HomeMy WebLinkAboutCALIFORNIA, STATE OF, EMPLOYMENT DEVELOPMENT DEPARTMENT (EDD)INSURANCE NOT REQUIRED
WORK MAY PROCEED
CITY CLERK
DATE: AUG 2 9 2024
l/AC"
City of Santa Ana
Return FULLY EXECUTED
Copy to City Clerk, M-30 A-2024-139
WIOA SUBGRANT AGREEMENT
PASS -THROUGH ENTITY:
State of California
Employment Development Dept.
Central Office Workforce
Services Division
P.O.Box 826880 MIC 69
Sacramento, CA 94280-0001
SUBGRANT NO: AA511027
MODIFICATION NO: New q�
SUBRECIPIENT CODE: SAN �+r�
UNIQUE ENTITY NO:
INDIRECT COST RATE:
SUBRECIPIENT: City of Santa Ana
801 W. Civic Center Drive
SANTA ANA, CA 92701
GOVERNMENTAL
ENTITY: Yes
This Subgrant Agreement is entered into by and between the State of California, Employment Development
Department, hereinafter the Pass -through Entity, and the City of Santa Ana, hereinafter the Subrecipient. The
Subrecipient agrees to operate a program in accordance with the provisions of this Subgrant and to have an approved
Workforce Innovation and Opportunity Act (WIOA) Local Plan for the above named Pass -through Entity filed with the
Pass -through Entity pursuant to the WIOA. This modification consists of this sheet and those of the following exhibits,
which are attached hereto and by this reference made a part hereof:
Funding Detail Chart
General Provisions
Youth Formula Rd 1
ALLOCATION(s)i PRIOR AMOUNT` $0.00
The Pass -through Entity agrees to reimburse the r
I INCREASE/DECREASE: $770,569.00
Subrecipient not to exceed the amount listed TOTAL: i $770,569.00
hereinafter 'TOTAL' I
TERM OF AGREEMENT Terms of Exhibits are as
From:4/1/2024 To: 6/30/2026 designated on each exhibit
PURPOSE: The purpose of this action is to initiate Program Year (PY) 2024-25 WIOA Subgrant and incorporate
WIOA Youth Formula funding under Grant Code 301. The term of these funds is from April 1, 2024, to June 30, 2026
APPROVED FOR PASS -THROUGH ENTITY(EDD)
(By Signature)
Name and Title
KIMBERLEE MEYER
CHIEF
CENTRAL OFFICE WORKFORCE SERVICES
DIVISION
I hereby certify that to my knowledge, the budgeted
funds are available for the period and purpose of
expenditures as stated herein
Signature of EDD Accounting Officer
FOR SUBRECIPIENT (By Signature)
f
i
I
i•LtiC
Name and Title
Alvaro Nufez
City Manager
This agreement does not fall within the meaning of Section
10295 of Chapter 2 of Part 2 of Division 2 of the Public
Contract Code of the State of California and pursuant to 58
OPS Cal. Atty. Gen 586, is exempt from review or approval of
the Dept. of General Services and the Dept. of Finance
Budget item: 7100 Fund 0869 Budgetary Altachment: No
Chapter:
ATTEST Stmute:2024 FY:2425 Approved as to F
Andrea Garcia- filler age of 14
Jennifer L. Assistant City Attorney
r
City of Santa Ana
Funding Source
WIAMIOA Formula
96105 301 Youth Formula Rd 1
04/01/2024 to 06/30/2026 Prog/Element'
61/90 Ref 101 Fed Catlg 17.259
Total WIA/WIOA Formula,
Grand Total:
SUBGRANT AGREEMENT
FUNDING DETAIL SHEET
I. Allocation
Prior Amount Increase
$0.00! $770,569.00',
$0.00; $770,569.00:
$0.00$770,569.001
SUBGRANT NO:AA511027
MODIFICATION NO:New
Decrease
$0.00,
$0.00'.
$0.00
Adjusted
Allocation
$770,569.00
$770,569.00',
$770,569.00,
All references are to the Workforce Innovation and Opportunity Act of 2014, Title I, unless Page 2 of 14
otherwise noted. For modifications purposes only. All other terms and conditions of this exhibit
NARRATIVE
SUBGRANT NO:AA511027
MODIFICATION NO: 0
SUBRECIPIENT:City of Santa Ana
FAIN NO:24A55AY000066
FEDERAL AWARD DATE:6/21/2024
FUNDING SOURCE: Youth Formula Rd 1 - 301
TERM OF THESE FUNDS: 04/01/2024 - 06/30/2026
......................................................•-----
; Use of funds added by this modification is limited to this period and ;
;additionally limited by the recapture provisions applicable to this
funding source. The state may at its discretion recapture funds
obligated under this exhibit, if expenditure plans are not being met.
......................................................
PROGRAM NARRATIVE
The purpose of this action is to initiate this Local Area's new
Program Year (PY) 2024-25 Workforce Innovation and
Opportunity Act (WIOA) Title I subgrant agreement and to
incorporate WIOA Youth formula funding into Grant Code (GC)
301. The amount in GC 301 represents this Local Area's entire
Youth formula allocation for PY 2024-25. The term date for these
funds is April 1, 2024 through June 30, 2026, FAIN
24A55AY000066. The Local Area will operate the WIOA program
in accordance with the approved Workforce Innovation and
Opportunity Plan on file in the Central Office Workforce Services
Division of the Employment Development Department, P.O. Box
826880, MIC 50, Sacramento, CA 94280-0001. Note: By signing
this subgrant you agree to all of the Terms and Conditions issued
by the Department of Labor for all WIOA funding for Program
Year (PY) 2024. The Term and Conditions are included in the
transmission of this Master Subgrant.
...........................................................................................
;This exhibit adds to and does not replace the terms and conditions of any other exhibit included in this
;agreement which terms and conditions remain in full force and effect.
1................................................... .......................... ...............:
WIOA (2015)
Page 3 of 14
Subrecipient:City of Santa Ana
WIOA SUBGRANT AGREEMENT
Subgrant No:AA511027
Modification No: New
1. Compliance In performance of this subgrant agreement, Subrecipient will fully comply with: a. The provisions of
the Workforce Innovation and Opportunity Act (WIOA), (29 U.S.C. §§ 3101- 3361 (2014), WIOA Final Regulations,
and all legislation, regulations, directives, policies, procedures and amendments issued pursuant thereto. b. All State
legislation and regulations to the extent permitted by federal law and all policies, directives and/or procedures, which
implement WICK c. Title 2, Code of Federal Regulations (C.F.R.) part 200 (Office of Management and Budget
Guidance) [OMB Guidance]. d. Title 2, C.F.R. Part 2900 (Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards) [Uniform Requirements]. e. The provisions of the Jobs for Veterans Act
(Pub. L. No, 107-288) as the law applies to Department of Labor (DOL) job training programs. f. Subrecipient will
ensure diligence in managing programs under this subgrant agreement, including performing appropriate monitoring
activities and taking prompt corrective action against known violations of WIOA. 2. Certifications, Assurances,
Standards Except as otherwise indicated, the Subrecipient agrees to comply with the certifications, assurances and
standards set out in Exhibit A: Certifications and Assurances, Exhibit B: Intellectual Property Provisions and Exhibit
C: Confidentiality Requirements. Failure to comply with all requirements of the certifications, assurances and
standards may result in suspension of payment under this subgrant agreement or termination of this subgrant
agreement or both, and the Subrecipient may be ineligible for award of future state subgrant agreements/contracts if
the Pass -through Entity determines that any of the following has occurred: a. false information on the certifications,
assurances and standards, or b. violation of the terms of the certifications, assurances and standards by failing to
comply with the requirements noted in Exhibits A, B and C. 3. Funding It is mutually understood between the parties
that this subgrant agreement may have been written before ascertaining the availability of congressional and
legislative appropriation of funds, for the mutual benefit of both parties, in order to avoid program and fiscal delays
which would occur if the subgrant agreement was executed after that determination was made. a. This subgrant
agreement Is valid and enforceable only if i, sufficient funds are made available by the State Budget Act of the
appropriate state fiscal years covered by this subgrant agreement for the purposes of this program, and H. sufficient
funds are made available to the state by the United States Government for the fiscal years covered by this subgrant
agreement for the purposes of this program. In addition, this subgrant agreement is subject to any additional
restrictions, limitations, or conditions enacted by the Congress and Legislature or any statute enacted by the
Congress and Legislature which may affect the provisions, terms, or funding of this subgrant agreement in any
manner. b. At the expiration of the terms of this subgrant agreement or upon termination prior to the expiration of this
subgrant agreement, funds not obligated for the purpose of this subgrant agreement will be immediately remitted to
the Pass -through Entity, and no longer available to the Subrecipient. c. The Pass -through Entity retains the right to
suspend financial assistance, in whole or in part, to protect the integrity of the funds or to ensure proper operation of
the program, providing the Subrecipient is given prompt notice and the opportunity for an informal review of the
Pass -through Entity's decision. The EDD Chief Deputy Director or his/her designee will perform this Informal review
and will issue the final administrative decision within 60 days of receiving the written request for review. Failure on
the part of the Subrecipient or a Subcontractor of the Subrecipient to comply with the provisions of this subgrant
agreement, or with WIOA or other applicable regulations, when such failure involves fraud or misappropriation of
funds, may result in immediate withholding of funds. d. If applicable, the chief elected official (CEO) of a unit of
general local government designated as a Local Workforce Development Area shall be liable to the Pass -through
Entity for all funds not expended in accordance with WIOA, and shall return to the Pass -through Entity all of those
funds. If there Is more than one unit of general local government in a local area, the CEO(s) will be the individual(s)
designated under an agreement executed by the CEO(s) of the local units of government. The CEO(s) designated
under the agreement shall be liable to the Pass -through Entity for all funds not expended in accordance with WIOA,
and shall return to the Pass -through Entity all of those funds. 4. Requirement to Provide Certain Information in Public
Communications (Steven's Amendment) Pursuant to Public Law 116-260, Division H, Title V, Section 505, when
issuing statements, press releases, requests for proposals, bid solicitations and other documents describing projects
or programs funded in whole or in part with Federal money, all non -Federal entities receiving Federal funds shall
clearly state: a. The percentage of the total costs of the program or project which will be financed with Federal
money; b. The dollar amount of Federal funds for the project or program; and c. The percentage and dollar amount
of the total costs of the project or program that will be financed by non -governmental sources. 5. Insurance a. Except
for city and county governmental entities, Subrecipients must provide the Pass -through Entity evidence of the
coverage specified in paragraphs (i), (ii), (III) and (Iv) below. The evidence of coverage shall include the registration
number of the subgrant agreement for identification purposes. I. Subrecipient will obtain a fidelity bond in an amount
of not less than , prior to the receipt of funds under this subgrant agreement. If the bond is
canceled or reduced, Subrecipient will immediately notify the Pass- through Entity. In the event the bond is canceled
or revised, the Pass -through Entity will make no further disbursements until it Is assured that adequate coverage has
been obtained. H. Subrecipient will provide general liability insurance with a combined limit of $1,000,000, or public
liability and property damage coverage with a combined limit of not less than $1,000,000. iii. Subrecipient will provide
Page 4 of 14
broad form automobile liability coverage with limits as set forth in (ii) above, which applies to both owned/leased and
non -owned automobiles used by the Subrecipient or its agents in performance of this subgrant agreement. Or, in the
event that the Subrecipient will not utilize owned/leased automobiles but intends to require employees, trainees or
other agents to utilize their own automobiles in performance of this subgrant agreement, Subrecipient will secure and
maintain on file from all such employees, trainees or agents a self -certification of automobile insurance coverage. iv.
Subrecipient wlll provide workers' compensation insurance, which complies with provisions of the California Labor
Code, covering all employees of the Subrecipient and all participants enrolled in work experience programs. Medical
and Accident Insurance will be carried for those participants not qualifying as "employee" (§ 3350, et seq. of the
California Labor Code) for workers' compensation. v. The Pass -through Entity will be named as "Certificate Holder"
of policies secured in compliance with paragraphs (1), (li), (iii) and (iv) above and will be provided certificates of
insurance or insurance company "binders" prior to any disbursement of funds under this subgrant agreement,
verifying the insurance requirements have been complied with. The coverage noted in paragraphs (iii) and (iv) above
must contain the following clauses: 1. Insurance coverage will not be canceled or changed unless 30 days prior to
the effective date of cancellation or change written notice is sent by the Subrecipient to: Employment Development
Department, Central Office Workforce Services Division Financial Management Unit, P.O. Box 826880, MIC 69,
Sacramento, CA 94280-0001. 2. State of California, its officers, agents, employees, and servants are included as
additional insured, but only insofar as the operations under this subgrant agreement are concerned. 3. State of
California is not responsible for payment of premiums or assessments on this policy. vi. Subrecipient agrees that the
liability insurance herein provided for shall be in effect at all times during the term of this subgrant agreement. In the
event said insurance coverage expires at any time or times during the time of this contract, the Subrecipient agrees
to provide, at least 30 days before said expiration date, a new certificate of insurance evidencing insurance coverage
as provided for herein for not less than the remainder of the term of the subgrant agreement or for a period of not
less than one year. New certificates of insurance are subject to the approval of the Pass -through Entity, and the
Subrecipient agrees that no work or services shall be performed prior to such approval. The Pass -through Entity
may, in addition to any other remedies it may have, terminate this subgrant agreement should Subrecipient fail to
comply with these provisions. 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 this subgrant agreement. Preferably resolutions should authorize a
designated position rather than a named individual. 7. Procurement Standards The Subrecipient must use the
methods of procurement in accordance with 2 C.F.R. § 200.320. 8. Grievances and Complaint System Subrecipient
will establish and maintain a grievance and complaint procedure in compliance with the WIOA section 181, OMB
Guidance, Uniform Requirements, federal regulations and state statutes, regulations and policy. 9. Remedies for
Non -Compliance If the Subrecipient fails to comply with Federal statutes, regulations or the terms and conditions of a
Federal award, the Pass -through Entity may impose additional conditions, as described in 2 C.F.R. § 200.207,
Specific conditions. If the Pass -through Entity determines that noncompliance cannot be remedied by imposing
additional conditions, the Pass -through Entity may take one or more of the following actions listed in 2 C.F.R. §
200.338. 10. Disallowed Costs Except to the extent that the state determines it will assume liability, the Subrecipient
will be liable for and will repay to the Pass -through Entity, any amounts expended under this subgrant agreement
found not to be in accordance with WIOA including, but not limited to, disallowed costs. Such repayment will be from
funds (Non- Federal), other than those received under the WIOA. 11. Termination This subgrant agreement may be
terminated in whole or in part for either of the two following circumstances: a. Termination for Convenience - Either
the Pass -through Entity or the Subrecipient may request a termination, in whole or in part, for convenience. The
Subrecipient will give a ninety (90) calendar -day advance notice in writing to the Pass -through Entity. The Pass -
through Entity will give a ninety (90) calendar -day advance notice in writing to the Subrecipient. b. Termination for
Cause - The Pass -through Entity may terminate this subgrant agreement in whole or in part when it has determined
that the Subrecipient has substantially violated a specific provision of the WIOA, regulations, the Uniform Guidance
or implementing state legislation and corrective action has not been taken. All notices of termination must be in
writing and be delivered personally or by deposit in the U. S. Mail, postage prepaid, "Certified Mail -Return Receipt
Requested", and will be deemed to have been given at the time of personal delivery or of the date of postmark by the
U. S. Postal Service. Notices to the Subrecipient will be addressed to:
Deborah Sanchez Director /
Administrator City of Santa Ana
801 W. Civic Center Drive, Suite 200
SANTA ANA, CA 92701
Notices to the Pass -through Entity will be addressed to: Employment Development Department Central Office
Workforce Services Division Financial Management Unit P.O. Box 826880, MIC 69 Sacramento, CA 94280-0001 12.
Audit Requirements a. The Subrecipient will maintain and make available to auditors, at all levels, accounting and
program records including supporting source documentation and cooperate with all auditors. All governmental and
non-profit organizations must follow the audit requirements (single audit or program -specific audit requirement) of
OMB Guidance, and Uniform Requirements. b. The Subrecipient and/or auditors performing monitoring or audits of
the Subrecipient or its sub -contracting service providers will immediately report to the Pass -through Entity any
Page 5 of 14
incidents of fraud, abuse or other criminal activity in relation to this subgrant agreement, the WIOA, or its regulations.
13. Entire Agreement This subgrant agreement contains the entire agreement of the parties and supersedes all
negotiations, verbal or otherwise and any other agreement between the parties hereto. This subgrant agreement is
not intended to and will not be construed to create the relationship of agent, servant, employee, partnership, joint
venture or association between the Pass -through Entity and the Subrecipient. Subrecipient represents and warrants
it is free to enter into and fully perform this subgrant agreement. 14. Unenforceable Position In the event that any
provision of this subgrant agreement is unenforceable or held to be unenforceable, then the parties agree that all
other provisions of this subgrant agreement have force and effect and shall not be affected hereby. 15. Accounting
and Cash Management a. Subrecipient will comply with controls, record keeping and fund accounting procedure
requirements of WIOA, federal and state regulations, and directives to ensure the proper disbursal of, and
accounting for, program funds paid to the Subrecipient and disbursed by the Subrecipient, under this subgrant
agreement. b. Subrecipient will submit requests for cash to coincide with immediate cash needs and assure that no
excess cash is on deposit in their accounts or the accounts of any sub -contracting service provider in accordance
with procedures established by the Pass -through Entity. Failure to adhere to these provisions may result in
suspending cash draw down privileges and providing funds through a reimbursement process. c. The Pass -through
Entity retains the authority to adjust specific amounts of cash requested if the Pass -through Entity's records and
subsequent verification with the Subrecipient indicate that the Subrecipient has an excessive amount of cash in its
account. d. Income (including interest income) generated as a result of the receipt of WIOA activities, will be utilized
in accordance with policy and procedures established by the Pass -through Entity. Subrecipient will account for any
such generated income separately. e. Subrecipient shall not be required to maintain a separate bank account but
shall separately account for WIOA funds on deposit. All funding under this subgrant agreement, will be made by
check or wire transfer payable to the Subreciplent for deposit in Subrecipient's bank account or city and county
governmental bank accounts. To provide for the necessary and proper internal controls, funds should be withdrawn
and disbursed by no less than two representatives of the Subrecipient. The Pass- through Entity will have a lien
upon any balance of WIOA funds in these accounts, which will take priority over all other liens or claims. 16.
Amendments This subgrant agreement may be unilaterally modified by the Pass -through Entity under the following
circumstances: a. There is an increase or decrease in federal or state funding levels. b. A modification to the
Subgrant is required in order to implement an adjustment to a Subrecipient's plan. c. Funds awarded to the
Subrecipient have not been expended in accordance with the schedule included in the approved Subrecipient's plan.
After consultation with the Subrecipient, the Pass -through Entity has determined that funds will not be spent in a
timely manner, and such funds are for that reason to the extent permitted by and in a manner consistent with state
and federal law, regulations and policies, reverting to the Pass -through Entity. d. There is a change in state and
federal law or regulation requiring a change in the provisions of this subgrant agreement. e. An amendment is
required to change the Subrecipient's name as listed on this subgrant 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. Except as provided above, this subgrant agreement
may be amended only in writing by the mutual agreement of both parties. 17. Reporting Subrecipient will compile
and submit reports of activities, expenditures, status of cash, and closeout information by the specified dates as
prescribed by the Pass -through Entity. All expenditure reports must be submitted upon the accrual basis of
accounting. Failure to adhere to the reporting requirements of this agreement will result in funds not being released.
18. Records a. If participants are served under this subgrant agreement, the Subrecipient will establish a participant
data system as prescribed by the Pass -through Entity. b. Subrecipient will retain all records pertinent to this subgrant
agreement for a period of three years from the date of final payment of this subgrant agreement. If, at the end of
three years, there is litigation or an audit involving those records, the Subrecipient will retain the records until the
resolution of such litigation or audit. Refer to OMB Guidance, Subpart D, Part 200.333-200.337. c. The Pass -through
Entity and/or the DOL, or their designee (refer to OMB Guidance, section 200.336) will have access to and right to
examine, monitor and audit all records, documents, conditions and activities related to programs funded by this
subgrant agreement. For purposes of this section, "access to" means that the Subrecipient shall at all times maintain
within the State of California a complete set of records and documents related to programs funded by this
agreement. The Subrecipient shall comply with this requirement regardless of whether it ceases to operate or
maintain a presence within the State of California before the expiration of the subgrant. Subrecipient's performance
under the terms and conditions herein specified will be subject to an evaluation by the Pass -through Entity of the
adequacy of the services performed, timeliness of response and a general impression of the competency of the firm
and its staff. 19. Subcontracting a. Any of the work or services specified in this subgrant agreement which will be
performed by other than by the Subrecipient will be evidenced by a written agreement specifying the terms and
conditions of such performance. b. The Subrecipient will maintain and adhere to an appropriate system, consistent
with federal, state and local law, for the award and monitoring of contracts which contain acceptable standards for
ensuring accountability. c. The system for awarding contracts will contain safeguards to ensure that the Subrecipient
does not contract with any entity whose officers have been convicted of fraud or misappropriation of funds within the
last two years. 20. Consultants Fees paid to a consultant, who provides services under a program, shall be limited to
$815 per day (representing an 8 hour work day). Any fees paid in excess of this amount cannot be paid without prior
approval from the Grant Officer. 21. Conflicts a. Subrecipient will cooperate in the resolution of any conflict with the
DOL that may occur from the activities funded under this agreement. b. In the event of a dispute between the Pass -
Page 6 of 14
through Entity and the Subrecipient over any part of this subgrant agreement, the dispute may be submitted to non-
binding arbitration upon the consent of both the Pass -through Entity and the Subrecipient. An election for arbitration
pursuant to this provision will not preclude either party from pursuing any remedy for relief otherwise available. 22.
Indemnification a. The following provision applies only if the Subrecipient is a governmental entity: Pursuant to
California Government Code § 895.4, each party agrees to indemnify and hold the other party harmless from all
liability for damage to persons or property arising out of or resulting from acts or omissions of the indemnifying party.
b. The following provision applies only if the Subrecipient is a non -governmental entity: The Subrecipient agrees to
the extent permitted by law, to indemnify, defend and hold harmless the Pass -through Entity, its officers, agents and
employees from any and all claims and losses accruing or resulting to any and all contractors, subcontractors,
materials persons, laborers and any other persons, firms or corporations, furnishing or supplying work, services,
materials, or supplies in connection with the performance of this agreement, and from any and all claims and losses
accruing or resulting to any persons, firms or corporations which may be injured or damaged by the Subrecipient in
the performance of this subgrant agreement. 23. Signatures This subgrant agreement is of no force and effect until
signed by both of the parties hereto. Subrecipient will not commence performance prior to the beginning of this
subgrant agreement. Contact information for the awarding official of the Pass -through Entity: Name: Kimberlee
Meyer Title: Chief Address: P.O. Box 826880, MIC 50 Sacramento, CA 94280-0001
Exhibit A
Certifications and Assurances
a. Corporate Registration: The Subrecipient, if it is a corporation, certifies it is
registered with the Secretary of the State of California.
b. Americans with Disabilities Act (ADA): Subrecipient assures that it complies with the
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.)
c. Sectarian Activities: The Subrecipient certifies that this subgrant agreement does
not provide for the advancement or aid to any religious sect, church or creed, or
sectarian purpose nor does it help to support or sustain any school, college,
university, hospital or other institution controlled by any religious creed, church,
or sectarian denomination whatsoever, as specified by Article XVI, Section 5, of the
Constitution, regarding separation of church and state.
d. National Labor Relations Board certification Subrecipient certifies that no more than
one (1) final unappealable finding of contempt of court by a Federal court has been
issued against Subrecipient within the immediately preceding two-year period because
of Subrecipient's failure to comply with an order of a Federal court, which orders
Subrecipient to comply with an order of the National Labor Relations Board. (Pub.
Contract Code § 10296) (Not applicable to public entities.)
e. Federal Funding Accountability and Transparency Act (FFATA): By signing this
subgrant agreement, Subrecipient hereby assures and certifies to comply with the
provisions of FFATA, which includes requirements on executive compensation, and
requirements implementing FFATA at 2 C.F.R. part 25 and 2. C.F.R. part 170.
f. Prior Findings: Subrecipient, by signing this subgrant agreement, certifies that it
has not failed to satisfy any major condition in a current or previous subgrant
agreement with the DOL or the State of California and has not failed to satisfy
conditions relating to the resolution of a final finding and determination, including
repayment of debts.
g. Drug Free Workplace requirement: Subrecipient 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:
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.
2. Establish a Drug -Free Awareness Program to inform employees about:
i. the dangers of drug abuse in the workplace;
ii. the person's or organization's policy of maintaining a drug -free
workplace;
Ill. any available counseling, rehabilitation and employee assistance programs;
and,
iv. penalties that may be imposed upon employees for drug abuse violations.
Page 7 of 14
3. Every employee who works on the proposed subgrant agreement will:
I. receive a copy of the company's drug -free workplace policy statement; and,
ii. agree to abide by the terms of the company's statement as a condition of
employment on the subgrant agreement.
4. Failure to comply with these requirements may result in suspension of payments
under this subgrant agreement or termination of the subgrant agreement or both
and Subreciplent may be ineligible for award of any future subgrant agreements
if the Pass -through Entity determines that any of the following has occurred: the
Subrecipient has made false certification; or violated the certification by
failing to carry out the requirements as noted above. (Gov. Code § 8350 et seq.)
h. Expatriate Corporations: Subreciplent hereby declares that it is not an expatriate
corporation or subsidiary of an expatriate corporation within the meaning of Public
Contract Code §§ 10286 and 10286.1, and is eligible to contract with the State of
California.
I. Priority Hiring considerations: If this subgrant agreement includes services in
excess of $200,000, the Subrecipient shall give priority consideration in filling
vacancies in positions funded by the subgrant agreement to qualified recipients of
aid under Welfare and Institutions Code § 11200 in accordance with Pub. Contract Code
§ 10353.
j. Sweatfree Code of Conduct:
1. All Subrecipients 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 this subgrant agreement 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 Subrecipient
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 § 6108.
2. The Subrecipient agrees to cooperate fully in providing reasonable access to the
Subrecipient's records, documents, agents or employees, or premises if
reasonably 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 (1).
k. Child Support Compliance: For any Agreement in excess of $100,000, the Subreciplent
acknowledges in accordance with Public Contract Code § 7110, that:
1. The Subrecipient recognizes the importance of child and family support
obligations and shall fully comply with all applicable state and federal laws
relating to child and family support enforcement, including, but not limited to,
disclosure of information and compliance with earnings assignment orders, as
provided in Chapter 8 (commencing with § 5200) of Part 5 of Division 9 of the
Family Code; and
2. The Subrecipient, to the best of its knowledge is fully complying with the
earnings assignment orders of all employees and is providing the names of all new
employees to the New Hire Registry maintained by the Pass -through Entity.
I. Air/Water Pollution violation certification: Under the State laws, the Subrecipient
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;
Page 8 of 14
2, subject to cease and desist order not subject to review issued pursuant to
§ 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.
m. Clean Air Act: Subrecipient agrees to comply with all applicable standards, orders or
regulations issued pursuant to the Clean Air Act (42 U.S.C. §§ 7401-7671q) and the
Federal Water Pollution Control Act as amended (33 U.S.C. §§ 1251-1387).
n. Domestic Partners: For contracts over $100,000 executed or amended after January 1,
2007, the Subrecipient certifies that it is in compliance with Public Contract Code
§ 10295.3.
o. Debarment and Suspension Certification: By signing this subgrant agreement, the
Subrecipient hereby certifies under penalty of perjury under the laws of the State of
California that the Subrecipient will comply with regulations implementing Executive
Orders 12549 and 12689, Debarment and Suspension and OMB Guidance 2 CFR Part 180,
that the prospective participant (i.e., Subrecipient), to the best of its knowledge
and belief, that it and its principals:
1. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by any federal
department or agency.
2. Have not within a three-year period preceding this subgrant agreement 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.
3. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity (federal, state or local) with commission of any of the
offenses enumerated in Section 2 of this certification.
4. Have not within a three-year period preceding this subgrant agreement had one or
more public transactions (federal, state or local) terminated for cause of
default.
Where the Subrecipient is unable to certify to any of the statements in this
certification, such prospective participant shall attach an explanation to this
agreement.
p. Lobbying Restrictions: By signing this subgrant agreement, the Subrecipient hereby
assures and certifies to the lobbying restrictions in 2 C.F.R. §200.450, 29 CFR Part
93 and in the Byrd Anti -Lobbying Amendment (31 U.S.C. §1352).
1. No federal appropriated funds have been paid, by or on behalf of the undersigned,
to any person for influencing or attempting to influence an officer or employee
of an agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress, in connection with this federal contract, grant
loan, or cooperative agreement, and the extension, continuation, renewal,
amendment, or modification of any federal contract, grant, loan, or cooperative
agreement.
2. If any funds other than federal appropriated funds have been paid or will be paid
to any person for influencing or attempting to influence an officer or employee
of any agency, a Member of Congress, and officer or employee of Congress, or an
employee of a Member of Congress, in connection with this subgrant agreement, the
undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to
Report Lobbying" in accordance with its instructions.
3. The undersigned shall require that the language of the lobbying restrictions be
included in the award documents for subgrant agreement transactions over $100,000
(per OMB) at all tiers (including subgrant agreements, contracts and
subcontracts, under grants, loan, or cooperative agreements), and that all
subrecipients shall certify and disclose accordingly.
4. This certification is a material representation of fact upon which reliance is
Page 9 of 14
placed when this transaction is executed. Submission of the Lobbying
Certification is a prerequisite for making or entering into this transaction
imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the
required certification shall be subject to a civil penalty of not less than
$10,000 and not more than $100,000 for each failure.
q. Nondiscrimination Clause:
1. As a condition to the award of financial assistance from the Department of Labor
under Title I of WIOA, the Subrecipient assures that it has the ability to comply
with the nondiscrimination and equal opportunity provisions of the following laws
and will remain in compliance for the duration of the award of federal financial
assistance:
i. Section 188 of the Workforce Innovation and Opportunity Act (WIOA), which
prohibits discrimination against all individuals in the United States on the
basis of race, color, religion, sex (including pregnancy, childbirth, and
related medical conditions, transgender status and gender identity),
national origin (limited English proficiency), age, disability, political
affiliation or belief, and against beneficiaries on the basis of either
citizenship status or participation in any WIOA Title 1-financially assisted
program or activity;
ii. Title VI of the Civil Rights Act of 1964, as amended, which prohibits
discrimination on the bases of race, color and national origin;
Ill. Section 504 of the Rehabilitation Act of 1973, as amended, which prohibits
discrimination against qualified individuals with disabilities;
iv. The Age Discrimination Act of 1975, as amended, which prohibits
discrimination on the basis of age; and
v. Title IX of the Education Amendments of 1972, as amended, which prohibits
discrimination on the basis of sex in educational programs.
The Subrecipient also assures that, as a recipient of WIOA Title I financial
assistance, it will comply with 29 CFR part 38 and all other regulations implementing
the laws listed above. This assurance applies to the Subrecipient's operation of the
WIOA Title I -financially assisted program or activity, and to all agreements the
Subrecipient makes to carry out the WIOA Title 1-financially assisted program or
activity. The Subrecipient understands that the United States has the right to seek
judicial enforcement of this assurance.
Avoidance of Conflict of Economic Interest: An executive or employee of the
Subrecipient, an elected official in the area or a member of the Local Board, will
not solicit or accept money or any other consideration from a third person, for the
performance of an act reimbursed in whole or part by the Subrecipient or Pass -
through Entity. Supplies, materials, equipment or services purchased with subgrant
agreement funds will be used solely for purposes allowed under this subgrant
agreement. No member of the Local Board will cast a vote on the provision of services
by that member (or any organization, which that member represents) or vote on any
matter which would provide direct financial benefit to that member (or immediate
family of the member) or any business or organization which the member directly
represents.
Page 10 of 14
0i1 M&I
Intellectual Property Provisions
Federal Funding
Pursuant to 2 CFR 200.315, in any subgrant funded In whole or in part by the federal
government, Pass -through Entity acquires the title to intangible property, as defined in 2
CFR 200.59 as including Intellectual Property, which results directly or indirectly from the
subgrant. The federal government shall have a royalty -free, non-exclusive and irrevocable
right to reproduce, publish, or otherwise use the Intellectual Property for Federal
purposes, and to authorize others to do so. Additionally, pursuant to 2 CFR 2900.13,
Intellectual Property developed under this subgrant will be licensed under a Creative
Commons Attribution license, which allows subsequent users to copy, distribute, transmit and
adapt the copyrighted work and requires such users to attribute the work in the manner
specified by the Pass -through Entity.
Exhibit C
Confidentiality Requirements
The State of California and the Subrecipient will exchange various kinds of information
pursuant to this subgrant agreement. That information will include data, applications,
program files, and databases. These data and information are confidential when they define
an individual or an employing unit or when the disclosure is restricted or prohibited by any
provision of law. Confidential information requires special precautions to protect it from
unauthorized use, access, disclosure, modification, and destruction. The sources of
information may include, but are not limited to, the EDD, the California Department of
Social Services, the California Department of Education, the California Department of
Corrections and Rehabilitation, the County Welfare Department(s), the County IV-D Directors
Office of Child Support, the Office of the District Attorney, the California Department of
Mental Health, the California Office of Community Colleges and the Department of Alcohol and
Drug Programs.
The Pass -through Entity and Subrecipient agree that:
a. Each party shall keep all information that is exchanged between them in the strictest
confidence and make such information available to their own employees only on a
"need -to -know" basis.
b. Each party shall provide security sufficient to ensure protection of confidential
information from Improper use and disclosures, including sufficient administrative,
physical, and technical safeguards to protect this information from reasonable
unanticipated threats to the security or confidentiality of the information.
c. The Subrecipient agrees that information obtained under this subgrant agreement will
not be reproduced, published, sold or released in original or in any other form for
any purpose other than those specifically identified in this agreement.
1. Aggregate Summaries: All reports and/or publications developed by the
Subrecipient based on data obtained under this agreement shall contain
confidential data in aggregated or statistical summary form only. "Aggregated"
refers to a data output that does not allow identification of an individual or
employer unit.
2. Publication: Prior to publication, Subrecipient shall carefully analyze
aggregated data outputs to ensure the identity of individuals and/or employer
units cannot be inferred pursuant to California Unemployment Insurance Code
Section 1094(c). Personal identifiers must be removed. Geographic identifiers
should be specified only in large areas and as needed, and variables should be
recorded in order to protect confidentiality.
3. Minimum Data Cell Size: The minimum data cell size or derivation thereof shall
be three participants for any data table released to outside parties or to the
public.
Page 11 of 14
d. Each party agrees that no disaggregate data, identifying individuals or employers,
shall be released to outside parties or the public.
e. The Subrecipient shall notify Pass -through Entity's Information Security Office of
any actual or attempted information security incidents, within 24 hours of initial
detection, by telephone at (916) 654-6231. Information security incidents include,
but are not limited to, any event (intentional or unintentional), that causes the
loss, damage, or destruction, or unauthorized access, use, modification, or
disclosure of information assets.
The Subrecipient shall cooperate with the Pass -through Entity in any investigation
of security incidents. The system or device affected by an information security
Incident and containing confidential data obtained in the administration of this
program shall be immediately removed from operation upon confidential data exposure
or a known security breach. It shall remain removed from operation until correction
and mitigation measures are applied. If the Subrecipient learns of a breach in the
security of the system which contains confidential data obtained under this
Subgrant, then the Subrecipient must provide notification to individuals pursuant
to California Civil Code Section 1798.82.
The Subrecipient shall be responsible for all costs incurred by the Pass -through
Entity due to a security incident resulting from the Subrecipient's failure to
perform or negligent acts of its personnel, and resulting in an unauthorized
disclosure, release, access, review, or destruction; or loss, theft or misuse of
an information asset. If the Subrecipient experiences a loss or breach of data,
the Subrecipient shall immediately report report the loss or breach to the Pass -
through Entity. If the Pass -through Entity determines that notice to the
individuals whose data has been lost or breached is appropriate, the Subrecipient
will bear any and all costs associated with the notice or any mitigation selected
by the Pass -through Entity. These costs include, but are not limited to, staff
time, material costs, postage, media announcements, and other identifiable costs
associated with the breach or loss of data.
f. The Subrecipient shall provide for the management and control of physical access to
information assets (including personal computer systems, computer terminals, mobile
computing devices, and various electronic storage media) used in performance of this
Subgrant. This shall include, but is not limited to, security measures to physically
protect data, systems, and workstations from unauthorized access and malicious
activity; the prevention, detection, and suppression of fires; and the prevention,
detection, and minimization of water damage.
g. At no time will confidential data obtained pursuant to this agreement be placed on a
mobile computing device, or on any form of removable electronic storage media of any
kind unless the data are fully encrypted.
h. Each party shall provide its employees with access to confidential information with
written instructions fully disclosing and explaining the penalties for unauthorized
use or disclosure of confidential information found in Section 1798.55 of the
California Civil Code, Section 502 of the California Penal Code, Section 2111 of the
California Unemployment Insurance Code, Section 10850 of the California Welfare and
Institutions Code and other applicable local, state and federal laws.
i. Each party shall (where it is appropriate) store and process information in
electronic format, in such a way that unauthorized persons cannot reasonably retrieve
the information by means of a computer.
j. All Subrecipient staff and subcontractors that are provided access to any data
systems of the Pass -through Entity, excluding CaIJOBS, are required to complete
and sign an Employee Confidentiality Statement (DE 7410).
k. Each party shall promptly return to the other party confidential information when
its use ends, or destroy the confidential information utilizing an approved method of
destroying confidential information: shredding, burning, or certified or witnessed
destruction. Magnetic media are to be degaussed or returned to the other party.
I. If the Pass -through Entity or Subrecipient enters into an agreement with a third
party to provide WIOA services, the Pass -through Entity or Subrecipient agrees to
include these data and security and confidentiality requirements in the agreement
with that third party. In no event shall said information be disclosed to any
Page 12 of 14
individual outside of that third party's authorized staff, subcontractor(s), service
providers, or employees.
m. The Subrecipient may, in its operation of the America's Job Center of California
(AJCC), permit an AJCC Operator to enter into a subcontract to manage confidential
information. This subcontract may allow an Individual to register for resume
distribution services at the same time the individual enrolls in CaIJOBS.
Subrecipient shall ensure that all such subcontracts comply with the intellectual
property requirements of this subgrant agreement, the confidentiality requirements of
this subgrant agreement and any other terms of this subgrant agreement that may be
applicable. In addition, the following requirements must be included in the
subcontracts:
1. All client information submitted over the internet to the subcontractor's
databases must be protected, at a minimum, by 128-bit Secure Socket Layer (SSL)
encryption. Clients' social security numbers must be stored in a separate
database within the subcontractor's network of servers, and protected by a
firewall and a secondary database server firewall or AES data encryption. If a
subcontractor receives client social security numbers or other confidential
information in the course of business, for example a resume -distribution service
that provides enrollment in CaIJOBS, social security numbers must be destroyed
within two days after the client registers for CaIJOBS. If a subcontractor
obtains confidential information as an agent of the Subrecipient, the subcontract
must specifically state the purpose for the data collection and the term of
records retention must be stated, and directly related, to the purpose and use of
the information. Social security numbers and other client specific information
shall not be retained for more than three years after a client completes
services.
2. Client information (personal information that identifies a client such as name
and social security number) and/or demographic information of a client (such as
wage history, address, and previous employment) shall not be used as a basis for
commercial solicitation during the time the client or agency is using the
subcontractor's services. Client information and/or demographic information
shall not be used for any purposes other than those specific program purposes set
forth in the subcontract.
3. An AJCC client must still be given the option to use the AJCC's services,
including CaIJOBS, even if he or she chooses not to use any services of the
subcontractor. This option shall be prominently, clearly and immediately
communicated to the client upon registration within the AJCC or for CalJOBS, the
subcontractor's resume -distribution services, or any other services
subcontractor offers to the client or the AJCC Operator.
4. The subcontractor must clearly disclose all of its potential and intended uses of
the client's personal and/or demographic information for the services the client
seeks and for any other services the subcontractor offers. The subcontractor
shall not use a client's personal and/or demographic information without the
client's prior permission. A link to the subcontractor's Privacy Policy shall
appear prominently on the registration screens that list the potential and
intended uses of the client's personal and/or demographic information.
5. When the Pass -through Entity modifies State automated systems such as the State
CaIJOBS System, it shall provide reasonable notice of such changes to the
Subrecipient. The Subrecipient shall be responsible to communicate such changes
to the AJCC Operator(s) in the local area.
n. Each party shall designate an employee who shall be responsible for overall security
and confidentiality of its data and information systems and each party shall notify
the other of any changes in that designation. As of this date, the following are
those Individuals:
Page 13 of 14
FOR THE PASS -THROUGH ENTITY:
Name: Nicole Laktash
Title: Section Manager
Address: P.O. Box 826880, MIC 50 Sacramento, CA 94280-0001
Telephone: (916) 654-6804
Fax: (916) 654-9586
FOR THE SUBRECIPIENT:
Name: Deborah Sanchez
Title: Economic Development Specialist III
Telephone: 714-565-2621
Fax:
Page 14 of 14
ATTACHMENT 1
Subrecipient Information Change Form — Type 1
Local Area Z Non -Local Area 0
City of Santa Ana
801 W. Civic Center Drive, Suite 200
Santa Ana CA 92701
www.santa-ana.org/WORK-Center
WAFWP�Qblfi Z:�_ R
Same
714-565-2600
11"11 VVED
Salutation First
MI
Last
Title
MS Deborah
Sanchez
Econ. Dev. Specialist
IIIANDB Director
Address 801 W. Civic Center Drive, Suite 200 Santa Ana CA 92701
Phone 714-565-2621
Fax
E-Mail Address dsanchez@santa-ana.org
min ewZ
Salutation
First
MI
Last
Title
Mr
Marc
Morley
Economic Development
Manager
Address
20 Civic Center Plaza, M-25 Santa Ana CA 92701
Phone 714-64-6588
Fax
E-Mail Address mmorley@santa-ana.org
Local Area
-Only:
e -tw
Salutation
First
MI
Last
Title
Ms
Daisy
Campos
WDB Chair
Board Name
Santa Ana Workforce Development Board
Address
801 W. Civic Center Drive, Suite 200 Santa Ana CA 92701
Phone 714-864-8030 1
Fax —TE-Mail
Address campos.r.daisy@gmail.com
a❑ MEMWO
Salutation First
MI
Last
Title
Ms. Valerie
Amezcua
Mayor
Organization Name
City of Santa Ana
Address
1 20 Civic Center Plaza, M-31 Santa Ana CA 92701
Phone 714-647-6900
Fax
E-Mail Address vamezcua@santa-ana.org
ewwkm
Salutation First MI Last Title
Mr.
Alvaro
Nufiez City Manager
Address
20 Civic Center Plaza, M-31 Santa Ana CA 92701
Phone 714-647-6900
1 Fax
I E-Mail Address anunez@santa-ana.org
Page 11 8/26/24
Please check applicable entity type:
Government Entity
State Agency ❑
Private Entity ❑
Econ Dev.
III/WDB Director
Page 12
8/13/24
ATTACHMENT
Subrecipient Information Change Form — Type 2
Local Area ® Non -Local Area ❑
Fiscal Administrator New ❑ Delete ❑ Update
Salutation
First
MI
Last
Title
Mr.
John
Valadez
Accountant II
Address
20 Civic Center Plaza, M-17 Santa Ana CA 92701
Phone 714-647-5436
1 Fax
I E-Mail Address jvaladez@santa-ana.org
Fiscal Administrator Alternate #1 New ❑ Delete ❑ Update
Salutation
First
MI
Last
Title
Ms.
Angie
Benavides
Accountant II
Address
20 Civic Center Plaza, M-17 Santa Ana CA 92701
Phone 714-647-5438
1 Fax
I E-Mail Address abenavides@santa-ana.org
Fiscal Administrator Alternate #2 New ❑ Delete ❑ Update
Salutation
First
MI
Last
Title
Mr.
Waldo
Barela
Administration Services
Manager
Address
20 Civic Center Plaza, M-25 Santa Ana CA 92701
Phone 714-647-5376
Fax
I E-Mail Address wbarela@santa-ana.org
Local Area Only:
Rapid Response Coordinator New ❑ Delete ❑
Update
Salutation
First
MI
Last
Title
Ms.
Araceli
Delgado
Workforce Specialist II
Address
801 W. Civic Center Drive, Suite 200 Santa Ana CA 92701
Phone 714-565-2654
1 Fax
I E-Mail Address adelgado@santa-ana.org
Deborah Sanchez, Econ. Dev. Specialist III/WDB Director
I AA /a oa y
Page 1 of 1 8/13124
ATTACHMENT
America's Job Center of CaliforniasM
Change Form - Type 3
locationSection 1. Enter current office prior to any changes
Today's Date: 8/13/2024
County: Orange
Office Name: Santa Ana WORK Center
Street Address: 801 W. Civic Center Drive, Suite 200
City: Santa Ana
Zip Code: 92701
Effective Date of Change: N/A
Section II. Enter new information
Action Codes
ITEM NO.
A C D Key: A= Add, C= Change, D= Delete No changes
1
l
r
I-
Name, Physical Address,
City, State, and Zip
2
f-
I-
r
Mailing Address (if different)
3
r
r
r
Building Name
4
r
r
f County
5
r—
r—
r
Public Phone
6
r-
r-
r-
Public Fax
7
f-
r
r
TTY Number
8
r-
r
r
Hours
9
r-
r
r
ILevel of service
Comprehensive 57 Affiliate r- Specialized r'
10
r
r
r
Local Workforce Development Board
it
r
r
r
Operator
12
r
r
r
Veterans Representative
Yes r No r
13
r
r
r
EDD Staff
Yes r No r
14
r
W
r
Website Address
www.santa-ana.org/WORK-Center
15
r
Office Manager/Administrator
Carlos de la Riva
(not for
trFo-F-
rEmail
Address
cdelariva@santa-ana.org
publication)
r
Phone Number
714-565-2629
Ill
ApprovalSection
Deborah Sanchez 714-565-2621 dsanchez@santa-a•a.o,•
Contact Name (if different from item 15) Phone Email o
Deborah Sanchez Econ. Dev. Specialist III/WDB Director A b a� �2U
Office Manager/Administrator (type or print name and title) Signature Date
CaIJOBSsM MIS Admin Registration Form
Please complete the following form by typing the information into each box. For assistance, please
contact the CaIJOBS Operations Unit at caljobsadmin@edd.ca.gov or 1-916-653-0202.
Requestor Information
* Requestor
N/A - No Change
* Requestor Email
* Phone Number
* Organization Name
* Sub -recipient Code
* Mailing address
Requested Accounts
User
User
*Type
(Add/Update/Delete)
N/A —No Change
N/A —No Change
* First Name
* Last Name
* lob Title
* ZIP Code
* Email
* Phone
SIGNATURE: The person signing below must be designated to represent the organization and has authority
to make changes to the information provided in this form. The signature authorizes the Employment
Development Department to make changes to its records as described above.
a 0 -4 A �' �
Signature of Requestor
Signature of Executiv irector
T ( ;z'-b-o'?�/
Date
Date
Return completed and signed form to caljobsadmin@edd.ca.gov.
The requested username and a temporary password will be sent to the requested staff with a cc to the
Requestor.
Page 1 of 1
ATTACHMENT
FEDERAL INFORMATION FORM
To be completed for each Subrecipient.
Return to:
Attention: Contracts Analyst
Financial Management Unit
Workforce Services Division
P.O. Box 826880, MIC 69
Sacramento, CA 94280-0001
Subrecipient Name City of Santa Ana
Subrecipient Address 20 Civic Center Plaza, M-25 Santa Ana CA 92701
Subrecipient CalJOBSs' Code (3 letters) SAN
Employer Identification Number (EIN)/Federal Tax Identification Number
(Refer to www.irs.govl 95-6000785
Unique Entity ID (SAM) also known as the Unique Entity Identifier
(Refer to www.sam.sov) KZE9G2M4GRX9
Person to contact regarding this form Deborah Sanchez
Phone Number ( 714 ) 565-2621 Date 08/22/2024
ATTACHMENT 6
INDIRECT COST DECLARATION
Subrecipient Name: City of Santa Ana
1. Will your organization claim indirect costs to the WIOA Title I program?
X Yes
❑ No (If no, skip to Signature Authority)
2. If yes, which indirect cost method will be used (select only one):
X Indirect Cost Rate Agreement (ICRA) - Attach ICRA and indirect cost certification letter
❑ Cost Allocation Plan (CAP) - Attach CAP and certification letter
❑ De Minimis Rate (check only if you do not receive more than $35 million annually in
direct federal funds and you do not have a currently approved ICRA)
❑ An ICR approved by the Employment Development Department - Attach ICR proposal
and indirect cost certification letter
3. Do you have an approved and valid ICRA/CAP?
X Yes (List Cognizant/Approving agency on question 6)
❑ Pending Approval -Date submitted for approval: Not applicable to Local
government, see Uniform
Guidance, Appendix VII, D
❑ No, provide explanation:
4. Approved/Pending ICRA Rate: 15.92%
5. Approved ICRA/CAP Expiration Date: June 30, 2025
6. Cognizant/Approving Agency: US HUD
If you claim indirect costs, include your indirect cost rate proposal/approval from your
Cognizant/Approving Agency OR attach your Cost Allocation Plan with certification letter.
If you have any questions, please contact WSBFinancialMonaaementUnit@edd.co.gov
Alvaro Nunez City Manager
Printed N me Title
Gfir.� August 22, 2024
ignature Date
Must be signed by Signatory Authority.
State of California
Financial Information System for California (FI$Cal) FI$Cal
GOVERNMENT AGENCY TAXPAYER ID FORM
2000 Evergreen Street, Suite 215 Financial Information System for California
Sacramento, CA 95815
www.fiscal.ca.gov
1-855-347-2250
The principal purpose of the information provided is to establish the unique identification of the government entity.
Instructions: You may submit one form for the principal government agency and all subsidiaries sharing the same TIN. Subsidiaries with a
different TIN must submit a separate form. Fields bordered in red are required. Hover over fields to view help information. Please print the
form to sign prior to submittal. You may email the form to: vendors@fiscal.ca.gov, or fax it to (916) 576-5200, or mail it to the address above.
Principal
Pity of Santa Ana
Government
Agency Name
Remit -To
.O. Box 1974 M-13
Address (Street
or PO Box)
City
Panta Ana
State PAA Zip Cade+4 2702-19iJ
Government Type:
❑✓ City ❑ County
Federal
Special District Federal
❑ ❑
Employer
Identification
❑ Other (Specify)
Number
(FEIN)
List other subsidiary Departments, Divisions or Units under your principal agency's jurisdiction who share the same
FEIN and receives payment from the State of California.
Dept/Division/Unit Complete
Name Address
Dept/Division/Unit
Name
Dept/Division/Unit
Name
Complete
Address
Complete
Address
Dept/Division/Unit Complete
NameI i Address
Contact Person Peborah Sanchez Title JEcon. Dev. Specialist III
Phone number 14-565-2621 E-mail address sanchez@santa-ana.org
Signature
Date 22-24
Attachment 8
USER REGISTRATION FORM (URF)
(Please type the requested information)
(Please type)
Organization
City of Santa Ana
Date:
July 25, 2023
Name:
Contact Name:
Deborah Sanchez
Sub -recipient
SAN
Code:
Email:
dsanchez(a-)santa-ana.org
Phone Number:
714-565-2621
Mailing
Address:
801 W. Civic Center Dr., Suite 200 Santa Ana CA 92701
Circle or bold the programs for which this office has grants: WIOA Other
USER REGISTRATION
Use the box below:
1. Enter an Action Code in the first column to designate the action you want to make.
Enter letter A to Add a new user. The new user's signature, phone number, and email are
required.
Enter letter C to Change the status of an existing user. The user's signature is required
Enter letter D to Delete a user. No signature, phone number, or email is required.
Enter letter E for Existing user. No signature, phone number, or email is required.
2. Enter a User Type Code in the second column to describe the permissions you are giving the
user.
Enter letter F if user can make cash requests and enter expenditure data.
Enter letter G if user can make cash requests only.
Enter letter H if user can enter expenditure data only.
ACTION
USER
CODE
TYPE
A/C/D/
CODE
E
F / G / H
NAME
SIGNATURE
PHONE
EMAIL
E
F
John Valadez
714-647-
jvaladez@santa-
5436
ana.or
E
F
Angie
714-647-
abenavides@sant
Benavides
5438
a-ana.or
E
H
Waldo Barela
714-647-
wbarela@santa-
5376
ana.or
SIGNATURE
The person signing below must be designated to represent the organization and has authority to
make changes to the Subgrantee information provided in this form. The signature authorizes the
Employment Development Department to make changes to its records as described above.
Name: Deborah Sanchez, Date: 8-22-2024
Signature: kev, K \ j Email: dsanchez@santa-ana.or
11 Employment
EDD Development
Department
State of California
CaIJOBS
Attachment 9
CASH DELIVERY FORM (CDF)
INSTRUCTIONS:
➢ Send completed CDF with original signature to:
Employment Development Department
Fiscal Programs Division, MIC 70
Cash Control Unit
P. O. BOX 826217
Sacramento, CA 94230-6217
Phone: (916) 654-7868
AND
➢ Email a PDF of the signed form to:
CaIJOBSCashHelpDesk(a)edd.ca.gov
➢ When sending the PDF form via email, on the Subject Line, please type:
Your Subrecipient Code/Subgrantee Code (i.e. ABC) SFY 2017-18 CDF
➢ After emailing the PDF form, the Cash Control Unit must receive the completed
form with original signature within 10 calendar days; otherwise, your
organization's cash requests will be placed on hold.
Employment Development Department (EDD) Page 1 of 2
CASH DELIVERY FORM (CDF)
(Please type)
Organization
City of Santa Ana
Date:
August 22,2024
Name:
Contact Name:
John Valadez
Sub -recipient
SAN
Code:
Email:
jvaladez@santa-ana.org
Phone Number:
714-647-5436
Mailing
20 Civic Center Plaza, MAT Santa Ana CA 92701
Address:
CASH DELIVERY INSTRUCTIONS
Complete this section of the form to indicate no banking changes or to provide new or updated cash
delivery instructions for EDD.
Use an X in the box to the left to indicate your choice:
x
No banking changes from the previously submitted Cash Delivery Form
Please mail checks to the address provided above. (U.S. Mail Delivery)
Please transfer cash directly to our bank account, using the information provided below.
Inter -branch & Wire Transfers
Bank Name:
Bank Account Name:
Bank Phone Number:
Account Number:
ABA Routing Number:
SIGNATURE:
The person signing below must be designated to represent the organization and has
authority to make changes to the Sub -grantee information provided in this form. The
signature authorizes the Employment Development Department to make changes to its
records as described above.
Name: Deborah Sanch _ Date: August 22, 2024
dsanchez@santa-
Signature: ad z .- Email: ana.org
Employment Development Department (EDD) Page 2 of 2