HomeMy WebLinkAbout2011-229
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3 RESOLUTION OF THE CITY OF SAN BERNARDINO RATIFYING THE
SUBMITTAL OF A GRANT APPLICATION TO KAISER FONTANA
4 COMMUNITY BENEFIT GRANTS PROGRAM FOR FUNDING IN THE
AMOUNT OF $25,000 TO PROVIDE THE PARKS, RECREATION AND
5 COMMUNITY SERVICES DEPARTMENT AQUATICS PROGRAM FOR THE
2011 SUMMER SEASON.
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7 BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF
THE CITY OF SAN BERNARDINO AS FOLLOWS:
RESOLUTION NO.
2011-229
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SECTION I. That the Mayor and Common Council hereby ratify the submittal
of a grant application to Kaiser Permanente, a copy of which is attached hereto, marked
Exhibit "A" and incorporated herein by reference as fully as though set forth at length;
and
SECTION 2. If awarded, authorize the City Manager to accept and administer
the grant amount of$25,000.
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RESOLUTION NO. 2011-229
3 RESOLUTION OF THE CITY OF SAN BERNARDINO RATIFYING THE
SUBMITTAL OF A GRANT APPLICATION TO KAISER FONTANA
4 COMMUNITY BENEFIT GRANTS PROGRAM FOR FUNDING IN THE
AMOUNT OF $25,000 TO PROVIDE THE PARKS, RECREATION AND
5 COMMUNITY SERVICES DEPARTMENT AQUATICS PROGRAM FOR THE
2011 SUMMER SEASON.
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I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the
Mayor and Common Council of the City of San Bernardino at a joint regular
9 meeting thereof. held on the -1JL Jay of .T" 1 Y , 20 II, by the following vote, to wit:
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AYES
NAYS
ABSTAIN ABSENT
Council Members:
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MARQUEZ
VACANT
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BRINKER
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SHORETT
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KELLEY
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JOHNSON
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MC CAMMACK
a~};.~
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City Clerk
The foregoing resolution is hereby approved this =?bf day of July. 2011.
~~~yor
City of San Bernardino
Approved as to Form:
es F. Penman. City Attorney
Fontana Medical Center Community Benefit Grants Program Application
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EXHIBIT A
Fontana Medical Center Community Benefit Grants Program Application
Introduction
Welcome!
As the nation's largest nonprofit, integrated health care system, Kaiser Permanente seeks to
make positive contributions to health and wellness in the community as part of our social
mission. Kaiser Permanente addresses needs and priorities identified locally which affect
overall community health and the health care system. This is accomplished, in part, by
supporting partnerships with community-based organizations through our community grants
program.
The Kaiser Permanente Fontana Community Benefit Grants Program provides opportunities to
respond to grant requests from nonprofit organizations, educational institutions, and
government agencies whose work aligns with our key funding priorities.
Guidelines and application instructions for this funding are provided below. The limited
availability of funds restricts our ability to act favorably on many deserving requests. Please
review the guidelines carefully to assess the potential fit between your organization's objectives
and Kaiser Permanente's funding priorities before submitting a proposal.
The deadline for submitting your grant application is Monday, June 27, 2011. Every
required document must be submitted by this date. Incomplete applications will not be eligible
for funding consideration. All submitted grant proposals and supplemental documents become
the property of Kaiser Permanente. You are encouraged to keep copies of all submitted
documents for your records.
If you have any questions about Kaiser Permanente's grants program, please contact Martha
Valencia, Sr. Community Benefit Health Specialist at Martha.RValencia(Cil.kp.orQ.
Eligibility
To be eligible for a Community Benefit grant, an applicant organization (or fiscal agent), must
have operations in California and be a local, state, or federal government agency operating for
public purpose, or one of the following types of nonprofit organizations:
. 501 (c)(3) tax-exempt organization with a 509 (a) designation indicating that the
organization is not a private foundation
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. 501 (c)(19)
. 501 (c)(8) or 501 (c)(10) operating under a lodge system and only if used solely for
charitable purposes and serving the general community
. A local, state, or federal government agency, including any of its subdivisions that
perform substantial governmental functions
In addition, organizations must:
. Provide services to disadvantaged and/or underserved populations that address funding
priorities identified in the Kaiser Permanente Fontana Needs Assessment
. Provide services within the geographic boundaries of the Kaiser Permanente Fontana
Medical Center service area, which includes the majority of San Bernardino County and a
section of eastern Los Angeles County. Communities include Apple Valley, Banning,
Beaumont, Big Bear, Bloomington, Calimesa, Cherry Valley, Chino, Chino Hills,
Claremont, Colton, Crestline, Diamond Bar, Fontana, Glen Avon, Grand Terrace,
Hesperia, Highland, La Verne, Lake Arrowhead, Loma Linda, Montclair, Mountain View
Acres, Muscoy, Ontario, Pomona, Rancho Cucamonga, Redlands, Rialto, Rubidoux,
Running Springs, San Antonio Heights, San Bernardino, Victorville, Upland, Wrightwood,
and Yucaipa.
. Address critical public health needs among vulnerable populations
. Have submitted progress and/or final reports for all previous grants
Needs Assessment Funding Priorities
Kaiser Permanente Fontana provides grants to local nonprofit health and human service
organizations that address these needs among vulnerable populations:
. Need I: Improve Access to Health Insurance and Health Care Services for the
Uninsured and Underserved
. Need II: Reduce Obesity Rates
. Need III: Improve Social Determinants of Health
Funding Restrictions
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Kaiser Permanente Fontana Community Benefit will generally not consider funding requests
from international, social, recreational clubs, or for the following:
. Sports teams and tournaments (e.g., golf, tennis, walks, and runs)
. Individuals
. Religious purposes
. Partisan political activities
. Endowments or memorials
. Re-granting purposes to other organizations
Kaiser Permanente will not consider requests from organizations that discriminate on the basis
of race, color, national origin, religion, sex/gender, sexual orientation, age, physical or mental
disability, or veteran status in their programs, services, policies, hiring practices, and
administration. In addition, Community Benefit grants will not be awarded for activities, events,
or programs organized or solely sponsored by alcohol, tobacco, or pharmaceutical companies.
We generally do not provide grants for academic research, capital campaigns, event
sponsorships (including community health fairs), or political campaigns.
Filing Deadline
Grant requests must be submitted on or before Monday, June 27, 2011.
All requests for information should be directed to Martha Valencia, Sr. Community Benefit
Health Specialist, at Martha.RValencia@kp.orq.
Grant Selection Process and Timeline
. Grant applications will be reviewed by the Kaiser Permanente Fontana Medical Center's
Community Benefit Grant Committee once during the 2011 calendar year.
. At the discretion of Kaiser Permanente Fontana Medical Center's Community Benefit
Grants Committee additional information may be requested from grant applicants.
. All grant applicants will be notified about funding decisions by the beginning of August
2011.
Online Submission Process
Save or bookmark the link that was sent to you via e-mail after you created your account.
For your convenience, it is: https://www.GrantRequest.com/SID 946?SA=AM. Use this to
access any Kaiser Permanente Community Benefit applications you started and/or submitted
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EXHIBIT A
through our online application process.
In addition to this online grant proposal submission process, you should have received these
two documents from Kaiser Permanente via e-mail:
. Kaiser Permante Sample Priority Goals and Strategies
. Kaiser Permanente Budget Template
. Kaiser Permanente FAQs (Responses to Frequently Asked Questions)
The budget needs to be completed and attached to your online grant application, along with
other required documentation. Please see the last page of this application for a list of all
required documents.
We suggest that you review the FAQs and requirements of the grant application by viewing a
printer-friendly version of the form at the top of this paQe.
When you are working in the online application form, you have the option to save your work
and return to the application at a later time through the account you created. In addition you:
. Can view a history of submissions
. Will receive a submission acknowledgement
Prior to submitting your online application, you will be able to review your grant application for
completeness. Please note that once a grant application has been submitted, it cannot be edited
or resubmitted.
Note: If you forget your account password, please follow the on screen instructions from the
account log-in page to retrieve your password. If this method does not work, please send an
e-mail toSo.CaI.Grants@kp.orQ with "Fontana Online Application Password Reset" in the
subject line to reset your password.
Select Next to start your online application
Organization Information
Organization's Legal Name
This is the name that appears on your IRS Determination letter, other legal documentation, or
Form 990.
City of San Bernardino - Parks, Recreation and Community Services Department
Organization's Tax ID# (EIN or TIN)
## //:JNs'lU:iN
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95-6000772
Tax Status
Select your organization's tax status from the pull-down list below. If you use a fiscal agent,
select "Other" and complete the Fiscal Agent information requested later in this application.
Government or Public Agency
Organization Name
Please use the name as it appears on your letterhead.
City of San Bernardino - Parks, Recreation and Community Services Department
Street Address
Please enter a street address. Do not use a post office box.
1350 South E Street
City
San Bernardino
State
CA
Zip Code
9-digit zip code if known (##t#t#-####)
92408
Organization's General Phone Number
Please use the following format: (###) ###-####
(909) 384-5233
Organization's General Fax Number
Please use the following format: (###) ###-####
(909) 384-5160
Organization's Main E-mail Address
assumma_mi@sbcity.org
Organization's Web Address (URL)
Please use the following format: www.example.com
www.sbcity.org
Annual Total Organization Budget
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5579171.00
Select Next to continue to the Chief Executive contact information
Organization Chief Executiv~ Contact
Information
Please enter the following information for your agency's Executive Director,
CEO, or President:
Prefix
Mr.
First Name
Kevin L.
Last Name
Hawkins
Title
Director of Parks, Recreation and Community Services
Phone
Please use the following format: (###) ###-####
(909) 384-5030
Fax
Please use the following format: (###) ###-####
(909) 384-5160
E-mail
Hawkins _ Kevin@sbcity.org
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Select Next to continue to Fiscal Agent Information
Fiscal Agent Information
If your organization will be using a fiscal agent, please com plete the
following information. If not, please select 'Next' (at the bottom of the page).
Fiscal Agent's Legal Name
As it appears on the IRS determination letter or Form 990
Fiscal Agent's Tax 10# (EIN or TIN)
xx- xxxxxxx
Fiscal Agent's Mailing Address
Street Address, City, State, and Zip Code (9-digit code, if known)
Fiscal Agent's Contact
Prefix, First and Last Name of the Chief Executive of the Fiscal Agent
Fiscal Agent Contact Title
Fiscal Agent's Contact Phone Number
Please use the following format: (###) ###-####
Fiscal Agent's Contact E-mail Address
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Select Next to continue to Project Contact Information
Project Contact Information
Please check this box if the project contact for this proposal is the same as the
contact previously provided for the Chief Executive (CEO, President, or Executive
Director. )
If the project contact is not the same as the Chief Executive, please complete
the following information for the project contact of this proposal.
Prefix
Mr.
First Name
Mitch
Last Name
Assumma
Title
Community Recreation Manager
Phone
Please use the following format: (###) ###-####
(909) 384-5132
Fax
Please use the following format: (###) ###-####
(909) 384-5160
E-mail
assu mma _ mi@sbcity.org
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Select Next to continue to Organizational Capacity
Organizational Capacity
Organization's History
Brief summary of your organization's history (300 word max)
The City of San Bernardino ("City") is one of Southern California's most historic communities.
Incorporated in 1854, it is a city of 205,000 residents in 59.3 square miles at 1,049 feet above
sea level. As the county seat of San Bernardino County, it lies in the midst of the booming
Inland Empire region. The City was founded early in California's history, and it had recently
celebrated its Bicentennial in 2010. Influences of Native Americans, Mexican settlers, Spanish
missionaries, Mormon emigrants, and Railroads can still be seen throughout the City today.
From 1910 when Franciscan missionary Father Dumetz named the area San Bernardino to the
present, San Bernardino has been recognized for its scenic beauty and strategic location, once
a resort stop for movie stars and famous entertainers traveling from LA to Palm Springs.
San Bernardino has a wide variety of recreational attractions and entertainment venues. From
playing golf at one of its many public and private golf courses, to a 30-60 minute drive to
mountains, skiing, deserts, beaches, resorts, and world-class cultural and sporting events, a
variety of activities for all ages is available to residents and visitors. San Bernardino's ethnically
diverse, yet below average income, population enjoys some of America's finest temperate
weather.
The City operates under a hybrid Mayor-Council-City Manager form of government. The Mayor
is elected by the voters at large, and is the City's Chief Executive Officer. Each of the seven
members of Council is elected by voters within their respective Wards. The City Manager is the
Chief Administrative Officer, who directs most City Departments, other than those governed by
separate boards (Water Dept., Civil Service, Library) and the office of elected officials. The City
of San Bernardino also has an elected City Attorney, City Treasurer, and City Clerk.
Date the Organization was Established
If you do not know the exact date, please use January 1st of the year of establishment.
01/01/1854
Background Information
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Brief summary of the organization's mission, goal(s), and the communities/localities and
populations served. (300 word max)
Creating Community through People, Parks, and Programs: The Department of Parks,
Recreation and Community Services is committed to providing quality services, programs, and
activities for all residents of the City of San Bernardino youth, adult, senior, and challenged
populations. Programs include sports and fitness, after-school activities, recreational classes,
open gym, nutrition programs, special events, aquatics, trips/tours, volunteer management and
outdoor play.
Current Programs and Activities
Describe the organization's current programs, activities, as well as recent accomplishments and
any awards and/or recognition received. (300 word max)
The Parks, Recreation and Community Services Department's mission is to provide excellent
parks, recreation and cultural opportunities which enhance the quality of life within the San
Bernardino community. We create community through people, parks and programs. In the
current year we have successfully provided aquatics programs to more than 20000 residents
with over 80 swim lessons and 10 water safety and lifeguard certification classes. through the
partnership with Operation Splash Kaiser Regional and Local Grants that funded summer
aquatics programming (Jr. Life guard, Learn to Swim and free swim passes) our city pools
provided a safe and affordable relief to the summer heat for San Bernardino residents. The
Department also published four quarterly activity guides advertising anf highlighting the
partnership with Kaiser and services offered through aquatics. In addition to pools and
community centers, the department has continued to offer after-school programs, senior
services, and therapeutic recreation to regional visitors.
Select Next to continue to Grant Request
Grant Request
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Please provide the following information for the project or program you are
proposing:
Project Title
Please provide a title that describes the project you are proposing (10 words max)
Open Swim and Learn-to-Swim at Nunez Neighborhood Pool
Project Start Date
All grant applicants will be notified about funding decisions by the beginning of August 2011.
06/13/2011
Project End Date
09/05/2011
Total Project Budget
Please enter the total cost of the project you are proposing in whole dollar amounts.
25000.00
Amount of funding you are requesting
Please enter the amount of funding you are requesting whole dollar amounts.
25000.00
Is this project new or continuing work?
Continuing
Proposal Narrative
In the sections below, please describe the need or problem your project or program
addresses, what capacity your organization has to address this need, your proposed
project or program, and challenges and/or barriers that may impede the work you
are proposing.
If data is used to highlight and/or justify the need for this program, please cite the
references used.
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PARKS, RECREATION & COMMUNITY SERVICES DEPARTMENT
KEvIN L. HAWKINS - DIRECTOR
1350 South "E" Street. San Bernardino' CA 92408-2725
909.384.5233' Fax: 909.384.5160
www.sbcily.org
w
June 27, 2011
Kaiser Permanente Fontana Medical Center
Jennifer Resch-Silvestri, Director
Public Affairs Department
9961 Sierra Ave., Fontana, CA 92335
Dear Jennifer Resch-Silvestri,
This cover letter attachment will confirm the Organization's Contact Information regarding the Grant
Application for the Kaiser Permanente Fontana Medical Center Community Benefit Grants Program. The
project for consideration is the Nunez Pool Open Swim and Leam-To-Swim activities as part of the City
of San Bernardino's 2011 Summer Aquatics Swim Program. We are again gracious for the opportunity to
keep fit the residents of our great City who are hard-pressed to afford access to water play, physical
fitness, and safety.
As stated in the Letter of Intent, we are extremely pleased to report a growth in visitation at the Nunez
Pool this past summer season, which had been slated for closure due to budget reductions. The
neighborhood also benefited from no interruption in the cycle of learn-to-swim; again, this is a crucial
element in reducing the incidence of drowning. This next summer we intend to reach out more to the
low-income Hispanic patron to participate more in water play activities in an effort to improve their
overall health and fitness as part of a campaign to reduce childhood obesity.
I'm sure you will agree that the project outlined in the grant application is most identifiable to Need II:
Reduce Obesity Rates as identified in your Needs Assessment report. Thank you for consideration of our
proposal and for the continued commitment Kaiser makes toward the health and wellness of the Southern
California community.
S~
Robert Lennox
Deputy Director of Parks, Recreation and Community Services
cc. Charles McNeely, City Manager
CITY OF SAN BERNARDINO
COMMUNICATE, COORDINATE, COOPERATE
2011-229
EXHIBIT A
Operation SPLASH
City of San Bernardino - PRCSD
PROGRAM BUDGET NARRATIVE
Project Description:
Aquatics activity planning and facilities management are an essential part of municipal
recreation and leisure services delivery. Operation SPLASH funding allows the Department of
Parks, Recreation and Community Services to increase the public's access to the Nunez Pool at
Nunez Park and the Ruben Campos Community Center, which is located in a disadvantaged area
of the City. The Department will also offer the opportunity for low-income youth (ages 6-17
years) to learn how to swim at the Nunez Pool. The bulk of the grant funds are to pay for the
part-time staff lifeguard services, who also serve as swim instructors.
Narrative Justification:
Open Swim: Personnel Expenses cover the cost for one Pool Manager, one Senior Lifeguard,
and two Lifeguards at the Nunez Pool. (See attached document of Job Descriptions) These
aquatics staff members also serve as cashier (as needed), office management, and custodian
during operational hours. Two open swim sessions will be offered Monday through Saturday
from 1:00pm-3:00pm & 3:30pm-5:30pm for a 10-week summer season only. Basic custodial
supplies (toiletries, cleaning) and office supplies (swim passes, forms/reporting sheets, reg.
materials) are included, along with expendable first aid supplies for routine care (stubbed toes,
bumped heads, cut finger). 5,000 visitations are projected, both daily sessions combined, in this
10-week season.
Learn-to-Swim: The Nunez Pool is located in the southwest comer of San Bernardino and
serves a "walking" clientele. The staff at the Nunez Pool (1 Pool Manager, I Senior Lifeguard, 2
Lifeguards) are certified swim instructors. Learn-to-swim classes will be taught from 6:00pm-
6:45pm, following open swim. Four 2-week swim sessions, M-Th, will be taught to two classes
of 8-10 students each session (96 novice swimmers). Office supplies include reporting/recording
materials and certificates of completion for each student. Other expenses are to replace kick
boards as needed and other basic training materials and for routine custodial supplies (toiletries
and cleaning supplies) for increased use of bathhouse facilities.
Additional Funding:
A minimal user fee (50 cents -$2.00 per visit) will be collected from all users. Based on previous
years attendance, we predict an income of $5,300 from open swim only; Iearn-to-swim classes
will be free to scholarship-qualifying applicants. (We have found that free swim not only
encourages a more aggressive clientele with more deviant behavior patterns, but it also presents a
false image of "low-quality" that hinders participation by other users.) Note: $20,000 has already
been received from the Kaiser Foundation Hospitals Southern California Region to assist in
providing healthy water play activities, learn-to-swim classes, and a Junior Lifeguard Program at
other low-income areas within the City of San Bernardino.
Sustainability:
As with all public agencies, private businesses, and not-for-profit organizations, a depressed
economy hampered by a high unemployment rate and reduced home property values has
significantly reduced revenues for operating many public services. The City of San Bernardino
has developed a plan to weather these circumstances. Unfortunately, revenues are not
realistically projected to improve much in the next three fiscal years. .It is hoped that at that time
(2014) that aquatics programs will be fully funded again. Other sources of revenue will be
needed until that time.
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111_ ........EHTE.
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, "
" Budget , ,
Organization Name: City of San Bernardino - PRCSD
Project Title: Nunez Pool Open Swim & Learn"To-Swim
Date:
27-Jun-11
Request from In~Kind Other TOTAL
Kaiser Foundation Contribution Sources BUDGET
Hosnitals of Income
PERSONNEL/STAFFING EXPENSES
list title and % on Droiectl
1 15% . Aquatics Recreation Suaervisor $ 1 )63 00 $ 5,300.00 $ 7,06300
2 100% . Pool Manaaer $ 4,175.00 $ 4,175.00
3 100% - Senior lifeauard $ 7,19200 $ 7,192.00
4 100% - Lifeauard $ 6,83100 $ 6,831.00
5100% - Recreation Leader (Cust.&Maint.) $ 1,105.00 $ 3,10000 $ 4,20500
6100% - Recreation leader (Cashierl $ 2,349.00 $ 2,349.00
$ -
Subtotal, Personnel/StaffinQ EXDenses $ 23,415.00 $ $ 8,40000 $ 31,815.00
Benefits ( 5.3 % of Personnel) $ 1,241.00 $ 1,241.00
TOTAL, PERSONNEL $ 24,656.00 $ $ 8,400.00 $ 33,05600
PROGRAM/OPERATING EXPENSES
Office Suoolies $ 50.00 $ 50.00
Communications (e. a., arintina, convina\ $ - $ -
First Aid Suoolies $ 50.00 $ 50.00
Custodial SUDDlies $ 14400 $ 144.00
Swim Class SUDolies $ 10000 $ 100.00
$
Other: $
TOTAL, PROGRAM EXPENSES $ 344.00 $ - $ $ 344.00
INDIRECT/OVERHEAD EXPENSE.
( % of Expenses) $ -
TOTAL EXPENSES
Personnel + Proaram + Indirect) $ 25,000.00 $ - $ 8,400.00 $ 33,400.00
NARRATIVE: City pays all utilities cost (water, electric, gas), all pool chemical costs, licenses and fees for commercial
pool operation, and equipment maintenance and replacement (chemical feed system, filtration, deck & grounds)
Narrative: The Staff at the Nunez Pool (1 Pool Manager, 2 Senior lifeguards, 2 lifeguards, 1 Cashier, 1 PrT Rec.Ldr.-Maint.) are
budgeted to serve as thelifesaving services for the open swim program and as swim instructors. Two swim sessions are
offered Monday through Saturday from 1 :OOpm-J:OOpm &J:JOpm-5:JOpm for a 10-week summer season only. Learn-to-swim
classes are taught 12:00pm-12:45pm on M-Th just prior to open swim. Four 2-week swim sessions are taught to three classes of
8-10 students each session. Operating supplies include toiletries and sanitation supplies (staff also serve as custodians during
daily use), routine first aid supplies, minor repair items (chemical tubing replacement or hardware for signs), and kickboards
as teaching aids.
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EXHIBIT A
City of San Bernardino
11. Audited Financial Statement - Fiscal Year 2009-2010 Comprehensive Annual Financial Report
Due to document file size, the full audited financial statement could not be uploaded with the
application. However, the required document is posted on the Agency website for public access
at any time:
http://www.ci.san-bernardino.ca.us/c ivicalfi leba n k/blo bd load. as p ?Blobl D= 10661
City of San Bernardino - Elected Officials
Elected Officials
Mayor
EXHIBIT A
City of San Bernardino
Patrick J. Morris
Mayor Patrick J. Morris grew up in Needles, California. He is a
graduate of the University of Redlands, cum laude, Phi Beta
Kappa, and Stanford University School of Law.
Read more about Patrick J. Morris
VirQinia MarQuez
Read more about Virqinia Marquez
Council Member - Ward 2
Vacant
Tobin Brinker
Tobin Brinker was elected in a special election in November
2006 to serve the one remaining year of Gordon McGinnis' term.
Mr. Brinker previously served one term as a Colton School Board
Member from 2001-2005.
Read more about Tobin Brinker
Council Member - Ward 4
Fred Shorett
Fred Shorett, a 3rd-generation San Bernardino resident and
small businessman, was elected to represent the citizens of the
http://www . s bc i ty .orgl offic ial sl default. asp
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City of San Bernardino - Elected Officials
EXHIBIT A
4th Ward in a Special Election in March of 2009. He received
more than 72% of the total vote.
Read more about Fred Shorett
Chas A. Kelley
Councilman Chas A. Kelley was elected to the City Council in
November 2003 and was sworn in to represent the residents of
the Fifth Ward of the City of San Bernardino on March 1, 2004.
His term will expire in March 2008. He currently serves on the
Legislative Review Committee.
Read more about Chas A. Kellev
Rikke Van Johnson
Rikke Van Johnson is a 40 year resident of the City of San
Bernardino. He is a graduate of Eisenhower High School in
Rialto, CA and has an Associate of Arts Degree from San
Bernardino Valley College.
Read more about Rikke Van Johnson
Wendy McCammack
Wendy McCammack is presently serving her second term on the
San Bernardino City Council. Her current term continues to the
year 2008. .
Read more about Wendy McCammack
City Attorney
James F. Penman
Jim Penman missed being a native son of the Golden West
when his Mississippi-born mother refused to "give birth to a
damn Yankee" and flew back to Jackson, Mississippi from San
Bernardino for the occasion. Approximately two months later, Jim
became a resident of San Bernardino County.
http://www . s be ity .org/ officials/ defaul t.asp
Page 2 of3
2011-229
4/15/2010
City of San Bernardino - Elected Officials
EXHIBIT A
Read more about James F. Penman
Rachel Clark
The City Clerk's Office consists of four divisions: Administration,
Business Registration, Elections, and Records Management.
The Elections Division is mobilized only during the period when
elections are conducted.
Read more about the Clerk's Office
David C. Kennedv
The City Treasurer is a part-time position elected at large to a
four-year term. The City Treasurer is responsible for overseeing
City investments and related policies as established by the
Common Council.
Read more about David C. Kennedv
http://www . s bc ity. org/ offic ial sl default.asp
Page 3 of3
2011-229
4/15/2010
~'iii\ IRS DelJartment of the Treasury
~tm"I' Intl1rnl*1 Rnllnul:! Sl1tYice
P.O. Box 2508
Cincinnati OH 45201
2011-229
EXHIBIT A
In reply refer to: 0248221235
Oct. 30, 2009 LTR 4076C EO
95-6000772 000000 00
00014241
BODC: TE
I('~
~
CITY OF SAN BERNARDINO CITY HALL
% MICHAEL GOMEZ
300 N D ST
SN BERNRDNO CA 92418-0001
003426
Federal Identification Number:
Person to Contact:
Toll Free Telephone Number:
95-6000772
April Howard
1-877-829-5500
Dear Taxpayer:
This responds to your request for information about your federal tax
status. Our records do not specify your federal tax status. However,
the following general information about the tax treatment of state
and local governments and affiliated organizations may be of interest
to you.
GOVERNMENTAL UNITS
Governmental units, such as States and their political subdivisions,
are not generally subject to federal income tax. Political
subdivisions of a State are entities with one or more of the
sovereign powers of the State such as the power to tax. Typically
they include counties or municipalities and their agencies or
departments. Charitable contributions to governmental units are
tax-deductible under section 170(c)(1) of the Internal Revenue Code
if made for a public purpose.
ENTITIES MEETING THE REQUIREMENTS OF SECTION 115(1)
An entity that is not a governmental unit but that performs an
essential government function may not be subject to federal income
tax, pursuant to Code section 115(1). The income of such entities is
excluded from the definition of gross income as long as the income
(1) is derived from a public utility or the exercise of an essential
government function, and (2) accrues to a State, a political
subdivision of a State, or the District of Columbia. Contributions
made to entities whose income is excluded income under section 115
may not be tax deductible to contributors.
TAX-EXEMPT CHARITABLE ORGANIZATIONS
An organization affiliated with a State, county, or municipal
government may qualifY for exemption from federal income tax under
section 501(c)(3) of the Code, if (1) it is not an integral part of
the government, and (2) it does not have governmental powers
inconsistent with exemption (such as the power to tax or to exercise
enforcement or regulatory powers). Note that entities may meet the
requirements of both sections 501(c)(3) and 115 under certain
circumstances. See Revenue Procedure 2003-12, 2003-1 C.B. 316.
2011-229
EXHIBIT A
0248221235
Oct. 30. 2009 LTR 4076C EO
95-6000772 000000 00
00014242
CITY OF SAN BERNARDINO CITY HALL
Yo MICHAEL GOMEZ
300 N D ST
SN BERNRDNo CA 92418-0001
Most entities must file a Form 1023. Application for Recognition
of Exemption Under Section 501(c))(3) of the Internal Revenue Code,
to request a determination that the organization is exempt from
federal income tax under 501(c)(3) of the Code and that charitable
contributions are tax deductible to contributors under section
170(c)(2). In addition, private foundations and other persons
sometimes want assurance that their grants or contributions are made
to a governmental unit or a public charity. GenerallY. grantors and
contributors may rely on the status of governmental units based on
State or local law. Form 1023 and Publication 4220, Applying for
501(c)(3) Tax-Exempt Status, are available online at www.irs.gov/eo.
We hope this general information will be of assistance to you. This
letter, however, does not determine that you have any particular
tax status. If you are unsure of your status as a governmental unit
or state institution whose income is excluded under section 115(1)
you may seek a private letter ruling by following the procedures
specified in Revenue Procedure 2007-1, 2007-1 I.R.B. 1 (updated
annually).
If you have any questions, please call us at the telephone number
shown in the heading of this letter.
Sincerely yours,
~ 'nC ),."..........'
Michele M. Sullivan. Oper. Mgr.
Accounts Management Operations I
2011-229
EXHIBIT A
CITY OF SA" BERNARDINO
RECREATION SUPERVISOR
Class specifications are intended to present a descriptive list of the range of duties performed by employees in the
class. Specifications are not intended to reflect all duties performed within the job.
SUMMARY DESCRIPTION
Under general supervision, plans, organizes, and implements assigned City-wide recreation, social
or cultural programs of average difficulty; supervises assigned full-time, part-time and grant
funded staff; and performs related work as required.
ORGANIZA TlONAL RELATIONSHIPS
The class of Recreation Supervisor is the journey level in the recreation series. Supervision is received from
a Senior Recreation Supervisor. Supervision is exercised over full-time ,part-time, grant funded, and
volunteer staff.
REPRESENTATIVE DUTIES
The fallowing duties are typicalfor positions in this classification. Any single position may not perform all afthese
duties and/or may perform similar related duties not listed here:
]. Provides courteous and expeditious customer service to the general public and City department staffs.
2. Ability to supervise multiple recreation facilities/centers; multiple city-wide recreation program areas;
and/or supervise a major recreation/soccer complex/facility.
3. Evaluates adequacy of recreational, social or cultural services.
4. Plans, organizes and implements assigned City-wide social, cultural and recreational programs; plans
and directs periodic events such as tournaments, City-wide programs and festivals; establishes
schedules and methods for providing assigned recreation services.
5. Instructs recreation participants in one or more activities.
6. Directs the work of assigned staff and volunteers; provides vacation and temporary relief to
subordinates as required.
7. Participates in the selection of assigned recreation staff; trains part-time volunteers and recreation
leaders in the methods and procedures of programs and activities; demonstrates methods of
organizing and teaching programs and activities; works with employees to correct deficiencies;
implements discipline procedures.
8. Responds to requests for information and assistance from the public regarding assigned recreation
programs and facility use and rental procedures; interprets City recreation policy to participants and
the general public.
9. Communicates with school district and college officials regarding facility use.
10. Maintains a variety of logs and records including records of team standings in leagues; prepares
reports concerning activities and attendance; develops staff manuals and program guides.
11. Collects, counts, receipts, and transmits cash.
12. Requisitions materials and equipment.
Page - I
2011-229
EXHIBIT A
CITY OF SAN BER'<ARDINO
Recreation Supervisor (Continued)
13. Secures the interest and support of neighborhood community groups; promotes and publicizes social,
cultural and recreational programs through public speaking engagements or public information media;
14. Routinely adheres to and maintains a positive attitude towards City and Department goals.
IS. Performs related work as required.
QUALIFICATIONS
Knowledl!e of:
Methods and techniques of developing and organizing group recreation and social activities;
Rules, practices and equipment involved in a variety of social, cultural and recreational activities;
Methods and techniques of recreation program development and implementation;
Basic principles of supervision, training and performance evaluation;
Record keeping methods;
Public relations principles and techniques;
Basic budgetary principles and procedures;
Business math.
Ability to:
Analyze and evaluate community needs and work with community organizations in developing
recreation programs;
Formulate and execute a variety of programs;
Prepare and administer recreation program budgets;
Schedule and supervise the work of part -time staff;
Prepare comprehensive written reports;
Speak effectively before groups of people;
Listen to complaints and take appropriate action;
Understand and carry out oral and written instructions;
Communicate clearly and concisely, both orally and in writing;
Establish and maintain effective relationships with those contacted in the course of work.
Minimum Qualifications:
Those employees hired after July 1,2003, the minimum qualifications are a Bachelor's degree in the
area of recreation, physical education, sociology or a closely related field and one (1) year of full-time
experience in social, cultural, and/or recreation services and supervision; or in lieu of above education
requirements, four (4) years as a Community Center Manager with the City of San Bernardino.
License or Certificate:
Possession of a valid Class "c" California Drivers' License is required. For out-of state applicants, a
valid driver's license is required. A valid Class "c" California's Driver's License must be obtained
within ten (10) days of appointment (CA Vehicle Code 12405c).
PHYSICAL DEMANDS AND WORKING ENVIRONMENT
The conditions herein are representative of those that must be met by an employee to successfully perform the
essential functions of this job. Reasonable accommodations may be made to enable individuals .with disabilities to
perform the essential job junctions.
Environment: Normal office setting; occasional work indoors and out in a variety of environmental
conditions including hot, cold or damp weather with exposure to noises, vibrations, odors or dust;
some travel to attend meetings.
Page - 2
2011-229
EXHIBIT A
CITY OF SAN BERNARDlr-iO
Recreation Supervisor (Continued)
Physical: Incumbents require sufficient mobility to work in an office setting and operate office
equipment; to travel to various locations; transport materials and supplies weighing up to 50 pounds.
Vision: See in the normal visual range with or without correction; vision sufficient to read small
print, computer screens and other printed documents.
Hcarin!!: Hear in the normal audio range with or without correction.
APPROVED:
DATE:
Director of Human Resources
CSB APPROVED DATE:
HRlJob Descriptions/Class&Comp App:Recreation.Supv.20912
Page - 3
2011-229
EXHIBIT A
POOL MANAGER I
(Part-Time)
JOB DESCRIPTION
Under general supervision, plans and supervises the operation of a public swimming pool;
accomplishes specialized work in protecting life, preventing accidents, enforcing safety regulations
and providing instructions; and, performs related work as required.
REPRESENTATIVE DUTIES
Provides courteous and expeditious customer service to the general public and City department
staffs.
Assists the Recreation Supervisor in scheduling and programming swimming pool facilities; serves
as a pool lifeguard; instructs classes in fundamentals of swimming; supervises swimming activities
in and around a City pool to ensure that policies, rules and regulations are observed and enforced
and that no hazard to safety is created; warns swimmers of improper activities or danger.
Enforces pool regulations and water safety policies; rescues swimmers in distress or danger of
drowning; administers first aid in the event of injury; administers artificial respiration if required;
inspects pool facilities, equipment and water to ensure that they are safe and usable.
Supervises and assists in cleaning the pool and related facilities and equipment; instructs classes in
fundamentals of swimming; accomplishes chlorine residual or other water tests; maintains records
and charts of water test results and records of accidents; adds chemicals to pool water.
Maintains effective public relations with users of the pool and surrounding park grounds;
supervises all pool personnel at a specified pool facility; ensures implementation of all policies and
procedures related to the management and operation of facilities and program.
Routinely adheres to and maintains a positive attitude towards City and Department goals; and,
performs other related work as required.
MINIMUM QUALIFICATIONS
Age 18 or older and graduation from high school or GED equivalent and a minimum of one (I)
year full-time paid experience in instructing or supervising water recreational activities. Additional
qualifYing experience may be substituted for the required education on a year-for-year basis to a
maximum oftwo (2) years.
Possession of a valid Red Cross Lifeguard Training, YMCA Lifeguard or Ellis and Associates
Lifeguard Certificate and Red Cross Water Safety Instructor's (WSI) Certificate or YMCA
SKIPPERS/Progressive Instructor Certificate and a Red Cross Standard First Aid Certificate or
American Red Cross Community First Aid and Safety Certificate or National Safety Council
Page 1 of 3
2011-229
EXHIBIT A
Standard First Aid Certificate or Medic First Aid Certificate and American Heart Association CPR
Level "C" BLS (Basic Life Support) Certificate or American Red Cross Community CPR
Certificate or American Red Cross CPR for the Professional Rescuer Certificate are required.
All certificates must be valid for the duration of employment.
Possession of a valid Class "C" California Driver's License is required. For out of State applicants,
a valid driver's license is required. A valid Class "C" California Driver's License must be obtained
within (10) days of appointment (CA Vehicle Code 12405c).
GENERAL QUALIFICATIONS
Knowledge of:
Water hazards, lifesaving techniques and rescue methods;
First aid as applied to accidents in water and surrounding area;
Policies, rules and regulations governing swimming pool operation.
Abilitvto:
Swim with proficiency and endurance for possible rescues;
Evaluate situations and adopt intelligent methods of action;
Remain calm and efficient in stressful situations;
Maintain constant observation of an assigned area and note any sign of impending trouble;
Prevent dangerous situations from arising;
Recognize emergencies and take appropriate action;
Supervise subordinate lifeguards, volunteers or support staff;
Maintain records and prepare reports;
Establish and maintain effective working relationships with those contacted in the course of
work;
Effectively instruct persons in the techniques of swimming and water safety;
Follow oral and written instructions;
Transport materials and supplies weighing up to 40 pounds;
See in the normal visual range with or without correction;
Hear in the normal audio range with or without correction;
Work indoors and outdoors in a variety of environmental conditions, including high
temperatures, humidity, moisture and distracting noises.
Page 2 of 3
2011-229
EXHIBIT A
ORGANIZA nON RELATIONSHIPS
The Pool Manager I is a working supervisory position in the Recreation Division of the Parks,
Recreation and Community Services Department. Works under the supervision of a Recreation
Supervisor. Supervises subordinate lifeguards at a specified location.
APPROVED:
DATE:
Director of Human Resources
CSB APPROVED:
HR/Job Descriptions/Class&Comp App:PooI.Manager.1.00331
Page 3 of 3
EXHIBIT A
POOL MANAGER II
(Part-Time)
JOB DESCRIPTION
Under general supervision, plans and supervises the operation of a large or year-round public
swim center; accomplishes specialized work in protecting life, preventing accidents, enforcing
safety regulations and providing instructions; and, performs related work as required.
REPRESENTATIVE DUTIES
Provides courteous and expeditious customer service to the general public and City department
staffs.
Assists the Recreation Supervisor in scheduling and programming swimming pool facilities:
serves as a pool lifeguard; instructs classes in fundamentals of swimming; supervises swimming
activities in and around a City pool to ensure that policies, rules and regulations are observed and
enforced and that no hazard to safety is created; warns swimmers of improper activities or
danger.
Coordinates swim class registration; assigns and coordinates instructions; coordinates and
supervises lifeguard duties; enforces pool regulations and water safety policies; rescues
swimmers in distress or danger of drowning; administers first aid in the event of injury;
administers artificial respiration if required; inspects pool facilities, equipment and water to
ensure that they are safe and usable.
Supervises and assists in cleaning the pool and related facilities and equipment; accomplishes
chlorine residual or other water tests; maintains records and charts of water test results and
records of accidents; adds chemicals to pool water.
Maintains effective public relations with users of the pool and surrounding park grounds;
supervises all pool personnel at a specified pool facility; ensures implementation of all policies
and procedures related to the management and operation of facilities and program.
Routinely adheres to and maintains a positive attitude towards City and Department goals; and,
performs other related work as required.
MINIMUM QUALlFICA TIONS
Age 18 or older and graduation from high school or GED equivalent and a minimum of two (2)
years full-time paid experience in instructing or supervising water recreational activities.
Additional qualifying experience may be substituted for the required education on a year-for-
year basis to a maximum of two (2) years.
Possession of a valid Red Cross Lifeguard Training, YMCA Lifeguard or Ellis and Associates
Lifeguard Certificate and Red Cross Water Safety Instructor's (WSI) Certificate or YMCA
Page 1013
2011-229
EXHIBIT A
SKIPPERS/Progressive Instructor Certificate and a Red Cross Standard First Aid Certificate or
American Red Cross Community First Aid and Safety Certificate or National Safety Council
Standard First Aid Certificate or Medic First Aid Certificate and American Heart Association
CPR Level "c" BLS (Basic Life Support) Certificate or American Red Cross Community CPR
Certificate or American Red Cross CPR for the Professional Rescuer Certificate are required.
All certificates must be valid for the duration of employment.
Possession of a valid Class "c" California Driver's License is required. For Qut-of-state
applicants, a valid driver's license is required. A valid Class "e" California Driver's License
must be obtained within (10) days of appointment (CA Vehicle code 12405c).
GENERAL OUALlFICATlONS
Knowledge of:
Water hazards, lifesaving techniques and rescue methods;
First aid as applied to accidents in water and surrounding areas;
Policies, rules and regulations governing swimming pool operation;
Swim lesson organization, administration and implementation procedures;
Effective personnel management and motivation.
Ability to:
Swim with proficiency and endurance for possible rescues;
Evaluate situations and adopt intelligent methods of action;
Remain calm and efficient in stressful situations;
Maintain constant observation of an assigned area and note any sign of impending
trouble;
Prevent dangerous situations from arising;
Recognize emergencies and take appropriate actions;
Supervise subordinate lifeguards, volunteers or support staff;
Establish and maintain effective-working relationships with those contacted in the course
of work;
Effectively instruct persons in the techniques of swimming and water safety;
Follow oral and written instructions;
Transport materials and supplies weighing up to 40 pounds;
See in the normal visual range with or without correction;
Hear in the normal audio range with or without corrections;
Work indoors and outdoors in a variety of environmental conditions, including high
temperatures, humidity, moisture and distracting noises.
Handle and account for cash deposits of daily recreational swim and swim lesson
receipts.
Page 2 of 3
2011-229
EXHIBIT A
ORGANIZATION RELATIONSHIPS
The Pool Manager II is a working supervisory position in the Recreation Division of the Parks,
Recreation and Community Services Department. Warks under the supervision of a Recreation
Supervisor. Supervises subordinate lifeguards and swim instructors at a specified location.
APPROVED:
DATE:
Director of Human Resources
CSB APPROVED:
5801
I J lR/Job Deserin\iClIlSClass&CulllP '\I1D:P\lol.\1Jlm::!.~r.[!'()(l.:n_-;
Page 3 of 3
2011-229
r Deleted;
..J
( Deleted~ HR/Job --"
.1' Descriptions:POOL.MANAGER.1I
04/06/01 dp
2011-229
EXHIBIT A
SENIOR LIFEGUARD
(Part-Time)
JOB DESCRIPTION
Under general supervision, assists in supervisIng the operation of a public swimming pool;
accomplishes specialized work in protecting life, preventing accidents, enforcing safety regulations
and providing instructions; and performs related work as required. May supervise site during
absence of Pool Manager.
REPRESENTATIVE DUTIES
Provides courteous and expeditious customer service to the general public and City department
staffs.
Serves as Pool Lifeguard; instructs classes in fundamentals of swimming; supervises swimming
activities in and around a City pool ensure that policies, rules and regulations are observed and
enforced and that no hazard to safety is created; warns swimmers of improper activities or danger;
enforces pool regulations and water safety policies; rescues swimmers in distress or danger of
drowning; administers first aid in the event of injury; administers artificial respiration, if necessary.
Inspects pool facilities, equipment and water to ensure that they are safe and usable; supervises and
assists in cleaning the pool and related facilities and equipment; instructs classes in fundamentals of
swimming; assists the Pool Manager and other Senior Lifeguards with chlorine residual and other
water tests.
Assists with records and charts of water test results and records of accidents; adds chemicals to
pool water; maintains effective public relations with users of the pool and surrounding park
grounds; ensures the implementation of all policies and procedures related to the management and
operation of the facilities and program.
Routinely adheres to and maintains a positive attitude towards the City and Department goals; and
performs other related work as required.
MINIMUM OUALIFICATlONS
Possession of a valid Red Cross Lifeguard Training, YMCA Lifeguard or Ellis and Associates
Lifeguard Certificate and Red Cross Water Safety Instructor's (WSI) Certificate or YMCA
SKlPPERSlProgressive Instructor Certificate and a Red Cross Standard First Aid Certificate or
American Red Cross Community First Aid and Safety Certificate or National Safety Council
Standard First Aid Certificate or Medic First Aid Certificate and American Heart Association CPR
Level "C" BLS (Basic Life Support) Certificate or American Red Cross Community CPR
Certificate or American Red Cross CPR for the Professional Rescuer Certificate are required. Must
be 17 years of age or older.
All certificates must be valid for the duration of employment.
2011-229
EXHIBIT A
GENERAL OUALIFICATIONS
Knowledge of:
Water hazards, lifesaving techniques and rescue methods;
First aid as applied to accidents in water and surrounding area;
Policies, rules and regulations governing swimming pool operation.
Abilitv to:
Swim with proficiency and endurance for possible rescues;
Evaluate situations and adopt intelligent methods of action:
Remain calm and efficient in stressful situations;
Maintain constant observation of an assigned area and note any sign of impending trouble;
Prevent dangerous situations from arising;
Recognize emergencies and take appropriate action;
Supervise subordinate lifeguards, volunteers or support staff;
Maintain records and prepare reports;
Establish and maintain effective working relationships with those contacted in the course of
work;
Effectively instruct persons in the techniques of swimming and water safety;
Follow oral and written instructions;
Transport materials and supplies weighing up to 40 pounds;
See in the normal visual range with or without correction;
Hear in the normal audio range with or without correction;
Work indoors and outdoors in a variety of environmental conditions, including high
temperatures, humidity, moisture and distracting noises.
ORGANIZATION RELATIONSHIPS
The Senior Lifeguard is a working supervisory position in the Recreation Division of the Parks,
Recreation and Community Services Department. Works under the supervision of a Pool Manager
or Recreation Supervisor. May supervise subordinate lifeguards.
APPROVED:
DATE:
Director of Human Resources
CSB APPROVED:
HR/Job Descriptions - New:00283.Senior.Lifeguard.PT
4/22/97
2011-229
EXHIBIT A
LIFEGUARD
(Part-Time)
JOB DESCRIPTION
Under general supervision, accomplishes specialized work in protecting life, asslstmg in
instructions, and assisting in the operation of public swimming pools; and performs related work as
required.
REPRESENTATIVE DUTIES
Provides courteous and expeditious customer service to the general public and City department
staffs.
Supervises swimming activities in and around a City pool to ensure that policies, rules and
regulations are observed and enforced and that no hazard to safety is created; warns swimmers of
improper activities or danger; enforces pool regulations and water safety policies.
Rescues swimmers in distress or danger of drowning; administers first aid in the event of injury;
administers artificial respiration if required.
Assists in cleaning the pool and related facilities, and equipment; and assists in instructing classes
in fundamentals of swimming.
Routinely adheres to and maintains a positive attitude towards City and Department goals; and
performs other related work as required.
MINIMUM QUALIFICATIONS
Possession of a valid Red Cross Lifeguard Training Certificate, YMCA Lifeguard or Ellis and
Associates Lifeguard Certificate, Red Cross Standard First Aid Certificate or American Red Cross
Community First Aid and Safety Certificate or National Safety Council Standard First Aid
Certificate or Medic First Aid Certificate and American Heart Association CPR Level "C" BLS
(Basic Life Support) Certificate or American Red Cross Community CPR Certificate or American
Red Cross CPR for the Professional Rescuer Certificate are required. Must be 16 years of age.
All certificates must be valid for the duration of employment.
GENERAL QUALIFICATIONS
Knowledge of:
Water hazards, lifesaving techniques and rescue methods;
First aid as applied to accidents in water and surrounding area;
Policies, rules and regulations governing swimming pool operation.
2011-229
EXHIBIT A
Ability to:
Swim with proficiency and endurance for possible rescues;
Evaluate situations and adopt intelligent methods of action:
Remain calm and efficient in stressful situations;
Maintain constant observation of an assigned area and note any sign of impending trouble;
Prevent dangerous situations from arising;
Recognize emergencies and take appropriate action;
Supervise volunteers and support staff;
Maintain records and prepare reports;
Establish and maintain effective working relationships with those contacted in the course of
work;
Effectively instruct persons in the techniques of swimming and water safety;
Follow oral and written instructions;
Transport materials and supplies weighing up to 40 pounds;
See in the normal visual range with or without correction;
Hear in the normal audio range with or without correction;
Work indoors and outdoors in a variety of environmental conditions, including high
temperatures, humidity, moisture and distracting noises.
ORGANlZA nON RELATIONSHIPS
The Lifeguard is an entry-level position in the Recreation Division of the Parks, Recreation and
Community Services Department. Works under the supervision of a Senior Lifeguard, Pool
Manger of Recreation Supervisor.
APPROVED:
DATE:
Director of Human Resources
CSB APPROVED:
5113/97
HRlJob Descriptions/Class&Comp App:Lifeguard.PT.00133
2011-229
EXHIBIT A
LIST OF CITY OF SAN BERNARDINO POOLS
Mill Pool
533 E. Central Ave
(909) 384-5422
Hernandez Center Pool
222 N. Lugo Ave.
(909) 384-5420
Delmann Heights Center Pool
2969 N. Flores Ave
(909) 384-5418
Nunez Pool
1717 W. 5th St
(909) 384-5421
Boys & Girls Club Pool
1180 West Ninth Street
(909) 888-6751
Center for Individual Development
8088 Palm Lane
(909) 384-5426
Jerry Lewis Family Swim Center
831 East Highland A venue
(909) 384-5419
Note: All pools are maintained by the City of San Bernardino, except according to a IPA
the C.I.D. is maintained by the San Bernardino City Schools and managed by City of San
Bernardino PRCSD. In addition, the Boys & Girls Club of San Bernardino manages the
aquatics programs of the Delmann Heights Pool and the Boys & Girls Club Pool (9th
Street Community Center).
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EXHIBIT A
Fo,m W-g
2011-229
Request for Taxpayer
Identification Number and Certification
Give form to the
requester. Do not
send to the IRS.
(Rev, November 2005)
Dapartment of the Treasury
Internal Revenue Service
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Name (as shown on your income tax return)
Business name, if different from above
D Individual! D Corporation
Check appropriate box: Sole proprietor
Address (number, street, and apt or suite no.)
City, state, and ZIP code
list account number{s) here (optional)
Taxpayer Identification Number (TIN)
o Partnership D Other'" _.-
o Exempt from backup
withholding
Requester's name and address (optional)
Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid 1 Social security number , , I
backup withholding. For individuals, this is your social security number (SSN). However, for a resident ~
alien, sole proprietor, or disregarded entity, see the Part 1 instructions on page 3. For other entities, it is
your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter.
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal
Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
notified me that I am no longer subject to backup withholding, and
3. I am a U.S. person (including a U.S. resident alien).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply.
For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement
arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. (See the instructions on page 4.)
Sign I Signature of
Here ,u.s. person ~ Date ~
Purpose of Form
A person who is required to file an information return with the
IRS, must obtain your correct taxpayer identification number
(TIN) to report, for example, income paid to you, real estate
transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or
contributions you made to an IRA.
U.S. person. Use Form W-9 only if you are a U.S. person
(including a resident alien), to provide your correct TIN to the
person requesting it (the requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are
waiting for a number to be issued),
2. Certify that you are not sUbject to backup withholding, or
3. Claim exemption from backup withholding if you are a
U.S. exempt payee.
In 3 above, if applicable, you are also certifying that as a
U.S. person, your allocable share of any partnership income
from a U.S. trade or business is not subject to the
withholding tax on foreign partners' share of effectively
connected income.
Note. If a requester gives you a form other than Form W-9 to
request your TIN, you must use the requester's form if it is
substantially similar to this Form W-9.
For federal tax purposes, you are considered a person if you
are:
. An individual who is a citizen or resident of the United
States,
. A partnership, corporation, company, or association
created or organized in the United States or under the laws
of the United States, or
. Any estate (other than a foreign estate) or trust. See
Regulations sections 301. 7701-6(a) and 7(a) fm additional
information.
Special rules for partnerships. Partnerships that conduct a
trade or business in the United States are generally required
to pay a withholding tax on any foreign partners' share of
income from such business. Further, in certain cases where a
Form W-9 has not been received, a partnership is required to
presume that a partner is a foreign person, and pay the
withholding tax. Therefore, if you are a U.S. person that IS a
partner in a partnership conducting a trade or business in the
United States, provide Form W-9 to the partnership to
establish your U.S. status and avoid withholdiRg on your
share of partnership income.
The person who gives Form W.9 to the partnership for
purposes of establishing its U.S. status and avoiding
withholding on its allocable share of net income from the
partnership conducting a trade or business in the United
States is in the following cases:
. The U.S. owner of a disregarded entity and not the entity,
Form W-9 (Rev_ 11-2005)
Cat No. 10231X
EXHIBIT A
Form W-9 (Rev. 11-2005)
2011-229
Page 2
. The U.S. grantor or other owner of a grantor trust and not
the trust, and
. The U.S. trust (other than a grantor trust) and not the
beneficiaries of the trust.
Foreign person. If you are a foreign person, do not use
Form W-9. Instead, use the appropriate Form W-8 (see
Publication 515, Withholding of Tax on Nonresident Aliens
and Foreign Entities).
Nonresident alien who becomes a resident alien.
Generally, only a nonresident alien individual may use the
terms of a tax treaty to reduce or eliminate U.S. tax on
certain types of income. However, most tax treaties contain a
provision known as a "saving clause." Exceptions specified
in the saving clause may permit an exemption from tax to
continue for certain types of income even after the recipient
has otherwise become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an
exception contained in the saving clause of a tax treaty to
claim an exemption from U.S. tax on certain types of income,
you must attach a statement to Form W-9 that specifies the
following five items:
1. The treaty country. Generally, this must be the same
treaty under which you claimed exemption from tax as a
nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that
contains the saving clause and its exceptions.
4. The type and amount of income that qualifies for the
exemption from tax.
5. Sufficient facts to justify the exemption from tax under
the terms of the treaty article.
Example. Article 20 of the U.S.-China income tax treaty
allows an exemption from tax for scholarship income
received by a Chinese student temporarily present in the
United States. Under U.S. law, this student will become a
resident alien for tax purposes if his or her stay in the United
States exceeds 5 calendar years. However, paragraph 2 of
the first Protocol to the U.S.-China treaty (dated April 30,
1984) allows the provisions of Article 20 to continue to apply
even atter the Chinese student becomes a resident alien of
the United States. A Chinese student who qualifies for this
exception (under paragraph 2 of the first protocol) and is
relying on this exception to claim an exemption from tax on
his or her scholarship or fellowship income would attach to
Form W-9 a statement that includes the information
described above to support that exemption.
If you are a nonresident alien or a foreign entity not subject
to backup withholding, give the requester the appropriate
completed Form W-8.
What is backup withholding? Persons making certain
payments to you must under certain conditions withhold and
pay to the IRS 28% of such payments (after December 31,
2002). This is called "backup withholding." Payments that
may be subject to backup withholding include interest,
dividends, broker and barter exchange transactions, rents,
royalties, nonemployee pay, and certain payments from
fishing boat operators. Real estate transactions are not
subject to backup withholding.
You will not be subject to backup withholding on payments
you receive if you give the requester your correct TIN, make
the proper certifications, and report all your taxable interest
and dividends on your tax return.
Payments you receive will be subject to backup
withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the Part
II instructions on page 4 for details),
3. The IRS tells the requester that you furnished an
incorrect TIN,
4. The IRS tells you that you are subject to backup
withholding because you did not report all your interest and
dividends on your tax return (for reportable interest and
dividends only), or
5. You do not certify to the requester that you are not
subject to backup withholding under 4 above (for reportable
interest and dividend accounts opened atter 1983 only).
Certain payees and payments are exempt from backup
withholding. See the instructions below and the separate
Instructions for the Requester of Form W-9.
Also see Special rules regarding partnerships on page 1.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN
to a requester, you are subject to a penalty of $50 for each
such failure unless your failure is due to reasonable cause
and not to willful neglect.
Civil penalty for false information with respect to
withholding. If you make a false statement with no
reasonable basis that results in no backup withholding, you
are subject to a $500 penalty.
Criminal penalty for falsifying information. Willfully
falsifying certifications or affirmations may subject you to
criminal penalties including fines and/or imprisonment.
Misuse of TINs. If the requester discloses or uses TINs in
violation of federal law, the requester may be SUbject to civil
and criminal penalties.
Specific Instructions
Name
If you are an individual, you must generally enter the name
shown on your income tax return. However, if you have
changed your last name, for instance, due to marriage
without informing the Social Security Administration of the
name change, enter your first name, the last name shown on
your social security card, and your new last name.
If the account is in joint names, list first, and then circle,
the name of the person or entity whose number you entered
in Part I of the form.
Sole proprietor. Enter your individual name as shown on
your income tax return on the "Name" line. You may enter
your business, trade, or "doing business as (DBA)" name on
the "Business name" line.
Limited liability company (LLC). If you are a single-member
LLC (including a foreign LLC with a domestic owner) that is
disregarded as an entity separate from its owner under
Treasury regulations section 301.7701-3, enter the owner's
name on the "Name" line. Enter the LLC's name on the
"Business name" line. Check the appropriate box for your
filing status (sole proprietor, corporation, etc.), then check
the box for "Other" and enter "LLC" in the space provided.
Other entities. Enter your business name as shown on
required federal tax documents on the "Name" line. This
name should match the name shown on the charter or other
legal document creating the entity. You may enter any
business, trade, or DBA name on the "Business name" line.
Note. You are requested to check the appropriate box for
your status (individual/sole proprietor, corporation, etc.).
Exempt From Backup Withholding
If you are exempt, enter your name as described above and
check the appropriate box for your status, then check the
"Exempt from backup withholding" box in the line following
the business name, sign and date the form.
2011-229
EXHIBIT A
Form W-9 (Rev. 11-2005)
Generally, individuals (including sole proprietors) are not
exempt from backup withholding. Corporations are exempt
from backup withholding for certain payments, such as
interest and dividends.
Note. If you are exempt from backup withholding, you
should still complete this form to avoid possible erroneous
backup withholding.
Exempt payees. Backup withholding is not required on any
payments made to the following payees:
1. An organization exempt from tax under section 501 (a),
any IRA, or a custodial account under section 403(b)(7) if the
account satisfies the requirements of section 401 (n(2),
2. The United States or any of its agencies or
instrumentalities,
3. A state, the District of Columbia, a possession of the
United States, or any of their political subdivisions or
instrumentalities,
4. A foreign government or any of its political subdivisions,
agencies, or instrumentalities, or
5. An international organization or any of its agencies or
instrumentalities.
Other payees that may be exempt from backup
withholding include:
6. A corporation,
7. A foreign central bank of issue,
8. A dealer in securities or commodities required to register
in the United States, the District of Columbia, or a
possession of the United States,
9. A futures commission merchant registered with the
Commodity Futures Trading Commission,
10. A real estate investment trust,
11. An entity registered at all times during the tax year
under the Investment Company Act of 1940,
12. A common trust fund operated by a bank under
section 584(a),
13. A financial institution,
14. A middleman known in the investment community as a
nominee or custodian, or
15. A trust exempt from tax under section 664 or
described in section 4947.
The chart below shows types of payments that may be
exempt from backup withholding. The chart applies to the
exempt recipients listed above, 1 through 15.
IF the payment is for. . .
THEN the payment is exempt
for.. .
I nterest and dividend payments
All exempt recipients except
for 9
Broker transactions
Exempt recipients 1 through 13.
Also, a person registered under
the Investment Advisers Act of
1940 who regularly acts as a
broker
Barter exchange transactions
and patronage dividends
Exempt recipients 1 through 5
Generally, exempt recipients
1 through 72
Payments over $600 required
to be reported and direct
sales over $5,000 1
'See Form 1099-MISC. Miscellaneous Income. and its instructions.
,
However, the following payments made to a corporation (including gross
proceeds paid to an attorney under section 6045(f), even if the attorney is a
corporation) and reportable on Form 1099-MISC are not exempt from
backup withholding: medical and health care payments, attorneys' fees; and
payments for services paid by a federal executive agency
Page 3
Part I. Taxpayer Identification
Number (TIN)
Enter your TIN in the appropriate box. If you are a resident
alien and you do not have and are not eligible to get an SSN,
your TIN is your IRS individual taxpayer identification number
{ITIN). Enter it in the social security number box. If you do
not have an ITIN, see How to get a TIN below.
If you are a sole proprietor and you have an EIN, you may
enter either your SSN or EIN. However, the IRS prefers that
you use your SSN.
If you are a single-owner LLC that is disregarded as an
entity separate from its owner (see Limited liability company
(LLC) on page 2), enter your 88N (or EIN, if you have one). If
the LLC is a corporation, partnership, etc., enter the entity's
EIN.
Note. See the chart on page 4 for further clarification of
name and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one
immediately. To apply for an 88N, get Form 88-5,
Application for a Social Security Card, from your local Social
Security Administration office or get this form online at
www.socialsecurity.gov. You may also get this form by
calling 1-800-772-1213. Use Form W-7, Application for IR8
Individual Taxpayer Identification Number, to apply for an
ITIN, or Form S8-4, Application for Employer Identification
Number, to apply for an EIN. You can apply for an EIN online
by accessing the IRS website at www.irs.govlbusinesses and
clicking on Employer 10 Numbers under Related Topics. You
can get Forms W-7 and SS-4 from the IRS by visiting
www.irs.govor by calling 1-800-TAX-FORM
(1-800-829-3676).
If you are asked to complete Form W-9 but do not have a
TIN, write "Applied For" in the space for the TIN, sign and
date the form, and give it to the requester. For interest and
dividend payments, and certain payments made with respect
to readily tradable instruments, generally you will have 60
days to get a TIN and give it to the requester before you are
subject to backup withholding on payments. The 50-day rule
does not apply to other types of payments. You will be
subject to backup withholding on all such payments until you
provide your TIN to the requester.
Note. Writing "Applied For" means that you have already
applied for a TIN or that you intend to apply for one soon.
Caution: A disregarded domestic entity that has a foreign
owner must use the appropriate Form W-B.
EXHIBIT A
Form W-9 (Rev_ 11-2005)
2011-229
Part II. Certification
Page 4
To establish to the withholding agent that you are a U.S.
person, or resident alien, sign Form W-9. You may be
requested to sign by the withholding agent even if items 1, 4,
and 5 below indicate otherwise.
For a joint account, only the person whose TIN is shown in
Part I should sign (when required). Exempt recipients, see
Exempt From Backup Withholding on page 2.
Signature requirements. Complete the certification as
indicated in 1 through 5 below.
1. Interest, dividend, and barter exchange accounts
opened before 1984 and broker accounts considered
active during 1983. You must give your correct TIN, but you
do not have to sign the certification.
2. Interest, dividend, broker, and barter exchange
accounts opened after 1983 and broker accounts
considered inactive during 1983. You must sign the
certification or backup withholding will apply. If you are
subject to backup withholding and you are merely providing
your correct TIN to the requester, you must cross out item 2
in the certification before signing the form.
3. Real estate transactions. You must sign the
certification. You may cross out item 2 of the certification.
4. Other payments. You must give your correct TIN, but
you do not have to sign the certification unless you have
been notified that you have previously given an incorrect TIN.
"Other payments" include payments made in the course of
the requester's trade or business for rents, royalties, goods
(other than bills for merchandise), medical and health care
services (including payments to corporations), payments to a
nonemployee for services, payments to certain fishing boat
crew members and fishermen, and gross proceeds paid to
attorneys (including payments to corporations).
5. Mortgage interest paid by you, acquisition or
abandonment of secured property, cancellation of debt,
qualified tuition program payments (under section 529),
IRA, Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions. You must give
your correct TIN, but you do not have to sign the
certification.
What Name and Number To Give the
Requester
For this type of account:
Give name and SSN of:
1. Individual
2. Two or more individuals Uoint
account)
3. Custodian account of a minor
(Uniform Gift to Minors Act)
4. a. The usual revocable
savings trust (grantor is
also trustee)
b. So-called trust account
that is not a legal or valid
trust under state law
5. Sole proprietorship or
single-owner LLC
The individual
The actual owner of the account
or, if combined funds, the first
individual on the account 1
The minor 2
The grantor-trustee 1
The actual owner 1
The owner 3
For this type of account:
6. Sole proprietorship or
single-owner LLC
7. A valid trust, estate, or
pension trust
8. Corporate or LLC electing
corporate status on Form
8832
9. Association, club, religious,
charitable, educational, or
other tax-exempt organization
10. Partnership or multi-member
LLC
11 . A broker or registered
nominee
12. Account with the Department
of Agriculture in the name of
a public entity (such as a
state or local government,
school district, or prison) that
receives agricultural program
payments
Give name and EIN of:
The owner 3
Legal entity 4
The corporation
The organization
The partnership
The broker or nominee
The public entity
'list first and circle the name of the person whose number you furnish. If
only one person on a joint account has an SSN. that person's number must
be furnished
,
Circle the minor's name and furnish the minor's SSN.
,
You must show your individual name and you may also enter your business
or "DBA" name on the second name line. You may use either your SSN or
EIN (if you have one). If you are a sole proprietor, IRS encourages you to
use your SSN.
. List first and circle the name of the legal trust, estate, or pension trust. (Do
not furnish the TIN of the personal representative or trustee unless the legal
entity itself is not designated in the account title.) Also see Special rules
regarding partnerships on page 1.
Note. If no name is circled when more than one name is
listed, the number will be considered to be that of the first
name listed.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons who must file information returns
with the IRS to report interest, dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or
abandonment of secured property, cancellation of debt, or contributions you made to an IRA, or Archer MSA or HSA. The IRS
uses the numbers for identification purposes and to help verify the accuracy of your tax return. The IRS may also provide this
information to the Department of Justice for civil and criminal litigation, and to cities, states, the District of Columbia, and U.S.
possessions to carry out their tax laws. We may also disclose this information to other countries under a tax treaty, to federal
and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat
terrorism.
You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 28% of taxable
interest, dividend, and certain other payments to a payee who does not give a TIN to a payer. Certain penalties may also apply.