Application
Fiscal Year 2023–24 Continued Funding
Early Education Division
DUE DATE: December 9, 2022
Overview
Contractors holding a current California State Preschool Program (CSPP) contract, and if applicable a Prekindergarten and Family Literacy Support (CPKS) contract, who wish to be considered for continued funding for fiscal year (FY) 2023–24 must complete this application for continued funding. The FY 2023–24 Continued Funding Application (CFA) Overview and Instructions may be accessed on the CFA web page.
Upon completion of this CFA, the California Department of Education (CDE) will review the application and may contact your agency seeking additional information. CSPP contractors who apply for and are approved for continued funding do not need to sign a contract with the CDE to provide CSPP and CPKS services for FY 2023–24, as contracts will be automatically renewed in accordance with all applicable federal and state laws as well as all CSPP Contract Terms and Conditions (CT&Cs) that will be incorporated into the 2023–24 CSPP contract, and all CPKS CT&Cs, as applicable. By signing this CFA, the CSPP contractor is indicating that it wishes to automatically renew its contract for FY 2023–24 and is willing to, and does accept, all of the terms and conditions of the 2023–24 CSPP contract and, if applicable the 2023–24 CPKS contract, which will be provided to the CSPP contractor no later than June 1, 2023.
Please also note that contractors have no vested right to a subsequent contract. Completion of this CFA does not guarantee a renewal of funding. 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, 2023, pursuant to the California Code of Regulations, Title 5 (5 CCR) Section 17828. Contractors who apply for and are approved for continued funding do not need to sign a contract with the CDE to provide CSPP and, if applicable, CPKS services for FY 2023–24, as contracts will be automatically renewed in accordance with all applicable federal and state laws as well as all CSPP and CPKS CT&Cs that will be incorporated into the 2023–24 contract, as applicable.
If the CFA is returned to the CDE in a timely manner but is not fully and accurately completed, funding for FY 2023–24, if approved, may be delayed.
DocuSign Envelope ID: 74ECD090-433B-4105-8517-BBEF60E153B3 Contractors that wish to reject the terms of the FY 2023–24 CSPP and/or CPKS contract must provide the CDE with a written notice that the terms of the contract(s) are rejected by emailing [email protected] on or before June 30, 2023. The email should come from the Executive Director/Superintendent of the contracting entity or their authorized representative and state that the terms of the FY 2023–24 CSPP and, as applicable, the CPKS contract are rejected. Contractors providing such notice to the CDE of the rejection of the terms of the contract will not have a contract(s) in effect for FY 2023–24. Note that while contractors who currently receive CPKS funding may reject their 2023–24 CPKS contract, they cannot reject their 2023–24 CSPP contract and still receive funding under a CPKS contract since CPKS funding is tied to having a CSPP contract.
If a contractor wishes to terminate the contract for any reason during the FY 2023–24 contract term, the contractor shall notify the CDE of its intent to terminate the contract at least 90 calendar days in advance of contract termination and shall follow CCR 17795.
Instructions
All application fields are required for submission of the application unless otherwise noted as optional. The application is structured into the following sections:
Section I: Contractor Information
Section II: Contract and Program Type
Section III: Contractor’s Officers and Board of Directors Information Section IV: Program Narrative
Section V: Personnel Certification
Section VI: Subcontract Certification
Section VII: Contractor Certification
Section VIII: Certification of Contractor Information in the CDMIS Section IX: Required Attachments
Section X: CFA Checklist
The CFA must be signed by the District Superintendent, Charter School Administrator, or authorized designee with authority to submit applications for funding on behalf of the Local Education Agency (LEA).
If you do not intend to complete the CFA in one session, you must select the Save Responses button located on the bottom of the screen. Once selected, you will be redirected to a new browser window to enter your email address. You will receive an email with a unique web address for entrance back into the CFA. It is recommended that you save the application web address. If you have any questions regarding the CFA, please contact [email protected].
Section I: Contractor Information
Contractor Legal Name:
City of Emeryville
Contractor "Doing Business As" (DBA):
Emeryville Child Development Center
DocuSign Envelope ID: 74ECD090-433B-4105-8517-BBEF60E153B3 Headquartered County:
01 Alameda
Vendor Number:
2178
Executive Director Name:
Paul Buddenhagen
Executive Director Telephone Number: (999-999-9999)
510-596-4300
Executive Director Email Address:
[email protected]
Legal Business Address:
1333 Park Avenue
City:
Emeryville
Zip Code:
94608
Is Mailing Address different from Legal Business Address? Yes
No
Mailing Address:
1220 53rd Street
Mailing City:
Emeryville
Mailing Zip Code:
94608
Name of Person Completing the CFA:
Lois Porter
Title of Person Completing the CFA:
Manager
DocuSign Envelope ID: 74ECD090-433B-4105-8517-BBEF60E153B3 Contact Person Telephone Number: (999-999-9999)
510-596-4348
Contact Person Email Address:
[email protected]
Section II: Contract and Program Type
Part 1: Contract and Program Type
Check all applicable boxes indicating the programs the contractor intends to continue to administer for the FY 2023–24. The contractor agrees to continue implementation of these programs with funds provided by the CDE.
Contract Type: (select all that apply)
CSPP
CPKS
Does the CSPP operate a Family Childcare Home Education Network? Yes
No
ProgramType: (select all that apply)
Full-Day/Full-Year
Part-Day/Part-Year
Full-Day/Part-Year
Part-Day/Full-Year
Part 2: Funded Enrollment
Insert the number of children your agency expects to enroll with the CSPP contract for each county services are provided, as applicable.
How many counties does your agency operate in?
1 County 1 Information
Select the County Name:
01 Alameda
DocuSign Envelope ID: 74ECD090-433B-4105-8517-BBEF60E153B3 Number of Children to be
Enrolled in Part-Day CSPP in
County 1:
0 Number of Children to be
Enrolled in Full-Day CSPP in
County 1:
11 Total Number of Children to be
Enrolled in County 1: 11
Total Number of CSPP Children to be Enrolled: (Add the total from each county.) 11 To request a change to these numbers during the fiscal year, the contractor must submit a Program Narrative Change to request approval from their assigned regional consultant. The new “Number of Children” must also be reported during the Program Self Evaluation survey.
Section III: Contractor’s Officers and Board of Directors Information Does the contractor have a board of directors?
Yes
No
How many officers and board members/governing individuals does your agency have? (If there are more than 10, please complete this section and email [email protected] with any additional members and their contact information.) 5 Officer #1:
Officer 1 First Name: John
Officer 1 Last Name: Bauters
Officer 1 Title: Mayor
Officer 1 Telephone Number:
(999-999-9999)
510-596-4376
Officer 1 Mailing Address: 1333 Park Avenue Emeryville CA 94608 Officer 1 Email Address: [email protected]
Officer #2:
Officer 2 First Name: Courtney
Officer 2 Last Name: Welch
Officer 2 Title: Vice Mayor
Officer 2 Telephone Number
(999-999-9999): 510-596-4376
Officer 2 Mailing Address: 1333 Park Avenue Emeryville CA 94608 Officer 2 Email Address: [email protected]
DocuSign Envelope ID: 74ECD090-433B-4105-8517-BBEF60E153B3 Officer #3:
Officer 3 First Name: Ally
Officer 3 Last Name: Medina
Officer 3 Title: Council Memebr
Officer 3 Telephone Number
(999-999-9999): 510-596-4376
Officer 3 Mailing Address: 1333 Park Avenue Emeryville CA 94608 Officer 3 Email Address: [email protected]
Officer #4:
Officer 4 First Name: David
Officer 4 Last Name: Mourra
Officer 4 Title: Council Member
Officer 4 Telephone Number
(999-999-9999): 510-596-4376
Officer 4 Mailing Address: 1333 Park Avenue Emeryville CA 94608 Officer 4 Email Address: [email protected]
Officer #5:
Officer 5 First Name: Kalimah
Officer 5 Last Name: Priforce
Officer 5 Title: Council Member
Officer 5 Telephone Number
(999-999-9999): 510-596-4376
Officer 5 Mailing Address: 1333 Park Avenue Emeryville CA 94608 Officer 5 Email Address: [email protected]
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
Section IV: Program Narrative
Does the contractor have programmatic or calendar changes? Yes
No
Section V: Personnel Certification
The State of California requires any contractor receiving early education and care funding, disbursed by the CDE, to employ fully qualified personnel as stipulated in the California Education Code (EC); and the 5 CCR; and the CT&Cs.
DocuSign Envelope ID: 74ECD090-433B-4105-8517-BBEF60E153B3 I certify, as the authorized agent representing this contractor, that I have read and understand the staffing requirements for Program Director, Site Supervisor, and Teacher. All staff employed by the contractor for the provision of preschool services 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.
AGREEMENT: By signing this application electronically, I, the District Superintendent, or authorized designee, agree that my electronic signature is the legally binding equivalent to my handwritten signature.
Yes
No
Printed Name of the Contractor's Authorized Representative:
Paul Buddenhagen
Title of the Contractor's Authorized Representative:
City Manager
Certification Date: (MM/DD/YYYY)
01/17/2023
Authorized Representative’s Telephone Number: (999-999-9999) 510-596-4300
Authorized Representative’s Email Address:
[email protected]
Section VI: Subcontract Certification
Does the Contractor have subcontractors?
Yes
No
AGREEMENT: By signing this application electronically, I, the District Superintendent, or authorized designee, agree that my electronic signature is the legally binding equivalent to my handwritten signature.
Yes
No
Printed Name of the Contractor’s Authorized Representative:
Paul Buddenhagen
Title of the Contractor’s Authorized Representative:
City Manager
DocuSign Envelope ID: 74ECD090-433B-4105-8517-BBEF60E153B3 Certification Date: (MM/DD/YYYY)
01/17/2023
Authorized Representative’s Telephone Number: (999-999-9999) 510-596-4300
Authorized Representative’s Email Address:
[email protected]
Section VII: Contractor Certification
Under penalty of perjury, I certify the following: (Each box below must be selected in order to continue with the application.)
I am authorized by the contractor’s Board of Directors or other governing authority to execute this CFA, signifying their intent to automatically renew the current CSPP contract and CPKS contract if applicable for FY 2023–24, 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 June 30, 2023.
On behalf of the 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 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 or persons with governing authority have been trained in understanding conflict of interest requirements associated with their positions on the board and have reported all known conflicts of interest.
I have supervisory authority over the CSPP, have actual, personal knowledge of the information provided in this CFA and certify that it is true and correct in all material respects.
I am familiar with and will ensure that the contractor complies with all applicable program statutes and regulations, including but not limited to: (Each box below must be selected in order to continue with the application.) Subcontracting requirements, including competitive bidding, CDE approval, and audit requirements in 5 CCR.
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 EC.
Cost reimbursement requirements, including reimbursable and non-reimbursable costs, documentation requirements, the provisions for determining the reimbursable amount and other provisions in 5 CCR, and accounting and reporting requirements in 5 CCR.
Operational and programmatic requirements.
DocuSign Envelope ID: 74ECD090-433B-4105-8517-BBEF60E153B3 By signing this CFA, the contractor is indicating that it wishes to automatically renew the current contract for FY 2023–24 and, if approved, is willing to, and does accept, all terms and conditions of the CSPP contract, which will be provided to the CSPP contractor no later than June 1, 2023. The contractor may reject the FY 2023–24 contract by providing the CDE with a written notice of rejection no later than June 30, 2023. Contractors that wish to reject the terms of the FY 2023–24 contract must provide written notice that the terms of the contract are rejected by emailing [email protected] on or before June 30, 2023. The email should come from the Executive Director/Superintendent of the contracting entity or their authorized representative and state that the terms of the FY 2023–24 CSPP and/or CPKS contract are rejected. Contractors providing such notice to the CDE of the rejection of the terms of the contract will not have a contract in effect for FY 2023–24.
AGREEMENT: By signing this application electronically, I, the District Superintendent, or authorized designee, agree that my electronic signature is the legally binding equivalent to my handwritten signature.
Yes
No
Printed Name of the Contractor’s Authorized Representative:
Paul Buddenhagen
Title of the Contractor's Authorized Representative:
City Manager
Certification Date: (MM/DD/YYYY)
01/17/2023
Authorized Representative’s Telephone Number: (999-999-9999) 510-596-4300
Authorized Representative’s Email Address:
[email protected]
Section VIII: Certification of Contractor Information in the CDMIS 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.
DocuSign Envelope ID: 74ECD090-433B-4105-8517-BBEF60E153B3 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 City of Emeryville and updates, additions, or deletions have been submitted as needed for information in all of the areas below: (Each box below must be selected in order to continue with the application.)
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, if applicable
To the best of my knowledge, the information on the CDMIS website reflects accurate information for City of Emeryville as of the date this certification is signed.
AGREEMENT: By signing this application electronically, I, the District Superintendent, or authorized designee, agree that my electronic signature is the legally binding equivalent to my handwritten signature.
Yes
No
Printed Name of Program Director/Authorized Representative:
Paul Buddenhagen
Certification Date: (MM/DD/YYYY)
01/17/2023
Section IX – Required Attachments
All attachments and/or documentation below must be completed and current for this CFA and attached to this application for this CFA and included when submitting the CFA. Download, complete, and save attachments A-L, as applicable, from the CFA web page.
All applicants are required to upload the Program Calendar (EED 9730), California Civil Rights Laws Certification (CO-005), Contractor Certification Clauses (CCC), and Federal Certification (CO.8) into the online application system. Public agencies and non-public agencies each have their own documentation requirements, as noted below, that must be uploaded into the online application system.
These files should be saved into a single zip file for uploading into the system as only one file can be uploaded per applicant. No additional information included in the zip file will be reviewed. The zip file size limit is 20MB. To learn more about zip files and how to create them, visit Microsoft Support.
DocuSign Envelope ID: 74ECD090-433B-4105-8517-BBEF60E153B3 Which forms will be included in the uploaded zip file? (Select all that apply; Items with an asterisk indicate a signature is required.)
A. Fiscal Year 2023–24 Program Calendar (EED 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 (EED 3704A) (as applicable) G. Subcontractor Certification (EED 3704B) (as applicable) * H. CSPP License Exemption Self-Certification (as applicable) * I. California Civil Rights Laws Certification (CO-005) * J. Contractor Certification Clauses (CCC) *
K. Federal Certification (CO.8) *
L. Agency’s board resolution and/or minutes authorizing signature on this document, and a delegation of authority, if applicable (public agencies only) * Upload the required attachments selected above to the application by selecting the attach icon below.
ref:0000003248:Q70
Submitting the CFA
Note: Print a copy of your completed CFA for your records before submitting it. By selecting the Print button below, you will be redirected to a new browser window to print the form. You must return to the previous browser window to submit your CFA to the CDE.
Once you select the Submit button below, your CFA will be sent to the CDE and you will be redirected to the CDE CFA web page. An automatically generated email will be sent to the email address(es) provided on your CFA. Please check your email account's spam folder if you do not receive a confirmation email to your inbox. There is an additional step to complete your application contained in the confirmation email you will receive.
Approved As To Form:
__________________
General Counsel
DocuSign Envelope ID: 74ECD090-433B-4105-8517-BBEF60E153B3