Loading...
HomeMy WebLinkAbout00-100. L P.:.. r - _ .,. s 7 00-100 RESOLUTION AUTHORIZING THE CHIEF PROBATION OFFICER TO EXECUTE 2000-01 VICTIMfWITNESS PROGRAM GRANT EXTENSION WHEREAS, the County of Butte desires to continue a certain project designated the Butte County Victim/Winless Assistance Program to receive Joint Powers money for the purpose of verification of the victim claims, The State Board of Control has allocated $141,612 for the fiscal year 2000-01 for this specific task. NOW, THEREFORE, BE IT RESOLVED that the Chief Probation Officer is authorized on behalf of the County of Butte to sign the attached agreements for the Joint Powers money with the State Board of Control for the Victin~/Witness Program and is authorized to sign for the purposes including any extensions or amendments thereof; and BE, IT FURTHER RESOLVED that the state funds received thereLmder shall not be used to supplant local funds that would in the absence of the California VictimlWimess Program he made available to support the assistance of victims and witnesses of crime. PASSED AND ADOPTED, by the Butte County Board of Supervisors this 8th day of August 2000 by the following vote: AYES: Supervisors Beeler, Houx, Josiassen, Davis and Chair Dolan NOES: None ABSENT: None NOT VOTING: None ,-' ~ ~ -- JANE DOLAN Chair, Board of Supervisors ATTEST: JOHN S. BLACKLOCK, Chief Administrative Officer and Clerk of the Board of Supervisors .~ ~: ~ ... deputy ~ STATE OF CALIFORNIA ,hi -~ ; APPROVED BY THE CONTRACT NO . ` AM. NO ;'' STANDARD AGREEMENT - ATTORNEY GENERAL BOC - 0045 sro z tRevsoot TAXPAYERS FEDERAL EMPLOYER IDENTIFICATION NO THI5 AGREEMENT, made and entered into this ~ St day of JUIy 20 00 , in the State of California, by and between State of California, through its duly elected or appointed, qualified and acting TITLE OF OFFICER ACTING FOR STATE DEPUTY EXECUTIVE OFFICER AGENCY STATE BOARD OF CONTROL CONTRACTOR'S NAME County Of Butte hereinafter called the State, and hereinafter called the Contractor, WITNESSETH: That the Contractor for and in consideration of the covenants, conditions, agreements, and stipulations of the State herein expressed, does hereby agree to furnish to the State services and materials as follows: (Set forth service to be rendered by Contractor, amount to be paid Contractor, time for performance or completion, and attach plans and specifications, if any). This agreement is entered into by and between the State Board of Control, Victims of Crime Division, an agent of the State of California, hereinafter referred to as the BOARD and the County of Butte ,' a county and political subdivision of the State of California, hereinafter referred to as the COUNTY, which is operating a designated Victim Witness Assistance Center, hereinafter referred to as the CENTER, for the purpose of verifying and submitting claims for the unreimbursed financial losses of victims of crime in accordance with the specification contained herein. CONTINUED ON SHEETS, EACH BEARING THE NAME OF CONTRACTOR AND CONTRACT NUMBER. The provisions on the reverse side hereof constitutes a part of this agreement. IN WITNESS WHEREOF, this a reement has been executed b the arties herein, u on the date first above written. _ STATE OF CALIFORNIA CONTRACTOR aGENCY 3Y {AUTHORIZED SIGNATURE} PRINTED NAME OF PER: KELLY J. BRODIE _XECUTIVE OFFICER BY (AUTHORIZED SIGNATUR PRINTED NAME AND TITLE Helen Harberts, Chief Probation Officer ADDRESS 2279-C DeI Oro Ave., Oroville, CA 95965 +MDUNT ENCUMBERED BV THIS 3000MENT PROGRAMICATEGORY (CODE ANO TITLE) FUND TITLE Department of Genera) Services tJse Only l b i ~ (OPTIONAL USE) PRIOR AMOUNT ENCUMBERED OR THIS CONTRACT ITEM CHAPTER STATUTE FISCAL YEAR ~OTAL AMOUNT ENCUMBERED "0 DATE ~141,b13 OBJECT OF EXPENDITURE (CODE AND TITLE) hereby certify upon my own personal knowledge that budgeted funds are available for the period and purpose of the expenditure stated above T B a NO e. R. NO. i!GNATURE OF ACCOUNTING OFFICER DATE other than individual, state whether a corporation, partnership, etc}. ~ CONTRACTOR ^ STATE AGENCY ^ DEPT. OF GEN.SVCS ^ CONTROLLER ^ Butte July 1, 2000 Page 1 2. EXHIBITS The following exhibits, attached hereto, are incorporated into this Agreement. A. Exhibit A, Verification Specifications B. Exhibit B, Non-Discrimination Clause C. Exhibit C, Budget Worksheet D. Exhibit D, Drug-Free Workplace Certification E. Exhibit E, Monthly Claims Processing Staff Utilization Report F. Exhibit F, Accuracy Rate Report G. Exhibit G, JP Crime/Claim Notification Sheet H. Exhibit H, Overpayment Determination Summary I. Exhibit I, Civil Suit Lien Worksheet J. Exhibit J, Workers' Compensation Lien Worksheet K. Exhibit K, Auto Insurance Worksheet L. Exhibit L, Approved Travel Reimbursement M. Exhibit M, Sample Resolution 3. TIME OF PERFORMANCE The Term of this Agreement shall be July 1, 2000 through June 30, 2001. 4. COMPENSATION: A. The total amount of this Agreement shall not exceed $141,613. The GOUNTY or the CENTER will be paid by the BOARD out of funds from the Restitution Fund. Any payments shall be contingent upon the availability of Restitution Funds. Any funds paid shall not be a charge upon any Federal monies or State General Fund monies. Funds provided under this Agreement are not to supplement existing services to victims and shall not be used to supplant those currently provided by county funds, or grants administered by the Office of Criminal Justice Planning. B. The BOARD reserves the right to withhold payment of the final invoice amount from the COUNTY or the CENTER until the final year-end closeout statement, as required by Paragraph 11 c, is processed by the BOARD. 5. APPROPRIATION OF FUNDS Payment for services from July 1, 2000, through June 30, 2001 is contingent upon the appropriation of funds for payment of this service. If such appropriation is not made, the BOARD shall be relieved of any payment for services provided during that. period. If during the term of this Agreement, the State funds appropriated for the purpose of this Agreement are terminated, suspended, discontinued or reduced by the California Legislature, the BOARD may immediately terminate this Agreement by written notice to the COUNTY or the CENTER. Butte July 1, 2000 Page 2 6. SERVICES: A. The COUNTY or the CENTER shall submit to the BOARD completed application and bill verifications in accordance with Exhibit A, Verification Specifications. B. The Board reserves the right to redirect workload from either the Board or a COUNTY or GENTER to another COUNTY or CENTER. C. The COUNTY or the CENTER must "date-stamp" applications and bills with the date that the applications and bills are received by the COUNTY or the CENTER and must enter the "date-stamps date into the VOX system as the JP received date. 7. PERFORMANCE ASSESSMENT The BOARD shall reimburse the COUNTY or the CENTER for actual expenses incurred, not to exceed the amount of the contract. The BOARD shall assess/evaluate the COUNTY's or the CENTER's performance in a manner consistent with those assessments/evalutions currently in place for the BOARD's claims processing staff. The COUNTY or the CENTER shall submit, by the fifth calendar day of each month, information regarding the prior month's claim processing activity as required by the Monthly Claims Processing Staff Utilization Report (Exhibit E). Based upon this data, the BOARD will summarize the COUNTY's or the CENTER's claim processing performance. A. Performance criteria will be provided by the BOARD to coincide with the standards used by the BOARD. B. The COUNTY or the CENTER shall provide accuracy rate reports {Exhibit F) for each claim processing employee and for all claim processing employees, by the fifth {5 } of each month. This information shall be derived from the results of the Quality Review Checklist reviews conducted by the COUNTY ar CENTER supervisors or lead claim processors. C. The COUNTY or the CENTER shall forward both reports {Monthly Claims Processing Staff Utilization Report and the Accuracy Rate Report ,Exhibits E and F respectively) by fax, to the VOC Manager. D. The BOARD shall provide reports of the COUNTY's or the CENTER's performance to the District Attorney, the Chief Probation Officer ar the Executive Officer. Butte July 1, 2000 Page 3 BASIS FOR PAYMENT: For satisfactory performance of the work as noted in paragraph seven (7), the BOARD shall reimburse the COUNTY or the CENTER an amount equal to actual costs incurred in performance of this agreement and as set forth in Exhibit C. In no event, shall the total amount payable under this agreement exceed the total set forth in Paragraph 4. 9. JOB-REQUIRED MEETINGS/TRAININGS The BOARD will reimburse salaries, benefits and travel costs for Joint Power staff to attend job-required meetings or training. These costs must be absorbed within the maximum contract amount. Job required meetings/training include: A. Up to four weeks of manual verification and VOX training in Sacramento for new claims verification staff and/or B. Training on the BOARD's computer system, VOX, to learn new activities that may became available. C. Any training mandated by the Board including claims manual verification training. D. Re-training for staff who require improvement in their job performance. E. Job required meetings (i.e., coordinator meetings, supervisor meetings). F. Regional meetings for claims processing staff. 10. PERSONNEL SERVICES & WORKLOAD The COUNTY or the CENTER must obtain written authorization prior to filling new positions and/or vacancies or prior to changing the time base of existing positions even though funding was previously requested and made part of the budget (Exhibit C-1 ). Approval for filling the new/vacant positions will be based on the BOARD's review of the COUNTY or the CENTER's workload. Written requests should be addressed to the COUNTY'S or the CENTER's VOC Manager, State Board of Control, P. O. Box 3036, Sacramento, CA 95814-3036, with a copy to Skip Ellsworth, Manager, State Board of Control, Administration Division, P. O. Box 48, Sacramento, CA 95814. Butte July 1, 2000 Page 4 11. INVOICING: The COUNTY or the CENTER shall provide a detailed invoice monthly as set forth in Exhibit C-1. A. The Joint Powers Agreement invoice should be submitted to the BOARD at the address below within forty-five (45) calendar days after the end of the month billed. The COUNTY or the CENTER will be assessed five percent (5%) of the billed amount that an invoice is submitted to the BOARD beyond the forty-five(45) calendar day timeframe after the end of the invoice month. Attn: Bettzan Mar State Board of Control P. O. Box 48 Sacramento, Ca 95812-0048 B. Payment shall be made monthly in arrears upon receipt and approval of the invoices noted above. To allow the Board to adequately administer its budget, the COUNTY or the CENTER shall notify the Board if/why they are unable to submit invoices within forty-five (45} calendar days after the end of the invoice month. Notification should be signed by the signatory of the contract. C. The COUNTY or the CENTER shall submit a final year-end closeout invoice within sixty (60) calendar days after June 30, 2001. The final reimbursement to the COUNTY or the CENTER shall be contingent upon the receipt of this closeout invoice by the BOARD. 12. MOVING: A. The COUNTY or the CENTER must obtain written authorization from the BOARD prior to modifying existing spacelaccommodations and/or relocating operations to a new facility. The request should include the date of the move, the square footage of the new location, the cost per square foot, and the cost of relocation. In addition, the COUNTY or the CENTER should reflect the pro-ration of expenses between the Board and the Office of Criminal Justice Planning where the space is being shared. B. Due to the time required to relocate computer terminals far the VOX claims processing system, the COUNTY or CENTER must provide a sixty (60) calendar day notification to the following address of any planned move to the COUNTY's or the CENTER's appropriate VOC Manager, State Board of Control, P. O. Box 3036, Sacramento, Ca 95814-3036. Notification of relocation must include the new address, including room number and the name, title, address, and phone number of a contact person who is responsible for telephone line and computerlelectrical cable installation. This advance notice Butte July 1, 2000 Page 5 must be given to enable the BOARD to make necessary arrangements to relocate equipment. Relocation of computer terminals must be approved in writing by the BOARD prior to the actual move. The COUNTY or the CENTER will be reimbursed by the BOARD for expenses incurred as a result of the relocation exce t for cabling costs). 13. ADMINISTRATION OF AGREEMENT: The BOARD's Contract Liaison shall be Bettzan Mar, telephone number: (916) 327-5188; and the BOARD's Audit Manager, telephone number: (916) 445-2580 for questions related to financial audits. - The COUNTY's contact person shall be: Name: Larry Dunn Title: Program Coordinator Phone No: (530) 538-7976 14. REGULATIONS AND GUIDELINES: All parties agree to be bound by all applicable Federal and State laws and regulations and BOARD guidelines/directives/memos as they pertain to the performance of the Agreement. 15. DISPUTE RESOLUTION: In the event of a dispute between the parties over any part of this Agreement, the dispute may be submitted to the Executive Officer of the BOARD. Submission of a dispute to the Executive Officer pursuant to this provision shall not preclude either party from pursuing any remedy or relief otherwise available. 16. CHANGES IN AGREEMENT AMOUNT: The BOARD reserves the right to reduce the Agreement amount if the BOARD's fiscal monitoring indicates that the COUNTY or the CENTER'S rate of expenditure will result in unspent funds at the end of the program year. Changes in this Agreement will be made after consultation with the COUNTY or the CENTER. Such changes shall be incorporated into this Agreement upon written notice to the COUNTY or the CENTER from the BOARD. Butte July 1, 2000 Page 6 17. AUDIT PROGRAM EVALUATION AND MONITORING PROVISIONS: A. AUDIT PROVISIONS: The BOARD is responsible for performing any audits} of the expenditures. Therefore, no audit costs can be charged to the contract for reimbursement. The COUNTY and/or CENTER shall have available all records which support expenses charged to the contract including, but not limited to, payroll registers, time sheets, purchase orders, purchase estimates, receiving reports, and appropriation ledgers. These records are subject to examination and audit by the State for a period of three years beyond the date of the final payment. If an audit is forthcoming, the BOARD will notify the COUNTY and/or CENTER at least 30 calendar days in advance of the dates of the audit. B. PROGRAM EVALUATION AND MONITORING: The COUNTY or the CENTER shall make available to the BOARD, and their representatives, far purposes of inspection and review, any and all of its books, papers, documents, financial and other records pertaining to the operation of this Agreement. The aforesaid records shall be available for inspection and review during regular business hours throughout the term of this Agreement, and for a period of three (3} years after the expiration of the term of this Agreement. The COUNTY or the CENTER shall permit the BOARD, and their authorized representatives, to inspect and review its facilities and claims verification operation from time to time as may be requested by the BOARD. Said representatives may monitor the operation of this Agreement to assure compliance with all applicable Federal and State laws and BOARD regulations and guidelines. In the event that any such inspection reveals violation of any provision of this Agreement, and the COUNTY or the CENTER fails to correct any such violation to the satisfaction of the BOARD, the BOARD may unilaterally terminate this Agreement by giving the COUNTY or the CENTER thirty (30} calendar days written notice of such termination. 18. EQUIPMENT: The following equipment will be provided and/or reimbursed by the BOARD: A. Costs for providing electronic data processing (EDP) input and output devices, with software, including monthly maintenance fee and installation, as deemed necessary by the BOARD shall be provided and/or reimbursed by the BOARD. B. Capitalized assets needed/purchased for the claims verification process, are to be fully set forth in Exhibit C and paid for from Agreement funds. Butte July 1, 2000 Page 7 Acquisition of any/all equipment {capitalized assets}, including "modular furniture", must be approved by the Board in writing prior to actual purchases being made even though funding was previously requested and made part of the budget {Exhibit C). Without prior written approval, the COUNTY or the CENTER may be required to absorb the cost(s). Requests for equipment should be addressed to Skip Ellsworth, Manager, State Board of Control, Administration Division, P. O. Box 48, Sacramento, CA 95814 with a copy to the COUNTY or the CENTER's VOC Manager, State Board of Control, P. O. Box 3036, Sacramento, CA 95814-3036. 19. OPERATING EXPENSES: Operating expenses shall be fully set forth in Exhibit C and may be reimbursed by the BOARD. The COUNTY or the CENTER must submit, upon request, to Skip Ellsworth, Manager, Financial and Business Operations Section, an indirect cost allocation plan which demonstrates how the rate was established. This plan must clearly indicate that line items charged to a direct cost category (e.g., "Postage") are NOT included in the indirect cost category. Ali costs included in the plan must be supported by formal accounting records which substantiate the propriety of eventual charges. Further, the COUNTY or the CENTER must obtain written approval prior to anyiall modifications being made to the line items under the operating expense category such as an increase to rent or offsetting savings from one line-item to another. Requests should be directed to Skip Ellsworth, Manager, Financial and Business Operations Section, with a copy to the VOC Manager. 20. INVENTORY: EDP equipment, capitalized assets and non-capitalized assets, shall remain the property of the BOARD and shall bear identification tags supplied by the BOARD. The COUNTY or the CENTER shall prepare an inventory listing as of June 30, 2001, on forms provided by the BOARD, and submit the list to Skip Ellsworth, Manager, Financial and Business Operations Section. In the event of termination of this Agreement, those identified items shall revert to the BOARD. The COUNTY or the CENTER must hold any/all items identified in the inventory list in storage for forty-five (45) calendar days from the date of termination or until the BOARD retrieves its property. Payment of storage and retrieval shall be the responsibility of the BOARD. 21. TERMINATION AND TERMINATION COSTS: This Agreement may be terminated at any time by either the BOARD ar the COUNTY or the CENTER upon thirty (30} calendar days notice in writing to the other party. In such Butte July 1, 2000 Page 8 event, the COUNTY or the CENTER shall be compensated for claim verification costs performed in accordance with the~terms of this Agreement that have not been previously reimbursed, to the date of said termination to the extent Restitution Funds are available. Payment shall be made only upon filing with the BOARD, by the COUNTY or the CENTER, vouchers evidencing the time expended and the said costs incurred. In addition, the BOARD will reimburse the COUNTY or the CENTER for the costs of reasonable expenses. to close down the program as determined by the BOARD. Said vouchers must be filed with the BOARD within thirty (30) calendar days of the date of said termination. 22. SEPARATE VERIFICATION STAFF: Each COUNTY or CENTER shall have verification staff to provide the services required in paragraph six (6}, which are separate from staff performing other functions of the COUNTY or the CENTER unless the COUNTY or the CENTER has requested and received a written waiver of this condition. 23. HOLD HARMLESS: The COUNTY and the CENTER agree to defend, save, indemnify and hold harmless the BOARD, its agents, officers and employees from and against any and all liabilities, damages, suits, costs of suits, expenses for defense and legal services, and claims for damages of any nature or kind whatsoever, arising from or connected with the COUNTY or the CENTER's operations or its services hereunder. The BOARD agrees to defend, save, indemnify and hold harmless the COUNTY and the CENTER, their agents, officers and employees from and against any and all liabilities, damages, suits, costs of suits, expenses for defense and legal services, and claims for damages of any nature or kind whatsoever, arising from or connected with the BOARD's acts or omissions hereunder. 24. AMENDMENT VARIATIONS: Except as provided herein, this writing embodies the whole of the Agreement of the parties hereto. There are no oral agreements not contained herein. No addition or variation of the terms of this Agreement shall be valid unless made in the form of a written amendment to this Agreement formally approved and executed by both parties, except as specified in Paragraphs 16 and 21 of this Agreement. 25. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: By signing this Agreement, the COUNTY or the CENTER does swear under the penalty of perjury that no more than one final unappealable finding of contempt of court by a Federal court has been issued against the COUNTY or the CENTER within the immediately preceding two-year period because of the COUNTY'S or the CENTER's failure to comply with an order of the National Labor Relations Board. Butte' July 1, 2000 Page 9 26. RESTITUTION In those counties or centers where the Revenue Recovery Compliance Division (RRCD) has initiated a Criminal Restitution Compact (CRC) with the county's District Attorney's Office, the JP staff within the county shall identify crime and/or offender information tied to VOCP claims and forward this information to the RRCD and/or the CRC Restitution Specialist in their respective county. This process should be done in compliance with the procedures outlined in the JP Crime/Claim Notification Sheet, Exhibit G. JP staff will work collaboratively with the RRCD to ensure that the CRC Restitution Specialist receives the JP Crime/Claim Notification Sheet in a timely manner. This process is important to ensure that restitution is requested at the time of sentencing upon every identified offender. 27. OVERPAYMENT AND LIEN SUBROGATION RECOVERY The COUNTY or the CENTER {and/or applicable agency(s)} will cooperate with BOARD staff to assist in the identification and collection of any monies owed the Restitution Fund in the form of overpayments and liens. All information regarding overpayments and liens should be forwarded to: Laura Nill, Manager Revenue Recovery Compliance Division P. O. Box 1348 Sacramento, CA 95812-1348 FAX: (916) 327-2933 A. OVERPAYMENT RECOVERY: The COUNTY or the CENTER shall submit complete information regarding any claimant, provider, or attorney who has been overpaid. By signing this contract, the COUNTY or the CENTER agrees to the submission of overpayment information on an Overpayment Form (Exhibit H) in a complete and timely manner based on criteria developed by RRCD. B. LIEN RECOVERY: The COUNTY or the CENTER shall continue to submit the information outlined in the Recovery Manual, Sections 6005-6005.32, regarding a civil suit(s), a workers' compensation, or an auto insurance claims} initiated by a victims} that is related to the crime incident. Additionally, once an attorneys} has been identified and information pursued via the appropriate VOX verification letter, staff should tickle the claim for a response within fifteen (15) calendar days. If no response is received, staff will fallow up by phone, then forward the worksheet to RRCDILORS with the information received to date. All information, partial or otherwise, shall be routed to RRCD/LORS with the appropriate worksheet, as directed in the Recovery Manual. Further, parties needing an immediate response pertaining to lienlsubrogation information shall be directed to RRCD/LOBS staff within twenty-four (24} hours. By signing this contract, JP staff will Butte July 1, 2000 Page 10 work collaboratively with the RRCD to ensure that civil suit, workers' compensation, and auto insurance information are submitted on a Civil Suit Lien Worksheet (Exhibit I) or Workers' Compensation Worksheet (Exhibit J) or Auto Insurance Worksheet (Exhibit K) in a complete and timely manner. 28. CONFIDENTIALITY OF RECORDS: The COUNTY or the CENTER shall maintain the confidentiality of all records containing personal identification. The COUNTY or the CENTER shall not disclose any personal information in a manner that would link the information disclosed to the individual to whom it pertains unless the disclosure is explicitly authorized by law. The COUNTY or the CENTER shall insure that all staff are informed of the requirements of this provision and of direction given by the BOARD in the "2000 Information Security Pamphlet" (distributed February 1, 2000). The COUNTY or the CENTER shall establish procedures to insure confidentiality of personal information. 29. RETENTION OF RECORDS The COUNTY or the CENTER shall retain claim files in their respective file rooms for up to two (2) years after the claim's last activity date. After two years of inactivity, the COUNTY or the CENTER must submit a list of claim files to the BOARD for comparison prior to destruction. The COUNTY or the CENTER shall ensure that all staff are informed of the requirements of this provision and of direction given by the BOARD in the BOARD Policy Memorandum No. 99-08 (distributed August 17, 1999}. 30. SUBPOENA The COUNTY or the CENTER shall inform a server of a subpoena that such subpoena for the Victims of Grime Program records produced, obtained or retained are to be served on the State Board of Control at 630 K Street, 5~' Floor, Sacramento, Ca 95812, Attn: Legal Office. The COUNTY or the CENTER may also contact the Legal Office at 9161324-8070 for further assistance. EXHIBIT A VERIFICATION SPECIFICATIONS The CENTER shall provide fully verified claims and bills to the BOARD as herein specified: 1. Verified claims and bills must be reviewed and approved by persons who have completed all required claims verification training provided by the BOARD, and wha have been certir"led as eligible to submit fully verified claims. Notwithstanding this requirement, mental health bills processed in VOX utilizing the PREAUTHORIZATION process can be done by non-certified staff. 2. All the following claim and bill types must be processed pursuant to the standards established in the Claims Verification Manual, Claims Processing Manual, and Board guidelines/directiveslmemos applicable to claims verification in the performance of this agreement, in order to be considered verified by the Board. The different types of claims and bills are defined as follows: INITIAL ELIGIBILITY DETERMINATION CLAIM (Direct or Derivative) An initial eligibility determination claim is one which has been filed for the first time by the applicant {for an individual incident) for verification by the county contract verification staff, and is fully verified when submitted to the Board far action. Components of a fully verified initial eligibility determination claim includes application, crime report, verification report with cover page, history page, verification farms. Prior to submitting an initial eligibility determination claim, verification must include an initial sending of the Claimant Notification Letter and verification forms to the known providers, employers, insurance companies, etc., BILL(s) A bill is an expense which can be submitted in one of two ways: either together with the initial eligibility determination claim in which case the components of the regular claim should include the itemized bill(s), bill data and verification forms or on its own in a subsequent action after the initial eligibility determination has been approved, with a supplemental (golden-rod) claim form. Components of the subsequent bill include history page, itemized bilk(s), bill data and verification forms. The bill should be "date-stamped" the day it is received by the COUNTY or the CENTER and that date must be entered into the VOX system as the date received. MENTAL HEALTH BILL(s) There are three types of mental health bills: initial mental health, subsequent mental health and preauthorized mental health bill. Components of a fully verified mental health bill include the bill data, itemized bill{s), verification forms, history page, and billinglverification form. A mental health supplemental claim processed in VOX utilizing the PREAUTHORIZATION process need not have verification forms or history pages. EXHIBIT B NONDISCRIMINATION CLAUSE During the performance of this contract, the recipient contractor and its subcontractors shall not deny the contract's benefits to any person on the basis of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, or sexual orientation nar refuse to hire or employ the person or to refuse to select the person for a training program leading to employment, to bar or to discharge the person from employment or from a training program leading to employment, or to discriminate against the person in compensation or in terms, conditions, or privileges of employment. 2. Contractor shall comply with the provisions of the Fair Employment and Housing Act (Govemment Code, Section 12900 et seq.), the regulations promulgated thereunder (California Administrative Code, Title 2, Section 7285.0 et seq.}, the provisions of Article 9.5, Chapter 1, Part 1, Division 3, Title 2 of the Government Code (Govemment Code, Sections 11135-11139.5} and the regulations or standards adopted by the awarding State agency to implement such article. 3. Recipient, contractor and its subcontractors shall give written notice of their obligations under this clause to labor organizations with which they have a collective bargaining or other agreement. 4. The contractor shall include the nondiscrimination and compliance provisions of this clause in all subcontracts to perform work under the contract. JOINT POWERS CONTRACT BUDGET {Rev. 5100) Name of County: Butte County PERSONAL SERVICES Employee's Name Salaries & Wages Contract Number: BOC-0045 PositioNClass #FTE Rate { 80 Hours) 1 Larry Dunn Program Coordinator 0.21 ` $ 387 ` 80 hours ` 26 = $ 10,068 2 Lisa Beach Claims Specialist 1.00 ` $ 1,481 ` 80 hours "26 = $ 38,506 3 Pat Rose Claims Specialist 0.50 ` $ 485 80 hours ` 26 = $ 12,618 4 Pat Schell Clerical Su ort 0.50 $ 541 ` 80 hours ` 26 = $ 14,061 5 Vacant Clerical Support 0.50 ' $ 541 80 hours' 26 = $ 14,061 Total Personnel Services FRINGE BENEFITS Employee's Name PositioNCfass #FTE Salaries Rate 1. Larry Dunn Program Coordinator 0.21 $ 10,068 0.25 2. Lisa Beach Claims Specialist 1.00 $ 38,506 ` 0.31 3. Pat Rose Claims Specialist 0.50 ` $ 12,618 0.38 4. Pat Schell Clerical Support 0.50 ' $ 14,061 ` 0.31 Vacant Clerical Support 0.50 $ 14,061 0.31 Total Employee Benefits OPERATING EXPENSES Rent Utilities Insurance Equipment Rental {Copier) Equipment Repair Office Supplies Telephone Postage Expendable Equipment (non capitalized assets) Overhead Data Processing County A-87 Costs Training Conference Other {moving expense) EOUIPMENT {capitalized assets} Description none EXHIBIT C-1 Year: FY 2000!2001 Time Annual Cost $ 81 $ - $ 500 $ 5,814 $ 3aa $ 29 $ - $ - $ - $ 2,930 $ 4,500 $ 240 $ 10,000 Total Operating Expenses $0 $ 89,314 Annual Cost $ 2,508 $ 11,852 $ 4,850 $ 4,327 $ 4,327 $ 27,864 $ 24,434 Total Operating Equipment $0 TOTAL EXPENDITURES $141,612 STATE CF :AI~OgN1A DI-iUG-Fr~-.1=~ WGRKFLAC~ C~nT1~ ,fi,TlOty E:CriIdIT p ~. z, ;aEv. cy 4T CFRTIFiCAT1QN I, the of~=icial named below, r~eYebU s~t,Te^r th~~t I am duly author~_e d legallu to b?r:d the COtttrliCpr pr ~• ~ ~, , grant recipient to the certi~rcat7on descnned aelvw. I am fully aware that this certification, e_~ecu-ad on the date below, is made under penalty of perjury under the laws of t,~e State of California. ~oNraAc-oa~a~coE~ ~ia~u NAME ~ Butte County VictimJAssistance Center ''-CE.~AlONU1.+6E.~ i i 3Y (AwAOnzndSgnan.in~ OAic EXEC:/TEJ ~ I July 20, 2000 '4N i E~ N.WE ENO T1TL CF 2E,a$CN $ICiNING 1'ei,E?HCNE NUM9c? ~Ine~ae .tna CaCn( Helen Harberts,~Chief Probation Officer I(~530}538-7664 ~, nE Chief Probation Officer .CNTaaC'CFLBiCCEaFtA,4'S uAiUNG,~CCAESS 2279-C Del Oro Ave., Oroville, CA 95965 The contractor or grant recipient named above hereby certifies compliance with Government Code Section ~:,~~ in matters relating to providing adrug-Free workplace. The above named contractor or grant recipient wall: 1. Publish a statement notifying employees that uria•.vful manufac~ure, distribution, dispensation, possession, or use of a controlled substance is prohibited and specii•ring actions to be taken against employees Ecr violations, as rewired by Government Code Sectio>-t 33SS(a). ~'. EstabIsh a Drug-Free Awareness Program as rewired by Gover_n:ner;t Code Section 83~5(b), to :rferr:l ernplovees about all of the following- (a) The dangers of drug abuse in the workplace, (b) lire DerSOn'S or organization's pO11CV Of .i~dintdlning a drug-Free WOrkplaCe, (c) Anv ava~'abie counseling, rehabilitation and employee assistance programs, and (d) Penalties that may be imposed upon employees for drug abuse violations. 3. Provide as required by Government Code Section 8355(c), that every employee who works or, the proposed contract or grant: (a) Wlll receive a copy of the compan;:'s drug-free ~yvorl<place eclicy statement, and (b) Will d~ree t0 3blde bV the ter'TlS Of the COInCar~Y 7 Stdtement aS 3 COnditiOn OI zmplo ,~ ent 0:1 the contract or grant Y. At the election of the contractor or grantee, From and aster the "Date Executed" and until ~.,F, (tiQ T TO F':CCFED3o ~fOiV-C'r',.S), thestate ~.viil regard this certiricateas'~alid Eorallcontracts orgrants z^t2Y~~: into between the contractor or grantee and this state agency without rewiring the contractor or grantee to provide a new and ir.dividuai certificJte Eor each contract or grant. fE the cont.-actor or grantee e!eCts to Eiil In the b1Jnk date, then file ter'n5 and CO.^.CittiCC15 OC tills C2.':.itC:lt2 SnJ:I IlJy2 the sa;::e tOrCe, meaning, 2rt~'-'t and entOCCe3btllt'/ a5 tr d Cert:f:CJte '.Vc're 52CJa'at?('!, _~t,t"~::a:,!I'/, a^~: ;nom 1V,~:tlJiti' ~CO~; lt~t-'C. ;OC?,iC~' Ci:r~[":~C: OC '.;-ant bet•,vee^, the COntrJCtOr Or ~~?'ant2~ anu : ^,ls StJ:e a~~^C'J . EXHIBIT E N N QS O N j 47 7] W H X Q J.I ~ O a W Z ~t ~ d N J H Ll.. U7 C~ Z_ W E... U Z ~ Q V ~ ~ ~ Q ?~, J ~ U a >- ~ J Z = © Z ~ Q w N d 3 a~ L U Y O 3 :: ~n c a~ R 0 E ¢ ~ ~ J ~,., .~ O t9 W ~ ~ , a u: O F. ~ ,O O t O s ~ _ U J 2 _ _ ~ O ~ O --- w Q' ~ ~ 0. a~ T 0 3 u n. ~ ^ ~ W ~. 2 O Q LL s w 3 m ~ J U t!; O ¢ ~ .~ > .. X E m Z O N F ~ U 2 J pf ff) ~ S Q' Q J N F ~ Q: O U 2 r- w Y w 3 O 2 w N _W 7 L U N Y O 3 m c °r ro L 0 E ¢ ~ 2 w J H ~ W O ' t0 W O O. a ~ O ~,, ~ +- O ~ O V a~ z u J 2 = C = O ~ O W ~ y ~ a a~ T ° 3 °; a ~ ~ ~ W o ¢ u .G w m ~ J U V O ~q ~ 2 > Z X d E z O ~- S U S J ~ N ~ J '_ Q J N {- O 0' O U 2 ~- w o_ Y w 3 N h 2 w O U W F= 2 3 0 0 p N z c o ° q C 2 ~ a a J x X ~ W ~p 7 } c .~ 0 a a~ ~ ~ ~ J ~ w o ~ w ~ d 4 . ~ N O ~ 2 -~ ~ J 2 ~ ~ ~ O ~ Q a z w o ~ o ~ W Y W } w f O ~ '" J m a W O ¢ o: J 2 > y Q O ~ ~ ~ U 2 J ~ U7 ~ 2 J Q q J N ~- ~ 4' O U 2 r- w 2 z 0 a c 0 'HIBIT F J ¢ Z ~ ~ d O Q W ?- 2 u. F- 2 Q ~... O ~ ~ ~ F- Z O U ¢ w ~ ~ } ~ w yy Qw Z H Z w O ~ Z w ~ w w > w a ~ Z ¢ ~ ¢ z cn ~ ~ a ~ ~ Oz z n. O U ~ ~ ~ ~ ~ z J ~ Q t= ~ J O VJ ¢ (n r h~ ~ F- z ¢ E-. J O Q ~ ' ~ d ~ _ m ~ _ °~ w O a u ~ O 4. w ~ cY O O a w _ °~ C? ~ w ~ Z ~ O c o C7 w 4. ~ O C7 ~ ¢ u. O ~ O . O Z p O w O =, } ¢ F- O O ~'' ? ~ ~ <n o w a u a ~ v x ? a w a a O a3nn a~a swirn ~ a~Na aan~ ~o a~ eissod jo ~s aoaa a ~ alva A ~van ~~ti EXHIBIT, G Procedures for ]P Crime/Claim Notification Sheet Attached is the Joint Powers' (JP) CrimejClaim Notification Sheet which was designed by the Revenue Recovery and Compliance Division (RRCD) to be used in conjunction with the criminal disposition processing procedures for JP staff. This form is to be completed as soon as possible, but no later than two {2) business days after the receipt of the Victims of Crime (VOC) application and the crime report. NOTE: If the crime report does not accompany the VOC application, please hold the Notification Sheet until the crime report is received and then complete and forward the Notification Sheet within two (2) business days of the receipt of the crime report. Instructions for Com letin the Form: Note: Only the fields denoted with asterisks are required to be completed. The RRCD appreciates any other information you can provide. 1. ]oint Power Information: Enter the name of your county, the name of the JP staff member who prepared the form and the date in which the form was prepared. 2. Claim/Vi+ctim Information: Enter the VOC claim number(s) and the victim/claimant name(s). *If more space is necessary for additional companions, please record them on the back of the sheet and. note this fact on the front of the sheet. (NOTE: If companion/related claims are received, fill out only one (1) form for all companion/related claims rather than one (1) form for each claim filed. Make sure you include all related claim numbers.) *If you are faxing this information, please remember to include both sides with your fax. 3. Child Protective Services Information: Check this box if on/ya Child Protective Services investigation was conducted. If not, leave blank. 4. Suspect Identification Information: According to the crime report, check the appropriate suspect identification box. If a suspect was partially identified by only a first name, last name or an AKA and with no other identifying information, check the box marked "No Suspect Identified". 5. Law Enforcement Information: Required on/y if no suspect identified box is checked. Complete this section with the name of the most current law enforcement agency that conducted the investigation or completed the crime report. Make sure to also include the name of the officer, investigator or detective who is currently handling the case. The law enforcement agency address is on/y required if it is not located in VOX. Update) Apnl 2000 6. Grime Information: JP staff are not required to complete these fields. 7. Suspect Information: Complete this section with as much pertinent suspect information as possible. *Be sure to include complete information including suspects full name. Instructions for Forwardin Com leted Forms • If suspect(s) was identified: JP staff should retain one (1) copy of notification sheet in the JP claim file, mail or fax one (1) copy to the county Restitution Specialist and mail or fax one (1) copy to RRCD. • If suspect(s) was not identified, do not send a copy to the county Restitution Specialist: JP stafF should retain one (1) copy of the notification sheet for the JP claim file, and mail or fax one (1) copy to RRCD. Forward To: State Board of Control -RRCD P.O. Box 1348 -Fourth Floor Sacramento, CA 95812-1348 Your County`s Restitution Specialist: Address: FAX Number: (916) 327-3897 Fax Number: Telephone Number: If you have any questions regarding this process, please contact any of the following: Theresa Schell (916) 324-6888 Ron Hodges (916)323-9493 Lehua Kalanui-Tonra (916) 323-6868 Tara Naisbitt (916) 322-4970 Elizabeth Furtado (916) 327-5837 Brenda Lopes (916) 327-5837 Tom Robinson (916) 445-6293 Kristy Lum (916) 445-6292 Gail Fasciola (916) 322-2484 Richard Moritz (916) 445-5821 Paul Willover (916) 323-5923 Tricia Yu (916) 323-9477 Updated Apnl 2000 s~ ~~~;.,,,,~,~~-,,, JP C~1~'~j~'C~A(~ri ~+OT1=IC.~,T1G~~ Sr-!E=T :.u,.:oarv ~ Csaoi E:CHISIr G_1 Joint Powers Staff • Pleasa prcvide inror,:.ation in rieics denoted with an as~arisk 1. Joint Fower Information: Ccunty: x Frep2rec by: G2t2 =repay=~: 2. C1aimNictim Information: ((. accitienal space a needec, ~iees2 use ~ac:< cf ~prr,). Claim No. VicamiCiatrant C.clm ~.^1p. tirictirniC:zir-;ant x * '~' T ~ ; T Y x ~ 3. Child Protective Serrices Inr"orrtation: CCPS doc::menis in nie. 4. Suspec: Identi;=ication Information• (per cr:^e r=~cr,;: #~Na Suspec: ic2rnii~ec ~j (Suspect Identinec ~. Law E~forczment Informatien: fccmplet2 pniv ,p ~c susp2c::cenrinec cr suspect e2ricily icentir'~e~) Law ~:~fcrcer-ent Ace..^.c•r Name: Crrcer/Irvestica:priC2t2c:ivn: ~ ?•N C^fpip2:'1^e''t ACe^C'J ACCi2SS: (Nct recuired i.` in V!C^) _ Cii~J, ~ta:e. %:,, C.:cz c. Crime !nrormation: Clime ~epcr, ~v~;-;;;er Date o~ Ci i,-z Crime Ccce;s; r . Suspec: Information: Suspec: Na;~^e =~ tnJcie Ci ^Ir~:i~. T .~. L, C~Ci S2C:. r:~! ICI u~;,p e:. Driver's Licz^s2iSta:e: r arras; L2t2: Cpur. Case Numpe-: T x CA Case Nu~;.per. Suspec: N2r~2 T_ 02t2 or °irh: Scc:al S2c::ncr Nun^cer. Drovers LacsnsalState: Arrest Gate: Cur, Case ,vumcer 0,~=Case wur^cer. rXHI~rT ~ STAic GF CAI.IrOR.VIA STSTFBOARD OFCONTZpL 'OV~RP.~~tiYJ~~T DETER~II~'~TZON SL~Lti.I~.RY SaOC-~.D~I-CQ! {New Er961 PLEASE COr~LPLETE TICS FORIYI AMT S~:BIYIIT IT lY7TI3.~ CLAI.I~I TIL-!T IS FORiYA.Rl).ED TO TIIE RR CD FOR COLLECTION OF A:V p YERP.~ Y.YIE'NT. PLEASE :VOTE ALL LVFORyt.~ TI'0N YIUST BE PROVIDED BEFORE COLLECTION OF T~ O L`ERPAY~LL~VT Br GIVS. CL?,Lbi?+.`iT'S Nr1tiIE 0~"ER°AID PARTY OtlERPAID PARTIES' ADDRESS LLALtii NL~iBER 0~ ARP.-~Y:~(EtiT .~.~tOC~T BRIEFLY EY.PL ~L`t THE RE~.SON FOR THE OVERP~Y:1-LENT CL?.I~[ SPECL~LIST PHONE tiZ~BER I H_aVE RE~ZEtiVED 'THE OVERPAYyLEi~T DETER.'~IZYATIOV .~,YD :AGREE THAT .-~+.,Y OVER.P.~Y~CEitT E<~STS FOR THIS CL~LbI. SL-PERViSOR'S SIGMA i SRS ErJR `/OC GSc ONL'f C^,~~IP:.4TC: YES vC ST.•~.~ OF C.~LIFOR~+Za EYHIBIT I CIVIL SLIT LIEN tiVORKSHEET SBOC-~.DM-OQl STATE B0,3RD OF CONTROL REv~E':rt.rE RF' VE~Y3c CO~Q'LL~.~(CE DIVIgION P.O.Box 1;43 Sacramea~o, Ca 9531'-13x3 FA.X: (9[b) 327-2933 CLAI.itii NTJyLBER TOTAL PAID BY VOCP S VICTL~rI CLAItiIANT FILED BY SUPERIOR OR NILNICIPAL COURT (circle one) COUNTY COURT CASE N0. PLAIlv'I'LFF(S) NAME , DEFENDA1~tT(S) NAME PLA.k~TIFF(S} ATTORNEY DEFENDANT(S) ATTORNEY' . ADDRESS (Street Address or P.O. Box) . ADDRESS (Street Address or P.O. Box) CITY, STATE, ZIP - _ _ - CITY, STATE, ZIP PHONE NO. PHONE NO. ire there sddiriona( VC~C' claims involved is this case? iVfust circ le ves or ao. If ves. otease lisc the names and claim numbers belo~~. . N A~ti1E CLA.Ltif NO. ?. NA:~LE CLAIM NO. 3. N:~~IE CLAIM N0. STATUS OF CIVIL. CASE (if available): ~O~LtiIEN"TS ~ONIF'LETED BY TELEPHONE NO. i D~.TE lICTL~U~IITNESS CENTER "OR VOC (SE ONZY: CO~~LETE YES :~+"0 5TATE OF C.~Lff~'OR`r'I.-~ E:{ ~~ I B I T J ~'~TE 80ARD OF CONTROL REVEi+'UE RE 'ERY3c COMPLIA~`1CE DIVISION P.O.Box t~~t3 Sacrameaca. CA 9~3I2-13-13 WORKERS' C01~LPENS~TIO~ LIE>`t ti~'O~HEET SBOC-ADM(-00 t F.4X: (916) 327-Z4.3 ,~ i *~t CH THE WORKc"RS' COMPEV$,{ rON vE~lFi Gi T:ON FORb( IF !T CONT.~IrVS i ~fE INFOR,bt.{ ITON .3E'QUES"cJ BELO tv CLALI~I ~Zti(BER ~ TOTAL. PAID BY VOCP S ~'ICTL~I CL.-~L~L-'~.ti"I' FILED BY DATE OF CR.L'~LE ~ WOR..KERS' CONH'. REPRESEN'T'ATIVE WORKERS' CO~g'ENSATION CLAP+i I ti0. I'itJL`RED WORKERS' EMPLOYER WORKERS' CO~tiIPENSATION CARRIER ADDRESS (Street Address or P.O. Box) ADDRESS (Street.4ddress or P.O..Boz) CITY, STATE, ZIP ._ CITY, STATE, ZIP -, ~ _ .. PHONE NO. PHONE NO. . WORiC:=.RS' CObIP. APPEAL. BOARD LOCATION ([~ spp~;c~blc> WCAB CASE NO. (if none, explain. in Comrnencs). AiTOEL`+`EY FOR (NICKED WO(L~CER (if none, explain in Cammencs) EMPLOYER C.s.R.4.(ER,'~TT0(2.NEY .-ADDRESS (Street.~ddress or P.O. Boz) ADDRESS (Street ,-address or P. O. Bo.r) CITY, STATE. ZIP ( CITY, STATE, ZIP PHOivc NO. I PHONE NO. STATI.;'S OF CASE (circle one) PE:`+~L`iG CLOSED SOCL-~L SECL'RlTY NO. OF VICTLtit CO~L~(ENZ'S CONLtiCE:NTS (continued) O~+Lti~NTS (continued) TELEPHONE NO. .:OM~'LE i" ~.D BY ~lICTL~tlWIiNESS CENTER DATE FOR VCC liSE ONZY: COMPLETE YES NO EXHIBIT If STATE OF CALIFORNIA REVENUE RECOVERY & COMPLIANCE DIVISION P.O. BOX 1348 SACRAMENTO, CA 95812-1348 AUTO INSURANCE RECOVERY WORKSHEET FAX: (916) 327-2933 SBOC-ADM-1020 (Revised 06/99) GLAIM NUMBER ~ TOTAL PAID BY VOC VICTIM CLAIMANT AUTO INSURANCE CLAIM NO. GATE OF CRIME NAME OF INSURANCE CARRIER ^ Victim ^ Defendant NAME OF PERSON INSURED ^ Victim ^ Defendant ADDRESS (Street Address or P.O. Sax) AUTO INSURANCE POl_iCY NO. CITY, STATE, ZIP AMOUNT PAID BY INSURANCE COMPANY ^Medical ^MH ^Income ^Personal Property ATTORNEY FOR VOC C1~-11MANT - _ . - ATTORNEYIADJUSTER FOR INSURANCE COMPANY ^Victim ^ Defendant ADDRESS {Street Address or P.O. Box) I ADDRESS {Street Address or P.O. Box) CITY, ST;-ITE, ZIP CITY, STATE, ZIP PHONE NO. FHONE N0. COMMENTS: A COMPANION C~AIti1S: COMPLETED BY TEAMIUNIT TELEPHONE NO. DATE EXHIBIT L APPENDIX #1 APPROVED TRAVEL REIMBURSEMENTS Mileage The reimbursement rate to operate aprivately-awned vehicle is from 31 cents per mile. Meals Breakfast X6.00 - Breakfast may be claimed when travel commences at or prior to 6:00 a.m. Breakfast may be claimed on the last fractional day of a trip of more than 24 hours if travel terminates at or after 9:00 a.m. Lunch X10.00 - Lunch may not be claimed for travel less than 24 hours. Lunch may be claimed if the trip begins at or before 11:00 a.m. and may be claimed on the last fractional day of a trip of more than 24 hours if the travel terminates at or after 2:00 p.m. Dinner X18.00 -Dinner may be claimed if the trip begins at or before 4:00 p.m. Dinner may be claimed when travel terminates at or after 7:00 p.m. whether on a one-day trip or on the last day of a trip of mare than 24 hours. Incidentals $ 6.00 - Incidentals may be claimed for trips of 24 hours or more. Total $40.00 Lod in Statewide, without a lodging receipt $47.00 Statewide, with a lodging receipt Actual lodging expense or up to the applicable state rate + applicable taxes Other Taxi, airport shuttle, etc., which exceeds $10.00 must be supported by receipt. Parking in excess of X10.00 must be supported by receipt.