HomeMy WebLinkAbout18-Animal Control
CiTY OF SAN BERN.DINO - REQUEST FOI COUNCIL ACTION
From: Deborah L. Biggs
Dept: Animal Control
Subject: Contract from California Department
of Transportation (Cal Trans) FY 92
Date: May 6. 1991
Synopsis of Previous Council ection:
Council has renewed contract each year since 1980
Recommended motion:
Adopt Resolution
~ n .
. v-r><L-r-h j{ '-64~
Signature
Contact panon:
Deborah L. Bi22S
Phone: 184-1)771)
Supporting data attached:
Yes
Ward:
FUNDING REQUIREMENTS:
Amount:
Source: (ACCT. NO.)
(ACCT. DESCRIPTION)
FlnBncB:
Council Notel:
It.. ___...._ 1.__ "1_
J9:
C'ITY OF SAN BERNADINO - REQUEST FGI COUNCIL ACTION
STAFF REPORT
Since 1980 the City has permitted access to the Animal Shelter freezer, by
Cal Trans employees for the purpose of depositing animal carcasses removed from the
State roadways. The number of carcasses is unknown, however, it is only a small
fraction of the total number deposited monthly from all other sources. The monthly
fee has been established at $42.00 per month for the FY 1992 and is to be billed
quarterly.
75-0264
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RESOLUTION NO.
RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING
THE EXECUTION OF AN AGREEMENT WITH THE STATE OF CALIFORNIA
DEPARTMENT OF TRANSPORTATION FOR THE DISPOSAL OF ANIMAL
CARCASSES FROM STATE HIGHWAYS IN THE SAN BERNARDINO AREA.
BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF
THE CITY OF SAN BERNARDINO AS FOLLOWS:
SECTION 1. The city Administrator of the City of
San Bernardino is hereby authorized and directed to execute
on behalf of said city an Agreement with the State of
California Department of Transportation for the disposal of
animal carcasses from state highways in the San Bernardino
area, a copy of which is attached hereto, marked Exhibit "A"
and incorporated herein by reference as fully as though set
forth at length.
SECTION 2. The authorization to execute the above
referenced agreement is rescinded if the parties to the
agreement fail to execute it within sixty (60) days of the
passage of this resolution.
I HEREBY CERTIFY that the foregoing resolution was
duly adopted by the Mayor and Common council of the city of
San Bernardino at a
meeting thereof, held
on the
day of
, 1991, by the
following vote, to wit:
/ / /
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6 ESTRADA
7 REILLY
8 HERNANDEZ
9 MAUDSLEY
10 MINOR
11 POPE-LUDLAM
12 MILLER
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RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING THE
EXECUTION OF AN AGREEMENT WITH THE STATE OF CALIFORNIA
DEPARTMENT OF TRANSPORTATION FOR THE DISPOSAL OF ANIMAL
CARCASSES FROM STATE HIGHWAYS IN THE SAN BERNARDINO AREA.
Council Members:
NAYS
ABSTAIN
AYES
CITY CLERK
The
foregoing resolution is hereby
approved this
day of
, 1991.
W. R. HOLCOMB, Mayor
city of San Bernardino
Approved as to form
and legal content:
JAMES F. PENMAN
C1'}~=~
By: .'1-:>? ~~
2
. 0 CON1RAcTOR
o CAL TRANS
o DEPT. OF GEN. SEA.
o CONTROLLER
o ADMIN.
c;la intenance/W. Thanpson
o
STATE OF CALIFORNIA 0
DEPARTMENT OF
TRANSPORTATION
Sheet ......1..... of ..I!......
................................
eo. Route P.M.
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DaIlllll'WtCIE
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FUNDING:
UP. AUnt.
08603
501000
7079
$504.00
91/92 Ai4
e9STATE
o JOINT
o FEDERAL
ITEM
2660-001-042
CfW'I'ER IfAtUTU FISCAL YEAR
467 1990 90/91
CONTRACT NO.
08G443
.............................
I ".,.",cerllly upon m,own""""" l'nowfIcfte"., ~ lundl.,.......
tot rite".,. purpou 0' rite npetICHtuN.,.., abol'&
Th. ......w to be t*cId on 8111nYo6ce1
.~I':I.~~fl.l'l~fl.QINQ............... . CALIFORNIA.
Date ... .AJ?x:i. ~ . ~~ t .1 ?? ~ . . . . . . . . . . . . . . . . . . . . . .
... !=.i~y. ?f. .s,a.11.~~'!~~9<? .~!~L ~!t!:!n!:!F....... Phone.. n~(.3.8.4.-.5.0.4.8.......
l_blI.._
Address .. ~~~. p.l?o? .~~ .~'l'!4.. .~9. .~~!?j!'l?I. f:A.. .9.2.~q~..................................
Ul>>nM No..... c....
The Contractor hereby agrees to furnish the service or rental as heralnafter set forth to the Depart-
ment of Transportation In accordance with the provisions on BOTH SIDES of this form and on the
atteched sheets, and he agrees to receive and accept as full compensation therefor the prices named
herein.
The consideration to be paid Contractor, as provided herein, shall be In 0 _ F_
compensation for all of Contractor's expenses Incurred In the performance _"'_80__l
hereof. including travel and per diem, unless otherwise expressly 80
provided
Noaiteration or variation of the terms of this contract shall bevelld unle..
made In writing and signed by the parties hereto, and no oral underatandlng
or agreement not Incorporated herein shall be binding on any of the
parties hereto.
The said Department of Transportation hereby agrees to the terms as
setforth herein, and hereby agrees to pay the same, provided that by mutual
written consent this agreement may be modified and that the State reserves
the right to terminate this agreement upon written notice to the Contractor.
IN WITNESS WHEREOF, the parties to these presents have hereunto set their hand the year and date first
above written.
DEPARTMENT OF TRANSPORTATION
CONTRACTOR
CITY OF SAN BERNARDINO ANIMAL SHELTER
.............................................
--
By..........................................
Berberta M. Olive
Assistant Contracts Officer
By ..........................................
.............................................
Approved by .................................
Kathleen D. Sansone
District Contracts Officer
_or_
.............................................
Federal LD. Number
DA&08M-128AfMV IIHI
.
.
. 0 .. 0
A. The Contractor shall keep himself fully Informed of all existing and future State and Federal laws and
county and municipal ordinances and regulations which In any manner affect those engaged or employed
in the work, orthe bodies ortrlbunals having any juriadlctlon or authority overthe same. He shall at all times
observe and comply with, and shall cause all his agents and employees to observe and comply with all
such existing and future laws, ordinances, regulations, orders, and decrees of bodies or tribunals having
any jurisdiction or authority over the work. If any discrepancy or Inconsistency Is discovered in this con-
tract in relation to any such law, ordinance, regulation, order or decree the Contractor shall forthwith
report the same to the State in writing.
B. The Contractor agrees to indemnify, defend and save harmless the State, Its officars, agents and
employees from any and all claims and losses occurring or resulting to any and all contractors, subcontrac-
tors, materialmen, laborers and any other parson, firm or corporation furnishing or supplying work, ser-
vices, materials or supplies in connection with the performance of this contract, and from any and all claims
and losses occurring or resulting to any person, firm or corporation who may be injured or damaged by the
Contractor In the performance of this contract
C. The mentioning of certain statutes In this contract shall not relieve the Contractor from the responsibility
of complying with any other statutes applicable to the service or rental to be furnished hereunder.
D. The Contractor shall Indemnify the State against all loss and damage to the Contracto~s propertyorequlp-
ment during Its use under this contract and he shall at his own expense maintain such fire, theft, liability or
other insurance as he deems necessary for his protection. The Contractor assumes all responsibility
which may be imposed by Iswfor property damage or personal Injuries caused bydefective equipment fur-
nished under this contract or by operations of the Contractor or his employees under this contract
E. The cost of employer payments to or on behalf of employees, subsistence, trave~ compensation Insurance
premiums, unemployment contributions, social security taxes, contract bond premiums, and any other
taxes or assessments INCLUDING SALES TAXES required by law or otherwise shall be Included In the
price bid and no additional allowance will be made therefor, unless separate payment proviSion should
specifically be provided for.
F. The Contractor, and the agents and employees of Contractor, In the performance of this agreement, shall
actin an Independent capacity and not as officers or employees or agents of State of Califomia.
G. The Contractor warrants, by execution of this contract that no person or selling agency has been
employed or retained to solicit orsecure this contract upon an agreement or understanding for a commis-
sion, percentage, brokerage, or contingent fee, excepting bona flda employees or bona fide established
commercial or selling agencles maintained by the Contractor for the purpose of securing business. For
breach or violation of this warranty the state shall have the right to annul this contract without liability, pay-
ing onlyforthe value of the work actually performed, or In Its dlscration, to deduct from the contract price or
consideration, or otherwise recover, the full amount of such commission, percentage, brokerage or con-
tingent fee.
H. Pursuant to the authority contained In Section 591 ofthe Vehicle Code, the Department has determined
that within such areas as are within the limits of the project and are open to public traffic, the Contractor
shall comply with all ofthe requlrement88etforth in Divisions 11, 12, 13, 14 and 15 ofthe Vehicle Code. The
Contractor shall take all necessary precautions for safe operation of his equipment and the protection of
the traveling publiC from Injury and damage from such equipment
I. The State may terminate thla agreement and be relieved of the payment of any consideration to Contrac-
tor should Contractor fall to perform the covenants herein contained at the time and In the manner herein
provided. In the event of such termination the State may proceed with the work in any manner deemed pro-
per by the State. The cost to the State shall be deducted from any sum due the Contractor under this agree-
ment, and the balance, if any, shall be paid the Contractor upon demand.
J. Withoutlhe written consent of the State, this agreement Is not assignable by Contractor either In whole or
In part
K. Time is of the essence in this agreement
L In accordance with Public Contract Code 10296, a Contractor who is not a public entity, by signing this
contract, hereby swears under penalty of perjury that not more than one final unappealable finding of con-
tempt of court by a federal court has been lasued against him within the Immediately preceding two-year
period because of the Contracto~s failure to comply with an order of a federal court which orders him to
comply with an order of the National Labor Relations Board.
DA&OIIM-1284(AEV.8111)
.
.
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Contract Sheet l of 8
Contract No. 08G443
ARTICLE I - DESCRIPTION OF WORK
The City of San Bernardino shall provide the Department of
Transportation with 14 keys to the animal shelter, which State
forces will use to dispose of animal carcasses. The City
shall take possession of animal carcasses removed by State
forces from State highways in the San Bernardino area.
ARTICLE II - CONTRACT ADMINISTRATOR
The Contract Administrator for the State is Mr. Walt Thomtlson,
telephone number 714/383-4427.
ARTICLE III - PERIOD OF PERFORMANCE
A. This contract shall begin on Julv 1. 1991 contingent upon
approval by the State and shall terminate" on June 30. 1992
unless extended by supplemental agreement.
B. The Contractor is advised that any recommendation for contract
award is not binding on the State until contract is fully
executed and approved by the State.
ARTICLE IV - RATES/COST LIMITATION
A. Rate per month is $42.00, which shall include all animals
taken to the Shelter.
B. Total amount of this contract shall not exceed $504.00.
ARTICLE V - PAYMENT
A. Payment will be made monthly, in arrears, upon receipt of
signed invoices submitted in triplicate. Invoices shall
reference this contract number and be submitted to the
Contract Administrator at the following address:
Department of Transportation
P.O. Box 231
San Bernardino, CA 92402
Attention: Mr. Walt Thompson/Maintenance
B. In order to expedite payment, invoice letterhead (printed or
stamped) should read the same as the name on the contract.
C. Payment may be made by the State Controller's Office or the
Department of Transportation. Payment by the Department is
permitted only when the covering invoices offer a discount of
at least half-of-one percent (minimum $5.00). Payment by the
Department will usually result in receipt of the check about
three weeks earlier than when payment is made by the State
Controller.
,
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o
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Contract Sheet L of 8
Contract No. 08G443
ARTICLE V - PAYMENT (Continued)
D. It is mutually understood between the parties that this
contract may have been written before ascertaining the
availability of congressional or legislative appropriation of
funds, for the mutual benefit of both parties, in order to
avoid program and fiscal delays that would occur if the
agreement were executed after that determination.
E. This agreement is valid and enforceable only if sufficient
funds are made available to the State by the United States
Government or the California State Legislature for the purpose
of this program. In addition, this agreement is subject to
any additional restrictions, limitations, conditions or any
statute enacted by the Congress or the State Legislature that
may affect the provisions, terms or funding of this contract
in any manner.
F. It is mutually agreed that if the Congress or the State
Legislature does not appropriate sufficient funds for the
program, this contract shall be amended to reflect any
reduction in funds.
G. The State has the option to void the contract under the 30-day
cancellation clause or to amend the contract to reflect any
reduction of funds.
ARTICLE VI - COST PRINCIPLES
A. The Contractor agrees that the Contract Cost Principles and
Procedures, CFR 48, Federal Acquisition Regulations System,
Chapter 1, Part 31, shall be used to determine the
allowability of individual items of Cost.
B. The Contractor also agrees to comply with Federal procedures
in accordance with 49 CFR, Part 18, Uniform Administration
Requirements for Grants-in-Aid to State and Local Governments.
ARTICLE VII - CHANGE IN TERMS/TERMINATION
A. The terms of this agreement may be amended or modified only by
mutual written agreement of the parties.
B.' The Department of Transportation reserves the right to
terminate this agreement upon thirty (30) days written notice
to the Contractor.
.
o
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Contract Sheet L of 8
Contract No. 08G443
ARTICLE VIII - DISPUTES
A. Any dispute concerning a question of fact arising under this
contract that is not disposed of by agreement shall be decided
by the State's Contract Officer, who may consider any written
or verbal evidence submitted by the Contractor. The decision
of the Contract Officer, issued in writing, shall be
conclusive and binding on both parties to the contract on all
questions of fact considered and determined by the Contract
Officer.
B. Neither the pendency of a dispute nor its consideration by the
Contract Officer will excuse the Contractor from full and
timely performance in accordance with the terms of the
contract.
ARTICLE IX - NONDISCRIMINATION
A. During the performance of this contract, contractor and its
subcontractors shall not unlawfully discriminate against any
employee or applicant for employment because of race,
religion, color, national origin, ancestry, physical handicap,
mental condition, marital status, age (over 40) or sex.
Contractors and subcontractors shall insure that the
evaluation and treatment of their employees and applicants for
employment are free of such discrimination. Contractors and
subcontractors shall comply with the provisions of the Fair
Employment and Housing Act (Government Code, Section 12900 et
seq.) and the applicable regulations promulgated thereunder
(California Administrative Code, Title 2, Section 7285.0 et
seq.). The applicable regulations of the Fair Employment and
Housing Commission implementing Government Code, Section
12990, set forth in Chapter 5 of Division 4 of Title 2 of the
California Administrative Code are incorporated into this
contract by reference and made a part hereof as if set forth
in full. contractor and its subcontractors shall give written
notice of their obligations under this clause to labor
organizations with which they have a collective bargaining or
other agreement.
B. This contractor shall include the nondiscrimination and
compliance provisions of this clause in all subcontracts to
perform work under the contract.
ARTICLE X - MBE/WBE PARTICIPATION GOALS
In accordance with Public Contract Code Section 10115, it is
not required that Minority Business Enterprise and Women
Business Enterprise (MBE/WBE) participation goals be
established on contracts of $10,000 or less. Therefore, the
goal for MBE/WBE participation in this contract is zero. This
fact is not intended to preclude or discourage the prime
contractor from soliciting or using MBE/WBEs in contracts of
$10,000 or less.
.
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Contract Sheet ~ of ~
Contract No. 08G443
ARTICLE XI - DRUG-FREE WORKPLACE CERTIFICATION
A. By signing this contract, the contractor hereby certifies under
penalty of perjury under the laws of the State of California that
the contractor will comply with the requirements of the Drug-Free
Workplace Act of 1990 (Government Code section 8350 et seq.) and
will provide a drug-free workplace by doing all of the following:
1. Publish a statement notifying employees that unlawful
manufacture, distribution, dispensation, possession, or
use of a controlled substance is prohibited and
specifying actions to be taken against employees for
violations, as required by Government Code Section
8355(a).
2. Establish a Drug-Free Awareness Program as required by
Government Code Section 8355(b), to inform employees
about all of the following:
(a) the dangers of drug abuse in the workplace,
(b) the person's or organization's policy of
maintaining a drug-free workplace,
(c) any available counseling, rehabilitation and
employee assistance programs, and
(d) penalties that may be imposed upon employees
for drug abuse violations.
3. Provide as required by Government Code Section 8355 (c)
that every employee who works on the proposed contract
or grant:
(a) will receive a copy of the company's drug-
free policy statement and
(b) will agree to abide by the terms of the
company's statement as a condition of
employment on the contract or grant.
B. Failure to comply with these requirements may result in
suspension of payments under the contract or termination of the
contract or both and the contractor may be ineligible for award
of any future state contracts if.the department determines that
any of the following has occurred: 1) the contractor has made a
false certification or 2) violates the certification by failing
to carry out the requirements as noted above.
C. Contractor's attention is directed to Form STD. 21 which IIIWlt be
completed and returned with the signed contract. Failure to
return the completed form will prevent final execution of
contract.
'~:;~tt:.III"D_. _.c of T~atlon
....;..._........... ..awtI m-r ImQUDtD
oDII-1206 <.... 9190) '''' I of 2
o
-...;.....~4.,.~-~,- .
Contract Sheet 6 of 8
Contract No. 08G443
I..tructlona: us. In !IJ. of the follooolnt contracU not r....lrlnt pr,vatllnt _: Minor' <_llc \Iorltal, 11Ft of Way
Cl..ronc./D_Lltlon, liFt of Way pr_rtY M_._t and Ilpor.ud "IF_ E""I_t lental Contracu.
...... of ~
Eight la) ........ labor conatltut.. . 1000l .y'. ...rk. Th. Contractor aholl forf.lt, .. a .....ltY to tho SUt. of c.lIfomla,
125.00 for _ ...rk.r ..IDY*l In tho uocutlon of tho contract by tho Contractor or any .ubcontractor ..... hi. for .ach
calondor day durlnt ""ich lIUCh workar Is .....Irod or po..lttod to work .... than a I\oUro In any - calandar . and 40 hour.
In any _ calondor _ In violation of tho provlalona of tho LoIlor Codo. and In pertlcular IoCtlon laID to la15 thoreof.
Incl.-Iw, oacopt that _k perfo..-d by _1__ In _. of a houra por .. and 40 ........ durtnt any - -. ahall bo
po..1 ttod upon c . ..tlon for all ........ ...rkod In ....... of a ...... por day at not I... then - and _hol f tl_ the
bo.lc r.t. of pey. a. _Idad In section lal5.
_~ of AIlIIroIltI-
attention 10 dlroctod to the provi.lona In IoCUon 1777.5, 1777.6 and 1777.7 of the Lebor C_ cone.mint th. ..I_t of
Ipprentlc.. by the Contractor or any ....entractor undtr hi.. (Sectlen 1777.5 .hall not _ly to ...ral contractorl or to
contractl of .pecillty contractor. not bidding for work throulh . ,.nar.l or pri.. contractor, involving l...
then 20 ...rklnt *Yo or 130,000.)
. Th. Contractor .nd .ny .ubcontr.ctor. under hi. shall coaply with the r.qulreaents of s.ctlon. 1777.6 and 1777.5
In the _loyaent of --,tic...
Ta In.ur. coapllanc. end coapl.t. understandlnt of the law r.,ardlnt apprentlc.., and OplIClflcally the raq.llrod r.tlo
thareundtr, _ contractor or a\lbcontractor ahould. ""era 0_ _tlen ul.U. conUct tho Stata Dlvl.lon of Apprenticeship
Stondorcls, P. O. ... 603, Son froncl.co, Callfomla 94101, or _ of IU branch offlc... prior to coaaenc_t of verk en
public ...rk. contracU. ~liance with seCtlon.I777.5 II.. with the prl_ contractor.
UOI"'ten ' t
_ci..
The Contractor c.rtifi.. thot the Conuactor 10 _.. of the provlslona of Lebor C_ Section 3700 ""Ich .....1... IVOry ..loyer to
be I..ure QlI..t llalltllty for _k.rl' c_tlon or to undtruk. ..U.lrwur.... In .ccordone. with pravl.iona of th.t
c_ end .,.... to _ly with ouch previ.l... bofo.. _Int the porfo_. of the ...rk of this contr.ct.
_I~ of _ltNSt Actl...
Th. Contractor's attlntlon Is dlr.ctad to the followlnt provisions of Gov.rnaent Coda Sonlon. 4551 and 4552
~Ich .hall be appllcabl. to tho Contr'ctor and hi. .ubcontroctor. on public worka contract. or ta tho bldd.r on
controcU for thl purcII_ of ~, _urloll or ..rvlc..,
itot. ef bUt.....'..,..".. _.1 .f' Tr-MIt~...
~--~~
_-1206 (N... 9190) ,_ 2 of 2
J"'lrontract Sheet 7 of 8
'-"Contract No. 08G443
. ".n entering into I pbltc MOr'U contract or ."*'contract to ....ly looda', ..rvic.., or _teriall pu~t to . pubLic work.
contract, the Cantrector or Sl.D:antractor off.r. 8r'Id ear... to ...ign to tl\8 ...rdi", bodv aU rights, title, Md interest in
.nd to .11 c..... of ection' it MY h.... under Section 4 of the Cllyton Act (15 U.S.C.Sec.15) or under the C.rtwrltllt Act
[Ch.pt.r 2 (c....ncing with Section 16700)' of '.rt 2 of Divi.lon 7 of the IUllne...nd 'rof...ion. Code), .ri.ing from
purchase. of loods, "..rvic.., or .It.rial. pursuant to the pubUc ..ork. contrlct or the subcontract. Thi.
...i.nment .h.ll be ..de .nd b.co.. .ffectiv. at the ti.. the .wardin. body tend... fin.l p'YIIent to the
contr.ctor without further ec_l.d.---.,t by the pert'....
.In _iUing . bid to . public purch..lng body, the bidder off... IInd ...... th.t if the bid fa ecc'Pted. it will ...ign to
the purch..ing body .11 rltllts, tiUe, IInd Int....t In IInd to .11 cauan of eccion it MY h.... under Section 4 of the Cl.yton
Act (15 U.S.C. Sec. 15) or under the C.rtwri.ht Act [Chapt.r 2 (c......lng with Section 16700) of '.rt 2 of Oivl.ion 7 of the
Business and Profe..i0n8 Codel, .ri.ing froa purch.... of goods, ..teriltl, or ..~c.. by the bidder for ..Le to the
purch..ing body pur.uant to the bid. Such ...,_t sh.ll be _ _ __ effecti... .t the tl_ the purch..ing body
tenders final paylllftt to the bidder..
T r....1 IInd SUbe i stence ,_t
Attention i. directed to the require..nt. of Section 1773.8 of the Labor Code. The Contractor shall ..te travel
.nd subsistence pe_u to each worker needed to execute the work in _ordance with ..Id r"",ir-.t.
londa
If contract bonds Ire required, Ilteration., e.tensions of ti.., eatra and additional work, and other authorized
contr.ct ch...... _ be _ without .ecurlng .....- of the .....tl.. on said _.
SC90
STA~OF~~~ 0
DRUG.FREE WORKPLACE CERTIFICATION
STD. 21 CHEW I t.1O)
~ SHEET 8 OF il
CCNl'RACT NO. 08G443
FAILURE TO RETURN THIS ~ FOllM WITH CCNl'RACT
DOCUMENTS WILL PREVENT FINAL EXEx:tJTICN OF CCNl'RACT.
COMP......_IZATlON NAIIE
The contractor or grant recipient named above hereby certifies compliance with Government Code
Section 8355 in matters relating to providing a drug-free workplace. The above named contractor or
grant recipient will:
1. Publish a statement notifying employees that. unlawful manufacture, distribution, dispensation,
possession, or use of a controlled substance is prohibited and specifying actions to be taken against
employees for violations, as required by Government Code Section 8355(a).
2. Establish a Drug-Free Awareness Program as required by Government Code Section 8355(b), to
inform employees about all of the following:
(a) The dangers of drug abuse in the workplace,
(b) The person's or organization's policy of maintaining a drug-free workplace,
(c) Any available counseling, rehabilitation and employee assistance programs, and
(d) Penalties that may be imposed upon employees for drug abuse violations.
3. Provide as required by Government Code Section 8355(c), that every employee who works on the
proposed contract or grant:
(a) Will receive a copy of the company's drug-free policy statement, and
(b) Will agree to abide by the terms of the company's statement as a condition of employment on
the contract or grant.
CERTIFICATION
I, the official named below, hereby swear that I am duly authorized legally to bind the contractor or
grant recipient to the above described certification. I am fully aware that this certification, executed on
the date and in the county below, is made under penalty of perjury under the laws of the State of
California.
OFFICWo'S NAME
DAtE EXECUtED
CONTRACTOR.. GRANT AEc"IENT IlGNA1UAE
I EXECUtED linE COlJNTY OF
TITlE
FEOERAL I.D, NUMBER