HomeMy WebLinkAboutHUMAN OPTIONS, COMMUNITY SERVICE PROGRAMS INC. AND THE LGBT CENTERJAN 2 1 2016 N -2016 -008
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Garr1SOn MEMORANDUM OF UNDERSTANDING BETWEEN EMPOWERING SANTA ANA
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WHEREAS, Human Options, Inc. (Human Options), a nonprofit domestic violence
victim services program; Santa Ana Police Department (SAPD), a law enforcement agency;
Community Service Programs Inc. (CSP), a victim focused program, and The LGBT Center
OC, an organization dedicated to serving the needs of LGBTQ individuals, have come together
to collaborate on the 2016 Consolidated Grant Program to Address Children and Youth
Experiencing Domestic and Sexual Assault and Engage Men and Boys as Allies (OVW -2016-
9002).
WHEREAS, the partners listed above have agreed to enter into a collaborative agreement
in which Human Options, Inc. will be the lead agency and named applicant and the other
agencies will be partners in this application; and will allocate a full time coordinator to oversee
the implementation of this project.
WHEREAS, the partners herein agree to be collectively referred to as the `Empowering
Santa Ana Youth Collaborative' and desire to enter into a Memorandum of Understanding
setting forth the roles of each respective partner; and
WHEREAS, the application prepared by the collaboration through its partners is to be
submitted to the Office on Violence against Women on or before January 21, 2016.
The parties therefore agree as follows that this Memorandum of Understanding ( "MOU ")
stands as evidence that Human Options, Inc. (Human Options), Community Service
Programs Inc. (CSP), The LGBT Center OC, and Santa Ana Police Department (SAPD), in
this collaborative have consulted and coordinated in a meaningful way and intend to work
together as partners to develop and deliver prevention and intervention strategies, community
education, awareness, and direct services to adolescents, boys, and men, in the City of Santa Ana
as set forth in the Consolidated Grant Program. The Grant Program's purpose is to Address
Children and Youth Experiencing Domestic and Sexual Assault and Engage Men and Boys as
Allies (OVW- 2016- 9002).
1. Description and History of Partners
Human Options (Lead Agency) is a nonprofit that has been offering comprehensive services to
victims of domestic violence for over 34 years. Its mission is to provide safe haven and life
changing programs to help abused women, their children and families rebuild their lives — and
work with the community to break the cycle of violence. Human Options has evolved from a
small grassroots organization into a large, multi- service program with a full continuum of
programs that address the specific needs of abused adults and children. Services include the
Residential Shelter Program that provides adults and children with a safe, supportive place that
gives them the tools to begin reclaiming their lives. The community based Center for Children
Memorandum of Understanding Page 1
and Families (CCF) provides a safety net and support services to individuals who are not ready
to enter a residential program but are trying to break the cycle of violence. Services at CCF are
designed to reach underserved clients with limited access to resources and offices are also
located in five Family Resource Centers throughout Orange County. Seniors and older adults in
need of accessible, affordable domestic violence services can obtain resources through Human
Options' Safe Options for Seniors program. Lastly, Human Options' Community Education
program is well -known throughout the community, offering violence prevention
education/awareness presentations to community groups and business organizations since 1984.
Every year Human Options provides community -based prevention, intervention and treatment
services to over 1,400 children/families each year, answers over 4,000 emergency hotline calls,
and provides community education programming to over 6,000 students and community
members. Human Options is the only domestic violence service provider in the City of Santa
Ana.
Community Service Programs Inc. (CSP) is a nonprofit agency committed to serving children,
adults and families living in Orange County who are involved with, or at -risk of involvement
with, the justice system. Established in 1972, CSP began as a field study project for students at
the University of California, Irvine. CSP established the Victim Assistance Programs in 1978
with the commitment of the community and the encouragement of law enforcement and the
criminal justice system. Working in close collaboration with the Orange County District
Attorney's Office, Superior Court, law enforcement agencies, social services and other
community-based organizations and individuals, Victim Assistance Programs is dedicated to
providing comprehensive services to crime victims and witnesses, their families, and
communities. Certified Sexual Assault Counselors, both staff and volunteer, are on call 24 -hours
a day, 7 days a week. They are available to provide assistance to callers on the crisis hotline and
respond to "Safe Place" at Anaheim Memorial Hospital to provide support for victims during
forensic exams. Counselors also provide in- person counseling, support groups, accompaniment
services during interviews at local police departments and court hearings, and other assistance as
required. The prevention program is the only program of its kind in the entire county and is a
component of Orange County's only rape crisis center. Sexual Assault Prevention provides
education programs throughout the county and reaches thousands of individuals each year. CSP
Victim Assistance Programs provides assistance to 50,000 victims and witnesses each year. In
addition to general victim services, the program has developed specialized Victim Advocate
Units to meet the needs of victims of human trafficking, sexual assault, domestic violence,
families of homicide victims, and victims of gang related violence.
Human Options and CSP have a long history of collaboration and have worked closely for over
three decades. The shared purpose and missions of the agencies to provide services to victims of
domestic violence, dating violence, stalking, human trafficking, and sexual assault, creates a
natural partnership for referrals and cross- training. Human Options and CSP coordinate services
to clients and share expertise through cooperative training agreements. These trainings include
the 40 -hour state mandated Domestic Violence Counselor Training and the Sexual Assault
Counselor Certification training, a 48 -hour state - certified training. Together, these two programs
train an estimated 210 professionals annually. Additionally, Human Options and CSP have
served on many committees together such as the OC Family Violence Council, Anaheim Family
Justice Center Advisory Board, Irvine PD Family Violence Prevention Project, the Victim
Memorandum of Understanding Page 2
Service Partnership, and the Orange County Human Trafficking Task Force. The two agencies
have been able to collaborate in a way that avoids the duplication of services and allows for the
leveraging of each other's expertise when working with victims who have experienced complex
trauma. Cross referrals occur regularly between the programs; Human Options refers clients to
CSP for sexual assault counseling services and CSP refers clients to Human Options for shelter
and other domestic violence victim services. Human Options and CSP currently participate in the
Women's Health Project as lead service providers in the areas of curriculum development and
public service awareness.
The LGBT Center OC is a nonprofit agency that started as a volunteer group in 1971 and
incorporated as a nonprofit in 1975. Its mission is to advocate on behalf of the Orange County
lesbian, gay, bisexual, transgender, and queer /questioning (LGBTQ) community, and to provide
services that ensure its well -being and positive identity. The LGBT Center OC is the second
oldest and I 11 largest LGBT center in the nation. The LGBT Center OC programs emphasize
five strategic focus areas: advocacy and social justice, strengthening youth, improving
health/wellness, increasing social support, and seniors. Services include outreach, consultation,
psychotherapy, support groups, capacity - building workshops, and referrals. All programs and
services are conducted within the context of unconditional acceptance of sexual orientation,
gender identity and expression, and cultural diversity. Through workshops, community outreach,
presentations and the focus on youth leadership development, the LGBT Center OC continues to
support the community in making life- affirming choices that are consistent with a positive self -
image and a sense of self - efficacy. Through advocacy, outreach and education initiatives, The
LGBT Center OC works to raise awareness and acceptance of LGBTQ people, and protect and
defend LGBTQ rights through system change. The LGBT Center OC remains the most
comprehensive health and social service organization specifically targeting Orange County's
LGBTQ community, and is proud to serve not only the LGBTQ community, but also their
friends and family.
Human Options and The LGBT Center OC have a long history of overlapping interests as
social service agencies in Orange County, CA, but have never entered into a formal partnership
before this grant proposal. Both organizations are members of the Orange County Women's
Health Project, Health and Domestic Violence Taskforce which has been convening since 2011.
As a result of taskforce efforts, Blue Shield of Southern California has funded a three year
project aimed at training health care providers across the county to appropriately screen for, and
respond to, domestic violence. Human Options is a funded strategy lead for this effort and is
responsible for developing and administering a comprehensive curriculum to health care
providers on the intersection of domestic violence and health. The LGBT Center OC has
expressed interest in offering this training to their staff. As a result of these interactions, Human
Options and The LGBT Center OC have strengthened their relationship and subsequently are
now entering into a formal partner relationship as a result of this grant proposal. This proposal
presented the unique opportunity to engage in a collaborative effort that has the potential to
provide an increase in intervention and prevention services to a traditionally underserved
community (LGBTQ youth within Santa Ana), and develop meaningful and lasting change
within the community.
Memorandum of Understanding Page 3
The Santa Ana Police Department (SAPD) is a community- oriented department committed to:
high quality services, innovative leadership, and problem prevention through highly trained and
professional employees in modern facilities using the latest technology. The purpose of the
SAPD is to ensure the safety and security of all people in the city by providing responsive and
professional police services with compassion and concern. The mission of the SAPD is
accomplished within the moral and legal standards of the community, through a problem - solving
partnership with the community and members of the department. The SAPD has a long history of
Problem Oriented Policing. SAPD's Problem Oriented Policing philosophy is a commitment to
identify underserved community members and address their needs in a proactive manner, with an
eye on transformational community change. In 2014, the City of Santa Ana adopted a five year
Strategic Plan, which supports addressing community needs in the area of domestic violence and
sexual assault. In support of the Strategic Plan, the SAPD has made several initiatives to promote
education and services to domestic violence and sexual assault victims. Each initiative involves a
partnership with nonprofit, community, or government agencies.
Human Options, CSP, and SAPD. The SAPD has had an operational agreement with Human
Options to provide assistance for crime victims residing in Orange County since 2004. The
SAPD links domestic violence victims to Human Options' 24 hour emergency hotline where
hotline advocates assesses the client's needs and provides referrals and shelter to victims. In
addition, members of the SAPD are common speakers at community outreach events. CSP has
had a victim service advocate stationed at the SAPD since 2009 assigned to work alongside
SAPD domestic violence detectives. This symbiotic relationship allows for CSP's expertise to
assist victims when navigating through government services like restraining orders or victim
compensation, restitution, witness assistance, or providing shelter, alcohol, or other referral
services in Orange County.
2. Roles and Responsibilities
Each partner agrees to participate in the Empowering Santa Ana Youth Collaborative as
outlined below.
In this collaborative, Human Options, Inc. Community Service Programs Inc., The LGBT
Center OC, and the Santa Ana Police Department will each commit as appropriate to the
following roles and responsibilities to ensure the success of the project:
• Develop, expand, and strengthen prevention strategies and intervention services that
target youth and/or young adults who are victims of and/or exposed to sexual assault,
domestic violence, and dating violence
• Develop and implement public education, campaigns, community organizing activities,
and/or prevention strategies focusing on engaging men and male youth as leaders and
role models
• Participate in a new grantee orientation meeting and all technical assistance trainings
• Commit to working with the OVW Technical Assistance providers to establish the
groundwork for the developing project
• Upon completion of the planning phase, each partner commits to developing a technical
assistance plan to support the needs and implementation of the project
Memorandum of Understanding Page 4
• Provide one professional staff member to be a part of the Steering Committee and to
attend regularly scheduled meetings
• Ensure linguistically, culturally, and community relevant services are available for
underserved communities or that linkages to existing services in the community are
tailored to the needs of the underserved population
• Have policies in place that address confidentiality, information sharing, parental consent,
and mandatory reporting in compliance with local, state and federal law.
• Have policies that support or enhance the safety and security of children and youth who
have been or are being exposed to violence including the non - abusing caregiver
• Secure background checks for any adults working with minors or vulnerable populations
within organizations receiving grant funds from the collaboration partners.
• Commit to fully participate in data collection and program evaluation to the extent
allowed by law
• Indicate approval of the proposed budget
• Provide information to lead agency for evaluation of the program
• Report on performance measures and grant- funded activities through the timely
submission of complete semi - annual progress reports
As the lead agency, Human Options, Inc. will receive compensation from this grant in the
amount of $606,987 to:
• Provide a full time Project Coordinator in order to organize and coordinate partner
agencies
• Send Project Coordinator to New Grantee Orientation for 2 -day meeting
• Provide one Project Coordinator and one professional staff member to be a part of the
multi - disciplinary training team to attend the monthly collaboration meetings
• Send Project Coordinator to attend 1.5 day OVW sponsored training
• Provide administrative support in order to implement grant activities
• Ensure that linguistically, culturally, and community relevant services are available
• Coordinate and finalize evaluation of the program
• Report on performance measures and grant- funded activities through the timely
submission of complete semi - annual progress reports and other grant reporting
requirements
• Provide training for organizations and groups in Santa Ana who serve children and youth
in order to improve their ability to appropriately address and respond to the needs of
children and youth who are victims of and /or are exposed to domestic violence and dating
violence
• Provide partners a clear description of emergency shelter, transitional housing and home
visitation services available to victims of domestic violence and dating violence and will
consider referrals for services from each of its partners
As a collaborating, funded agency, Human Options, Inc. will commit to the following roles and
responsibilities to ensure the success of this project:
Memorandum of Understanding Page 5
• Work in conjunction with CSP, The LGBT Center OC, and the SAPD to develop a
comprehensive curriculum around the topics of sexual assault, teen dating violence,
domestic violence, healthy relationships, gender norms, and the Bystander Approach
• Deliver teen dating violence prevention education to youth (13 -18) in the Santa Ana
Unified School District
• Provide Safe Dates (an evidence -based curriculum) to youth (13 -18) in Santa Ana
• Work in conjunction with CSP to enhance services to address the intersection of domestic
violence, sexual assault, and teen dating violence with other youth issues
• Work in conjunction with The LGBT Center OC to enhance services to address the
intersection of domestic violence, sexual assault, and teen dating violence with other
issues related to LGBTQ youth
• Provide emergency shelter for victims of domestic violence and their children
• Provide evidence -based counseling to the non- abusing parent
• Provide referrals and case management to the non - abusing parent
• Provide legal advocacy to victims of domestic violence
• Implement awareness campaigns for youth (13 -18) during the month of February for
Teen Dating Awareness and Prevention Month
• Implement the `Purple Socks' awareness campaigns for males and young men (13 -24)
during the month of October for Domestic Violence and Awareness Month
• Implement the `Walk in Her Shoes' charity event, co- hosted by SAPD
As a collaborating, funded agency Santa Ana Police Department will receive compensation
from this grant in the amount of $13,353 pursuant to the terms and obligations of the grant
program as applicable and commit to the following roles and responsibilities to ensure the
success of this project:
• Provide two representatives to be members of the Curriculum Committee and commit to
attending six (2 hour) curriculum development meetings
• Provide two representatives to be members of and attend quarterly Steering Committee
meetings (seven total meetings throughout the grant period, 2 hours in length each)
• Provide one representative (male) that will prepare for and present at educational
prevention presentations meant to engage young men and boys
• Provide two representatives to attend `Purple Socks' sporting events meant to engage
young men and boys
• Provide one representative that will coordinate with the Human Options Project
Coordinator to prepare and implement the awareness event `A Walk in Her Shoes'
• Provide three representatives to help coordinate the day of activities for the awareness
event, `A Walk in Her Shoes'
• Invoice the lead agency, Human Options, for reimbursement of grant associated
expenses.
As a collaborating, funded agency, Community Service Programs Inc. will receive
compensation from this grant in the amount of $68,275 and commit to the following roles and
responsibilities to ensure the success of the project:
Memorandum of Understanding Page 6
• Work in conjunction with Human Options, The LGBT Center OC, and the SAPD to
develop a comprehensive curriculum around the topics of sexual assault, teen dating
violence, domestic violence, healthy relationships, gender norms, and the Bystander
Approach
• Provide teen dating violence prevention education to youth (13 -18) in the Santa Ana
Unified School District
• Implement awareness campaigns for youth (13 — 18) in the month of April for Sexual
Assault Awareness Month
• Provide education and training about sexual assault for youth (13 -18)
• Provide a 24 -hour sexual assault response team
• Provide a 24 -hour rape crisis hot line
• Provide sexual assault group counseling for youth (13 -18)
• Provide emergency shelter for youth (11 -18)
As a collaborating, funded agency, The LGBT Center OC will receive compensation from this
grant in the amount of $61,385 and commit to the following roles and responsibilities to ensure
the success of the project:
• Work in conjunction with Human Options, CSP, and the SAPD to develop a
comprehensive curriculum around the topics of sexual assault, teen dating violence,
domestic violence, healthy relationships, gender norms, and the Bystander Approach
• Provide teen dating violence prevention education to youth (13 -18) in the Santa Ana
Unified School District
• Provide culturally appropriate content to both awareness campaigns for youth (13 — 18)
in the months of February for Teen Dating Awareness and Prevention Month and April
for Sexual Assault Awareness Month to ensure the inclusivity of needs specific to
LGBTQ youth
• Provide LGBTQ youth health education, support, and a safe environment in which to
socialize
• Provide LGBTQ individuals HIV testing, counseling, and prevention education
• Provide culturally competent mental health counseling services to LBGTQ individuals
3. Individuals Responsible for Implementing the Project
Human Options, Inc.
The person responsible for implementing project activities for this project at Human Options is
Jessica Reynaga, Community Education Program Manager, (949) 757 -3635 x 113.
Community Service Programs
The person responsible for implementing project activities for this project at CSP is Lita
Mercado, Director of Victim Assistance Programs, (949) 975 -0244.
The LGBT Center OC
The person responsible for implementing project activities for this project at The LGBT Center
OC is Dana Ransons, Director of Development, (714) 953 -5428 x 109.
Memorandum of Understanding Page 7
Santa Ana Police Department
The person responsible for implementing project activities for this project at SAPD is Detective
Gabriel Gutierrez, Special Crimes Section/Domestic Violence, (714) 245 -8516 or any other
person that may be designated by the Chief of Police.
Commitment to Partnership
The collaboration service area includes Santa Ana, CA. The partners agree to collaborate and
provide community- specific services and prevention strategies to youth who are victims of
domestic violence, dating violence, or sexual assault. The partners agree to collaborate and
improve the of identification, coordination and response of victims, improve treatment of youth
who are victims and/or exposed to sexual assault, teen dating violence, and domestic violence,
and to meaningfully engage men and boys (13 -24) in public education campaigns, community
organizing activities and prevention strategies focused on empowering men and male youth as
leaders, role models, and advocates against sexual assault, teen dating violence and domestic
violence. Compensation for non -lead partners' contribution to this project will be provided as
outlined in the attached OVW budget detail worksheet.
The roles and responsibilities described above are contingent on Human Options, Inc. receiving
funds requested for the project described in the OVW grant application.
Term of MOU
The tern of the Memorandum of Understanding would coincide with the grant period,
anticipated to be 10/01/2016 through 09/30/2019 or until the end of the grant period as specified
in the grant award.
4. Development of Application
When the 2016 Consolidated Grant Program to Address Children and Youth Experiencing
Domestic and Sexual Assault and Engage Men and Boys as Allies (OVW- 2016 -9002) grant
opportunity was released, the Human Options leadership team realized that this grant seeks to
fund programs and activities already being offered by Human Options' Community Education
department and the community based Center for Children and Families. It is anticipated that with
the funds provided by this grant, and in conjunction with the collaborative partners, Human
Options will be able to strengthen and expand these services and create meaningful change in
the attitudes and beliefs that perpetuate the cycle of violence in Santa Ana communities.
Based on the overall goals of this grant, Jessica Reynaga, Community Education Manager
and Judith Rose, Director of The Center for Children and Families at Human Options
strategically chose to reach out to three nonprofit organizations whose mission and services also
Memorandum of Understanding Page 8
align with the grant requirements. Subsequently, Human Options' leadership reached out to Lita
Mercado, Director of Victim Assistance Programs at Community Service Programs, Dana
Ransons, Director of Development at The LGBT Center OC, and Detective Gabriel
Gutierrez, Special Crimes Section/Domestic Violence with the Santa Ana Police
Department to initiate a discussion regarding project goals and to negotiate the terms of this
partnership.
Funding from this grant will strengthen and expand an existing collaborative made up of three of
Orange County's most respected and long standing nonprofits and a law enforcement agency
dedicated to serving the people of the City of Santa Ana: Human Options, CSP, The LGBT
Center OC, and SAPD. These agencies have long had both formal and informal agreements in
place. The organizations have met with the intention of prioritizing project objectives and
identifying resources related to combating domestic violence, teen dating violence, and sexual
assault within the Santa Ana, California community. When this funding became available these
agencies considered this project to be a good opportunity to enhance service provisions and
outreach to children and youth (13 -18) in Santa Ana.
Termination
This Agreement can be terminated without cause by any party with thirty days written notice to
the parties. Any unused grant funds would be returned to the lead agency.
Hold Harmless
The partners shall indemnify, defend, and hold harmless each other, their respective officers,
agents, and employees from any expense, liability, or claim for death, injury, loss, damage or
expense to person or property that may arise or is claimed to have arisen pursuant to this MOU to
the extent that such expenses, liability, or claim is proximately caused by any act or omission of
the other, or its officers, agents, or employees.
Entire Agreement
This Agreement constitutes the entire agreement between the parties regarding the subject matter
herein, and supersedes all other agreements, oral or written, between the parties. This
Agreement may only be modified in a writing signed by authorized representatives of all parties.
Venue /Choice of Law
This Agreement and all questions relating to its validity, interpretation, performance, and
enforcement shall be governed by and construed in accordance with the laws of the State of
California. The parties further agree that Orange County, California, shall be the venue for any
action or proceeding that may be brought or arise out of, in connection with, or by reason of this
Agreement.
WHEREFORE, the parties have entered into this Agreement on the date first written above.
Memorandum of Understanding Page 9
For Human Options:
Maricela Rios -Faust Date
Chief Operations Officer
Human Options, Inc.
For Community Service Programs: For The LGBT Center OC:
Lita Mercado
Date
Director of Victim Assistance Programs
Community Service Programs, Inc.
ATTEST:
MA IA HUIZAR,'Cit&Tlerk
APPROVED AS TO FORM:
SONIA R. CARVALHO, City Attorney
Ann Mason Date
Interim Executive Director
The LGBT Center OC
143VIM61MONIZ "I "ry1
1
DAV CA A OS, City Tanager
RECOMMENDED FOR APPROVAL:
Laura A. Rossini, Senior Assistant City Attorney CARLOS ROJ of Police
[Signatures for MOU Empowering Santa Ana Youth Collaborative Partners]
Memorandum of Understanding Page 10
OVW Consolidated Youth Program Grant
Detailed Budget Narrative
Year 1:
Curriculum Development Meetings:
1 PIS attend 6, 2 hour meetings = 12 hours
• 1 Det attend 6, 2 hour meetings = 12 hours
Quarterly Steering Committee Meetings:
1 PIS attend 1, 2 hour meeting = 2 hours
1Det Attend 1, 2 hour meeting = 2 hours
Walk In My Shoes Event
• 1 Det. attend 4, 2 hour prep meetings= 8hours
1 Det. prep /travel time, =8 hours
• 1 PIS presence day of event= 4 hours
1 Det. presence day of event =4 hours
1 Det. presence day of event =4 hours
Year 2:
Quarterly Steering Committee Meetings:
1 PIS attend 3, 2 hour meetings = 6 hours
1 Det attend 3, 2 hour meetings = 6 hours
Purple Socks Campaign
• 1 Det. attend 2, 1 hour meetings = 2 hours
1 Det. Prep /travel, 3 hours
1 Det. attend 2, 2 hour presentations = 4 hours
• 1 DET attend 21 2 hour presentations = 4 hours
• 1 DEt attend 2, 2 hour sporting events = 4 hours
1 Det. attend 2, 2 hour sporting events = 4 hours
Walk In My Shoes Event
1 DET attend 41 2 hour prep meetings =8 hours
• 1 DET prep /travel time= 8 hours
1 PIS presence day of event= 4 hours
1 Det. presence day of event= 4 hours
1 Det. presence day of event =4 hours
Year 3:
Quarterly Steering Committee Meetings:
• 1 PIS attend 3, 2 hour meetings = 6 hours
1 Det attend 3, 2 hour meetings = 6 hours
Purple Socks Campaign
• 1 Det. attend 2, 1 hour meetings = 2 hours
• 1 Det. Prep /travel, 3 hours
• 1 Det. attend 2, 2 hour presentations = 4 hours
1 DET attend 2, 2 hour presentations = 4 hours
1 DEt attend 2, 2 hour sporting events = 4 hours
• 1 Det. attend 2, 2 hour sporting events = 4 hours
Walk In My Shoes Event
1 DET attend 4, 2 hour prep meetings =8 hours
• 1 DET prep /travel time= 8 hours
• 1 PIS presence day of event= 4 hours
1 Det. presence day of event= 4 hours
• 1 Det. presence day of event =4 hours
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COTC PROCESSING FORM����
Agreements / Amendments / Deeds ?1313 'll'ti dap try:
CITY ()F SANI
CLERK <
i),
TO: CLERK OF THE COUNCIL OFFICE rt
FROM: DEPT.: I OL, CG / l MAIL STOP: -1 —)
PROJECTMANAGER: �r Ply" �OLp`� EXT.: e,�41 0
AGREEMENT NUMBER (if amendment): A / N
AMENDMENT NUMBER (if applicable): ❑ 1ST ❑ 2ND ❑ 3RD ❑
NAME OF CONSULTANT / PARTY: H LAvrnAj O m o ojs
AMOUNT: ❑ * OVER $25,000 - (A) [( *UP TO $25,000 - (N) Note: If your agreement with a vendor exceeds $25,000
within a Fiscal Year, then you will need to obtain Council
,-J -,/ Approval.
L r) NOT approved by council.
❑ 2) Approved by council.
1Ki1111[ ]I W:1>11.10IT /11gJ:1111114
TERM OF AGREEMENT- EFFECTIVE DATE: 10 1// 1&
SIGNATURES REQUIRED: ❑ VENDOR
❑ CITYATTORNEY
ITEM #:
TERMINATION DATE: C113 D J I9
❑ AGENCY
❑ OTHER
(INSURANCE APPROVAL REQUIRED BY CAD PRIOR TO SUBMITTING TO COTC)
INSURANCE REQUIRED: ❑ YES ❑ NO (Provide City Attorney Office approval)
❑ AUTO ❑ CGL (Commercial General Liability)
❑ PROFESSIONAL LIABILITY ❑ WORKERS COMPENSATION
COMMENTS: Ucy^+- G y-av�`Ir- orlon c4u,2 `toant J Q Yvyckk no� -.
❑ DO NOT PROCESS
❑ Needs Council Approval
❑ Missing Signatures
❑ Other
* Charter amendment effective December 21, 2006 for City Manager contract authority increase; NS -2717
1: 1Agreements\Form - AGREEMENT PROCESSING FORM_canary.doc
Revised: 1/17/2012