HomeMy WebLinkAbout23-Parks & Recreation
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Date: April 9, 2001
CITY OF SAN BERNARDINO - REQUEST FOR COUNCIL ACTION
Subject: 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 $200,000 FROM SAN
BERNARDINO COUNTY
DEPARTMENT OF AGING AND
ADULT SERVICES FOR THE
ADMINISTRATION OF THE SENIOR
NUTRITION PROGRAM.
MICC Meeting Date:
From: Annie F. Ramos, Director
Dept: Parks, Recreation &
Community Services Dept.
Synopsis of Previous Council Action:
On June 5,2000 the Council approved Resolution 2000-120 authorizing the Department
to apply for and administer the grant. This programs operations have been approved by
Council since 1977
Recommended Motion:
~
, Signature
Adopt Resolution
Contact person: Inhn 4 Kr..m..r
Phnn..' ~R4_~n~1
Supporting data attached Staff Report, Reso., & contract Ward:
City-wide
FUNDING REQUIREMENTS: Amount:
Source: (Acct. No.)
(A"" n~::::'~l U
Council Notes:
Agenda Item No. ~ 3
S/7/0J
'.
CITY OF SAN BERNARDINO - REQUEST FOR COUNCIL ACTION
Staff Report
Subiect:
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 $200,000 from San Bernardino
County Department of Aging and Adult Services for the administration of the Senior Nutrition
Program.
Backl!:round:
The Parks, Recreation and Community Services Department has provided nutrition services to
seniors for 23 years. During fiscal year 99/00, the Senior Nutrition Program served over 70,000
total meals for a daily average of 275 meals to 8 nutrition sites. This program celebrated its
twenty-third anniversary July 17-21, 2000. Every three years the Department of Aging and
Adult Services goes out to bid and requests applications from interested parties to operate senior
nutrition programs in the County of San Bernardino. This application fulfills that bid
requirement.
Financial Imnact:
The Senior Nutrition Program is financially supported by a combination of grants, donations, and
USDA reimbursements, and requires no direct support from the City's general fund. The 2001-
2002 Senior Nutrition grant is $200,000 with an additional $90,000 in required in-kind matching
contribution. This in-kind is provided through the operation of two Senior Centers including
utilities, maintenance, and staffing. This in-kind is included in the department budget.
Recommendation:
This program provides a vital service to Senior Citizens 60 years and over, and it is
recommended that the Resolution be approved so that services may continue for fiscal year
2001-2002.
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~(Q)~V
RESOLUTION NO.
2 RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING THE MAYOR OF
THE CITY OF SAN BERNARDINO OR HER DESIGNEE TO APPLY FOR AND ADMINISTER
3 A GRANT IN THE AMOUNT OF $200,000 FROM SAN BERNARDINO COUNTY DEPARTME~T
OF AGING AND ADULT SERVICES FOR THE ADMINISTRATION OF THE SENIOR
4 NUTRITION PROGRAM.
5 BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY
6 OF SAN BERNARDINO AS FOLLOWS:
7 SECTION 1. The Mayor of the City of San Bernardino or her designee is hereby
8 authorized to apply for and administer a grant in the amount of $200,000 from San Bernardino
9 County Department of Aging and Adult Services for the administration of the Senior Nutrition
10 Program.
II SECTION 2. The authorization granted hereunder shall expire and be void and of no
12 further effect if the agreement is not executed by both parties and returned to the office of City
13 Clerk within one hundred twenty (120) days following effective date of the resolution.
14 /II
IS 1/1
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22 /II
23 /II
24 /II
25 /II
26 /II
27 /II
28 /II
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1
2
3
4
5
6
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 $200,000 FROM SAN
BERNARDINO COUNTY DEPARTMENT OF AGING AND ADULT SERVICES FOR
THE ADMINISTRATION OF THE SENIOR NUTRITION PROGRAM.
I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the Mayor
and Common Council of the City of San Bernardino at a
meeting thereof, held on the
7 _day of
,2001, by the following vote, to wit:
Council Members:
AYES
NAYS
ABSTAIN
ABSENT
ESTRADA
LIEN
McGINNIS
SCHNETZ
SUAREZ
ANDERSON
McCAMMACK
City Clerk
The foregoing resolution is hereby approved this
day of
,2001.
Judith Valles, Mayor
City of San Bernardino
Approved as to
Form and legal content:
JAMES F. PENMAN,
City Attorney
/' "
By: ln11r kO !. f'r..AA~
/
t?9-0 I dlb
2001-88
Attachment F
Application for Project Award
for
Senior Nutrition Services
Congregate Nutrition &
Home Delivered Meals
Due 5:00 p.m.
Thuffiday,April12,2001
See Instruction Package for guidance in completing this
application.
John Michaelson
Assistant County Administrator -
Human Services System
County of San Bernardino
Linda Haugan
Interim Director
Department of Aging & Adult Services
Contract Administration
150 South Lena Road
San Bernardino, CA 92415-0515
(909) 388-0255
RFP HSS 01-06
56
Attachment F
Table of Contents
Section Pa~
Part I Face Sheet.... .................... ............. ............. ............................... 58
Part II Project Design
A. Identifying Information about the Organization........................ 59
B. Congregate Nutrition....................................................... ........ 60
C. Home Delivered Meals ...........................................................64
Part III Fiscal Management
A. Describe the fiscal management procedures used .................69
B. Fiscal Management Questions ...............................................69
C. Additional funding being sought.............................................. 70
Part IV Budgetary Information
A. Congregate Meals Quote........................................................ 72
B. Home Delivered Meals Quote................................................. 73
C. Title III - Budgetary Information Form 312A ............................ 74
D. Schedule of Personnel Form 315............................................76
E. Schedule of Equipment Form 316...........................................77
F. Budget In-Kind Narrative Form 332 ........................................78
Part V Assurances
A. List of Assurances .................................................................. 79
B. Assurance Response Sheet ...................................................82
Part VI Child Support Compliance Program Certification ..................83
57
Part 1 - Face Sheet
A. Title of ProjecUProgram
Attachment F
For DAAS Use Only
Application #:
Date Received:
Application Committee Score:
Disposition:
B. Dates of Project
C. Applicant Agency (Name, Street, City, D. Agency Director (Name, Title, Street, City, Zip,
State, Zip, Telephone): Telephone):
E.1. Type of Agency
Public Agency 0
Private for Profit 0
Private Non-Profit 0
F. Proposed
Budget
Total
Project
Costs
Project
Income
$
$
E. 2. Private Non-Profit
Date of Incorporation
Corporation Number
IRS Employer 10 #
Tax Status
Co tributions
Cash Match
Non-match Cash In-Kind
T&III
Grat Furi:ls
$
$
$
G. Name, Title and Address of Official Authorized H. Payee (Specify to whom checks should be mailed-Name,
to Sign for Applicant Agency: Title, Address):
Signature of Person as noted in Item #G
Name
San Bernardino County
OMS Form- 508
Revised 01/08/2001
Date
58
Attachment F
Part II - Project Design
A. Identifying Information about the Organization -- Briefly describe the mission and purpose of the applicant
agency. Briefly describe your organization's prior successful experience in providing services to older
participants and/or individuals with a disability. Briefly describe your organization relationships to other
organizations who may provide other services at your proposed site(s).
59
Attachment F
B. Congregate Nutrition (C-1) Instructions - Complete a separate form with Project Objectives and a Project
Description for each nutrition site.
Site Name:
Address:
1. Project Objectives
a. Total number of meals to be served per year.
b. Total number of individual participants to be served per year.
c. Total number of individual participants in the following categories to receive service per year:
Black
Hispanic
Caucasian
ASianlPacific Islander
American Indian
Other
TOTAL
The total should be the same as item b.
d. Total number of low income participants.
e. Check box if community is a rural area (fewer than seven individuals per square mile). 0
f. Hours and days services are to be provided.
g. Geographic boundaries of the area to be served by this site. List each city or community. NOTE:
Applicants must serve the entire city or community listed.
h. Number of proposed hours of social or entertainment activities per week.
i. Number of proposed outreach hours each month to identify potential participants who
are low income minority seniors, seniors residing in rural areas, seniors with limited
English speaking ability, seniors with severe disabilities, seniors with speech, visual, or
hearing impairments, and seniors with Alzheimer's disease and related dementia
disorders.
60
i .
Attachment F
2. Project Description
a. Summarize how the service or activities will be implemented, how long will it take to implement. and the
locations of services to be provided. Provide a time frame for the first three-month implementation period.
61
Attachment F
b. Describe how you will address the issues of quality and management to create and maintain a warm, caring
environment for participants.
c. Describe which holidays will be observed with meal service.
d. Describe your proposed buying system, inventory control, and dietitian services.
e. Describe how the project will internally monitor its performance and what evaluation criteria will be used to
gauge its accomplishments. Attach samples of forms.
1. Describe in detail the equipment available within the kitchen to be used to prepare the meals.
62
Attachment F
g. Describe your relationship to the facilities where meals will be prepared and served. Identify the source of
funds for space, utilities, water, gas, telephone, and trash. The applicant's or another party's contribution to
pay these expenses will result in additional points being awarded when this application is scored.
h. Describe where vehicles will be used to deliver bulk food to more than one site.
i. Describe personnel who will manage the site(s) and their experience with maintaining warm, caring
environments, food services management, training of staff and volunteers, etc.
j. Describe how you will create an environment for meal service and socialization that addresses the issues of
quality listed on page 20.
k. Describe the physical characteristics of the site. REQUIRED: Attach the Accessibility survey found in
Attachment E (page 43) of the RFA.
63
C. Home Delivered Meals Nutrition (C-2)
regardless of the number of routes.
Attachment F
Complete a form with Project Objectives and Project Description
Site Name:
Address:
1. Project Objectives
a. Total number of meals to be delivered per year.
b. Total number of individual participants to be served.
c. Total number of individual participants in the following categories to receive service per year:
Black
Hispanic
Caucasian
AsianlPacific Islander
American Indian
Other
TOTAL
The total should be the same as item b.
d. Hours and days services are to be provided (specify if these differ by site or project elements).
e. Geographic boundaries of the area to be served. List each city or community. NOTE: Applicants must
serve the entire city or community listed.
f. Number of proposed outreach hours each month to identify potential participants who are
low income, minority seniors residing in rural areas, seniors with limited English-speaking
ability, seniors with some disability, seniors with speech, visual, or hearing impairments,
and seniors with Alzheimer's disease or related dementia disorders.
64
Attachment F
2. Project Description
a. Summarize how the service or activities will be implemented, how long will it take to implement, and
locations where the service will be provided. Provide a time frame for the first three-month implementation
period.
65
Attachment F
b. Describe which holidays will be observed with home delivered meal service.
c. Describe your proposed buying system, inventory control, and dietitian services. (If you have answered this
item in part B-Congregate and the information remains the same, please note it in the space below,
otherwise, describe it in detail).
d. Describe how the project will internally monitor its performance and what evaluation criteria will be used to
gauge accomplishments. Attach samples of forms. (If you have answered this item in part B-Congregate
and the information remains the same, please note it in the space below, otherwise, describe it in detail).
e. Describe in detail the equipment available within the kitchen that will be used to prepare the meals. (If you
have answered this item in part B-Congregate and the information remains the same, please note it in the
space below, otherwise, describe it in detail)
66
Attachment F
f. Describe your relationship to the facilities where meals will be prepared and served. Identify the source of
funds for space, utilities, water, gas, telephone, and trash. The applicant's or another party's contribution to
the budget to pay these expenses will result in additional points being awarded when this application is
scored. (If you have answered this item in part B-Congregate and the information remains the same,
please note it in the space below, otherwise, describe it in detail)
g. Describe the management of the vehicles to be used to deliver homebound meals.
h. Describe personnel who will manage the program and their experience with food services management,
training of staff and volunteers etc. (If you have answered this item in part B-Congregate and the
information remains the same, please note it in the space below, otherwise, describe it in detail)
i. Describe how assessments will be conducted using the information on page 6. Include information about
the knowledge, ability, and skill of the outreach worker.
j. How would you prioritize client participation?
67
Attachment F
k. Describe how participants will be given the opportunity to donate in a confidential manner.
D. Training
Describe the proposed training plan i.e. type of training and content of each session for site managers, staff, and
volunteers within the site and home delivered meals program, meeting the following requirements:
1. Regular, at least monthly, training events, lasting at least one hour, for the paid and/or volunteer managers
of each site and home delivered meals routes. .
2. Regular, at least monthly, training events, lasting at least one hour, for all line staff, home delivered meal
program drivers, and especially volunteers at each site.
68
Part III - Fiscal Management
Attachment F
A. Describe the fiscal management procedures used. If fiscal management is to be performed by other than
program staff, identify outside service provider.
S. Fiscal Management Questions - Indicate (X) Yes or No for each of the following:
1. A detailed budget of public support revenue and expenses is adopted officially each
year by the agency's governing body.
2. Variances from budgeted expenses are analyzed on a systematic basis.
3. The agency uses functional budgeting and accounting procedures that are consistent
with the standards set up by the funding source.
4. The agency maintains a satisfactory set of financial records, which are reviewed
annually by an independent examiner.
5. The agency follows the administrative guidelines of one of the following OMS
circulars: A-a7, A-102, A-122, A-l10, and follows the audit guidelines of OMS Circular
A-133. (Copies are available as reference documents, Page 11).
6. There is adequate insurance coverage, including worker's compensation insurance
(including volunteers), insurance for fire and water damage, public liability insurance
on motor vehicles, and, when appropriate, provisions for health and accident
insurance for service users.
7. Agency practice allows the participation of persons served through confidential
donations.
Yes No
o
o
o
o
o
o
o
o
o
o
o
o
o
o
69
8. Agency practice encourages the seeking of alternative financial resources.
9. All necessary licenses and permits are current and valid.
Attachment F
o 0
o 0
10. Explain any items marked "No":
C. Additional funding being sought (if any):
70
Attachment F
Part IV - Budgetary Information
Forms 312A, 315, 316, & 332
Quote Forms
71
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CONGREGA TE SITESD
EXPENDITURE CATEGORY
Funding
Less Match
HOME DELIVERED MEALS D
Match
Cash In-Kind
TOTAL
1. PERSONNEL
Attach Schedule of Personnel
2. STAFF TRAVEL
3. STAFF TRAINING
6. FOOD COSTS
7. CONSUMABLE SUPPLIES
8. INSURANCE
9. REPAIRS & MAINTENANCE
10. RENT/BUILDING SPACE
11. UTILITIES
12. VEHICLE OPERATIONS
13. VOLUNTEER EXPENSES
14. OTHER
Total Expenditure
LESS FUNDING
Non Match USDA"
Non Match Cash
Program Income
TOTAL FUNDING REQUEST
Prepared By:
Phone No:
San Bernardino County. OMS Form 312A
Revised 01/08/2001
"CDBG funds, United Way funds, etc.
74
Attachment F
Instructions for Completing Budget Summary
Please check appropriate box at the top of Budget Summary. If completing budget
for congregate sites, check that box, if for home delivered meals, check that box.
Line Item
1. Personnel
2. Staff Travel
3. Staff Training
4. Equipment
5. Consultants
6. Food Costs
7. Consumable Supplies
8. Insurance
9. Repair & Maintenance
10. Rent/Building Space
11. Utilities
12. Vehicle Operations
13. Volunteer Expenses
14. Other
Description of Allowable Costs
Should be computed for all staff paid out of requested funds. Use
Schedule of Personnel OAAS form 315 to itemize by position and
activity costs and provide a brief (one to two lines) position
description. Also included in this category are payroll taxes which
should be computed for FICA (Federal Insurance Contributions
Act) for employers match, FUTA (Federal Unemployment Tax
Act) and Fringe Benefits compute for health, worker
compensation, SOl, etc.
Should be computed at you agreed upon travel rate and is for
normal day-to-day travel.
Should include travel per diem for special training sessions or
nation conferences, etc.
Includes expendable equipment purchased for under $500 and
equipment purchased for over $500. Kitchenware and glassware
are included in this category. Use OAAS for 316 to itemize.
Are purchased services such as a Nutritionist etc.
Includes raw foods used to prepare meals.
Includes paper supplies, cleaning supplies.
Includes insurance for vehicles, personal liability etc.
Applies to maintenance on facilities and/or equipment.
Rental Lease Fees
Monthly telephones, electricity, gas, water, and trash expenses.
Leasing and maintenance costs for gas, oil, repairs, tires, etc.
Agreed upon per diem and travel reimbursement rates for
volunteers.
Other costs Included but limited to are:
Accounting/Audits - accounting and outside services if purchased.
Advertising
Linens
Membership & Subscriptions
Printing costs for pamphlets, brochures, etc.
Other supplies
Taxes and licenses, i.e., Business licenses
On the lines at the bottom of the form, be sure to include name and phone number of the preparer. Direct any
questions regarding allowable costs to RFA contact person.
75
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Attachment F
Item
Descri tion
Quantity
Budgeted
Cost
Total
Costs
Provider Name:
San Bernardino County - OMS Fonn 316
RevIsed 0110812001
77
Provide information regarding specific in-kind to be used as match. Include site
location, if applicable, descriptions, rates and other relevant information. The Total
should equal the amount of in-kind reported as match on your budget summary.
"(Identify type of in-kind: rent, volunteer services, etc.)
DATE OF SUBMISSION
PROVIDER NAME
San Bernardino County-OMS Form 332
Revised 01/0812001
78
Part V - Assurances
Attachment F
,----- -- - - -- -- - ---- -- -- - - - --- - -- -- -
I Assurances I
~---- - -- ----- -- ------ - -- -- - - __ I
NOTE: All references given are for the Older Americans Act of 1965, as amended.
The Applicant Assures that they shall:
1. Set specific goals for providing services to older individuals with the greatest economic or
social needs, including specific objectives for providing services to low income minority
individuals. (306 (a}{5}{A}{i))
2. Include in each agreement made with a subcontractor a requirement that such service will-
(I) specify how the provider intends to satisfy the service needs of low income minority
individuals in the area served by the provider; (II) to the maximum extent feasible, provide
services to low-income minority individuals in accordance with their need for such services;
and (III) meet specific objectives established by the area agency on aging, for providing
services to low-income minority individuals within the planning and services areas. (306
(a}{5}{A}{ii))
3. Use outreach efforts that will - (i) identify individuals eligible for assistance under this Act,
with special emphasis on (I) individuals residing in rural areas; (II) older individuals with
greatest economic need (with particular attention to low-income minority individuals); (III)
older individuals with greatest social need (with particular attention to low-income minority
individuals); (IV) older individuals with severe disabilities; M older individuals with limited
English-speaking ability; and (VI) older individuals with Alzheimer's disease or related
disorders with neurological and organic brain dysfunction (and caretakers of such
individuals); and (ii) inform the older individuals feferred to in subclauses (I) through (IV) of
clause (i), and the caretakers of such individuals, of the availability of such assistance.
(306 (a}{5}{B})
4. . Assure that it will - (A) maintain the integrity and public purpose of services provided, and
service providers, under this title in all contractual and commercial relationships; (8)
disclose to the Commissioner and the State agency - (i) the identity of each non
governmental entity with which such agency has contract or commercial relationship
relating to providing any service to older individuals; and (ii) the nature of such contract or
such relationship; (C) demonstrate that a loss or diminution in the quantity or quality of the
services provided, under this title by such agency has not resulted and will not result from
such contract or such relationship; (0) demonstrate that the quantity or quality of the
services to be provided under this title by such agency will be enhanced as a result of such
contract or such relationship; and (E) on the request of the Commissioner or the State for
the purpose of monitoring compliance with this Act (including conduct an audit), disclose all
sources and expenditures of funds such agency receives or expends to provide services to
older individuals. (306 {a}{14} {A} through (E))
79
Attachment F
5. Assure that funds received under this title will not be used to pay any part of a cost
(including an administrative cost) incurred by the applicant to carry out a contract or
commercial relationship that is not carried out to implement this title. (306 (a){15})
6. Assure that preference in receiving services under this title will not be given by the
applicant to particular older individuals as a result of a contract or commercial relationship
that is not carried out to implement this title. (306 (a){16})
7. Assure that (A) the applicant will pursue activities to increase access by older individuals
who are Native Americans to all it's programs under this title.
8. Assure that persons age 60 or over who are frail, homebound by reason of illness or
incapacitating disability, or otherwise isolated shall be given priority in the delivery of
services under this part. (91321.69 (a}). .
9. Such fiscal control and fund accounting procedures will be adopted as may be necessary to
assure proper disbursement of, and accounting for, Federal funds paid under this title to the
applicant. (307 (a}(7){A})
. 10. (i) No individual (appointed or otherwise) involved in the designation of the head of any
subdivision of an area agency on aging, is subject to a conflict of interest prohibited under
this Act; (ii) no officer, employee, or other representative of an area agency on aging is
subject to a conflict of interest prohibits under this Act; and (iii) mechanisms are in place to
identify and remove conflicts of interest prohibited under this Act. (307 (a}{7}{B})
11. (i) (It will) maintain the integrity and public purpose of services provided in all contractual
and commercial relationships; (ii) Demonstrate that a loss or diminution in the quantity or
quality of the services provided, or to be provided, under this Act by such applicant has not
resulted and will not result from such contract or such relationship; (iii) Demonstrate that
the quantity or quality of the services to be provided will be enhanced as a result of such
contract or such relationship. (307 (a}(7){C})
12. Furnish assurances to the area agency that the applicant will maintain efforts to solicit
voluntary support and that the funds made available under this title to the applicant will not
be used to supplant funds from non-federal sources. (307 (a){13}{H})
13. It shall establish procedures that will allow the option to offer a meal, on the same basis as
meals are provided to elderly participants, to individuals providing volunteer services during
the meal hours, and to individuals with disabilities who reside at home with and/or
accompany to meal sites older individuals who are eligible for meals. (307 (a){13){I})
14. In the case of purchase or construction, that there are no existing facilities in the community
suitable for leasing as a multipurpose senior center, [and that the] plans and specifications
for the facility are in accordance with regulations relating to minimum standards of
construction promulgated with particular emphasis on securing compliance with the
requirements of the Act of August 12, 1968, commonly known as the Architectural Barriers
Act of 1968. (307 (a}{14}{B}{C})
15. Any laborer or mechanic employed by any applicant in the performance of work on the
[multipurpose senior center] facility will be paid wages at rates not less than those
prevailing for similar work in the locality as determined by the Secretary of Labor in
80
Attachment F
accordance with the Act of March 3, 1931 (40 USC 276a-276a-5, commonly know as the
Davis-Bacon Act), and the Secretary of Labor shall have, with respect to the labor
standards specified in this clause, the authority and functions set forth in reorganization
plan number 14 of 1950 (15 FR 3176; 64 Stat. 1267), and Section 2 of the Act of June 13,
1934 (40 U.S.C. 276c). (307 (a}{14}{D})
16. If a substantial number of older individuals in the applicants service area are of limited
English-speaking ability, the applicant shall (A) utilize in the delivery of outreach services
under Sec. 306 (a) (2) (A) and 306 (a) (6) (P), the services of workers who are fluent in the
language spoken by a predominate number of elderly individuals who are of limited
English-speaking ability. (307 (a}{20})
17. All services provided under Title III meet all existing state and local licensing, health, and
safety requirements for the provision of those services.
18. All staff hired by the program will be required to attend appropriate training sessions and
workshops sponsored by the Department of Aging & Adult Services and the California
Department of Aging.
19. All materials, videotapes, and publicity will acknowledge the San Bernardino County
Department of Aging & Adult Services and indicate that the programs are made possible by
Older Americans Act funds.
81
Attachment F
Assurance #
List of Assurances
Reason for Non-Compliance
Any exceptions to the assurances must be noted and fully explained and attached as an Appendix to
the RFA.
82
Attachment F
Part VI - Child Support Compliance Program
SOLICITING DEPARTMENT: HSS - DeDartment of Al!inl! & Adult Services
ADDRESS: 686 East Mill Street. San Bernardino. CA 92415
CONTACT NAME & PHONE NO.: Jacki Baxter (909) 388-0259
CHILD SUPPORT COMPLIANCE PROGRAM CERTIFICATION
San Bernardino County Code Section 110.0101 et seq. contains the San Bernardino County Child Support Compliance
Program. This Program requires 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 department, along with their bids or proposals. (In an emergency
procurement, as determined by the soliciting County department, these certifications may be provided immediately
following the procurement).
IN ORDER TO COMPLY wlm THIS REQUIREMENT, COMPLETE THIS FORM AND SUBMIT IT
DIRECTLY TO mE SOLICITING COUNTY DEPARTMENT, ALONG WIm YOUR BID OR PROPOSAL.
IN ADDITION, THE SOLICITING DEPARTMENT WILL PROVIDE A COPY TO THE DISTRICT
ATTORNEY AT THE ADDRESS OR FAX NUMBER SHOWN BELOW.
I, (print name)
proposal)
(contractor's address)
is in compliance with San Bernardino County's Child Support Compliance Program and has met the following
requirements:
hereby certifY that (contractor name as shown on bid or
, located at
I. Submitted a completed Principal Owner Information 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 1088.5), and will continue to comply with such reporting requirements;
3. Fully complied with all lawfully-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.
Executed this
day of
(Month & Year)
at
(City I State)
(Telephone Number)
By:
(Signature of a Principal Owner, an Officer, or Manager responsible for submission of the hid or proposal to the County).
Soliciting Dept Send
Copy to: District Attorney, Child Support Division
. Ombudsman Program
10417 Mountain View Avenue
Lorna Linda, CA 92354-2030
FAX: (909) 478-7470
PHONE: (909) 478-7300
83
,
rJ
,J _Q~
~--
HUMAN SERVICES SYSTEM
aJUNIYOFSANIlFllNARUI'KJ
ffiJMANsmvDSbWDM
Administrator
July 18,2001
Reply to:
l&l Administrative Office
150 South Lena Road
San Bernardino CA 92415.0515
Attn: Ginny Lloyd
City of San Bernardino
547N. Sierra Ave
San Bernardino, CA 92410-4816
RE: Board of Supervisors Approved Senior Nutrition Program Contract - Fiscal Year 2001-2002
Enclosed is your copy of the Board approved Contract number 01-687 to provide senior nutrition services to
San Bernardino County seniors for Fiscal Year 2001-2002. The term of the contract is July 1,2001 to June
30, 2002.
I will be serving as the contract representative for this contract. If you have any questions or require
assistance, please feel free to contact me directly. Also, any notices pursuant to the contract should be sent to
the address below.
County of San Bernardino
Human Services System - Building & Finance - Contract Administration
150 South Lena Road
San Bernardino, CA 92415-0515
Attention: Jacki Baxter
Additionally, according to the contract, any modification, change or addition to the scope of work or any
other aspect of this contract must be executed via contract amendment. Any such amendment must first be
submitted to this office for approval and usually requires prior approval from the County Board of
Supervisors. As such, please understand County staff does not have the authority to authorize any changes
and any payment request based on an unauthorized revision will not be honored.
Feel free to call me at (909) 388-0259 if you have any questions or concerns. We would like to thank you
again for helping the County serve its senior population.
Sincerely,
~(:l~ ~
Jacki B~ter
Staff Analyst 1
Enclosure
cc: DAAS
File
j
Administrator
<IXNIYOF~BnlNARIINO
lIUMAN!ilM(ESlMIIM
,
HUMAN SERVICES SYSTEM
JOHN F. MICHAELSON
Assistant County
Reply 10:
1&1 Administrative Office
150 South Lena Road
San Bernardino CA 92415-0515
June 25, 2002
Attn: Oscar Perrier
City of San Bernardino
547N. Sierra Ave
San Bernardino, CA 92410-4816
RE: Board of Supervisors Approved Senior Nutrition Contract (01-687) Amendment No.2 - Fiscal
Year 2001-2002
Enclosed is your copy of the Board approved County Contract No. 01-687 A-2 to provide senior nutrition
services to San Bernardino County seniors for Fiscal Year 2001-2002. This amendment awards an additional
$12,000 for Fiscal Year 2001-2002.
1 will be serving as the contract representative for this contract. If you have any questions or require
assistance, please feel free to contact me directly. Also, any notices pursuant to the contract should be sent to
the address below.
County of San Bernardino
Human Services System - Building & Finance - Contract Administration
150 South Lena Road
San Bernardino, CA 92415-0515
Attention: Jacki Baxter
Additionally, according to the contract, any modification, change or addition to the scope of work or any
other aspect of this contract must be executed via contract amendment. Any such amendment must first be
submitted to this office for approval and usually requires prior approval from the County Board of
Supervisors. As such, please understand County staff does not have the authority to authorize any changes
and any payment request based on an unauthorized revision will not be honored.
Feel free to call me at (909) 388-0259 if you have any questions or concerns. We would like to thank you
again for helping the County serve its senior population.
Sincerely,
Op~'~
Jacki Baxter
Staff Analyst
Enclosure
cc: DAAS
File
\
** FOR OFFICE USE ONLY - NOT A PUBLIC DOCUMENT **
RESOLUTION AGENDA ITEM TRACKING FORM
Meeting Date (Date Adopted); 5, I-a \ Item # 'Z~ Resolution #
Vote; Ayes 1-, Nays -Fr Abstain-er-
Change to motion to amend original documents:
Reso. # On Attachments;
Contract term;
Note on Resolution of Attachment stored separately; -==----
Direct City Clerk to (circle I); PUBLISH, POST, RECORD W/COUNTY
Date Sent to Mayor; ,") - 'is'-C \
Date of Mayor's Signature; 5--'is-6/
Date of Clerk/CDC Signature; 5 -"1-0 \
Date Memo/Letter Sen
re:
See Attached;
See Attached;
60 Day Reminder Letter Sent on 30th day;
90 Day Reminder Letter Sent on 45th day:
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);
Copies Distributed to:
'"
,/
City Attorney
Parks & Rec.
Code Compliance
Dev. Services
Police
Public Services
Water
Notes:
7coI- %8-
Absent A-
NullNoid After; 1"20 OA<J~ / q-l{-c, (
,
By; -
Reso. Log Updated;
Seal Impressed;
,,/
,/'
Date Returned;
-
YesL No By
Yes No a/ By
Yes No ,/ By
-
Yes No V By
Yes No ----;7 By
,.
EDA
Finance
MIS
Others;
BEFORE FILING. REVIEW FORM TO ENSURE ANY NOTATIONS MADE HERE ARE TRANSFERRED TO THE
YEARLY RESOLUTION CHRONOLOGICAL LOG FOR FUTURE REFERENCE (Contract Term, etc.)
Ready to File; ()Tr
Date: 6-(~-C1
Revised 01/12/01