HomeMy WebLinkAboutPW Funding Request Certification; CalRecycleA Recycle
San Rafael
Funding Request Cycle: FY 2016-2017
Program Requirements
Beverage Container Recycling City/County Payment Program
City/County Annual Payment and Reporting System
Funding Request Certification
Type: Individual
Eligible Funds ($): 15,374
1) Provide a brief description of the proposed project(s) that you plan to implement with city/county payment program funds.
Public Resources Code 14581 (a)(3)(B).
Project Description:
San Rafael's goal is to maximize the amount of recyclable material that will be processed through the local landfill recycling center.
Our secondary goal is litter abatement. For FY 16/17, our goal will be to maintain the current ratio of recyclable versus non -recyclable
material at 80% for all California Refund Value (CRV) beverage containers collected from City streets, parks and other public spaces.
The primary means of determining that ratio is by measuring the change of volume of beverage containers and other recyclable
materials, as determined by pre/post tonnage reports generated by landfill personnel.
2) Please specify supermarket siting information pursuant to Public Resources Code 14581 (a)(3)(F).
Have you prohibited the siting of a supermarket site?
No
Have you caused a supermarket to close its business?
No
Have you adopted a land use policy that restricts or prohibits the siting of a supermarket site within your jurisdiction?
No
3) Are you currently participating in mediation mandated by AB 506? Have you attempted to initiate such mediation or have
you declared a fiscal emergency within the last 12 months? Note: The answer is for informational purposes and will not be
used to determine eligibility for payment funding.
No
4) These funds shall not be used for activities unrelated to beverage container recycling or litter reduction, Public Resources
Code 14581 (a)(4)(C).
Yes, I Accept
Contacts -
Name Contact Type Title Phone
Mr. Jim Schutz Signature Authority City Manager (415) 485-3070
Ms. Christine Foster
Ms. Talia Smith
Addresses
Address
P.O. Box 151560
1400 Fifth Ave.
San Rafael, 94915
San Rafael
Secondary
Secondary, Primary
(Funding Request)
Administrative
Assistant
Senior
Administrative
Analyst
Address Type
(415) 485-3352
(415) 485-3354
Physical, Mailing, Payment
Page 1 of 2
Email
city. man ag er@cityofsa n rafael.
org
christine.foster@cityofsanrafa
el.org
talia.smith@cityofsanrafael.or
9
County
Marin
Printed: 4/27/2017
Beverage Container Recycling City/County Payment Program
Recycle City/County Annual Payment and Reporting System
Funding Request Certification
Documents
Document Type Date Title
Resolution 05/16/2016 San Rafael City Council Resolution #142120
Activity ExpenTituces
Current Activity Group Current Activity Item Budgeted Funds ($)
Public Parks / Recreational Areas
Litter Clean-up Roadways 15,374
Community Events
Equipment / Supplies
Total: 15,374
Penalty of Perjury Statement:
"I certify under penalty of perjury, under the laws of the State of California that I am authorized to sign this Funding Request
on behalf of Recipient, th hav read the City/County Payment Program Guidelines and that to the best of my knowledge
and belief thar`informati n drov ed i is funding Request is true and correct."
1
Signature of Sig ture Authority (as a tho ized in Resolution) or Date
Authorized Designee (as authorized in er of Designation)
Jim Crhiit7
Print Name
f:ity ManagPr, ritg of Can RafaP1
Print Title
IMPORTANT! Recipient must print out this page, obtain signature of Signature Authority, upload signed document to the
City/County Annual Payment and Reporting System, and retain the original document in the Recipient's cycle file.
San Rafael Page 2 of 2 Printed: 4/27/2017
CONTRACT ROUTING FORM
INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below.
TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER:
Contracting Department: Public Works
Project Manager: Talia Smith
Extension: 3354
Contractor Name: CalRecyle grant — needs City Manager signature to submit
Contractor's Contact: n/a
Contact's Email: n/a
❑ FPPC: Check if Contractor/Consultant must file Form 700
Step RESPONSIBLE DESCRIPTION
DEPARTMENT
1 Project Manager a. Email PINS Introductory Notice to Contractor
9 City Clerk Attest signatures, retains original agreement and
forwards copies to Project Manager
COMPLETED
DATE
n/a
4/27/2017
en'te`r da%. �i
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Click here to
enter a date.
❑ N/A
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7/x/1 7
REVIEWER
Check/Initial
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b. Email contract (in Word) & attachments to City
Atty c/o Laraine.Gittens@cityofsanrafael.org
2 City Attorney
a. Review, revise, and comment on_ifaftegreement
and return to Project Manager f
b. Confirm insurance requirements, create
PINS, send PINS insurance notice to contractor
3 Project Manager
Forward three (3) originals of final agreement to
contractor for their signature
4 Project Manager
When necessary, * contractor -signed agreement
agendized for Council approval
*PSA > $20,000; or Purchase > $35,000; or
Public Works Contract > $125,000
Date of Council approval
PRINT
CONTINUE ROUTING PROCESS WITH HARD COPY
5 Project Manager
Forward signed original agreements to City
Attorney with printed copy of this routing form
6 City Attorney
Review and approve hard copy of signed
agFE'@m—A, r"",dj.5.nccr -JYr 1`'��r ct� Pier.
7 City Attorney
Review and approve insurance in PINS, and bonds
(for Public Works Contracts)
8 City Manager/ Mayor
Agreement executed by Council authorized official
9 City Clerk Attest signatures, retains original agreement and
forwards copies to Project Manager
COMPLETED
DATE
n/a
4/27/2017
en'te`r da%. �i
Clic�}t,to
enter a ate.
Click here to
enter a date.
❑ N/A
Or
t
d
7/x/1 7
REVIEWER
Check/Initial
®TS
54- pQ__
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