HomeMy WebLinkAboutMINUTES - 02271996 - C85 C.g�
To- BOARD OF SUPERVISORS
Contra
FROM: JOAN V. SPARKS, DIRECTOR �• Costa
COMMUNITY SERVICES DEPARTMENT CQUrIIv
DATE: `J
January 2, 1996
SUBJECT: APPROVAL OF 1996 COMMUNITY SERVICES BLOCK GRANT STANDARD AGREEMENT
WITH THE STATE DEPARTMENT OF COMMUNITY SERVICES AND DEVELOPMENT
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
APPROVE and AUTHORIZE the Community Services Director or her designee to execute and
submit to the State, on behalf of the County, the 1996 Community Services Block Grant (County
Contract Number 39-813--State Number 96F-1333) with the State Department of Community
Services and Development in the amount of $97,297 for the period from January 1, 1996 through
December 31, 1996.
II. FINANCIAL IMPACT:
This Contract is Federally funded through the State Department of Community Services and
Development. Funding from this agreement for the period from January 1, 1996, through June 30,
1996, is reflected in the Community .Services Department's FY 1995-96 budget. Funding for the
period from July 1, 1996, through December 31, 1996, will be reflected in the Department's
FY 1996-97 budget. No County funding is required.
III. REASONS FOR RECOMMENDATIONS/BACKGROUND:
The budget negotiations in Washington, D.C. are still in progress and the Community Services Block
Grant (CSBG) program is currently being operated under a continuing resolution. This agreement
is for 25% of last year's CSBG funding and will be amended to add funds once Congress determines
the final appropriation for the 1996 CSBG program. This agreement will continue the CSBG anti-
poverty programs and emergency services to eligible county residents.
This contract will be reviewed and approved as to form by County Counsel prior to submission to
the State.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOA D OMMITTEE
APPROVE OTHER
SIONATURE(S):
ACTION OF BOARD ON February27, 1996 APPROVED AS RECOMMENDED X OTHER
VOTE OF SUPERVISORS
1 HEREBY CERTIFY THAT THIS IS A TRUE
X UNANIMOUS(ABSENT AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
WACT: Joan Sparks, 313-7350
CC: CAO ATTESTED February 27, 1996
CSD PHIL BATCHELOR,CLERK OF THE BOARD OF
STATE CSD: 4 SEALED COPIES SUPERVISORS AND COUNTY ADMINISTRATOR
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INCOMING FUNDS
NARRATIVE STATEMENT FORMAT
1. PROJECT/PROGRAM TITLE. Community Services Block Grant (CSBG).
2. FUNDING AGENCY. State Department of Community Services and Development.
(Department of Economic Opportunity in 1995)
3. SUBMITTAL STATUS. This agreement continues a current program.
4. PROPOSED TERM. January 1, 1996 through December 31, 1996.
5. CURRENT FUNDING. $97,297 of federal funding through the State Department of
Community Services and Development. This amount represents 25% of last year's CSBG
funding. Budget negotiations in Washington, D.C. are still in progress and the program is
currently being operated under a continuing resolution. The agreement will be amended to
add funds once Congress determines the final appropriation for the 1996 program.
6. FUTURE FUNDING. This has been a long-range program for which funding is expected
to continue. Additional 1996 funding is expected after budget negotiations are completed
in Washington, D.C. The amount of future funding is dependent upon Congressional
action.
7. BUDGET SUMMARY. A budget is being prepared to cover the amount of funding under
this agreement. A revised budget will be prepared when the total amount of 1996 funding
is determined.
8. STAFFING REQUIREMENTS. Darnell Turner will be responsible for administration of
this project.
9. PROGRAM NEED. A portion of the CSBG contract is used for the administration costs
of the Community Services Department and the subcontracting of services with Community
Based Organizations in providing assistance to the low-income communities.
10. RELATIONSHIP TO OTHER PROGRAMS. The CSBG program is used to leverage
other program dollars and to assist in collboration with CBO's in developing economic
opportunities for the low-income communities. CSD recently performed an RFP which
allowed us to awarded the CSBG contract to these agencies for services that were not being
provided for in the local community.
11. PROJECT GOALS. This program is designed to assist the low-income community in
gaining the economic tools to break the cycle of proverty. It is the intent of Community
Services Block Grant program to assist the low income in achieving economic self-
sufficiency.
1
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12. STATED OBJECTIVES. The objectives of this program are:
a. Provide economic assistance to the low-income community.
b. To develop programs with Community Based Organizations in aiding the poor.
c. Develop programs in the local community that will provide job opportunties and self
sufficiency.
13. ACTIVITY SUMMARY. This program will be administraed by Darnell Turner,
Program Manager of the Community Services Block Grant program. The CSBG program
will subcontract a our funding to provide the following services such as a senior Brown
Bag, after school tutorial program, job training/development.
14. EVALUATION METHOD(S). Darnell Turner,Program Manager will be responsible for
the evaluation of the program monitoring. Quarterly reports will be submit to the program
manager as indicated in the contract.
15. CHANGES COMPARED TO PRIOR YEAR (if any). None.
16. POTENTIAL CONTROVERSIAL ISSUES. None.
2
STATE OF CALIFORNIA C 8�
STANbARD AGREEMENT- AnoRNEYGE ERAL
CONTRACT NUMBER AM NO.
sTo.zt�lEvs91) t 96F-1333 0
TAXPAYERS FEDERAL EMPLOYER IDENTIFICATION NUMBER
1st January 96 94=6000509
THIS AGREEMENT,made and entered into this day of , 19_,
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 AGENCY
)eputy Director, Admin. Dept of Conty Srvcs and Development hereafter called the State,and
CONTRACTOR'S NAME .
.ontra Costa County(Community Services Department) #39-813 hereafter called the Contractor.
WITNESSETH::That the Contractor for and in consideration of the covenants,conditions,agreements,and stipulations of the State hereinafter expressed,
does hereby agrzle 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.)
1HEREAS, pursuant to government Code Section 12725 et seq. , as
tmended, and 42 United States Code (USC) 9901 et seq. , as amended,
:he Community Services Block Grant Act, the Parties hereto agree to
)rovide services and activities to eligible participants residing
-n the service area described as :
Contra Costa County
1 . Consideration
A. The total amount payable by the State to Contractor shall
not exceed $ 97, 297 . 00 as specified in
Exhibit I, CSBG Fiscal Data series .
B. The consideration to be paid Contractor as provided
Herein, shall be in compensation for all Contractor' s
reasonable expenses incurred in the performance hereof,
Including travel and per diem, unless otherwise expressly
so provided.
CONTINUED ON SHEETS,EACH BEARING NAME OF CONTRACTOR AND CONTRACT NUMBER. FOV"
The provisions on the reverse side hereof constitute a part of this agreement w J. '%V C i/ coniscl
IN WITNESS WHEREOF,this agreement has been executed by the parties hereto,upon the date first above writte Ry ,
. STATE OF CALIFORNIA CONTRACTOR
AGENCY CONTRACTOR(if other than an individual,state whether a corporation,partnership,etc.)
Dept of Cmnty Srvcs and Development Contra Costa County(Comrnznity Services Dept.)
BY(AUTHORIZED SIGNATURE) BY(AUTHORIZED SIGNATURE)
D D
PRINTED NAME OF PERSON SIGNING PRINTED NAME AND TITLE OF PERSON SIGNING
Carmen J. Ochoa Joan Sparks, Director
TITLE ADDRESS1220 Moreilo Avenue, Sui e101
Deputy Director, Administration Martinez, CA 94553
AMOUNT ENCUMBERED BY THIS PROGRAMICATEGORY(CODE AND TITLE) FUND TITLE Department of General Services
DOCUMENT 40 .40 CSBG/CAA f T.F. use Only
$ 97 , 297 . 00 (OPTIONAL USE)
THISOR NT ENCUMBERED FOR
THIS CONTRACT ndex2600 PCA55440 FC#93 .569 CSCAAL WP 9
1 hereby certify that all con I
Q ITEM CHAPTER STATUTE FISCAL YEAR tlo�
for exemption have been com-
TOTAL AMOUNT ENCUMBERED TO 4700-101-890 303 1995 195/96 lied with, and this document is
DATE OBJECT OF EXPENDITURE(CODE AND TITLE) P
$ 97, 297 . 00 702 - Grants/Subventions exempt from the Department ct
I hereby certify upon my own personal knowledge that budgeted funds 11
T.B.A.No, B.R.No, General Services approvol.
are available for the period and purpose of the expenditure stated above.
S\IGNATURE OF ACCOUNTING OFFICER DATE
El CONTRACTOR STATE AGENCY ❑ DEPT.OF GEN.SER. CONTROLLER
' 96F CSBG � Qvooll
`• r O
2 . Term
The term of This Agreement shall be from January 1, 1996
through December 31, 1996.
3 . indemnification
Contractor agrees to indemnify, defend, and save harmless the
State, its officers, agents, and employees from any and all
claims and losses accruing or resulting to any and all
contractors, subcontractors, materialmen, laborers, and any
other person, firm, or corporation furnishing or supplying
work, services, materials, or supplies in connection with the
performance of This Agreement, and from any and all claims and
losses accruing or resulting to any person, firm, or
corporation who may be injured or damaged by Contractor in the
performance. of This Agreement.
4. Independent Contractor
Contractor, and the agents and employees of Contractor, in the
performance of This Agreement, shall act in an independent
capacity and not as officers, employees, or agents of the
State.
5. Suspension, Revocation. and Termination
A. Suspension
(1) If Contractor has failed to comply with the
material terms of This Agreement the State may,
upon fifteen (15) calendar days written notice to
Contractor, suspend This Agreement in whole or in
part. In the case of Contractor's fraud or gross
negligence, suspension without prior notice by the.
State is permissible.
(2) The notice of suspension shall state the reasons
for the suspension, corrective action required of
Contractor to comply with the terms of This
Agreement, and the effective date of the
suspension. Contractor shall have the right to
submit in writing any arguments against suspension
within fifteen (15) calendar days of the notice of
suspension or show compliance.
(3) The notice of suspension shall become effective
upon delivery. The suspension shall not exceed a
thirty (30) calendar-day period, unless during such
period of time termination proceedings are
initiated in which the suspension shall remain in
Page 2
96F CSBG
full force and effect until proceedings are fully
concluded, or the Parties agree to a continuation
of the suspension for an additional period of time.
(4) The total time of suspension may not exceed thirty
(30) calendar days unless proceedings are initiated
toward revocation of Community Action Agency
recognition or unless the State and Contractor
agree to a continuation of the suspension for an
additional period of time. If revocation
proceedings are initiated, the suspension shall
remain in full force and effect until such
proceedings have. been fully concluded.
(5) New obligations incurred by Contractor under This
Agreement during the suspension period will not be
allowed unless expressly authorized by the State in
the notice _ of suspension or in a written
authorization document.
B. Revocation of Community Action Agency (CAA) Recognition
(1) The State may, upon Contractor's unsatisfactory
compliance with notice of suspension, initiate
procedures to revoke the recognition of a Community
Action Agency (CAA) for failure to comply with the
material provisions of This Agreement or Government
Code Section 12725 et seq. , the California
Community Services Block Grant Program.
(2) These revocation procedures shall meet the
requirements of 42 USC 9904 and 9905A which provide
for notice and opportunity for hearing on the
record and review by the Secretary of the
U.S. Department of Health and Human Services (DHHS)
of the State' s determination to revoke. Hearing
shall be conducted consistent with Title XXII,
sections 100780 (g) , (h) , and (i) of the California
Code of Regulations, as amended.
(3) In the event of final revocation of Contractor's
CAA status and the ratification thereof by the
Secretary of DHHS, the State may proceed with the
work in any manner deemed proper by the State. The
cost to the State shall be deducted from any sum
due -Contractor under This Agreement, and the
balance, if any, shall be paid by Contractor upon
demand. The State retains lien rights on all funds
advanced. Such rights shall be superior to and
unaffected by claims of all other creditors whether
by agreement with third parties or other State
agencies or by the direction of a trustee in
bankruptcy.
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96F CSBG
U
C. Termination
(1) The State may terminate This Agreement and be
_ relieved of the payment of any consideration to
Contractor should Contractor fail to perform the
covenants contained herein at the time and in the
manner provided herein. In the event of
termination, the State may proceed to perform the
covenants contained herein in any manner deemed
proper by the State. The State retains lien rights
on all funds advanced.
(2) Contractor may terminate This Agreement at any time
prior to its date of expiration upon thirty (30)
calendar days notice to, the other party. Such
notice shall be delivered to the other party in
writing, stating the reason for termination and the
effective date thereof.
(3) Upon termination of This Agreement, the State,
unless granted in writing, shall not pay Contractor
for any obligations incurred after the effective
date of such termination.
6. Assignment
Without the written consent of the State, This Agreement is
not assignable by -Contractor either in whole or in part.
7 . Subcontracts
A. Contractor may enter into subcontracts to carry out the
provisions of This Agreement.
B. Should Contractor enter into a subcontract, Contractor
shall:
(1) Remain liable for the performance of the terms and
conditions of This Agreement.
(2) Assure that subcontractors comply with the
requirements set forth under 42 USC 9901 et seq. ,
As amended.
(3) Provide to the State within sixty (60) calendar
days of execution of such subcontract, the
subcontractor' s name, address, telephone number,
contact person, contract amount, and program
description.
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96F CSBG
(4) Make subcontracts, documents, papers, and records
available to the State or its duly-authorized
representatives for examination, copying, or
mechanical reproduction on or off the premises of
Contractor or subcontractor upon request during
usual working hours.
(5) Notify the State in, writing within thirty (30)
calendar days if any subcontract under This
Agreement is suspended or terminated.
Additionally, in such notice Contractor shall
identify how the suspension or termination will
impact Contractor' s budget and work plan, and
identify any appropriate corrective actions.
(6) Provide written notice to each subcontractor within
five (5) calendar days from the date Contractor
terminates-or the State suspends This Agreement.
(7) Request of each subcontractor the certification
required in Section 21.I. of This Agreement
regarding debarment and suspension.
8. Time
Time is of the essence in the performance of This Agreement.
9. Amendment
A. No alteration or variation of the terms of This Agreement
shall be valid unless made in writing in the form of an
amendment and signed by the parties. Exceptions to this
requirement are line-item changes to the contract budget
which do not affect the maximum amount payable under the
contract or the work to be performed (see Section 28.B) ,
and the exceptions. provided for in Section 14, Provisions
. for Federally-Funded Grants.
(1) CSD Form 425b, Justification for Contract
Amendment/Modification, is provided upon request
to submit changes to Exhibit I or Exhibit II.
(2) Said justification shall be submitted no later than
forty-five (45) calendar days prior to the
expiration date of This Agreement.
B. No oral understanding or agreement not incorporated
herein shall be binding on any of the Parties.
Page 5
• 96F CSBG � •`�
10. Enforceable Agreement
This Agreement shall become a valid, enforceable agreement
only after it is signed by Authorized Agents of the Parties.
11. compliance with Rules and Regulations
Activities of Contractor with respect to This Agreement shall
be conducted in accordance with pertinent Federal and State
rules and regulations, including relevant Office of Management
and Budget (OMB) circulars and amendments thereto.
12 . Record-Keeping Responsibilities
. A. All records maintained by Contractor shall meet the OMB
requirements contained in the following Circulars:
Common Rule, Subpart C, (Uniform Administrative
Requirements for - Grants and Cooperative Agreements to
State and Local Governments) or A-110, Subpart C,
Nonprofit Organizations, whichever is applicable.
B. Contractor shall maintain all records pertaining to This
Agreement for a minimum period of three (3) years after
submission of the Final Report of Expenditures. However,
Contractor shall maintain all such records until
resolution of all audit findings is completed.
C. Contractor shall make available appropriate books,
documents, papers, and records to the Federal Government, .
the State, or any of their duly authorized
representatives for examination, copying, or mechanical
reproduction, on or off the premises of the appropriate
entity upon a reasonable request therefor.
D. Contractor assures that employee and applicant records
shall be maintained in a confidential manner to assure
compliance with the Information Practices Act of 1977, as
amended, and the Federal Privacy Act of 1974, as amended.
E. Upon request from the Department of Community. Services
and Development (CSD) , Contractor shall submit a
certificate prepared by an independent accountant stating
that Contractor's accounting system and internal controls
are adequate to record and safeguard the assets entrusted
to Contractor.
0
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96F CSBG .�
13 . Insurance and Fidelity ty Bond
A. General Requirements
(1) Third-Party Insurance
a. By execution of This Agreement, Contractor
agrees that the below-required insurance
policies and bond shall be in effect at all
times during the term of This Agreement.
b. Contractor shall provide the State written
notice at least thirty (30) calendar days
prior to cancellation or reduction of
insurance coverage to an amount less than that
required.
C. In the. -event said insurance coverage expires
at anytime or times during the term of This
Agreement, Contractor agrees to provide, at
least thirty (30) calendar days prior to said
expiration date, a new certificate of
insurance evidencing insurance coverage as
provided for herein for . not less than the
remainder of the term of This Agreement.
d. New certificates of insurance are subject to
review for content and form by CSD.
e. In the event Contractor fails to keep in
effect at all times insurance and bond
coverage as herein provided, the State may, in
addition to any other remedies it may have,
suspend This Agreement.
f. The State of California shall be named as an
additional insured on all certificates of
insurance, except workers' compensation and
fidelity bond, required under This Agreement.
(2) Self-Insurance
When Contractor is a governmental entity which
self-insures, the State, upon satisfactory proof,
will waive the appropriate insurance requirements
upon written certification. This certification
shall be signed by an appropriate county or city
risk manager and contain assurance of the adequacy
of the governmental entity's ability to cover any
potential losses under This Agreement and shall
specify which areas Contractor will self-insure.
Should Contractor use a subcontractors) to provide
Page 7
96F CSBG
services under This Agreement, Contractor shall
indemnify and hold the State harmless against any
liability incurred by that subcontractor(s) .
B. Workers' Compensation Insurance
(1) Contractor shall have and maintain, for the term of
This Agreement, workers' compensation insurance .
issued by an insurance carrier licensed to
underwrite workers ' compensation insurance in the
State of California.
(2) Unless a current copy is on file with CSD,
Contractor shall submit either an applicable
Certificate of Insurance (ACORD 25) or a
Certificate of Consent to Self-Insure issued by the
Director of the Department of Industrial Relations
to the State as evidence of compliance with the
worker's compensation insurance requirement prior
to issuance of an initial cash advance.
C. Fidelity Bond
(1) Contractor shall maintain a fidelity bond in the
minimum amount of eight percent (8%) of the total
amount of consideration set forth -' under This
Agreement. o
(2) Unless a current copy is on file with CSD,
Contractor shall submit an applicable Certificate
of Insurance (ACORD 25) to the State as evidence of
compliance with the fidelity bond requirement prior
to issuance of an initial cash advance.
D. public Liability Insurance
(1) Contractor shall have and maintain for the term of
This Agreement general liability and property
damage insurance for a combined single limit of not
less than $500, 000 per occurrence.
(2) Unless a current copy is on file with CSD,
Contractor shall submit an applicable Certification
of Insurance (ACORD 25) , naming the State of
California as an additional insured, to the State
as evidence of compliance with the public liability
insurance requirement prior to issuance of an
initial cash advance.
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96F CSBG A •a�
E. Vehicle Insurance
(1) Contractor shall have and maintain for the term. of
This Agreement vehicle insurance in the amount of
$500, 000 for each person and each accident for
bodily injury and in the amount of $500, 000 for
each person and each accident for property damage.
(2) When employees use their own vehicles to perform
duties within the scope of their employment,
Contractor shall have and maintain for the term of
This Agreement non-owned and hired auto liability
insurance in the amount of $500, 000 for each person
and each accident for bodily injury, and $500, 000
for each person and each accident for property
damage. (Driving to and from work is not in the
scope of employment. )
(3) Unless a . current copy is on file with CSD,
Contractor shall submit an applicable Certification
of Insurance (ACORD 25) , designating the State of
California as an additional insured, to the State
as evidence of compliance with said vehicle
insurance requirements prior to issuance of an
initial cash advance.
14. Proviaions for Federally-Funded-Grants
A. It is mutually understood that This Agreement may have -
been written before ascertaining the availability of
Congressional appropriation of funds, for the mutual
benefit of both Parties, in order to avoid program and
fiscal delays which would occur if This Agreement were
executed after that determination was made.
B. This Agreement is valid and enforceable only if
sufficient funds are made available to the State by the
United States Government for the purposes of this
program. In addition, This Agreement is subject to any
additional restrictions, limitations, or conditions
enacted by the Congress or any statute enacted by the
Congress which may affect the provisions, terms, or
funding of This Agreement in any manner.
C. It is mutually agreed that if the Congress does not
appropriate sufficient funds for this program, This
Agreement shall be amended to reflect such reduction.
D. The State has the option to void This Agreement under the
thirty (30) day cancellation clause or to amend This
Agreement to reflect any reduction of funds.
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96F CSBG
c .g5
15. Limitation on Use of Funds
A. Contractor shall assure that funds received under This
Agreement shall not be used to replace discontinued State
or local funding. Unless waived by the Secretary of
DHHS, Contractor shall assure that funds received under
This Agreement shall not be used for the purchase or
improvement of land or for the purchase, construction, or
permanent improvement of any building or other facility.
B. Contractor shall assure that funds provided under This
Agreement shall not be transferred to any other local,
State, or Federal government program.
16. Right to Monitor. Audit, and Investigate
A. Any duly-authorized representative of the Federal or
State government, which includes but is not limited to
the Bureau of State Audits, shall have the right to
monitor and audit Contractor and all subcontractors
providing services under This Agreement through on-site
inspections, audits, and other applicable means the State
determines necessary.
B. Any duly-authorized representative of the Federal or
State government shall have the right to undertake
investigations in .accordance with Section 42 USC 9908 et
seq. , as amended.
C. All agreements entered into by Contractor with audit
firms for purposes of conducting independent audits under
This Agreement shall contain a clause permitting any
duly-authorized representative of the State or Federal
government access to the working papers of said audit
firm(s).
17 . Contractor's National Labor Relations Board Certification
Contractor hereby certifies under penalty of perjury that no
more than one final unappealable finding of contempt of court,
by a Federal Court, has been issued against Contractor within
the immediately . preceding two-year period because of
Contractor's failure to comply with an order of a Federal
Court which orders Contractor to comply with an order of the
National Labor Relations Board.
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96F CSBG (2 -s-50
18. Nondiscrimination Compliance
A. Contractor hereby certifies compliance with the
following:
(1) Federal Executive Order 11246, as amended by
Executive Order 11375-, relating to equal employment
opportunity.
(2) Title VI and Title VII of the Civil Rights Act of
1964, as amended.
(3) Rehabilitation Act of, 1973, as amended.
(4) Vietnam Era Veterans Readjustment Assistance Act of
1972, as amended.
(5) Title 41, -. Code of Federal Regulations (CFR) ,
Chapter 60, Office of Federal Contract Compliance
Programs, Equal Employment Opportunity, Department
of Labor.
(6) Public Law 101.336, Americans with Disabilities Act
of 1990.
B. Contractor agrees to abide with and shall include the
nondiscrimination and compliance provisions of the
following clause in all subcontracts to perform work
under This Agreement.
"During the performance of this contract, Contractor and
its subcontractors shall not unlawfully discriminate,
harass or allow harassment, against any employee or
applicant for employment because of sex, race, color,
ancestry, religious creed, national origin, physical
disability (including HIV and AIDS) , mental disability,
medical condition (cancer) , age (over 40) , marital
status, and denial of family care leave. Contractors and
subcontractors shall insure that the evaluation and
treatment of their employees and applicants for
employment are free from such discrimination and
harassment. Contractor and subcontractors shall comply
with the provisions of the Fair Employment and Housing
Act (Government Code, Section 12900 et seq. ) and the
applicable regulations promulgated thereunder (California
Code of Regulations, Title 2, Section 7285. 0 et seq. ) .
The applicable regulations of the Fair Employment and
Housing Commission implementing Government Code, Section
12990 (a-f) , set forth in Chapter 5 of Division 4 of
Title 2 of the California Code of Regulations are
incorporated into this contract by reference and made a
part hereof as if set forth in full. 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. "
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96F CSBG
(1) Contractor's signature affixed hereto shall
constitute a certification that to the best of its
ability and knowledge it will, unless exempted,
comply with the nondiscrimination program
requirements set forth in this Section.
19 . Affirmative Action Compliance
A. Each Contractor or subcontractor who has fifty (50) or
more employees and has an agreement of fifty thousand
dollars ($50,000) or more shall be required to develop a
written Affirmative Action Compliance Program.
B. The written program shall follow the guidelines set forth
in Title 41 CFR Section 60-1.40, Sections 60-2. 10 through
60-2 . 32 , Sections 60-250. 1 through 60-250. 33 , and
Sections 60-741..4 through 60-741. 32.
C. Each Contractor or subcontractor with less than fifty
(50) employees shall comply with Section 202 of Part II
of Executive Order 11246, as amended by Executive
Order 11375. Contractor shall ensure that subcontractors
falling within the scope of this provision shall comply
in full with the requirements thereof.
20. Administrative Hearing for Denial of Client Benefits by
Contractor
A. Contractor has read and agrees to strictly comply with
Title 22 ' of the California Administrative Code,
Section 100751, as amended, which sets forth elements to
be included in client benefit denial appeal procedures
and shall advise individuals who have been denied
assistance of their twenty (20) day right to appeal to
the State for an administrative hearing pursuant to 42
USC 8624 (b) (13) , as amended.
B. Within five (5) working days of receipt of an appeal from
a client, CSD' s Fair Hearings Officer shall schedule an
administrative hearing to be conducted no later than
thirty (.30) calendar days from the receipt of the
request.
C. The client may withdraw request for appeal for
admi-nistrative hearing at any time during the appeal
process by rendering written or oral notice to the State.
Where oral notice is given, such notice shall be
confirmed in writing by the Parties. .
Page 12
96F CSBG
21. Co rac-tor Assurances and Certifications
A. Contractor certifies that it possesses legal authority to
apply to the State for grants funded under the California
Community Services Block Grant Program Act and the
Federal Community Services Block Grant Act.
B. Contractor assures that its governing body has adopted
and passed a resolution specific to This Agreement which
shall be forwarded to the State and which includes, at a
minimum, the following provisions:
(1) Authorization for the submittal to the State of
This Agreement, including all exhibits and
assurances contained herein; and
(2) The name and original signature of the chairperson
of the board; the date signed by the chairperson;
and, if applicable, the date the resolution was
ratified by the board of directors; and
(3) Authorization to and identification of the person
certified as the official representative of the
governing board to sign and enter into This
Agreement; and
(4) Identification of the contract number and program;
and
(5) Authorization to and identification of the person
certified as the official representative of the
governing board to enter into and accept any
subsequent amendments to This Agreement and
revisions to exhibits, including a statement
specifying whether the governing board intends to
delegate authority for amendments which alter
Section 1, Consideration, and Section 2 , Term of
This Agreement.
C. Contractor assures that all supplies, materials,
equipment, or services purchased with funds provided by
This Agreement shall be used solely for the activities
allowed under This Agreement, unless a fair market value
for such use is charged to the benefiting program and
credited to This Agreement.
(1) Contractor shall adhere to its established policy
and procedures regarding the purchase or lease of
equipment having an aggregate cost of five thousand
dollars ($5000) or more. Policy and procedures will
be in conformance with OMB requirements contained
Page 13
96F CSBG
in the following Circulars: Common Rule, Subpart C
or A-110 and approved by the Board of Directors.
(2) Include the type and cost of equipment or material
to be purchased or leased on the appropriate line
item of the budget. If the purchase or lease of
equipment is not included in the execution of This
Agreement, CSD Form 558, Request for Purchase/Lease
of Equipment must be submitted to DEO for approval.
(3) Notwithstanding adherence to OMB requirements
contained in the following Circulars: Common Rule,
Subpart C or A-110, or prior approval from a Board
of Directors to procure, prior approval for the
purchase or lease of motor vehicles and trailers
must be obtained from CSD by submitting CSD Form
558 in each instance.
D. Contractor assures that it shall exercise due care- in the
use, maintenance, protection,* and preservation of State-
owned property in Contractor's possession or any. other
property purchased by Contractor with State funds. Such
care shall include, but is not limited to, the following:
1. Maintaining insurance coverage against loss or
damage to such property.
2 . Ensuring that the legal ownership of any motor .
vehicle or trailer is in the name of the
Contractor, not CSD.
E. Contractor assures that it shall be in compliance with
Federal and State Occupational Safety and Health
Statutes, the California Safe' Drinking Water and Toxic
Enforcement Act of 1986, and Workers ' Compensation laws.
F. Contractor assures that it shall coordinate its plans and
activities with other Community Services Block Grant
Contractors who serve any part of Contractor's service
area, so that funds provided under This Agreement are not
used to duplicate particular services to the same
beneficiaries.
G. Contractor' s plans and policies affecting all other
Community Services Block Grant Contractors shall be
equitable and beneficial to all such Contractors and the
population they serve.
H. Contractor assures that it shall be in compliance with
anti-discrimination provisions of Section 102 of the
Immigration Reform and Control Act of 1986 as well as
Page 14
- 96F CSBG
requirements disqualifying certain legalized aliens from
receiving benefits under This Agreement for five (5)
• years from the date they were granted temporary resident
status, even if they have been provided status according
to Section 245A (amnesty or legalization) and 210A
(replenishment workers) of the Immigration and
Nationality Act, as amended.
I. Federal Certification Regarding Debarment, Suspension,
and Related Matters
Contractor hereby certifies to the best of its knowledge
that it or any of its officers:
(1) Are not presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily
excluded from covered transactions by any Federal
department .or agency;
(2) Have not within a three (3) year period preceding
This Agreement been convicted of or had a civil
judgment rendered against them for commission of
fraud or a criminal offense in connection with
obtaining, attempting to obtain, or performing a
public (Federal, State, or local) transaction or
contract under a public transaction; violation of
Federal or State antitrust statutes or commission
of embezzlement, theft, forgery, bribery,
falsification or destruction of records, making .
false statements, or receiving stolen property;
(3) Are not presently indicted for or otherwise
criminally- or civilly-charged by a governmental
entity (Federal, State, or local) with commission
of any of the offenses enumerated in paragraph (2)
of this certification; and
(4) Have not within a three (3) year period preceding
This Agreement had one or more public (Federal,
State, or local) transactions terminated for cause
or default.
J. Drug-Free Workplace Certification
Contractor certifies that a Drug Free Workplace
Certification (Std. 21) is on -file with. CSD. The terms
and conditions of Std. 21 shall have the same force,
meaning, effect, and enforceability as if a certification
were separately, specifically, and individually provided
for each grant between Contractor and CSD.
Page 15
96F CSBG
.$5
K. Pro-Children Act of 1994
Contractor must comply with Public Law 103-227, Part C -
Environmental Tobacco Smoke, also known as the Pro-
Children Act of 1994 (Act) . This Act requires that
smoking not be permitted in any portion of any indoor
facility owned or leased or contracted by an entity and
used routinely or regularly for the provision of health,
day care, education, or library services to children
under the age of 18, if the services are funded by
Federal programs either directly or through State and
local governments. Federal programs include grants,
cooperative agreements, loans or loan guarantees, and
contracts. The law does not apply to children's services
provided in private residences, facilities funded solely
by Medicare or Medicaid funds, and portions of facilities
used for inpatient drug and alcohol treatment.
The Contractor further agrees that the above language
will be included in any subcontracts which contain
provisions for children' s services and that all
subcontractors shall certify compliance accordingly.
L. Contract Administration
Contractors shall administer This Agreement in accordance
with OMB requirements contained in. the following
Circulars: Common Rule, Subpart C for public agencies;
A-110 for nonprofit organizations.
22 . Conflict of Interest
A. Contractor certifies that its employees and the officers
of its governing body shall avoid any actual or potential
conflicts of interest, and that no officer or employee
who exercises any functions or responsibilities in
connection with This Agreement shall have any personal
financial interest or benefit which either directly or
indirectly arises from This Agreement.
B. Contractor shall establish safeguards to prohibit its
employees or its officers from using their positions for ,
a purpose which could result in private gain or gives the
appearance of being motivated for private gain for
themselves or others, particularly those with whom they
have - family, business, or other ties.
23 . Political Activities
A. Contractor shall refrain from all political activities if
such activities involve the use of any funds which are
the subject of This Agreement.
B. Contractor is prohibited from any activity which is
designed to provide voters or prospective voters with
Page 16
96F CSBG
transportation to the polls or to provide similar
assistance in connection with an election if such
activities involve the use of any funds which are subject
to This Agreement.
24 . Lobbying Activities
A. Contractor shall refrain from all lobbying activities if
such activities involve the use of any funds which are
the subject of This Agreement or any other funds,
programs, projects, or activities which flow from This
Agreement.
B. If Contractor engages in lobbying activities, Contractor
shall complete and sign and date the Certification .
Regarding Lobbying/Disclosure of Lobbying Activities,
Exhibit III, required by the U.S. Department of Health
and Human Services under 45 CFR Part 93.
25. Severability of Provisions
Should a provision of This Agreement be held invalid by a
court of competent jurisdiction, the remaining provisions of
This Agreement shall continue to be valid and enforceable.
26. Address for the State
All documents submitted by Contractor to the State pursuant to
the terms of This Agreement shall be made by deposit in the .
U.S. Mail, first class postage prepaid, or delivered by a
commercial carrier bearing a legibly dated receipt, and
addressed as follows:
Department of Community Services and Development
Attention: PROGRAMS BRANCH
P.O. Box 780
Sacramento, CA 95812-0780
27. Programmatic Provisions
A. Payments
(1) The State shall issue one working capital advance
to Contractor in an _ amount equal to one hundred
percent (1000) of the amount of the total
consideration set forth in Section I.A. of This
Agreement. Subsequent bi-monthly payments shall be
made based on actual expenditure reports being
submitted timely as indicated in Section 27 .B. of
This Agreement.
Page 17
96F CSBG
(2) In the event the term of This Agreement is less
than one (1) year, the advance payment shall be
• made by the State in the amount to be consistent
with the program needs as identified in Exhibit I,
CSBG Contract Budget, and the CSBG Work Plan and
the Outcome Evaluation Strategy (alternate form) .
(3) Contractor shall insure that the required agency-
wide audit be submitted timely, corrective action
plans are adhered to; CSD receivables are submitted
timely, and/or that repayment schedules are met and
adhered to or CSD may withhold advance or
subsequent payments.
B. Reporting Requirements
(1) Bi-Monthly .Re oorrts
Contractor shall complete and submit to the State,
on the current, appropriate CSD Form, a bi-monthly
Fiscal Expenditure Report. Contractor shall ensure
that the report is received no later than the
fifteenth (15th) calendar day of the month
following each consecutive two-month period,
irrespective of the level of activity or amount of
expenditure in the preceding two-month period.
Beginning January 1, 1996, the reports are due
March 15, May 15, July 15, September 15, and .
November 15, 1996, and January 15, 1997 .
(2) Quarterly Reports
Contractor shall complete and submit to the State,
on the current, appropriate CSD Forms, a quarterly
Programmatic Work Plan Progress Report and a Client
Characteristics Report. Contractor shall ensure
that the reports are received no later than the
fifteenth (15th) calendar day of the month
following each calendar quarter, irrespective of
the level of activity or amount .of expenditure in
the preceding calendar quarter. Beginning January
1, 1996, the reports are due April 15, July 15, and
October 15, 1996, and January 15, 1997 .
(3) - Other Funds and Other Resources
Contractor shall submit to the State, on the
current, appropriate CSD Forms, fiscal data
representing Other Funds and Other Resources, no
later than ninety (90) calendar days after the
expiration of the term of This Agreement. The
reports are due March 30, 1997 .
Page 18
96F CSBG
(4) Close-out Report
Contractor shall submit on the current, appropriate
CSD Forms, a financial and programmatic close-out
report and, return all unexpended funds to the
State within ninety (90) calendar days after
expiration of the term of This Agreement. The
close-out report is due March 30, 1997 . Final
reimbursement to Contractor, if owed, shall be
contingent upon receipt of this close-out by the
State. Subsequent payments for subsequent CSBG
contracts may also be contingent upon receipt of
the close-out of This Agreement.
(5) Review
a. The State shall review Contractor's program
operations reports and evaluate Contractor' s
demonstrated ability to effectively utilize
all funds available under This Agreement.
b. An amendment to the total consideration of
This Agreement may occur as a result of the
State's review of Contractor' s program and
fiscal operations.
C. _ Audit Reports
(1) Funds provided under This Agreement shall be.
included in an audit conducted in accordance with
the provisions of OMB Circular A-133 for nonprofit
agencies, or OMB Circular A-128 for public
agencies, standards promulgated by the American
Institute of Certified Public Accountants (AICPA) ,
and those standards included in "Government
Auditing Standards, 1994 Revision" .
(2) The financial and compliance audit shall contain
the following supplementary financial information:
a. A combining statement of revenue and
expenditures for each contract which presents,
by budget line item, revenue and expenditures
for the contract or audit period.
b. A computation sheet for each contract used to
calculate the Contractor's earnings for the
contract or audit period, including measurable
values, and a schedule of administrative
expenditures. The results of this calculation
will be used to determine:
Page 19
• 96F CSBG C •26
o The amount due Contractor
o The amount due CSD, or
o Whether the Contractor has been paid in
full
(3) If the Contractor has used the same independent
audit firm for more than five (5) consecutive
years, the Contractor must submit, to the CSD Audit
Services Unit, a written justification for using
the same audit firm in excess of five (5) years and
request approval from the Audit Services Unit to
continue using the same audit firm.
(4) Private, nonprofit contractors shall submit to CSD
two (2) copies of the required audit report within
one hundred and eighty (180) calendar days of the
end of the-Contractor's fiscal year. Upon written
request by the Contractor' s CPA, which includes an
explanation of why the audit cannot be submitted
within one hundred and eighty (180) calendar days
of the end of the Contractor' s fiscal year, an
extension may be granted by CSD's Audit Services
Unit for submittal of the audit report not to
exceed an additional thirty (30) calendar days from
the original due date. The audit reports are to be
submitted to the following address:
Department of Community Services
and Development
Audit Services Unit
700 North 10th Street, Room 258
Sacramento, CA 95814
Attention: Richard J. Bueche
(5) Local governmental entities shall submit to CSD
two(2) copies of the required audit report within
thirty(30) calendar days after the completion of
the audit, but no later than one (1) year after the
end of the audit period. The audit reports are to
be submitted to the address stated in Section 4 ,
above.
a. Local governmental agencies shall submit the
required number of copies of the audit report
in accordance with the guidelines set by the
Division of Audits of the State Controller' s
Office. Said reports are to be submitted to
the following address:
State Controller
Division of Audits
300' Capitol Mall, Fifth Floor
Sacramento, CA 95814
Page 20
96F CSBG
(6) Where services or funds under This Agreement are
provided to, for, or by a wholly-owned, or wholly-
controlled, subsidiary of Contractor, _ Contractor
hereby provides assurance that an audit shall be
performed of this subsidiary organization in
accordance with this Section 27 . Said required
audit report shall be made available to the State
upon request.
28. . Budget and Work Plan
A. Prior to execution of This Agreement by the State,
Contractor shall submit to the State Exhibit I, CSBG
Contract Budget (Summary) , Budget Support - Personnel
Costs, and Budget Support - Nonpersonnel Costs (CSBG
Fiscal Data series) . Contractor shall also submit to the
State Exhibit II, CSBG Work Plan (CSBG Program Data
series) , which .shall reflect a description of outcome
measures to be used to monitor success in promoting self-
sufficiency, family stability, and community
revitalization, measurable goals, objectives, and
available resources for the delivery of services
throughout the program period. With the exception of the
Limited Purpose Agencies and American Indian Contractors,
the CSBG Work Plan (Exhibit II) will be required in a
contract amendment when the final 1996 CSBG appropriation
is determined or when a continuing resolution is adopted
for the remaining 1996 Federal Fiscal Year.
B. Pursuant to CSBG Regulations, Section 100715 (a) (1) ,
contractor is granted approval to exceed budget line
items in excess of 10%. This provision does not alter
the requirement of Section 28.C. below pertaining to the
12% administration limitation, nor does it alter Section
21.C. 3 . requiring prior approval for the purchase of
equipment or vehicles. Expenditures in excess of the
budget total shall not be reimbursed by CSD. In all
other circumstances, pursuant to Section 9 .A, prior DEO
approval of a properly completed Justification for
Contract Amendment/Modification , CSD Form 425b, shall be
required.
C. For the purpose of administrative expenditures,
Contractor shall use funds allocated under This Agreement
in an amount not to exceed twelve percent (120) of its
total operating funds.
Page 21
96F CSBG 0�
29 . Schedule of Exhibits
The following exhibits are attached to This Agreement and are
incorporated by this reference.
EXHIBIT I. ' CSBG FISCAL DATA
CSBG Contract Budget (Summary) CSD 425.S
Budget Support CSD 425. 1. 1
- Personnel Costs CSD 425. 1.2
- Nonpersonnel Costs CSD 425.2
EXHIBIT II. CSBG PROGRAM DATA
CSBG Work Plan:
Narrative CSD 420.N
Summary CSD 420.5
Administration CSD 420.A
Employment CSD 420. 1
Education CSD 420.2
Income Management CSD 420. 3
Housing CSD- 420.4
Emergency Services CSD 420. 5
Nutrition CSD 420.6
Linkages With Other Programs CSD 420.7
Family-Self Sufficiency CSD 420.8
Health CSD 420. 9
Outcome Evaluation CSD 410-6a/b
Strategy (Alternate Form)
EXHIBIT III. CERTIFICATION REGARDING LOBBYING/STD.FORM LLL
DISCLOSURE OF LOBBYING ACTIVITIES
EXHIBIT IV. DEFINITIONS
Page 22
96F CSBG � • ��
EXHIBIT I
CSBG FISCAL DATA
CSBG Contract Budget (Summary) CSD 425.S
Budget Support CSD 425. 1. 1
- Personnel Costs CSD 425. 1. 2
- Nonpersonnel Costs CSD 425. 2
Page 23
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EXHIBIT II
CSBG Work Plan:
Narrative CSD 420.N
Summary CSD 420.S
Administration CSD 420.A
Employment CSD 420. 1
Education CSD 420. 2
•Income Management CSD 420. 3
Housing CSD 420. 4
Emergency Services CSD 420. 5
Nutrition CSD 420. 6
Linkages With Other Programs CSD 420.7
Family-Self Sufficiency CSD 420.8
Health CSD 420. 9
Outcome Evaluation CSD 410-6a/b
Strategy (Alternate Form)
Page 24
96F CSBG
EXHIBIT III
CERTIFICATION REGARDING LOBBYING
DISCLOSURE OF LOBBYING ACTIVITIES
Std LLL
Page 25
yG DEPARTMENT OF HEALTH AND HUMAN SERVICES
O ;
7
FAMILY SUPPORT ADMINISTRATION
Z
us
'a Community Services Block Grant
r- ^� PROGRAM.
c
��0 • USX • -January1, 1996 thh
PERIOD. roM_December_11... 96
The undersigned certifies, to the best of his or her knowledge
and belief, that:
(1) No Federal appropriated funds have been paid or will be paid
by or on behalf of the undersigned, to any person for influencing
or attempting to influence an officer or employee of any agency,
a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Cog
nress in connection with the awarding
of any Federal contract, continuation, renewal, amendment, or
modification of any Federal contract, grant, loan, or cooperative
agreement.
(2) If any funds other than Federal .appropriated funds have been
paid or will be paid to any person. for influencing or attempting
to influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a
Member of Congress in .:onnection with this Federal contract,
grant, loan, or cooperative agreement, the undersigned shall
complete and submit Standard Form LLL,- "Disclosure Form to Report
Lobbying," in accordance with its instructions.
3) The undersigned shall require that the language of this
certification be included in the award document for subawards at
all tiers (including subcontracts, subgrants, and contracts
under grants, loans, and cooperative agreements) and that all
subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon
which reliance was placed when this transaction was made or
entered into. Submission of this certification is a prerequisite
for making or entering into this transaction imposed by Section
1352 , Title 31, U.S. Code. Any person who fails to file the
required certification shall be subject to a civil penalty of not
less than $10,000 and not more than $100,000 for each such
failure..
Director, Community Svices. Dept.
Signature Title
Contra Costa County
Community Services Department
Agency / Organization Date
DISCLOSURE OF LOBMNG ACflV FES `'°"'" C •��
Complete this form to disclose lobbying activities pursuant to 31 U.S-C-US2
(,See reverse for public burden disclosure.?
t: Type of.Federal Action Z Status of Federal AcG= 1 Report TYPV
a a. eontraC t i:dkhffesrappliatiorm
a. W"6iv+g
b. grant b. f shial award b. material dwrVe
G eoopecstive a®eetnent C. post-award Faw!Material Chance On)T
d. loan year quarter
e. loan guarantee date of last report
f. loaninsuraoce
4. Name and Address of(teporting Eatity. L tf Reporthl Entity in No.4 is Subawardee.Enter Nance
O Prime O Subawardee and Address of Prim—c
Tier ,i tno.rer.
Congmskmal District.d'irowrr Cor4pessiortal DisbicL Ybhomver.
L Federal D"w1awswAge+ed. 7. federal Pr9grarw Na+wralOesvip4ore
CtDA Number.A'AppfiicaWe:
L Federal AcOm Number.if haowrrt 9► AmwW AmawnG U17aownc
s
t0. a. Name and Address of Lobbying Entity h lndivwuak Perform Servkes firdt+dina address b
Of a�rdMdual,bit samne.1<rst name.Aft g(Wer*rtt k"hia 10�i
frost away-first namt A41h
c.«.•..n.+ srvtt r...n+o
I L Amount of Payment fdKvk all that apply): 13. Type of Palowest fchec*SNOW apply!:
f O seal C planned 0 & retainer
O'b.one-time fee
12. Foeat of Paytwewt fc tick at daft applyt O V- torrtasiasio13 a. cash a
O d.cuminpm foe
O b. L-"4jnd.spedfy: nature O s.dand
O -11. other,spedfy:
value
14. BAd Description d Services PeWormed er to be Pedorwmd and Dates)of Srervfed - jeffm-Ksl.ewgAvyeebs).
a Menhberts).coehtaded,for Payment ledicatad L rtes tt:
�.wMwa�a► lett! r wear
-I& Caeeswatae Sheeds)SF.LLL.A attached; O Yes O No
ti. Mim-w.+r ar..0 eft rawa is a eiw*r by,re+r "r-
We raft.w..idrdw6p;MOMM"r a wmtie up.w"Now
4160 ea...f.e►#Amw ow ehm4 or aw-ry daro.06
s.i..a..w...w�.�.•...�w.>L w�..r.�.r n•••�r• Paint thtame:,
am"r- ML MM ie...�as to wpm"*.b r..two..Awww
.v..rr w I.a be...a.w be wrra..war..•wr p...w ow.ri... Tick:
sww we ww.w OWN h Unca Ow a.e.Web edM.. Tekp h~Nos Date:
fFedcral the Ckn�► A.we...ud r..toed
INSTRUCTIONS FOR COMPLEIlON OF SF-LLL„DISCLOSURE Of LOBBYING ACTIVITIES
This disdosurc form shall be completed by the reporting entity, redp�'ent. at the
C 5
initiation or mccipt of a covered Federal action. or a materia! previous Ming,
� pursuantto a to title 31 U.S.C.
section 1352.The filing of a corm Epte,quired for each payment or agreemenrto make payment to any lobbying entity for
inBuer4ing or attempting to influence an officer or employee of any agency, a-Member of Congress, an officer or
employee of Congress,or an employee of a Member of Congress in connection with a covered Federal action.Use the
SF-LL&A Continuation Sheet for additional information if the space on the form is inadequate. Complete all items that
apply for both the initial filing and material change report.Refer to the implementing guidance published by the Office of
Management and Budget for additional information.
1. identity the type of covered Federal action for which lobbying activity is andlor has been secured to influence the
outcome of a covered Federal action.
2. identify the status of the covered Federal action.
3. identify the appropriate classification of this report. if this is a followup report caused by a material change to the
information previously reported,enter the year and quarter in which the change occurred.Enter the date of the last
previously submitted report by this reporting entity for this coveted Federal action.
4. Enter the iA name, address, city, state and zip code of theentity. include Congressional District. if
known.Check the appropriate dassificatiod of the reporting entity if it h6 or expects to be.a Prune
or subaward recipient. Identify the tier of the subawardee, e4, the Wet subawaidee of the prime is the lac firs.
Subawards include but are not limited to subrowrarts,subgrants and contras awards under grants.
S. if the organization filing the report in Item 4 ch"ki—kibirwardee',then enter the full name,address,city,star».rnrl
zip code of the prime Federal mcipient:Incudr Congressional DatrkL it known.
6. Enter the name of the Federal agency making the.ward or loan Commitment. Include at least one organiz.utiurul
level below agency,nares.it known, For example,Department of Transportation,United States Coast Gumd.
7. Enter the Federal program name or description for the eovei+ed Federal-action Gtem U. •If known, enter the full
Catalog of Fedeial Domestic Assistancm (CFDA) number for grants, cooperative agreements, loanm and ban
commitments.
L Enter the most appropriate Federal identifying number avaitabk for the Federal action identilled in item 1 (e.g.
Request for Proposal (RFP) number; htvitation for Bid OFil) number, grant announcement number; the contract,
grant, or loan award number, the applicstiontproposal control member assigned by the Federal agency). include
prefixes,e4,OUP-DE-90-00V
9. For a cwQred Federal action where there has been an award or ban commitment by the Federal agency,enter the
Federal amount,of the awardlloan commitment for the prime entity identified In item 4 or S.
10. ta)Enter the full name, address, city. state and zip code of the lobbying entity engaged by the reporting entity
identified In item 4 to influence the covered Federal action.
(b)Enter the full names of the indivi kWW performing services. and include full address it different from 10 (a).
Enter Last Name,First Name.,and Middle Initial(MI).
11. Enter the amount of compentation paid or reasonably expected to be paid by the reporting entity(item 4)to the
lobbying entity(item 10). Indicate whether the payment has been made(actual)or will be made(planned). Check
au
i boxes that apply. If this is a material change report enter the anulative amount of payment made or planned
to be made.
i2 Check the appropriate box(es),. Check an boxes that apply. It payment is made through an k kind contribution.
specify the nature and value of the in-kind payment:
13. Check the appropriate boAW. Checlk all boxes that apply. If other,specify nature.
14. Provide a specific and detailed description of the services that the lobbyist has performed, or wilt be expected to
perform and the date(s)of any services rendered Include all preparatory and related activity,not fast time spent in
actual contact with Federal offib"s. identify the Federal offidal(s) or employee(s) contacted or the officeKs).
enVioyee(s).or Member(s)of Congress that were contacted.
1S. Check whether or not a SF-UL,A Continuation Sheet(s)is attached.
W The certifying official shall sign and date the tomb print Ws4w name,title.and telephone number.
Public reporting bhraden for this collection at irdonntmon b estimated to average 30 nrnm+es per resporhst.inc�ludrrug tiwhe for reviering
instthucoone,sesrcfhir+g em"data sources,gathering and nuirrtai"the data needed.and completing and reviewing tit eollecrion of
4dannaoon.Send CMWM b regard V the burden estimate or any other aspect of*A cokaxin of iniee melon.kKkWvq aftesti m
for reducing this bum*m to the oWsw d mw%agemem and Sudgee Paperwork tteduc6on P feet(0348418").Washington,O.C.tosez.
DISCLOSURE OF LOBBYING AcnvmES --
CONTINUATION SHMET
ltepw liiwg Bdtr- Page �(
wi..ls.�Ise1�cd
f�wian/Pam.&"-A
96F CSBG
EXHIBIT I�
DEFINITIONS
1. Authorized Agent: The duly authorized representative of the
Board of Directors of Contractor and duly
elected or appointed, qualified, and acting
officer of the State. In the case of
Contractor, the State shall be in receipt of
board resolution affirming an agent's
representative capacity to bind Contractor to
the terms of This Agreement.
2 . Contractor: The entity (partnership, corporation,
association, agency, or individual)
designated on page 1 of This Agreement.
3 . CSD: The Department of Community Services and
Development, State of California.
3 . Parties: The State of California and the Contractor.
4 . Subcontractor: An entity (partnership, corporation,
association, agency, or individual) that
enters into a subcontract with Contractor to
fulfill the terms of This Agreement.
5. Subcontracts: Contracts entered into by and between
Contractor and subcontractor to carry out the
purposes of This Agreement.
6. The State: The State of' California, Department of
Community Services and Development
7 . This Agreement: The complete contents of this contract
entered into by and between the State and
Contractor, including all rights, duties, and
obligations whether express or implied.
required toward the legal performance of the
terms hereof.
8. This Program: The Community Services Block Grant (CSBG)
Program, 42 USC 9901 et seq. , as amended.
Page 26