HomeMy WebLinkAboutMINUTES - 05021995 - 1.28 TO: BOARD OF SUPERVISORS Contra
JOAN V. SPARKS, DIRECTOR Costa
FROM: COMMUNITY SERVICES DEPARTMENT
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MAY 2, 1995 �'�; , r� County
DATE:
AUTHORIZATION TO EXECUTE 1995-96 DEPARTMENT OF ENERGY CONTRACT WITH
sueJEcr: THE STATE DEPARTMENT OF ECONOMIC OPPORTUNITY
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, Contract
#39-800 (State #95C-8012) with the State Department of Economic
Opportunity in the amount of $79, 166 for continuation of the
Department of Energy (DOE) Low-Income Weatherization 'Assistance
Program for the period from April 1, 1995 through March 31, 1996 .
II . FINANCIAL IMPACT:
This Contract is Federally funded through the State Department of
Economic Opportunity. The contract payment limit of $79, 166 is
reflected in the Community Services Department's proposed FY 1995-96
budget. No County funding is required.
III . REASONS FOR RECOMMENDATIONS/BACKGROUND:
On June 21, 1994 the Board approved State Standard Agreement #94C-7012
with the Department of Economic Opportunity for weatherization
services. This agreement continues services through March 31, 1996 .
This contract provides $79 , 166 in reimbursable funds to enable the
County to weatherize approximately 128 dwellings in Contra Costa
County during the period April 1, 1995 through March 31, 1996 .
This contract will be reviewed and approved as to form by County
Counsel prior to submission to the State.
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CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S):
ACTION OF BOARD ON 9 9 S APPROVED AS RECOMMENDED i OTHER
VOTE OF SUPERVISORS
_Z
1 HEREBY CERTIFY THAT THIS IS A TRUE
`� 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.
CONTACT: Joan Sparks, 313-7350
CC: CAO ATTESTED
CSD PHIL BATCHELOR,CLER OF THE BOARD OF
SUPERVISORS AND COUNTY ADMINISTRATOR
M382 (10/88) BY DEPUTY
a2�
S uF CALIFORNIA
~STANDARD AGREEMENT— APPROVED BY THE CONTRACTNUMBER AM.NO.
ATTORNEY GENERAL 95C-8012 0
STD.2(REV.5-91)
TAXPAYERS FEDERAL EMPLOYER IDENTIFICATION NUMBER
THIS AGREEMENT,made and entered into this 1St day of Ap r l 1 19 95 94-6000509
in the State of California,by and between State of California,through its duly elected or appointed,qualified and.acting County #39-800
TITLE OF OFFICER ACTING FOR STATE AGENCY
Deputy Director, Admin. Department of Economic Opportunity ,hereafter called the State,and
CONTRACTOR'S NAME
Contra Costa County Community Services Department ,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 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.)
WHEREAS, pursuant to 42 United States Code (USC) 6861 et seq. , as amended,
Contractor desires to implement the Department of Energy (DOE) Low-Income
Weatherization Assistance Program to weatherize the dwellings of the eligible
low-income population residing within the designated service area as described
in Exhibit C.
1 . Consideration
A. The total consideration payable by the State to Contractor for DOE/WX
assistance under This Agreement shall not exceed $ 79, 166 . 00 as
set forth in Exhibit F.
B. The consideration to be paid Contractor as provided herein; shall be in
compensation for all Contractor' s reasonable expenses incurred including
travel and per diem unless otherwise expressly so provided, and in
exchange for Contractor' s unit performance of weatherization measures as
specified in Section 31 .D of This Agreement .
CONTINUED ON SHEETS,EACH BEARING NAME OF CONTRACTOR AND CONTRACT NUMBER.
The provisions on the reverse side hereof constitute a part of this agreement.
IN WITNESS WHEREOF,this agreement has been executed by the parties hereto,upon the date first above written.
STATE OF CALIFORNIA CONTRACTOR
AGENCY CONTRACTOR(if other than an individual,state whether a corporation,partnership,etc.)
Department of Economic opportunity Contra Costa Co . Comm Svcs Dept .
BY(AUTHORIZED SIGNATURE) BY(AUTHORIZED SIGNATURE)
D �
PRINTED NAME OF PERSON SIGNING PRINTED NAME AND TITLE OF PERSON SIGNING
Carmen Ochoa JOAN SPARKS DIRECTOR COMMUNITY SVCS DFPT
TITLE ADDRESS 1220 Morello Avenue, Suite 101
Deputy Director, Administration Martinez CA 94553
AMOUNT ENCUMBERED BY THIS PROGRAWCATEGORY(CODE AND TITLE) VT.F.
UND TITLE Department of General Services
DOCUMENT 20 . 50 DOE/WX Use only
`P (OPTIONAL USE)
PRIOR AMOUNT ENCUMBERED FOR
THIS CONTRACT ndex2 6 0 0 PCA4 5 2 5 0 FC##81 . 04 2 DOELAS WP 9
$ 0 ITEM CHAPTER STATUTE FISCAL YEAR i hereby certify that all conditions
TOTAL AMOUNT ENCUMBERED TO 4 700-101-890 13 9 1994 9 4 9 5 for exemption have been com-
DATE OBJECT OF EXPENDITURE(CODE AND TITLE)
$ 79 166 . 00 702 - Grants Subventions plied with, and this document is
I hereby certify upon my own personal knowledge that budgeted funds I TBA.NO. B.R.NO. exempt from the Department of
are available for the period and purpose of the expenditure stated above. General Services'approval.
SIGNATURE OF ACCOUNTING OFFICER DATE
D
E] CONTRACTOR STATE AGENCY DEPT.OF GEN.SER. ❑ CONTROLLER
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C. . The total amount budgeted for Administrative Costs shall not exceed the limits described
in Section 30.B. Adherence to Section 23.D, regarding equipment purchase or lease, is
required and is not altered by the provisions of this Section. Expenditures in excess of
the budget total shall not be reimbursed by the State.
2. Term
The term of This Agreement shall be from April 1, 1995 through March 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 that may be injured or damaged by Contractor in the performance of This
Agreement.
4. Independent Contractor
Contractor and its agents and employees, in the performance of This Agreement, shall act in an
independent capacity and not as officers, employees, or agents ofthe State.
5. Suspension and Termination
A. Suspension
1. If Contractor or subcontractor has failed to comply with the performance-based
terms of This Agreement, the State may, upon reasonable notice to Contractor or
Subcontractor, suspend This Agreement in whole or in part.
The State may suspend This Agreement, in whole or in part, if Contractor has
demonstrated two consecutive contract terms of unexpended funds in an amount
of 10% or greater of their contract amount. The 93C DOE contract was
designated the base-year or the inception year to calculate the specific time-frame
denoting the first.in a series of_'.consecutive" years. _Additionally, the State may
mandate special contract conditions which may require subcontracting of the
DOE weatherization services.
In the case of fraud or gross negligence, suspension without prior notice by the
State is permissible.
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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.
3. A suspension shall remain in effect until Contractor has taken corrective action
satisfactory to the State, or has provided evidence satisfactory to the State that
such corrective action will be taken.
4. 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. 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. Either party to This Agreement may terminate it at any time prior to its date of
expiration upon thirty(30) 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 expressly 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.
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7. Subcontracts
A. Contractor shall provide to the State within sixty(60) calendar days of execution the
name of the entity, address, contact person, telephone number, contract amount, and
program description of each subcontractor to This Agreement.
B. Contractor shall assure that subcontractor(s) comply with all terms and conditions of This
Agreement.
C. Contractor shall immediately notify all of its subcontractor(s), in writing, in the event the
State suspends or terminates This Agreement.
D. Contractor is the responsible party, without recourse to the State, regarding the
settlement and satisfaction of all contractual and.administrative issues arising out of
subcontracts entered into in support of This Agreement, including but not limited to
disputes, claims, or other matters of a contractual nature as well as civil liability arising
out of negligence or intentional misconduct of subcontractor(s).
8. Time
Time is of the essence in the performance of This Agreement.
DEO will not approve a term extension in order-to meet the goals in Exhibit E, DOE Schedule
of Energy Program Goals/Expenditures.
9. Amendment - Modification
A. No alteration or variation of the terms of This Agreement shall be valid unless made in
writing in the form of an amendment-modification 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, and the
exceptions provided for in Section 15, Provisions for Federally-Funded Grants.
1. Request for Amendment-Energy, DEO 509 (Rev. 1/95) is provided to submit
changes to Exhibit.-E, Schedule-of Energy-Program Goals/Expenditures, and
Exhibit F, the Weatherization Program Budget.
2. Said requests shall be submitted no later than 45 days prior to the expiration date
of This Agreement.
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B. No oral understanding or agreement not incorporated herein shall be binding on any of
the Parties.
10. Enforceable Agreement
This Agreement shall become a valid, enforceable agreement only after it is signed by
authorized agents of the parties.
11. Equitable Treatment
Contractor shall assure that owners and renters receive equitable treatment under This
Agreement.
12. 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 and applicable licenses as required by the
Contractors' State License Board.
13. Record-Keeping Responsibilities
A. All records maintained by Contractor shall meet the requirements of the Common Rule,
Subpart C (Uniform Administrative Requirements for Grants and Cooperative
Agreements to State and Local Governments), or OMB Circulars A-102, 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 years after submission of the final report. However, Contractor shall maintain all
such records until resolution of all audit findings is completed. In the event any record
must be maintained for a period longer than three years, the State shall send appropriate
notification to Contractor.
C. Contractor shall make appropriate books, documents, papers, and records available to the
Federal government, the State, or any of their duly-authorized representatives, including
representatives of the entity selected by DEO to perform inspections, for examination,
copying, or mechanical reproduction, on or off the premises of the appropriate entity
upon a reasonable request therefore.
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D. Contractor shall maintain a separate file for each applicant certified as eligible to receive
assistance. Said files shall include at least the following documentation:
1. Intake and Job Order Sheet,DEO 565 (New 4/95).
2. Copies of source documents supporting eligibility.
3. Building Check and Job Order Sheet or Contractor's equivalent.
E. Contractor shall also maintain an Intake and Job Order Sheet,DEO 565 (Rev. 4/95) and
supporting documents, if any, including any appeal documents, for each applicant who is
not certified as being eligible to receive assistance.
F. 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.
14. Insurance and Fideli, 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 with written notice at least thirty(30)
days prior to cancellation or reduction of insurance coverage to an amount
less than that required in This Agreement.
C. In the event said insurance coverage expires at any time or times during the
term of This Agreement, Contractor agrees to provide, at least thirty(30)
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. In the event Contractor fails to keep in effect at all times insurance and
bond coverage as herein provided, the State may suspend This Agreement.
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e. The State shall be named as 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 utilize subcontractor(s)to
provide services under This Agreement, Contractor shall indemnify and hold the
State harmless against any liability incurred by the 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 DEO, 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 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.
2. Contractor shall submit an applicable Certificate of Insurance (ACORD 25)to the
State as evidence of compliance with said bond requirement prior to issuance of
an initial cash advance.
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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. Contractor shall submit an applicable Certificate of Insurance (ACOR.D 25),
naming DEO as an additional insured, to the State as evidence of compliance
with public liability insurance requirements prior to issuance of an initial cash
advance.
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. Contractor shall submit an applicable Certificate of Insurance(ACORD 25),
designating DEO as an additional insured, to the State as evidence of compliance
with said vehicle insurance requirements prior to issuance of an initial cash
advance.
3. 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.)
15. Provisions 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.
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C. It is agreed that if the Congress does not appropriate sufficient funds for This Program,
This Agreement shall be amended to reflect any reduction in funds.
D. The State has the option to void This Agreement under the thirty-day(34)cancellation
clause or to amend This Agreement to reflect any reduction of funds.
16. Limitation on Use of Funds
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 other than low-income weatherization energy-related home
repairs.
17. Right to Monitor. Audit, and Investigate
A. The Federal, State, or duty-authorized representative of the State government, which
includes but is not limited to the Bureau of State Audits and the entity selected by DEO
to perform inspections, 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. _
1. Unless Contractor assumes the task of arranging inspection visits with the
selected weatherization clients, Contractor shall provide the use of a telephone to
the inspector.
2. Contractor is not expected to accompany the inspector on client inspection visits,
to provide transportation, or to provide equipment to the inspector unless
Contractor desires to do so. The inspector, however, will permit Contractor
personnel to participate in client visits.
B. The Federal, State, or duly-authorized representative of the State government shall have
the right to undertake investigations in accordance with 42 USC 6861 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 the State or a
duly-authorized representative of the State or Federal government access to the working
papers of said audit firm(s).
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18. 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.
19. 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 promul-
gated thereunder(California Code of Regulations, Title 2, Section 7285.0 et seq.). The
applicable regulations 6fthe 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 M. 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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C. Contractor's signature affixed hereon shall constitute a certification under the penalty of
perjury under the laws of the State of California that to the best of its knowledge will,
unless exempted, complied with the nondiscrimination program requirements set forth in
this section.
20. Affirmative Action Compliance
A. Each Contractor or Subcontractor that has fifty(50)or more employees and has an
agreement of fifty thousand dollars(550,000)or more shall be required to develop a
written Affirmative Action Compliance Program.
B. The written program is to 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.
21. Fair Hearing Process for Alleged Violation of the Civil Rights Act Against Contractor
A. In the event of any violation or alleged violation of Title VI of the Civil Rights Act of
1964, as amended, Contractor has the right to request a fair hearing in response to such
violation or alleged violation within thirty(30) calendar days from the date of such
action.
B. The State shall conduct such fair hearing in accordance with Title 45, Code of Federal
Regulations, Section 81.1, et seq.
22. Fair Hearing;Process for Applicants for Denial of Benefits by Contractor
A. Contractor shall inform, at the time of intake, all applicants of their right to appeal all
claims for assistance that are denied or are not acted upon with reasonable promptness.
1. Contractor shall conduct a structured, fair, and impartial meeting within five(5)
working days of the initial request for appeal and shall make a good faith effort to
resolve the applicant's complaint(s)at the local level. Contractor shall make a
written finding which sets forth the case of both parties and the decision of
Contractor.
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2. If the appeal is not resolved to the satisfaction of the applicant at the local level,
Contractor shall inform the applicant that an appeal to the State may be requested
as part of the Fair Hearing process and shall provide the applicant with an
appropriate form.
3. If the applicant decides to appeal to the State, applicant shall submit a written
appeal request to be received by the State within ten(10) working days from the
date of Contractor's final decision. Upon request from DEO, Contractor shall
provide all supportive documentation to be received by the State within five(5)
working days.
23. Contractor Assurances and Certification
A. Contractor certifies that it possesses legal authority to apply to the State for grants
funded under the DOE Weatherization Assistance Program for Low-Income Persons and
assures compliance with the purposes as set forth in 42 USC 6861, et seq., as amended.
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 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 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, along with a statement
specifying whether the governing board intends to delegate authority for
amendments which alter-Section-1. Consideration, and/or Section 2, Term of This
Agreement; and
6. A statement which stipulates whether the governing board intends to delegate
authority for changes to Exhibit D, Assistance Priority and Limits.
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C. 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 DEO.
D. Contractor acknowledges that this is a performance-based contract as cited in Section
5.A-1 and 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
($5,000.00) or more. Policy and procedures will be in conformance with OMB
Circulars A-102 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,DEO Form 558, Request for
Purchase/Lease of Equipment must be submitted to DEO for approval.
3. Notwithstanding adherence to OMB Circulars A-102 or A-I10, 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 DEO by submitting DEO Form
558 in each instance.
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 conduct outreach activities designed to assure that eligible
households with elderly, handicapped, American Indian, migrant or seasonal farm
worker individuals, and children age 18 and under are made aware of the assistance
available under This Agreement.
G. 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 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.
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H. 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 trans-
action;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.
I. Drug-Free-Workplace Certification
Contractor certifies that a Drug Free Workplace Certification (Std. 21) is on file with
DEO. 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 DEO.
I Contract Administration
Public agencies shall administer this contract in accordance with OMB Circular A-102;
nonprofit organizations shall administer this contract in accordance with OMB Circular
A-110.
24. Conflict of Interest
A. Contractor certifies-that its employees and the7officers 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, arise from This
Agreement.
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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 which gives the
appearance of being motivated for private gain for themselves or others, particularly
those with whom they have family, business, or other ties.
25. 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 or any other funds, programs, projects, or
activities which flow from This Agreement pursuant to 42 USC 9904(e), as amended.
B. Contractor is prohibited from any activity which is designed to provide voters or
prospective voters with 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.
26. 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, sign, and date the
Certification Regarding Lobbying/Disclosure of Lobbying Activities(Exhibit G).
27. 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.
28. Addresses 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 Economic Opportunity
ATTENTION: PROGRAMS BRANCH
P.O. Box 780
Sacramento, CA 95812.0780
15
95c-
29. Programmatic Provisions
A. Pa, ents
Beginning in 1994, DEO established performance-based contracts. Effective with This
Agreement, attention to the distribution of carryover funds, or other funds designed to
enhance DOE funds, shall consider previous year(s) adequate achievement of fiscal and
programmatic performance. Adequate fiscal and programmatic performance will be the
achievement of 90% of the stated goals and expenditures as submitted on DEO 564
(Rev. 4/95). Seventy-percent(70%)of the aforementioned 90% achievement shall have
occurred prior to February 1, 1995. Additionally, Contractor shall insure that the
required agency-wide audit be submitted timely; that corrective action plans are adhered
to;DEO receivables are submitted timely, and/or that re-payment schedules are met and
adhered to.
I. Advance Payments
a. Upon written request by Contractor, the State may issue an advance
payment to Contractor in an amount not to exceed twenty-five percent
-(25%) of the total amount of This Agreement, as set forth-in Section LA.
b. In the event This Agreement is amended to increase the consideration of
This Agreement, a subsequent advance payment not to exceed twenty-five
percent (25%) of the amount of the increase may be authorized by the
State, if Contractor requests such advance payment in writing. The need
for such additional advance payment shall be based upon a review of
Contractor's cash flow status as recorded on Contractor's current monthly
expenditure report,
C. Advance payments outstanding ninety (90) days prior to the expiration date
of This Agreement will be offset against subsequent payments.
2. Subsequent Payments
a. Payments to Contractor are contingent upon receipt by the State of the
three-part Monthly Expenditure/Activity/Earned Measures Report, DEO
571 (Rev. 4/95), as required under Section 29.0 of This Agreement.
b. Contractor shall be entitled to obtain a maximum reimbursement of$1,854
per dwelling unit weatherized and for applying the conservation measures
and activities described in Section 31.D. In the event the Governor declares
a State of Emergency or Local Emergency under Article 13 or 14 of the
16
95C—
Emergency Services Act, the maximum reimbursement shall be$2,000 per
dwelling unit.
c. In dwelling units in which the heating/cooling unit must be replaced,
Contractor may expend no more than$2,750. This limitation includes all
weatherization measures installed.
d. Contractor may apply no more than 25%of the total program funds
expended towards abating health and safety hazards based on heating and
cooling services.
e. Contractors will be authorized to abate health and safety hazards generated
by heating/cooling sources, and to increase air exchange rates which are
determined to be less than the minimum level.
B. Contractor Activities
1. Coordination- Contractor shall refer potentially eligible applicants to other
energy or conservation programs. Contractor shall coordinate its activities with
other Federal, State, or local energy conservation programs with the goal of
conserving energy, improving thermal efficiency, and defraying energy costs of
low-income households.
2. Contractor shall not divide the application of individual weatherization measures
between This Program and other weatherization programs unless the maximum
DEO rate for a measure has been reached.
3. Client Education
Contractor shall provide to all recipients of energy assistance under This
Agreement applicable energy conservation information which shall include at least
the following:
a. A description of the benefits which the client can expect to receive as a
result of the weatherization measures installed in the dwelling.
b. An explanation of the action of each measure in terms of preventing air
infiltration or the escape of heated or cooled air from the dwelling and how
to maximize the effect of such measures.
C. Written information which describes energy-saving behavioral adjustments
which will decrease the energy consumption of the household.
17
95C-
d. Resource information and referral,and family and budget counseling in
order to assist clients in achieving self-sufficiency.
C. Reporting
I. Monthly Reports
Contractor shall ensure that the monthly report consisting of the three-part
Monthly Expenditure/Activity/Earned Measures Report, DEO 571 (Rev. 4/15)is
received by the State on or before the 15th calendar day of each month, regard-
less of the level of activity or amount of expenditures during the previous month.
2. Close-Out Report
Contractor shall submit, on the appropriate DEO forms, a financial and
programmatic close-out report and return all unexpended funds to the State
within ninety(90) days after expiration of This Agreement. Final reimbursement
to Contractor, if owed, shall be contingent upon receipt of this close-out by the
State. Subsequent payments for other DEO contracts may also be contingent
upon receipt of the close-out of This Agreement. —
3. Review
a. The State shall review Contractor's monthly program operation reports and
evaluate Contractor's demonstrated ability to effectively utilize all funds
available under This Agreement.
b. As set forth in Section 9, 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.
D. Audit Reports
I. 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".
18
95C-
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:
(1) The amount due Contractor
(2) The amount due DEO, or
(3) 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 DEO 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 DEO two (2) copies of the required
audit report within one hundred 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
eighty(180) calendar days of the end of the Contractor's fiscal year, an extension
may be granted by DEO's Audit Services Unit for submittal of the audit report not
to exceed thirty(30)calendar days from the original due date. The audit reports
are to be submitted to the following address:
Department of Economic Opportunity
Audit Services Unit
700 North 10th Street, Room 258
Sacramento, CA 95814
Attention: Richard J. Bueche
5. Local governmental entities shall submit to DEO 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.
19
95C—
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
C. 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 29D. Said required audit report shall be made
available to the State upon request.
30. Budget Definitions
A. Cost Reportifl& _
All costs shall be reported using a "modified accrual' or "accrual' method of accounting.
B. Administrative Costs
1. Administrative Costs shall mean costs for auxiliary functions such as accounting,
auditing, monitoring assistance, facilities, utility costs, and like services necessary
to sustain the direct effort involved in administering a grant program or an activity
providing services to the grant program.
2. Local governments shall use OMB Circular A-87(Cost Principles for State and
Local Governments)as a guide for determining administrative costs.
3. Private, nonprofit corporations shall use OMB Circular A-122 (Cost Principles
for Nonprofit Organizations) as a guide for determining administrative costs.
4. Unless applied for and approved on DEO 574 (Rev. 4195), payment under this
budget line item shall not exceed five percent(5%) of the cumulative allowable
program expenditures for weatherization activities performed under This
Agreement.
20
95C—
C. Program Costs
1. Program Costs are all allowable costs other than Administrative Costs.
2. Program Costs include those costs which are directly attributable to the
performance of This Agreement, and which are reasonable and necessary as
determined by the State, for the purpose of delivering services. Allowable costs
shall be as set forth in.Title 10, Code of Federal Regulations, Section 440.18(c).
3I. Special Provisions
A. Applicant Eliaibility
1. Weatherization assistance services shall be available only to the following
households:
a. Households in which one or more individuals are receiving:
1) Aid to Families with Dependent Children(AFDC); or
2) Supplemental Security Income (SSI)/State Supplementary Program
(SSP) payments; or
3) Food Stamps; or
4) . Payments under Sections 415, 521, 541, or 542 of Title 38 of the
United States Code, or under Section 306 of the Veterans' and
Survivors'Pension Improvement Act of 1978. OR
b. Households with incomes that do not exceed an amount equal to one
hundred fifty percent(150oto) of the Federally-established poverty level. If
applicable income records for a minimum period of at least sixty(60)days
immediately preceding the date of application shall be used in determining
eligibility based on income only.
C. Appropriate documents shall be maintained in each applicant's file.
2. No household shall be excluded from eligibility for services if the household has
an income which is less than one hundred ten percent-(I 10%)of the Federally-
established poverty level.
3. The provision of weatherization services shall begin within one hundred twenty
(120)calendar days of eligibility certification or the household shall be recertified.
21
95C-
B. Service Priority
1. Contractor shall give first priority for weatherization services to those households
which have the lowest incomes and the highest energy cost in relation to income,
taking into account family size.
2. Contractor shall factor into its first priority, eligible households with elderly,
handicapped, and children.
3. Additional priorities shall be as set forth in Exhibit D.
C. Scope of Services
1. Outreach
Contractor may claim reimbursement for outreach as set forth in Section 31.13
only once for each unit weatherized whether under This Agreement or a previous
DEO agreement.
a. Unweatherized Dwellings
Reimbursement for outreach may be claimed by Contractor in accordance
with Section 3 LD for each eligible unit not previously weatherized. Addi-
tionally, Contractor will be allowed to claim reimbursement when a safety
check of combustion appliances reveals safety hazards which preclude
tightening of the envelope.
b. Dwellings Weatherized with Nonfederal Funds
Reimbursement for outreach may be claimed by Contractor only if the
previous weatherization was performed by another service provider.
C. Dwellings Weatherized with Low-income Home Energy Assistance
Program (LIHEAP)and DOE Funds
Reimbursement for outreach may be claimed by Contractor only once when
LIHEAP and DOE funds are used concurrently in the same unit.
22
95C—
Intake
a. Unweatherized Dwelllnes
Reimbursement for intake may be claimed by Contractor in accordance with
Section 31.1?for each eligible household not previously weatherized. Addi-
tionally, Contractor will be allowed to claim reimbursement when a safety
check of combustion appliances reveals safety hazards which preclude
tightening of the envelope.
b. Dwellings Weatherized with Nonfederal Funds
If the previous weatherization was performed under a nonfederal program,
the occupant eligibility must be certified; therefore, Contractor may claim
reimbursement for intake.
C. Dwellings Weatherized with LIHEAP and DOE Funds
Reimbursement for intake may be claimed by Contractor only once when
LIHEAP and DOE funds are used concurrently in the same-unit.
3. Assessment of Dwelling
a. Contractor shall inspect the dwelling of each eligible applicant to determine
if the unit is structurally sound and not in need of extensive repairs.
b. If the dwelling unit is not eligible because of the need for extensive repair,
the unit shall not be serviced and the applicant should be referred to the
local Housing and Community Development Department, U.S. Farmers
Home Administration Housing Loan Program or other similar organizations
or programs.
C. Documentation of ineligibility due to the need for extensive repairs shall be
recorded on the Intake and Job Order Sheet,DEO 565 (Rev. 4/95), and
reported to DEO.
d. If the applicant can obtain the necessary repairs to make the dwelling unit
eligible for weatherization services, weatherization activities may be
accomplished following the repair work.
23
95C-
e. If an unvented space heater is being utilized, envelope-tightening measures
shall not be applied unless venting is installed or the unit is replaced.
f. Contractor shall conduct a preliminary combustion appliance safety check
on all dwelling units that are not all-electric units, and, where applicable,
perform a post-check of said dwelling .
g. Reimbursement for assessment may be claimed by Contractor in accordance
with Section 3 LD for each eligible household not previously weatherized.
Additionally, Contractor will be allowed to claim reimbursement when a
safety check of combustion appliances reveals safety hazards which
preclude tightening of the envelope.
h. Following a determination that no combustion by-product hazards exist, a
blower door test shall be performed on all mobile(manufactured)homes
and at least ten percent(IO%) of all single-family detached, duplex, and
triplex dwelling units.
i. Blower door testing and resulting infiltration repairs, other than Caulking
and/or Weatherstripping, may result in attaining the lower limit of cubic feet
per minute infiltration, thereby precluding further tightening by Caulking
and/or Weatherstripping. _
j. If the unit otherwise qualified for Weatherization because of the apparent
need for Caulking and/or Weatherstripping, it now becomes ineligible.
However, Contractor may requalify the unit by substituting Optional
Measures (other than Furnace or Air Conditioning Filter Replacement and
Water Flow-Restricting Devices), as needed, in place of the now
nonfeasible Caulking and/or Weatherstripping measures.
4. Unweatherized Dwellings
a. A unit may qualify if a health or safety hazard is found to exist which
requires a combustion appliance to be repaired or replaced to correct, the
cost of which will preclude the installation of the required number of
mandatory measures.
If combustion appliances are not present, single family detached and other
single story dwellings which have not been previously weatherized under a
DEO or other program shall not be weatherized under This Agreement
unless:
24
95c-
o ceiling insulation plus two(2)additional mandatory measures are
installed, 4R
o in the event ceiling insulation is not feasible, at least four mandatory
measures are installed, unless the Blower Door test indicates that
fewer than four mandatory measures are needed to be installed as
noted under Section 31.C.7.a.1.
b. Multi-story, multi-unit complexes may qualify with the installation of ceiling
insulation and any two(2)other mandatory measures or, in the event ceiling
insulation is not feasible, at least three(3)mandatory measures.
Installation of ceiling insulation may be counted as a ceiling insulation
measure for each unit within that building envelope. The charge shall be
prorated among all dwelling units.
Insulation of a common water heater shall qualify as a mandatory measure
for each unit served by the same water heater. However, reimbursement
may be claimed for only one water heater and the equivalent number of
standard-sized water heater blankets installed, and the cost shall be prorated
among all dwelling units. _
C. Reimbursement for dwelling assessment may be claimed by Contractor in
accordance with Section 3 LD for each eligible unit not previously
weatherized. -
5. Previously-Weatherized Dwellings
a. If a dwelling has been previously weatherized under a Federal Program
between September 30, 1975, and September 30, 1985, Contractor may
provide, within the dollar limits of This Agreement, heretofore unapplied
mandatory and optional measures. The dwelling eligibility must be
recertified; therefore, Contractor may claim reimbursement for assessment
of the dwelling.
Additionally, a dwelling unit which has been damaged by a natural disaster
such as fire, flood, earthquake, hurricane, etc., or any other act of God, and
repair of the damage to weatherization materials is not paid for by
insurance, Contractor may have the damages repaired. The occupant must
be certified as currently eligible, and a new dwelling assessment must be
performed.
25
95C—
b. If the previous weatherization was performed under a nonfederal program,
the dwelling and occupant eligibility must be recertified;therefore,
Contractor may claim reimbursement for assessment of dwelling and intake.
6. Dwellings Weatherized with LMAP and DOE Funds
Reimbursement for dwelling assessment may be claimed by Contractor only once
when LIHEAP and DOE funds are used concurrently in the same unit.
7. Installation Guidelines
a. Mandatory measures are to be installed in priority order, and no measure
shall be excluded or skipped unless:
(1) a blower door test indicates that installation of the measure is not
necessary, or
(2) the dwelling already has that measure in place, or
(3) the measure cannot be properly installed, or
(4) the client refuses installation(client refusal is to be documented and
placed in file), or
(5) the maximum dollar limit is reached.
(6) the measure is not needed or required
Notations of exception(s) shall be included in the client file
b. If the dollar limit has not been reached in installing feasible mandatory
measures, Contractor may install optional measures.
C. Measures shall be applied in accordance with the initial dwelling assessment
documented on the Building Check and Job Order Sheet or Contractor's
equivalent. Installation of those measures contained therein shall be
accomplished in conformance with the DEO Weatherization Installation
Standards (WIS) manual, hereby incorporated by reference.
Standards contained in the Uniform Building Code and local city and
county codes shall take precedence over the DEO WIS manual if the code
requirement: (1) is not included in the manual or(2)is more stringent.
26
95C
d. Upon the State's request, Contractor shall furnish proof that materials used
under this program conform to the requirements of Exhibit A,Materials
Standards, the DEO WIS manual and/or State, county;-or local regulations
and were procured in conformance with OMB Circular A 110, Attach-
ment O, (Grants and Agreements with Institutions of Higher Education,
Hospitals, and Other Nonprofit Organizations) or the Common Rule,
Section 36(Uniform Administrative Requirements for Grants and Co-
operative Agreements to State and Local Governments).
e. Any weatherization materials purchased with these grant funds and
remaining at the expiration of This Agreement shall be credited against
Contractor's weatherization materials expenditures under This Agreement
and charged to whatever other weatherization program Contractor may
have in effect. If Contractor has no other weatherization program in effect,
the State shall be contacted for disposition instructions.
8. Qualb Assurance
a. Contractor, or its designee, shall review all of the dwellings Contractor has
weatherized. A statement certifying that all required measures were
installed per contract and DEO installation standards shall be noted on the
front of the Building Check and Job Order Sheet, or the Contractor's
equivalent, and signed and dated by the reviewer. Contractor shall not
report a dwelling as weatherized nor request reimbursement prior to this
final certification.
b. The State, or its designee, may perform an inspection of dwellings
weatherized under This Agreement. Contractor agrees to correct any work
deficiencies noted by the State or its designee. Contractor agrees to take
action and correct such deficiencies within twenty(20)working days of
written notification.
C. Contractor shall attempt to correct safety hazards resulting from
weatherization measure installation within twenty-four(24)hours and shall
completely resolve such hazards within five(5)working days of written
notification.
27
95C-
9. Client Education
a. Unweatherized Dwell
Client education shall be conducted in accordance with Section 29.B.3. and
reimbursement for such may be claimed in accordance with Section 3 LD
for the occupants of each eligible unit not previously weatherized.
Additionally, Contractor will be allowed to claim reimbursement when a
safety check of combustion appliances reveals safety hazards which
preclude tightening of the envelope.
b. Dwellings Weatherized with Nonfederal Funds
Reimbursement for client education shall not be claimed by Contractor
unless the dwelling was previously weatherized by non-Federal funds, i.e.,
regulated or non-regulated utility companies, private sector funds, etc., or
by a weatherization service provider not associated with the provisions of
This Agreement. If such circumstances exist, client education shall be
conducted in accordance with Section 29.13.3 and reimbursement may be
claimed in accordance with Section 31.D for the occupants of each eligible
unit previously weatherized. _
C. Dwellings Weatherized with LIHEAP and DOE Funds
Reimbursement for client education may be claimed by Contractor only
once when LIHEAP and DOE funds are used concurrently in the same unit.
10. Selection of Units to be Weatherized
a. Multiple Unit Dwellings
Funds under This Agreement may be used to weatherize an entire building
containing multiple dwelling units only if the dwelling units occupied by
eligible applicants represent at least sixty-six and two-thirds percent(66-
2t3%)of the total units within the building (as defined in Section 31.A. of
This Agreement). In order to weatherize a building which contains two
units or four units, at least fifty percent (50%) of the dwelling units must be
eligible. Otherwise, only units occupied by eligible households shall be
serviced.
28
95C
b. The amount of funds applied to weatherization services in a building shall
not exceed the number of eligible dwelling units multiplied by the$1;854
maximum per unit. Example: If a building of ten(10)units has eight(8)
units occupied by eligible households and two(2)units occupied by
ineligible households, $14,832 is the maximum to be paid.
Within the$14,832 ($754 maximum for minor envelope repairs per eligible
unit), $6,000 is the maximum amount for the minor envelope repairs which
can be reimbursed.
C. Contractor shall certify unit eligibility by completing Intake and Job Order
Sheet, DEO 565 (New 4/95), for each dwelling unit in each building.
Certification of eligibility by the owner/manager of the occupants of the
building/complex is not acceptable.
d. A DEO Form 75P (New 4/94), Multifamily Dwelling Unit Eligibility Certi-
fication form shall be completed for each complex, and a copy shall be
maintained in each individual client file.
e. Unoccupied Multi-unit Buildings
If an entire building is unoccupied, or it will become eligible within 180
days from assessment, under a Federal, State or local government building
improvement program, each dwelling unit within said building may be
weatherized providing the owner or owner's agent signs an agreement
limiting occupancy to those meeting eligibility guidelines set forth in
Section 31.A. of This Agreement for a period of two (2)years from the
completion of the weatherization work.
f. Group Homes
If the building does not qualify as a multifamily structure, income eligibility
is based on all occupants as a group, and the building must be weatherized
as a single dwelling unit. The maximum which can be paid is $1,854 as
specified in Section 29.A.2.b.
g. Temporary Shelters/Homeless Individuals
Eligibility of the occupants may be assumed if the owner/operator will
certify in writing that occupancy is-limited to no more than ninety(90)days
and that admittance criteria complies with DEO contract eligibility
guidelines. Whether or not.rent is paid has no effect on eligibility. Maxi-
mum reimbursement will be based on the unit otherwise qualifying as a
multifamily structure or a group home.
29
. 95C
h. Contractor shall obtain written permission of the owner of a rental unit, or
his/her agent, prior to performing any weatherization services. Such per-
mission shall be recorded on the sample Weatherization Service Agent
Agreement-Rental Units form, or Contractor's equivalent.
i. Weatherization services shall be provided to a dwelling unit on a one-time
basis for the same occupant(s), except that Contractor may return to the
unit within the same calendar year under which the initial services were
provided and apply measures not applied during the initial services within
the total remaining expenditure limit.
j. Reimbursement for outreach and assessment shall not be claimed nor can
the unit be claimed as another completion. Client education may be claimed
at the Previously Weatherized rate per Section 31.D. The only exception
shall be when the unit is damaged by a natural disaster such as a fire,
earthquake, hurricane, etc., and such damage is not covered by insurance.
k. Contractor shall not weatherize a dwelling unit which is designated for
acquisition or clearance by a Federal, State, or local program within twelve
(12) months from the date weatherization of the dwelling unit would be
scheduled to be completed.
D. Payment Guidelines
Reimbursement to Contractor shall be the equivalent of either Contractor's actual
expenditures or the value of all energy conservation measures and activities
completed and reported, whichever amount is less, provided that Contractor does
not request reimbursement or credit for the same activity or measure, except for
intake and dwelling assessment, from any other source. Contractor may claim
credit only for allowable measures and activities performed under This Agreement
In addition to the applicant eligibility criteria set forth in Section 3 LA, each
dwelling unit shall be assessed for eligibility.
A Building Check and Job Order Sheet, or Contractor's equivalent;and Intake
and Job Order Sheet, DEO Form 565 shall be maintained for each dwelling which
reimbursement is claimed.
30
95C-
REDVIBURSEMENT GUIDELINES
ACTIVITIES PER DWELLING
Outreach $25
Intake $25
Non-Blower Door Assessment:
Units with attics $50
Units without attics $35
Client Education:
Unweatherized $40
Previously Weatherized $25
Reimbursement for any or all of the outreach, intake, assessment, and client education
activities shall only be made for dwelling units weatherized under the terms of This
Agreement.
Initial General Heat Waste and Safety Assessment: _
Safety Check of Combustion Appliances Pre-Test $45
Post-Test $35
Blower Door Test = $60
Duct Leakage Tests Pre-Test $35
Post-Test $25
Should the safety check of combustion appliances reveal safety hazards which preclude
envelope-tightening measures, and cannot be eliminated, Contractor will be allowed to
claim reimbursement for outreach, intake, client education, and safety check and for the
installation of mandatory measures identified by Note 5 on page 35 of This Agreement.
Example:
Outreach $ 25
Intake $ 25
Non-blower Door Assessment $ 50
Safety Check of Combustion Appliances 45
Total $145
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95c—
MANDATORY MEASURES (A11 rates include labor and material costs)
Priority
1. Combustion Appliance Health or Safety (See annotations
Hazard Repair or Replacement, per dwelling of Exhibits A&B)
(indicate on the intake and Job Order Sheet,
DEO Form 565, which Health or Safety
conditions are to be addressed)
Vented Heating Source Replacement . . . Max. $2,750.00 * * *
Heating Source Repair . . . . . . . . . Max. $1,000.00 * * *
Air Conditioning Unit Repair . . . . . . Max. $1,000.00 * * *
Carbon Monoxide Detector/Alarm . . . . Max. $ 80.00
(Install only if operating carbon monoxide
producing appliances. Limit of two detectors
per dwelling for a maximum of$160.00 per
dwelling. If only one detector is installed,
the maximum reimbursement will be $80.00,
including labor and materials. Display labor _
and material costs on Earned Measures Report,
DEO 571.)
[refer to installation standards forwarded February 7, 1995]
2. Glass Replacement, per dwelling = Up to $ 750.00*"
3. Duct and Register Repair/Replace Up to $1,000.00*1•6
4. Minor Envelope Repairs, per Up to $ 750.00*'-6
dwelling(see Exhibit B)
5. Evaporative Cooler/Air Conditioner Vent Cover $ 53.004
6. Attic Venting, per dwelling Up to $ 300.00*1
(Install only if insulating attic)
7. Ceiling Insulation Ceiling Kneewall
R-11, per square foot $.32 $.42
R-19, per square foot .42 .48
R-30, per square foot .48 NIA
R-38, per square foot .55 NIA
32
95C-
8. Water Flow Restrictors: Per Dwelling
a. Low-Flow Showerhead, each $ 21.001
b. Hot Water Faucet Restrictor, each $ 6.401
9. Door Weatherstrip, per hinged entrance $ 32.004,6
10. Water Heater Blanket, each $ 27.001
11. Water Heater Pipe Wrap, $ 1.601
per linear foot of pipe
12. Duct Wrap, per linear foot of duct $ 2.15'
13. Outlet Switch Gaskets, $ 26.504-6
per dwelling
14. Caulking, per dwelling Up to $ 65.00*1,6
15. Non-door Weatherstrip, $ 1.60'
per linear foot
(Includes sliding glass doors. _
Does not,include weatherstrip
applied to attic access hatches
or evaporative cooler/air conditioner
vent covers.)
33
95C-
OPTIONAL MEASURES Per Dwellinry
Evaporative Cooler Repair, per cooler Up to $ 75.00*1
Filter Replacement for Air Conditioning or Furnace Unit:
Filters Only $ 16.005
Filters plus Filter Replacement Signal $ 21.005
Floor Foundation Venting(Crawl Space Venting) Up to $ 300.00*2
Floor Insulation, over 36" clearance, per square foot $ .64**4
Floor Insulation, under 36" clearance, per square foot $ .74**4
Electric Water Heater Timer, each $ 90 005
Setback Thermostat, per dwelling $ 127.005
Shadescreen, per square foot $ 2.651
Shutters, per square foot _ $ 4.801
Storm Windows, Operable, Vinyl, per square foot $ 4.80'
Storm Windows, Operable,Polycarbonate, per square foot $ 5.254
Storm Windows, Operable, Glass, per square foot $ 6.904
Storm Windows, Fixed, per square foot $ 2.404
Tinted Film, per square foot $ 2.651
Wall Insulation, per square foot $ 854
Furnace/Boiler Replacement, Including Vented Space Heaters Up to $2,750.00***',5
per dwelling
Heating Source Repair, per dwelling Up to $ 1,000.00***I"
Air Conditioning Unit Repair, per dwelling Up to $ 1,000.00***'-'
34
95C
E. Mileage
Contractor shall be credited $.53 per mile for one round trip for any one dwelling
weatherized. This credit is applicable only to those dwellings located outside a forty(40)
mile radius from Contractor's materials storage site, or headquarters if the work is being
performed by a subcontractor. If more than one dwelling is weatherized per trip, the
mileage credit applies only to the dwelling serviced which is the farthest from Contractor's
materials storage site, or headquarters if the work is being performed by a subcontractor.
Notes:
* Materials cost plus $35 per hour per person for labor
** Crawl space height shall be documented on the Intake and Job Order Sheet, DEO 565
(Rev. 4/95), (or Contractor's equivalent).
*** Must be completed by a licensed contractor. Materials cost plus labor. Furnace/Wood-
Fueled Space Heater/Boiler, and vented-space heater installations shall be covered by a
building permit.
' May be classified as mandatory if safety hazard exists. Reimbursement shall be based upon
the type of measure repaired or replaced as specified in the rate schedule under Optional
Measures.
2 Perform only when installing floor insulation.
3 Do not perform if residence has an operative evaporative cooler.
When using a blower door in conjunction with weatherizing a dwelling, these measures are
not to be applied if the infiltration rate is 1200 CFM at 50 pascals or less or if the economic
stop point for air sealing has been reached. (Refer to Section 2 of the DEO WIS.)
s If a combustion appliance safety hazard is found to exist, Contractor may apply the non-
envelope sealing Mandatory and Optional Measures identified by this note.
6 When applying infiltration-reducing measures in conjunction with blower door testing, the
crew hours set forth in the charts in Appendix A of the DEO Weatherization Installation
Standards(WIS)manual may be increased up to double the applicable amount for no more
than the first fifteen(I5)units.
35
95C-
32. Forms
Enclosed under Attachment 1 is a packet of 1995/96 DOE forms for your agency's
uselduplication.
33. Exhibits
The following exhibits are attached to This Agreement and are hereby incorporated by this
reference.
A. Materials Standards Which Are Not Included in the
DEO Weatherization Installation Standards Manual
B. Definitions
C. Service Area
D. Assistance Priority and Limits
E. Schedule of Energy Program Goals/Expenditures, DEO 564 (Rev. 4/95)
F. DOE Weatherization Budget, DEO 570 (Rev. 4/95)
G. Certification Regarding Lobbying/Disclosure of Lobbying Activities
Exhibits C,D, E, F, and G(if applicable) must be completed and/or signed by Contractor and
returned with signed copies of This Agreement to DEO.
Sample Forms:
Weatherization Service Agent Agreement, Rental Units
Building Check and Job,Order Sheet(Rev. 4/95)
36
95C-
EXHIBIT A
MATERIALS STANDARDS WHICH ARE NOT INCLUDED IN THE
DEO WEATHERIZATION INSTALLATION STANDARDS MANUAL
REPLACEMENT FURNACES AND BOILERS
Chimneys, fireplaces, vents, and solid fuel-burning apparatuses NFPA' 211-1988
Gas-fired furnaces NFPA 54-1988/ANSI2
and Z2147-1987,
Z2147a-1988,
Z21.47b-1989, and
Z223.1-1988
Oil-fired furnaces UL(3)727, August 27,1991
Revision and NFPA 31-1987
Liquid petroleum gas standard NFPA 58-1989
HEATING REPAIRS
Replacement Combustion Chamber Conformance to NFPA 31-1987
in Oil-Fired Furnace, Boiler
Preliminary Standards for Carbon Monoxide Detector/Alarm
1. Must comply with UL 2034.
2. Must incorporate semiconductor technology.
3. Must have rapid response time with confirmation circuit.
4. Must be tamper resistant.
5. Must have a re-set button with sealed switch.
6. Must operate on 110V AC.
7. Must have a five-year warranty.
37
95C-
EXHMIT B
- DEFINITIONS
GENERAL DEFINITIONS
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 a resolution from the Board of Directors affirming an agent's representative
capacity to bind Contractor to the terms of This Agreement.
Contractor- The entity(partnership, corporation, association,
agency, or individual) designated on page 1 of This Agreement.
DEO - The Department of Economic Opportunity, State of California.
Parties- The State of California and the Contractor. _
Subcontractor- An entity(partnership, corporation, association, agency, or individual) that enters into
a Subcontract with Contractor to fulfill the terms of This Agreement.
Subcontracts- Contracts entered into by and between Contractor and
Subcontractor to carry out the purpose of This Agreement.
The State-The State of California.
This Agreement- The complete contents of this contract entered into by and between the State and
Contractor, including all rights, duties, and obligations whether expressed or implied required toward
the legal performance of the terms hereof
This Program- Weatherization services provided under 42 USC 6861, et seq., as amended.
38
95C-
Exhibit B -Definitions(Continued)
APPLICANT DEFINITIONS
American Indian-Any individual who is a member or a descendant of a North American tribe, band, or
other organized group of native people who are indigenous to the continental United States or who
otherwise have a special relationship with the United States through treaty, agreement, or some other
form of recognition, residing within the State. This includes any individual who claims to be an Indian
and who is regarded as such by the Indian community of which he or she claims to be a part. This
definition also includes Indians of Alaska.
Children-Members of a household who have not attained their nineteenth(19)birthday.
Dwelling Unit- A house, including a stationary mobile home, an apartment, a group of rooms, or a
single room occupied as separate living quarters.
Elderly- An individual 60 years of age or older.
Family Unit - All persons living together in a dwelling unit.
Handicapped Person- Any individual who is: (1) a handicapped individual as defined in Section 7 (6)
of the Rehabilitation Act of 1973; (2)under a disability as defined in Section 1614(a)(3)(A) or
223(d)(1) of the Social Security Act or in Section 102(7) of the Developmental Disabilities Services
and Facilities Construction Act; or (3) receiving benefits under Chapter 11 or 15 of Title 38 U.S.C.
Migrant Farm worker- A seasonal farm worker who performs or has performed farm work during the
eligibility determination period(any consecutive 12-month period within the 24-month period
preceding application for program benefits and/or services)which requires travel such that the worker
is unable to return to his/her domicile(permanent place of residence)within the same day.
Seasonal Farm worker-A person who during the eligibility determination period (any 12-month period
within the 24-month period preceding application for program benefits and/or services)was employed
at least 25 days in farm work or earned at least $400 in farm work; and who has been primarily
employed in farm work on a seasonal basis, without a constant, year-round salary.
Separate Living Quarters-Living quarters in which the occupants do not live and eat with any other
persons in the structure and which have either: (1) direct access from the outside of the building or
through a common hall; or(2) complete kitchen facilities for the exclusive use of the occupants. The
occupant(s)may be a single family, one person living alone, two or more families living together, or
any other group of related or unrelated persons who share living arrangements.
39
95c-
Exhibit B -Definitions(Continued)
ENERGY CONSERVATION MEASURE AND ACTIVITY DEFINITIONS
Assessment- The process of performing an on-site review of the dwelling unit of an eligible applicant
in order to determine the if the dwelling qualifies for weatherization and, if so, to ascertain the labor
and materials necessary to weatherize the unit.
Energy Conservation Measures-The measures as defined in the DEO Weatherization Installation
Standards Manual and the DEO Mobile Home Weatherization Installation Standards listed in
Section 3 I.D. In addition, the following definitions are provided:
Evaporative Cooler Repairs-Repair or replacement of filter pads, water pumps, belts, motors, or
other components which will promote efficient operation of the unit.
Filter Replacement-May be a one- or a two-step measure as outlined in Section 16 of the
Weatherization Installation Standards. The one-step measure is to replace the.air conditioning or
furnace filter.. The two-step measure includes a filter replacement signal in addition to the filter.
Heating/Air Conditioning Appliance Repairs - Cleaning of fuel nozzles and jets, replacement of
thermocouples, freon, or other component repairs or replacements necessary for safe and efficient
operation. Must be accomplished by a person licensed to perform such work.
Intake-Includes, but is not limited to, the process of completing an intake form and reviewing
applicant documentation in order to verify eligibility.
Minor Envelope Repairs-Those repairs necessary for the effective performance or preservation of
weatherization materials or to stop infiltration, such as:
a. Patching holes in the building envelope which are too big to caulk.
b. Replacement of entrance doors and attendant hardware(except no'deadbolts)into conditioned
areas.
40
95C
ENERGY CONSERVATION MEASURE AND ACTIVITY DEFINITIONS (continued)
c. Repair, replacement, or installation of doors and windows, including frames, thresholds, door
stops,MINOR roof repairs, and materials such as paint used to protect the materials installed
from the weather.
d. Modification or repair of entrance doors, including doorshoes, door locksets(no deadbolts),
raindrips, automatic door bottoms, etc.
e. Contractor shall maintain labor hours costs, materials costs, and required building permits in
client file.
f. Blower door-identified infiltration repairs and final testing, including the testing of the repairs for
effectiveness:.
Contractor shall maintain labor hours cost and materials cost in clients'files.
Mobile Horne- A manufactured home that is a permanent, full-time residential dwelling and which is
not used for commercial purposes.
41
95C-
EXHIBIT C
SERVICE AREA
Contractor shall provide services to eligible applicants residing within the area(s) described below:
O County(ies) of
and/or
( ) Service Area(s) as designated in the attached map(s) and list(s) of Zip Code boundaries,
if applicable.
42
95C-
THIS PAGE IS GENERATED TO ACCOMMODATE MAPS
OR LISTS OF ZIP CODES IF NECESSARY
43
_ 95C-
EXMIT D
ASSISTANCE PRIORITY AND LMTS
DOE
44
State df CaliforniaEXHIBIT E
DEPARTMENT OF ECONOMIC OPPORTUNITY
1995 DOE SCHEDULE.OF ENERGY PROGRAM GOALS/EXPENDITURES
DEO 564(Rev.4/95)
Contractor Contract Number . Service Area
95C-
PROJECTED GOALS/EXPENDITURES ". y: x .PROJECTED'UNITS? ...
Blower Door Total
Month Units Units Expenditures Types of Units Owner Rental Other
January
Single Family
February
-
March Multi-Family:
fi x
April Duplex/Triplex
_,a s
May Multi-Family:
June Apartment
Jul
Mobile Home
August
September TempJGraup Shelter a
October -
-November
Unoccupied
December
TOTAL TOTALS
.HOUSE80LD3CATEGORY,
.y d
Jan Feb March April May June July Aug Sept Oct Nov Dec Total
Children s 18
Elderly
Handicapped
American Indian
MSF W
Other
TOTAL
CATEGORY OF PERSONS:TO BEASSISTED
Jan Feb March Aril May June July AugSet Oct Nov Dec Total
Number of Persons
in Household
Children s 18
Elderly
Handicapped
American Indian
MSF W
Other
-
Authorized Person's Name/Title(Please print) Telephone Number
JOAN SPARKS, DIRECTOR, COMMUNITY SERVICES DEPARTMENT 510 313-7350
Authorized Signature Date
INSTRUCTIONS--SCHEDULE OF DOE ENERGY PROGRAM GOALS/EXPENDITURES
DEO 564(Rev.4/95)
PROJECTED GOALS/EXPENDIJURES
Blower Door Units: Where applicable,enter the projected number of units to be weatherized with Blower Door technology. The
total number of Blower Door units must comply with Section 3I.C.3.h.
Total Units: Where applicable,enter the projected number of units to be weatherized which includes Blower Door and
non-Blower Door units.
Expenditures: Where applicable,enter the projected amount of expenditures,not to exceed the per dwelling cost as stated
in Section 29.A.2.b.
PROJECTED UNITS
Enter the projected number of units to be weatherized under the applicable Projected Units'columns. The total sum of these columns
must match the total under the Projected Goals/Expenditures"Total Units"column.
HOUSEHOLD CATEGORY
Enter the number of households to be assisted monthly under the applicable household category to reflect your Agency's Priority
Plan. The monthly Total must match the monthly total indicated under Projected Goals/Expenditures"Total Units"column.
EXAMPLE: HOUSEHOLD CATEGORY PROJECTED GOALS/EXPENDITURES
Elderly 2
MSFW 4 Total Units(January) 10
Other 4
Total(January) 10
(CATEGORY OF PERSONS TO BE ASSISTED
NUMBER OF PERSONS IN HOUSEHOLD
Enter the total number of persons living in the household. (Unduplicated Count.)
CATEGORY CLASSIFICATIONS T
Enter the total number for the person(s)living in the household under the category that applies. If the person(s)falls into more
than one category,enter the person(s)under all of the categories that are applicable.(Duplicate Count.)
DO NOT ADD CATEGORY CLASSIFICATIONS TO DETERMINE"NUMBER OF PERSONS IN HOUSEHOLD."
(SEE EXAMPLE BELOW.)
EXAMPLE: I am projecting to assist five persons(two children and three adults)in one household. One of the children is
handicapped,one of the adults is elderly,handicapped and MSFW. The other two adults are MSFW. ..
THE SECTION ON THE FORM"CATEGORY OF PERSONS TO BE ASSISTED"SHOULD BE COMPLETED AS FOLLOWS:
'CATEGORY'OF PERSONS,TO BE:ASSISI'EI)
Jan Feb March Aril May_ June July AugSet Oct Nov Dec Total
Number of Persons
in Household 5 5
Children s 18 2 2
Elderly 1 1
Handicapped 2 2
American Indian 0 0
MSFW 3 3
Other 0 0
THE NUMBER OF PERSONS IN THE HOUSEHOLD IS 5 NOT 8.
Siete of Califomia _ EXHIBIT F
DEPARTMENT OF ECONOMIC OPPORTUNITY
1995 DOE WEATHERIZATION PROGRAM BUDGET
DEO 570(Rev.4195)
Contractor Contract Tenn Contract Number
95C-
c. + �
La Salaries and Wages
All $
i.b Fringe Benefits
Lc Facilities
Ld Utilities
Le E ui ment TOTAL s eci below:
1. 2.
3. 4.
Lf Tele hone-Communications
I.g Travel
Lh Accounting
Li Insurance-Bonding
Li Office Su lies
Lk Miscellaneous TOTAL (specify below:
1- 2. ,,
3.
a. 1 m1w
TOTAL SECTION A(La-1.k}.(Should not exceed 5%of Section C.� .......... $
......................................... ..... ..
Administrative Costs in Excess of 5%Requires DEO Approval See DEO Form 57
2.a Audit Cost $
2.b Public Liability Insurance
3.a *Weatherization Materials 40%Minimum of Program Costs
- :,.*`PROGRAM'SUPPORTAND.I ABOR= 60°Io Maaimuim ' -F
3.b Labor
3.c Outreach
3.d Intake
3.e Client Education
3.f Equipment TOTAL (specify below:
1. 2. L
3. 4.
3.g Assessment
3.h Storage
31 Vehicular Insurance
3.` Travel-Transportation
3.k Maintenance-Repair
3.1 Miscellaneous TOTAL (specify below:
1. 2.
3. 4. f
SUBTOTAL PROGRAM SUPPORT AND LABOR(3.b--3.1) $
TOTAL SECTION B L2.9-3.1 o less than 95%of Section C. % is
TOTAL CONTRACT BUDGET (Total of Sections A&B. $
NOTE: *DOE audit cost and public liability insurance are not to be included in the 40160 calculation.
INSTRUCTIONS-DOE PROGRAM BUDGET
DEO 574(Rev.4/95)
SECTION A
Enter the total amount of Administrative Costs. Administrative Costs shall not exceed 5%of the.
total contract budget. Administrative Costs in excess of 5%requires DEO approval.
(See DEO form 574.)
SECTION B
Enter the total amount budgeted for each line item 2.a-31.
Weatherization materials costs shall be no less than 40%of the program budget,not including
2.a and 2.b.
Enter program support and labor costs 3.b-3.1. Program support and labor shall not exceed 60%
of 3.a-3.1.
Enter the total amount of Program Costs(2.a-3.1). The total shall not be less than 95%of the
total contract budget.
SECTION C
Add the totals of Sections A and B and enter the amount in Section C (Total Contract Budget).
Section C should be equal to the total contract budget.
Enter the calculated percentages in Sections A and B.
X EX HIBIT G
Page 1 of 4 pages
C 'y; DEPARTMENT OF HEALTH AND HUMAN SERVICES
r. FAMILY SUPPORT ADMINISTRATION
2
1Y �
PROGRAM DOEIWX
c
ago ' SA. ' PERIOOs''o\ , April 1 , 1995 - March 31 , 1996
The undersigned certifies, to the best of his or her knowledge
and belief, that:
(i) No Federal appropriated funds have been paid or will be paid
.by o_ 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 Congress 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 connection with this Federal contract,
Grant, loan, or cooperative agreement, the undersigned shall
complete and submit Standard Form LLL,- "Disclosure Form to Report
Lobbying, " in accordance with its instructions.
3) The undersigned shall require that the language of this
certification be included in the award 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
Signature Title
CONTRA COSTA COUNTY
COMMUNITY SERVICES DEPARTMENT
Agency / Organization Date
EXHIBIT G
• Page 2 of 4 pages
DISCLOSURE Of LOBMNG ACnVMES 4
complete zf>tt form to disclose lobbying activities pursuant to 31 6f.X.t3S2
Lee reverse for public burden*sdosureJ
L Type of Federal Ac6ow Z Status of redeerd AcCmc = Report Type.
a. contract � a4 biri'oiieaapp`cstion El a. WOb. W 6iir+g
❑ b.e coffin,peGative afire eww"t b. pastii0tit s� („��titate al Clss++Sr lc
Oe
d. loan ?TV �'��
e. loan guarantee date of last repwt
f. loan insurance
!. Naur+e and Address of Reporting ftetity S. it Reporting fntity in No.a is Subatratdee.Ester kmw
awd Address of PnssMe
O *rime O Sub ardeeTom
� r
C siartal District rf b►awrr c `onal Dimilct.ifbw+vn
L Federal Departtnent/Agencr T. Federal Program N8rwdDescripd0W
CFDA Numb-%it app-rieafstr. �.._...._�
L Federal Aetiae kum er.if issowm S. AmmW Antownl.if lotoasz
i
IL a. Name and Address of Lobbying Entity h Irtdviduak Pert° ,�F Services W dud ng address d
(d imdivrdwt.ear mom,ifrst guys �f�(��Ad&
t....wn.+iisraet sRrst �ansar®
1 L Aa,ount of Paymeat(chft-k all that appy): 13. Type of Paywwesse(check ail`afsat applyr
S O acttd C planned Q : retainer
O" b. one-flute he
ti Form of Paymea fc3wecE aT lyse 4VO)r Q C. a'waAnioo
D s cash 0 d eoertisrgtsstt foe
Q e;.deterred
O b. in-kind spedfr. nature __ O f. other«"dfy%
•ague
1t Elate!Description of Serrka Pedoeswed or to be Pedosiesed and D410W of 50 Vic lwdt ft effWWJL ew*kryee"
or Member(s).comadet for Peytwewt Itdiested L Iter 11:
d cr•+Mw.rww. lRttt s'
4S. C,ewtwwm iron Shred SMIL-A Wamdw& O Yes O No
IL 6*mmoro awawd e..o a►r.tr i awr.d k ab Ms "C
tawtw rata Mrf ad--r w6wq soon b a mowd pwmom �..`.�
1f Mss tori"ON*"—t ~ MN aw-aw m"a WM am PAN IKatOr __.`.ter
rsRrw"a-20 t --w Ms air&wmm a momw 0~0 r
as ust uas.a.ft—ai ba W."•er Gov.. Me:
wmo&r N a b..W.b Ari,- 0. --. M"Mm aft%&
• �----
or M.rwow"irsa– "b tat,-u a a.r p Woq sr art bs @NO TtieplwerMt Nos: Daae:�—
MAW awl!ww awn*'mmoat*..a, .m bar..
t ArAiwieed fw tacrlW+
"'� ...,,es2 •.. .:rfM. f. v �— +►.'!';� �;' '»" w . iNidrr�Nss•tat
Z► " '�
4
E X HIBIT G
Page 3 of 4 pages
INSTRUCTIONS FOR COMPLEnON OF SF-"DISCLOSURE OF 1.066YtNC ACTMnitb
This disclosure fat++ shalt be completed by the reporting entity, whether subawardet or prime federal recipient, at the
initiation or receipt of a covered Federal action, or a material dual;e to a previous 1pinS„ pursuant to title 31 U.S.C.
section 1352.The Ming of a fain is.regWed for each payment or agreemsnno,matte paymmem to any lobbying entity for
induencin5 or attempting to influence an officer or employee of any agency, &-Member of
est. or an em an officer
� or
employee of Con
g* employee of a member o!Congress in coruheu:tioi with a covered federal sctioes. Use the
SF-LLL-A Continuation Sheet for additional information if the spar on the fonts is inadequate. Complete all items that
apply for both the initial Riling and emuerial change report.Refer to the implementing guidance published by the Office of
Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is andror has been secured to influence the
outcome of a covered Federal action.
2. identify the status of the covered Federal action.
1 identify the-appropriate classification of this report. If this is a loliowup 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 covered Federal action.
4- Enter the full name, address, city. sate and sip code of die eepoitin entity- Induce Congressional District, if
n.
knowCheck the appropriate classification of the reporting entity that designates if It is6 or itcpeQs to be.a prime
or WAMward recipient. Identify the tier of the cubawardee. e.g. the first subawaidee of the prime is the iu lief.
Surbawardis include but are not limited to subrontrans,subgrants and contract awards tender grants.
S. if the oManitation fifamg the report in item&th..ki-Suba vardee-,then enter the full namne,address,cftyi star« ,,sd
cap code of the prince Federal recipient.Induds-Losigressional District,if known.
6. Enter the name of the Federal agency nuking the .sward or loam eomunitmett. Incbjk at least one orSaniwi•nul
level bellow agency rAr e,if known. For example, Department of Transportation,United States Coast guard.
7. Enter the Federal programs name or description for the owei~ed Federal.acsiori (item 1k. l!knowiu, enter the fuil
Catalog of Federal Domestic Assistance (CFDA) number for gamut. cooperative aareernene. loans, and loan
cornmitmersts„
L Enter the most appropriate Federal identifying number minable for dee Federal ac*m idemtfW in stern 1 (e.g.
Request for Proposal MM number. invitation for !did (IFS) number. Swt annocrnaemeresst member; the contract.
SrAML or ban award number. the appiicaumvproposal convol number assigned by the Federal agency). Include
prefixes.e.g.,6"p-OE-90-00
9- For a cohered Federal action when there has been an award or loan comnmsitment by the Federal agency,enter the .
Federal amount of the r-&MVloan oornmiitment for the prime entity identified in item<or S.
10- (&)Enter the full name. address, city, state and sip code of the lobbying entity engaged by tfwe repprth entity,
.401 ified In item t to influence dntt cove ed Federal aCdor.
(b)Enter the hd! names o( the individual{:) performsing services, and include lta8 address if di fa tiv ftm 10 (a).
Etter Last Name,Fust Name!and Middle initial M).
It Enter the amncwnt of compenation paid or ntasaiably expected to be paid by the reporting emtfty(tram 4 to the
lobbying entity Giem 10). Indicate whether the paymnent has been made(aCW*or will be mnade tptann,*4 Check
A boxes
to be made.t apply. If this Is a material changerepot,enter the c rmutadve amount of payment made or planned
12. Che* the appropriate box(esL Check all bones that appy. If payrnemt is made through an in-kind contribution.
spau3ty tune ihatsre and vahie of the in-kind payment.
11 Check the appropriate box{eS,). Check aD boxes that apply. If other,specify,nature.
14- I'Mvide a specific acid detailed description of the services thu the bbbyiu has perfom wd.or wit be expected to
perforeu.and the d"$)of any services rendesed.include all preparatory and related ae kit not jurat three spent in
acrual cord with Federal *4d&IL Identiy the Federal otllrzalW or employee(:) contacted or tM officer(s).
0100 UL or MexIdw 9)of Congress that were contacted
15. 0"whether err not a SF-UL,A Continuation Nicene)is MUched.
"IL rine certifying off."shat!sign and date the forme print hi0w turns,tido Ind telephone rntrtibes.
Pubic repo* Uvtlen ivr this collection d info mw400n is ens mgW so srsrage 30 adnores lire'itesponre,incimeC% thio for wvisv.irng
urarsh ft aim%data sources path meg and mi intair ng to data needed.and osiaspleft MW ievkr.ing tive osiactiow o!
ihr a bwden ea maar or ante odd aapeet of thin-�ypn of hdormadorb iwndu ft suggesdovns
r.tanat'e+rn+t and WdgK pspwvork ftadac"tian titofsezW4 0ML Waddington,Or "W&
E X KBIT G
Page 4 of 4 pages
DISCLOSURE Of LOBBY[NG ACnVME5
CONTINUATION SHEET
Repmling Entor pace 0i
t:
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