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Home My WebLink About2011-057 RESOLUTION NO. ?011-,7 2 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO RATIFYING THE SUBMITTAL OF THE APPLICATION FOR WASTE TIRE CLEANUP and AMNESTY GRANT PROGRAM FROM THE CALIFORNIA DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY (CALRECYCLE). 3 4 5 6 WHEREAS, funds are available from the California Department of 7 Resources Recycling and Recovery (CaIRecycle) for grants to local government 8 to pay for the costs of cleanup, abatement, and other forms of remedial action 9 related to the disposal of used whole tires; and 10 WHEREAS, the City proposes to implement a Waste Tire Cleanup that 11 involves collection and proper disposal of illegally dumped waste tires; and 12 13 WHEREAS, the City has demonstrated it has sufficient staff resources, 14 technical expertise, and experience with similar projects to carry out the 15 proposed program; and 16 WHEREAS, the grant application deadline was February 18, 2011. The 17 grant term is July 1,2011 through June 30, 2012. 18 NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AS FOLLOWS: 19 20 SECTION 1. Submittal of an application to the California Department of 21 Resources Recycling and Recovery (CaIRecycle) for a Waste Tire Cleanup and 22 Amnesty Event Grant Programs, a copy of which is attached hereto and 23 24 incorporated herein as Exhibit "A," is hereby ratified. The City Manager of San 25 Bernardino, or his designee, is further authorized to (1) submit all supporting 26 documents required by the Waste Tire Cleanup and Amnesty Grant Program 27 during its pendency, including, but not limited to, payment requests, (2) to 28 administer grant funds; and 1 RESOLUTION NO. 7011-')7 2 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE 3 CITY OF SAN BERNARDINO RATIFYING THE SUBMITTAL OF THE APPLICATION FOR WASTE TIRE CLEANUP and AMNESTY GRANT 4 PROGRAM FROM THE CALIFORNIA DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY (CALRECYCLE). 5 6 (3) to implement and carry out the purposes specified in the grant application. 7 III 8 III 9 III 10 III 11 11/ 12 III 13 14 III 15 III 16 III 17 III 18 III 19 III 20 11/ 21 22 III 23 III 24 III 25 III 26 III 27 III 28 2011-57 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO RATIFYING THE SUBMITTAL OF THE 2 APPLICATION FOR WASTE TIRE CLEANUP and AMNESTY GRANT 3 PROGRAM FROM THE CALIFORNIA DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY (CALRECYCLE). 4 5 I HEREBY CERTIFY that the foregoing resolution was duly adopted by the Mayor and Common Council of the City of San Bernardino at a 6 7 joint regular meeting thereof, held on the 7th day of 8 March , 2011 by the following vote, to wit: 9 10 Council Members: 11 MARQUEZ 12 VACANT 13 BRINKER 14 SHORETT 15 KELLEY 16 JOHNSON 17 18 MCCAMMACK 19 20 Aves Navs Abstain Absent ---X- x x x x x a~ II;;. ~ ~ City Clerk 21 The foregoing resolution is hereby approved this 9n,; day of 22 March ,2011. 23 24 ~~~ 25 26 Approved as to form: Tobin Brinker, Mayor Pro Tern City of San Bernardino 27 28 2011-57 calReCYCle~ December 2010 Natural Resources Agency Department of Resources Recycling and Recovery (ea/Recycle) EXHIBIT A LOCAL GOVERNMENT WASTE TIRE CLEANUP AND AMNESTY EVENT GRANT PROGRAMS APPLICATION TCA8 Cycle - FISCAL YEAR (FY) 2010/11 page Grant Application Form .......... ... ............. .... ... ............. ....................... ................ .................. ......... ................2 Environmental Justice Certification..... ............. .......... .................... ...... .......... .................. ... ............ .............2 Resolution Requirement. ...... ... ....... ................ .......... ................ .................... ... ............ ... ......... ............... .......3 Environmentally Preferable Purchases and Practices Policy Requirement...................................................3 Acceptance of Grant Provisions..... ................ .... .................... ......... ....... ... ...................... ........ ......................3 Application Certification... ................... ....... ................ .......... ....... ...... ....... ...... ........................................ ......3 Waste Tire Cleanup Project(s) Description.... ............. ....... ...........................................................................4 Waste Tire Amnesty Event( s) Description.................. .... .......... ...................... ..................................... .........4 Work Plan (Waste Tire Cleanup Projects) ....................................................................................................5 Work Plan (Waste Tire Amnesty Events) .....................................................................................................6 Budget (Waste Tire Cleanup Projects) ................................................................... ..................... ........... .......7 Budget (Waste Tire Amnesty Events) ...... ................ .... ................ ....... ............. ... ......... ... ... ... ........... .............8 General Checklist of Business Pennits, Licenses and Filings.......................................................................9 Application Checklist.. .......... ... ... .......... ... .................... ................... ............. ....... ... ... ... ... ... ..... ............ ... ..... II Mailed applications must be postmarked no later than February 18, 2011. Hand delivered applications must be received and date stamped by CalRecycle Staff no later than 3:00 p.m. on February 18, 2011. Late applications will be disqualified. Emailed or faxed applications will not be accepted. Please follow instructions in the Application Guidelines and Instructions when completing this application. The Application Guidelines and Instructions are critical to properly completing and submitting this application. Applications become the property of CalRec.ycle and are subject to disclosure under the Public Records Act. Do not submit confidential information. Applications sent by Us. Postal Service or a commercial delivery service should be sent in a manner that al/ows for tracking by the sender and that provides an addressed and dated receipt. Failure to do so is at the risk of the applicant and if delivery is delayed or the application is lost by the Post Office or delivery service, the burden is on the applicant to demonstrate timely mailing or delivery of the application. I nr.;::!1 (.;nvp.rnmp.nt W::l~tP. Tirp. r.1p.::Inlln ::Inr! Amnp.~tv Fvp.nt ~r;:!nt Prnnr::lm", Tr.AR (FY ?01 0/11 \ STATE OF CALIFORNIA GRANT APPLICATION FORM CalRecycle 243- TCA (Revised 12/10) 2011-57 DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY (CaIRecycle) LOCAL GOVERNMENT WASTE TIRE CLEANUP AND AMNESTY EVENT GRANT PROGRAMS - TCAS (FY 2010/11) lete and submit all sections. N~O A' T"ON' 'i i "'''-'I:J:i~:i.:"'.~''oI:,, f'("d,:t" ) , i},;;:',"~' 11', r-; ,0.: "1.-". '~, ~~" if ",_~q'.;;.~. ~:r, ',_ _'")~'':''' APPLICANT I ORGANIZATION NAME (MUST MATCH RESOLUTION): CLEANUP PROJECTS AMOUNT: -.--. AMNESTY EVENTS AMOUNT: REQUESTED TOTAL AMOUNT: (ROUND AMOUNTS TO THE NEAREST WHOLE DOLLAR) 20000 City of San Bernardino PARTICIPATING JURISDICTIONS (FOR REGIONAL PROGRAMS ONLY): 20000 MAILING ADDRESS: 300 North D Street CITY: San Bernardino COUNTY: San Bernardino PRIMARY CONTACT NAME: PROJECT ADDRESS: CITY: ZIP CODE: 92418 COUNTY: ZIP CODE: SIGNATURE AUTHORITY NAME: (AS AUTHORIZED IN RESOLUTION) AUTHORIZED DESIGNEE NAME: (IF APPLICABLE, AS AUTHORIZED IN LETTER OF DESlGNATION- lOD, SEE APPENDIX A FOR MORE INFO.) Charles McNeel TITLE: Cit Mana er TELEPHONE NUMBER: 909-384-5549 909-384-5122 FAX NUMBER: FAX NUMBER: 909-384-5190 909-384-5138 EMAIL ADDRESS: EMAIL ADDRESS: alien de sbcit ,or mcneel ch sbcit ,or INDICATE WHICH TYPE OF ENTITY YOU ARE (CHECK ONLY ONE): ~ CITY D COUNTY D CITY & COUNTY D QUALIFYING INDIAN TRIBE D OTHER (LIST TYPE LEGISLATIVE DISTRICT NUMBERS (TO FINO YOUR DISTRICT, USE MArLING ADDRESS ABOVE AND GO TO www.calrecvcle.ca.C1ov/ProfileslJurisl) ASSEMBLY: SENATE: 62 32 Nadeem Ma'a' TITLE: Director of Public Works TELEPHONE NUMBER: 909-384-5140 FAX NUMBER: 909-384-5190 FEDERAL TAX IDENTIFICATION NUMBER: 95-6000772 \. J I r ~ I I I ~I' I 'I I\"'~ - f i.' ....; ~). r ,,, ( \ '( r " t , I \ , . I ',' ,. ~ \ , . .. ". I f 11 . l CalRecycle Grantees must in the performance of the Grant Agreement conduct their programs, policies, and activities that substantially affect human health or the environment in a manner that ensures the fair treatment of people of all races, cultures, and income levels. including minority populations and low-income populations of the State, (Govt, Code 965040.i2(e) and Public Resources Code pillO(a)) us cfieC 60x ',." . ",t, '.- . ~ l-' ", , [8J We acknowledge that our organization will comply with these principles of Environmental Justice. Local Government Waste Tire Cleanup and Amnesty Event Grant Programs, TeAS (FY 2010/11) 2 - 2011-57 STATE OF CALIFORNIA GRANT APPLICATION FORM CalRecycle 243- TCA (Revised 12/10) DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY (CaIRecycle) . !:l!J n~' ~'m"~;:'" ^., . '.'. . ,,'- , .. Jl l'll~ '.... ,,' ... -.l!" 1,,l .,,-'o$~', _' ',0. . '~~h~-"" ': Submit either an approved Resolution, valid up to 5 years, with your application or the following acknowledgement. (If applicable, submit a current Leiter of Designation (LOD) for signature designee) Note: All previous approved multiyear Resolutions must be updated to include new Department name. See Application Guidelines & Instructions or Resolution and Letter 0 Des; nation OD in ormation and exam les. o We acknowledge that an approved Resolution and, if applicable, LOD designating additional signature authority is enclosed in the application. We acknowledge that our approved Resolution must be received by CalRecycle no later than March 18,2011. We further acknowledge that if our Resolution is received after this date, our application will be disqualified. r:>::<J I~::" .tm! tl ill.6J~J:1IE1~ Jft'1!;S..tJj ~Ut? :i.W.p.i:}; ~ UimltJ.!.'.i~:3 ,:;l.'l!),}1 aMAf<J!l :!fj, ;.lG)11<~ 'r <J;t{ II;' {t, ;rl (t)JJ I Environmentally preferable purchasing protects human health and environmental well-being by reducing the procurement of goods and services that result in larger volumes of waste and pollutants. The Legislature declares I that the responsibility of environmentally preferable purchasing shall be that of any agency that does procuring on , behalf of the state (Chan, Statutes of 2002, Chapter 575), and this extends to grantees using state jimds. "Environmentally preferable purchasing (EP P) " as defined in PCC section 12400 means "the procurement or acquisition of goods and services that have a lesser or reduced effect on human health and the environment when compared with competing goods or services that serve the same purpose. This comparison shall take into I' consideration, to the extent feasible, raw materials acquisition, production, manufacturing, packaging, distribution, reuse, operation, maintenance, disposal, energy efficiency, product performance, durability, safety, the needs of the I purchaser, and cost." In other words, EPP considers, among other things, the environment, performance and cost." fA ,'no tour '0 sa e [8J Yes, our entire organization I has an Environmentally Preferable Purchasing and Practices Policy. Date adopted: I No, our entire organization does not have an Environmentally Preferable Purchasing and I Practices Policy. We acknowledge that our organization must adopt one by March 18,2011 i and send notification to the CalRecycle of such adoption by secondary deadline; March 18, I 2011, or our application will be disqualified. o [8J I By checking this box, Applicant acknowledges that submittal of this application constitutes , acceptance of all Grant Agreement provisions as contained in the Terms and Conditions and I Procedures and Requirements. To download these documents see: ,h :llwww.calreccle.ca.ov/tireslGrantslCleanuIFY201011/default.htm ':.'(;.~''f'~! . -.~ I Certification: I declare, under penalty of perjury under the laws of the State of California, that I have read a/l information in the Application Guidelines and Instructions and that a/l information submitted for the I CaIRe::Jf'e'~ consIderation for award of grant funds is true and correct to the best of my knowledge. X//L4L- -" ,,2/16 1/ Signature Authority - as ut orized in Resolution or Letter a/Commitment; or Date Authoriz~d Designee - as authorized in submitted Letter of Designation Nadeem Majaj I Print Name Director of Public Works Print Title 1 "Entire organization" refers to the entire city, county or non-profit applicant, not an individual office or subunit of the larger entity. Local Government Waste Tire Cleanup and Amnesty Event Grant Programs. TeAS (FY 2010/11) 3 STATE OF CALIFORNIA GRANT APPLICATION FORM CalRecycle 243-TCA (Revised 12/10) 2011-57 DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY (CaIRecycle) R~,': ~:~':,;"~{':;""'~:-.:I~~~-W~~t~ u~1t{l;),m1,'1 .; Provide the location, parcel number and a description of each site, which includes proximity to populated areaS or . sensitive environments, number of tires, proposed method of remediation, and end use. Photographs should also be included. Please include a quote from a registered waste tire hauler to justifY the estimated cost per tire. If there are more than 500 tires on private property and the owner is not responsible for the illegal disposal of the tires, then an affidavit for each site must be included with the application. See Application Guidelines and Instructionsfor the affidavit form. See attachments How many tires are estimated to be removed: 2750 Will these tires be recycled or landfilled? recycled Is the applicant able to utilize the California Conservation Corps or Local Community Conservation Corps for tire removal? not currently Provide a description of the amnesty event(s), including the estimated cost per tire for each event (grant amount divided by number of tires to be collected). Please include a quote from a registered waste tire hauler to justifY the estimated cost per tire. NA How many tires are estimated to be removed: NA Will these tires be recycled or landfilled? NA Is the applicant able to utilize the California Conservation Corps or Local Community Conservation Corps for tire removal? NA Local Government Waste Tire Cleanup and Amnesty Event Grant Programs. TCA8 (FY 2010'1 1) 4 N ~ 0 N Q) c: :l .., ~ ~ 0 N >- :; .., iii i= u W .., " 0 ~ u a:: C/) ~ a.. ~ :t: " W 0:: a.. ::;; III "ii ::l - "' <( en >1- z z ::- >- < I- 0:: W U C i:3 w ..J W > U -, ~ 0 0 CJ u W c:: w a:: ll. a. 0:: i= :l Cl Cl , z r::W w c: <( C/) III .,,1- 0 Q) c: Cl _lIl C3 .9 z a.< ll. -0 ::J ~;: 0 l!! u c:: ~ >- "l- ll. i= 0 u ~ffi u w Q) 0:: ~ en ::!! i= w z u a:: a 0:: W 0 ;:; :l 0 0 > 0 N en 0 0 >- w CJ ~ ~ 0:: "- ..J '" 0 < <( U I- U I- Z 0 .. W ..J E ::; I- ~ l! 0:: ~ ~ <( Ci Q. Q. W ~ E Cl C> N .. >- " u.. E ~ w ;?;- '" " ~ :!! ~ a: VJ "D Q) ~ Os ~ .. .. LL~ Co z~ :; ~ ~ W III .. Oil .J::: " ::;; u U -'" <( 0 I- "S; .!: c: l! <(<C" z III ;:: ZO!!:. I- "E -0 0::-<( Z III " o..Ju <( c: ~ .. "-a.1- u ~ 0 ~ Q) :JD..M :J III U E ~<~ ll. c: " ll. u.~~ <( III E oZu en E w <C ~ I- - " z 0 > 0 !;(o::~ ~ ::- Cl ~,,~ (:l i:3 N ~ 0 -' ~o;...c>. , r'"' - '.,1 ~ W' '. r.. . '- .~:; " ':- OJ: Icrq ~; ;l' ,:-=, '~, I .~.,- ',.. 1 .I'...~.:' ;'0) ,. ~.- .- l,r .~ , ' . ' , . [] '~l' ;.' G _,~' .,...,....' ",' -.. " ;j,O;' ....~! " , . 'ri. 2011-57 Ui i= z w " > u w ~ ~ ""'- co " (/) cr 1Il ~ n; W W ~ Z ::E >- :;; <{ cr z W <C I- 6 w z () 0:: w W i= > cr w 0 W 0 z 1:1- w <{ 1\I11l (/) t.? -<C 0 z a..;: a. ::l 0 () .lO:1- 0: >- "'z a. () Ow W :1::;; cr rn Z a W 0:: () W ;; cr > N :J 0 >- 0 !!;. rn Cl W co cr ...J <S u.. <C 0 U .... .... 0 '" z ...J E m W C, ~ ~ ~ e cr 0 a. <( ~ C a. 0 m W N " 0 >- c u. " > W ];- ~ " c .\: :E ." C 0:: m Os a. ~ LL- c z~ m " W l3 Oil ::E ~ - ~ <{ j:: t- .:; <(<C" z " zu!<S I- 1;; Z m cr-<s s: o...J <{ u..a...... () C :JQ.r/, :J " C3<~ a. E a. c u.......s! <{ ~ OzU > I- 0 WoeS: ~ Z t.? ~o::~ ~ n; t;~~ u C> 0 ...J 2011-57 . 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'5 0"<( wz o o o o N .,. c " E " Q; > o " ~ o -' .:..i e( I- o l- e z ~ C) I- o W .., o II: II.. .... o - <> N >- \!:. <Xl < tl .... .. E .. C, e Q. c l! " C " > w ~ " " " ~ ." " .. Co " " .. " U !! i= " 1ii .. ;;: a;- u >- U " '" " ~ >- '" w 15 u w '" Cl z ..: Cl z :J U >- U w '" (f) W U '" ::> o (f) w '" u. o .... z w :;; ~ 1t w Cl ::i!: 0::: OS IL- z~ Oil -'" t- "S: ..:<C" ZO!!:. "'-..: O...JU u.o...... :JD.,M c3<~ u.t-.!:? OZU w <C i;' ~o:::g; t;;C)~ in 1= z w ijj ~ III w Z ::;; < w lr ~ w t- ..Ill &~ 'at- ::Iz row ::;; z lr w > o <.? ...J < (J o ...J .... .... - o .... o N > lL w ::;: <{ Z I- Z <{ U ::J n. n. <{ I- Z <{ 0:: Cl - c:. Q)ctl~ c:~- c: Cl.c: 0:;:' .Q> (f) U (f) ~ Q) ~ Q) '- Q) ~ 0 > ""-~O lil l!! 1...:';:::; 001 .Qc: ctl= -'"0 c: ctl .c: ~ 2011-57 C .Q a 'C U (f) Q) o c: o .. ctl t:: o a. (f) c: ctl .:: ctl > o E ~ ~ (f)~ Uctl ctl (f) '::0 c:o. o (f) Oi) c: .Q a 'C U (f) Q) o OJ - c: Q) 0::: - c: Q) E .9- ::> c:r W c: o .. a. 'C U (f) Q) o '" .~ a. a. OJ en 06 (f) ctl 'C Q) - ctl :2 c: o :;::; c- 'C u '" Q) o . 01 c: 'iij '2 Q) > "0 <{ 06 c: o .. ctl u ::> "0 W iri (ij o t- fI=" 0: E I I.'l .... .2 "l:l Q) ~ '" ..Q I:: 'e .!2 - '" :S - c: '" o I:: '" ~ .8 Q) :S .... o ?fi. ll) '" .8 g. Q) :is '" ~ '" ..Q .1:: e ~ c: o ~ '" "ti Q) c: :0 I:: o u oj Q) '" c: Q) ~ Q) Ol c: 'c;; :e ~ "l:l '" "l:l c: '" .c: u '" ~ '" o '" .Q 1ij -5 Q) "l:l c: '" 1:CIi .S2">1: ~ ~ ~Q) ~~ u '" .~~ &~ '" - - <; (; N >- ~ '" <3 .... .. E m ~ a. C ~ Cl c " > w z:. '" " c ~ "0 C m "- " c m " U !! i= !! '" m 3: c " E c :;; > o Cl ~ .3 STATE OF CALIFORNIA 2011-57 DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY (CaIRecycle) GENERAL CHECKLIST OF BUSINESS PERMITS, LICENSES AND FILINGS CalRecycle 669 (Rev. 01110)) GRANT APPLICANT/GRANTEE NAME City of San Bernardino GRANT NAME AND CYCLE Waste Tire Cleanup/Amnesty Grant Program GRANT NUMBER, IF APPLICABLE DATE sUBMmEO/uPOATED TCA8 2-8-11 Mark (.f or X) appropriate box on eacb line below. All lines must be completed. Note: This list is not all-inclusive. Grant Applicant/Grantee must list other critical permits/licenses/filings not identified be/ow. Grant Applicant/Grantee currently holds this valid permit/license/filing Grant Applicant/Grantee will modify and/or obtain this permit/license/filing This permit/license/filing is not applicable for this grant project or business F'C'.'.:'!"':' w"'.""\~TS, CICj:NSES ~ FIUNGS "-',. J"'~ ..:,,,,: :"~I!A<roR'dR ISSUER 0 0 ~ Authority to Construct/Permit to Operate Air Quality Management District 0 0 ~ Building Construction Permit City or County 0 0 ~ Business License City or County 0 0 ~ Fictitious Business Name Filing County 0 0 ~ Land Use Permit/Zoning Clearance/Conditional Use Permit City or County 0 0 ~ Permit By Rule (PBR) for Permanent HHW Facilities or Temporary City, County or CallEPA-DTSC Collection Events ~ 0 0 Waste Hauler Permit City or County ....;'...,Jr~ STAtE P~ltS. UcENSES'& FILINGS .i_"> ' . . . 0 0 ~ Antifreeze, Battery, Oil & Paint (ABOP) Notification CUPA or CallEPA-DTSC 0 0 ~ Corporate, Company or Partnership Filings Ca. Secretary of State 0 0 ~ Hazardous Waste Haulers Permit CallEPA - DTSC 0 0 ~ Industrial Activities Storm Water General Permit CallEPA - SWRCB 0 0 ~ Non-Profit Organization 501 (C) (3) Ca. Secretary of State 10 0 ~ Prop. 65 Safe Drinking Water & Toxic Enforcement Act CallEPA - OEHHA 0 0 ~ Solid Waste Facilities Permit CallEPA - CIWMB I ~ 0 0 State EPA Identification Number CallEPA - DTSC ~ 0 0 Waste and Used Tire Hauler Registration CallEPA - CIWMB 0 0 ~ Waste Discharge Requirements CallEPA - SWRCB 0 0 ~ Waste Tire Facilities Permit CallEPA - CIWMB ,.......,. . . .,' FEDERAL PEiUilts;UCEN~S & FILINGll ~ 0 0 US EPA - Identification Number US EPA ~ 0 0 US EPA - NPDES and/or NSR Permits US EPA 6iHER PERMITS,'UCENSES & .FILlNGS " .. . 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 DO NOT submit copies of the permits/licenses/filings with this form. Please retain all permits/licenses/filings in grant file for audit purposes. 2011-57 -_."....--- -------~. -- ---.--" CommentsINotes: . ---------"--_._._---_._---~._----_._-- o Mark (,( or X) appropriate box below. I PRIVATE ENTITY CERTIFICATION: I declare under penalty of perjury under the laws of the i State of California that the proposed grantee: 1) is in good standing and qualified to do business : in the State; and 2) has or will comply with all applicable state, federal, and local laws, i ordinances, regulations, license and permit requirements necessary for the proper performance : of this grant; and 3) where compliance has not been met, I have attached a letter describing what I has been done to achieve full compliance. I PUBLIC ENTITY CERTIFICATION: I declare under penalty of perjury under the laws of the I State of California that the proposed grantee: 1) has or will comply with all applicable state, I federal, and local laws, ordinances, regulations, license and permit requirements necessary for 1 the proper performance of this grant; and 2) where compliance has not been met, have attached a letter describing what has been done to achieve full compliance. ~ Executed at: San Bernardino, CA City and State on 2-16-11 Date ~~3~ry?if[ed=e~-~-==:.- (as authorized in Resolution or Letter oj Designation-LOD) .:2-/I'{1I Date }-Jadeem Majaj Print Name Director of Public Works Print Title -----------~---_.,.--------- ._~ Note: Falsification under penalry of perjury may result in criminal and civil penalties. In addition, pursuant to the terms of the grant agreement, any misrepresentations in the above certification shall constitute a breach of contract that could result in non-payment of grant jimds to the grantee; relinquishment by the grantee of jimds previously paid; termination of the grant; and/or placing the grantee on CalRecycle's Unreliable Contractor's List. <n STATE OF CALIFORNIA GRANT APPLICATION FORM CalRecycle 243-TCA (Revised 12110) 2011-57 DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY (CaIRecycle) APPLICATION CHECKLIST This application checklist is provided for your convenience and is not intended to be all inclusive. Prior to submitting your application, check the Q&A website at htto:llwww.calrecvcle.ca.gov/tires/Grants/Cleanuo/FY201011/Aoolv/OandA.htm for additional information. You are res onsible for com letin and submittin all re uired documentation. 24 C'<A" ,."f,.it": _' l. " a e, ,c e' '" .".,;""..,,' I2SI All applicable information and documents are provided; applicable boxes are checked. I2SI Application Certification is signed by the: I) Signature Authority as authorized in Resolution, or 2) Authorized Designee. Authorized Designee may sign only if the Letter of Designation has been submitted to CalRecycle. I2SI A registered waste tire hauler quote is included. I2SI Photo for waste tire cleanup project is included. o If applicable, Property Access Authorization and Responsibility Affidavit For Private Property is included. See Application Guidelines & Instructions for more information. :<'_,';:~~;~h~~~C:~;_ ;'1~( '~:~~>~~~-i~A:~~~~rFA ~:;~\~:~~..:ti~~~t ~'_- -:':~:~,,_~~~:~1~! !!Ruir mill1i '~1~;\'" ":~~'!A.~j)';ji$;;,"it'.~w},.;:;~i'l{t;A.~}'tiifa" ,,' ~, ';i~y.~..:. ,. S 1}S ,"!'C io~ ~O~ it~{f~Ytte1::~l DI(~ i1j1/ ~JfPi9ti9TfO,!'_9~{J~P!!!Rles.: .. -:'~;:\~;'\::, o Approved Resolution is included with Application; box is checked, or I2SI If applicable, approved Resolution not submitted with Application but will be submitted to CalRecycle for receipt by March IS, 2011; box is checked. o o Signature Authority has certified that Applicant has an Environmentally Preferable Purchases and Practices Policy (EPPP Policy); box is checked, or I2SI Applicant does not have an EPPP Policy but will adopt one by March IS, 2011 and submit a Notification to the CalRecycle for receipt by March IS, 2011; box is checked. ,.~,: ,". '.".~ I2SI Copies: One application with original signature (blue ink preferred), and two copies I2SI Paper: Sv, X II, printed double-sided, single spaced, on 100% post consumer fiber, and numbered consecutively I2SI Stapled, not bound: upper left-hand corner I2SI Font: Comparable to 12 pI. Times New Roman I2SI Addressed to the appropriate mailing address of CaiRe cycle Local Govemment Waste Tire Cleanup and Amnesty Event Grant Programs, TCA8 (FY 2010/11) l' 2011-57 CalRecycle. December 2010 Natural Resources Agency Department of Resources Recycling and Recovery (ea/Recyc/e) . LOCAL GOVERNMENT WASTE TIRE CLEANUP AND AMNESTY EVENT GRANT PROGRAMS APPLICATION TCAS Cycle - FISCAL YEAR (FY) 2010/11 page Grant Application Form ................. ........ ....... ................... .... ..................... ...................................... .............. 2 Environmental Justice Certification.............................................................................................................. 2 Resolution Requirement ........ ..... ......... .......... .... ......... ....... ..................... ............ ........................................... 3 Environmentally Preferable Purchases and Practices Policy Requirement...................................................3 Acceptance of Grant Provisions.................................................................................................................... 3 App I ication Certification.................................................................................................................... ........... 3 Waste Tire Cleanup Project(s) Description.............. ... ..... ............ .... .... ..... .......................... .......... ...... .... ...... 4 Waste Tire Amnesty Event(s) Description. ..... ......... .... .... ................ ............. .......................................... ...... 4 Work Plan (Waste Tire Cleanup Projects) ....................................................................................................5 Work Plan (Waste Tire Amnesty Events) ..................................................................................................... 6 Budget (Waste Tire Cleanup Projects)..........................................................................................................7 Budget (Waste Tire Amnesty Events)........................................................................................................... 8 General Checklist of Business Permits, Licenses and Filings.......................................................................9 Application Checklist............... ............. .... ............... .... .... .... ........ ................. ........... .................. ........... ...... II Mailed applications must be postmarked no later than February 18,2011. Hand delivered applications must be received and date stamped by CalRecycle Staff no later than 3:00 p.m. on February 18,2011. Late applications will be disqualified. Emailed or faxed applications will not be accepted. Please follow instructions in the Application Guidelines and Instructions when completing this application. The Application Guidelines and Instructions are critical to properly completing and submitting this application. Applications become the property of CaiRe cycle and are subject to disclosure under the Public Records Act. Do not submit confidential information. Applications sent by U.S Postal Service or a commercial delivery service should be sent in a manner that allows for tracking by the sender and that provides an addressed and dated receipt. F ai/ure to do so is at the risk of the applicant and if delivery is delayed or the application is lost by the Post Office or delivery service, the burden is on the applicant to demonstrate timely mailing or delivery of the application. __,_ ....____~.....___~,...,._______ ,........."0 ,~v....n~""~A' STATE OF CALIFORNIA GRANT APPLICATION FORM CalRecycle 243-TCA (Revised 12/10) 2011-57 DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY (CaIRecycle) LOCAL GOVERNMENT WASTE TIRE CLEANUP AND AMNESTY EVENT GRANT PROGRAMS - TCAS (FY 2010/11) Complete and submit all sections. . -", ., -. ..- -, APP.L1CANT/,oRG!.'NIZA-rION INFORM,!TION. - . APPLICANT I ORGANIZATION NAME (MUST MATCH RESOLUTION): CLEANUP PROJECTS 20000 AMOUNT: City of San Bernardino AMNESTY EVENTS PARTICIPATING JURISDICTIONS (FOR REGIONAL PROGRAMS ONLY): AMOUNT: REQUESTED TOTAL AMOUNT: 20000 (ROUND AMOUNTS TO THE NEAREST l-VHOLE DOLLAR) MAILING ADDRESS: PROJECT ADDRESS: 300 North D Street CITY: CITY: San Bernardino COUNTY: ZIP CODE: COUNTY: ZIP CODE: San Bernardino 92418 PRIMARY CONTACT NAME: SIGNATURE AUTHORITY NAME: AUTHORIZED DESIGNEE NAME: (AS AUTHORIZED IN RESOLUTlON) (IF APPLICABLE, AS AUTHORizeD IN LETTER OF DESIGNATION. lOC, see APPENDIX A FOR MORE INFO.) Deborah Allen Charles McNeely Nadeem Maiai TITLE: TITLE: TITLE: Environmental Proiects Manaaer Citv Manaaer Director of Public Works TELEPHONE NUMBER: TELEPHONE NUMBER: TELEPHONE NUMBER: 909-384-5549 909-384-5122 909-384-5140 FAX NUMBER: FAX NUMBER: FAX NUMBER: 909-384-5190 909-384-5138 909-384-5190 EMAll ADDRESS: EMAll ADDRESS: EMAll ADDRESS: alien deilllsbcity.ora mcneely ch sbcity.ora maiai na@sbcitv.ora INDICATE WHICH TYPE OF ENTITY YOU ARE (CHECK ONLY ONE): ~CITY o COUNTY o CITY & COUNTY o QUALIFYING INDIAN TRIBE o OTHER (LIST TYPE) lEGISLATIVE DISTRICT NUMBERS (TO FINO YOUR DISTRICT, USE MAILING ADDRESS ABOVE AND GO TO www.calrecvcle.ca.aov/Profiles/Jurisll FEDERAL TAX IDENTIFICATION NUMBER: ASSEMBLY: SENATE: 62 32 95-6000772 CalRecycle Grantees must in the performance of the Grant Agreement conduct their programs, policies, and activities that substantially affect human health or the environment in a manner that ensures the fair treatment of people of all races, cultures, and income levels, including minority populations and low-income populations of the Stale. (Govt. Code j65040.12(e) and Public Resources Code pI I IO(a)) Must cbec:l( 60x [8:J We acknowledge that our organization will comply with these principles of Environmental Justice. Local Government Waste Tire Cleanup and Amnesty Event Grant Programs, TeAS (FY 2010/11) 2 STATE OF CALIFORNIA GRANT APPLICATION FORM CalRecycle 243- TCA (Revised 12/10) 2011-57 DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY (CaIRecycle) RESOLUTION REQUj~EMENT ':. I "''i:'f'~101 I ;;r;S,.tt,"{~(.\:..j7,;: . Submit either an approved Resolution, valid up to 5 years, with your application or the following acknowledgement. (If applicable, submit a current Letter of Designation (LOD) for signature designee) Note: All previous approved multiyear Resolutions must be updated to include new Department name. See Application Guidelines & Instructions or Resolution and Letter 0 Des; nation LOD in ormation and exam /es. Must check one We acknowledge that an approved Resolution and, if applicable, LOD designating additional signature authority is enclosed in the application. We acknowledge that our approved Resolution must be received by CalRecycle no iater than March 18,2011. We further acknowledge that if our Resolution is received after this date, our application will be disqualified. j:N I~QNM~~TALL Y PR,I;:F~RAB!,.E.PlJRQHAS~S: NDPRA,"'tlpES;Pp!)IOV "'~EI!TIF. G 'l"1~. Environmentally preferable purchasing protects human health and environmental well-being by reducing the procurement of goods and services that result in larger volumes of waste and pollutants. The Legislature declares that the responsibility of environmentally preferable purchasing shall be that of any agency that does procuring on behalf of the state (Chan, Statutes of 2002, Chapter 575), and this extends to grantees using state fUnds. "Environmentally preferable purchasing (EPP) " as defined in PCC section 12400 means "the procurement or acquisition of goods and services that have a lesser or reduced effect on human health and the environment when compared with competing goods or services that serve the same purpose. This comparison shall take into consideration, to the extent feasible, raw materials acquisition, production, manufacturing, packaging, distribution, reuse, operation, maintenance, disposal, energy efficiency, product performance, durability, safety, the needs of the purchaser, and cost." In other words, EPP considers, among other things, the environment, performance and cost." Ackn~wl~!!em~~t tha~ y~~r ~r!la!:,~ation ~as ~ E!!~i~onme~~I~!,referabl,:!urcha~~s and",,~!l~~!"! r~~py. Must check one ,\:Ol~: See ApplicatIOn Guiddmt!5 & Instructions/or Em',ronmentally Preferable Purchasi".g and Practices Po/tel injontllltion AOlificallOn D [8J o Yes, our entire organization 1 has an Environmentally Preferable Purchasing and Practices Policy. Date adopted: _ No, our entire organization does not have an Environmentally Preferable Purchasing and Practices Policy. We acknowledge that our organization must adopt one by Marcb 18,2011 and send notification to the CalRecycle of such adoption by secondary deadline; Marcb 18, 2011, or our application will be disqualified. [8J ftfr' By checking this box, Applicant acknowledges tbat submittal oftbis application constitutes [8J acceptance of all Grant Agreement provisions as contained in the Tenns and Conditions and Procedures and Requirements. To download these documents see: ht ://www.calreccle.ca.ov/tires/Grants/Cleanu/FY20101IIdefault.htm APPLlCAllO CERIIFIC liON Certification: I declare, under penalty of perjury under the laws of the State of California, that I have read all information in the Application Guidelines and Instructions and that all information submitted for the caIRe;Jfle'~ consideration for award of grant funds is true and correct to the best of my knowledge. X//UL... -' r:l /16 II Signature Authority - as ut orized in Resolution or Letter afCommitment: or Dale Authorized Designee - as authorized in submitted Letter of Designation Nadeem Ma'a' Print Name Director of Public Works Print Title 1 "Entire organization" refers to the entire city, county or non-profit applicant, not an individual office or subunit of the larger entity. Local Government Waste Tire Cleanup and Amnesty Event Grant Programs. TeAS (FY 2010/11) 3 STATE OF CALIFORNIA GRANT APPLICATION FORM CalRecycle 243-TCA (Revised 12/10) 2011-57 DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY (CaIRecycle) ." .. _...,-' k-._..~.,_-. WASTE TIRE CLEANUP PROJECT(S) DESC~IP:rJ9tf Provide the location, parcel number and a description of each site, which includes proximity to populated areas or sensitive environments, number of tires, proposed method of remediation, and end use. Photographs should also be included. Please include a quote from a registered waste tire hauler to justifY the estimated cost per tire. Ifthere are more than 500 tires on private property and the owner is not responsible for the illegal disposal of the tires, then an affidavit for each site must be included with the application. See Application Guidelines and Instructions for the affidavit form. See attachments How many tires are estimated to be removed: 2750 Will these tires be recycled or landfilled? recycled Is the applicant able to utilize the California Conservation Corps or Local Community Conservation Corps for tire removal? not currently WASTE TIRE AMNESTY EVENT(S) DESCRIPTION Provide a description of the amnesty event(s), including the estimated cost per tire for each event (grant amount divided by number of tires to be collected). Please include a quote from a registered waste tire hauler to justifY the estimated cost per tire. NA How many tires are estimated to be removed: NA Will these tires be recycled or land filled? NA Is the applicant able to utilize the California Conservation Corps or Local Community Conservation Corps for tire removal? NA Local Government Waste Tire Cleanup and Amnesty Event Grant Programs, TeAS (FY 2010/11) 4 Iii t=" u w .., o 0: en Do ~ Do W ::l ::;: Z ~ <( I- W U ...J W U -, w 0 0: g: i= 0 c w lli ~lii 0 a. <( a. -":: ~ ... 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OZU w <C i:i' ~a:~ t;C)~ in f=" z w > w ~ VI W Z ~ c( w a:: i= w f- _VI Glc( Cl:!: 't:If- ::lz a1w ~ z a:: w > o Cl ...J c( U o ...J ~ ~ o ~ o N > l.L w :;: <( Z I- Z <( U :J 11. "- <( I- Z <( a: Cl " 6f9.,-.!: :ca ;0' f- ~ - c E C> ~ s::. u - .. , ::!; ~ c - ;;:: Ql C Ql III .e .. 0:: ~ .. ii Ul f .:0 o 0 ZJ: .. o c o ;:; .. u .., -;; III .. o - Ql +> j:: E ~ GI C ::::i - _ c. Ql ctl ~ c~- c: C).g, 0:;' .- oo U oo ~ Ql ~ Ql '- Ql 0..0> 5.0 ~ lil ~ ,-:;:; 00) .Dc cu:.= ....J-c c ctl s::. ~ 2011-57 c o :;:: 0. 'C U oo Ql o c o ~ t o 0. oo C ctl ~ - ctl > o E ~ ~ Ul~ o(ij ctl Ul ':-0 co. o Ul U:O c o :;:: 0. 'C U oo Q) o ctl - c Ql a: - c Ql E 0. "5 0- w c .2 a. 'C u oo Q) o Ul .91 0. 0. ::J (j) O/l oo m 'C Ql OJ ::;;: c o :;:: 0. 'C U oo Ql o . 0) c 'w € Ql > -c <C O/l c o :;:: ctl U ::J -c W ." '" en '0 10 .!! (5 (5 f- U '" .c o - .. Gl ~ i= ... o ~ '" .c E :0 Z ." Gl - .. E :;::: .. w '" ~ i= ~ '" lL - .. o U II - - C :0 o E c( - c .. ~ Cl " '- Q '0 Q) ~ ::J .0 E .@ "~ - ctl :S - <:: ::J o E ctl ~ .2 Q) :S ..... o *- lO '" .2 g. S1 .0 ctl ~ ::J .0 E .@ ~ <:: o l!! ctl '0" Q) <:: :a E 8 oj Q) '" <:: Q) ~ Q) Ol <:: 'r;; 'E Q) :> '0 ctl '0 <:: ctl 13 ctl 1; ::J o <::" ~ ctl <:> ::J '0 Q) '0 <:: ctl - .c:" Ol~ "- <:: ~~ ~ Q) 0>- '0(;; Q)Q) .~<:: ~~ - - <Xl ~ o o N >- !!, <Xl <( ~ '" E .. C, e 11. E .. i5 E " > w ~ ~ " ~ " c .. c. ~ c .. " U !! i= " 1ii .. ;: E " E c 0; > o Cl 0; U o -' STATE OF CALIFORNIA 2011-57 DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY (CaIRecycle) GENERAL CHECKLIST OF BUSINESS PERMITS, LICENSES AND FILINGS CalRecycle 669 (Rev. 01110)) GRANT APPLICANT/GRANTEE NAME City of San Bernardino GRANT NAME AND CYCLE Waste Tire Cleanup/Amnesty Grant Program . GRANT NUMBER, IF APPLICABLE DATE SUBMITTEO/UPDATED TCA8 2-8-11 Mark (.f or X) appropriate box on each line below. All lines must be completed. Note; This list is not all-inclusive. Grant Applicant/Grantee must list other critical permits/licenses/filings not identified below. Grant Applicant/Grantee currently holds this valid permit/license/filing Grant Applicant/Grantee will modify and/or obtain this permit/license/filing This permit/license/filing is not applicable for this grant project or business LOCAL PERMITS, LICENSES & FILINGS r REGULATOR OR ISSUER D D ~ Authority to Construct/Permit to Operate Air Quality Management District D D ~ Building Construction Permit City or County D D ~ Business License City or County D D ~ Fictitious Business Name Filing County D D ~ Land Use Permit/Zoning Clearance/Conditional Use Permit City or County D D ~ Permit By Rule (PBR) for Permanent HHW Facilities or Temporary City, County or CaI/EPA-DTSC Collection Events ~ D D Waste Hauler Permit City or County STATE PERMITS, LICENSES & FILINGS D D ~ Antifreeze, Battery, Oil & Paint (ABOP) Notification CUPA or CaVEPA-DTSC D D ~ Corporate, Company or Partnership Filings Ca. Secretary of State D D ~ Hazardous Waste Haulers Permit CallEPA - DTSC D D ~ Industrial Activities Storm Water General Permit Cal/EPA - SWRCB D D ~ Non-Profit Organization 501 (Cl (3) Ca. Secretary of State D D .~ Prop. 65 Safe Drinking Water & Toxic Enforcement Act Cal/EPA - OEHHA D D ~ Solid Waste Facilities Permit Cal/EPA - CIWMB ~ D D State EPA Identification Number Cal/EPA - DTSC 1:8:1 D D Waste and Used Tire Hauler Registration Cal/EPA - CIWMB D D ~ Waste Discharge Requirements Cal/EPA - SWRCB D D 1:8:1 Waste Tire Facilities Permit Cal/EPA - CIWMB FEDERAL PERMITS, LICENSES & FILINGS 1:8:1 D D US EPA - Identification Number US EPA 1:8:1 D D US EPA - NPDES and/or NSR Permits US EPA OTHER PERMITS, LICENSES & FILINGS D D D D D D D D D D D D D D D DO NOT submit copies of the permitsllicenses/jilings with this form. Please retain all permits/licenses/filings in grant file for audit purposes. I n,..~1 r:':nw::omm".nt \N:::.c::tp Tirp r:lp::lnlln ::lnd Amnp.stv Event Grant Proarams. TeAS (FY 2010J11) 9 2011-57 Comments/Notes: [8J Mark (V" or XI appropriate box below. ! -.- ! PRIVATE ENTITY CERTIFICATION: I declare under penalty of perjury under the laws of the : State of California that the proposed grantee: 1) is in good standing and qualified to do business i in the State; and 2) has or will comply with all applicable state, federal, and local laws, ! ordinances, regulations, license and permit requirements necessary for the proper performance : of this grant; and 3) where compliance has not been met, I have attached a letter describing what , has been done to achieve full compliance. ! PUBLIC ENTITY CERTIFICATION: I declare under penalty of perjury under the laws of the State of California that the proposed grantee: 1) has or will comply with all applicable state, , federal, and local laws, ordinances, regulations, license and permit requirements necessary for the proper performance of this grant; and 2) where compliance has not been met, have attached a letter describing what has been done to achieve full compliance. ,0 Executed at: San Bernardino, CA City and State on 2-16-11 Date x ~/t~' ------.-..,___~~_._.._. ----.P--- Signature Authority I A thorized Designee (as authorized in Resolution or Letter ofDesignation-LOD) P-/I' / II Date NadeelTl_ Majaj Print Name Director of Public Works ----..-- --- .------ Print Title Note: Falsification under penalty of perjury may result in criminal and civil penalties. In addition, pursuant to the terms of the grant agreement, any misrepresentations in the above certification shall constitute a breach of contract that could result in non-payment of grant fimds to the grantee; relinquishment by the grantee offUnds previously paid; termination of the grant; and/or placing the grantee on CalRecycle's Unreliable Contractor's List. Local Government Waste Tire Cleanuo and Amnestv Event Grant Pmor::lm~ Tf.:AR {FY ,n1 n/11 \ 1n STATE OF CALIFORNIA GRANT APPLICATION FORM CalRecycle 243-TCA (Revised 12/10) 2011-57 DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY (CaIRecycle) APPLICATION CHECKLIST This application checklist is provided for your convenience and is not intended to be all inclusive. Prior to submitting your application, check the Q&A website at huo://www.calrecvc\e.ca.gov/tires/Grants/CleanuoIFY2OlOll/Aoolv/OandA.htm for additional information. You are 'bl Ii I' db" II . d d respons, e or completing an su mlttlng a reqUIre ocumentatlOn. Grant Aptfiicatioh Form '(CaIRecycle 243-TCA) ~ All applicable information and documents are provided; applicable boxes are checked. ~ Application Certification is signed by the: 1) Signature Authority as authorized in Resolution, or 2) Authorized Designee, Authorized Designee may sign only if the Letter of Designation has been submitted to Ca/Recycle. ~ A registered waste tire hauler quote is included. ~ Photo for waste tire cleanup project is included. 0 If applicable, Property Access Authorization and Responsibility Affidavit For Private Property is included. See Application Guidelines & Instructions for more information. Environmentai Justice Certification ~ Box is checked. Resolution or Requirement- See Application Guldelines & Inslme/ions for Resolution. and l.elter of Designation (LOD) informal ion and e.:mmpfes 0 Approved Resolution is included with Application; box is checked, or ~ If applicable, approved Resolution not submitted with Application but will be submitted to CalRecycle for receipt by March 18,2011; box is checked. 0 If applicable, Letter of Designation (LOD) is included with Application. A LOD is not required to be submitted with the Application: however, it must be submitted prior to Desi~nee 's exercise of his/her authority. Environmentally Prefetilble Purchases and Practices Policy-See Application Guidelines & Instructions lorin/ormation & 'ndt;J;calion 0 Signature Authority has certified that Applicant has an Environmentally Preferable Purchases and Practices Policy (EPPP Policy); box is checked, or ~ Applicant does not have an EPPP Policy but will adopt one by March 18,2011 and submit a Notification to the CalRecycle for receipt by March 18,2011; box is checked. Certificjltio!l of ~Qrnpletion of Generjll ~hecklist of Business Pennits, Licenses and Filings (CIWM~669) ~ CIWMB 669 form is completed. Accep,tance of Grant Provisions ~ I Box is checked. Applij:a~pp.f9Iwat & $\I!lp,itt;!1 ~ Copies: One application with original signature (blue ink preferred), and two copies ~ Paper: 8Y, X 11, printed double-sided, single spaced, on 100% post consumer fiber, and numbered consecutively ~ Stapled, not bound: upper left-hand comer ~ Font: Comparable to 12 pI. Times New Roman ~ Addressed to the appropriate mailing address ofCalRecycle Local Government Waste Tire Cleanup and Amnesty Event Grant Programs, TCA8 (FY 2010/11) 11 - 2011-57 EXHIBIT A CalRecycle ~ December 2010 Natural Resources Agency Department of Resources Recycling and Recovery (ea/Recyc/e) LOCAL GOVERNMENT WASTE TIRE CLEANUP AND AMNESTY EVENT GRANT PROGRAMS APPLICATION TCA8 Cycle - FISCAL YEAR (FY) 2010/11 page Grant Application Form ................. .......................... ......... ............................................................................2 Environmental Justice Certification.............................................................................................................. 2 Reso lution Requirement............................................................................................................................. ... 3 Environmentally Preferable Purchases and Practices Policy Requirement................................................... 3 Acceptance of Grant Provisions.................................................................................................................... 3 Application Certification.......................................................................................................................... ..... 3 Waste Tire Cleanup Project(s) Description............. ........... ..... ........... ...... .... .......... .... .................... .......... ..... 4 Waste Tire Amnesty Event( s) Description............ ..... .............. ...... ...................................... ......................... 4 Work Plan (Waste Tire Cleanup Projects) ....................................................................................................5 Work Plan (Waste Tire Amnesty Events).....................................................................................................6 Budget (Waste Tire Cleanup Projects).......................................................................................................... 7 Budget (Waste Tire Amnesty Events).................... .... ............... ............................... .....................................8 General Checklist of Business Permits, Licenses and Filings....................................................................... 9 Application Checklist............................................................................................................................... ... I 1 Mailed applications must be postmarked no later than February 18,2011. Hand delivered applications must be received and date stamped by CalRecycle Staff no later than 3 :00 p.m. on February 18, 2011. Late applications will be disqualified. Emailed or faxed applications will not be accepted. Please follow instructions in the Application Guidelines and Instructions when completing this application. The Application Guidelines and Instructions are critical to properly completing and submitting this application. Applications become the property of CaiRe cycle and are subject to disclosure under the Public Records Act. Do not submit confidential information. Applications sent by u.s. Postal Service or a commercial delivery service should be sent in a manner that allows for tracking by the sender and that provides an addressed and dated receipt. Failure to do so is at the risk of the applicant and if delivery is delayed or the application is lost by the Post Office or delivery service. the burden is on the applicant to demonstrate timely mailing or delivery of the application. STATE OF CALIFORNIA GRANT APPLICATION FORM CalRecycle 243-TCA (Revisec 12/10) 2011-57 DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY (CaIRecycle) LOCAL GOVERNMENT WASTE TIRE CLEANUP AND AMNESTY EVENT GRANT PROGRAMS - TCAS (FY 2010/11) Complete and submit all sections. .- .. .- APPLICANT I ORGANIZATION INFORMATION APPLICANT I ORGANIZATION NAME (MUST MATCH RESOLUTION): CLEANUP PROJECTS AMOUNT: 20000 City of San Bernardino AMNESTY EVENTS PARTICIPATING JURISDICTIONS (FOR REGIONAL PROGRAMS ONLY): AMOUNT: REQUESTED TOTAL AMOUNT: 20000 (ROUND AMOUNTS TO THE NEAREST WHOLE DOLLAR) MAILING ADDRESS: PROJECT ADDRESS: 300 North D Street CITY: CITY: San Bernardino COUNTY: ZIP CODE: COUNTY: ZIP CODE: San Bernardino 92418 PRIMARY CONTACT NAME: SIGNATURE AUTHORITY NAME: AUTHORIZED DESIGNEE NAME: (AS AUTHORIZED IN RESOLUTION) (IF APPLICABLE, AS AUTHORIZED IN lETTER OF DESIGNA nON. LOD, see APPENDIX A FOR MORE INFO.) Deborah Allen Charles McNeel v Nadeem Maiai TITLE: TITLE: TITLE: Environmental Projects Manager City Manager Director of Public Works TELEPHONE NUMBER: TELEPHONE NUMBER: TELEPHONE NUMBER: 909-384-5549 909-384-5122 909-384-5140 FAX NUMBER: FAX NUMBER: FAX NUMBER: 909-384-5190 909-384-5138 909-384-5190 EMAIL ADDRESS: EMAIL ADDRESS: EMAIL ADDRESS: alien de@sbcity.org mcneely _ ch@sbcity.org majaL na@sbcity.org INOICATE WHICH TYPE OF ENTITY VOU ARE (CHECK ONLY ONE): [8J CITY o COUNTY o CITY & COUNTY o QUALIFYING INDIAN TRIBE o OTHER (LIST TYPE) LEGISLATIVE DISTRICT NUMBERS (TO FINDVOUR DISTRICT. USE MAILING ADDRESS ABOVE AND GO TO W\oVW.calrecvcfe.ca.cov/ProfileslJurisl) FEDERAL TAX IDENTIFICATION NUMBER: ASSEMBLY: SENATE: 62 32 95-6000772 ENVIRONMENTAL JUSTICE CERTIFICATION CalRecycle Grantees must in the performance of the Grant Agreement conduct their programs, policies. and activities that substantially affixt human health or the environment in a manner that ensures the fair treatment of people of all races, cultures, and income levels, including minority populations and low-income populations of the State. (Govt. Code f65040.12(e) and Public Resources Code f7111O(a)) Must check box [8] We acknow ledge that our organization will comply with these principles of Environmental Justice. Local Government Waste Tire Cleanup and Amnesty Event Grant Programs, TCA8 (FY 2010/11) 2 STATE OF CALIFORNIA GRANT APPLICATION FORM CalRecycle 243-TCA (Revised 12/10) DEi>Sl.HM~~T OF RESOURCES RECYCLING AND RECOVERY (CaIRecycle) L_ :WASTIi Tlf(~~NUP PROJl!Pt(s)o~1 Provide the location, parcel number and a description of each site, which includes proximity to populated areas or sensitive environments, number of tires, proposed method of remediation, and end use. Photographs should also be included. Please include a quote from a registered waste tire hauler to justify the estimated cost per tire. Ifthere are more than 500 tires on private property and the owner is not responsible for the illegal disposal of the tires, then an affidavit for each site must be included with the application. See Application Guidelines and Instructions for the affidavit form. See attachments . How many tires are estimated to be removed: 2750 Will these tires be recycled or landfilled? recycled Is the applicant able to utilize the California Conservation Corps or Local Community Conservation Corps for tire removal? nO~l:LJrrently____ .______ "~ WAsn: Tlf(& A.NEe" MHt{eJ Jl'~ttoN, :, ,': ...' "<," Provide a description of the anmesty event(s), including the estimated cost per tire for each event (grant amount divided by number of tires to be collected). Please include a quote from a registered waste tire hauler to justify the estimated cost per tire. NA How many tires are estimated to be removed: NA Will these tires be recycled or landfilled? NA Is the applicant able to utilize the California Conservation Corps or Local Community Conservation Corps for tire removal? NA Local Government Waste Tire Cleanup and Amnesty Event Grant Programs, TCAB (FY 2010/11) 4 Q;' " ~ '" rn ~ >- '" W > o <..) 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'" - '" '",c ~ ~ .J:: 0 en c- eo "C ~~ ~C)~ l? ~ U15 w :2 w 0 --' STATE OF CALIFORNIA 20 bb~~TMENT OF RESOURCES RECYCLING AND RECOVERY (CaIRecycle) GENERAL CHECKLIST OF BUSINESS PERMITS, LICENSES AND FILINGS CalRecycle 669 (Rev. 01/10)) GRANT APPLICANT/GRANTEE NAME City of San Bernardino GRANT NAME AND CYCLE Waste Tire Cleanup/Amnesty Grant Program . GRANT NUMBER, IF APPLICABLE DATE SUBMITTED/UPDATED TCA8 2-8-11 Mark (,f or X) appropriate box on each line below. All lines must be completed. Note: This list is not all-inclusive. Grant Applicant/Grantee must list other critical permits/licenses/filings not identified below. Grant Applicant/Grantee currently holds this valid permit/license/filing Grant Applicant/Grantee will modify and/or obtain this permit/license/filing This permit/license/filing is not applicable for this grant project or business "----_..._".._--_._..._~_._--- --- ------------- LOCAL PERMITS, UCENSES & FIUNGS REGULATOR OR ISSUER - - ---------------------.. --....-.-- D D [g] Authority to Construct/Permit to Operate Air Quality Management District D D [g] Building Construction Permit City or County D D [g] Business License City or County D D [g] Fictitious Business Name Filing County D D [g] Land Use Permit/Zoning ClearancelConditional Use Permit City or County D D [g] Permit By Rule (PBR) for Permanent HHW Facilities or Temporary City, County or CaIIEPA-DTSC Collection Events [g] D D Waste Hauler Permit - ------..--- ---..----..-- STATE PERMITS, UCENSES & FIUNGS Antifreeze, Battery, Oil & Paint (ABOP) Notification Corporate, Company or Partnership Filings Hazardous Waste Haulers Permit D D [g] D D [g] D D [g] D D [g] D D [g] D D [g] D D [g] [g] D D [g] D D D D [g] D D [g] [g] D D [g] D D D D D D D D D D D D D D D D D City or County CUPA or Cal/EPA-DTSC Industrial Activities Storm Water General Permit Non-Profit Organization 501 (C) (3) Prop. 65 Safe Drinking Water & Toxic Enforcement Act Solid Waste Facilities Permit State EPA Identification Number Waste and Used Tire Hauler Registration Waste Discharge Requirements Waste Tire Facilities Permit FEDERAL PERMITS, UCENSES & FIUNGS US EPA - Identification Number US EPA - NPDES and/or NSR Permits _____________________n____n_______ _______.___~__ __ OTHER PERMITS, UCENSES & FIUNGS Ca. Secretary of State Cal/EPA - DTSC Cal/EPA - SWRCB Ca. Secretary of State Cal/EPA - OEHHA Cal/EPA - CIWMB Cal/EPA - DTSC Cal/EPA - CIWMB Cal/EPA - SWRCB Cal/EPA - CIWMB US EPA US EPA DO NOT submit copies of the permits/licenses/filings with this form. Please retain all permits/licenses/filings in grant file for audit purposes. Local Government Waste Tire Cleanup and Amnesty Event Grant Programs, TeA8 (FY 2010/11) 9