevention education, culturally sensitive materials and necessary knowledge and skills for attitude and behavior change. Contractor must have up-to-date information readily available for participants on HIV testing and counseling, needle exchange programs and written information on HIV/AIDS and Hepatitis A, B and C. Contractor must also make access to condoms available to all program participants. D. Contractor will consult with San Mateo County AIDS Program to determine the best way for the AIDS Program, or Contractor’s staff trained by the AIDS Program, to deliver HIV/AIDS group education to program participants. HIV/AIDS group education for participants will occur monthly for two hours, with participant attendance expected. Group education will be designed with recovery as a focus, and will include culturally sensitive materials, and necessary knowledge and skills for attitude and behavior change. E. Contractor will coordinate with the Alcohol and Drug Services Administrator, and San Mateo County AIDS Program to develop a plan for either on-site or easy access to HIV antibody testing including phlebotomy, for program participants through County AIDS Program HIV testing services. HIV antibody testing and counseling will be conducted according to California State Law including HIV testing/AIDS confidentiality laws, and California State Office of AIDS guidelines by certified HIV counselors.

Human Services Agency’s (HSA) Responsibilities. A. Provide provide technical assistance and support to assist Contractor’s implementation of the County’s OBM initiative; B. Issue issue and review OBM Implementation Guidelines; and C. Conduct conduct review of performance and outcome information. All payments under this agreement must directly support services specified in this Agreement. Service Modality Authorized Contract Amount Monthly Amount Authorized Units – Staff Available Hours (SAH) or Bed Days (BD) Authorize d Unit Rate NNA Funded Post Detox Residential Detox Services $79,178 $6,598.17 730 BD $108.46 NNA Funded Residential Detox Services $484,940 $40,411.67 4,471 BD $108.46 Total Maximum Contract Obligation $564,118 Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973, as Amended The undersigned (hereinafter called the "Contractor(s)") hereby agree/agrees that it will comply with Section 504 of the Rehabilitation Act of 1973, as amended, all requirements imposed by the applicable DHHS regulation, and all guidelines and interpretations issued pursuant thereto. The Contractor(s) give/gives this assurance in consideration of and for the purpose of obtaining contracts after the date of this assurance. The Contractor(s) recognize/ recognizes and agree/agrees that contracts will be extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the Contractor(s), its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Contractor(s). The Contractor(s): (Check a or b) a. ( ) employs fewer than 15 persons. b. ( ) employs 15 or more persons and, pursuant to Section 84.7 (a) of the regulation (45 C.F.R. 84.7 (a)), has designated the following person(s) to coordinate its efforts to comply with the DHHS regulationsregulation. Name of 504 Person – Type or Print Name of Contractor(s) Type or Print Street Address or P.O. Box City State X.X. Xxx Xxxx Xxxx, XX 00000 Xxxx Xxxxx Zip Code I certify that the above information is complete and correct to the best of my knowledge *Exception: DHHS regulations state that: "If a recipient with fewer than 15 employees finds that, after consultation with a handicapped person seeking its services, there is no method of complying with (the facility accessibility regulations).other regulations) other than making a significant alteration in its existing facilities, the recipient may, as an alternative, refer the handicapped person to other providers of those services that are accessible."" L:\CLIENT\H_DEPTS\HSA\DRUG\Flat Rate Treatment & Prevention Attachments\ATTACH 1 - A FLAT- Section 504 05-12- 05.doc A. In accordance with the Child Abuse Prevention and Reporting section of this Agreement, Contractor agrees as follows: Each applicant for employment or a volunteer position at Contractor’s program who will have a supervisory or disciplinary power over a minor or any person under his or her care will be fingerprinted in order to determine whether they have a criminal history which would compromise the safety of such minor(s) or person(s) under his or her care. (Penal Code 11105.3(a), as amended in 1990 by AB 2617). All fingerprinting will be at Contractor’s sole expense. B. The fingerprinting process will be completed and the results of the process will be obtained before any of Contractor’s employees, subcontractors, assignees or volunteers are assigned or permitted to work at the program. Alternatively, the Contractor may set a hire date prior to obtaining fingerprinting results contingent on the applicant certifying that: (1) his or her employment application truthfully and completely discloses whether he or she has ever been convicted of a felony or misdemeanor or been on parole or probation, and (2) that the applicant understands that a background check will be conducted, and that he or she will be dismissed from employment immediately if he or she has failed to provide information regarding convictions, has provided incomplete information regarding convictions, has or omitted information regarding convictions, or if the fingerprinting results reveal any conviction incompatible with this employment. C. Contractor will maintain, and will make available to County upon request, a written fingerprint certification for each applicant for employment or a volunteer position at the program for whom fingerprinting is required. Such certification shall state that the individual has been fingerprinted, that the process has disclosed no criminal history on the part of the individual which would compromise the safety of persons with whom that individual has contact. Fingerprint information received from the Department of Justice (DOJ) will be retained or disposed of pursuant to DOJ directive. Name (Signature) Date L:\CLIENT\H_DEPTS\HSA\DRUG\Flat Rate Treatment & Prevention Attachments\ATTACH 2 - FLAT-FINGER PRINTING 05-12-05.doc I. Contractor will provide the following HIV/AIDS services which are part of all Contractors basic alcohol and drug treatment program(s): A. Contractor’s staff will attend a minimum of two (2) hours of HIV update training specifically designed for counselors in alcohol and drug recovery programs. This requirement may be met by attendance at the San Mateo County AIDS Program in-service for alcohol and drug treatment staff, or equivalent training approved by the AIDS program monitor. Seventy-five percent (75%) of Contractor’s staff will receive this training. B. Contractor will make available to each program participant (and families as appropriate) individual HIV/AIDS as a recovery issue, risk assessment and prevention education, culturally sensitive materials, and necessary knowledge and skills for attitude and behavior change. Contractor must have up-to-date information readily available for participants on HIV testing and counseling, needle exchange programs and written information on HIV/AIDS and Hepatitis A, B, C and Sexually Transmitted Diseases (STD). Contractor must also make access to condoms available to all program participants. C. Contractor will consult with San Mateo County AIDS Program to determine the best way for the AIDS Program, or Contractor’s staff trained by the AIDS Program, to deliver HIV/AIDS group education to program participants. HIV/AIDS group education for participants will occur monthly for two (2) hours, with participant attendance expected. Group education will be designed with recovery as a focus, and will include culturally sensitive materials, and necessary knowledge and skills for attitude and behavior change. D. Contractor will coordinate with the Alcohol and Drug AIDS program monitor, and San Mateo County AIDS Program to develop a plan for either on-site or easy access to HIV antibody testing including phlebotomy, for program participants through County AIDS Program HIV testing services. HIV antibody testing and counseling will be conducted according to California State Law including HIV testing/AIDS confidentiality laws, and California State Office of AIDS guidelines by certified HIV counselors. L:\CLIENT\H_DEPTS\HSA\DRUG\Flat Rate Treatment & Prevention Attachments\ATTACH 3 - Treatment only Flat HIV AIDS 05-12-05.doc

Human Services Agency’s (HSA) Responsibilities. A. Provide technical assistance and support to assist Contractor’s implementation of the County’s OBM initiative; B. Issue and review OBM Implementation Guidelines; and C. Conduct review of performance and outcome information. Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973, as Amended The undersigned (hereinafter called the "Contractor(s)") hereby agrees that it will comply with Section 504 of the Rehabilitation Act of 1973, as amended, all requirements imposed by the applicable DHHS regulation, and all guidelines and interpretations issued pursuant thereto. The Contractor(s) give/gives this assurance in consideration of and for the purpose of obtaining contracts after the date of this assurance. The Contractor(s) recognize/ recognizes and agree/agrees that contracts will be extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the Contractor(s), its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Contractor(s). The Contractor(s): (Check a or b) a. ( ) employs fewer than 15 persons. b. ( ) employs 15 or more persons and, pursuant to Section 84.7 (a) of the regulation (45 C.F.R. 84.7 (a)), has designated the following person(s) to coordinate its efforts to comply with the DHHS regulations. Name of 504 Person – Type or Print Name of Contractor(s) Type or Print Street Address or P.O. Box City State Zip Code I certify that the above information is complete and correct to the best of my knowledge Date Signature and Title of Authorized Official *Exception: DHHS regulations state that: "If a recipient with fewer than 15 employees finds that, after consultation with a handicapped person seeking its services, there is no method of complying with (the facility accessibility regulations).other than making a significant alteration in its existing facilities, the recipient may, as an alternative, refer the handicapped person to other providers of those services that are accessible."