RESOLUTION NO. 22-36
Resolution Of The City Council Of The City Of Emeryville Authorizing The City Manager To Execute A Continued Funding Application With The California Department Of Education For The Purpose Of Funding Continued Child Care And Development Services And To Authorize The City Manager To Sign Contract Documents For Fiscal Year 2022–23, The Continuing Funding Application, And All Related Contract Documents, And Any Future Amendments And Appropriate Said Funds When Received By The City To Accounts 230-53600 And 230-52300 WHEREAS, the City of Emeryville provides childcare services through the Emeryville Child Development Center (“Center”), located at 1220 53rd Street, Emeryville, California; and
WHEREAS, the Center is eligible to receive continued funding from the California State Department of Education on a yearly basis for its childcare services program to subsidize the costs of providing childcare to low-income families; and WHEREAS, the State requires the City to submit a completed continued funding application for continued funding for Fiscal Year 2022-23; now, therefore, be it RESOLVED, that the City Council of the City of Emeryville hereby authorizes the City Manager to execute a continued funding application with the California Department of Education for the purpose of funding continued child care and development services and to authorize the City Manager to sign contract documents for fiscal year 2022–23, the Continuing Funding Application, and all related contract documents and any future amendments and appropriate said funds when received by the City to accounts 230- 53600 and 230-52300.
ADOPTED, by the City Council of the City of Emeryville at a regular meeting held Tuesday, April 19, 2022, by the following vote:
AYES: 5
Mayor Bauters, Vice Mayor Medina and Council Members Donahue, Martinez and Welch
NOES: 0
ABSTAIN: 0
ABSENT: 0
MAYOR
ATTEST: APPROVED AS TO FORM:
CITY CLERK CITY ATTORNEY
DocuSign Envelope ID: 2427606C-E1F9-49E0-B93B-D274F47B38C3 California Department of Education
Early Education Division
EED-3704
CFA FY 2022–23
California State Preschool Program
Continued Funding Application Fiscal Year 2022–23
California Sate Preschool Program (CSPP) contractors who wish to be considered for continued funding for fiscal year (FY) 2022–23 must read the accompanying instructions and fully and accurately complete this application for continued funding.
Instructions may be accessed on the Continued Funding Application (CFA) web page at: https://www.cde.ca.gov/sp/cd/ci/cfaforms2223.asp.
Please note that CSPP contractors have no vested right to a subsequent contract.
Completion of this CFA does not guarantee a renewal of funding. Upon completion of this CFA the California Department of Education (CDE) will review the application and may contact your agency seeking additional information. If the CDE determines your agency will not be renewed for a subsequent contract year, you will be notified in writing no later than April 7, 2022, pursuant to the California Code of Regulations, Title 5 (5 CCR). CSPP contractors who apply for and are approved for continued funding do not need to sign a contract with the CDE to provide CSPP services for FY 2022–23, as contracts will be automatically renewed in accordance with all applicable federal and state laws as well as all CSPP Funding Terms and Conditions and Program Requirements that will be incorporated into the 2022–23 CSPP contract. By signing this CFA, the CSPP contractor is indicating that it wishes to automatically renew the CSPP contract for FY 2022–23 and is willing to, and does accept, all of the terms and conditions of the CSPP contract, which will be provided to the CSPP contractor no later than June 1, 2022. The CSPP contractor may reject the FY 2022–23 CSPP contract by providing the CDE with a written notice no later than July 1, 2022. Instructions on how to provide written notice of rejection of the terms of the new FY 2022–23 contract will be provided in forthcoming communication, on or before June 1, 2022, to CSPP contractors.
Failure to submit the CFA in a timely manner shall constitute as a notice to the CDE of the intent to discontinue services at the end of the current contract year, unless the CSPP contractor has received a written notice of extension of time from the CDE. If the CFA is returned to the CDE in a timely manner but is not fully and accurately completed, funding for FY 2022–23, if approved, may be delayed.
If you have any questions regarding the CFA, please contact [email protected].
DocuSign Envelope ID: 2427606C-E1F9-49E0-B93B-D274F47B38C3 California Department of Education
Early Education Division
EED-3704
CFA FY 2022–23
Section I – CSPP Contractor Information
Legal Name of CSPP Contractor:
CSPP Contractor Doing Business As (DBA):
Headquartered County:
Vendor Number:
Executive Director Name:
Executive Director Telephone Number:
Executive Director Fax Number:
Executive Director Email Address:
Legal Business Address:
City:
Zip Code:
Mailing Address (if different from above):
City:
Zip Code:
Name of Person Completing the CFA:
Title of Contact Person Completing the CFA:
Contact Person Telephone Number:
Contact Person Email Address:
California Department of Education Page 2 of 13
City Of Emeryville 01 Alameda 2178 Christine Daniel 510-596-4371 [email protected] 1333 Park Ave Emeryville 1220 53rd Street 94608 Emeryville 94608 Quera Owens ECDC Child Development Manager 510-596-4367 [email protected] DocuSign Envelope ID: 2427606C-E1F9-49E0-B93B-D274F47B38C3 &DOLIRUQLD'HSDUWPHQWRI(GXFDWLRQ
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Early Education Division
EED-3704
CFA FY 2022–23
Contractor Name: Vendor #: County:
Section III – CSPP Contractor’s Officers and Board of Directors Information Does the CSPP contractor have a board of directors? Yes No If no, please explain the entity type and the governance structure (i.e., number of owners and partnership).
Have any of the listed officers, board members, owners or other governing individuals ever served as an officer, board member, owner or governing individual with an agency that received state or federal funding and which agency funding was terminated or involuntarily non-renewed, or the agency was debarred from funding for any period of time?
Yes No
If yes, list on a separate page the officer(s), board member(s), owner(s) or other governing individual(s) to which this applies and include the former agency(ies) with which the individual(s) was/were previously affiliated and the circumstancesleading to the termination, involuntary non-renewal or debarment.
List all officers and board members/governing individuals (i.e., owner, director, etc.) Attach additional sheets as necessary.
Officer, Board
Member, Owner
or Governing
Individual Name
Title Telephone
Number
Mailing
Address
Email
Address
California Department of Education Page 4 of 13
City Of Emeryville 2178 01 Alameda
John Bauters
Mayor
510-596-4300
1333 Park Ave.
Emeryville, CA
94608
jbauters@emery
ville.org
Ally Medina Vice Mayor 510-596-4300 1333 Park Ave.
Emeryville, CA
94608
amedina
@emeryville.org
Dianne Martinez
Scott Donahue
Courtney Welch
Council Member 510-596-4300
1333 Park Ave.
Emeryville.org
[email protected]
[email protected]
[email protected]
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California Department of Education
Early Education Division
EED-3704
CFA FY 2022–23
Contractor Name: Vendor #: County:
Section V – CSPP Personnel Certification
The State of California requires any CSPP contractor receiving child care and development funds, disbursed by the CDE, to employ fully qualified personnel as stipulated in the California Education Code (EC); and the California Code of Regulations, Title 5 (5 CCR); and the Funding Terms and Conditions of the CSPP contract.
I certify, as the authorized agent representing this CSPP contractor, that I have read and understand the staffing requirements for Program Director, Site Supervisor, and Teacher. All staff employed in CDE funded CSPP are fully qualified for their respective positions. The exception to this certification is a person employed as Program Director or Site Supervisor who possesses a current Staffing Qualifications Waiver approved by the Early Education Division (ELCD).
Signature of the CSPP Contractor's
Authorized Representative:
Printed Name and Title of the CSPP
Contractor's Authorized
Representative:
Date of Signature:
Authorized Representative’s
Telephone Number:
Authorized Representative’s
Email Address:
California Department of Education Page 6 of 13
City Of Emeryville 2178 01 Alameda
DocuSign Envelope ID: 2427606C-E1F9-49E0-B93B-D274F47B38C3
California Department of Education
Early Education Division
EED-3704
CFA FY 2022–23
Contractor Name: Vendor #: County:
Section VI – Subcontract Certification
A. Please select the box below if the CSPP contractor does not have subcontractors, and move to section VII:
No subcontractors
B. Please select the box below if the CSPP contractor does have subcontractors,
and complete the information and sign in the section below. CSPP Contractors who subcontract CSPP services will need to complete and submit the form ELCD 3704B. The form is available on the CFA web page at:
https://www.cde.ca.gov/sp/cd/ci/cfaforms2223.asp.
Subcontractors
I certify that the contractual arrangement(s) listed above are made in adherence tothe required subcontract provisions contained in the 5 CCR, and the Funding Terms and Conditions of the CSPP contract.
I understand that signing this certificate does not lessen the legal responsibility for the CSPP contract requirements. As the CSPP contractor, it is my responsibility to monitor the performance of the subcontractor to ensure services are provided appropriately through the entire contract term.
Signature of the CSPP Contractor’s
Authorized Representative:
Printed Name and Title of the CSPP
Contractor’s Authorized Representative:
Date of Signature:
Authorized Representative’sTelephone Number:
Authorized Representative’s EmailAddress:
California Department of Education Page 7 of 13
City Of Emeryville 2178 01 Alameda
DocuSign Envelope ID: 2427606C-E1F9-49E0-B93B-D274F47B38C3
California Department of Education
Early Education Division
EED-3704
CFA FY 2022–23
Contractor Name: Vendor #: County:
Section VII – CSPP Contractor Certification
• Under penalty of perjury, I certify the following:
• I am authorized by the CSPP contractor’s Board of Directors or other governing authority toexecute this CFA, signifying their intent to automatically renew the current contract for FY 2022–23, under new terms and conditions to be established by the CDE, unless rejected in writing prior to the effective date of the new CSPP contract on July 1, 2022.
• On behalf of the CSPP contractor and its governing authority, we understand some information requested in this CFA is intended for use by CDE auditors in connection with future audit work and performance reviews and may not be used, or even reviewed or considered by the CDE until well after the CSPP contract has expired, if ever. Therefore, we further understand that the information (and any underlying transactions) disclosed by this CFA shall not be considered properly noticed to the CDE, nor approved, accepted or authorized by the CDE, even if our request for continued funding by the CDE is subsequently approved. • The governing board members have been trained in understanding conflict of interestrequirements associated with their positions on the board and have reported all knownconflicts of interest.
• I have supervisory authority over the CSPP, have actual, personal knowledge of the information provided in this CFA and certify that it istrue and correct in all material respects.
• I am familiar with and will ensure that the CSPP contractor complies with all applicableprogram statutes and regulations, including:
o Subcontracting requirements, including competitive bidding, CDE approval, andaudit requirements in 5 CCR.
o Prohibitions on conflicts of interests, including (i) the assurances required to establish that transactions with officers, directors and other related party transactions are conducted at arm’s length, and (ii) employment limitations stated in Education Code.
o Cost reimbursement requirements, including reimbursable and nonreimbursablecosts, documentation requirements, the provisions for determining the reimbursable amount and other provisions in 5 CCR, Accounting and reporting requirements in 5 CCR.
o Operational and programmatic requirements.
California Department of Education Page 8 of 13
City Of Emeryville 2178 01 Alameda
DocuSign Envelope ID: 2427606C-E1F9-49E0-B93B-D274F47B38C3 California Department of Education
Early Education Division
EED-3704
CFA FY 2022–23
Contractor Name: Vendor #: County:
By signing this CFA, the CSPP contractor is indicating that it wishes to automatically renew the current CSPP contract for FY 2022-23 and, if approved, is willing to, and does accept, all of the terms and conditions of the CSPP contract, which will be provided to the CSPP contractor no later than June 1, 2022. The CSPP contractor may reject the FY 2022–23 CSPP contract by providing the CDE with a written notice of rejection no later than July 1, 2022. Instructions on how to provide written notice of rejection of the terms of the new FY 2022–23 contract will be provided in forthcoming communication, on or before June 1, 2022, to CSPP contractors.
Signature of the CSPP Contractor’s
Authorized Representative:
Printed Name and Title of the
CSPP Contractor's
Authorized Representative:
Date of Signature:
Authorized Representative’s
Telephone Number:
Authorized Representative’s Email
Address:
California Department of Education Page 9 of 13
City Of Emeryville 2178 01 Alameda
DocuSign Envelope ID: 2427606C-E1F9-49E0-B93B-D274F47B38C3 California Department of Education
Early Education Division
EED-3704
CFA FY 2022–23
Contractor Name: Vendor #: County:
Section VIII – Certification of CSPP Contractor Information in the Child Development Management Information System
CSPP contractors are required to review all information in the Child Development Management Information System (CDMIS) and update any outdated or incorrect information. To review the information and submit changes, log on to the CDMIS at https://www4.cde.ca.gov/cdmis/default.aspx.
As the authorized representative of the CSPP contractor listed below, I certify, under penalty of perjury, that I have reviewed all of the information for and updates, additions, or deletions have been submitted as needed for information in all of the areas below:
• Executive Director/Superintendent information
• Program Director information
• Sites and Licenses and/or Office information
• CSPP Family Child Care Home Education Network (FCCHEN) provider summary information
To the best of my knowledge, the information on the CDMIS website reflects accurate information for the
as of the date this certification is signed.
Program Director/Authorized Representative Signature: Date Signed:
Printed Name of Program Director/Authorized Representative:
California Department of Education Page 10 of 13
City Of Emeryville 2178 01 Alameda City Of Emeryville City Of Emeryville DocuSign Envelope ID: 2427606C-E1F9-49E0-B93B-D274F47B38C3
California Department of Education
Early Education Division
EED-3704
CFA FY 2022–23
Contractor Name: Vendor #: County:
Section IX – Required Attachments
All attachments and/or documentation below must be completed and included when submitting the CFA. Attachments A-J are located on the CFA web page at:
https://www.cde.ca.gov/sp/cd/ci/cfaforms2223.asp.
A. Fiscal Year 2022–23 Program Calendar (ELCD-9730)
B. Payee Data Record (STD. 204) (Non-public agencies only) C. Payee Data Record Supplement (STD. 205) (Non-public agencies only, as applicable)
D. Secretary of State (Non-public agencies only)
E. Verification of School District Name and Address (Public agencies only) F. Program Narrative Change (ELCD 3704A) (As applicable) G. Subcontractor Certification (ELCD 3704B) (As applicable) H. California Civil Rights Laws Certification (CO-005)
I. Contractor Certification Clauses (CCC 04/2017)
J. Federal Certification (CO.8)
K. For Public Agencies only, include a copy of the agency’s board resolution and/or minutes authorizing signature on this document, and a delegation of authority, if applicable
California Department of Education Page 11 of 13
City Of Emeryville 2178 01 Alameda
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California Department of Education
Early Education Division
EED-3704
CFA FY 2022–23
Contractor Name: Vendor #: County:
Section
Number Section Description Page Number
Check
Box
Section IX G. Subcontractor Certification (ELCD
3704B)
Insert
after page
7 Section IX
H.*
California Civil Rights Laws
Certification (CO-005)
11 Section IX I.* Contractor Certification Clauses
(CCC 04/2017)
11 Section IX J.* Federal Certification (CO.8) 11
Section IX
K.*
For Public Agencies, include a copy
of the agency’s board resolution or
minutes authorizing signature on this
document, and a delegation of
authority, if applicable
11 All Sections must be included in the CFA package, as applicable *Bolded sections require a signature
California Department of Education Page 13 of 13
City Of Emeryville 2178 01 Alameda
DocuSign Envelope ID: 2427606C-E1F9-49E0-B93B-D274F47B38C3 Contractor Certification Clauses
CCC 04/2017
CERTIFICATION
I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind the prospective Contractor to the clause(s) listed below. This certification is made under the laws of the State of California.
Contractor/Bidder Firm Name (Printed) Federal ID Number By (Authorized Signature)
Printed Name and Title of Person Signing
Date Executed Executed in the County of
CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with the nondiscrimination program requirements. (Gov. Code §12990 (a-f) and CCR, Title 2, Section 11102) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-free workplace by taking the following actions:
a. 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.
b. Establish a Drug-Free Awareness Program to inform employees about:
1) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free workplace; 3) any available counseling, rehabilitation and employee assistance programs; and, 4) penalties that may be imposed upon employees for drug abuse violations. c. Every employee who works on the proposed Agreement will:
1) receive a copy of the company's drug-free workplace policy statement; and, City of Emeryville 94-6000326 Christine Daniel, City Manager Alameda DocuSign Envelope ID: 2427606C-E1F9-49E0-B93B-D274F47B38C3
2) agree to abide by the terms of the company's statement as a condition of employment on the Agreement.
Failure to comply with these requirements may result in suspension of payments under the Agreement or termination of the Agreement or both and Contractor may be ineligible for award of any future State agreements if the department determines that any of the following has occurred: the Contractor has made false certification, or violated the certification by failing to carry out the requirements as noted above. (Gov. Code §8350 et seq.)
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor certifies that no more than one (1) final unappealable finding of contempt of court by a Federal court has been issued against Contractor within the immediately preceding two-year period because of Contractor's failure to comply with an order of a Federal court, which orders Contractor to comply with an order of the National Labor Relations Board. (Pub. Contract Code §10296) (Not applicable to public entities.)
4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO REQUIREMENT: Contractor hereby certifies that Contractor will comply with the requirements of Section 6072 of the Business and Professions Code, effective January 1, 2003.
Contractor agrees to make a good faith effort to provide a minimum number of hours of pro bono legal services during each year of the contract equal to the lessor of 30 multiplied by the number of full time attorneys in the firm’s offices in the State, with the number of hours prorated on an actual day basis for any contract period of less than a full year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state contract for legal services, and may be taken into account when determining the award of future contracts with the State for legal services.
5. EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an expatriate corporation or subsidiary of an expatriate corporation within the meaning of Public Contract Code Section 10286 and 10286.1, and is eligible to contract with the State of California.
6. SWEATFREE CODE OF CONDUCT:
a. All Contractors contracting for the procurement or laundering of apparel, garments or corresponding accessories, or the procurement of equipment, materials, or supplies, other than procurement related to a public works contract, declare under penalty of perjury that no apparel, garments or corresponding accessories, equipment, materials, or supplies furnished to the state pursuant to the contract have been laundered or produced in whole or in part by sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor, or with the benefit of sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor.
The contractor further declares under penalty of perjury that they adhere to the Sweatfree Code of Conduct as set forth on the California Department of Industrial Relations website located at www.dir.ca.gov, and Public Contract Code Section 6108. b. The contractor agrees to cooperate fully in providing reasonable access to the contractor’s records, documents, agents or employees, or premises if reasonably DocuSign Envelope ID: 2427606C-E1F9-49E0-B93B-D274F47B38C3
required by authorized officials of the contracting agency, the Department of Industrial Relations, or the Department of Justice to determine the contractor’s compliance with the requirements under paragraph (a).
7. DOMESTIC PARTNERS: For contracts of $100,000 or more, Contractor certifies that Contractor is in compliance with Public Contract Code section 10295.3.
8. GENDER IDENTITY: For contracts of $100,000 or more, Contractor certifies that Contractor is in compliance with Public Contract Code section 10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of California.
1. CONFLICT OF INTEREST: Contractor needs to be aware of the following provisions regarding current or former state employees. If Contractor has any questions on the status of any person rendering services or involved with the Agreement, the awarding agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code §10410):
1). No officer or employee shall engage in any employment, activity or enterprise from which the officer or employee receives compensation or has a financial interest and which is sponsored or funded by any state agency, unless the employment, activity or enterprise is required as a condition of regular state employment. 2). No officer or employee shall contract on his or her own behalf as an independent contractor with any state agency to provide goods or services.
Former State Employees (Pub. Contract Code §10411):
1). For the two-year period from the date he or she left state employment, no former state officer or employee may enter into a contract in which he or she engaged in any of the negotiations, transactions, planning, arrangements or any part of the decision-making process relevant to the contract while employed in any capacity by any state agency. 2). For the twelve-month period from the date he or she left state employment, no former state officer or employee may enter into a contract with any state agency if he or she was employed by that state agency in a policy-making position in the same general subject area as the proposed contract within the 12-month period prior to his or her leaving state service.
If Contractor violates any provisions of above paragraphs, such action by Contractor shall render this Agreement void. (Pub. Contract Code §10420) Members of boards and commissions are exempt from this section if they do not receive payment other than payment of each meeting of the board or commission, payment for preparatory time and payment for per diem. (Pub. Contract Code §10430 (e))
2. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware of the provisions which require every employer to be insured against liability for Worker's Compensation or to undertake self-insurance in accordance with the provisions, and DocuSign Envelope ID: 2427606C-E1F9-49E0-B93B-D274F47B38C3
Contractor affirms to comply with such provisions before commencing the performance of the work of this Agreement. (Labor Code Section 3700)
3. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits discrimination on the basis of disability, as well as all applicable regulations and guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE: An amendment is required to change the Contractor's name as listed on this Agreement. Upon receipt of legal documentation of the name change the State will process the amendment. Payment of invoices presented with a new name cannot be paid prior to approval of said amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the contracting agencies will be verifying that the contractor is currently qualified to do business in California in order to ensure that all obligations due to the state are fulfilled. b. "Doing business" is defined in R&TC Section 23101 as actively engaging in any transaction for the purpose of financial or pecuniary gain or profit. Although there are some statutory exceptions to taxation, rarely will a corporate contractor performing within the state not be subject to the franchise tax.
c. Both domestic and foreign corporations (those incorporated outside of California) must be in good standing in order to be qualified to do business in California. Agencies will determine whether a corporation is in good standing by calling the Office of the Secretary of State.
6. RESOLUTION: A county, city, district, or other local public body must provide the State with a copy of a resolution, order, motion, or ordinance of the local governing body which by law has authority to enter into an agreement, authorizing execution of the agreement.
7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the Contractor shall not be: (1) in violation of any order or resolution not subject to review promulgated by the State Air Resources Board or an air pollution control district; (2) subject to cease and desist order not subject to review issued pursuant to Section 13301 of the Water Code for violation of waste discharge requirements or discharge prohibitions; or (3) finally determined to be in violation of provisions of federal law relating to air or water pollution.
8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all contractors that are not another state agency or other governmental entity.
DocuSign Envelope ID: 2427606C-E1F9-49E0-B93B-D274F47B38C3 California Department of Education
Fiscal & Administrative Services Division
CO-005 (NEW 4/2020)
CALIFORNIA CIVIL RIGHTS LAWS CERTIFICATION
Pursuant to Public Contract Code section 2010, if a bidder or proposer executes or renews a contract in the amount of $100,000 or more on or after January 1, 2017, the bidder or proposer hereby certifies compliance with the following:
1. CALIFORNIA CIVIL RIGHTS LAWS: For contracts $100,000 or more, executed or renewed after January 1, 2017, the contractor certifies compliance with the Unruh Civil Rights Act (Section 51 of the Civil Code) and the Fair Employment and Housing Act (Section 12960 of the Government Code); and
2. EMPLOYER DISCRIMINATORY POLICIES: For contracts $100,000 or more, executed or renewed after January 1, 2017, if a Contractor has an internal policy against a sovereign nation or peoples recognized by the United States government, the Contractor certifies that such policies are not used in violation of the Unruh Civil Rights Act (Section 51 of the Civil Code) or the Fair Employment and Housing Act (Section 12960 of the Government Code).
CERTIFICATION
I, the official named below, certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
1. Proposer/Bidder Firm Name (Printed):
2. Federal ID Number:
3. By (Authorized Signature):
4. Printed Name and Title of Person Signing:
5. Date Executed:
6. Executed in the County and State of:
City of Emeryville 94-6000326 Christine Daniel, City Manager Alameda, CA DocuSign Envelope ID: 2427606C-E1F9-49E0-B93B-D274F47B38C3
FEDERAL CERTIFICATIONS
CO.8 (REV. 06/20)
California Department of Education
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants should also review the instructions for certification included in the regulations before completing this form. Signature on this form provides for compliance with certification requirements under 45 CFR Part 93, “New restrictions on Lobbying,” and 45 CFR Part 76, “Government-wide Debarment and Suspension (Non procurement) and Government-wide requirements for Drug-Free Workplace (Grants).” The certifications shall be treated as a material representation of fact upon which reliance will be placed when the Department of Education determines to award the covered transaction, grant, or cooperative agreement.
_____________________________________________________________________________________
1. LOBBYING
As required by Section 1352, Title 31 of the U.S.
Code, and implemented at 45 CFR Part 93, for
persons entering into a grant or cooperative
agreement over $100,000 as defined at 45 CFR
Part 93, Sections 93.105 and 93.110, the applicant
certifies that:
(a) No federal appropriated funds have been paid
or will be paid, by or on behalf of the undersigned,
to any person for influencing or attempting to
influence an officer or employee of any agency, a
member of Congress in connection with the
making of any federal grant, the entering into of
any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification
of any federal grant or cooperative agreement:
(b) If any funds other than federal appropriated
funds have been or will be paid to any person for
influencing or attempting to influence an employee
of Congress, or any employee of a Member of
Congress in connection with this Federal grant or
cooperative agreement, the undersigned shall
complete and submit Standard Form -LLL,
“Disclosure Form to Report Lobbying,” in
accordance with this instruction;
(c) The undersigned shall require that the language
of this certification be included in the award
documents for all subawards at all tiers (including
subgrants, contracts under grants and cooperative
agreements, and subcontracts) and that all
subrecipients shall certify and disclose
accordingly.
________________________________________
2. DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS
As required by executive Order 12549, Debarment
and Suspension, and other responsibilities
implemented at 45 CFR Part 76, for prospective
participants in primary or a lower tier covered
transactions, as defined at 45 CFR Part 76,
Sections 76.105 and 76.110.
A. The applicant certifies that it and its principals:
(a) Are not presently debarred, suspended
proposed for debarment, declared ineligible, or
voluntarily excluded from covered transactions by
any federal department or agency:
(b) Have not within a three-year period preceding
this application been convicted of or had a civil
judgment rendered against them for commission of
fraud or a criminal offense in connection with
obtaining, attempting to obtain, or performing a
public (federal, state, or local) transaction or
contract under a public transaction violation of
federal or State antitrust statutes or commission of
embezzlement, theft, forgery, bribery, falsification
or destruction of records, making false statements,
or receiving stolen property;
(c) Are not presently indicted for or otherwise
criminally or civilly charged by a governmental
entity (federal, state, or local) with commission of
any of the offenses enumerated in paragraph (1)
(b) of this certification; and
1 DocuSign Envelope ID: 2427606C-E1F9-49E0-B93B-D274F47B38C3 (d) Have not within a three-year period proceeding
this application had one or more public
transactions (federal, state, or local) terminated for
cause or default; and
B. Where the applicant is unable to certify to any
of the statements in this certification, he or she
shall attach an explanation to this application.
________________________________________
3. DRUG-FREE WORKPLACE (GRANTEES
OTHER THAN INDIVIDUALS)
As required by the Drug-Free Workplace Act of
1988, and implemented at 45 CFR Part 76,
Subpart F, for grantees, as defined at 45 CFR Part
76, Sections 76.605 and 76.610-
A. The applicant certifies that it will or will continue to provide a drug-free workplace by:
(a) Publishing a statement notifying employees that
the unlawful manufacture, distribution, dispensing,
possession, or use of a controlled substance is
prohibited in the grantee’s workplace and
specifying the actions that will be taken against
employees for violation of such prohibition.
(b) Establishing an on-going drug-free awareness
program to inform employees about-
(1) The danger of drug abuse in the workplace;
(2) The grantee’s policy of maintaining a drugfree workplace; (3) Any available drug counseling, rehabilitation,
and employee assistance programs; and
(4) The penalties that may be imposed upon
employees for drug abuse violations occurring in
the workplace;
(c) Making it a requirement that each employee to
be engaged in performance of the grant be given a
copy of the statement required by paragraph (a);
(d) Notifying the employee in the statement required
by paragraph (a) that, as a condition of
employment under the grant, the employee will -
(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or her
conviction for a violation;
(e) Notifying the agency, in writing, within 10
calendar days after receiving notice under
subparagraph (d) (2) from an employee or
otherwise receiving actual notice of such
conviction. Employers of convicted employees
must provide notice, including position title,
to: Director, Grants, and Contracts Service, U.S.
Department of Education, 400 Maryland Avenue,
S.W., (Room 3124, GSA Regional Office
Building No. 3), Washington, DC 20202-4571.
Notice shall include the identification number(s)
of each affected grant;
(f) Taking one of the following actions, within 30
calendar days of receiving notice under
subparagraph (d) (2), with respect to any
employee who is so convicted:
(1) Taking appropriate personnel action against
such an employee, up to and including termination,
consistent with the requirements of the
Rehabilitation Act of 1973, as amended; or
(2) Requiring such employee to participate
satisfactorily in a drug abuse assistance or
rehabilitation program approved for such purposes
by a federal, state, or local health, law
enforcement, or other appropriate agency:
(g) Making a good faith effort to continue to
maintain a drug-free workplace through
implementation of paragraphs (a), (b), (c), (d),(e),
and (f).
B. The grantee shall insert in the space provided
below the
site(s) for the performance of work done in
connection with the specific grant:
Place of Performance (Street address, city,
county, state, zip code)
2 1220 53rd St. Emeryville Ca 94608 Alameda County
DocuSign Envelope ID: 2427606C-E1F9-49E0-B93B-D274F47B38C3 Check [ ] if there are workplaces on file that are
not identified here.
DRUG-FREE WORKPLACE
(GRANTEES WHO ARE INDIVIDUALS)
As required by the Drug-Free Workplace Act of
1988, and implemented at 45 CFR Part 76,
Subpart F, for grantees, as defined at 45 CFR
Part 76, Sections 76.605 and 76.610-
a. As a condition of the grant, I certify that I will
not engage in the unlawful manufacture,
distribution, dispensing, possession, or use of a
controlled substance in conducting any activity
with the grant, and
b. If convicted of a criminal drug offense resulting
from a violation occurring during the conduct of
any grant activity, I will report the conviction, in
writing, within 10 calendar days of the conviction,
to: Director, Grants and contracts Service, U.S.
department of Education, 400 Maryland Avenue,
S.W. (Room 3124, GSA Regional Office Building
No. 3) Washington, DC 20202-4571. Notice shall
include the identification numbers(s) of each
affected grant.
ENVIRONMENTAL TOBACCO SMOKE ACT
As required by the Pro-Children Act of 1994,
(also known as Environmental Tobacco Smoke),
and implemented at Public Law 103-277, Part C
requires that:
The applicant certifies that smoking is not
permitted in any portion of any indoor facility
owned or leased or contracted and used
routinely or regularly for the provision of health
care services, day care, and education to
children under the age of 18. Failure to comply
with the provisions of this law may result in the
imposition of a civil monetary penalty of up to
$1,000 per day. (The law does not apply to
children’s services provided in private residence,
facilities funded solely by Medicare or Medicaid
funds, and portions of facilities used for inpatient drug and alcohol treatment.) _____________________________________________________________________________________ As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above certifications.
NAME OF APPLICANT (CONTRACTOR) CONTRACT #
PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE
SIGNATURE DATE
3 City of Emeryville Christine Daniel, City Manager
DocuSign Envelope ID: 2427606C-E1F9-49E0-B93B-D274F47B38C3