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RESOLUTION NO. 2000-1.22
RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING THE
MAYOR OF THE CITY OF SAN BERNARDINO OR HER DESIGNEE TO APPLY
FOR AND ADMINISTER A GRANT IN THE AMOUNT OF $196,968 FROM SAN
BERNARDINO COUNTY DEPARTMENT OF AGING AND ADULT SERVICES FOR
THE ADMINISTRATION OF THE EXPANDED SENIOR COMPANION PROGRAM
FOR THE VICTOR VALLEY AND MORONGO BASIN AREAS FOR THE PERIOD
JULY 1, 1999 -JUNE 30, 2001.
BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE
CITY OF SAN BERNARDINO AS FOLLOWS:
SECTION 1. The Mayor of the City of San Bernardino or her designee is hereby
authorized to apply for and administer a grant in the amount of $196,968 from San Bernardino
County Department of Aging and Adult Services for the administration of the Expanded Senior
Companion Program for the Victor Valley and Morongo Basin areas for the period July 1, 1999
through June 30, 2001.
SECTION 2. The authorization granted hereunder shall expire and be void and of no
further effect if the agreement is not executed by both parties and returned to the office of City
Clerk within 60 days following effective date of the resolution.
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2000-122
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RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING THE'
MAYOR OF THE CITY OF SAN BERNARDINO OR HER DESIGNEE TO APPLY
FOR AND ADMINISTER A GRANT IN THE AMOUNT OF $196,968 FROM SAN
BERNARDINO COUNTY DEPARTMENT OF AGING AND ADULT SERVICES FOR
THE ADMINISTRATION OF THE EXPANDED SENIOR COMPANION PROGRAM
FOR THE VICTOR V ALLEY AND MORONGO BASIN AREAS FOR THE PERIOD
JULY 1, 1999 - JUNE 30, 2001.
I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the Mayor
Joint
and Common Council of the City of San Bernardino at a Regular meeting thereof, held on the
5.!L day of June
, 2000, by the following vote, to wit:
Council Members:
NAYS
ABSTAIN
AYES
ABSENT
ESTRADA
x
LIEN
x
McGINNIS
x
SCHNETZ
x
SUAREZ
x
ANDERSON
x
McCAMMACK
x
stc~ h,c~
The foregoing resolution is hereby approved this _7 th-. day or~e ,2000.
Approved as to
Form and legal content:
JAMES F. PENMAN,
City Attorney
27 By:
28
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REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY, CALIFORNIA
AND RECORD OF ACTION
. z::cu - (2,2
. .
.
Agreements 98-949
99-699
June 20, 2000
FROM:
MIKE DECKER, Director
Department of A9in9 and Adult Services
SUBJECT:
AMENDMENT NO.2 TO CONTRACT NO. 98-949, AND AMENDMENT NO. 1 TO
CONTRACT 99-699 WITH THE CITY OF SAN BERNARDINO.
RECOMMENDATION:
1. Approve Amendment NO.2 to Contract 98-949 with the City Of San Bemardino to provide
nutrition services to seniors, Amendment NO.2 will:
a, Increase the amount of the contract by $12,965 for FY 99-00, from $181,360 to
$194,325.
b. Change the method of payment to the contractor, and
c, Extend the terms of the agreement through FY 00/01 for $178,104.
2. Approve Amendment No. 1 to Contract 99-699 with the City of San Bernardino to provide
Senior Companion Services to seniors. Amendment NO.1 will:
a. Increase the amount of the contract by $45,317 for FY 00/01 from $53,167 to $98,484.
b. Extend the terms of the agreement through FY 00/01 for $98,484.
BACKGROUND INFORMATION:
1, On November 10, 1998, the Board of Supervisors approved Contract No. 98-949 for $148,693
with the City of San Bernardino to provide congregate meals daily to 303 seniors for 212 days
from September 1, 1998 through June 30, 1999. The City of San Bernardino was one of the
agencies selected to provide nutrition services for seniors after a competitive award process
performed in July, 1998. This process is required every four years by the Older Americans Act
(OM),
On August 17, 1999, the Board of Supervisors approved Amendment NO.1 to Contract No.
98-949 to extend the contractlhrough FY 99/00 in the amount of $181 ,360,
Approval of Amendment NO.2 to Contract No. 98-949 will:
a. Increase the amount of the contract for FY 99/00 by $12,965, from $181,360 to $194,325.
The City of San Bernardino will use these funds to purchase an ice machine and to fund
an unanticipated shortfall in donation income. These types of expenditures and purchases
are permitted with One-Time-Only OM funds.
b. Change the method of payment to the contractor to the same method used by the
California Department of Aging (CDA) in reimbursing the Department.
cc:
OMS-Mike Decker w/agree.
City of San Bernardino w/agree.
c10DMS
Auditor w/agreement
SBD w/agreement
Risk Management
CAO-Hughes
HSS
File w/agreement
Record of Action of the Board of Supervisors
Rev 07/97
mil
MOTION
MOVE
5
BY
ITEM 024
?oo:y \'2.2..
AMENDMENT NO.2 TO CONTRACT NO. 98-949, AND AMENDMENT NO.1 TO CONTRACT
99.699 WITH THE CITY OF SAN BERNARDINO.
June 20, 2000
PAGE 2
c. Extend the term of the contract through FYOO/01 for $178,104. The City of San Bernardino has
met the goals of the prior contract. They qualify for a contract extension as allowed by the
Older Americans Act. The City of San Bernardino is expected to serve 261 seniors daily for
249 days.
2. On July 27, 1999, the Board of Supervisors approved Contract No. 99-699 for $53,167 with the
City of San Bernardino to provide Senior Companion Services to 40 seniors in FY 99/00 using
Community Based Services Program (CBSP) State funds. Services offered through the Senior
Companion Program by volunteers include friendly visitation of seniors, shut-ins, and those
individuals who may be cut off from the normal day to day activities of living because of a serious
illness. The funds are used to pay for stipends, meals, travel and facilities, and administrative
costs allowed by the program regulations. The City of San Bernardino was selected because the
State regulation requires that if there is an existing provider in San Bernardino County, that
provider must be given the opportunity to accept this State-funded program through a sole source
contract. The Senior Companion Program must meet specific performance criteria; services that
are accessible to the frail and elderly, services provided in a timely manner, services that provide
social intervention to shut-ins with serious or terminal illness, and the requirement to service 40
program participants, These performance standards were established by the Older Americans Act
and the Older Californian's Act. This program is required to be monitored routinely, and monitoring
is also conducted by the California Department of Aging in their annual County reviews.
Approval of Amendment No.1 to Contract No. 99-699 will:
a. Increase the amount of the contract for FY 99/00 by $45,317 from $53,167 to $98,484. The
City of San Bernardino will use $5,314 to increase Senior Companion services hours in the
Victor Valley area and use $40,003 to expand this program to the Morongo Basin area. An
additional 35 seniors will be served through the Senior Companion program through the
expansion
b. Extend the term of the contract through FY 00/01 for $98,484. The City of San Bernardino is
expected to serve 75 seniors,
REVIEW BY OTHERS: These contract amendments have been reviewed and recommended for
approval by the Senior Affairs Commission on April 12, 2000, Deputy County Counsel Fiona Luke on
May 15, 2000, and Deputy County Counsel Michael Sachs for Risk Management on May 15, 2000.
FINANCIAL IMPACT: Appropriations and revenues are included in the Fiscal Year 1999/2000
Budget and the Fiscal Year 2000-2001 Requested Budget and are adequate to cover these
expenditures. All costs are funded by State and Federal revenues. There is no additional local cost.
SUPERVISORIAL DISTRICT(S): First, Third and Fifth.
PRESENTER: Mike Decker, Director, Department of Aging and Adult Services
JUNE 20, 2000
ITEM 024
20::0-''7,-
FOR COUNTY USE ONLY
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E New Vendor Code Dept. Contract Numtier
M Change SC A 99-699 A-1
X Cancel
County Department Dept Orgn. Contractor's Ucense No.
AGING AND ADULT SERVICES OOA OOA NIA
County Department Contract Representative Ph. Eld. Amount of Contract
MIKE DECKER, DIRECTOR ***$196,96S***TOTAl
Fund Dept. Organiza!ion Appr. ObjlRev Source AclMty GRClPROJ/JOB Number
SYW OOA OOA, 200 2445 ,
Canmodily Code Estimated Payment TctaI by FIScal Year
FY Amount lID FY Amount liD
Project Name - -
Senior Companion 99/00 $53,167
- -
Program 99/00 $45,317 I
- -
00/01 $ 98,484 I
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County of San Bernardino
FAS
STANDARD CONTRACT
THIS CONTRACT is entered into in the State of California by and between the County of San Bernardino, hereinafter called
the County, and
Name
City of San Bernardino hereinafter called Contractor
Address
547 N. Sierra Way
San Bernardino, CA 92401-1211
Phone Birth Date
(909) 384-5231
FederallD No. or Social Security No.
95-6000772
IT IS HEREBY AGREED AS FOllOWS:
(Use space below and additional bond sheets. Set forth service to be rendered, amount to be paid, manner of payment,
time for performance or completion, determination of satisfactory performance and cause for termination, other terms
and conditions, and attach plans, specifications, and addenda, if any.)
WHEREAS, the County and City of San Bernardino entered into a contract on July 27, 1999, desi9nated in County
Records as Contract No. 99-699, and
WHEREAS, the parties now desire to amend Contract No. 99-699.
NOW. THEREFORE, it is mutually agreed that Contract No. 99-699 is amended as follows:
I) Add to existing Article I:
N. Senior Companion Volunteer means an eligible volunteer aged 60 or older with an income that falls
below the federal eligibility guidelines and whose stipend is supported with State General Funds and
governed by the rules and regulations of the Corporation for National and Community Service
(CNCS).
O. Corporation for National and Community Service (CNCS) is the federal agency responsible for
implementation of the Domestic Volunteer Service Act of 1973, as amended (public Law 93-113,87
Stat. 394, 42 USC 4951, et seq).
P. Disabled is a physical or mental impairment that substantially limits one or more of an individual's
major life activities.
Q. Benefits means and includes: a stipend; meals and transportation, or reimbursement for those costs;
an annual physical examination; training; uniforms and badges, if appropriate; and participation in an
annual recognition event.
LC:Q::) - \ 22..
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2) Delete existing Article II, and substitute therefore the following as a new Article II:
"The term of this Agreement will begin on the 1st day of July, 1999 and terminate on the 30th day of
June 2001."
3) Delete existing Article III, Paragraph A.l, and substitute therefore the following as new Article III,
Paragraph A.1 :
The maximum amount of funds available under this Agreement shall be $196,968, and shall be subject
to availability of funds from CDA. These funds are divided as follows:
F iscal Year 1999 - 2000
Fiscal Year 2000 - 2001
$ 98,484
$ 98,484
The budget displays for the funds for FY 1999-2000 are attached as Fiscal Year 1999-2000 Revised
Exhibit A, Exhibit A-I, and Exhibit A-2, and for Fiscal Year 2000-2001 are attached as Fiscal Year
2000-200 I Exhibit A. Unless specified in this amendment, the budget displays, attachments, and
narratives attached to this contract amendment are in addition to the existing budget displays,
attachments, and narratives included with Contract No. 99-699.
4) Delete existing Article III, Paragraph A.2, and substitute therefore the following as a new Article III,
Paragraph A.2:
Schedule Of Payments
Contractor may be provided a payment advance equal to 25% of the total funding for each fISCal year.
This advance is to be recouped from reimbursements to the Contractor within the first six months of the
fiscal year the advance is for. Contractor shall be reimbursed with the remainder of the Community
Based Services Program funds monthly based on their reimbursement claims but not to exceed the total
contract amount for the fiscal year.
5) Delete existing Article III, Paragraph C.
6) Delete existing Article IX, and substitute therefore the following as a new Article IX:
The County agrees to:
I. Initiate/procure subcontracts pursuant to Welfare and Institutions Code, Chapters 7 and 7.5.
2. Review, approve, and monitor subcontractor budgets and expenditures and any subsequent
amendments and revision to budgets.
3. Review and approve program operating plans.
4. Annually monitor, evaluate, and document subcontractor performance and compliance.
5. Collect, review, and approve subcontractor program and fmancial reports and data in
accordance with the program manual. Data collected must be timely, complete, accurate, and
verifiable,
'2 :'j-~):J . \ '2.."_
6. Provide support and technical assistance to the subcontractor and respond in writing to all
written requests for direction, guidance, and interpretation of instructions.
7. Distribute and maintain up-to-date CDA Senior Companion Program Manual so that all
responsible persons have ready access to standards, policy, and procedure guidelines.
8. Provide program information and referral to the public
7) Add to the existing Article X, Paragraph B, the following:
8. Performance of the Subcontractor
The subcontractor shall perform the following:
1. Implement statutory provisions of the Senior Companion Program (Welfare and
Institutions Code, Section 9547) and provide support for Senior Companion
volunteers in accordance with law and regulation, and the Senior Companion Program
Manual as issued by the Department. Perform services with a good faith effort at the
levels stated in the Performance Estimate Form, herein incorporated into this Agreement.
2. Develop volunteer service opportunities through which low-income individuals who are
60 years of age or older can volunteer and contribute to their community.
3. Provide a stipend and other benefits that enable eligible individuals to participate as
Senior Companion volunteers without costs to themselves.
4. Establish new social service roles for Senior Companion volunteers through which they
can maintain a sense of self-worth, retain physical health and mental alertness, and enrich
their social contacts.
5. Provide supportive services through Senior Companion volunteers to adults, with an
emphasis on adults age 60 and older, in an effort to maintain those participating adults in
an independent living environment.
6. Recruit, select, train, and assign individuals for duty as Senior Companion volunteers
who shall serve at least four (4) hours per day, five (5) days per week in exchange for
stipends and benefits of the Program.
7. Provide transportation for Senior Companion volunteers.
8. Provide supervision of Senior Companion volunteers.
9. Provide at least one free meal per day to Senior Companion volunteers.
10. Submit quarterly program performance reports and financial reports in accordance with
the Senior Companion Program Manual. Data must be timely, complete, accurate, and
verifiable [Welfare and Institutions Code, Section 9547 (c) (8)].
') /'")'",,-
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11. Maintain an up-to-date Senior Companion Program Manual and related Department
guidelines so that all responsible persons have ready access to standards, policy, and
procedure guidelines [Welfare and Institutions Code. Section 9100 (c) & (d)).
8) Add to existing Article X as Paragraph R:
R. ASSURANCES SPECIFIC TO SENIOR COMPANION PROGRAM
I. The Contractor shall assure that the subcontractor will comply with the following:
a. Eligible Service Population. Assure Senior Companion Program services for
the eligible service population which is defined as low-income volunteers aged
60 years and older, with an income that falls below the federal eligibility
guidelines [W&I Code, Section 9547 (b)).
2. The Contractor shall assure that, in exchange for services, each Senior Companion
volunteer will receive the following benefits:
a. A stipend; meals and transportation, or reimbursement for those costs;
insurance coverage; an annual physical examination; training; uniforms and
badges, if appropriate; and participation in an annual recognition event.
b. Stipend amounts that are the same as those received by the federally-funded
volunteers.
3. The Contractor shall assure their organization is in good standing with the federal
CNCS.
4. The Contractor shall assure that mileage reimbursements are adequately supported for
Senior Companion volunteers having their own auto insurance coverage.
5, The Contractor shall abide by the Senior Companion Program Manual, training manuals,
and other guidance issued by the Department, including any subsequent changes to State
and federal law.
6. The Contractor shall not expend more than twenty percent (20%) of the total federal
dollars for administration.
7. The contractor shall not use contract funds awarded under the Senior Companion
Program to purchase any personal property or equipment with State Funds.
8. The Contractor shall have the ability to provide the specified services in a variety of
settings, including but not limited to, in-residential, nonresidentia~ institutional and in-
home settings.
9. The Contractor shall assure tbat no Senior Companion volunteers will be assigned
Institutions Code, Section 9547 (e)).
2.. o,_-,:,~- \'2..'''-.
Except as modified by this amendment, all provisions of Contract No. 99-699 remain in full force
and effect, and are incorporated by this reference.
This Amendment shall; not be effective until approved in writing by both parties.
FOR THE DEPARTMENT OF AGING
AND ADULT SERVICES
Jon~~~
San Bernardino County
Board of Supervisors
Date
.IIIN 202000
G.- 7 -00
Date
2 a Cy,:) ~ \ ~2')~
COUNTY OF SAN BERNARDINO
.
dJ~
CITY OF SAN BERNARDINO
(Print or type nat7I6 of corporation, company, contractor, etc.)
BY,~~;Y ~?J
(Authorized signature - sign In blue In
~
Jon
ikels, Chairman, Board of Supervisors
Dated:
JUN 2Q1OOQ
Name Esther Estrada
(Print or type name of person signing contract)
SIGNED AND CERTIFI
DOCUMENT HAS
CHAIRMAN OF T
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Title Mavor Pro Tem
6 (PrintorType)
Dated: ~-F- ~
Reviewed by Contract Canpliance Reviewed to( Processing
~~i3 &)2.ICJ(VAL CCf'/77?4d ~
!'(Jeney Administra\orlCAO
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Date f.lZ.Oo
Dale
Date
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C 11'.0 of sAJ fH-12AJAR.J;wJ D
C135P - 5~,jIOR.. C0P1P4NION
PART ll- BUDGET 99/00 . .
. Amendment #1 , Contract #99-699
Applicant Organization: City orSan Bernardino SCP Budget Dates: 7/1/99 - 6/30/2000
SECTION 1: VOLUNTEER SUPPORT EXPENSES
I Columil 1 Column 2 ,
Column 3 Column 4 Colwnn 5 Column 6
A. PROJECT PERSONNEL Annual % Time Spent Total State Funds Match Non-
on Project Project Excess
EXPENSES Salary Requested Federal Resources
Position Title Cost Resources
P.T. Coord. Of Volunteers
$9.42 hr. (Victorville - 10 hrslwk) 4898 25% 4898 4898 0
P.T. Coord. Of Volunteers
$9.42 hr (Morongo Basin)-20hrslwk) 9797 50% 9797 9797 0
TOTAL PERSONNEL EXPENSES 14,695 14,695 0
B:'"PERSONNEL FRINGE BENEFITS 0 0 0
C. PROJECT STAFF TRAVEL Local Travel 1,500 1,500 0
Long Distance Travel 0 0 0
D. EQUIPMENT - See attached 5,200 3,352 1,848
E. SUPPLIES ~---
550 350 200
F. CONTRACTUALSERVTCES 0 0 0
G. OTHER VOLUNTEER Communications 1,416 1,316 100
SUPPORT COSTS Printing 320 0 320
Space 2,000 0 2,000
._._ _~E:er Allowable SUPPc:.::.t..__~__.+_____~~__ 0
H. INDIRECT COSTS ' 0 I 0 i 0
TOTAL VOLUNTEER SUPPORT EXPENSES I 25,681 r 21,213 I 4,468 -,
SECTION 2: VOLUNTEER EXPENSES
Column 3 Column 4 Colwnn 5 Column 6
A. VOLUNTEER 20 Vol x 1044 hrsStipends 53,244 53,244 0
SERVICE-RELATED Meals 7,621 7,073 548
COSTS AND Uniforms 500 325 175
REIMBURSEMENT msurance 165 69 96
EXPENSES R( cognition 500 325 175
. .
V olunber Travel 16,536 16,235 301
Physical Exa..rninatious 1,000 0 1,000
Other Allowable Expenses 0 0 0
rOTAL VOLUNTEER EXPENSES 79,566 77,271 2,295
,.....-
roTAL PROJECT COSTS 105,247 98,484 6,763
IUNDING PERCENTAGES (percent distribution between Columns 4 and 5 only) ~
. ~ - "
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VOLUNTEER STRENGTH PROJECTION
-\. NON-STIPEND ED VOLUNTEERS: 0 B. .HOURS: 20,880
STIPENDED VSY'S -FEDERAL: 0 NON-FEDERAL: 20 C. STATIONS:
VSSC Form 424 A
Rev. 3/00
'A-~~dn--.~""/ C.......~c:::t- -,.... qq--(,'T9
I PART II-BUDGET
(lk:::br V" [I E.'t)
'pplicant Organization: Q;+,,/ "f. s..-.. D~ ~... J..i'",.,u Sc..p Budget Dates: 7,/,/<<4' _ t./"1b/6" .
;ECTION 1: VOLUNTEER SUPPORT EXPENSES S~..
Column 1 Column 2 Column 3 Co umn 4 Column 5 Column 6
~. PROJECT PERSONNEL % Time Total COofL_l:nn Yv\<\~
EXPENSES Annual Spent on Project Funds Non-Federal Excess
Position Title Salary Project Cost Requested Resources Resources
~c','rd .,.);:: lJ~/ ~e.oQy$ t.J-'3'W. ;z ::;70 'f'iJ<{'6. t.,Ud.9'i1.
(p"..-i--"'I-,- >"Y\~ ' "-0--'
/I>hrs/Nk:. \!.Q....ks '{. 1'7.1L~~
~OT AL PERSONNEL EXPENSES $ tfg'f~. $ IfW&. $ -0- $
3. PERSONNEL FRINGE BENEFITS -0- --0- -"'-
, PROJECT STAFF TRAVEL 0 Local Travel ClOD, qro.
h -0-
300~..v. ',I),;).)<Yl.;>'I.. ,::>S~. Long Distance Travel -()- -0_ -,,~
). EQUIPMENT D"sk,~leCQj,.."",*,-+..J"fj,,,,.,, F~'(, ('.,.,""'t.:;ta,- "'11>00. '3/.;'2.. Jr.Wr.
..
,.SUPPLlES . " 3po_, 3.2) . -0-
'. CONTRACTUAL SERVICES .
. -0- -0- -0-
,. OTHER VOLUNTEER Communications QS1D. '1<2D, --0-
SUPPORT COSTS ' . Printing 2...c> co. -0- ~o.
, ..-
..' Space ) ODO' J DoO .
A -"'-
:
Other Allowable Support
f. INDIRECT COSTS
[,OT 1-\L VOLUNTEER SUPPORT EXPm,rSES $1'.., ""'-.0 :B/a 280, $3DI.).'6, $
- l.;2.r>A..2:> .
;ECTION 2: VOLUNTEER EXPENSES .. CcI1.tmn~'
..~, ' . . . . Coll1mn3 . Column 5 Column 6
.---.. _.._._,-~._-_..._-_.._.._._-,..._--,---
~. VOLUNTEER /3voly. I~ II 1./ I, "f. :tr Stipends 2J!: I--LA. 'iSl/. /-/'><7. -D~
r:s @..;t,ss-:
SERVICE-RELATED Meals 5" .A7:El. S67'? . -,o~ .
COSTS AND = Uniforms 325".
'3:>&'_ -o~
I./i', -
REIMBURSEMENT - Insurance b"l -~
.
EXPENSES Recognition ;' ;IS"" 3,;1...5". . -.:.-
; .., 9."D
Volunteer Travel 7. g",.:>. -"'-
Physical Examinations , 65b.
&,s-z" -0-
Other Allowable Expenses -6~ -"'- -0-
LOT AL VOLUNTEER EXPENSES $L).8.~SI, $4-<6.;;.,/ , $ t:,$[:J, $
roTAL PROJECT COSTS $ f,12.../ 7Q. %'8, 1j.8/. $ ;3/-,qg. $
. ~
!'UNDING PERCENT AGES (percent distribution between Columns 4 and 5 only)
VOLUNTEER STRENGTH PROJEC,TION
\, NON-STIPENDED VOLUNTEERS: 0 B, HOURS: / 35"7:;;l..
STIPENDED VSY'S - FEDERAL: 0 NON-FEDERAL: /3 C. STATIONS:
,SSC Form 424A Modified SF-424A (4/88 and 12/97)
PAGE 7
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i\\-n~JI-n~.;t- ~l." c.o",~c:::t-=fI:- qq-C:. '1'7 - (l'V\DY'a-nj0 &St f)) ,
PART II - BUDGET
Applicant Organization: 0..;+ '-I ~ S'''l..,..-, i3~G\....J..,YL;.. Sc...p Budget Dates:' .7 t1' J""",~ 7:.../6b '
SECTION 1: VOLUNTElfRSUPPORTEXPENSES '5 ~"""e..
Column I Column 2 Column 3 Co umn 4 Column 5 Column 6
A. PROJECT PERSONNEL 0/0 Time Total c I <O[ "j"n Y'Y\o;kB.....
EXPENSES Annual Spent on Project Funds Non-Federal Excess
Position Title Salary Project Cost Requested Resources Resources
~ DD n:1 : t> -r. [) D ',....."',:-\-..... .... V" S
(?aA->j.. ~'>'n-9
:;'oh'/'s! <-J/<. '/.. 5'2.. L-">}<-Sj. ~,4'-~h ~ Q7C('7.. 5"DO("" 9 "7Q7. Q797, -<.>-
TOTAL PERSONNEL EXPENSES $ Q79,. $ C("''7? $-0 - $
B. PERSONNEL FRINGE BENEFITS -D- -0_ -", -.
C,. PR~5;STAFFTRAVEL . Local Travel c'OO /...60 -0-
Rt>~ . ~.X /;;'/">"O:!7 G2;Js~ Long Distance Travel -0- -0- --e,-
D. EQUIPMENT ie-I~oh-...",- I r"../\v :2..DD ';:z'i!>D. --o~
,.
E. SUPPLIES "//'>0. -<>- 2DD.
F. CONTRACTUAL SERVICES -0_ ---6 _ --0 -.
G. OTHER VOLUNTEER Communications <t- 3~ 'g::?L 100.
SUPPORT COSTS . .:: Printing J '"j,.., -D- J2L>.
~-' '. Space / ~~n_ --0-- / DDO.
Other Allowable Support ,
H. INDIRECT COSTS .
TOTAL VOLUNTEER SUPPORT EXPENSES $;::", -:jr.;'3 $/.').<7;; '" $ I LJ.:?,:'. $
.-........ ", - , ~
SECTION 2: VOLUNTEEREXPEl'lSES '. . -.' .... ' . . .
. "-'~':''''- . " ":"'.' : . Column 3 '. Column~. .' . Column 5 . Column 6
,wl 'l-lbI.f4':"f-s'/.:/,;J.''5~k, ---
A. VOLUNTEER Stipends /9. (, :$S. 18' L=is: -0-
SER VICE-RELATED "7 vol X ~ 8 days. 'f. $/. i~ Meals :.) """-a: 2. .!>=. S~
COSTS AND i -;. ri;J..S". Uniforms } '?,!,-, -6- )..,,,,""
REIMBURSEMENT Insurance q~. .....- <i'b
EXPENSES "1 y. $,;l..!>.' Recognition J..,.,.. -C-. I'? .s.
.., v.t>ly. ~'1n-J) ~o1d"')<S Volunteer Travel 'B 7 3" 8.435-" 301.
@;"b'q. JT~ Physical Examinations ':1<:7>, -0- '35'b.
0----' 0 -"'-
Other Allowable Expenses
TOTAL VOLUNTEER EXPENSES $~71S-:-. $,2'1 0'"70. $ I (,t.i,. $
TOTAL PROJECT COSTS $'-'3,01-.9 $40, OO~. $ . $
. 3.oft,s:;,
FUNDING PERCENTAGES (percent distribution between Columns 4 and 5 only) lIBI
..
VOLUNTEER STRENGTH PROJEqION
A. NON-STIPENDED VOLUNTEERS: 0 B, HOURS: '1308
STIPENDED VSY'S" FEDERAL: 0 NON-FEDERAL: 7 C. STATIONS:
NSSC Form 424A Modified SF-424A (4/88 and 12/97)
PAGE 7
~- ,~~ -"-' ........,.-
PART II - BUDGET
_pplicant Organization: City of San Bernardino - SCP Budget Dates: 7-1-00 I 6-30-01.
ECTION 1: VOLUNTEER SUPPORT EXPENSES ..
State
,.... T ".
Column 1 Column 2 Column 3 Column 4 Column 5 Column 6
.. PROJECT PERSONNEL % Time Total Hatch
EXPENSES Annual Spent on Project Funds Non,Federal Excess
Position Title Salary Project Cost Requested Resources Resources
Coord. of Volunteers ,
.T.
(Victorville - 9.42 hr.
10 hrs/wk) $4,898. 25% $ 4,898. $ 4,898. -0-
.T. Coord. of Volunteers
(Morongo Basin - 9.42 hr~ $9,797. $ $
20 hrs/wk) 50% 9,797. 9,797. -D-
OT AL PERSONNEL EXPENSES $14.695. $ 14.695. $ -0- $
PERSONNEL FRlNGE BENEFITS _no _n_ -0-
PROJECT STAFF TRAVEL Local Travel 1,500. 1,500. -0-
Long Distance Travel -0- -0- -0-
I. EQUIPMENT 5,200. 3,352 1,848.
. SUPPLIES --
550. 350. 200.
. CONTRACTUAL SERVICES -0- -0- -0-
i. OTHER VOLUNTEER Communications 1 .Ld h_ 1.,1 h. inn
SUPPORT COSTS Printing 320. -0- 320,
.'
, Space 2,000. -0- 2,000.
Other Allowable Support -0- -0- -0-
I. INDIRECT COSTS -0- -0- -0-
'OTAL VOLUNTEER SUPPORT.EXPENSES $ "5 681 $ 21 213. $ 4,468. $
I "
,ECTION 2: VOLUNTEER 'EXPENSES . .... ....-.;. ,. . . : ,. ',' ,".>. '..,
, . .... " .' ..>-. :",: .- Column 3 Column <I .' ' Column 5, . Column 6
,. VOLUNTEER 20 vo).s x Stipends 5'1.244, 53 244. -0":
SERVICE-RELATED 1044 hrs Meals
7,621. 7,073. :'548.
COSTS AND . Uniforms 'ion. ,25. 175.
REIMB URSEMENT . Insurance 165. 69. 96.
EXPENSES Recognition 500. 325. 175.
. Volunteer Travel 16,536. 16,235. 301.
Physical Examinations 1 000. -0- 1,000.
Other Allowable Expenses -0- -0- -0-
'OTAL VOLUNTEER EXPENSES $79.566. $ 77.271. $ 2,295. $
:OTAL PROJECT COSTS 105 247. $ 98 484. $ 6.763. $
.
1l1li
'UNDING PERCENTAGES (percent distribution between Columns 4 and 5 only) . '. \.~:
..;ao,: .'
VOLUNTEER STRENGTH PROJECTION
"NON-STIPENDED VOLUNTEERS: 0 B. HOURS: 20,880
STIPENDED VSY'S - FEDERAL: 0 NON-FEDERAL: 20 C. STATIONS:
iSSC Form 424A Modified SF-424A (4/88 and 12/97)
PAGE 7
L-':='1___"-J - ',,2'Z.
Attachment B
...
PRINCIPAL OWNER INFORMATION FORM
San Bernardino County Code Section 110,0101 et seq, contains the San Bernardino County Child Support Compliance Program.
This Program requires the COllnt)' to provide certain information to the District Anorney concerning its employees and business
licenses, It further requires that bidders or proposers for County contracts provide. directly to the District Anorney, inforn1ation
concerning their "Principal Owners," that is, those nanlral persons \;'ho ow~ an interest of 10% or more in the Contractor. For each
"Principal O\\'ner," the infonnation which must be provided to the District Attorney is: 1) the Principal Owner's name: 2) his or her
ritle, and; 3) whether or not the Contractor has made a payment of any sort to the Principal Owner.
I:\' ORDER TO CO;\IPL Y WITH THIS REQUIREMENT, CO;\IPLETE THIS FORM A.:'\D lIIA1L OR FA.X IT DIRECTLY
TO THE DISTRlCT ATTORc\EY AT THE ADDRESS ORFA..x!\U~IBERSHOW" BELOW 0" OR BEFORE THE DATE
YOU SUB:\IIT A BID OR PROPOSAL TO A COUl\TY DEPARBIEl\T,
]lIAI"TAI" DOCUlIIEl\T A no" OF SUB;\IISSIO".
In addition, bidders or proposers must certify to the soliciting County depann1Cnt that they are in full compliance with the Program
requirements by submining the Child Support Compli:mce Program Certification, along with the bid or proposaL
To:
District Anorney Child Support Division
Ombudsman Program
10417 Mountain View Avenue
Lama Linda. CA 92354-2030
FAX: (909) 478-7470
PHO:\E: (909) 478-7300
Contractor Name as Shown on Bid or Proposal:
Contractor Address:
.
Contractor Phone:
County Department Receiving Bid or Proposal:
Type of Goods or Services to be Provided:
Contract or Purchase Order Number (ifapplicable):
Fax:
PrincipalOll'llers: Please check appropriate box, If Box 1 is checked, no further infonnation is required. Please sign and date the
form below.
I. 0 1\0 natural person owns an interest of 10% or more in this Contractor.
11. 0 Required Principal Owner infonTIation is provided below. (Use a separate sheet, if necessary)
J\'AME OF PRl;\CIPAL O\\'l\ER
TITLE
P A Y'JIIEl\T
RECEI\'ED FRO:\I
CO"TR"-CTOR
\'ES I'm
1.
2,
3.
I DECLARE, Ui\DER PEi'I'ALTY OF PERJURY, THAT THE FOREGOl:'\G IMOR.:'\IATIO:\ IS TRUE A,,"D
CORRECT.
By: Date:
( gllnnlre of a Prillcipe.! O;.'/:er, (l!l Officer, or A (l.r.r.ger responsible/or mbmissioll oflhe bid or proposal to ,he COllllt)).
b ~ P-.>eJOcJ
Esther Estrada
Prinid:\J:nc
Mayor Pro Tem
Title J P~l5ilion
2-(:;'.J~ - _
ATTAcmlENT C
~.
. SC:Jn Bernardino County
CDA217 (6196)
Deportment of Aging end Adult Ser;;ce$
. '
,
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS
The undersigned cenifies, to the best of his or her knowledge and belief. that:
(1) No federal appropriated funds hove been paid or will be paid, by or an behalf of the
undersigned, to any person for influencing or attempting to influence on officer or
employee ot any agency, 0 Member of Congress, an officer or employee of Congress.
or an employee of a Member of Congress in connection with the awarding of ony federal
contract, the breaking of any federal grant. the making of any federal loan, the entenng
into ,of any cooperative ogreement. and the extension, continuation, renewal.
amendment. or modification of any federal contract. grant. loan, or cooperative
agreement.
(2) If any funds other than federol appropriated funds have been paid or will be paid to any
person for influencing or ottempting to influence an officer or employee of any agency,
a Member of Congress, on officer or employee of Congress. or an employee of a
Member of Congress in connection yvith this federal contract. grant. loan, or cooperative
agreement the undersigned shall complete and submit Standard Form-LLL, "Disclosure
Form to Repon Lobbying," in accordonce with its instructions.
(3) The undersigned sholl require that the language of this certification be included in the
award documents for all subawards at allliers (including subcontracts, subgrants, and
contracts under grants, loons, and cooperative agreements) and that 011 subrecipients
shall certify and disclosure accordingly,
This cenificatian is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is 0 prerequisite for mOKing
or entering into this transaction imposed by Section 1352, Title 31, U,S. Code. Any person who
foils to tile the required certification sholl be subject to a civil penalty of not less than $10,000 and
not more than $100.000 for each such foilure.
.C I 'f1( Or:. S-NJ 8eTc/(4!l.-v ( ~!O
CONTRACTOR
CA
STATE
-C.> ~
Mayor Pro Tem
TITLE
b/J/~
DATE
UTHORIZED SIGNATURE Esther Estrada
~,~:; .~~ .~, - --:
AT7AC3MFNT D
SOLICITIl'."G DEPARTME:'\T: DEPARTMENT OF AGING
ADDRESS: 686 E. MILL STREET, SAN BERNARDINO,
CO:\"TACT NA~lE & PHO:\"E NO.:MIKE DECKER
& ADULT SERVICES
CA 92415-0640
CHILD SUPPORT COMPLIANCEPRDGRAM CERTIFICATION
San Bernardino County Code Section 110,0101 et seq, contains the San Bernardino County Child Support
Compliance Program. This Program rcqL:iros the County to provide certain information to the District Attorney
concerning its employees and business licenses. It further requires that bidders or proposers for County contracts
submit certifications of Program compliance to the soliciting County deport~~er:t, 210n.? with their bids or
. ,proposals. (In an emergency proclirement, as detemlined by the soliciting County department, these cenific2.rior,s
may be provided immediately following the procurement),
II\' ORDER TO CQ:\lPLY WITH THIS REQUIREi\lEI\'T, CQ:\lPLETE THIS FORM AND SUB:\IIT IT
DIRECTLY TO THE SOLICITING COUNTY DEPARTi\1EI\'T, ALO:'\G WITH YOUR BID OR
PROPOSAL. IN ADDITIO:\", THE SOLICITING DEPARTi\lEI\'T WILL PROVIDE A COPY TO THE
DISTRICT ATTORi',EY AT THE ADDRESS OR FAX NUMBER SHOWN BELOW.
I, (prillt name)
proposal)
at (COil tractor 's address)
is in compliance with San Bernardino County's Child Support Compliance Program ind has met the following
hereby certify that (contractor name as shown OJI bid or
, located
requirements:
1. Submitted a completed Principal Owner Infomlation Form to the District Attorney, Child Support Division;
."
2. Fully complied with employment and wage reporting requirements (42 USC Section 653a and California
Unemployment Insurance Code Section 10SS.5), and will continue to comply with such reporting
requirements;
3, Fully complied with alllawfully-served Wage and Earnings Withholding Orders or District Attorney Notices
of Wage and Earnings Assignment, [Code of Civil Procedure Section 706.031 and Family Code Section
5246(b)), and will continue to comply with such Orders or Notices.
I declare, under penalty of perjury, that the foregoing is true and correct.
dayof ~ /~
(Month & Year)
"'
<"
c:r
~.
Executed this
(elt I S,,:e)
(Telephone'l\um:,er)
Bv: Esther Estrada, Mayor Pro Tem
.. (SigJ;(),!lIre 0/ n Principal O.'..r.u. (;1; OJ)7:;::r. 0,' ,\I{I!;{lger responsible/or submission oJlhe bid or proposal 10 the COlin!)).
Soliciting Dept Send
Copy to: District Attorney, Child Support Division FAX: (909) 47S-7470
Ombudsman Program
10417 Mountain Vie\\' Avenue PHO:--.'E: (909) 478.7300
Lorna Linda, CA 92354-2030
COUNTY COUNSEl
Fax:9093874068
r-. .~
!._ 'J,) \-
"May 12 '00
AT'l'AClilVJ...t:,;LV1T lE.
7:04 P.03
. '
... ... ..
..J~. _~..
. .
, ,
ASSURANCE OF COMPLIANCE WITH
THE SAN BERNARDINO COUNTY
WELFARE DEPARTMENT
NONDISCRIMINATION IN STATE
AND FEDERALL V-ASSISTED PROGRAMS
C 171! tJ? $1.tJ (Sef!/l;:;+(2i) I jlJh
NAME OF VENDOR/RECIPIENT
HEREBY AGREES THAT it will comply with Title VI of the Civil Rights Act of 1964 as amended;
Section 504 of the Rehabilitation Act of 1973, as amended; the Age Discrimination Act of 1975, as
. amel1ded;the Food Stamp Act of 1977, as amended, and in particular Section 272.6; Title \I ofthe
Amencans with Disabilities Act of 1990; California Civil Code, Section 51 et seq., as amended;
California Government Code Section 11135-11139.5, as amended; Califomia Government Code
Section 12940 (c), (h) (1), (I), and 0); California Government Code, Section 4450; Title 22, California
Code of Regulations Section 98000-98413; the Dymally-Alatorre Bilingual Services Act; Section 1808
Removal of Barriers to Inter Ethnic Adoption Act of 1996 and other applicable federal and state laws,
as well as their implementing regulations [including 45 Code of Federal Regulations (CFR) Parts 80,
84, and 91; 7 CFR Part 15; and 28 CFR Part 35], by ensuring that employment practices and the
administration of publiC assistance and social services programs are nondiscriminatory, to the effect
that no person shall because of age, sex, color, disability, national origin, race, marital status, religion
or political affiliation be excluded from participation in or be denied the benefits of, or be otherwise
subject to discrimination under any program or activity receiving federal or state financial assistance;
and HEREBY GIVES ASSURANCE THAT it will immediately take any measures necessary to
effectuate this agreement.
THIS ASSURANCE is given in consideration of and for the purpose of obtaining any and all federal
and state assistance; and THE VENDOR/RECIPIENT HEREBY GIVES ASSURANCE THAT
administrative methods/procedures which have the effect of subjecting individuals to discrimination or
defeating the objectives of the California Department of Social Services (CDSS) Manual of Policies
and Procedures (MPP) Chapter 21, will be prohibited.
BY ACCEPTING THIS ASSURANCE, the vendor/recipient agrees to compile data, maintain records
and submit reports as required, to permit effective enforcement of the aforementioned laws, rules and
regulations and permit authorized CDSS and/or federal government personnel, during normal working
hours, to review such records, books and accounts as needed to ascertain compliance. If there are
any violations of this assurance, CDSS shall have the right to invoke fiscal sanctions or other legal
remedies in accordance with Welfare and Institutions Code Section 10605, or Government Code
Section 11135-11139.5, or any other laws, or the issue may be referred to the appropriate federal
agency for further compliance action and enforcement of this assurance.
6/dY~
Dale 11 Ir J
~ .;V. /) P'-fT.
ddress o~cipien~
THIS ASSURANCE is binding on the vendor/recipient directly or through contract, license, or other
provider services, as long as it receives federal or state assistance.
~~-
Vendor Director's Signa ure
Esther Estrada
Mayor Pro Tem
(03fOO)