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Home My WebLink About20-Parks & Recreation '" . . ctrv OF SAN BERNARDINO - REQUEST FOR COUNCIL ACTION From: Lemuel P. Randolph, Director Date: June 22, 2005 Subject: RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AUTHORIZING THE MAYOR OR HER DESIGNEE TO EXECUTE AN AGREEMENT WITH THE SAN BERNARDINO CITY UNIFIED SCHOOL DISTRICT TO PROVIDE CONTRACTUAL SERVICES FOR BEFORE & AFTER-SCHOOL RECREATION PROGRAMS AT EIGHTEEN (18) SCHOOL DISTRICT SITES. MICC Meeting Date: July 18, 2005 Dept: Parks, Recreation & Community Services Dept. Synopsis of Previous Council Action: ORIGINAL July 22,2004 - Mayor and Common Council approved Resolution No. 2004-233 for the 2004- 2005 Children's After-School Program for Success. Recommended motion: Adopt Resolution Rk-- / . Signature Contact person: Lynn Knutson Phone: 384-5006 Supporting data attached: Staff report, Reso & Agreement Ward: Citywide FUNDING REQUIREMENTS: Amount: $401,109 (From Federal & State Program Funds) Source: (Acct. No.) 123-594-5014 (Acct. Description) C.A.P.S. Finance: Council Notes.: ~. ~l>Or-:;4L/ Agenda Item No.l...tJ 1)1(10' -.~~.-- -~~-~'_"To'- - - -', Tfl"""~"."""'w' -''C''C-' '-'-_-7""'''~-''C'~ CITY pF SAN BERNARDINO - REQUEST FOR COUNCIL ACTION , Staff Report Subiect: Resolution of the Mayor and Common Council of the City of San Bernardino authorizing the Mayor or her designee to execute an agreement with the San Bernardino City Unified School District to provide contractual services for Before & After-school Recreation Programs at eighteen (18) school district sites. Baclmround: The Children's After-School Program for Success (CAPS) is a grant funded program administered by the San Bernardino City Unified School District to provide before & after- school programs at school sites. The City has been a sub-contractor with the school district in this program since 1999. The school provides teachers and aides to teach educational and tutorial programs. The Parks, Recreation and Community Services Department provides arts and crafts and other recreational activities for the youth. The CAPS Program was offered at nine elementary schools when first implemented. The program expanded to eighteen schools in FY2004-05. This agreement will provide for 18 after- school programs and 10 before school programs for a total of 28 programs at the continuing 18 sites for a period beginning July 1, 2005 through June 30, 2006. Sites Arrowhead Elementary(A) Burbank ~ementary(A) Hillside Elementary(A) Monterey Elementary(B & A) Newmark Elementary(B & A) Roosevelt Elementary(B & A) Barton Elementary(B&A) Bradley Elementary(A) Emmerton Elementary(A) Fairfax Elementary(B & A) Inghram Elementary(B & A) Lincoln Elementary(B & A) Mt. Vernon Elementary(A) Muscoy Elementary(B & A) Riley Elementary(B & A) Rio Vista Elementary(B & A) Warm SpringsElementary(A) Wilson Elementary(A) *(B - before school) (A - after school) Financial JmDact: The agreement amount is for $401,109 to cover 100 percent of costs for part-time staff. This will allow the department to provide a maximum of 6 part-time staff per program site, Monday - Friday. Supplies and equipment are provided by the district. There is no financial impact to the City. Recomme~dation: Adopt the esolution. ~~='"','" " 1 0 2 3 4 5 - ..~-,,-~ - -'" -'""~.,,., . RESOLUTION NO. COpy RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AUTHORIZING THE MAYOR OR HER DESIGNEE TO EXECUTE AN AGREEMENT WITH THE SAN BERNARDINO CITY UNIFIED SCHOOL DISTRICT TO PROVIDE CONTRACTUAL SERVICES FOR BEFORE & AFTER-SCHOOL RECREATION PROGRAMS AT EIGHTEEN (18) SCHOOL DISTRICT SITES. BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY 6 IOF SAN BERNARDINO AS FOLLOWS: 7 I 8 SECTION 1. The Mayor of City of San Bernardino or her deSIgnee is hereby authorized 9 and directed to execute on behalf of said City, an agreement with the San Bernardino City 10 Unified School District to provide contractual services for before & after-school recreation 11 programs at eighteen (18) school district sites. A copy of said agreement is hereby attached 12 Ihereto, marked Exhibit "A", and incorporated herein by reference as fully as though set forth at 131 'length. 14 151 SECTION 2. The authorization granted hereunder shall expire and be void and of no 1 G II further effect if the agreement is not executed by both parties and returned to the Office of the 171City Clerk within 120 days following effective date of the Resolution. 18 1/// 19"/J1 I 201 III 21! III 221 1,,111 <)~ .....: I III 24' -~.."~.".~..,,.... . '.,,~'~... ....-=........ "........ ." .~". ....,-..~ RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF 1 SAN BERNARDINO AUTHORIZING THE MAYOR OR HER DESIGNEE TO A EXECUTE AN AGREEMENt WITH THE SAN BERNARDINO CITY UNIFIED .. 2 SCHOOL DISTRICT TO PROVIDE CONTRACTUAL SERVICES FOR BEFORE & 3 FTER-SCHOOL RECREATION PROGRAMS AT EIGHTEEN (18) SCHOOL DISTRICT SITES 41 I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the Mayor 1) and Common Council of the City of San Bernardino at a Meeting, 6, i thereof, held on the day of , 2005, by the following vote to 7 wit: o o 8 o COUNCIL MEMBERS v AYES NAYS ABSTAIN ABSENT 10 ESTRADA I 11 /LONGVILLE I 12 IMC GINNIS II 13 'DERRY Rachel G. Clark, City Clerk The foregoing resolution is hereby approved this day of ,2005. 21 ' I 2211 2:i'j ~ :I, Approved as to form 2.. And Legal content: 25 James F. Penman 26 City Attorney JUDITH VALLES, MAYOR City of San Bernardino 27 By: v:-:~l.- 28 S f'p';:(cf C'() ~ "Se I ~- o - . ..- . ",-_. .__..".~..~- Contract No.: OSI06-747.ooS6 RD ORIG/NAl SAN BERNARDINO CIlY UNIFIED SCHOOL DISTRICT 777 North F Street San Bernardino, CA 92410 AGREEMENT FOR CONSULTANT SERVICES IN COLLABORATION WITH DISTRICT FOR THE CREATIVE BEFORE AND AFTER SCHOOL PROGRAM FOR SUCCESS (CAPS) TInS AGREEMENT is made and entered into this 21st day of June 2005, by and between the SAN BERNARDINO CIlY UNIFIED SCHOOL DISTRICT, hereinafter referred to as the "DISTRICT", and CIlY OF SAN BERNARDINO PARKS, RECREATION AND COMMUNIlY SERVICES DEPARTMENT, hereinafter referred to as the "CONSULTANT". RECITALS WHEREAS, the DISTRICT is authorized by Section 53060 of the California Government Code to contract with and employ any persons for the furnishing of special services and advice in financial, economic, accounting, engineering, legal, or administrative matters, if such persons are specially trained and experienced and competent to perform the special services required; and, WHEREAS, the CONSULTANT itself is, or those hired by the CONSULTANT are, specially trained, experienced and competent to render the special services required by the DISTRICT, and such services are needed on a limited basis; and, . NOW, THEREFORE, the DISTRICT and the CONSULTANT mutually agree as follows: I. TERM OF AGREEMENT A. This Agreement shall be for a period beginning July 1, 2005, continuing through June 30, 2006. B. Upon a showing of good and sufficient cause by the CONSULTANT, the DISTRICT may at its discretion, grant such extensions of time as it may deem advisable in which the CONSULTANT may accomplish the results required hereunder; provided, however, the DISTRICT shall not be obligated to pay the CONSULT ANT any additional consideration if such an extension of time has been granted. . II. RESPONSffiILITIES OF THE CONSULTANT A. The CONSULTANT will provide a variety of learning experiences in the area of art, fitness, sports skills, and values through the provision of Recreational Aides at each school participating in the Creative Before and After School for Success (CAPS) Program. A List of participating schools is attached to this agreement as Attachment "An and incorporated herein by this reference and made a part hereto. Consultant Services Agreement: City of San Bernardino Parks, Recreation Services - CAPS Program Page I of7 -o~~P",,'C'o C.' ~o o - CD ~m.,. . - "'."P'" "0 'O"~-_,,, 0> ~.o- "'O'-'~'-~~"'''n'''r'''''_H'''''_'-'''''~''~''BO''"''''>''''"""'I!'"!! "'_',"-:- Contract No.: 05/06-747-0056 RD B. In addition to the learning experience, the CONSULTANT will provide a mentoring program in cooperation with the DISTRICT that targets populations of elementary school students as a deterrent to juvenile crime, gangs, and other delinquent behaviors, Also, the CONSULT ANT agrees to provide in-kind services/activities for program administration, site supervision and equipment. C. The CONSULT ANT is ultimately responsible for the results to be achieved under this Agreement. The CONSULTANT itself, or other hired by the CONSULTANT and under the control of the CONSULTANT;ri1ay provide the services necessary to achieve the results required under this Agreement. D, The CONSULTANT's services will be provided on an as-needed basis to accomplish the results required under this Agreement. E. The CONSULTANT will perform services to achieve the results required hereunder in the CONSULTANT's own independent way as an independent contractor in the pursuit of the CONSULT ANT's independent calling and not as an employee of the DISTRICT, The CONSULTANT shall be under the control of the DISTRICT as to the results to be accomplished and not as to the means or manner by which such results are to be accomplished. ' F. The CONSULTANT shall provide its services at such times as the CONSULTANT itself determines within the scope of the results to be achieved, If the CONSULT ANT is a regular employee of a public agency (any governmental agency or agent supported by public tax dollars), all services which the CONSULTANT renders under this Agreement will be performed at times other than the CONSULT ANT's regular assigned workday for said entity, or during periods of vacation or leave of absence from said entity, in order that the CONSULTANT shall not receive double compensation from public tax dollars for its time. G. The CONSULT ANT shall provide all of its own supplies, equipment, and materials as may be necessary within the scope of the results to be achieved. H. The CONSULTANT shall complete and return to the DISTRICT the Internal Revenue Service Form W-9, which is included as an enclosure with the Agreement package. I. The CONSULTANT understands that, as an independent contractor, it is not an employee of the DISTRICT and agrees that it will not purport to be nor represent itself as a DISTRICT employee, officer, or agent. The CONSULTANT agrees that it will not act as nor perform in the capacity of a DISTRICT employee. The CONSULTANT further agrees that it will specifically explain its independent contractor, non-employee status to those it contacts (including DISTRICT employees and non-DISTRICT employees), as a result of its work hereunder, in Consultant Services Agreement: City of San Bernardino Parks, Recreation Services - CAPS Program Page 2 of7 o G o co" "C ,,0.' ",~, ,,' - ~"-- --. "-~....<-".._,,,...,~. ".."""~~ Contract No,,: 05/06-747-0056 RD order to prevent any misconception on the part of third parties that the CONTRACTOR is an employee or representative of the DISTRICT 1. The CONSULTANT agrees to conduct and certify to the DISTRICT's governing board that it has completed any background check requirements of Education Code Sections 45122_1 and 45125.1 and has returned the Contractor Certification form in advance of providing any contracted services described herein with the DISTRICT Any expenses incurred to implement this requirement will be the sole responsibility of the CONSULT ANT Ill. RESPONSffiILITlES OF THE DISTRICT A The DISTRICT will prepare and furnish to the CONSULTANT upon the CONSULTANT's request, such information as is reasonably necessary to the performance of the CONSULTANT's work under this Agreement. The CONSULT ANT understands that all information provided to the CONSULTANT is the property of the DISTRICT and shall not be removed from the DISTRICT's possession. Failure to keep such information confidential and/or failure to return information requested by the DISTRICT is reasonable cause for termination of this Agreement and may subject the CONSULTANT to liability for damages to the DISTRICT B. The DISTRICT reverses the right to add to or substitute grants as long as the cost remains within the agreed upon maximum amount IV. CONSULTANT'S FEE AND PAYMENT THEREOF A. The DISTRICT agrees to compensate the CONSULTANT for services rendered in a total amount not to exceed $401, 109.00 (four hundred one thousand one hundred nine dollars). The CONSULTANT may invoice the DISTRICT, on a monthly basis, as the work progresses for that portion of the work that has been completed. The invoice shall describe in detail the services rendered and must include the CONSULTANT's Social Security or Federal Tax 1.0. Number. The DISTRICT shall make payment to the CONSULT ANT after the receipt and approval of the invoice. R The CONSULT ANT's fee is inclusive of all services hereunder and the DISTRICT will pay no separate amount for travel or other expenses of the CONSULT ANT under this Agreement. C. The DISTRICT will not withhold federal or state income tax deductions from payments made to the CONSULT ANT under this Agreement. D. The CONSULTANT is aware that under California law, no disability or unemployment insurance will be deducted from payments made to CONSULTANT or paid by the DISTRICT out of DISTRICT funds. Consultant Services Agreement: City of San Bernardino Parks, Recreation Services - CAPS Program Page 3 of7 _.e."_.,~~,,,,,,,",',,~e,_ o G o --"--,~",,,._,,,--, ~- ."..- '.- ~~ .'-, _e~ . c.. ,,,,ey,, _~"_, ... Contract No,: 05/06-747-0056 RD CONSULTANT further recognizes that CONSULTANT cannot claim unemployment benefits after services have been completed. E. If the CONSULT ANT is receiving any type of retirement benefits, such as those from California State Teacher's Retirement System (STRS) or Public Employee's Retirement System (PERS) or other retirement plan, or Social Security, or other similar benefits, the DISTRICT and the CONSULT ANT are both aware that continuance of said benefit amount, is or may be subject to certain limits on current annual income from public schools and/or other sources in order to maintain full benefits. The CONSULTANT understands and acknowledges that it has full responsibility for being aware of any limits and monitoring and not accepting or contracting to accept income in excess of said limits. Furthermore, the CONSULTANT specifically agrees to indemnify, defend, and hold harmless (as defined in Section VI) the DISTRICT, from any liability or damages resulting from receipt of monies paid under this agreement, which adversely affect the CONSULTANT's own retirement benefits. V. INVOICES Any invoices submitted for these services shall be sent directly to both: Bobby Pregman 2204 Sunrise Lane, Apt. #Al San Bernardino, California 92404 Narciso Cardona Student Services 777 North F Street San Bernardino, California 92410 The Agreement number on the upper left side of this page should always be referenced in any correspondence or invoices pertaining to this Agreement to the DISTRICT. The invoice shall describe in detail the services rendered and must include the CONSULTANT's Social Security or Federal tax 1.0. number, and the purchase order number. The DISTRICT shall make payment to the CONSULTANT after receipt and approval of the invoice(s). VI CANCELLATION FOR NON-PERFORMANCE OR NON-COMPLIANCE OF CONSULTANT A. If, at any time during the performance of this Agreement, the DISTRICT determines, at the DISTRICT's sole discretion, that the CONSULTANT's services are not achieving the results required hereunder, the DISTRICT shall be obligated to pay the CONSULTANT only for that portion, if any, of the results achieved. B. Non-compliance by the CONSULTANT with the terms of this Agreement shall be cause for suspension and/or termination by the DISTRICT. The DISTRICT shall provide written notice to the CONSULTANT including the reasons for suspension or termination under this provision. If the Contract is suspended, the Consultant Services Agreement: City of San Bernardino Parks, Recreation Services - CAPS Program Page4 of? 8 G o --,--,-,. '" Contract No_ 05106-747-0056 RD VII. CONSULTANT shall have five (5) business days to cure the condition(s) for which the suspension was given or the contract will be terminated. HOLD HARMLESS The CONSULTANT hereby agrees to indemnify, defend, and hold harmless the DISTRICT and its departments, agents, officers, and employees from any and all claims or sums which the DISTRICT or any of its departments, agents, officers, or employees may be obligated to _ pay by reason of any liability of any kind imposed upon them, including damages to property or injury or death of persons, arising out of the performance of the services rendered by the CONSULTANT or caused by any error, omission, or act of the CONSULTANT or of any person employed by the CONSULTANT or of any others for whose acts the CONSULTANT is legally liable. Said sums shall include, in the event of legal action, court costs, expenses of litigation, and reasonable attorneys' fees. VIII. SPECIAL PROVISIONS A. INSURANCE REQUIREMENTS The CONSULTANT shall comply with all applicable federal, state and local laws, rules, regulations, and ordinances, including workers' compensation insurance laws. The CONSULTANT understands that as an independent contractor, it is not covered by any type of DISTRICT insurance, including workers' compensation insurance. The CONSULTANT shall provide, through insurance policies or self-insurance, workers' compensation insurance coverage for its employees who provide services hereunder, and insurance coverage for any and all claims for damages, injury, death or liability it may sustain or impose on others including the DISTRICT. The DISTRICT understands that the CONSULTANT may use independent contractors, volunteers, or others not covered by the CONSULTANT's workers' compensation insurance coverage, to provide services hereunder. The CONSULTANT shall advise such persons providing services hereunder at the direction of the CONSULTANT that the DISTRICT does not provide workers' compensation insurance and the CONSULT ANT shall hold the DISTRICT harmless from any and all claims for damages that may be asserted by such persons. B. ASSIGNMENT The CONSULTANT shall not in any manner, directly or indirectly, by operation of law or otherwise, assign, transfer or encumber this Contract or any portion hereof of any interest herein, in whole or in part, without the prior written consent of the DISTRICT. If consent is not given by the DISTRICT to assign, transfer, or encumber this Contract, such action shall be deemed automatically void. This Agreement shall not be assignable except with the mutual written consent of the parties hereto. Consultant Services Agreement: City of San Bernardino Parks, Recreation Services - CAPS Program Page 5 of? _'"Y"'~' C "'"~". o o o ,." .-.~--, -. --~---.'-- ..-. ""'''' "'-"-:'''~~~.f''~'?'-'''''~I..","""y,;~. ._"_n'~>"_ .-_. -"0' - " "OY"'''.''-:''-'J'.'=''_'_'C.~<."'''~ Contract No.: 05/06-747-0056 RD c. MODIFICATION This Agreement may be amended by the mutual written consent of the parties hereto. If any actual or physical deletions or changes appear on the face of the Agreement, such deletions or changes shall only be effective if the initials of both contracting parties appear beside such deletion or change. IX. DISTRICT AND PUBLIC POLICIES A By signing this agreement the CONSULTANT acknowledges receipt and acceptance of the following DISTRICT policies: I. Smoking and Use of Tobacco at District Facilities Policy (No. 3520a-b). 2. Affirmative Action Program for Equal Employment Opportunity Policy (No. 4136). 3. Nondiscriminatory Harassment Policy (No. 4136. la-c). 4. Drug-Free Workplace Policy (No. 4205). B. All parties agree that the CONSULTANT shall abide by the same terms and conditions of conduct as is expected of DISTRICT employees in each of these policies, without the implication of employment. It is further understood that failure to abide by these policies may result in immediate termination of this agreement and, in addition, may result in other personal legal avenues of remedy on the part of the individuals involved. While it is acknowledged that these policies specifically address employees of the DISTRICT, it is understood that the CONSULTANT is not an employee of the DISTRICT. C. The CONSULTANT certifies it will not unlawfully discriminate on the basis of race, color, national origin, ancestry, sex (including sexual harassment), marital status, handicap, disability, medical condition, religion, or age in any of its policies, procedures, or practices in compliance with: 1. Title VI and VII of the Civil Rights Act of 1964. as amended (pertaining to race, color, national origin, and religion); Title IX of the Education Amendments of 1972 (Pertaining to sex discrimination); Section 504 of the Rehabilitation Act of 1973 (Pertaining to handicap); The Age Discrimination Act of 1975 (pertaining to age); The Fair Employment and Housing Act (Pertaining to ancestry, race, national origin, color, sex, religion, physical or mental disability, medical condition, marital status, and age over 40); and, The Americans with Disabilities Act of 1990 (Pertaining to disability) 2. 3. 4. 5. 6. Consultant Services Agreement: City of San Bernardino Parks, Recreation Services - CAPS Program Page 6 of7 -. (~~...~.~..,.~ o G o "~.' .,~~ . q. " ." '."M""_~0_''', , ,~ -.-'.'i""~=~ Contract No,: 05/06-747-0056 RD It is the responsibility of the CONSULTANT to ensure that those employed by or subcontracted by the CONSULTANT also adheres to DISTRICT and Public Policies. These non-discrimination policies cover admission and access to, and treatment and employment in, the DISTRICT's programs and activities. x. COMPLETE AGREEMENT This document represents the entire agreement and understanding between the DISTRICT and CONSULTANT. The terms of this Agreement will prevail over any different or additional terms in any other agreement. One or more waivers of any term, condition or covenant by either party shall not be construed as a waiver of any other term, condition or covenant. IN WITNESS WHEREOF, the parties have executed this Agreement as set forth below. CITY OF SAN BERNARDINO PARKS, SAN BERNARDINO CITY UNIFIED RECREA nON AND COMMUNITY SCHOOL DISTRICT SERVICES DEPARTMENT LE~LP.RANDOLPH Director MOHAMMAD Z. ISLAM Assistant Superintendent Business Services Division Date: Date: Approved as to Form and Legal Content: JAMES F. PENMAN, City Attorney By: ~~ A_ Spec t~y'l!{;;~e 1 Consultant Services Agreement: City of San Bernardino ParkS. Recreation Services - CAPS Program Page 7 of7 ~.' o ~"~ '--,c'o '_< , '."T - - -- --~0-_'~"F- --'. - " -'-'~-- Contract No.: 05106-747-0056 RD ATTACHMENT "A" AFREEMENT FOR CONSULTANT SERVICES IN COLLARBORATION WITH DISTRICT FOR THE CREATIVE AFTER SCHOOL PROGRAM FOR SUCCESS (CAPS) ?~~~~l!~~ - --'~--- - _C_" ,.,. _ '~--'-"'-""",,----, >.'' ''1'' '-,--..,-,' ~' "~C'~S*~8i~""':o'F,~.,_, '_,"~.,:?,,,~ San Bernardino City Unified School District Purchasing Services Department o -- Contractor Certification -- Concerning Department of Justice (DOJ) fingerprint and criminal background investigation requirements of Education Code section 45125.1 et seq. With respect to the Agreement dated , between the San Bernardino City Unified School District- "DISTRICT" and City of San Bernardino Parks. Recreation & Community Services - "CONTRACTOR," for provision of Droviding contractual services for Before & After School Recreation Programs at school district sites. services: REQUIREMENTS MET A) fi The CONTRACTOR hereby certifies to the DISTRICT's governing board that it has completed the criminal background check requirements of Education Code (EC) section 45125.1 and that none of its employees that may come into contact with DISTRICT students have been convicted of a violent felony listed in Penal Code section 667.5(c) or a serious felony listed in Penal Code section 1192.7(c). --0 R-- IMPORTANT NOTICE: IF YOU ARE REQUESTING A WAIVER, BE ADVISED THAT NO SERVICES ARE TO BE PROVIDED UNTIL SUCH WAIVER IS APPROVED. REQUEST FOR WAIVER B) 0 The CONTRACTOR requests a waiver of the Department of Justice(DOJ) fingerprint and criminal background investigation for the following reason(s) permitted by Education Code section 45125.1 et seq. o o The CONTRACTOR and its employees will have NO CONTACT with pupils, (No school-site services will be provided.) o The CONTRACTOR and its employees will have LIMITED CONTACT with pupils. (Attach information aboullenglh of time on school grounds, proximity of work area to pupil areas, whether CONTRACTOR/ils employees will be working by themselves or with others, and any other factors that substantiate limited contact.) [EC 45125.1 (c)] o The CONTRACTOR and its employees WILL HAVE OTHER THAN LIMITED CONTACT with pupils but will assure that ONE(l) OR MORE of the following methods are utilized to ensure pupil safety. [EC 45125.2(a)] -- Check all methods to be used: o 1) Installation of a physical barrier althe worksite to limit contact with pupils o 2) Continual supervision and monitoring of all employees of the CONTRACTOR by an employee of the CONTRACTOR who has not been convicted of a serious or violent felony as ascertained by the DOJ o 3) Surveillance of employees of the CONTRACTOR by school personnel o The services provided by the CONTRACTOR are for an "EMERGENCY OR EXCEPTIONAL SITUATION, such as when pupil health or safety is endangered or when repairs are needed to make school facilities safe and habitable" [EC 45125,1(b)] CERTIFICATION I WAIVER REQUEST BY CONTRACTOR AUTHORIZED AGENT: nirp~tor Signature Title Date Office use only BOTH APPROVALS BELOW ARE REOUIRED: WAIVER REQUEST: DENIED By: Date Mohammad Z Islam, AssIstant Superintendent BusIness ServIces DIvIsIon OR orher Authorized Agent WAIVER REQUEST: DENIED By: Date Harold Vol/kommer, Ass/stant Superintendent, Humsn Resources Division OR orher Authorized Agent _~c"" ,"_CO, ""~C .~ C'C'C'C~OC.cc",c"",...c~., "'","'''~C~C~''""'~''"'C.'B_CCCOC''""C 'f "" ~~C'" c"~, -- C"C.",CC . c,. c".,,,,"::~ Vendor/Customer Name and Address - .T\e or place label here) .:;;. RECREAilON & COrlil't!.!'WTY SERVICES 547 North S;c~~o VVay San Bernardino. C<liifornia 92410-4816 . T'" r~~ ("alJ r;:::'l!"~:\,~::- ; "_", 0_"--.' t ~..." .lr-. ;l/.j1', .,'.. .. - . ~ . ,,0_ - r .. ,. ., ~JUN - 7 HIll: 2 I Vendor Tax Information ot:" .-. '-,.;.''''. ? \ ~ L; i~ :i t:. c-' (Substitute Form W-9) INDIVIDUAL Name of Individual (as it appears on Social Security Card) Social Security Number (SSN) Resident of California(Check one) YES NO SOLE PROPRIETOR Name of Individual Owner Business Name Taxpayer Identification Number / SSN (Use number thaI income from business will be reported under) Resident of California(Check one) YES NO PARTNERSHIP Name of Partnership Federal Identification Number . Resident of California(Check one) YES NO CORPORATION Name of Corporation Federal Identification Number Qualified to do business in California and/or perma- nent place of business in California(Check one) YES NO TAX EXEMPT ORGANIZATIONlENTITY . Name of Organization or Entity Ci tv of San Bernardi no Department or Unit,if applicable Parks . Recreation & COll1l1unity Services Dep . Federal Identification Number 95-6000772 Why Are You Tax Exempt? Local Government/Subdi vi sian fy under ~f perjury that the information provided on this document Is true and correct. ~ ) / ~ V '..-.-/ Account Manager ~ '1/) ') (909) Title Date Tel No. 384-5544 're to furnish correct information and return arm will subject ourpayment(s) to you to 31 % backup withholding per IRS regulations. Return this Form 10: SAN BERNARDINO CITY UNIFIED SCHOOL DISTRICT Attn: Richard Doolittle, Contract Analyst, Purchasing Dept. 777 North F Street San Bernardino, CA 92410-3017 W-9 Tax Form '. oj. G -~ , c ** FOR OFFICE USE ONLY - NOT A PUBLIC DOCUMENT ** RESOLUTION AGENDA ITEM TRACKING FORM M<eting Date (Date ~dd /( fI 0<:;"' Item # a 0 Re",lution # ;). ()~ J 't if Vote: Ayes 'L Nays Abstain Absent Change to motion to amend original documents 0 Companion Resolutions Null/Void After: days / Resolution # On Attachments: 0 Note on Resolution of attachment stored separately: 0 Date Sent to Mayor: ~ 1 t e r ./7 Date of Mayor's Signature: 1, 41" O/~ ..-/ / ....,..\;1 -l Date of Clerk/CDC Signature: ~r 0 ~ Da~~t for Signature: 1 sl Reminder Letter Sent: PUBLISH 0 POST 0 .' ;: ~ I ':~ RECORD W/COUNTY 0 By: /~ Reso. Log Updated: Seal Impressed: o 1/J61()5 Not Returned: 0 Date Returned: 2nd Reminder Letter Sent: Request for Council Action & Staff Report Attached: Updated Prior Resolutions (Other Than Below): Updated CITY Personnel Folders (6413,6429,6433, 10584, 10585, 12634): Updated CDC Personnel Folders (5557): Updated Traffic Folders (3985, 8234, 655, 92-389): :1 Copies Distributed to: Animal Control City Administrator City Attorney ~ J ~ ~ Code Compliance 0 Development Sffvices 0 Others: ~(~) Notes: / / Ready to File: V yes/ Yes Yes Yes Yes No By_ No ,-- By_ No-L2 By_ NO~_ No_ By_ EDA V Information Services ~ Parks & Recreation Police Department 0 0 Public Services 0 0 Water Department 0 Facilities Finance Fire Department Human Resources Date: ~ 1Id)~ Revised 12/18/03 """'"~-' _~~ '''""''__ ,___~- ~ b- _ -,' - -~----""""~-"--'--'- - ' <;-P''''."""-,"""",, ,/ .. . CITY OF SAN BERNARDINO Interoffice Memorandum CITY CLERK'S OFFICE Records and Information Management (RIM) Program DATE: July 26, 2005 TO: Lynn Knutsen Parks, Recreation & Community Services Department FROM: Eileen Gomez, Senior Secretary RE: Transmitting Documents for Signature - Resolution 2005-244 At the Mayor and Common Council meeting of July 18, 2005, the City of San Bernardino adopted Resolution No. 2005-244 - Resolution authorizing the Mayor or her designee to execute an agreement with the San Bernardino City Unified School District to provide contractual services for before & after-school recreation programs at eighteen (18) school district sites. Attached are four (4) original agreements. Please obtain signatures in the appropriate locations and return the ORIGINAL agreement to the City Clerk's Office as soon as possible, to my attention. Please keep the remaining three (3) fully executed copies for your records and for the other party. Please be advised that the resolution and contract will be nuD and void if not executed within 120 days from the date of adoption, or returned to our office by November 18, 2005. If you have any questions, please do not hesitate to contact me at ext. 3206. Thank you. Eileen Gomez Senior Secretary e above mentioned documents. DateM-dl9-oS Please sign and return