HomeMy WebLinkAbout25K - AGMT - YOUTH PROG OPERATOR
REQUEST FOR r'
COUNCIL ACTION J,f$~
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CITY COUNCIL MEETING DATE: CLERK OF COUNCIL USE ONLY:
JUNE 4, 2012
TITLE: APPROVED
? As Recommended
YOUTH PROGRAM OPERATOR AGREEMENTS ? As Amended
PROGRAM YEAR 2012-13 El Ordinance on 1st Reading
El Ordinance on 2n "d Reading
? Implementing Resolution
? Set Public Hearing For
CONTINUED TO
FILE NUMBER
CITY MANAGER
RECOMMENDED ACTION
1. Authorize the City Manager and Clerk of the Council to execute agreements with the following
Youth Program Operators for Program Year 2012-13 for a total of $991,795 for the period of
July 1, 2012 through June 30, 2013, subject to non-substantive changes approved by the City
Manager and City Attorney:
a. Orange County Children's Therapeutic Arts Center to provide tutoring, work experience,
occupational skills training, job preparation, supportive services, mentoring, and
counseling for twenty five Out-of-School Youth in the amount of $175,000;
b. Santa Ana Public Library to provide post-secondary occupational skills training in the
areas of digital technology, paid work experience, leadership development, and
supportive services for twelve In-School Youth and eight Out-of-School Youth in the
amount of $160,000;
C. Taller San Jose to provide occupational skills training in the fields of healthcare,
professional business services or construction, internship opportunities, supportive
services, counseling, job preparation, and placement to twenty Out-of-School Youth in
the amount of $126,795;
d. Orange County Conservation Corps to provide paid work experience, alternative
secondary education, post-secondary educational resources, and supportive services for
twenty-five Out-of-School Youth in the amount of $250,000;
e. Santa Ana WORK Center STEM Youth Program to provide paid work experience at
worksites related to science, technology, engineering, and math (STEM), workforce
preparation, post-secondary education resources, occupational training in customer
service and supportive services to fifteen In-School Youth and five Out-of-School Youth
in the amount of $160,000;
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Youth Program Operator Agreements PY 12-13
June 4, 2012
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f. NAPSAC to provide paid work experience with local businesses, workforce preparation,
case management, and supportive services to twelve In-School and three Out-of-School
in the amount of $120,000.
2. Authorize the City Manager and Clerk of the Council to execute the attached Memorandum of
Understanding term extension with the Santa Ana WORK Center for the Youth Service
Provider Navigator to June 30, 2013 and allocate funding from program year 2012-2013 funds
in the amount of $321,356.
WORKFORCE INVESTMENT BOARD/EXECUTIVE COMMITTEE ACTION
At its regular meeting on May 17, 2012, by a vote of 14:0 (Beasley, Elliott, Everett, Figueroa,
Fischer, Gonzalez, Jimenez-Hami, Wadhera absent; Ray, Claudio, Didion, de la Riva abstained)
the Workforce Investment Board:
1. Recommended that the City Council approve and authorize the City Manager and Clerk of the
Council to execute agreements for Workforce Investment Act Formula Youth funds for the
following Youth Program Operators for Program Year 2012-2013 in the amount of $991,795,
subject to non-substantive changes approved by the City Manager and City Attorney:
A. Orange County Therapeutic Arts Center $175,000
B. Santa Ana Public Library $160,000
C. Taller San Jose $126,795
D. Orange County Conservation Corps $250,000
E. Santa Ana WORK Center - STEM Project $160,000
F. NAPSAC $120,000
2. Recommended that the City Council approve and authorize the City Manager and Clerk of the
Council to extend the term of the Memorandum of Understanding with the Santa Ana WORK
Center for Youth Service Provider Navigator services to June 30, 2013 and allocate funding in
the amount of $321,355.
DISCUSSION
Under the Workforce Investment Act (WIA), the Santa Ana Workforce Investment Board (WIB) and
its Youth Council are required to procure and make funding recommendations in order to provide
WIA services to local qualified at-risk youth.
On February 6, 2012, the RFP was released with ten agencies submitting proposals for
consideration. On March 19, 2012, the RFP Review Committee, comprised of three Youth Council
members, reviewed the proposals and finalized recommendations to fund six youth service
providers. The requests are reflected in the funding recommendation chart (Exhibit 1). These
funding recommendations take into account the WIA requirement to ensure at least thirty percent
of the youth funds are spent on Out-of-School Youth and the Youth Council's commitment to serve
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Youth Program Operator Agreements PY 12-13
June 4, 2012
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the neediest youth as outlined by the Department of Labor's "New Services under the Workforce
Investment Act." These recommendations are the first steps needed to ensure that at least eighty
percent of the WIA youth funds are obligated each year, as required by the Act.
On June 20, 2011 the City Council approved an extension of the term of the Memorandum of
Understanding (MOU) with the Santa Ana WORK Center/Youth Service Program Navigator
through June 30, 2012. The Youth Service Navigator assumes the responsibility of determining
Workforce Investment Act (WIA) youth eligibility for WIA funded programs and services, provides
technical assistance to youth service providers, shares best practice in case management,
placement, exit, and follow-up services. In addition the Youth Service Navigator ensures the
completion and accuracy of all required forms and documentation, works cooperatively with all
youth service providers from the initial outreach, recruitment, and intake process to the successful
completion, exiting, and follow-up of all WIA youth enrolled in the Youth Service Provider Network
(YSPN). This year the Service Navigator is enhancing its services by providing 50 youth with
career exploration through Road Trip Nation. Road Trip Nation offers a unique curriculum that
exposes youth to real world career experiences, opportunities to conduct their own interviews with
leaders in their field of interest, and create a Road Trip Nation Profile using multimedia technology.
The Service Navigator Program Plan and Budget for Program Year 2012-2013 are attached
(Exhibit 2).
FISCAL IMPACT
Funds for these contracts will be available in the Workforce Investment Act Youth accounts
(account no. 12318750-69135 and account no. 12318755-various) upon City Council's adoption of
the Fiscal Year 2012-2013 budget.
APPROVED AS TO FUNDS AND ACCOUNTS:
Nancy T. ards Francisco Gutierrez
Interim Ex tive Director Executive Director
Community Development Agency Finance & Management_Services Agency
NTE/LAO/DS/kg
Exhibits: 1. Funding Recommendations PY 2012-13
2. Memorandum of Understanding and Youth Service Navigator Plan & Budget
3. Youth Program Operator Agreement Specimen
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Youth WIA Funding Recommendations
Program Year 2012-2013
Total Youth Out-of-
Agency Name Enrollment In-School School
O. C. Children's Therapeutic 25 25
Arts Center
Santa Ana Public Library 20 12 8
Taller San Jose 20 20
O.C. Conservation Corps 25 25
Santa Ana WORK Center STEM 20 15 5
NAPSAC 15 12 3
Total 125 39 86
Total In-School Out-of School
EXHIBIT 1
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Memorandum of Understanding
For
SANTA ANA W/O/R/K CENTER
YOUTH SERVICE NAVIGATOR
EXHIBIT 2
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MEMORANDUM OF UNDERSTANDING
BETWEEN THE
SANTA ANA WORKFORCE INVESTMENT BOARD/YOUTH COUNCIL
AND THE
SANTA ANA W/O/R/K CENTER/ YOUTH SERVICE PROVIDER NAVIGATOR
This Memorandum of Understanding is entered this 1St day of July 2012, by and between the Santa
Ana Workforce Investment Board ("WIB")/Santa Ana Youth Council and the Santa Ana W/O/R/K Center
("Provider") acting in its capacity as the Youth Service Provider Navigator.
1. PURPOSE: The Santa Ana Youth Council designated the Santa Ana W/O/R/K Center as their
"Service Navigator" for all WIA youth services, and its eligible participants. The Service Navigator's
function within the Youth Service Provider Network is to coordinate services in a manner that eliminates
bureaucracy from the participating providers.
2. STAFFING RESPONSIBILITY OF "PROVIDER":
The Santa Ana W/O/R/K Center must provide sufficient staff to conduct the following roles:
A. Assist with recruitment of potential WIA youth participants to Youth Service Provider Network
B. Refer eligible youth to appropriate WIA youth providers
C. Collect eligibility documentation (both at provider location and Service Navigator site)
D. Certify WIA eligibility
E. Ensure accuracy and timely submission of all Job Training Automated (JTA) MIS system forms
F. Provide technical assistance and eligibility training to all providers
G. Develop policies and procedures to ensure compliance with Federal, State and Local WIA rules,
regulations and goals
H. Track and maintain program/provider performance goals
1. Coordinate co-enrollment among youth providers
J. Actively participate on the Santa Ana Youth Council
K. Coordinate (and provide as needed) follow-up services with providers and participants
L. Process payment for services within 30 days of receipt
M. Conduct an annual fiscal monitoring of youth providers funded under WIA
N. Provide on-going Labor Market Information related to youth to providers
0. Provide on-going ADA/EEO information/training
P. Provide on-going information/training on Child Labor Laws
Q. Provide legislative/regulatory updates on services, programs impacted by Youth Workforce
Development
R. Collect, analyze and report to Youth Council the results of the Customer Satisfaction Surveys
S. Create and implement a continuous improvement project based on the results of the Customer
Satisfaction Survey
T. Be available and prepared for monitoring by Federal, State and SAWIB staff
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3. FOLLOW UP SERVICES: Follow-up services will be a coordinated effort between the
W/O/R/K Center Service Navigator and the youth program operators. The purpose of follow-up is to
determine a participant's employment and educational status after exiting the WIA program and to
provide additional assistance if needed.
4. BUDGET: The W/O/R/K Center acting as the "Provider", shall provide all of the services
discussed herein as well as those set forth in Exhibit A, for the monetary amount set forth in its budget
attached hereto as Exhibit B. Said Budget may annually be updated as approved by the WIB.
5. DURATION: This MOU shall remain in effect until a written cancellation is submitted by either
party giving a 30-day advance notice.
6. AMENDMENTS: Either party may propose amendments to this MOU at any time by
providing written notice to the other. Amendments to this MOU shall require the approval of the
authorized signatory for the WIB and the Executive Director for Community Development or his/her
designee ("Executive Director"), on behalf of the W/O/R/K Center.
7. DISPUTES: The parties shall first attempt to resolve all disputes informally. Any party may call
a meeting of all parties to discuss and resolve disputes. Should informal resolution efforts fail, the
dispute shall be referred to the Deputy City Manager for Development Services to act as mediator, to
attempt to resolve the dispute by holding an informal hearing with presentations by both parties. If
the Executive Director's resolution efforts fail, any party may file a grievance with the Deputy City
Manager for Development Services for review and hearing. The parties agree to be bound by the final
determination resulting from that procedure. All costs associated with the grievance procedure shall
be borne by the losing party.
8. SEVERABILITY: If any part of this MOU is found to be null and void, or is otherwise stricken,
the rest of this MOU shall remain in force.
9. HOLD HARMLESS: Each party to this MOU agrees to indemnify and hold harmless the other
parties, their officers, agents, employees, and volunteers from and against any and all loss or damage,
and from any and all suits, actions and claims filed or brought by any person or persons arising out of
acts or omissions of the party or its officers, agents, employees or volunteers in the performance of
this MOU.
10. DISCRIMINATION: Provider shall not discriminate because of race, color, creed, religion, sex,
marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited
by applicable law, and Provider affirms that it shall comply with all applicable federal, state and local
laws and regulations.
11. AUTHORITY AND SIGNATURES: The individuals signing this MOU or its attachments have
the authority to commit the party they represent to the terms of this MOU, and do so commit by
signing.
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first
above written.
ATTEST: CITY OF SANTA ANA
Maria D. Huizar Paul Walters
Clerk of the Council Interim City Manager
APPROVED AS TO FORM:
Sonia R. Carvalho, City Attorney
By:
Lisa Storck
Assistant City Attorney
MOU Youth Navigator 5-12
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The City of Santa Ana
SANTA ANA
wo R
K
CENTER
Service Navigator Plan
Program Year 2012-2013
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EXECUTIVE SUMMARY
The concept of the "Daisy Wheel" service delivery was adopted in 2002 by the Santa Ana Youth Council
to provide an "All Youth One System", where resources would be leveraged from a network of Youth
Service Providers now known as the Youth Service Provider Network (YSPN). The concept allowed
youth regardless of eligibility to receive services from the various Service Providers and the Santa Ana
W/O/R/K Center (SAWC). The Workforce Investment Act (WIA) requires that ten program elements be
delivered in a developmental approach to allow youth to receive resources that will help them overcome
barriers to education and employment. The WIA ten elements require a collaborative, coordinated and
sequenced approach to assisting youth served with WIA funds.
The YSPN was formulated with this principle in mind so that no one Service Provider would have to
provide all ten elements, allow more youth to be served by the Service Providers through other non-WIA
funding streams, and to streamline services provided to youth. The YSPN consists of Service Providers
that collectively offer the ten WIA program elements in a creative and interactive manner. The concept
allows the Service Provider to focus on what service they specialize in and do best. This, however, is not
possible without the role of the Service Navigator. The role of the Service Navigator is critical to promote
broad-based coordination and cooperation among all youth Service Providers and to provide the technical
assistance needed to make the network a success.
Funded through the Santa Ana Workforce Investment Board (WIB) and acting as the Youth Service
Navigator, the City of Santa Ana W/O/R/K Center (SAWC) assumes the primary responsibility of
determining youth eligibility, providing technical assistance, reviewing JTA/MIS forms for completion
and accuracy, training new providers, sharing best practice in case management, providing Labor Market
Information, overseeing the placement, exit, and follow-up services for youth, as well as being an active
member on the Youth Council Board. In addition, the SAWC will collaborate with Roadtrip Nation to
implement the Roadtrip Nation Experience Program, which was created to empower youth to map their
interests to future career pathways in life. As the Service Navigator, the SAWC will work cooperatively
with all Service Providers from the initial outreach, recruitment and intake process to the successful
completion, exiting, and follow-up of all WIA youth enrolled in the YSPN.
As the Service Navigator, the SAWC brings to the YSPN over 30 years of extensive experience
administering a variety of Federal and State funded programs. Staff is well versed in both programmatic
and fiscal requirements. As an on-going effort, the SAWC has made it a priority to keep staff updated and
trained on all State and Federal workforce legislation pertinent to various targeted programs. Since the
inception of the YSPN, the SAWC has been instrumental in helping the Network meet the required
performance measures through consistent oversight and guidance in intake, eligibility, case management,
exit, and follow-up. Moreover, through its partnership with local businesses and organizations, the SAWC
has a comprehensive realm of services and resource available to the YSPN and the youth they enroll.
The SAWC will maintain communication with the youth Service Providers during the term of the contract
by coordinating monthly meetings with all Service Providers for program, legislation, MIS/JTA paper
work updates, and to address any questions or concerns they may have. Individual meetings with Service
Providers will also be arranged to assist and address individual issues or questions. The SAWC will assist
with the marketing, recruitment, outreach, and placement efforts of the YSPN. Ultimately the SAWC's
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goal is to provide the assistance and tools necessary to allow the Service Providers to focus on providing
streamlined services to the youth of Santa Ana. A more detailed description on how the SAWC will
function as the Service Navigator is explained below.
OUTREACH AND RECRUITMENT
Since the development of the YSPN, the SAWC has made it a priority to inform the public of the services
and programs available through the YSPN. Through its partnerships and collaboration with community
agencies, the SAWC has been engaged in planning and participating in community events, job fairs,
resource fairs and conducting presentations to connect youth with the YSPN programs. Some of the major
events in which the SAWC participates include the Annual Summer Youth Job Fair hosted by
Employment Development Department (EDD), the Senior Transitions Day hosted by the Santa Ana
Unified School District (SAUSD) and other annual events hosted by Segerstrom, Century High Schools in
Santa Ana and Youth Summit, a collaboration between the Young Men's Christian Association (YMCA)
and the Boys & Girls Club of Santa Ana.
Utilizing the relationships we have established with the SAUSD, EDD, Orange County Probation, O.C.
Social Services Agency and the Orange County Department of Education, the SAWC has been able to
deepen its outreach effort to a much broader base of youth, parents, and educators in the community. The
SAWC recognizes the importance of marketing the entire YSPN and its comprehensive service programs.
Every effort is made to ensure that staff markets the network at all job fairs, youth oriented recruitment
and outreach events, thus, benefitting all Service Providers.
TRAINING & TECHNICAL ASSISTANCE
For more than 30 years, the SAWC staff has successfully administered and implemented many federally
and state funded employment and training programs. As an on-going effort, the SAWC has made it a
priority to keep staff updated and trained on all State and Federal workforce legislation pertinent to
various targeted programs. Over the years, staff has kept abreast with the latest workforce trends and
legislative changes to ensure compliance with state and federal regulations. Staff has developed
comprehensive training manuals, policies, procedures and conducted regular training for all Service
Providers using a customer friendly and easily understood format. Since the inception of the Daisy Wheel
YSPN in 2002, staff has also translated various complex system measurements and mandatory reporting
requirements into an easily understood format for the YSPN Service Providers.
As the Service Navigator, the SAWC has organized and developed the following training for all Service
Providers not only to broaden staff's knowledge, but also to stay current and be in compliance with our
state and federal regulations:
• What is WIA? • New Enrollment Intake
• Enrollment Strategies • Eligibility/Income Calculations
• Case Management Strategies • Case Notes
• Co-Enrollments • Exit Strategies
• Credential Information • Follow-up training
• Fiscal Invoicing • Disability Awareness
• Fiscal Responsibility • CaIJOBS Training
• Common Measures
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For the past ten years, the SAWC, as the Service Navigator, has met with the YSPN on a monthly basis to
provide monthly reports and the status of their case loads. At the monthly YSPN meetings, the SAWC
reports on enrollments, activities, co-enrollment, exits, and follow-ups. As needed, the SAWC also
conducts in-service training for the Service Providers and alerts them of any changes to paperwork as well
as modifications to process and procedures. The monthly YSPN meeting also provides staff an
opportunity to share their best case management practices and updates on the changes occurred within
each Service Provider. One of the goals has been to provide the YSPN with all the tools necessary to
allow them to focus on providing services to the youth in Santa Ana.
The SAWC continues to avail itself to all Service Providers for individualized training and technical
assistance. At times, when Service Providers have experienced staff turnover, the SAWC staff readily
provided needed transitional and customized training to ensure continuity and consistency of service
delivery. Examples of training include eligibility requirements, intake process, activity setting, case
management techniques, performance management, internal Provider policies & definitions, exit
strategies and follow-up techniques. The trainings were tailored to meet the specific needs of each Service
Provider. The technical assistance mentioned above has proven to be beneficial when State Monitors
have performed audits of our YSPN youth files, documentation, process, and data validation. Of the last
audits we received this past year, there were no major finding and their observations were positive.
ELIGIBILITY DETERMINATION
The SAWC as the Service Navigator will assume the primary responsibility of determining WIA youth
eligibility in accordance with Federal, State, and local rules and regulations. We will train Service
Providers on the eligibility process, provide eligibility forms, calculate participant family income,
determine participant eligibility, review and analyze participant activities, and process eligibility
JTA/MIS forms.
The SAWC has a designated Eligibility Technician with the experience and knowledge to determine WIA
youth eligibility effectively. The Eligibility Technician will review all submitted pre-applications,
barriers, verifying right to work documents, reviewing or registering young male adults to selective
service, and determining income eligibility in accordance with the Poverty Guidelines. The Technician
will also ensure that proper documentation for Equal Opportunity Grievance Procedure and Participant
Grievance Procedure are recorded for each participant. Upon reviewing all eligibility documentations, the
Technician will inform the Service Provider of its youth's eligibility status accordingly. Moreover, the
Eligibility Technician will review enrolled participant activities to ensure their accuracy, record the
participants' information in a database in order to produce reports necessary to keep Service Providers
informed, and forward accurate JTA forms to MIS personnel.
Recommendations, suggestions or corrections are given to each Service Provider for each participant
enrolled as needed to ensure that the eligibility requirements have been met and that enrollment goals for
each program and the YSPN as a whole are reached. An Eligibility Flow Chart is attached (see attachment
A) to provide a better understanding of how eligibility is processed.
COMPLETING JTA & MIS FORMS
The SAWC will ensure that JTA/MIS forms are completed accurately and submitted within the allotted
timeframe. We will review all JTA/MIS forms to ensure accuracy and compliance with Federal, State, and
Local guidelines. All Service Providers will be provided JTA/MIS forms, training on completion of
JTA/MIS forms, and a JTA/MIS Time Line Policy. SAWC staff will be available to answer questions and
provide technical assistance to all Service Provider regarding any forms.
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JTA/MIS forms are processed in a chronological order by the Service Provider and the SAWC. Once the
application, enrollment, and youth test score forms are submitted to the SAWC for enrollment, it is the
responsibility of the Service Navigator to ensure that all information is accurate, including documented
youth test scores, enrollment activities, education status, in addition to making sure all forms have
appropriate signatures and dates It is very important to track key information from each form in order to
produce reports for Service Providers, track performance outcomes, and have the information readily
available to provide guidance to the Service Provider on how to proceed with their participants at any
given period. The SAWC has developed its own tracking database tailored to provide the above
capabilities while giving itself the flexibility and information to provide the YSPN with specialized
technical assistance.
In addition to the tracking system, a reference file has been created for each youth enrolled in the YSPN
in order to track JTA/MIS forms and ensure accuracy of information. The SAWC will make copies of the
completed JTA/MIS forms and forward them to the MIS Unit for entry into the State data system for
official enrollment. Copies of the JTA/MIS forms with an official stamp will be returned to the
corresponding Service Provider.
As youth activities are updated or closed, the Service Provider is to submit JTA/MIS forms along with
data verification, if necessary. The SAWC will ensure their accuracy, input the data into the tracking
system, duplicate the forms, and submit the forms to the MIS Unit for official recording.
Once a Service Provider is ready to exit a youth participant, SAWC is consulted to determine the best exit
strategy. The objective is to make sure that the youth has received quality and necessary assistance to
improve their situation and meet WIA Performance Measures. As the Service Navigator, the SAWC is
responsible for reviewing every exit form, requesting data validation if necessary for all outcomes
claimed, obtaining post-test score forms, making sure that all activities are closed, and ensuring that
exiting the youth is in the best interest of the youth first and then to the YSPN as a whole. Once that has
been established, all exit forms and pertinent information are inputted into the tracking system and copies
are made and sent to the MIS unit for entry into the JTA system. Follow-up services will be conducted for
one year for each exited participant by the responsible Service Provider. Follow-Up forms will be
submitted to the SAWC for review, for input into the tracking system, for data validation, and to enter
into the JTA system.
ROADTRIP NATION EXPERIENCE PROGRAM
The SAWC through collaboration with Roadtrip Nation, an independent organization that empowers
youth to define their own road in life, plans to embed the Roadtrip Nation (RTN) Experience curriculum
into the Service Navigator's responsibility. The goals of the RTN Experience are to inspire and excite
youth about what they have or are studying in school, to connect youth's educational experience to their
real world experiences, and to expose youth to pathways that are relevant to their individual hopes and
dream. The SAWC believes that bringing together youth from each Service Providers program and the
program curriculum from the RTN, will help Youth gain a new perspective on education, gain exposure to
life, and career pathways that they may have not otherwise known existed.
The SAWC will implement Roadtrip Nation project-based curriculum with 50 youth throughout program
year 2012-2013. All youth who participate will benefit from multiple perspectives that they would not
otherwise have had in their transition into adulthood. Multimedia materials and Interview Archive will be
provided to all participating youth as a tool in order to help them discover their own passions and
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interests. Every youth will also receive a workbook to connect their theory-based online content to their
real-world experience. With the Interview Archive, youth will be able to hear directly from a broad range
of leaders who can describe what skills, education and/or training they needed to succeed and how they
navigated challenges to attain success. The RTN Experience offers participating youth the opportunity to
conduct their own interview with leaders in their field of interest. Youth will be trained on how to share
their insights and create a Roadtrip Profile.
The SAWC and Roadtrip Nation staff will work together to build and provide a range of support activities
to maintain youth engagement. Roadtrip Nation will host a series of training sessions to provide the
Service Navigator and other administrators with on-the-ground implementation information. In addition
to the up-front training, Roadtrip Nation will also provide ongoing technology and administrative support
to help drive fidelity throughout the term of the implementation. The signature Roadtrip Nation RV will
visit a targeted site to further drive youth engagement. In essence, the RTN Experience gives youth the
tools to embark on a journey of self-discovery. It is built around three overarching themes, Exposure,
Self-Construction, and Hit the Road, the curriculum guides youth in exploring options, discovering their
interests, setting goals and mapping out a plan for success. Hearing directly from successful individuals
who have followed their dreams and navigated challenges to attain success in wildly diverse fields will
provide the youth a map for getting to the next stage in their own lives. Moreover, the combination of an
Interview Archive, the real world experiential learning and reflective exercises will provide youth with
unprecedented exposure to pathways that are relevant to their individual hope and dreams.
JOB DEVELOPMENT & PLACEMENT
The SAWC has a comprehensive realm of services available through its partnership with local businesses
and organization. The SAWC is an integral part of the City's Economic Development Division that also
manages the Enterprise Zone Programs. The Enterprise Zone program is designed to promote business
growth and job generation by offering State tax credits and highly valuable economic incentives to
businesses. Many of our Santa Ana residents including youth qualify for these tax credits.
It is through our experience, expertise, and partnerships with businesses and community partners, we are
able to provide the community with quality job placement assistance and offer connections to a strong
labor market. The SAWC will offer assistance and guidance in job placement by notifying Service
Providers and youth of job opportunities, employer on-site hiring recruitments, and job fairs. SAWC will
notify Service Providers daily via electronic mail and/or flyers regarding job announcements. The Youth
Help Desk will also be available to assist youth looking for employment by providing them with job
search assistance, job opening, resume assistance, labor market information and demand occupations.
In addition the SAWC utilizes a robust job matching software to post local job openings, upload resumes,
and automatically match job seekers to the openings that fit their interests, skills, and availability. As an
added value, youth that are job ready will have their resume uploaded by the Navigator staff into the job
matching software to assist in placing them with local companies.
Furthermore, the SAWC integrated one-stop service system and various partners including EDD, allows
more individual assistance for our older youth to find employment. Workshops on resume writing and
interviewing techniques are just a few of the added components to help them find employment.
PERFORMANCE MANAGEMENT
The SAWC, through its extensive experience in administering Federal and State funded programs,
understands that WIA performance management is vital to the success of the YSPN. As the Service
Navigator, the SAWC prepares and trains staff on WIA performance measures and any new and updated
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legislation. Staff attends training through DOL and attends the annual California Workforce Association
Conferences to stay updated with the most recent legislation and requirements regarding WIA. This is
just one example of our commitment to helping the YSPN stay in compliance and in meeting all Federal,
State, and locally mandated performance measures. The SAWC also provides training on Common
Measures to allow all Service Providers to have a basic understanding of what Common Measures are and
how they will affect them individually and as a network.
The SAWC will provide all Service Providers with individual exit oversight. Staff will meet individually
with each Service Provider to go over exit strategies for each youth actively enrolled on their case load
and evaluate which youth are ready to exit the program and how their exit will impact the overall success
of the YSPN. The SAWC will train all Service Providers on how to exit and follow-up on their youth in
order to comply with federal, state, and local regulations. Staff will use the Navigator data base to provide
reports to the Service Providers and inform them of follow-up due dates for each participant at their 30,
60, 1 st 2°a, 3rd and 4t" quarter follow-up. The Service Provider will also receive updated charts and data
informing them of their progress with WIA Performance Measures-individually and as a Network. This
will ensure that as a network we stay informed of our planned versus actual goal attainments and that we
meet all performance measurements.
CUSTOMER SATISFACTION
Measuring customer satisfaction has always been an integral part of the YSPN program operation. As the
Navigator, the SAWC is responsible collecting and analyzing customer satisfaction for the YSPN. A
customer satisfaction survey tool for the youth has been developed for those enrolled in the YSPN (see
attachment B). The SAWC will randomly survey participants enrolled and exited from the YSPN during
the term of the program. In addition, all customer satisfaction outcomes will be reported to the Youth
Council Staff for their review. We are committed to providing exceptional customer service and will
strive for continuous improvement utilizing data collected and by sharing this valuable information with
all youth Service Providers.
FISCAL OVERSIGHT
The SAWC is responsible for processing Service Provider invoices and reimbursement requests. It is the
responsibility of the SAWC to ensure that all Service Providers understand that the utilization of WIA
funds is to be reasonable, allowable and allocable as required by Office of Management and Budget
(OMB) circulars, Code of Federal Regulations, EDD Directives and City of Santa Ana policies. The
accounting staff provides a mandatory annual training to all Service Providers fiscal staff regarding the
necessary requirements for invoicing their program expenses.
The Santa Ana WIB is required by federal regulation to conduct a fiscal monitoring of all programs
funded by WIA. Onsite monitoring must occur at least once during the program year and includes review
of fiscal records as well as policies and procedures. A written report delineating findings will be provided
to all providers that will include any needed corrective actions, a timeline for accomplishing the corrective
actions and include any follow-up on corrective actions. The SAWC accounting staff establishes a
monitoring schedule for visiting each program operator in the YSPN. During the review, financial
records are sampled to ensure accuracy and compliance with federal, state and local regulations.
Technical assistance is offered when necessary to establish and maintain accurate accounting procedures.
SAWC fiscal staff works with the service provider's fiscal staff to resolve any issues that arise from the
monitoring. Staff follows up with the program operators to resolve findings and maintain financial
records as required by regulations.
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25K-16
FISCAL CAPACITY
The SAWC is a part of the City of Santa Ana. All fiscal and procurement operations follow the policies
and procedures of the City. As a part of the City's accounting system, the SAWC has various account
numbers assigned that relate to specific funding sources. Revenues and expenditures are coded with
account numbers relating to those funding sources. Monthly financial statements are produced based on
charges to those accounts. The monthly reports indicate the line item budget amounts, expenditures
against the budget and the balance remaining for each account and funding program.
Accounts Payable
YSPN service provider invoices with accompanying documentation are received and reviewed by the
accounting staff for allowable and reasonable expenditures and for completeness of documentation. Any
discrepancies are reported back to the Service Provider with requests for additional documentation as
needed. The invoices are assigned account numbers and approved for payment. Community Development
Agency Administrative staff prepares the request for payment, attach the necessary documentation and
forward to the Finance Accounts Payable unit for entry into the City's accounting system. Checks are
issued according to City policies and timelines.
General operating costs of the SAWC are processed in a similar manner. Invoices are reviewed by the
accounting staff who assigns the relevant account code based on the chart of account established by the
City. The invoices are approved and forwarded for processing and payment. At the end of the month,
expense reports are prepared by account and distributed to the various agencies within the City.
Payroll
As part of the City of Santa Ana, SAWC staff is paid twice a month. Time sheets are completed by all
staff indicating functions and programs that have been worked on during that particular pay period. That
information, with the accompanying account numbers, is entered into the payroll system by the Senior
Accounting Assistant. Payroll dollar amounts are posted to the accounting system and are reflected on the
monthly financial reports.
Procurement
The SAWC follows the City of Santa Ana's procurement policies as well as federal and state regulations
related to procurement. Purchase requisitions for items over $500 are entered into the accounting system
and approved by the finance staff at City Hall. Buyers from the Purchasing Department review the
requisitions and issue purchase orders following City policies and procedures. When the goods are
received by SAWC, staff compares the goods delivered to the purchase requisition for completeness and
accuracy. The purchase order paperwork is approved, signed and returned to the Purchasing department.
Payment for the goods is initiated through the Purchasing department following City procedures.
ORGANIZATAIONAL STRENGTHS
The SAWC brings over 30 years of experience operating various federally, state and locally funded
employment and training programs, and has consistently met or exceeded performance expectations.
Listed below are some of our organizational strengths.
I . A state recognized, award-winning entity with a proven record in leadership, workforce innovation,
service integration and quality services.
2. A One-Stop Center with versatility in its service delivery that is capable of addressing the needs of
diverse target populations resulting in the diversification of multiple funding streams.
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25K-17
3. Ability to effectively leverage resources across an extensive network of partner agencies and
community organization. Demonstrated fiscal stability and program sustainability over the past 20
years.
4. Exceptional track record in successfully implementing the following programs: WIA Adult,
Dislocated Worker, Youth Formula Grants, Rapid Response, National Emergency Grants,
Governor's 15% discretionary Grants, 25% Grants, DOL Welfare-to-Work Grant, DOL Faith-based
Initiative Grant, The Santa Ana Federal Empowerment Corporation funded - Housing and Urban
Development Grant - FEZ Daisy Wheel Employment and training Program, DOL - Youth Earmark
Grant, the Department of Justice - Weed and Seed Program, American Recovery and Reinvestment
Act programs for youth and adults.
5. Staff is well versed and current in workforce legislation. Through membership in State and national
workforce associations, staff has the ability to access timely workforce resources as well as any
pending legislative changes and to share the information with network service providers.
6. Has a fully developed internal monitoring and performance management system in place.
Comprehensive and time-tested policies and procedures manuals are updated regularly.
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25K-18
Eligibility Protocol
l
Trsinh4on *Iigib ft protocol is provided by Youth Sorvia ksvigator
i
•
Youth Service Na*ator supplies and maintains eligibility forms for all Providers
Participant Providers interview participants and have them fill out the eligibility in-take packets
Submit Eligibility Packets to SAWC
Providers submit ehgkg ty packets to the Youth Service Navigator for eligibility review
~W
SAWC Determines Eligibility
Review In-take packets Santa Ana Resident and Calculate Income Determine Second Barrier Assign Eligibility Date
14-21 V"rsold
Review Youth Activities
Ensurethat the youth activities match their needs
Revise and Record MIS Forms
Review official application and activities forms to prevent Inaccuracies. Input information on tracking system
• and Submit MIS Forms
Youth Service Navigator approves and signs youth documentation and submites to MIS data center
Enrollment
M IS personnel Inputs client information into !TA system, stamps forms, and returns copies to SAWC
Distribution
SAWC Oves a copy of official enrollment forms to ftv* er
Reference File
SAWC creates a file for each enrolled youth to reference eligiNty documents, MIS paperwork, and data Verification.
14
25K-19
~I
Budget Form
Administrative Total WIA
Cost (Not to Total Cost Match/In Kind
Exceed 10%) Program Cost
Personnel Salaries
Economic Development Mgr - .05 FTE, Workforce Specialist III - 1FTE,
Workforce Specialist II - 1.75 FTE, Senior Office Assistant - .25FTE $201,015.00
Personnel Benefits
Benefits based on salaries listed
above $61,595.00
Total Personnel Salaries &
Benefits $262,610.00 $0.00
Operating Expenses
Contractual Services $0.00
Rent $7,775.00 $7,775.00
Phones $2,040.00 $2,040.00
Professional Consultants $23,855.00 $23,855.00
Training and Conferences $1,160.00 $1,160.00
Commodities $0.00
Miscellaneous Office Supplies $3,870.00 $3,870.00
Fixed Charges $0.00
Vehicle lease* $2,420.00 $2,420.00
IT Maintenance $3,740.00 $3,740.00
Insurance $6,030.00 $6,030.00
Indirect Cost* $6,855.00 $6,855.00
Miscellaneous $0.00
Transportation Passes $500.00 $500.00
Client Supportive Services $500.00 $500.00
Total Operating Expenses $58,745.00 $58,745.00 $0.00
GRAND TOTAL (Personnel+Operating) $321,355.00 $0.00
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25K-20
BUDGET NARRATIVE
Personnel:
Economic Development Manager - .05 FTE - will oversee Youth functions as part of the Santa Ana Work
Center, collaborate with community and business leaders, establish and maintain partnerships with
various agencies to enhance employment training opportunities, represent Santa Ana WIB on regional and
statewide boards and associations.
Workforce Specialist III - 1 FTE - manage and oversee Youth Service Provider Network; provide
technical assistance and training to service providers; supervise YSPN case managers; provide monthly
performance and enrollment reports for YSPN, Youth Council, and State; mentor and follow up with
youth participants as needed.
Workforce Specialist II - 1.75 FTE - will determine WIA eligibility, review and approve MIS
documents, provide technical assistance to service providers, assist with job readiness skills training, job
search and job placements. Will oversee and train service providers on Roadtrip Nation program. Will
provide follow-up services for youth as needed.
Senior Office Assistant - .25 FTE - will assist with client phone calls, answering client questions, assist
with mail-outs, meeting preparation, and assist with the overall technical assistance provide by the
Navigator.
Benefits:
Benefits are based on rates determined by the City and are calculated as a percentage of salary with the
exception of health benefits which are based on each individual's health plan.
Retirement - 8.349%
Medicare - 1.45%
Retiree Medical - 1%
Workers Compensation - 1.04%
Operating Expenses
Rent/User Fee: The user fee is based on actual square footage for Youth staff and is charged at $1.97 per
square foot.
Phones: Phone charges are based on $85 per month and include usage charges as well as equipment
charges.
Security: The security charge is the Youth portion of the annual fee for the security system at the Work
Center.
IT Maintenance: Computer and internet services are maintained by the IT division of the City of Santa
Ana. The fee is based on the charges assessed by the City to the Santa Ana Work Center.
Insurance: Insurance is provided by the City of Santa Ana and is based on the rate assessed by the City to
the Santa Ana Work Center.
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25K-21
Vehicle Lease: The vehicle lease covers the cost of a car provided by the City of Santa Ana and includes
maintenance and gas.
Office Expenses: Office expenses cover the cost of office supplies including but not limited to paper,
pencils, pens, folders, duplicating costs and postage. All supplies are purchased under the City of Santa
Ana's purchasing agreements. Postage is charged by the City's Reprographics Division based on actual
usage.
Indirect Costs: An indirect cost rate of 5.32% based on salaries is charged by the City of Santa Ana as a
part of the City's overall cost allocation plan. The rates are calculated annually. A copy of the 2011-12
Indirect Cost Plan is attached.
Staff Training and Conferences: California Workforce Association hosts an annual Youth Conference
held locally. It provides staff with current information on youth programs throughout the state as well as
updates on current and pending legislation.
Roadtrip Nation: This educational component will provide curriculum, resources and intemet access to
the YSPN and youth participants. Cost includes the curriculum, books, training, and two events to engage
youth in the program.
Supportive Services: Bus passes, gas cards, clothing and other support services will be available to youth
who need assistance and are unable to receive support through other means.
17
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Contract No.
AGREEMENT UNDER THE WORKFORCE INVESTMENT ACT
THIS AGREEMENT, made and entered into this day of
, 2012, by and between the City of Santa Ana, a charter city and
municipal corporation duly organized and existing under the Constitution and laws of the
State of California ("CITY") and a non-profit corporation
("CONTRACTOR").
W-I-T-N-E-S-S-E-T-H
Recitals:
A. CITY has been designated a Local Workforce Investment Area
(LWIA) under the Workforce Investment Act of 1998, Public Law 105-220 ("the Act").
B. The State of California has created the LWIA to administer the Act
programs operated by the State of California pursuant to the Act.
C. As a LWIA, CITY is entitled to receive federal funds to establish
programs to prepare economically disadvantaged youths for entry into the labor market and
to provide basic skills development to those individuals who are economically
disadvantaged or otherwise face serious barriers to succeeding in life. One goal of
California's Workforce Investment System is to provide youth with the opportunities to
achieve career goals that will allow them to successfully compete in the labor market and
prepare them for higher education.
D. CONTRACTOR is experienced in operating education, occupational
development and employment programs for economically disadvantaged youths for entry
into the labor market ("said program").
E. CONTRACTOR is willing to operate said program pursuant to the
Act and California law.
WHEREFORE, for and in consideration of the respective and mutual
covenants and promises hereinafter contained and made, and subject to all the terms and
conditions hereof, the parties hereto do hereby agree as follows:
1.
CONTRACTOR'S OBLIGATIONS
A. CONTRACTOR agrees to provide the following services pursuant to
said program, as more specifically set forth in CONTRACTOR'S Program Narrative
t
This agreement serves as a specimen for
all other agreements to be executed once
approved by this action. 25K-23 EXHIBIT 3
contained in "Exhibit A" and in the Performance Standards "Exhibit B", attached hereto
and by this reference incorporated herein. CONTRACTOR'S failure to provide said
services may be grounds for CITY to readjust the level of payment to CONTRACTOR
otherwise provided for hereinafter.
B. CONTRACTOR agrees to provide benefits to individuals who
participate in the activities and services funded by this Agreement ("participants") in
accordance with the standards and requirements set forth in Workforce Investment Act of
1998, Public Law 105-220.
C. CONTRACTOR agrees to perform the services set forth herein in a
professional, timely and diligent manner.
D. CONTRACTOR shall provide wages and benefits to individuals who
participate
in the activities and services funded by this Agreement ("participants") in accordance with
the standards and requirements of the Act, including Section 181 of the Act.
E. CONTRACTOR shall adhere to the Labor Standards described in the
Act including Section 181 of the Act.
F. CONTRACTOR agrees to comply with the "Complaint Handling
Procedures Under the WIA", attached hereto as "Exhibit C" and incorporated herein as
though fully set forth in 20 CFR §667.200, Subpart F. CONTRACTOR shall advise
participants of their rights to file complaints under the Act and the procedures for resolution
of any complaints. CITY's procedures for handling complaints alleging a violation of the
Act, regulations, grants, or other agreements under the Act shall be followed and any
decision of CITY, the State or the federal government relating to the complaint shall be
binding and followed by CONTRACTOR. CONTRACTORS who are employers shall
operate a grievance system that incorporates CITY's procedures for resolution of
complaints relating to the terms and conditions of employment; these procedures shall be
approved in writing by CITY.
G. As a condition of this award of financial assistance under the Act to
CONTRACTOR from CITY, CONTRACTOR assures, with respect to operation of all
programs or activities funded with funds provided pursuant to the Act, and all agreements
or arrangements to carry out such programs or activities, that it will comply fully with the
nondiscrimination and equal opportunity provisions of the Act (Section 188) and
compliance with Equal Employment Opportunity provisions in Executive Order (E.O.)
11246, as amended by E.O. 11375 and supplemented by the requirements of 41 CFR Part
60; the Nontraditional Employment for Women Act of 1991; Title VI of the Civil Rights
Act of 1964, as amended; section 504 of the Rehabilitation Act of 1973, as amended; the
Age Discrimination Act of 1975, as amended; the Americans with Disabilities Act of 1990;
and with all applicable requirements imposed by or pursuant to regulations implementing
those laws, including, but not limited to, 29 CFR Part 33 and 37. The United States, the
State of California and CITY have the right to seek judicial enforcement of this assurance.
H. CONTRACTOR agrees that no participant(s) shall commence training
prior to the approval of funding pursuant to Section 123 of the Act.
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25K-24
I. CONTRACTOR agrees to maintain such records and submit such
reports, data and information, on the form and containing such information, at such times
as CITY may request or require regarding the performance of CONTRACTOR'S services
or activities, costs or other data, including but not limited to, participants' attendance,
payroll records and job duty statements.
CONTRACTOR agrees to forward to the Santa Ana Work Center
Administrative Office, 1000 East Santa Ana Blvd., Suite 200, Santa Ana, California 92701
a completed Workforce Investment Act Application form (WIA EWIR) and supporting
documents within 20 days of application date; a complete Workforce Investment Act
Enrollment/Registration form (WIA EWIE) within 20 days of determination (reviewer)
date; any subsequent updates to EWIE within 15 days of the begin date of activity or end
date of an activity; Workforce Investment Act Youth Test Scores form (WIA EYTS) within
20 days of application date; Workforce Investment Act Exit form (WIA EWIT) within 20
days of completion/termination of active enrollment of trainee; and the Workforce
Investment Act Follow-Up Contact Information form (WIA EWIF) within 20 days
following 30, 60, 90,180, 270, and 360 days of exit.
CITY, the State of California and the United States government and/or their
representatives shall have access for purposes of monitoring, auditing and examining of
CONTRACTOR'S activities, performance, books, documents, papers, and records of
CONTRACTOR subcontractors, bookkeepers and accountants, and employees and
participants related to this Agreement. Such agencies or representatives shall also schedule
on-site monitoring in their discretion. Monitoring activities may also include, but are not
limited to, questioning employees and participants and entering any premises or onto any
site in which any of the services or activities funded hereunder are conducted or in which
any of the records of CONTRACTOR are kept. Nothing herein shall be construed to
require access to any privileged or confidential information as set forth in federal or state
law.
In the event CONTRACTOR does not make the above-referenced
documents available within the City of Santa Ana, California, CONTRACTOR agrees to
pay all necessary and reasonable expenses incurred by CITY in conducting any audit at the
location where said records and books of account are maintained.
All accounting records and evidence pertaining to all costs of
CONTRACTOR and all documents related to this Agreement shall be kept available at the
location where CONTRACTOR conducted the program, as well as in the County of
Orange, for the duration of this Agreement and thereafter for three (3) years after
completion of an audit. Records which relate to (a) complaints, claims, administrative
proceedings or litigation arising out of the performance of this Agreement, or (b) costs and
expenses of this Agreement to which CITY, the State of California or the United States
Government take exception, shall be retained beyond the three (3) years until resolution of
disposition of such appeals, litigation, claims, or exceptions.
J. Without prejudice to any other section of this Agreement,
CONTRACTOR shall, where applicable, maintain the confidential nature of information
provided to it concerning participants in accordance with the requirements of federal and
3
25K-25
state law. Notwithstanding the foregoing, CONTRACTOR agrees to submit to CITY, the
State of California and/or the United States Government or their representatives, all records
requested for administrative purposes, including
audits, examinations, monitoring and verification of records submitted by CONTRACTOR,
costs incurred and services rendered hereunder.
K. CONTRACTOR agrees to complete in triplicate, a monthly
Invoice/Voucher on CITY's Invoice/Voucher form, showing in detail the amount of money
already expended by CONTRACTOR hereunder, as this is a cash reimbursement contract.
Accounting records must be supported by such source documentation such as cancelled
checks, paid bills, payrolls, time and attendance records, contract and subgrant award
documents [29 CFR-Subpart C, Section 97.20 (b)(6)]. CONTRACTOR agrees to submit
the above-stated documents to the WIB Administrative Office, 1000 East Santa Ana Blvd.,
Suite 200, Santa Ana, California, 92701, by the tenth (10th) day of the month following the
month in which CONTRACTOR'S services are performed. Should CONTRACTOR fail to
deliver said documents to CITY, CITY shall have the option to cancel this Agreement by
giving CONTRACTOR ten (10) days written notice thereof. CONTRACTOR shall either
return to the CITY excess revenues over costs or use such excess revenues as program
income by utilizing such program income for additional training activities authorized under
the Act.
L. CONTRACTOR agrees to expend all funds in accordance with all
applicable federal, state and local laws and regulations. CONTRACTOR also agrees to
provide at CONTRACTOR'S own expense supplies and other costs of said PROGRAM.
M. CONTRACTOR shall arrange independently for an audit that
includes WIA funds received from CITY, in accordance with the Act, 20 CFR Section
667.200 and OMB Circular A-133. CONTRACTOR shall submit one original of each
required audit report to CITY within (30) days after the date received by CONTRACTOR.
Should CONTRACTOR fail to comply with these requirements, CITY may at its option
withhold payment of funds, or disallow funds or suspend additional grant funds.
N. CONTRACTOR shall not expend funds pursuant to this Agreement
to provide services to any participant where costs of training are paid for by any other
person or entity.
0. CONTRACTOR shall comply with the provisions of Circular A-102
of the U.S. Office of Management and Budget (OMB) and the related "Common Rule"
entitled "Uniform Administrative Requirements for Grants and Cooperative Agreements to
State and Local Government", Subpart C, paragraphs 37 and 42, Circular A-128, and all
other applicable federal statutes and executive orders and their implementing regulations,
including regulations at 29 CFR Part 97.
P. CONTRACTOR shall comply with the requirements of federal
regulations found at 29 CFR 93 which provide that no appropriated funds may be expended
by the recipient of a federal contract, grant, loan or cooperative agreement to pay any
person for influencing or attempting to influence an officer or employee of any agency,
member of Congress or an officer or employee of a member of Congress in connection with
awarding of any federal contract, the making of any federal grant or loan, entering into any
4
25K-26
cooperative agreement and the extension, renewal, amendment or modification of any
federal contract, grant, loan or cooperative agreement. CONTRACTOR shall sign a
Certification Regarding Lobbying to that effect in a form as set forth in "Exhibit D,"
attached hereto and by this reference incorporated herein. CONTRACTOR shall submit
said signed Certification to CITY prior to performing any of its obligations under this
Agreement and prior to any obligation arising on the part of CITY to pay any sums to
CONTRACTOR under the terms and conditions of this Agreement.
Q. CONTRACTOR agrees to provide a drug-free work place and to
execute a Drug Free Workplace Certification as set forth in "Exhibit E" attached hereto
and incorporated herein by this reference.
R. CONTRACTOR, in accordance with the Child Support Compliance
Act, recognizes and acknowledges the importance of child and family support obligations
and shall fully comply with all 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 Section 5200) of
Part 5 of Division 9 of the state Family Code; and, 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 Employee Registry maintained by the California
Employment Development Department (EDD).
S. CONTRACTOR agrees to comply with all applicable provisions of the
ACT and the federal regulations, including but not limited to the regulations found at 20
CFR part 629.
T. CONTRACTOR agrees to that it is in compliance with the
Certification Regarding Debarment ("Exhibit F") as required by the regulations
implementing Executive Order 12549, Debarment and Suspension, 29 CFR Part 98,
Section 98.510, Participants' Responsibilities. The regulations were published as Part VII
of the May 16, 1988, Federal Register (Pages 19160-19211).
U. CONTRACTOR agrees to provide priority of services for veterans
and eligible spouses pursuant to 20 CFR part 1010 and the regulations implementing
priority of service for veterans and eligible spouses in Department of Labor job training
programs under the Jobs for Veterans Act published at 73 Fed.Reg. 78132 on December 19,
2008.
II.
CITY'S OBLIGATIONS
A. CITY agrees to pay to CONTRACTOR when, if and to the extent
federal funds are received under the provisions of the Act a sum not to exceed
$ .00 for CONTRACTOR'S performance in accordance with the Budget attached
hereto as "Exhibit G" during the period of this Agreement. Said sum shall be paid after
CITY receives invoices submitted by CONTRACTOR as provided hereinabove.
B. CONTRACTOR has the ability to adjust line item amounts in the
budget with the approval of the Executive Director, so long as the total Budget amount
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25K-27
does not increase.
C. CITY agrees to provide for on-site monitoring reviews of said
program
operation at least annually. In addition, monthly desk-top reviews of pertinent information
will be conducted.
D. CITY has the right to de-obligate the funds hereunder and take such
funding back from CONTRACTOR due to any of the following reasons: (a) lack of
performance by CONTRACTOR; (b) lack of fiscal accountability of CONTRACTOR; or
(c) decrease in available funding.
III.
TIME PERIOD OF AGREEMENT
This Agreement shall commence on and all duties
arising under this Agreement shall have been performed by . The term of
this Agreement may be extended by a writing executed by the Executive Director for the
Community Development Agency and the City Attorney.
IV.
INDEPENDENT CONTRACTOR
Consultant shall, during the entire term of this Agreement, be construed to
be an independent contractor and not an employee of the City. This Agreement is not
intended nor shall it be construed to create an employer-employee relationship, a joint
venture relationship, or to allow the City to exercise discretion or control over the
professional manner in which Consultant performs the services which are the subject matter
of this Agreement; however, the services to be provided by Consultant shall be provided in
a manner consistent with all applicable standards and regulations governing such services.
Consultant shall pay all salaries and wages, employer's social security taxes, unemployment
insurance and similar taxes relating to employees and shall be responsible for all applicable
withholding taxes.
V.
WORKER'S COMPENSATION AND EMPLOYER'S RIGHTS
A. CONTRACTOR shall use appropriate funds received from CITY to
provide workers' compensation to all those hired by CONTRACTOR under this
Agreement.
B. CONTRACTOR shall have the right to hire, dismiss, or promote its
employees or contract personnel hired under this Agreement so long as its hiring or
dismissal policy or standard does not violate Title VII of the Civil Rights Act of 1964, Fair
Labor Standards Act of 1938, or any other applicable law, and CONTRACTOR maintains
itself as an Equal Opportunity employer.
VI.
APPLICABLE GUIDELINES
A. The parties hereto agree that CONTRACTOR shall comply with all
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25K-28
applicable federal and state laws and regulations, including, but not limited to the
Performance Standards (Exhibit B) and general program requirements described in
Sections 106 and 141 of the Act (29 USC Sections 1516 and 1551) and applicable
regulations, and the U.S. Department of Labor guidelines and regulations, including
amendments or revisions made during the terms of this Agreement. Said applicable laws
are hereby incorporated by reference and made as part of this Agreement as though fully set
forth herein.
B. CONTRACTOR also assures and certifies that:
1. CONTRACTOR acknowledges and confirms that the U.S.
Department of Labor has established three (3) common measures for youth: (a) Placement
in employment or education; (b) Attainment of degree or certificate; and, (c) Literacy or
numeracy gains. Pending WIA reauthorization and or U.S. Department of Labor and EDD
updates, Contractor agree to implement and shall meet any additional performance
measures that may be subsequently required by the Workforce Investment Act or by any
other Federal, State, and local law.
2. CONTRACTOR shall comply with Title VII of the Civil
Rights Act of 1964 (P.L. 83-354) and in accordance with Title VII of the Act, no person
shall, on the grounds of race, color, religion, sex, age, handicap or national origin be
excluded from participation in, be denied the benefits of, or be otherwise subjected to
discrimination under this Agreement.
3. CONTRACTOR shall comply with any and all federal laws
limiting the political activity of employees hired under this Agreement.
4. CONTRACTOR shall comply with the requirements that no
program under the Act shall involve political activities.
5. RECORD INSPECTION. CONTRACTOR shall provide the
U.S. Department of Labor and the Controller General, by and through any authorized
representative, as well as the WIB Administrative Office, access to and the right to examine
all records, books, papers or documents relating to the accounting and use of funds under
this Agreement for a three-year period from and after the effective date of this Agreement.
6. No person with responsibilities in the operation of any
program under the Act shall discriminate with respect to any program participant or any
application for participation in such program because of race, creed, color, national origin,
sex, political affiliation or beliefs.
7. CONTRACTOR shall maintain appropriate standards for
health and safety in work and training situations.
8. CONTRACTOR shall comply with general provisions,
assurances, and execute the Assurances and Certifications attached hereto as "Exhibit H"
and incorporated herein.
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25K-29
9. EQUAL OPPORTUNITY. Any literature distributed by
CONTRACTOR for the purpose of apprising businesses, participants, or the general public
of its programs under this Agreement shall state that its programs are supported by the City
of Santa Ana and the Santa Ana Workforce Investment Board, and shall state that the
program is an "equal opportunity employer/program" and that "auxiliary aids and services
are available upon request to individuals with disabilities."
10. Based on the population eligible to be served, or likely to be
directly affected by the WIA program or activity, the services or information may need to
be provided in a language other than English in order to allow such population to be
effectively informed about or able to participate in the program or activity. Pursuant to 29
CFR 37.35, the Contractor must take reasonable steps to provide services and information
in appropriate languages after considering the scope of the program or activity, and the size
and concentration of the population that needs services or information in a language other
than English.
11. CONTRACTOR certifies that all property, finished or
unfinished documents, data, studies and reports prepared or purchased under this
Agreement, will be disposed of in accordance with the direction of the CITY. In addition,
any tools and/or equipment furnished to the CONTRACTOR by the CITY and/or
purchased by the CONTRACTOR with funds pursuant to this Agreement, will be limited to
use within the activities outlined in this agreement and will remain the property of the
United States Government and/or CITY. Upon termination of this Agreement,
CONTRACTOR will immediately return such tools and/or equipment to the CITY or
dispose of them in accordance with the direction of the CITY.
12. CONTRACTOR certifies that this 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, as specified by Article
XVI, Section 5, of the Constitution of the State of California, regarding separation of
church and state.
13. PATENT, COPYRIGHTS AND RIGHTS IN DATA. The
CONTRACTOR will disclose to the CITY any invention, written product, computer
program
developed or data assembled as a result of performance of work under this Agreement
within seventy four (74) days of invention, development or assembly. The CITY, State of
California, and U.S. Department of Labor will have the right to patent any invention and
copyright any written product or computer program or data generated by CONTRACTOR.
Upon written request, CONTRACTOR will transfer all pertinent information,
specifications and right, title and interest to the designated agency.
14. INVENTIONS, PATENTS AND COPYRIGHTS.
A. Reporting Procedure. If any project produces patentable items,
patent rights, processes, or inventions in the course of work under a U.S. Department of
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Labor (DOL) grant or agreement, the CONTRACTOR shall report the fact promptly and
fully to the CITY. The CITY shall report the fact to the Grant Officer, at the DOL. Unless
there is a prior agreement between the CITY and the DOL and its representative on these
matters, the DOL shall determine whether to seek protection on the invention or discovery.
The DOL and its representative shall determine how the rightsin the invention or
discovery, including rights under any patent issued thereon, will be allocated and
administered in order to protect the public interest consistent with the "Governmental
Patent Policy" (President's Memorandum for Heads of Executive Departments and
Agencies, August 23, 1971, and Statement of Government Patent Policy as printed in 36
FR 16889).
B. Copyright Policy.
1. Unless otherwise provided in the terms of the grant or agreement, when
copyright-able material is developed in the course of or under a DOL Grant or agreement,
the author and the CITY which developed the work is free to copyright material or to
permit others to do so. The CONTRACTOR and the Workforce Investment Board (WIB)
shall have a royalty-free, nonexclusive and irrevocable license to reproduce, publish, use
and to authorize others to use all copyrighted material.
2. The DOL reserves a royalty-free, nonexclusive, and irrevocable license
to reproduce, publish or otherwise use, and to authorize others to use, for Federal
Government purposes: (a) The copyright in any work developed under any grant, sub-
grant, or contract under a grant or subgrant; (b) Any right of copyright to which a grantee,
subgrantee or a CONTRACTOR purchases ownership with grant support; and (c)
CONTRACTOR shall comply with the requirements of 29 CFR Part 97.34.
C. Rights to Data. The DOL and the CITY shall have unlimited rights
to any data first procured or delivered under this Agreement.
15. CLEAN AIR / CLEAN WATER ACT. If the grant
hereunder exceeds $100,000, CONTRACTOR must comply with Section 306 of the Clean
Air Act [(42 USC 1875(h)]; Section 508 of the Clean Water Act (33 USC 1368); Executive
Order 11738 and Environmental Protection Agency ("EPA") regulations (40 CFR Part 15)
as any may now exist or be hereafter amended. Under these laws and regulations, the
CONTRACTOR assures that:
(a) No facility to be utilized in the performance of the proposed grant has
been listed on the EPA List of Violating Facilities;
(b) It will notify CITY prior to award of the receipt of any communication
from the Director, Office of Federal Activities, U.S. EPA, indicating
that a facility to be utilized for the grant is under consideration to be
listed on the EPA List of Violating Facilities;
(c) It will notify the CITY and the EPA about any known violation of the
above laws and regulations.
C. CONTRACTOR agrees to adhere to the following STANDARDS OF
CONDUCT:
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1. General Assurance. Every reasonable course of action will be taken by
CONTRACTOR in order to maintain the integrity of this expenditure of public funds and
to avoid favoritism. This Agreement will be administered in an impartial manner, free
from errors to gain personal, financial, political gain. CONTRACTOR, its officers and
employees, in administering this Agreement, will avoid situations which give rise to a
suggestion that any decision was influenced by prejudice, bias, special interest or desire for
personal gain.
2. Employment of Former State or CITY Employees. CONTRACTOR will ensure
that any of its employees who were formerly employed by the State of California or CITY,
in a position that could have enabled such individuals to impact policy regarding or
implementation of programs covered by this Agreement, will not be assigned to any part or
phase of the activities conducted pursuant to this Agreement for a period of not less than
two years following the termination of such employment.
3. Conducting Business Involving Relatives. No relative by blood, adoption or
marriage of any executive or employee of CONTRACTOR will receive favorable treatment
when considered for enrollment in programs provided by, or employment with,
CONTRACTOR.
4. Conducting Business Involving Close personal Friends and Associates.
Executives and employees of CONTRACTOR will be particularly aware of the varying
degrees of influence that can be exerted by personal friends and associates and, in
administering this Agreement, will exercise due diligence to avoid situations which give
rise to an assertion that favorable treatment is being granted to friends and associates.
When it is in the public interest for CONTRACTOR to conduct business with a friend or
associate of an executive or employee of CONTRACTOR, an elected official in the area or
a voting or non-voting member of the Workforce Investment Board (WIB), a permanent
record of the transaction will be retained.
5. Avoidance of Conflict of Economic Interest. No executive or employee of
CONTRACTOR elected official in the area, or voting or non-voting member of a WIB,
will solicit or accept money or any other consideration from a third person, for the
performance of an act reimbursed in whole or part by CONTRACTOR or CITY. Supplies,
materials, equipment or services purchased with Agreement funds will be used solely for
purposes asserted or allowed under this Agreement. No voting member of the WIB will
cast a vote on the provision of services or vote on any matter which would provide direct
financial benefit to that member or any business or organization which the member directly
represents.
6. Salary and Bonus Limitations. All Subrecipients of WIA program funds are
required to
comply with federal requirements regarding the limitations on salary and bonus payments
in accordance with Public Law 109-149, Section 7013.
VII.
HOLD HARMLESS
A. CONTRACTOR shall indemnify and save harmless CITY, its
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officers, agents and employees, from and against any and all damages to property or
injuries to or death of any person or persons, including property and employees or agents of
CITY, and shall defend, indemnify and save harmless CITY, its officers, agents and
employees, from any and all claims, demands, suits, actions or proceedings of any kind or
nature, including, but not by way of limitation, workers' compensation claims, resulting
from or arising out of the negligent acts, errors or omission of CONTRACTOR, its
employees or subcontractors.
B. CONTRACTOR shall indemnify and save harmless CITY, its
officers, agents and employees, from and against any and all damages to property or
injuries to or death of any person or persons, including property and employees or agents of
CITY, and shall defend, indemnify and save harmless CITY, its officers, agents and
employees, from and against any and all claims, demands, suits, actions or proceedings
therefore, resulting from or arising out of the intentional or malicious acts of
CONTRACTOR, its employees or subcontractors.
VIII.
INSURANCE
1. Commercial General Liability. CONTRACTOR agrees to obtain and
keep in force during the term of this Agreement a policy of comprehensive commercial
public liability insurance insuring the State of California, CITY, and CONTRACTOR
against any liability for accident, injury or death arising out of or in consequence of this
Agreement. Such insurance shall be in an amount not less than One Million Dollars
($1,000,000.00) for any injury to or death of any person or persons in any single accident or
occurrence. Said policy of comprehensive public liability insurance shall be endorsed to
provide to CITY and to the State of California, Employment Development Department, at
least thirty (30) days written notice prior to cancellation; name CITY, its officers, agents,
employees, and volunteers, and the State of California, its officers, employees, and
volunteers as Additional Insured; and state that such coverage is primary to any other
coverage or self-insurance of the State of California and CITY (in substantially the form as
Exhibit I , Additional Insured Endorsement, attached hereto). Governmental entities may
substitute a certificate of self-insurance.
2. Automobile Liability Coverage. CONTRACTOR shall also obtain and
maintain, during the effective period of this Agreement, broad form automobile liability
coverage with a $1,000,000 limit unless reduced by CITY, which applies to both
owned/leased and non-owned automobiles used by CONTRACTOR employees or
participants in performance of this Agreement, or, in the event that CITY will not utilize
such owned/leased automobiles but intends to require employees, participants or other
agents to utilize their own automobiles in the performance of this Agreement,
CONTRACTOR shall secure and maintain on file from all such employees, participants, or
agents as self-certification of automobile insurance coverage. Governmental entities may
substitute a certificate of self-insurance.
3. Workers' Compensation. If CONTRACTOR is an "employer", as set forth
in California Labor Code Section 3300 et seq., or utilizes participants as "employees," as
set forth in California Labor Code Section 3350 et seq., CONTRACTOR shall obtain and
keep in force during the term of this Agreement full Workers' Compensation insurance
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coverage for injuries suffered by participants. Said insurance policy shall guarantee CITY
at least thirty (30) days written notice of cancellation or modification. CONTRACTOR
shall carry medical and accident insurance for those participants not qualifying as
"employees" for Worker's Compensation Coverage, pursuant to California Labor Code
Section 3350, et seq.
4. Equipment Coverage. CONTRACTOR shall purchase a policy or policies
of insurance covering loss or damage to any and all Equipment provided to or purchased by
CONTRACTOR in accordance with this Agreement. Said insurance shall be in the amount
of the full replacement value thereof, providing protection against the classification of fire,
extended coverage, vandalism, malicious mischief, theft, and special extended perils.
Governmental entities may substitute a certificate of self-insurance.
5. Proof of Insurance. Certificates and endorsements must be submitted and
approved by CITY prior to any work under this Agreement. CONTRACTOR understands
that CITY will make no payments under this Agreement until the required certificates and
endorsements have been approved by CITY.
IX.
CORPORATE STATUS
All corporate CONTRACTORS shall be in good standing, without
suspension by the California Secretary of State, Franchise Tax Board and Internal Revenue
Service. Any change in corporate status or suspension shall be reported immediately to
CITY.
X.
ASSIGNABILITY
None of the duties of, or work to be performed by, CONTRACTOR under this
Agreement shall be subcontracted or assigned to any agency, consultant, or person without
the prior written consent of CITY. CONTRACTOR must submit all subcontracts and other
agreements that relate to this Agreement to CITY. No subcontract or assignment shall
terminate or alter the legal obligations of CONTRACTOR pursuant to this Agreement.
XI.
LAWS GOVERNING THIS AGREEMENT
In its performance under this Agreement, CONTRACTOR shall fully comply
with the requirements of the following, whether or not otherwise referred to in this
Agreement:
1. The Act and all applicable federal statutes, regulations, policies, procedures and
directives, including but not limited to, 20 C.F.R. Parts 652 and 660 through 671.
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2. All applicable State statutes, regulations, policies, procedures and directives;
3. All applicable CITY policies, procedures and directives;
4. All applicable local ordinances and requirements, including use permits and licensing;
5. Court orders applicable to its operation; and,
6. The terms and conditions of this Agreement.
If any of the foregoing is enacted, amended, or revised, CONTRACTOR will
comply with such or will notify CITY after enactment or modification that it cannot so
comply. CITY may thereupon terminate this Agreement, if necessary.
XII.
EXCLUSIVITY AND AMENDMENT OF AGREEMENT
This Agreement supersedes any and all other agreements, either oral or in
writing, between the parties hereto with respect to the employment of CONTRACTOR by
CITY, and contains all the covenants and agreements between the parties with respect to
such employment. Each party to this Agreement acknowledges that no representations,
inducements, promises or agreements, orally or otherwise, have been made by any party, or
anyone acting on behalf of any party, which are not embodied herein, and that no other
agreement or amendment hereto shall be effective unless executed in writing and signed by
both CITY and CONTRACTOR.
XIII.
FRAUD
CONTRACTOR shall immediately report to CITY all instances and facts
concerning possible fraud, abuse or criminal activity relating to expenditure or receipt of
funds under this Agreement.
XI V.
CONTINGENCY OF FUNDS
CONTRACTOR acknowledges that approval of and funding for this
Agreement is contingent upon State approval, and funds received or obligated from the
State of California to CITY. If such approval of funds is not forthcoming, or is otherwise
limited, CITY shall immediately notify CONTRACTOR. Within twenty (20) days of
receipt of such notice, CONTRACTOR shall modify or cease operations as directed by
CITY and negotiate necessary modification to this Agreement and/or reimbursement of
costs incurred hereunder.
XV.
TERMINATION
A. This Agreement may be terminated by either party at its sole discretion, upon
thirty (30) days written notice to the other party. Notice shall be deemed served on the date
of mailing. However, CONTRACTOR may not terminate this Agreement if undue
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hardship will result to any participant.
B. In the event CONTRACTOR defaults by failing to fulfill all or any of its
obligations hereunder, CITY may declare a default and termination of this Agreement by
written notice to CONTRACTOR, which default and termination shall be effective on a date
stated in the notice which is to be not less than ten (10) days after certified mailing or personal
service of such notice, unless such default is cured before the effective date of termination
stated in such notice. If terminated for cause, CITY shall be relieved of further liability or
responsibility under this Agreement, or as a result of the termination thereof, including the
payment of money, except for payment for approved expenses incurred for services
satisfactorily and timely performed prior to the mailing or service of the notice of termination,
and except for reimbursement of (1) any payments made for services not subsequently
performed in a timely and satisfactory manner, and (2) costs incurred by CITY in obtaining
substitute performance.
XVI.
DISPUTES
Except as otherwise provided in this Agreement, any dispute concerning any
question arising under this Agreement shall be decided by CITY. In such a case CITY shall
reduce its decision to writing and mail or otherwise furnish a copy thereof to
CONTRACTOR. The decision of the City shall be final and conclusive unless within
thirty (30) calendar days from the mailing or delivery of such copy, CITY receives from
CONTRACTOR written request to appeal said decision.
Procedures governing the appeal shall be prescribed by CITY and/or the
State of California in accordance with the Act and all corresponding regulations and OMB
circulars. Pending final disposition of the appeal, CONTRACTOR shall act in accordance
with CITY's decision unless the dispute involves a change order.
XVII.
BREACH - SANCTIONS
If, through any cause, CONTRACTOR violates any of the terms and
conditions of this Agreement, and/or prior agreements whereby grant funds were received
by CONTRACTOR pursuant to this Agreement, or if CONTRACTOR reports inaccurately
or if any Audit Report makes disallowances, CONTRACTOR shall promptly remedy its
acts or omissions and/or repay CITY all amounts due CITY as a result of
CONTRACTOR's violation. For any such failures or violations, CITY shall also have the
right at its sole discretion to either: (1) discontinue program support until such time as
CONTRACTOR fulfills its obligations or remedies all violations of this agreement or prior
agreements; and/or (2) collect outstanding amounts as determined by CITY due CITY by
offsetting or debiting from current claims or invoices, if after thirty (30) days' written notice
CONTRACTOR has failed to repay same or a repayment schedule has not been made;
and/or (3) terminate this Agreement by giving written notice to CONTRACTOR of such
termination in accordance the notice provision in Paragraph XVIII herein below.
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XVIII.
NOTICES
All notices, reports and correspondence between the parties hereto
respecting this Agreement shall be in writing and deposited in the United States Mail,
postage prepaid, addressed as follows:
CITY: City of Santa Ana
Manager, WIB Administrative Office
P.O. Box 1988 (M-73)
Santa Ana, CA 92702
and,
CLERK: Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Telefacsimile (714) 647-6956
CONTRACTOR:
Phone: (714)
Fax: (714)
Attn:
XIX.
MERGER
This Agreement, together with the attachments hereto, expresses the total
understanding of the parties. There are no oral understandings of the parties or terms and
conditions other than as stated herein.
XX.
VALIDITY
The invalidity in whole or in part of any provision of this Agreement shall
not void or affect the validity of any other provision of this Agreement.
XXI.
MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature hereinbelow has the
power, authority and right to bind their respective parties to each of the terms of this
Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for
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any injuries or damages to CITY in the event that such authority or power is not, in fact, held
by the signatory or is withdrawn.
b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully
set forth in the body of this Agreement.
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and
year first above-written.
CITY OF SANTA ANA, a municipal
corporation of the State of California
ATTEST: "CITY"
By:
Maria D. Huizar Paul Walters
Clerk of the Council Interim City Manager
APPROVED AS TO FORM: "CONTRACTOR"
Sonia R. Carvalho
City Attorney
BY: BY:
Lisa E. Storck Name:
Assistant City Attorney Title:
Tax ID
Proposal Narrative for Youth Service Provider Network (YSPN) Membership
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Note: Please answer each question as concisely as possible in the format provided.
Please do not exceed maximum allowable pages per section. Use font size 12.
1. PROPOSAL NARRATIVE (10 pages maximum for this section)
A. Executive Summary (1 page)
1. Briefly describe your organization.
2. Briefly describe how this program fits in with programs currently being offered by your
agency.
3. Briefly describe the basic program (indicate the number of youth to be served, which WIA
population will be served, activities/workshops, work experience, training, educational
resources, work readiness, case management strategies).
4. Indicate the planned outcomes and how they will meet the WIA Performance Goals.
5. Disclose the total funding request.
6. Indicate which of the 10 WIA elements the program will offer (all 10 elements not
required).
B. Program Description
1. Describe the program in its entirety from July 2012-June 30, 2013.
2. Indicate the number of youth that will be served
3. Indicate which WIA population will receive the services.
4. Indicate the age group that will be served.
5. Describe the recruitment plan. Indicate how the program will attract and interest youth.
6. How will your agency ensure that 75% of youth are enrolled by the second quarter of the
program year (December 31, 2012).
7. Describe the services that will be provided to the participants and the agency that will be
responsible for providing those services.
8. Describe how the program will lead to a pathway of self-sufficiency.
9. Describe how the program includes opportunities for participants to gain work experience
and receive compensation whether through payroll, stipends, incentives.
10. Indicate how the program uses innovative teaching strategies to improve numeracy and
literacy.
11. Describe how the program assists youth in attaining employment or entering post-
secondary education.
12. Indicate how the program will connect youth to resources that will help them earn an
accredited credential or certificate or diploma.
13. Indicate how the program will provide training and employment services that lead to
occupations in high growth/high demand industries.
14. What is the length of the program? How much time will a youth need to be in this program
to get he full benefits? How often will the WIA participant need to attend the program
and how often are specific activities offered (daily/weekly/monthly)?
15. How often will participants meet with agency staff? Will other non-WIA agency staff be
providing elements of the program? If so, please describe.
16. Describe how the program interacts and is supported by other (proposer's) agency
programs.
17. Describe what supportive services participants will receive.
18. Describe how services will be made easily accessible to youth in Santa Ana.
19. Describe the services that will be offered to the youth participant during the 12 month
follow-up period after exit? Indicate how participants will attain performance measures
during the follow-up period.
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EXHIBIT A
C. Priority Services
1. Demonstrate how the program will include targeted youth groups:
a) Foster and/or emancipated youth
b) Youth with disabilities
c) Youth on probation.
2. Demonstrate how the program will include targeted projects:
a) Job training programs that will prepare youth for green-collar careers
b) Projects that attract and prepare youth for STEM (science, technology,
engineering and mathematics) careers
c) Projects that offer work experience (youth compensation suggested via
hourly pay, stipends or incentives).
D. Program Timeline
1. Use a chart, timeline or other organization format to show sequence of events for the
entirety of the program.
2. Describe how the participant flow will occur. Include the following categories:
a. Outreach
b. Recruitment
c. Intake
d. Assessment
e. Eligibility Determination ( Note: program operator is responsible for gathering the
documents required by the Service Navigator to determine eligibility. Service
Navigator is responsible for determining eligibility.)
f. 75% youth enrollment benchmark
g. Case Management
h. Program Services
i. Supportive Services
j. Placement in Employment
k. Placement in education
1. Training Services
m. Services to improve Literacy/Numeracy
n. 12 Month Follow-up after exit and Retention (Describe how you will continue to
support youth during the follow up period. Discuss types of sources of support,
services and frequency of contact with youth).
E. Goals / Objectives and Performance Levels
1. How will your program meet the WIA performance goals listed below:
a. 65%- Placement in Employment or Education
b. 61% -Attainment of Degree or Certificate
c. 40%- Literacy Numeracy Gains.
2. Please indicate last year's performance measures for your agency (applicable to recipients
of WIA funds).
3. Describe how you will monitor program activity and manage for performance.
4. How will continuous improvement to the program be measured and conducted?
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EXHIBIT A
F. Facilities
1. State location where program services will be delivered (include cross streets).
2. List hours of operation. Will facility be available during non-traditional hours?
3. Describe what makes your facility youth friendly and suitable for the proposed
activities/services.
4. How will your agency assist youth in accessing your site if not within City of Santa Ana?
5. Is the facility compliant with the Americans with Disability Act (ADA)? Base your answer
on completion of ADA/EEO Survey (see attachment F). Describe corrective action plan if
necessary.
6. Discuss how Internet access will be available to program staff. List computer
programs/applications used by agency staff.
7. Describe how adequate staffing will be maintained to ensure success of this program.
II. ABOUT YOUR ORGANIZATION
(3 pages maximum for this section)
A. Qualifications
1. Discuss the current number of full-time and part-time personnel employed, include fiscal
staff.
2. Indicate average annual operating budget and sources of revenue.
3. How long has your organization been serving Santa Ana youth?
4. What kind of impact has your services made to the youth in the community?
B. Experience
1. Briefly outline all youth programs that your agency has operated during the last 2 years.
(Previous funding and contract performance will be verified.) Include discussion of past
performance as related to WIA performance goals. Organizations with no experience in
providing WIA services should explain unique advantages or value associated with their
proposal.
2. What kind of experience do you have in incorporating parents, youth and employers into
your programs?
3. Describe how staff will receive training and ongoing staff development to increase staff
capacity and expertise in the field of youth development and employment.
4. List the positions dedicated to this proposal (include fiscal staff). Include a description of
duties and time allocation for each responsibility.
Note: YSPN highly encourages programs to dedicate at least one full-time equivalent staff
to ensure program success.
C. Fiscal Capacity
1. Describe the process used to capture and report fiscal data.
2. Attach a copy of the organization's procurement policies and procedures.
3. What systems are used to ensure fiscal accountability and appropriate expenditures, and
planned costs?
4. Describe invoicing process and list qualifications of staff assigned to task.
5. Describe how agency's financial stability is not dependent on WIA funds.
6. Submit most recent 2 years of audited financial statements (see attachment G).
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D. Subcontracting
1. Subcontracting client services/activities is not permissible under this contract. However if
planning to subcontract non-client services, identify subcontracts role and estimated cost
for services.
EXHIBIT A
III. COST REASONABLENESS
(8 pages maximum for this section)
A. Budget
1. Use Budget Form (Attachment C, page 32) to outline the program's budget.
Budgets will be reviewed for accuracy and completeness. All proposals will be reviewed
for costs that are allowable under WIA, necessary, reasonable and competitive, as
measured by the review of the line item budget, the program design and the comparison
to all other proposals.
B. Budget Narrative
1. Include a detailed narrative that outlines each line item listed on the Budget Form as well
as a
description of how costs will be allocated to the program. Budget Narratives will be
reviewed to ensure that cost is justified and reasonable for the activities/services
proposed, applicant is not solely relying on WIA funds, and project is leveraging funds
from other resources.
2. Provide and explain the pertinent documents/forms that will be used to track work
experience compensation or participant incentives (i.e.: timecards, sign-in sheets, etc.)
3. Provide supportive service policy if program will provide participants with supportive
services.
4. Provide incentive policy if program will provide participants with incentives.
IV. ATTACHMENTS
A. Letter(s) of Intent/Partnership (required if partnerships are proposed in this proposal)
B. Letter(s) of Support
C. Program Forms (Samples)
D. Other documents that support proposal
EXHIBIT A
YSPN MEMBER PERFORMANCE PLAN 2012-2013
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WIA YOUTH POPULATION
Youth Population Ages # of Youth to be Served
In-School
Out-of-School
TOTAL NUMBER OF YOUTH TO BE SERVED
PROJECTED ENROLLMENTS & EXPENDITURES
(NOTE: 75% OF YOUTH MUST BE ENROLLED BY 2ND QUARTER-DECEMBER 31, 2012)
# of Enrollments
Quarter Estimated Expenditures per Quarter
per Quarter
1s $
2°d (75% Enrollment Required) $
3rd $
4th $
TOTAL $
PERFORMANCE GOALS/COMMON MEASURES
*DISCLAIMER: OUTCOMES ARE SUBJECT TO INCREASE/DECREASE DEPENDING ON YOUTH POPULATION
Total # of Youth Multiplied Minimum # of
Performance Category youth to fulfill
by Performance Rate
performance
Placement in Employment OR
Placement in Post-Secondary Education x 65% _
(by Exit or 15Y Quarter Follow-Up)
Attainment of Degree or Certificate
0
(by Exit or by 3`d Quarter Follow-Up) x 61/ _
Improved Literacy OR Numeracy x 40% _
EXHIBIT B
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COMPLAINT HANDLING
UNDER THE
WORKFORCE INVESTMENT ACT
SANTA ANA
WIA
Santa Ana Local Workforce Investment Area
Revised May 7, 2009
EXHIBIT C
25K-45 Page 23 of 54
Table of Contents
1. Information Regarding Complaints 3
A. Nondiscrimination and Equal Opportunity Complaints 3
1. Policy Statement 3
2. Civil Rights 4
3. Nondiscrimination laws under WIA 4
4. How to File Your Complaint 5
B. Criminal Complaints 6
II. General Procedures for Handling Non-Criminal Violations of the Act 6
III. Procedures for Handling Complaints at the LWIA Level 8
IV. Procedures for Handling Complaints at the State Level 12
V. Procedures for Handling Discrimination Complaints by Participants 15
VI. Procedures for Handling Handicap Complaints by Participants 17
GLOSSARY OF WIA TERMS 20
EXHIBIT C
25K-46 Page 24 of 54
I. Information Regarding Complaints
A. Nondiscrimination and Equal Opportunity Complaints
1. Policy Statement
In carrying out the purpose of the Workforce Investment Act (WIA), the City
of Santa Ana Local Workforce Investment Area (LWIA) will establish
programs to prepare youth and unskilled adults for entry into the labor force
and to afford job training to those individuals facing serious barriers to
employment. Every effort will be made to provide services necessary for
eligible individuals to obtain productive employment.
In implementing WIA, all contractors in the Santa Ana LWIA will foster equal
opportunity and non-discrimination, as provided in State and Federal equal
opportunity and non-discrimination laws including, but not limited to:
• Title VI of the Civil Rights Act of 1964
• Title VII of the Civil Rights Act of 1964
• The Age Discrimination Act of 1975, as amended
• Section 503 of the Rehabilitation Act of 1973
• Section 504 of the Rehabilitation Act of 1973
• Title IX of the Education Amendments of 1972
• Section 188 of the Workforce Investment Act of 1998
In keeping with our commitment, no individual shall be excluded from
participation in, denied benefits of, subjected to discrimination under, or
denied employment, in the administration or of in connection with any WIA
funded program because of race, color, religion, sex, national origin, age,
handicap, or political affiliation or belief.
Participation in programs and activities financially assisted in whole or in
part under WIA shall be open to citizens and nationals of the United States,
lawfully admitted permanent resident aliens, lawfully admitted refugee,
parolees, and other individuals authorized by the Attorney General to work
in the United States.
No individual will be intimidated, threatened, coerced, or discriminated
against because of filing a complaint, furnishing information, or assisting or
participating in any manner in an investigation, compliance review, hearing
or any other activity related to the administration of WIA.
EXHIBIT C
25K-47 Page 25 of 54
Administration responsibility for this Equal Opportunity/Affirmative Action
(EO/AA) Program is delegated to the Equal Employment Opportunity (EEO)
Officer for the Santa Ana local Workforce Investment Area. Equal
opportunity and non-discrimination, however, will only be achieved through
leadership and implementation of a viable Affirmative Action Equal
opportunity Program.
2. Civil Rights
No one applying for or enrolled in the Workforce Investment Act (WIA)
programs may be discriminated against because of race, color, creed,
handicap, national origin, sex, age, political affiliation, or beliefs.
This means that - for any of the characteristics listed above:
• You may not be denied the opportunity to enroll in WIA.
• No benefits or services may be denied you for discriminatory reasons.
• You may not be segregated or treated any differently from other
applicants or participants, while you are being registered, interviewed,
counseled or tested; or while you are working or attending classes as
part of the program.
• You must be provided an equal chance to use all facilities available in
the program.
• Fair employment practices must be provided to all staff with regard to
recruiting, hiring, transferring, promotions, training, compensation,
benefits, layoff, and termination.
You have the right to make a complaint if you feel you have been denied
any of the above opportunities. You cannot in any way be penalized for
filing a complaint. Your WIA sponsor has established a mechanism for
handling complaints and grievances. Your complaint must be filed within
180 days. All complaints will be handled confidentially.
3. Nondiscrimination Laws under WIA
Title VI of the Civil Rights Act of 1964
Prohibits discrimination on the basis of race, color, national origin, or
religion.
The Age Discrimination Act of 1975
EXHIBIT C
25K-48 page 26 of 54
Prohibits arbitrary discrimination against persons age 40-70.
The Rehabilitation Act of 1973
Prohibits discrimination based on handicap.
Title IX of the Education Amendments of 1972
Prohibits discrimination in any education or training program or activity
receiving federal financial assistance.
OTHER CIVIL RIGHTS LAWS:
Title VII of the Civil Rights Acts of 1964
Prohibits discrimination in employment based on race, color, religion,
sex, or national origin in all terms and conditions of employment and
establishes the Equal Employment Opportunity Commission as the
administrative agency.
White House Executive Order no. 11246 as Amended by Executive
Order No. 11375
Creates the office of Federal Contract Compliance and prohibits
discrimination based on race, color, sex, religion, or national origin.
Department of Labor Secretary's Order no. 4-73
Prohibits discrimination based on sex.
Equal Pay Act of 1963
Prohibits pay differential solely because of sex.
Emergency Employment Act of 1971
Prohibits discrimination based on race, creed, national origin, political
affiliation, or beliefs.
4. How to File Your Complaint
a. Put your complaint in writing.
b. Have it sworn to before a notary public, if possible.
C. Provides details that tell what happened, where it happened and when it
happened.
d. Give the name and addresses of all persons who were present or who
EXHIBIT C
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e. had anything to do with the matter.
...Complaints on the basis of race, color, or national origin, age, sex,
religion, political affiliation or belief, retaliation and citizenship, must be
filed within 180 days of the alleged occurrence directly with:
Director
Civil Rights Center
U.S. Department of Labor, Room N-4123
200 Constitution Ave., NW
Washington, D.C. 20210
Complaints on the basis of handicap must be filed within 180 days of the
alleged occurrence. These complaints must be filed directly with the
WIA administrative entity. The WIA administrative entity shall issue a
written decision within 30 days of the filing of the complaint. If the
complaint is still unresolved, an appeal may be made to the Chief of
State Workforce Investment Division Office.
The Department of Labor, the Civil Service Commission, the Equal
Employment opportunity Commission, and many other offices and agencies
are committed to assuring equal employment opportunities for all persons.
They will protect you.
A case may be taken to court if the other processes do not yield satisfactory
results.
You may hire your own lawyer, or if you cannot afford one, the court may
appoint one for you.
It is unlawful for an employer, union, or employment agency to punish you
or any witness for attempting to present the facts in a case.
YOUR CIVIL RIGHTS UNDER THE
WORKFORCE INVESTMENT ACT
Santa Ana Local Workforce Investment Area
1000 E. Santa Ana Blvd., Ste 200
Santa Ana, CA 92701
(714)565-2600
B. Criminal Complaints
In accordance with the WIA (P.L. 105-200) and the implementing code of
Federal section 667.600.... Federal handling of criminal complaints and report
fraud, abuse and other criminal activity. "All information and complaints
involving fraud, abuse or other criminal activity shall be reported directly and
EXHIBIT C
25K-50 Page 28 of 54
immediately to the City of Santa Ana and the Secretary of Labor."
II. General Procedures for Handling Non-Criminal Violations of
the Act
The following procedure is promulgated to meet the requirements of Title 20, of the
Code of Federal Regulations, Section 667.600 through 667.640 of the WIA
regulations, and Section 181(c) of the Act (Public Law 105.200: 29 U.S. Code Sec.
2931 et seq.) at the State and LWIA level for the receipt, investigation, hearing, and
resolution of complaints by WIA participants, sub recipients, applicants for
participation, or financial assistance, labor unions, community based organizations, or
any other persons.
These procedures provide for resolution of non-criminal complaints arising from the
operation of the Santa Ana LWIA.
A complaint is defined here as a written expression by a party alleging a violation of
the Act, regulations promulgated under the Act, recipient grants, sub agreements, or
other specific agreements under the Act, including terms and conditions of
employment of such
participants in employment training programs. All complaints, amendments and
withdrawals shall be in writing. These procedures are intended to resolve matters
which concern policies, procedures or action(s) arising in connection with WIA
programs operated by each LWIA grant recipient and sub recipient under the Act.
These procedures shall not be construed as affecting any other available legal remedy
outside of the WIA complaint process (i.e., disputes regarding terms and conditions of
employment of any employee who is not a participant), either separately or
simultaneously, that a person may wish to pursue in the resolution of a non-WIA
complaint. Also, these procedures do not restrict the LWIA grant recipient staff in
carrying out informal discussion
Procedures do not restrict the LWIA grant recipient staff in carrying out informal
discussion and resolution of any problems outside of and without resort to the formal
complaint procedure.
A. The following principles and rules apply to all complaints at all steps of the
complaint procedures:
1. All complaints must be made in writing within 180 days of the alleged
occurrence, except complaints alleging fraud or criminal activity.
2. All persons filing a complaint shall be free from restraint, coercion, reprisal,
or discrimination. Good faith efforts shall be made to informally resolve the
EXHIBIT C
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3. complaint prior to the scheduled hearing. Complainants have the right to
withdraw their complaints (in writing) at any time prior to the hearing. A
complainant may amend his/her complaint to correct technical deficiencies
but not to add issues.
4. Complainants shall have the right to be represented at their own expense by
person(s) of their choosing at all levels of the complaint process.
5. Upon enrollment into employment or training, participants shall be
provided with a written description of these procedures, including notification
of their right to file complaints and instructions for filing.
An employer of participants, including private-for-profit employers of
participants, may use this or other complaint resolution procedures so long
as the participant is informed of the complaint resolution procedure they are
to follow and the time frames governing review of complaints are met.
A "participant", within the meaning of these procedures, is an individual who
receives employment-training services under a program funded by Santa
Ana LWIA. The Complaint Resolution Procedures contained herein (or the
alternative procedures which an employer may use) shall be available to
participants to resolve disputes regarding items and conditions of
employment of such participants in employment training programs.
However, such procedures shall not be used to resolve disputes regarding
terms and conditions of employment of any employee who is not a
participant, as defined herein.
6. If a complaint does not receive a decision at the LWIA grant recipient
level within 60 days of filing the complaint or receives an unsatisfactory
decision, the complainant then has a right to request a review of the
complaint by the Governor.
7. Complainants must initially file and exhaust LWIA grant recipient/hearing
procedures prior to appealing to the State except where the State
determines that the LWIA grant recipient's procedures are not in compliance
with the State's procedures.
III. Procedures for Handling Complaints at the LWIA Level
A. Receipt Complaints
Pursuant to the WIA regulations found at 20 CFR, Section 667.600, the LWIA
EXHIBIT C
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administrative entities have the responsibility to conduct hearings and resolve
complaints made by individuals about the administration of programs in the LWIA.
"LWIA level" encompasses LWIA administrative entity and employers to which the
administrative entity has delegated the complaint resolution process. The following
comprise the guidelines for resolving issues arising in connection with WIA
programs operated by the Santa Ana LWIA including resolutions of complaints
arising from actions, such as audit disallowances or the imposition of sanctions
taken by the Governor with respect to audit findings, investigations or monitoring
reports.
1. Form and Filing of Compliant
Official filing date of the compliant is the date the written complaint is received.
The filing of the complaint with the Santa Ana LWIA Equal Employment
Opportunity Officer shall be considered as a request for hearing and a decision
must be issued within 60 days. The complaint must be in writing and must be
signed and dated. The complaint should also contain the following information:
a. Full name, telephone number, if any, and mailing address of the complainant;
b. Full name, telephone number, and mailing address of the agency involved
(respondent);
c. Clear and concise statement of facts including dates constituting alleged
violation;
d. What provisions under the Act, regulations, grant or other agreements under
the Act, are believed to have been violated;
e. Remedy sought by the complainant; and
f. If the complainant is a private or public entity or corporation, and not a natural
person, the filing of the complaint must be duly authorized by the governing
body of such entity or corporation.
The absence of any of the requested information shall not be a basis for dismissing
the complaint.
A copy of the complaint must be sent to the respondent and both parties notified of
the opportunity for an informal resolution. At each step of the complaint process, the
complainant must be notified in writing of the next procedural step.
2. Informal Conference
EXHIBIT C
25K-53 Page 31 of 54
Informal conferences will be utilized by the Santa Ana LWIA to resolve
complaints; however, such informal conferences shall not extend the time
within which a decision must be issued after receipt of a complaint. Attempts at
informal resolution will commence with two (2) weeks of the date of filing of the
complaint.
a. The EEO Officer will review the case and ascertain facts prior to the conference
so that appropriate resolution can take place at the time of this meeting
whenever possible.
b. Although the complainant should be encouraged to attend this conference,
his/her failure to do so should not preclude his/her right to request a hearing on
the matter.
c. If mutually satisfactory resolution results and the Santa Ana LWIA concurs, the
EEO Officer will write a brief report for the file stating the issues and resolution.
The matter shall then be considered closed.
d. If resolution does not result, the complainant shall be provided the necessary
information and assistance to request a hearing if he/she so desires.
3. Request for Hearing
a. As in the case of the complaint, the request for a hearing should be put in
writing and be filed in person or by mail. A governing board resolution of
authorization to appeal should also be submitted when appropriate. The
request should be filled with:
Anita Queen
Sr. Personnel Analyst - EEO Officer
20 Civic Center Drive, M-24
Santa Ana, CA 92701
(714) 647-5157
b. A hearing will be scheduled by the EEO Officer within thirty (30) days of the
date of filing of the complaint.
4. Notice of Hearing
Upon receipt of the request for hearing, the complainant and the respondent
will be notified in writing of the hearing ten (10) calendar days prior to the date
of the hearing. The ten-day notice may be shortened with the written consent
of the parties. A decision will be issued by the Santa Ana LWIA within sixty
(60) days of the date of filing of the complaint.
EXHIBIT C
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The hearing notice shall be in writing and contain the following information:
a. The date of notice, name of the complainant, and the name of the party against
whom the complaint is filed.
b. The date, time and place of hearing before an impartial hearing officer.
c. A statement(s) of the alleged violation(s)
d. Advise as to where information or assistance may be obtained, and the name,
address, and telephone number of the Santa Ana LWIA Equal Employment
Opportunities (EEO) Officer who can answer inquiries.
B. Conduct of Hearing
The hearing shall be conducted in an informal manner with strict rules of evidence
not applicable. Unnecessary technicalities should be avoided. It should provide
the flexibility to enable adjustment to the circumstances presented.
1. The hearing officer shall have complete independence to obtain facts and make
decisions. The hearing officer shall be in a position to render impartial
decisions and thus should not be subordinate to the Santa Ana LWIA or its sub
recipients. The hearing officer will be selected from a list of names on file with
the EEO Officer.
2. Full regard must be given to the requirements of due process to insure a fair
and impartial hearing.
3. The hearing office designated by the EEO Officer to function in a quasi-judicial
capacity should begin the hearing by summarizing the record and the issue and
should explain the manner in which the hearing will be conducted, making sure
that everyone involved understands the proceedings. Such explanations
should be adapted to the needs of the specific situation. The hearing officer
might take testimony under oath or affirmation to give some assurance of
veracity to the hearing.
4. The burden of proof should be reasonable and flexible, dependent upon the
circumstances of the case involved. The hearing officer determines the order
of proof. Generally, the party making the complaint has the obligation of
establishing his or her case and should be examined first.
EXHIBIT C
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5. The party involved should have the right to be represented (at their own
expense) if he/she so desires. Other he/she is limited to his/her own abilities
and those to the hearing officer in obtaining testimony in the case.
6. It is important that the hearing officer obtain the fullest information for the
record. If the parties involved, or their representatives, do not know how to ask
the right or pertinent questions in pursuing their right to due process, it shall be
necessary for the hearing officer to step in to have all the materials and relevant
facts elicited.
7. The practice in informal hearings is generally not to apply strict rules of
evidence in obtaining facts. However, the quantity of evidence required to
support a decision on an issue should be sufficiently credible that the state (or
other appropriate agency), upon reviewing the decision, would conclude that
the decision is supported by substantial evidence.
8. The hearing officer should attempt to negotiate a resolution of the issue at any
time prior to the conclusion of the hearing.
9. Within ten (10) days of the conclusion of the hearing, the hearing officer will
issue a recommended decision to the LWIA for final determination. The
recommended decision shall be in writing and may be accepted, rejected or
modified by the Santa Ana Workforce Investment Board.
C. Issuance of Decision
Within sixty (60) calendar days of filing of the complaint, the Santa Ana LWIA shall
issue a written decision to all parties by first class mail. The final decision shall
contain the following information:
1. The name of the parties involved.
2. A statement of the alleged violation and issues related to the alleged violation.
3. A statement of the facts.
4. The decision and the reasons for the decision.
5. A statement of corrective action, if any, to be taken.
6. Notice of the right to request, within ten (10) calendar days of receipt of the
decision, a review of the decision by the State Review Panel.
D. Record of Hearing
An administrative file containing support documents on the complaint resolution
EXHIBIT C
25K-56 Page 34 of 54
process hearing conducted will be retained by the Santa Ana LWIA. The purpose
of a record is to serve as substantiation of the process followed by the Santa Ana
LWIA on the resolution of the issues and the results. This information would then
be available for subsequent review in the event the matter is raised with the State.
Such records must be retained for a three-year period after the grant has been
officially closed out.
The Santa Ana LWIA's written decision will be included in the record. Evidence
received at the hearing, notes by the hearing officer, stenographer's notes and
tape recordings may also be used.
E. Establishment of Complaint Procedures
In accordance with Section 667.600, each employing agency including private-for-
profit employers of participants under the Act is required to establish a complaint
procedure for resolving matters relating to the terms and conditions of
employment. Employers may operate their own grievance system or may utilize
the Santa Ana LWIA's established procedures under Section 667.600. At a
minimum these procedures must include:
1. Written notice, upon enrollment into employment training services, of the scope
and availability of such procedures. Employer's grievance procedures shall be
set forth in a written document and must meet the regulation mandate that a
complaint will be resolved with sixty (60) days from the date the complaint was
filed. A copy of employer's grievance procedure shall be provided to each
participant upon enrollment in employment training.
2. Written notice, at the time the grievance is filed, of the procedures under which
the grievance will be processed.
3. Written notification of the disposition of the grievance and a written decision
shall be issued within thirty (30) days of the filing of the grievance unless a
present and long established grievance specifically provides other limits; and
4. Written notification of the participant's right to request a review of the
employer's decision by the Santa Ana LWIA and the State Review Panel in
accordance with Section 667.600.
IV. Procedures for Handling Complaints at the State Level
Section 181 (c) of the Act and the WIA regulations at 20 CFR, Section 667.600 (d)
requires the Governor to establish a State Review process of complaints filed at the
LWIA grant recipient level and of complaints initially filed at the State level.
Appeals of decisions issued at the LWIA level including audit disallowances and
EXHIBIT C
25K-57 Page 35 of 54
sanctions shall be reviewed by the State Review Panel. The State Review Panel shall
review the record established at the LWIA level and shall issue a decision based on
the information contained therein.
Complaints which may be initially filed at the State level will be heard by an
independent hearing officer designated by the State Workforce Investment Division
(WID). The hearing officer shall conduct a hearing and issue a recommended
decision to the State Panel. The recommended decision shall be in writing and may
be accepted, rejected or modified by the State Review Panel.
A. Form and Filing of Complaint.
1. Request for State Review of LWIA Level Decisions
On receipt of a complainant's request for review because of an unsatisfactory
decision, the State shall provide for an independent state review.
2. Filing of Requests for State Review
The State Review Panel shall review all LWIA level decisions when a request
for review is filed within 10 days of receipt of the adverse decision. Such
requests must be filed in writing with the Chief of the WID Office. The request
for review should contain the following information:
a. Full name, address, and telephone number of the party requesting the
review
b. Full name, address, and telephone number of the other party
c. A copy of the decision
d. Brief statement of reasons for review or the section of the LWIA decision
to be reviewed including regulatory and statutory citations
e. A statement of the relief sought.
3. Complainant Responsibility
It is the responsibility of the complainant to include in the request for review a
written statement setting forth the facts presented at the LWIA hearing which
support the requested relief.
The Chief, WID, shall mail a copy of the request for review to the other party
and to the LWIA. It shall be the responsibility of the LWIA to submit the
complete record including a typed record of the hearing to the Chief, WID,
within ten (10) days.
B. Conduct of Hearings.
EXHIBIT C
25K-58 Page 36 of 54
1. Request for Hearing at the State Level
If no decision has been issued at the LWIA level or the State has determined
an audit disallowance or imposed sanctions, the complainant may request a
hearing. The hearing officer will then issue a recommended decision to the
State's Review Panel for final determination.
2. Filing for Request for Review
The request for a State hearing shall be filed within ten (10) days after LWIA
should have issued a decision or ten (10) days after the issuance of the audit
disallowance or sanction. The request shall be filed directly with the Chief of
the WID in writing and should include the following:
a. Full name, address, and telephone number of the LWIA
b. Name, address, and telephone number of the LWIA
C. Copies of complaints made at LWIA level from which no decisions were
issued or sanctions and imposed.
d. A statement of basis for the request for hearing.
3. Evidentiary Hearing
Upon receipt of the request for a State level hearing, a hearing before a
designated hearing officer will be scheduled.
The hearing will be recorded mechanically or by court reporter.
Both parties concerned will have the opportunity to present oral and written
testimony under oath, to call and question witnesses in support of his/her
position, to present oral and/or written arguments, to examine records and
documents relevant to the issue(s), and to be represented.
The hearing officer shall issue a written decision, which shall be forwarded to
the State Review Panel for final determination.
The State Review Panel may accept, reject or modify this recommendation.
The decision of the State Review Panel is final except for audit disallowances,
which must be approved by the Secretary of Labor
C. State Review Panel
The State Review Panel will consist of a panel of three representatives from the
Employment Development Department: one from the Legal Offices, one from
EXHIBIT C
25K-59 Page 37 of 54
the WID, and one from the Director's office. The panel will issue a written
decision, which will be sent to the appropriate parties within thirty (30) days of
receipt of the request for State review.
Decisions issued by this panel, under the authority of the Governor, are final.
D. Issuance of State Review Decision.
The State review will be limited to violations of the WIA, implementing WIA
regulations or the grant agreement. This review shall be limited to the record
established at the LWIA hearing.
V. Procedures for Handling Discrimination Complaints by
Participants.
A. Complaints on the basis of race, color, or national origin, age, sex, religion,
political affiliation or belief, retaliation, and citizenship, where appropriate, must be
filed within 180 days of the alleged occurrence.
1. It is the responsibility of the Santa Ana LWIA's Equal Employment Opportunity
(EEO) Officer to determine jurisdiction and to make the complainant aware of
and provide assistance in filing a complaint in accordance with the Santa Ana
LWIA's procedure under Section II (A).
EXHIBIT C
25K-60 page 38 of 54
PROCEDURES FOR HANDLING NON-CRIMINAL
COMPLAINTS
No later than
180 days of
alleged Handling of complaints filed at LWIA level arising in connection with
discrimination WIA programs operated by LWIAs
Informal Resolution Process
Filing of Complaint/Request for Hearing
0
Notice of Hearing issued by LWIA o
Hearing Conducted
LWIA Decision within 60 days
Unsatisfactory Decision or LWIA Decision not issued within 60 days
Within 10 days of °
receipt of o
unsatisfactory
decision or 10
days from date Request for State Review w
LWIA decision o
should have been
issued. Governor's Decision issued by State Review Panel
If no decision issued by State Review Panel
Appeal to DOL
EXHIBIT C
25K-61 page 39 of 54
2. In cases where areas of authority overlap, it is the responsibility of the EEO
Officer to advise the complainant of the existence of State, Federal and other
proper action agencies, which may also have a bearing.
3. Complainants alleging discrimination under this part will be made aware of their
right to file directly with the Office of Civil Rights (OCR), U.S. Department of
Labor and applicable procedures.
4. Complainants must file their complaint directly with:
Anita Queen
Sr. Personnel Analyst - EEO Officer
20 Civic Center Drive, M-24
Santa Ana, CA 92701
(714) 647-5157
VI. Procedures for Handling Handicap Complaints by
Participants
Complaints alleging discrimination on the basis of handicap will be filed and processed
under the Department of Labor regulations implementing Section 504 of the
Rehabilitation Act of 1973 at 29 Code of Federal Regulations Section 32.
1. Complaints must exhaust the Santa Ana LWIA's informal resolution
procedures before filing their complaint with OCR.
2. Complainants will be made aware of the 180 days requirement in which to
file his/her complaint.
A. Procedures at the LWIA Level
1. The complainant shall file his/her complaint directly with the Santa Ana LWIA.
Upon receipt of the complaint, the EEO Officer shall investigate and gather
information concerning the complaint.
2. An informal conference will be held with the parties concerned in an effort to
resolve the issue(s). The complainant has the right to be present and may be
represented during the conference.
3. The Santa Ana LWIA shall issue in writing its decision to the complainant no
later than thirty (30) days after the filing of the complaint.
EXHIBIT C
25K-62 Page 40 of 54
B. Procedures at the State Level
1. The complainant may appeal to the State if he/she is not satisfied with the
decision of the Santa Ana LWIA.
2. The Complainant must file his/her appeal as a request for review directly with
the Chief WID within ten (10) calendar days after the receipt of the Santa Ana
LWIA's decision.
3. The Chief-WID, shall issue a decision no later than thirty (30) calendar days
after receipt of the request for review.
4. After the complainant has received a decision or no decision has been received
from the Director of Employment Development Department (on behalf of the
Governor), the complainant has the right to appeal his/her complaint within
thirty (30) calendar days to the Office of Civil Rights (OCR) with the Department
of Labor.
EXHIBIT C
25K-63 Page 41 of 54
PROCEDURES FOR HANDLING HANDICAP
COMPLAINTS
No later than
180 days of
alleged Filing of complaint on the basis Of Handicap with LWIA Day 1
discrimination
Informal Resolution
If no resolution reached
Requestfor Hearing
I
Notice of Hearing
I
Hearing Conducted Day /45 Day
LWIA Decision
Unsatisfactory Decision or No Decision
State Review
Filed within 30
days of
LWIA/State Governor's Decision
Decision or 90
days from date of 60 Days
initial filing of Appeal to Assistant Secretary Department of Labor
complaints
EXHIBIT C
2-SK-64 page 42 of 54
GLOSSARY OF WIA TERM
AGE DISCRIMINATION ACT - A law passed by Congress in 1975 which prohibits
discrimination on the basis of age by any program or activity receiving Federal Funds.
APPLICANT - An individual who applies to a subrecipient or contract for services provided
under WIA and who has not yet transitioned to the status of participant.
ASSESSMENT - Services designed to determine each participant's employability,
aptitudes, abilities and interests and to develop a plan to achieve the participant's
employment and related goals; also to identify the available employment and traning
activities appropriate for the participant. Testing and counseling may also be used during
assessment process.
CHARGING PARTY (CP), COMPLAINANT, GRIEVANT, OR AGGRIEVED PERSON - The
person who charges that he/she has been discriminated against under Department of
Justice nondiscrimination and civil rights regulations and/or guidelines.
DISCRIMINATION - In general, a failure to treat all equally, whether intentional or
unintentional; the effect of an action, policy or practice which selects an individual or class of
persons to receive unequal treatment.
ELIGIBLE NON-CITIZEN - Lawfully admitted permanent resident, aliens, lawfully admitted
refugees, and parolees and other individuals authorized by the Attorney General to work in
the United States.
EMPLOYER - An employer subject to the provisions of the Civil Rights Act of 1964, as
amended, including state and local governments and any Federal agency subjects to the
provisions of Section 717 of the Civil Rights Act, as amended; and any Federal contractor or
subcontractor covered by executive Order 11246, as amended.
GRIEVANCE - An allegation that something imposes an illegal obligation or burden or
denies some equitable or legal right, or causes injustice .
HANDICAPPED INDIVIDUAL - Any individual who has a physical or mental disability that
constitutes or results in a substantial handicap to employment.
INTAKE - Includes screening to determine eligibility; to select from eligible applicants those
individuals who are most in need and can benefit from program services; to complete
procedural requirements necessary to enroll an individual into the program and to refer
those not enrolled to other programs.
JOINT COMPLAINT - A complaint of employment discrimination covered by Title VII or the
Equal Pay Act and by Title VI or Title IX. Individual "joint complaints" are normally
investigated by EEOC unless OCR has a compelling reason to investigate. "Joint
complaints" alleging discrimination in employment and other practices and pattern or
EXHIBIT C
25K-65 Page 43 of 54
practice "joint complaints" are normally investigated by OCR.
JURISDICTION - Authority to investigate and resolve complaints against an institution
subject to a law or statute which has been assigned to OCR for enforcement, i.e., Title VI,
Title IX, etc.
PARTICIPANT - Any applicant who has: (1) Been determined eligible for participation upon
intake; and (2) Who is receiving subsidized employment, training or services (except post-
termination services) funded under the Act, following intake, except for an individual who
receives only outreach and/or intake and assessment services.
EXHIBIT C
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CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS
and COOPERATIVE AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief, that:
1) 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 awarding of
any Federal contract, the making of any Federal grant, the making of any Federal
loan, the entering into of any 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, 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, 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 this certification be included in the
award documents for all subawards at all tiers (including agreements) and that all
subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when
this transaction was made or entered into. Submission of this certification is a prerequisite for
making or entering into this transaction imposed by 31 U.S.C. 1352.
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 such failure occurring on or before
October 23, 1996, and of not less than $11,000 and not more than $110,000 for each such
failure.
Grantee/Contractor Organization Program Title
Signature
Name of Certifying Official Signature
EXHIBIT D
25K-67 Page 45 of 54
Certification Regarding Drug-Free Workplace Requirements
The certification set out below is a material representation upon which reliance is placed by
the U.S. Department of Housing and Urban Development in awarding the grant. If it is later
determined that the contractor knowingly rendered a false certification, or otherwise violates
the requirements of the Drug-Free Workplace Act, the U.S. Department of Housing and
Urban Development, in addition to any other remedies available to the Federal Government,
may take action authorized under the Drug-Free Workplace Act.
CERTIFICATION
A. The contractor certifies that it will 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 contractor's workplace and specifying the actions that will be
taken against employees for violation of such prohibition;
(b) Establishing a drug-free awareness program to inform employees about -
(1) The dangers of drug abuse in the workplace;
(2) The contractor's policy of maintaining a drug-free workplace;
(3) Any available drug counseling, rehabilitation, and employee assistance
program; 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 who will be engaged in the
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 contract, the employee will -
(1) Abide by the terms of the statement; and
(2) Notify the employer of any criminal drug statute conviction for a violation
occurring in the workplace no later than five days after such conviction.
EXHIBIT E
25K-68 Page 46 of 54
Pg. 2
(e) Notifying the U.S. Department of Housing and Urban Development within ten
days after receiving notice under subparagraph (d)(2) from an employee or
otherwise receiving actual notice of such conviction;
(f) Taking one of the following actions, within 30 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; 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 contractor shall insert in the space provided on the attached "Place of
Performance" form the site(s) for the performance of work to be carried out with the
grant funds (including street address, city, county, state, and zip code) .the contractor
further certifies that, if it is subsequently determined that additional sites will be used
for the performance of work under the contract, it shall notify the U.S. Department of
Housing and Urban Development immediately upon the decision to use such
additional sites by submitting a revised "Place of Performance" form.
Dated:
Program Operator
EXHIBIT E
25K-69 Page 47 of 54
DIVISION OF EMPLOYMENT SERVICES
PLACE OF PERFORMANCE
FOR CERTIFICATION REGARDING DRUG-FREE WORKPLACE
REQUIREMENTS
Name:
Name of Contractor:
Contractor Number:
Date:
The Contractor shall insert in the space provided below the site(s) expected to be used for
the performance of work under the contract covered by the certification:
Place of Performance (include street address, city, county, state, zip code for each site):
EXHIBIT E
25K-70 Page 48 of 54
Certification Regarding
Debarment, Suspension, Ineligibility and Voluntary Exclusion
Lower Tier Covered Transactions
This certification is required by the regulations implementing Executive Order 12549, Debarment and
Suspension, 29 CFR Part 98, Section 98.510, Participants' Responsibilities. The regulations were published as
Part VII of the May 16, 1988, Federal Register (Pages 19160-19211).
(Before completing certification, read instructions which are an integral part of certification)
1. The prospective primary participant, (i.e. grantee) certifies to the best of its knowledge and belief, 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 proposal been convicted 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 statues 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 government entity
(federal, state or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this
certification; and
d. Have not within a three-year period preceding this application/proposal had one or more public
transactions (federal, state or local) terminated for cause or default.
2. Where the prospective primary participant is unable to certify to any of the statements in this certification,
such prospective participant shall attach an explanation to this proposal.
Grantee/Contractor Organization
Name and Title of Official Authorized to Certify
On Behalf of the Grantee
Date
EXHIBIT F
Page 49 of 54
25K-71
INSTRUCTION FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective recipient of Federal assistance funds is providing
the certification as set out below.
2. The certification in this clause is a material representation of fact upon which reliance was placed when this
transaction was entered into. If it is later determined that the prospective recipient of Federal assistance
funds knowingly rendered an erroneous certification, in addition to other remedies available to the Federal
Government, the Department of Labor (DOL) may pursue available remedies, including suspension and/or
debarment.
3. The prospective recipient of Federal assistance funds shall provide immediate written notice to the person
to which this proposal is submitted if at any time the prospective recipient of Federal assistance funds
learns that its certification was erroneous whom submitted or has become erroneous by reason of changed
circumstances.
4. The terms "covered transaction", "debarment", "suspended", "ineligible", "lower tier covered
transaction", "participant", "person", "primary covered transaction", "principle", "proposal", and
"voluntarily excluded", as used in this cause, have the meanings set out in the Definitions and Coverage
sections of rules implementing Executive Order 12549. You may contact the person to whom this proposal
is submitted for assistance in obtaining a copy of those regulations.
5. The prospective recipient of Federal assistance funds agrees by submitting this proposal that, should the
proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered
transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from
participation in this covered transaction, unless authorized by the DOL.
6. The prospective recipient of Federal assistance funds agrees by submitting this proposal, that it will include
the clause title "Certification Regarding Debarment, Suspension, Ineligible, or voluntarily excluded from the
covered transaction unless it knows that the certification is erroneous.
7. Nothing contained in the foregoing shall be construed to require establishment of a system of records in
order to render in good faith the certification required to exceed that which is normally possessed by a
prudent person in the ordinary course of business dealings.
8. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered
transaction knowingly enters into a lower tier covered transaction with a person who is suspended,
debarred, ineligible, or voluntary excluded from participation in this transaction, in addition to other
remedies available to the Federal Government, the DOL may pursue available remedies, including
suspension and/or debarment.
EXHIBIT F
25K-72 Page 50 of 54
BUDGET FORM
Administrative Total Total Match/In
Cost (Not to Program WIA Cost Kind
Exceed 10%) Cost
Personnel Salaries
1
2
3
4
5
Personnel Benefits
1
2
3
4
5
Total Personnel Salaries & Benefits $0.00 $0.00 $0.00 $0.00
Operating Expenses
Rent*
Utilities
Phones
Internet Fees
Parking Fees
Security
Maintenance
Insurance
Equipment rental fees*
Equipment rental fees*
Vehicle lease*
Office expenses (consumables)
Accounting Services
Legal Services
Auditing Services
Indirect Cost*
Staff Training*
Staff Conferences*
Staff Travel/Mileage
*
Participant Wages
Supportive Services*
Participant Incentives*
Youth Conferences*
Total Operating Expenses $0.00 $0.00 $0.00 $0.00
GRAND TOTAL (Personnel+Operating) $0.00 $0.00 $0.00 $0.00
EXHIBIT G
25K-73 Page 51 of 54
ASSURANCES
A. The EMPLOYER assures that:
1. It will comply with the requirements of the Workforce Investment Act (WIA), the
California Unemployment Insurance Code, as amended, and the regulations and policies
promulgated thereunder.
2. No OJT participant displaces a regular employee nor shall an OJT participant fill a
position of a person who has been laid off from the same or similar position.
3. No current employees are receiving unemployment insurance benefits as a result of
layoffs or work reductions.
4. No person in the United States shall on the grounds of race, color, sex, religion, national
origin, age, disability, sexual orientation, or marital status be excluded from
participation in, be denied the benefits of, or be otherwise subjected to discrimination
under any program or activity for which the applicant receives federal financial
assistance and will immediately take any measure necessary to effectuate this
Agreement.
5. It will comply with provisions of the Hatch Act, if applicable, which limits the political
activities of employees.
6. Individuals receiving training on the job shall be compensated by the EMPLOYER at
such rate, including periodic increases, as may be deemed reasonable under regulations
prescribed by the Secretary of Labor, but in no event at a rate less than that specified in
Section 6 (a) (1) of the Fair Labor Standards Act of 1938 or, if higher, under the
applicable State or local minimum wage law.
7. Services and activities provided under this Agreement will be administered by or under
the supervision of the EMPLOYER.
8. No relative by blood, adoption or marriage] of the EMPLOYER may be trained under
this Agreement.
9. Appropriate standards for health and safety in work and training situations will be
maintained.
10. Conditions of employment or training are appropriate and reasonable with regard to the
type of work, the geographical region, and the proficiency of the trainee.
11. Training will not be for any occupation which requires less than six weeks of training
according to the Specific Vocational Preparation Table (SVP Code).
12. Training will, to the maximum extent practicable, be consistent with every individual's
fullest capabilities and lead to employment possibilities.
EXHIBIT H
25K-74 Page 52 of 54
13. The program will, to the maximum extent feasible, contribute to the occupational
development or upward mobility of individual participants.
14. Training will be in accordance with the training plan, which plan incorporates
documentation that must be completed by EMPLOYER before end of contract.
15. *Dot and **SVP code books will be used to determine length of OJT period. The
training time may not be longer than the SVP Code allows; however, contractors are
encouraged to negotiate shorter training periods whenever applicable.
16. OJT trainees shall not number more than 40% of the EMPLOYERS work force.
17. All EMPLOYER training payments (reimbursements) must be exclusive of any and all
EMPLOYER fringe benefits, paid holidays, paid sick days and overtime compensation.
18. The participating EMPLOYER must keep an accurate and up-to-date time sheet for the
OJT trainee.
19. Payroll records, time and attendance records and job duties retained on file by the
participating EMPLOYER for each OJT trainee are subject to review.
Service Provider Signature Date
Print First Name Print Last Name
Organization Name Organization Address
EXHIBIT H
Page 53 of 54
25K-75
1
ADDITIONAL INSURED ENDORSEMENT
Insurance Company
This endorsement modifies such insurance as is afforded by the provisions of Policy
# relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92702; its
officers, employees, agents and volunteers are named as additional insureds ("additional
insureds") with regard to liability and defense of suits arising from the operations and uses
performed by or on behalf of the named insured.
2. With respect to claims arising out of the operations and uses performed by or
on behalf of the named insured, such insurance as is afforded by this policy is primary and is
not additional to or contributing with any other insurance carried by or for the benefit of the
additional insureds.
3. This insurance applies separately to each insured against whom claim is made
or suit is brought except with respect to the company's limits of liability. The inclusion of any
person or organization as an insured shall not affect any right which such person or
organization would have as a claimant if not so included.
4. With respect to the additional insureds, this insurance shall not be canceled, or
materially reduced in coverage or limits except after thirty (30) days written notice has been
given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92702.
(Completion of the following, including countersignature, is required to make this
endorsement effective.)
Effective this endorsement form as a part of
Policy #
Issued to
Named Insured
Countersigned by
Authorized Representative
EXHIBIT I
Page 54 of 54
25K-76