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Home My WebLink AboutLR California State Preschool Program Continued Funding Application for Fiscal Year 2024-2025____________________________________________________________________________________ FOR CITY CLERK ONLY Council Meeting: November 20, 2023 Disposition: Resolution 15258 Agenda Item No: 4.f Meeting Date: November 20, 2023 SAN RAFAEL CITY COUNCIL AGENDA REPORT Department: Library and Recreation Prepared by: Kelly Albrecht, Senior Recreation Supervisor City Manager Approval: ______________ TOPIC: CALIFORNIA STATE PRESCHOOL PROGRAM CONTINUED FUNDING APPLICATION FOR FISCAL YEAR 2024-2025 SUBJECT: RESOLUTION APPROVING THE CITY OF SAN RAFAEL TO ENTER INTO A FUNDING AGREEMENT WITH THE CALIFORNIA DEPARTMENT OF EDUCATION FOR THE PURPOSE OF PROVIDING CHILDCARE AND DEVELOPMENT SERVICES RECOMMENDATION: Adopt the resolution approving the City of San Rafael to enter into a funding agreement with the California Department of Education to provide preschool services at Pickleweed Preschool and authorize the designated personnel, Senior Recreation Supervisor, to sign contract documents for fiscal year 2024- 2025, the Continued Funding Application and related documents. BACKGROUND: Assembly Bill 2759 (Chapter 308, Statutes of 2008) created the California State Preschool Program (CSPP). This program consolidated the funding for State Preschool, Prekindergarten and Family Literacy, and General Childcare center-based programs serving eligible three- and four-year-old children to create the California State Preschool Program. The program provides both part-day and full-day services which include a core class curriculum that is developmentally, culturally, and linguistically appropriate for the children served. The program also provides meals and snacks to children, parent education, referrals to health and social services for families, and staff development opportunities to employees. The program is administered through local agencies, colleges, community-action agencies, and private nonprofit agencies. The City of San Rafael has an agreement with the State of California to operate the Pickleweed Preschool as a CSPP contractor. Contractors who wish to be considered for continued funding for Fiscal year 2024- 25 must complete the continued funding application in a timely manner. Upon the City’s submission of the application, and the State’s acceptance thereof, the 2024-2025 contract is automatically renewed in accordance with all applicable federal and state laws as well as California State Preschool Funding Terms and Conditions and Program Requirements. SAN RAFAEL CITY COUNCIL AGENDA REPORT / Page: 2 ANALYSIS: Pickleweed Preschool has been providing preschool services since 1997. Pickleweed Preschool relies on the renewal of the CSPP contract to provide preschool services for sixty-eight income-eligible families. The preschool is designed to facilitate the transition to kindergarten for three-year-old and four-year-old children. Each child is given the opportunity to prepare and develop at their own pace, under the supervision and care of City childcare staff. Each year, the program establishes goals for each child to build a foundation of skills needed to succeed in their future schooling and society. FISCAL IMPACT: The City is seeking ongoing funding support through a grant from the California Department of Education for the preschool program at Pickleweed Preschool. This important funding from the California Department of Education is essential for the City to continue providing preschool services at Pickleweed Preschool. Estimated funds available through the grant program in fiscal year 2024-25 will depend on program enrollment and program costs to be determined through the fiscal year2024-25 budget process. For the current fiscal year, the State Department of Education is expected to provide $466,229 in grant funding, representing 69% of the program costs. The following provides a summary of the revenue sources supporting the Pickleweed Preschool Program in the current fiscal year: Pickleweed Preschool Program Fiscal Year 2023-24 Budget Revenue Sources: California State Department of Education State Preschool Program $466,229 First 5 Marin $100,000 Community Development Block Grant (Federal) $21,500 Safety Net (Marin Childcare Council) $20,000 Available (Prior Year) Fund Balance $66,763 Total Revenues $674,492 Expenditures: Personnel $620,453 Non-Personnel $54,040 Total Expenditures: $674,492 OPTIONS: The City Council has the following options to consider on this matter: 1.Adopt the resolution as proposed to enter into the funding agreement with the California Department of Education. 2.Do not adopt the resolution, resulting in the city declining the opportunity to receive grant from the California State Department of Education. RECOMMENDED ACTION: Adopt the resolution approving the City of San Rafael to enter into a funding agreement with the California Department of Education to provide preschool services at Pickleweed Preschool and authorize the designated personnel, Senior Recreation Supervisor, to sign contract documents for fiscal year 2024- 2025, the Continued Funding Application and related documents. SAN RAFAEL CITY COUNCIL AGENDA REPORT / Page: 3 ATTACHMENTS: 1. Resolution 2.Continued Funding Application Fiscal Year 2024-2025 RESOLUTION NO. 15258 RESOLUTION APPROVING THE CITY OF SAN RAFAEL TO ENTER INTO A FUNDING AGREEMENT WITH THE CALIFORNIA DEPARTMENT OF EDUCATION FOR THE PURPOSE OF PROVIDING CHILDCARE AND DEVELOPMENT SERVICES WHEREAS, the City operates the Pickleweed Preschool at the Pickleweed Children’s Center; and WHEREAS, the City desires to provide no-cost preschool programming to low- income families from East San Rafael through programming at the Pickleweed Children’s Center; and WHEREAS, the State of California has awarded the City of San Rafael funds for subsidy of the Pickleweed Preschool Program since 1997; and WHEREAS, the City desires to enter into a funding agreement with the California Department of Education for the purpose of providing childcare and Development services. NOW THEREFORE BE IT RESOLVED, the City Council of the City of San Rafael does hereby approve the City of San Rafael to enter into a funding agreement with the California Department of Education to provide preschool services at Pickleweed Preschool and authorize the designated personnel, Senior Recreation Supervisor, to sign contract documents for fiscal year 2024-2025, the Continued Funding Application and related documents. I, Lindsay Lara, Clerk of the City of San Rafael, hereby certify that the foregoing Resolution was duly and regularly introduced and adopted at a regular meeting of the City Council of the City of San Rafael held on Monday, the 20th of November 2023 by the following vote, to wit: AYES: COUNCILMEMBERS: Bushey, Kertz, Llorens Gulati & Mayor Kate NOES: COUNCILMEMBERS: None ABSENT: COUNCILMEMBERS: Hill Lindsay Lara, City Clerk Application Fiscal Year 2024-25 CSPP Continued Funding Early Education Division Overview Contractors holding a current California State Preschool Program (CSPP) contract, and if applicable a Prekindergarten and Family Literacy Support (CPKS) contract, who wish to be considered for continued funding for fiscal year (FY) 2024-25 must complete this application for continued funding. The FY 2024-25 Continued Funding Application (CFA) Overview and Instructions may be accessed on the CFA web Rag�. Contractors who apply for and are approved for continued funding do not need to sign a contract with the CDE to provide CSPP and CPKS services for FY 2024-25. Contracts will be automatically renewed in accordance with all applicable federal and state laws and Contract Terms and Conditions (CT&Cs). By signing this CFA, the contractor is indicating that it wishes to automatically renew its contract(s) for FY 2024-25 and accepts all of the terms and conditions of the 2024-25 CSPP contract, and if applicable the 2024-25 CPKS contract, which will be provided to the contractor no later than June 1, 2024. Upon completion of this CFA, the California Department of Education (CDE) will review the application and may contact your agency seeking additional information. If the CFA is returned to the COE in a timely manner but is not fully and accurately completed, funding for FY 2024-25, if approved, may be delayed. Please also note that contractors have no vested right to a subsequent contract. Completion of this CFA does not guarantee a renewal of funding. If the CDE determines your agency will not be renewed for a subsequent contract year, you will be notified in writing no later than April 7, 2024, pursuant to the California Code of Regulations, Title 5 (5 CCR) Section 17828. Contractors that wish to reject the terms of the FY 2024-25 CSPP and/or CPKS contract must provide the COE with a written notice that the terms of the contract(s) are rejected by emailing EarlyEducationContracts@cde.ca.gov on or before June 30, 2024. The email should come from the Executive Director/Superintendent of the contracting entity or their authorized representative and state that the terms of the FY 2024-25 CSPP and, as applicable, the CPKS contract are rejected. Contractors providing such notice to the COE of the rejection of the terms of the contract will not have a contract(s) in effect for FY 2024-25. Note that while contractors who currently receive CPKS funding may reject their 2024-25 CPKS contract, they cannot reject their 2024-25 CSPP contract and still receive funding under a CPKS contract since CPKS funding is tied to having a CSPP contract. If a contractor wishes to terminate the contract for any reason during the FY 2024- 25 contract term, the contractor shall notify the COE of its intent to terminate the contract at least 90 calendar days in advance of contract termination and shall follow CCR 17795. Instructions Review the "Fiscal Year 2024-25 Continued Funding Application Overview and Instructions" document provided on the CFA web page for detailed instructions on how to complete each section of the CFA. All fields must be completed unless otherwise noted as optional. The application is structured into the following sections: Section I: Contractor Information Section II: Contract and Program Type Section 111: Contractor's Officers and Board of Directors Information Section IV: Program Narrative Section V: Subcontract Certification Section VI: Contractor Certification Section VII: CFA Checklist Only a person with the legal authority to contractually bind the agency, or the contractor's "authorized representative" identified in the Board Resolution, may sign the CFA and related contractual documents on behalf of the agency. Please refer to the "Fiscal Year 2024-25 Continued Funding Application Overview and Instructions" and the template Board Resolution provided on the CFA web Rag . If you do not complete the CFA in one session, you must select the Save Responses button located on the bottom of the screen. Once selected, you will be redirected to a new browser window to enter your email address. You will receive an email with a unique web address for entrance back into the CFA. It is recommended that you save the application web address. If you have any questions regarding the CFA, please contact CFA@cde.ca.gov. I _Reset 11 Save Responses 11 Next j -·'1 }·'/'• ( ([ f / / () l / { rH P MU M N r • EDUCATION Section I: Contractor Information Contractor Legal Name: City of San Rafael Contractor "Doing Business As" (DBA): (Optional) Headquartered County: I 21 Marin v J Vendor Number: Executive Director Name: Cristine Alilovich Executive Director Telephone Number: (999-999-9999) 415-485-3384 Executive Director Email Address: cristine.alilovich@cityofsanrafael.org Legal Business Address: 1400 Fifth Avenue City: San Rafael Zip Code: 94901 Is Mailing Address different from Legal Business Address? @ Yes 0 No Mailing Address: 618 B Street Application Mailing Cit San Rafael Mailing Zip Code: 94901 Name of Person Completing the CFA: kelly Albrecht Title of Person Completing the CFA: Senior Recreation Supervisor Contact Person Telephone Number: (999-999-9999) 415-485-3386 Contact Person Email Address: kelly.atbrecht@cityofsanrafael.org j Back 11 Reset 11 Save Responses ] j Next ) ( J // I-" , ,1 ; : i ': fl, F .•\ 1 1 P/,. N r or • EDUCATION Section II: Contract and Program Type Part 1: Contract and Program Type Application Check all applicable boxes indicating the programs the contractor intends to continue to administer for FY 2024-25. The contractor agrees to continue implementation of these programs with funds provided by the COE. Contract Type: (select all that apply) rJ CSPP 0 CPKS Does the CSPP operate a Family Childcare Home Education Network (FCHEEN)? 0 Yes @ No ProgramType: (Select all that apply. A completed Program Calendar (Form EEO 9730) must be submitted. If the contractor operates both a full-day and a part-day program, a separate Program Calendar (Form EEO 9730) must be uploaded for each.) 0 Full-Day/Full-Year Part-Day/Part-Year D Full-Day/Part-Year D Part-Day/Full-Year Part 2: Projected Enrollment Insert the number of subsidized children your agency expects to enroll with the CSPP contract for each county services are provided, as applicable. How many counties does your agency operate in? I 1 VI County 1 Information Select the County Name: I 21 Marin v I Number of Children to be Enrolled in Part-Day CSPP 68 in County 1: --- Number of Children to be Enrolled in Full-Day CSPP o in County 1: ·--- Total Number of Children to -----68 be Enrolled in County 1: Total Number of CSPP Children to be Enrolled: (Add the total from each county.) 68 [ Back 11 Reset I [ Save Responses ] I Next I Application Section Ill: Contractor's Officers and Board of Directors Information Does the contractor have a board of directors? @ Yes 0 No How many officers and board members/governing individuals (i.e., owner, director, etc.) does your agency have? (If there are more than 10, please complete this section and email CFA@cde.ca.gov with any additional members and their contact information.) I s vi Officer #1: Officer 1 First Name: Officer 1 Last Name: Officer 1 Title: Officer 1 Telephone Number: (999- 999-9999) Officer 1 Mailing Address: Officer 1 Mailing City: Officer 1 Mailing Zip Code: Officer 1 Email Address: Officer #2: Officer 2 First Name: Officer 2 Last Name: Officer 2 Title: Kate Colin Mayor 415-205-3119 11400 Fifth Avenue San Rafael 94901 kate.colin@cityofsanrafael.org Maribeth Bushey Council Member Officer 2 Telephone Number (999- 999-9999): Officer 2 Mailing Address: Officer 2 Mailing City: Officer 2 Mailing Zip Code: Officer 2 Email Address: Officer #3: Officer 3 First Name: Officer 3 Last Name: Officer 3 Title: Officer 3 Telephone Number (999- 999-9999): Officer 3 Mailing Address: Officer 3 Mailing City: Officer 3 Mailing Zip.Code: Officer 3 Email Address: Officer #4: Officer 4 First Name: Officer 4 Last Name: Officer 4 Title: Officer 4 Telephone Number (999- 999-9999): Officer 4 Mailing Address: Officer 4 Mailing City: 415-485-3070 11400 Fifth Avenue San Rafael 94901 I maribeth. bushey@cityofsanrafael.org Eli Hill Council Member 415-485-3070 11400 Fifth Avenue San Rafael 94901 eli.hill@cityofsanrafael.org Maika Llorens Gulati Council Member 415-485-3070 11400 Fifth Avenue San Rafael Officer 4 Mailing Zip Code: Officer 4 Email Address: Officer #5: Officer 5 First Name: Officer 5 Last Name: Officer 5 Title: Officer 5 Telephone Number (999- 999-9999): Officer 5 Mailing Address: Officer 5 Mailing City: Officer 5 Mailing Zip Code: Officer 5 Email Address: 94901 maika.lorens@cityofsanrafael.org Rachel Kertz Council Member 415-485-3070 11400 Fifth Avenue San Rafael 94901 rachel.kertz@cityofsanrafael.org Have any of the listed officers, board members, owners or other governing individuals ever served as an officer, board member, owner or governing individual with an agency that received state or federal funding and which agency funding was terminated or involuntarily non- renewed, or the agency was debarred from funding for any period of time? 0 Yes @ No [ Back ] ! Reset ] [ Save Responses ] [ Next ] (/ I if',I'll i DEPARTMENT OF • EDUCATION Section IV: Program Narrative Application Does the contractor have program or minimum days of operation (MDO) changes? O Yes @ No I Back 11 Reset 11 Save Responses 11 Next I Application Section V: Subcontract Certification Subcontractor refers to a separate agency subcontracted to provide CSPP services in accordance with the provisions contained in the California Education Code, 5 CCR, and the CT&Cs. Does the Contractor have subcontractors? O Yes @ No Contractors who subcontract CSPP services must also submit a completed Subcontractor Information Form (EED-3704B). The form is available on the CFA web Rag§.. AGREEMENT: By signing this application electronically, I, the District Superintendent, or authorized designee, agree that my electronic signature is the legally binding equivalent to my handwritten signature. @ Yes 0 No Printed Name of the Contractor's Authorized Representative: kelly Albrecht Title of the Contractor's Authorized Representative: Senior Recreation Supervisor Certification Date: (MM/OO/YYYY) 10/25/2023 Authorized Representative's Telephone Number: (999-999-9999) 415-485-3386 Authorized Representative's Email Address: kelly.albrecht@cityofsanraf ael. org Application Section VI: Contractor Certification Under penalty of perjury, I certify the following statements as true and correct to the best of my knowledge: (Each box below must be selected in order to continue with the application.) l"J I have read and understand the staffing requirements for Program Director, Site Supervisor, and Teacher. All staff employed by the contractor for the provision of preschool services are fully qualified for their respective positions. The exception to this certification is a person employed as Program Director or Site Supervisor who possesses a current Staffing Qualifications Waiver approved by the Early Education Division. r'J I am authorized by the contractor's Board of Directors or other governing authority to execute this CFA, signifying their intent to automatically renew the current CSPP contract, and CPKS contract if applicable, for FY 2024- 25, under new terms and conditions to be established by the COE, unless rejected in writing prior to the effective date of the new CSPP contract(s) on June 30, 2024. rJ On behalf of the contractor and its governing authority, I understand that some information requested in this CFA is intended for use by COE auditors in connection with future audit work and performance reviews and may not be used, reviewed, or considered by the COE until after the contract has expired, if ever. Therefore, the contractor further understands that the information (and any underlying transactions) disclosed by this CFA shall not be considered properly noticed to the COE, nor approved, accepted, or authorized by the COE, even if the contractor's request for continued funding by the COE is subsequently approved. rJ The governing board members or persons with governing authority have been trained in understanding conflict of interest requirements associated with their positions on the board and have reported all known conflicts of interest. As the authorized representative of the CSPP contractor named in this application, I certify that: (Each box below must be selected in order to continue with the application.) l"J I have reviewed all of the information for my agency and, to the best of my knowledge, the information on the CDMIS website reflects accurate information for my agency as of the date this certification is signed. l'J I understand my obligation as a CSPP contractor to ensure the accuracy of information in CDMIS on an ongoing basis and will update the information in CDMIS as needed throughout the contract period. As the signer on this CFA I have supervisory authority over the CSPP and have actual, personal knowledge of the information provided in this CFA. I am familiar with and will ensure that the contractor complies with all applicable program statutes and regulations in effect for FY 2024-25, including but not limited to: (Each box below must be selected in order to continue with the application.) l'J Subcontracting requirements, including competitive bidding, COE approval, and audit requirements in 5 CCR. l'J Prohibitions on conflicts of interests, including (i) the assurances required to establish that transactions with officers, directors and other related party transactions are conducted at arm's length, and (ii) employment limitations stated in EC. l'J Cost reimbursement requirements, including reimbursable and non- reimbursable costs, documentation requirements, the provisions for determining the reimbursable amount and other provisions in 5 CCR, and accounting and reporting requirements in 5 CCR. ea Operational and programmatic requirements. l'J Personnel requirements as stipulated in the California Education Code, 5 CCR; and the CT &Cs. By signing this CFA, the contractor is indicating that it wishes to automatically renew the current contract for FY 2024-25 and, if approved, is willing to, and does accept, all terms and conditions of the CSPP contract, which will be provided to the contractor no later than June 1, 2024. The contractor may reject the FY 2024-25 contract by providing the COE with a written notice of rejection no later than June 30, 2024. Contractors that wish to reject the terms of the FY 2024-25 contract must provide written notice that the terms of the contract are rejected by emailing EarlyEducationContracts@cde.ca.gov on or before June 30, 2024. The email should come from the Executive Director/Superintendent of the contracting entity or their authorized representative and state that the terms of the FY 2024-25 CSPP contract, and CPKS contract if applicable, are rejected. Contractors providing such notice to the COE of the rejection of the terms of the contract(s) will not have a contract(s) in effect for FY 2024-25. I understand that failure to timely reject the terms of the contract means that the contract may be automatically renewed for FY 2024-25 starting on July 1, 2024. AGREEMENT: By signing this application electronically, I, the District Superintendent, or authorized designee, agree that my electronic signature is the legally binding equivalent to my handwritten signature. @ Yes 0 No Printed Name of the Contractor's Authorized Representative: kelly Albrecht Title of the Contractor's Authorized Representative: Senior Recreation Supervisor Certification Date: (MM/OO/YYYY) 10/25/2023 Authorized Representative's Telephone Number: (999-999-9999) 415-485-3386 Authorized Representative's Email Address: kelly.albrecht@cityofsanrafael.org [ Back ] ! Reset I ! Save Responses ] [ Next I Application Section VII -CFA Checklist Is the Contractor a public or non-public agency? (The State Administrative Manual defines a public agency as any state agency, city, county, special district, school district, community college district, county superintendent of schools, or federal agency. A charter school is also a public agency. Any agency that does not meet these criteria is considered a "non- public agency.'? @ Public Agency 0 Non-Public Agency Is the Contractor a community college or community college district in California? (Community colleges and community college districts appear in the California Community Colleges Chancellor's Office Directory) 0 Yes @ No Is the Contractor a local education agency (LEA)? (An LEA is a local entity involved in education including but not limited to school districts, county offices of education, direct-funded charter schools, and special education local plan areas. LEAs appear in the California School Directory) 0 Yes @ No All forms and documentation listed below must be completed and attached to this application when submitting the CFA. Download, complete, and save each required attachment, as applicable, from the CFA web Rag . Before uploading your completed attachments, they must be saved on your computer in a compressed (zipped) folder. Instructions for saving all attachments in a compressed (zipped) folder: Save all completed attachments in one folder on your computer. Name each document with your Vendor ID Number followed by the title of the document, for example "12345 -STD 204," "12345 -Board Resolution," etc. Name the folder containing all attachments with your Vendor ID Number followed by "CFAAttachments," for example "12345 -CFAAttachments." Right click on the folder, hover your cursor over the "Send to" option, then select "Compressed (zipped) folder." (Mac users may instead select all the documents within the folder, right click, and select "Compress X items" where X is the number of items selected.) The compressed folder will appear in the same location as the original folder. The compressed folder name will end with ".zip." Check each box below to confirm the required item is completed and included in your zipped file: Part-Day Calendar (Form EEO 9730). Required for contractors who indicated a Part-Day program type in Section II. Included California Civil Rights Laws Certification (C0-005). Required for all contractors. Included Contractor Certification Clauses (CCC). Required for all contractors. Included Federal Certification (C0.8). Required for all contractors. rJ Included CDMIS Agency Information Certification. Required for all contractors. (Review all information in CDMIS, update any outdated or incorrect information, and generate the Agency Information Certification form. Log on to the COM IS and follow the steps outlined in the FY 2024-25 CFA Instructions.) rJ Included Public Agency's Board Resolution or Minutes authorizing signature authority. Required for all Public Agencies. (If the contractor is a County Office of Education, Resolution is not required only IF the CFA is signed by the County Superintendent). rJ Included □Not Applicable If applicable: Application for License Exemption. Applicable only for LEAs choosing to apply to be exempt from licensure pursuant to Health & Safety Code (H&SC) Section 1596.792(0). □Included Not Applicable Upload the .zip file containing all required attachments. To upload the file, click the icon below, select the .zip folder saved on your computer, and click "upload." When the file has uploaded successfully a unique ID will appear in the box below . .!. I Back 11 Reset 11 Save Responses 11 Next I L;a11rornIa uepartment or t:.aucauon Early Education Division California State Preschool Program Fiscal Year 2024-25 Program Calendar t:.t:.U-l:H;jU 09/2023 Contractor Name: City of San Rafael Vendor Number: 2193 Contract Type: CSPP county: Marin Program Type: Part-Day Instructions: Check the box on each date your program will operate. Total days of operation will automatically calculate. July 2024 Days of Operation 0 SUN MON TUE WED THU FRI N/A 1 □ 2 □ 3 □ 4 □ 5 □ 7 □8 □9 □ 10 0 11 □ 12 □ 14 □ 15 □ 16 □ 17 0 18 0 19 □ 21 □ 22 □ 23 □ 24 □ 25 □ 26 0 28 0 29 □ 30 □ 31 □ NIA NIA A uoust 2024 D avs o fO oeratIon 13 SUN MON TUE WED THU FRI NIA NIA NIA NIA 1 □ 2 □ 4 □ 5 □ 6 □ 7 □ 8 □ 9 □ 11 □ 12 0 13 0 14 0 15 0 16 0 18 □ 19 0 20 0 21 0 22 0 23 0 25 □ 26 0 27 0 28 0 29 0 30 0 September 2024 Days of Operation 20 SUN MON TUE WED THU FRI 1 □2 □3 0 4 0 5 0 6 0 8 □9 0 10 Ii 11 0 12 I 13 0 15 1 16 0 17 0 18 0 19 0 20 0 22 □ 23 0 24 I 25 0 26 r 27 0 29 0 30 0 NIA NIA NIA NIA October 2024 Da s of O eration 14 SUN MON TUE WED THU FRI NIA N 6 13 20 27 NIA 3 10 17 24 December 2024 Davs of Operation 15 SUN MON TUE-WED THU 1 □ 2 0 3 171 4 0 5 0 8 □ 9 0 10 0 11 0 12 0 15 □ 16 [ l 17 0 18 0 19 0 22 □ 23 □ 24 0 25 0 26 □ 29 □ 30 □ 31 0 NIA NIA FRI 6 0 13 0 20 l.ll 27 0 NIA SAT 6 □ 13 □ 20 □ 27 □ NIA SAT 3 □ 10 0 17 0 24 0 31 0 SAT 7 □ 14 1 21 0 28 1 NIA SAT 7 □ 14 0 21 0 28 □ N/A January 2025 Days of Operation 19 SUN MON TUE WED THU NIA NIA NIA 1 □ 2 □ 5 □ 6 0 7 0 8 0 9 0 12 0 13 0 14 0 15 0 16 0 19 0 20 0 21 171 22 0 23 0 26 n 27 0 28 0 29 0 30 0 Februarv 2025 Days of Operation 16 SUN MON TUE WED THU NIA NIA NIA N/A NIA 2 □ 3 0 4 0 5 0 6 0 9 □ 10 0 11 0 12 0 13 0 16 0 17 0 18 0 19 0 20 0 23 0 24 0 25 0 26 0 27 0 M h 2025 D arc all's 0 Ipera I0n fO t' 15 SUN MON TUE WED THU N/A NIA N/A N/A NIA 2 □3 0 4 17 5 0 6 17 9 n 10 0 11 0 12 0 13 0 16 0 17 0 18 □19 0 20 0 23 0 24 0 25 J l 26 0 27 l l 30 0 31 0 NIA NIA NIA NI 6 13 20 27 May 2025 Days of Operation 21 SUN MON TUE WED THU NIA NIA NIA NIA 1 0 4 □ 5 0 6 0 7 0 8 0 11 □-12 l.ll 13 [ J 14 l.ll 15 0 18 LJ 19 0 20 0 21 0 22 0 25 0 26 L J 27 0 28 l.ll 29 I..{] June 2025 Days of Operation 9 SUN MON TUE WED THU 1 □2 0 3 0 4 0 5 0 8 □9 0 10 0 11 0 12 0 15 0 16 0 17 0 18 □19 0 22 0 23 0 24 0 25 0 26 0 29 □ 30 0 NIA NIA NIA Total Days of Operation: 175 EEO Consultant Initials (For EEO Use Only) Date Approved by EEO (For EEO Use Only) FRI SAT 3 □ 4 □ 10 0 11 □ 17 0 18 D 24 0 25 □ 31 0 N/A FRI SAT N/A 1 □ 7 0 8 □ 14 0 15 0 21 0 22 □28 0 N/A FRI SAT NIA 1 □ 7 0 8 r 14 0 15 0 21 0 22 0 28 0 29 0 NIA NIA FRI SAT FRI SAT 2 I..{] 3 □ 9 0 10 □ 16 I..{] 17 I l 23 0 24 0 30 I..{] 31 LJ FRI SAT 6 0 7 □ 13 □ 14 □ 20 0 21 □ 27 0 28 □ NIA NIA California Department of Education Fiscal & Administrative Services Division CO-005 (NEW 4/2020) CALIFORNIA CIVIL RIGHTS LAWS CERTIFICATION Pursuant to Public Contract Code section 2010, if a bidder or proposer executes or renews a contract in the amount of $100,000 or more on or after January 1, 2017, the bidder or proposer hereby certifies compliance with the following: 1. CALIFORNIA CIVIL RIGHTS LAWS: For contracts $100,000 or more, executed or renewed after January 1, 2017, the contractor certifies compliance with the Unruh Civil Rights Act (Section 51 of the Civil Code) and the Fair Employment and Housing Act (Section 12960 of the Government Code); and 2. EMPLOYER DISCRIMINATORY POLICIES: For contracts $100,000 or more, executed or renewed after January 1, 2017, if a Contractor has an internal policy against a sovereign nation or peoples recognized by the United States government, the Contractor certifies that such policies are not used in violation of the Unruh Civil Rights Act (Section 51 of the Civil Code) or the Fair Employment and Housing Act (Section 12960 of the Government Code). CERTIFICATION I, the official named below, certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. 1. Proposer/Bidder Firm Name (Printed): City of San Rafael 2. Federal ID Number: 946000424 3. By (Authorized Signature): 4. Printed Name and Title of Person Signing: Kelly Albrecht, Senior Recreation Supervisor 5. Date Executed: 10/24/2023 6. Executed in the County and State of: Marin Page 1 of 1 Contractor Certification Clauses CCC 04/2017 CERTIFICATION I, the official named below, CERTIFY UNDER PENAL TY OF PERJURY that I am duly authorized to legally bind the prospective Contractor to the clause(s) listed below. This certification is made under the laws of the State of California. Contractor/Bidder Firm Name (Printed) City of San Rafael By (Authorized Signature) Printed Name and Title of Person Signing Kelly Albrecht, Senior Recreation Supervisor Date Executed 10/24/2023 CONTRACTOR CERTIFICATION CLAUSES Federal ID Number 946000424 Executed in the County of Marin 1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with the nondiscrimination program requirements. (Gov. Code §12990 (a-f) and CCR, Title 2, Section 11102) (Not applicable to public entities.) 2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-free workplace by taking the following actions: a. Publish a statement notifying employees that unlawful manufacture, distribution, dispensation, possession or use of a controlled substance is prohibited and specifying actions to be taken against employees for violations. b. Establish a Drug-Free Awareness Program to inform employees about: 1) the dangers of drug abuse in the workplace; 2) the person's or organization's policy of maintaining a drug-free workplace; 3) any available counseling, rehabilitation and employee assistance programs; and, 4)penalties that may be imposed upon employees for drug abuse violations. c. Every employee who works on the proposed Agreement will: 1) receive a copy of the company's drug-free workplace policy statement; and, 2) agree to abide by the terms of the company's statement as a condition of employment on the Agreement. Failure to comply with these requirements may result in suspension of payments under the Agreement or termination of the Agreement or both and Contractor may be ineligible for award of any future State agreements if the department determines that any of the following has occurred: the Contractor has made false certification, or violated the certification by failing to carry out the requirements as noted above. (Gov. Code §8350 et seq.) 3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor certifies that no more than one (1) final unappealable finding of contempt of court by a Federal court has been issued against Contractor within the immediately preceding two-year period because of Contractor's failure to comply with an order of a Federal court, which orders Contractor to comply with an order of the National Labor Relations Board. (Pub. Contract Code §10296) (Not applicable to public entities.) 4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE-PRO BONO REQUIREMENT: Contractor hereby certifies that Contractor will comply with the requirements of Section 6072 of the Business and Professions Code, effective January 1, 2003. Contractor agrees to make a good faith effort to provide a minimum number of hours of pro bona legal services during each year of the contract equal to the lessor of 30 multiplied by the number of full time attorneys in the firm's offices in the State, with the number of hours prorated on an actual day basis for any contract period of less than a full year or 10% of its contract with the State. Failure to make a good faith effort may be cause for non-renewal of a state contract for legal services, and may be taken into account when determining the award of future contracts with the State for legal services. 5. EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an expatriate corporation or subsidiary of an expatriate corporation within the meaning of Public Contract Code Section 10286 and 10286.1, and is eligible to contract with the State of California. 6. SWEATFREE CODE OF CONDUCT: a. All Contractors contracting for the procurement or laundering of apparel, garments or corresponding accessories, or the procurement of equipment, materials, or supplies, other than procurement related to a public works contract, declare under penalty of perjury that no apparel, garments or corresponding accessories, equipment, materials, or supplies furnished to the state pursuant to the contract have been laundered or produced in whole or in part by sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor, or with the benefit of sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor. The contractor further declares under penalty of perjury that they adhere to the Sweatfree Code of Conduct as set forth on the California Department of Industrial Relations website located at www.dir.ca.gov, and Public Contract Code Section 6108. b. The contractor agrees to cooperate fully in providing reasonable access to the contractor's records, documents, agents or employees, or premises if reasonably required by authorized officials of the contracting agency, the Department of Industrial Relations, or the Department of Justice to determine the contractor's compliance with the requirements under paragraph (a). 7. DOMESTIC PARTNERS: For contracts of $100,000 or more, Contractor certifies that Contractor is in compliance with Public Contract Code section 10295.3. 8. GENDER IDENTITY: For contracts of $100,000 or more, Contractor certifies that Contractor is in compliance with Public Contract Code section 10295.35. DOING BUSINESS WITH THE STATE OF CALIFORNIA The following laws apply to persons or entities doing business with the State of California. 1. CONFLICT OF INTEREST: Contractor needs to be aware of the following provisions regarding current or former state employees. If Contractor has any questions on the status of any person rendering services or involved with the Agreement, the awarding agency must be contacted immediately for clarification. Current State Employees (Pub. Contract Code §10410): 1 ). No officer or employee shall engage in any employment, activity or enterprise from which the officer or employee receives compensation or has a financial interest and which is sponsored or funded by any state agency, unless the employment, activity or enterprise is required as a condition of regular state employment. 2). No officer or employee shall contract on his or her own behalf as an independent contractor with any state agency to provide goods or services. Former State Employees (Pub. Contract Code §10411 ): 1 ). For the two-year period from the date he or she left state employment, no former state officer or employee may enter into a contract in which he or she engaged in any of the negotiations, transactions, planning, arrangements or any part of the decision-making process relevant to the contract while employed in any capacity by any state agency. 2). For the twelve-month period from the date he or she left state employment, no former state officer or employee may enter into a contract with any state agency if he or she was employed by that state agency in a policy-making position in the same general subject area as the proposed contract within the 12-month period prior to his or her leaving state service. If Contractor violates any provisions of above paragraphs, such action by Contractor shall render this Agreement void. (Pub. Contract Code §10420) Members of boards and commissions are exempt from this section if they do not receive payment other than payment of each meeting of the board or commission, payment for preparatory time and payment for per diem. (Pub. Contract Code §10430 (e)) 2. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware of the provisions which require every employer to be insured against liability for Worker's Compensation or to undertake self-insurance in accordance with the provisions, and Contractor affirms to comply with such provisions before commencing the performance of the work of this Agreement. (Labor Code Section 3700) 3. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits discrimination on the basis of disability, as well as all applicable regulations and guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.) 4. CONTRACTOR NAME CHANGE: An amendment is required to change the Contractor's name as listed on this Agreement. Upon receipt of legal documentation of the name change the State will process the amendment. Payment of invoices presented with a new name cannot be paid prior to approval of said amendment. 5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA: a. When agreements are to be performed in the state by corporations, the contracting agencies will be verifying that the contractor is currently qualified to do business in California in order to ensure that all obligations due to the state are fulfilled. b. "Doing business" is defined in R&TC Section 23101 as actively engaging in any transaction for the purpose of financial or pecuniary gain or profit. Although there are some statutory exceptions to taxation, rarely will a corporate contractor performing within the state not be subject to the franchise tax. c. Both domestic and foreign corporations (those incorporated outside of California) must be in good standing in order to be qualified to do business in California. Agencies will determine whether a corporation is in good standing by calling the Office of the Secretary of State. 6. RESOLUTION: A county, city, district, or other local public body must provide the State with a copy of a resolution, order, motion, or ordinance of the local governing body which by law has authority to enter into an agreement, authorizing execution of the agreement. 7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the Contractor shall not be: (1) in violation of any order or resolution not subject to review promulgated by the State Air Resources Board or an air pollution control district; (2) subject to cease and desist order not subject to review issued pursuant to Section 13301 of the Water Code for violation of waste discharge requirements or discharge prohibitions; or (3) finally determined to be in violation of provisions of federal law relating to air or water pollution. 8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all contractors that are not another state agency or other governmental entity. FEDERAL CERTIFICATIONS co.a (REV. 06120) California Department of Education CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants should also review the instructions for certification included in the regulations before completing this form. Signature on this form provides for compliance with certification requirements under 45 CFR Part 93, "New restrictions on Lobbying," and 45 CFR Part 76, "Government-wide Debarment and Suspension (Non procurement) and Government-wide requirements for Drug-Free Workplace (Grants)." The certifications shall be treated as a material representation of fact upon which reliance will be placed when the Department of Education determines to award the covered transaction, grant, or cooperative agreement. 1. LOBBYING As required by Section 1352, Title 31 of the U.S. Code, and implemented at 45 CFR Part 93, for persons entering into a grant or cooperative agreement over $100,000 as defined at 45 CFR Part 93, Sections 93.105 and 93.110, the applicant certifies that: (a) 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 making of any federal grant, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, ormodification of any federal grant or cooperative agreement: (b) If any funds other than federal appropriated funds have been or will be paid to any person for influencing or attempting to influence an employee of Congress, or any employee of a Member of Congress in connection with this Federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance with this instruction; (c) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subgrants, contracts under grants and cooperative agreements, and subcontracts) and that all subrecipients shall certify and disclose accordingly. 1 2. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS As required by executive Order 12549, Debarment and Suspension, and other responsibilities implemented at 45 CFR Part 76, for prospective participants in primary or a lower tier covered transactions, as defined at 45 CFR Part 76, Sections 76.105 and 76.110. A. The applicant certifies 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 application been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction violation of federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental 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 proceeding this application had one or more public transactions (federal, state, or local) terminated for cause or default; and B. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an explanation to this application. 3. DRUG-FREE WORKPLACE (GRANTEES OTHER THAN INDIVIDUALS) As required by the Drug-Free Workplace Act of 1988, and implemented at 45 CFR Part 76, Subpart F, for grantees, as defined at 45 CFR Part 76, Sections 76.605 and 76.610- A. The applicant certifies that it will or will continue to 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 grantee's workplace and specifying the actions that will be taken against employees for violation of such prohibition. (b) Establishing an on-going drug-free awareness program to inform employees about- (1) The danger of drug abuse in the workplace; (2) The grantee's policy of maintaining a drug- free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; 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 to be engaged in 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 grant, the employee will - (1) Abide by the terms of the statement; and (2) Notify the employer in writing of his or her conviction for a violation; 2 (e) Notifying the agency, in writing, within 10 calendar days after receiving notice under subparagraph (d) (2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to: Director, Grants, and Contracts Service, U.S. Department of Education, 400 Maryland Avenue, S.W., (Room 3124, GSA Regional Office Building No. 3), Washington, DC 20202-4571. Notice shall include the identification number(s) of each affected grant; (f) Taking one of the following actions, within 30 calendar 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 includingtermination consistent with the requirements of the Rehabilitation Act of 1973, as amended; 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 grantee shall insert in the space provided below the site(s) for the performance of work done in connection with the specific grant: Place of Performance (Street address, city, county, state, zip code) Pickleweed Preschool 40 Canal Street San Rafael CA 94901 D Check if there are workplaces on file that are not identified here. DRUG-FREE WORKPLACE (GRANTEES WHO ARE INDIVIDUALS) As required by the Drug-Free Workplace Act of 1988, and implemented at 45 CFR Part 76, Subpart F, for grantees, as defined at 45 CFR Part 76, Sections 76.605 and 76.610- a As a condition of the grant, I certify that I will not engage in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance in conducting any activity with the grant, and b. If convicted of a criminal drug offense resulting from a violation occurring during the conduct of any grant activity, I will report the conviction, in writing, within 10 calendar days of the conviction, to: Director, Grants and contracts Service, U.S. department of Education, 400 Maryland Avenue, S.W. (Room 3124, GSA Regional Office Building No. 3) Washington, DC 20202-4571. Notice shall include the identification numbers(s) of each affected grant. ENVIRONMENTAL TOBACCO SMOKE ACT As required by the Pro-Children Act of 1994, (also known as Environmental Tobacco Smoke), and implemented at Public Law 103-277, Part C requires that: The applicant certifies that smoking is not permitted in any portion of any indoor facility owned or leased or contracted and used routinely or regularly for the provision of health care services, day care, and education to children under the age of 18. Failure to comply with the provisions of this law may result in the imposition of a civil monetary penalty of up to $1,000 per day. (The law does not apply to children's services provided in private residence, facilities funded solely by Medicare or Medicaid funds, and portions of facilities used for in- patient drug and alcohol treatment.) As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above certifications. FISCAL YEAR 2024-25 CONTRACTOR NAME VENDOR ID NUMBER City of San Rafael 2193 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE Kelly Albrecht, Senior Recreation Supervisor SIGNATURE 3 DATE 10/24/23