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SCO ID: 7120-521587120-A2 <br />STATE OF CALIFORNIA <br />AGREEMENT SUMMARY <br />STD 215 (Rev. 04/2020) <br />0 CHECK HERE IF ADDITIONAL PAGES ARE ATTACHED <br />AGREEMENT NUMBER AMENDMENT NUMBER <br />M0113521 2 <br />1. CONTRACTOR'S NAME 2. FEDERAL I.D. NUMBER <br />City of Santa Ana 1 9560000785 <br />3. AGENCY TRANSMITTING AGREEMENT 4. DIVISION, BUREAU, OR OTHER UNIT S. AGENCY BILLING CODE <br />California Workforce Development Board/EDD Contract Services Group 010015 <br />6a. CONTRACT ANALYST NAME 6b. EMAIL - So. PHONE NUMBER <br />Tyler Jennings Tyler.Jennings@edd.ca.gov (916) 653-1660 <br />7. HAS YOUR AGENCY CONTRACTED FOR THESE SERVICES BEFORE? <br />DNo n Yes (If Yes, enterprior Contractor Name and Agreement Number) <br />PRIOR CONTRACTOR NAME PRIOR AGREEMENT NUMBER <br />8. BRIEF DESCRIPTION OF SERVICES <br />Subvention Grant -CWDB RFA No.84049 <br />9. AGREEMENT OUTLINE (Include reason forAgreement: Identify specific problem, administrative requirement, program need or other circumstances making <br />the Agreement necessary; include special or unusual terms and conditions.) <br />The purpose of this amendment is due to the region removing the service provider, Chrysalis, from their Agency Funding Form, and <br />adding Working Wardrobes in its place. The region reallocated funds within their Agency Funding form to better serve participants in <br />their program. Also, the region implemented a budget modification to ensure their Invoicing is correct and allocated more funds for their <br />contracts. This scope of work amendment does not impact the amount of the contract or extend the term dates. <br />Contractor will provide services and deliverable specific t0 the Prison to Employment Initiative, as per CWDB RFA No. 84049. <br />10. PAYMENT TERMS (More than one mayapply) <br />Q Monthly Flat Rate <br />R) itemized Invoice <br />nReimbursement / Revenue <br />0 Other (Explain) Monthly <br />Quarterly n One -Time Payment L-J Progress Payment <br />Q Withhold % 1:1 Advanced Payment Not To Exceed <br />or % <br />FUND TITLE <br />ITEM <br />FISCAL <br />CHAPTER <br />STATUTE <br />PROJECTED <br />YEAR <br />EXPENDITURES <br />E GF <br />7120 101-0001 <br />18/19 <br />029 <br />2018 <br />$1,013,128.00 <br />171 <br />GF <br />7120-101-0001 <br />19/20 <br />023 <br />2019 <br />$1,497,722.00 <br />0 <br />0_ <br />OBJECT CODE <br />1497722 <br />AGREEMENTTOTAL <br />$2,510,850.00 <br />Page 1 of 4 <br />