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LR Pickleweed Preschool Funding 2019-20rTFIRST 5 M A R 1 N CHILDREN AND FAMILIES COMMISSION Program Contract Amendment For Fiscal Year: 2019-2020 Project Name: Pickleweed Preschool Contractor: City of San Rafael Start/End Dates of Original Contract: July 1, 2019 through June 30, 2020 Budget for Current Fiscal Year: 101,978 Contract Number: 21-009-10 This Contract Renewal Amendment is between First 5 Marin Children and Families Commission and City of San Rafael This Contract Amendment amends only the revised Exhibits A, (Attachments Al and A2) and Exhibit B, Attachment B. All and any other agreements executed under the original contract signed 6/22/11 are binding. The timelines of this contract amendment are from July 1, 2019 to June 30, 2020 Revised Exhibit A ? YES ® NO❑ • Attach Exhibit A/ Attachment Al & A2/ Scope of Work & Performance Measures Revised Exhibit B? YESN NO ❑ • Attach Exhibit B/Attachment B1/ Program Budget changes Current Liability and Workers' Compensation Policies: Expiration Date - Will the Project involve use of a vehicle? YES ❑ NO • If yes, proof of automobile insurance is required immediately. The "Contractor" agrees to the following terms and conditions in order to receive funds from Marin Children and Families Commission. • The "Contractor" will maintain a tobacco -free workplace • The "Contractor" will not accept any funding from the tobacco industry, including event sponsorship and in-kind contributions. The "Contractor" will purchase equipment that meets all applicable safety laws and standards. L-1 -3 -_7 33 GRANT NO. 21.009-10 AGREEMENT BETWEEN THE MARIN CHILDREN AND FAMILIES COMMISSION AND CITY OF SAN RAFAEUCHILD CARE DIVISION THIS AGREEMENT is entered into between the Marin Children and Families Commission, hereinafter called "Commission," and City of San Rafael/Childcare Division hereinafter called "Contractor." (This Agreement replaces any previous contracts between the Commission and the Contractor.) WITNESS: WHEREAS, pursuant to Health and Safety Code 130100, the Commission may contract for services to the community; and WHEREAS, the Exhibit A, Project Services and Exhibit B, Payments, Exhibit C, Tobacco Control Policy and Exhibit D, Acknowledgement of Funding are attached hereto and incorporated by reference herein; WHEREFORE, the Commission and Contractor agree as follows: 1. Services to be Performed In consideration of the payments hereinafter set forth in Exhibit B, attached hereto and incorporated by reference herein, Contractor under the general direction of the Executive Director of the Commission, or his/her authorized representative, with respect to the product or result of Contractor's services, shall perform services as described in Exhibit A and Exhibit D, attached hereto and incorporated by reference herein. Contractor shall ensure compliance with all state, federal and local laws or rules applicable to performance of the work required under this contract which includes the program for Pickleweed Preschool. Exhibits A and B and their attachments reflect the scope of work, performance measures and budget for the current fiscal year of the contract. It is understood and agreed that Executive Director, prior to commencing subsequent years of funding The scope of work and/or budget may be amended, with written approval of the Executive Director, upon review of the prior year's progress reports; however, that there shall be no change in the maximum amount payable under this Agreement. 2. Contract Term The term of this Agreement shall be from July 1. 2011 through June 30.2012. This contract is renewable annually, subject to: availability of funds, annual review of performance measures (specified in Exhibit A), financial reports (specified in Exhibit B), any required revisions, and approval of the Executive Director of the Commission. This Agreement is also subject to the termination provisions noted in paragraph 7, and subject further to the agreement provided for in paragraph 7 and is subject further to paragraphs 3.1) and 11, that there are reports due followed by final payment and evaluation required which occur after 30 days of the termination letter. Contractor further agrees that the requirements of this Page 1 Agreement pertaining to release of records in paragraph 12, and retention of records in paragraph 13 shall survive the termination of this Agreement. Contractor retains professional and administrative responsibility for the services rendered during the term of the contract. 3. Payments A. Maximum Amount. In full consideration of Contractor's performance of the services described in Exhibit A, the amount that the Commission shall be obligated to pay for services rendered under this Agreement for shall not exceed Seventy-three thousand, Two -hundred and Eighteen Dollars' $73,218), payable based on quarterly invoices per established Commission payment procedures. B. Rate of Payment. Payment shall be as specified in Exhibit B. Each payment shall be conditioned on the performance of the services described in Exhibit A. C. Time Limit for Submitting. Contractor shall submit quarterly progress reports within 15 days of the completion of every quarter starting October 15, 2011 (i.e., July 15, October 15, January 15, April 15,) of each funded year under this Agreement for services to the Commission for payment in accordance with the provisions of Exhibits A and B, unless otherwise determined by the Commission. Guidelines for progress reports will be provided by Commission staff. Any substantial changes to the approved project objectives and performance measures must be approved by the Commission or its representative. Guidelines for such changes will be provided by Commission staff. D. Availability_ of Funds. Payment for all services provided pursuant to this Agreement is contingent upon the availability of funds under Proposition 10. In the event such funds are not provided or not available to the Marin Children & Families Commission, the Commission shall not be liable for any payment whatsoever, including, but not limited to, payments that are based on Commission funds. The Commission may terminate the agreement for unavailability of State funds. In this event, the Commission shall, through its Executive Director, inform Contractor of such unavailability as soon as it is known, and to the extent legally possible pay all outstanding amounts due. E. Supplantation. Funds pursuant to this Agreement are provided pursuant to Proposition 10 and are intended to supplement, expand upon, and enhance activities funded from existing sources. Contractor shall not use funds under this Agreement to supplant existing resources or services. 4. Relationship of Parties It is expressly understood that this is an agreement between two (2) independent contractors and that no agency, employee, partnership, joint venture or other relationship is established by this Agreement. The intent by both the Commission and Contractor is to create an independent contractor relationship. Contractor expressly acknowledges and accepts his/her tax status as, and the tax consequences, of an independent contractor. 5. Hold Harmless Contractor shall indemnify and save harmless the Commission, its officers, agents, employees, and servants from all claims, suits, or actions of every name, kind and description, brought for, on account of. (A) injuries to or death of any person, including Contractor, or (B) damage to any property of any kind whatsoever and to whomever belonging; or (C) any other loss or claim, including but not limited to, injuries resulting from the concurrent active or passive negligence of the Commission, its officers, agents, employees, or servants resulting from the performance of any work required of Contractor or payments made pursuant to this Agreement, provided that this shall not apply to injuries or damage for which the Commission has been found in a court of competent jurisdiction to be solely liable by reason of its own negligence or willful misconduct. The duty of Contractor to indemnify and save harmless as set forth herein, shall include the duty to defend as set forth in section 2778 of the California Civil Code. Page 2 6. Insurance The Contractor shall not commence work or be required to commence work under this Agreement unless and until all insurance required underthis paragraph has been obtained and the Executive Director of the Commission has approved such insurance and Contractor shall use diligence to obtain such insurance and to obtain such approval. The Contractor shall furnish the Commission with certificates of insurance evidencing the required coverage within ten (10) days following the execution of this contract, and there shall be a specific contractual liability endorsement extending the Contractor's coverage to include the contractual liability assumed by the Contractor pursuant to this Agreement and documentation that the Commission is an additional insurance holder. These certificates shall specify or be endorsed to provide that thirty (30) days' notice must be given, in writing, to the Commission of any pending change in the limits of liability or of any cancellation or modification of the policy. A. Worker's Compensation and Employer's Liability Insurance. The Contractor shall have in effect during the entire life of this Agreement Worker's Compensation and Employer's Liability Insurance providing full statutory coverage. In signing this Agreement, the Contractor makes the following certification, required by section 1861 of the California Labor Code: I am aware of the provisions of Section 3700 of the California Labor Code, which requires every employerto be insured against liabilityfor Worker's Compensation or to undertake self-insurance in accordance with the provisions of the Code, and 1 will comply with such provisions before commencing the performance of the work of this Agreement. B. Liability Insurance. The Contractor shall take out and maintain during the life of this Agreement such Bodily Injury Liability and Property Damage Liability Insurance as shall protect him/her while performing work covered by this Agreement from any and all claims for damages for bodily injury, including accidental death, as well as any and all claims for property damage which may arise from contractor's operations under this Agreement, whether such operations be by himself/herself or by any subcontractor or by anyone directly or indirectly employed by either of them. Such insurance shall be combined single limit bodily injury and property damage for each occurrence and shall be not less than the amount specified below. Such insurance shall include: (a) Comprehensive General Liability $1,000,000 (b) Motor Vehicle Liability Insurance $1,000,000 In the event of the breach of any provision of this section, or in the event any notice is received which indicates any required insurance coverage will be diminished or canceled, the Commission at its option, may, notwithstanding any other provision of this Agreement to the contrary, immediately declare a material breach of this Agreement and suspend all further work and payments pursuant to this Agreement. 7. Non -Discrimination Contractor shall comply with the non-discrimination requirements described below: A. Non -Discrimination - General. No person shall, on the grounds of age (over 40), ancestry, creed, color, disability, marital status, medical conditions, national origin, political or religious affiliation, race, sex, sexual orientation or any non -job-related criteria be excluded from participation in, be denied the benefits, or be subjected to discrimination under this Agreement. Page 3 B. Non -Discrimination - Employment. Contractor shall ensure equal employment opportunity based on objective standards of recruitment, selection, promotion, classification, compensation, performance evaluations, and management relations, for all employees covered under this Agreement. Contractor's equal employment opportunity policies shall be made available to the Commission upon request. Violation of the non-disc(mination provisions of this Agreement shall be considered a breach of this Agreement and subject the Contractor to penalties, to be determined by the Executive Director, after consultation with the Chair of the Commission, including but not limited to: i). termination of this Agreement; ii) disqualification of the Contractor from bidding on or being awarded a Commission contract for a period of up to 3 years. The prohibitions and penalties contemplated by this section apply only to discrimination which results from, or arises in the context of, the provision of services provided pursuant to the terms and conditions of the Agreement, including but not limited to the provision of services to the general public and the employment of persons to provide the services herein contemplated. 8. Child Abuse Prevention and Reporting. NOTE. APPLICABLE FOR DIRECT SERVICES GRANTEE ONLY Contractor agrees to ensure that all known or suspected instances of child abuse or neglect are reported to a child protective agency as defined in Penal Code Section 11165.9. This responsibility shall include: A. A regdirement that all employees, consultants, or agents performing services under this contract who are required by Penal Code Section 11166(a), to report child abuse or neglect, sign a statement that he or she knows of the reporting requirement and will comply with it. A. Establishing procedures to ensure reporting even when employees, consultants, or agents who are not required to report child abuse under Penal Code 11166(a), gain knowledge of, or reasonably suspect that a child has been a victim of abuse or neglect. C. Contractor agrees that its employees, subcontractors, assignees, volunteers, and any other persons who provide direct services under this contract and who will have supervisory or disciplinary power over a minor or any person under his or her care (Penal 11105.3) will be fingerprinted in order to determine whether they have a criminal history which would compromise the safety of children with whom Contractor's employees, subcontractors, assignees or volunteers have contact. All fingerprinting services will be at the Commission's discretion and the Contractor's expense. 9. Tobacco Control Policy, All Contractors will implement and enforce the revise Tobacco Control Policy adopted by the Commission December 3, 2003 (Exhibit C, signature required). 10. Assignments and Subcontracts A. Without the written consent of the Executive Director of the Commission or his/her designee, this Agreement is not assignable in whole or in part. Any assignment by Contractor without the written consent both parties is void and shall automatically terminate this Agreement. B. All assignees, subcontractors, or consultants approved in writing by the Executive Director of the Commission or his/her designee shall be subject to the same terms and conditions applicable to Contractor under this Agreement, and Contractor shall be liable for the Page 4 assignee's, subcontractor's or consultant's acts and/or omissions. 11. Termination of Agreement The Executive Director, after consultation with the Chair of the Commission, may at any time from execution of Agreement, terminate this Agreement, in whole or in part, without cause and for the convenience of the Commission, by giving written notice specifying the effective date and scope of such termination. Termination shall be effective on a date not less than thirty days from notice. In the event of termination, all finished or unfinished documents, data, studies, maps, photographs, reports, and materials (hereafter referred to as materials) prepared by Contractor under this Agreement shall be promptly delivered to the Commission. In the event of termination, with the exception of the stipulations in paragraph 3D, the Contractor shall be paid for all work performed until termination. Such payment shall be that portion of the full payment that is determined by comparing the work/services completed to the work/services required by the Agreement. 12. Release of Records All data produced, compiled, and obtained in connection with the performance of this contract shall not be disclosed to any third party without notification to the Commission staff. All data produced or compiled by Contractor shall be considered confidential unless it shall constitute a public record under the current California law and shall not be shared with a third party without notification and approval from the Commission staff. The term 'data' in this section shall refer generally to aggregate information complied for the purpose of program evaluation, and shall not include any information otherwise privileged under the laws of the State of California. Each party shall maintain the confidentiality of medical records as required by law, including but not limited to the Health Insurance Portability and Accountability Act (HIPPA) (45 C.F.R. Part 160, et seq.) and the Confidentiality of Alcohol and Drug Abuse Patient Records Act (42 C.F.R. Part 2), as amended from time to time. Notwithstanding any provision of this Agreement to the contrary, neither party shall be obligated to disclose or make available for review to the other party any patient -specific information where such disclosure would violate applicable provisions of federal and state law regarding the confidentiality of medical records. The Commission will not at any time, either during or subsequent to the term of this Agreement, disclose to others, use, copy or permit to be copied, without express written consent of the Contractor, except pursuant to Commission's duties herein, any confidential or propriety information of the Contractor, including but not limited to costs, patients, and/or treatment methods. 13. Records Contractor agrees to provide to the Commission, to any Federal or State department having monitoring or reviewing authority, to Commission's authorized representatives and/or their appropriate audit agencies upon reasonable notice, access to and the right to examine and audit all records and documents necessary to determine compliance with relevant Federal, State, and local statutes, rules and regulations, and this Agreement, and to evaluate the quality, appropriateness and timeliness of services performed. Contractor shall maintain and preserve all records in its possession of any third party performing work related to this Agreement for a period of three (3) years from the termination date of this Agreement, or until audit findings are resolved; however, the maximum period will not exceed three (3) years from termination of this agreement. Page 6 14. Title All new products and concepts, however recorded, prepared or generated by the Contractor in the performance of this Agreement shall be the exclusive property of the Marin Children and Families Commission. The term "product" as used in the Agreement shall include, but is not limited to, documentation, findings, design, report, form, evaluation, method of analysis, system, software developed, design documents and concepts related to the work under this Agreement. This Agreement shall preclude Contractor from using or marketing products developed or originated for the Commission hereunder unless and until the parties execute a marketing agreement. All products, inventions, and discoveries developed in the performance of this Agreement while using Commission facilities, including hardware and software shall be the property of the Commission. If such product, invention, or discovery shall be determined to be the property of Contractor, Commission shall be granted a nonexclusive, irrevocable, royalty free license to use said invention or discovery. Notwithstanding the foregoing, Contractor may retain and use copies of new or unique work completed with the support of this Contractor for its reference, use and documentation of its experience and capabilities. Contractor agrees to credit Commission for funding support on all materials developed through this Agreement. 15. Audit If applicable, a copy of the agency's annual report shall be submitted with the agency's annual report to the Commission. For the purposes of this contract, in lieu of submitting the entire City of San Rafael Child Care Division, fiscal audit for each year of this agreement, City of San Rafael Child Care Division will submit the Agency's specific audit reports of all revenues received from all budgeted sources, all expenditures made, and remaining encumbrances that are related to this specific contract's budget obligations. 16. Compliance with Applicable Laws All services to be performed by Contractor pursuant to this Agreement shall be performed in accordance with all applicable Federal, State, County and Municipal laws, ordinances, regulations, including but not limited to appropriate licensure, certification regulations, confidentiality requirements and applicable quality assurance regulations. Contractor shall ensure that its services are accessible to people with disabilities as per DHEW Regulations, Section 504 of the Rehabilitation Act of 1973. 17. Monitoring/Evaluation Contractor shall retain professional and administrative responsibilitVfor services rendered Contractor shall track achievement of program objectives and the process, impact and outcome measures for this project as they are described in Exhibit A and included herein, or as revised in collaboration with the Commission's Evaluator and approved in writing by the Executive Director, after consultation with the Chair of the Commission, during the term of this contract. Contractor shall reasonably participate in a countywide evaluation of the effectiveness of Proposition 10 efforts, whether it occurs during the term of this contract or after, provided that such evaluation shall commence within twelve months following termination of the Contract. Participation in the countywide evaluation may require Contractor to, among other things, prepare and present an evaluation of the Grant Program's effectiveness in addressing and meeting its purpose. Page 6 18. Alteration of Agreement This Agreement is entire and contains all the terms and conditions agreed upon by the parties. No alteration or modifications shall be valid unless made in writing and signed by the parties hereto, or as permitted by the terms of this Agreement, and no oral understanding or agreement shall be binding on the parties hereto. 19. Notices A. Any notice, request, demand or other communication required or permitted hereunder shall be deemed to be properly given when deposited in the United States mail, postage prepaid, addressed: 1) In the case of Commission, to: Amy Reisch, Executive Director First 5 Marin Children and Families Commission 1101 5t' Avenue, Suite 215 San Rafael, CA 94901 Phone: (415) 257.8555 2) In the case of Contractor, to: William Scharf City of San Rafael Assistant Director, Community Services PO Box 151560, San Rafael, CA 94915-1560 (415) 485.3338 B. Controlling Law The validity of this Agreement and of its terms or provisions, as well as the rights and duties of the parties hereunder and In any action at law or in equity, including an action for declaratory relief, brought to enforce or interpret provisions of this Agreement, the interpretation and performance of this Agreement shall be governed by the laws of the State of California. IN WITNESS WHEREOF, the parties hereto, by their duly authorized representatives, have affixed their hands. CITY OF SAN RAFAEL Jim Schutz, City Manager PRINT Contractor Authorized Name and Title SI NA URE OF CO TRACTOR 17 Date 94-6000424 Contractor Federal Tax ID Number FIRST 5 MCFC Amy L. Reisch Executive Director = � m SIGNATURE OF EXECUTIVE DIRECTOR'-: . Date Page 7 Y L O 4-� O v Q O U N Q L; N Q a) u Y � � L L U C LU LL U a C dO E � N R R > CCD R N R NV.(� m O -a 0 V V R 0 H R 3 C C Q N CL i+ 0 N a 3 Ci O N co d 0) 0 a N d a 13 a) ° E a) _ c N Z 0 d = 3 �n m = 3 m o m a) � E> >,°t E m rn m�,sv N a ca m w N y p .�0 U N r C _V � E 'o 0 �°, R � O N 3 a� n.'N 'L)i aa)) 0 0 -- R O) Z, ) � (U M C: E a) O 70 a3 O 'p aNZ m°°c�� N N maoi�� U ~-. a.. C C C cQnmE a) N to a) O 3 N C a3 a) U 'o a) 7 E C N ca O a) �n > p N a) ;_ ` c o ECCLL ow 0 E CL r`n CD N o O_ 0 c 0 to «� C) " V) a) o cCO U 0 N .0 ax co a) LO N aN (D o A m"I w > 0 Exhibit A- A2 Fiscal Year: 2019-2020 Contract Number: 21-009-10 First -5 3's Program Performance Measures 1) By the end of the year 100% of students will advance at least one developmental level in their social and emotional understanding. (Social and Emotional Development Domain: Measure SED 2 DRDP2017) 2) By the end of the year 100% of students will advance at least one developmental level in their self-control of feelings and behavior. (Approaches to Learning -Self -Regulation Domain: Measure ALT -REG 5) 3) By the end of the year 100% of students will advance at least one developmental level in both their curiosity & initiative in learning, and engagement & persistence. (ALT -REG 5 & 7) 4) By the end of the year 100% of students will advance at least one developmental level in their relationships and social interactions with peers—which will become increasingly cooperative. (SED 4) 5) By the end of the year 100% of students will advance at least one developmental level in their ability of shared use of space and materials. (ALT -REG 7) 6) By the end of the year 100% of students will advance at least one developmental level in their ability to express themselves through language and their use of language in conversation. (Language and Literacy Development Domain: Measure LLD 3 & 4) 7) By the end of the year 100% of students will advance at least one developmental level in symbol, letter, and print knowledge in English. (English Language Development Domain: Measure ELD 4) 8) By the end of the year 100% of students will advance at least one developmental level in their ability to classify objects and pattern. (Cognition- Including Math and Science Domain: Measure 2 & 6) 9) By the end of the year 100% of students will move up at least one developmental level in all measures of Physical Development- Health Domain DRDP2015. (Gross Motor Movement & Manipulative Skills, Fine Motor Skills, Active Physical Play, etc.) 10) By the end of the year 100% of students will move up at least one developmental level in their healthy lifestyle choices. (PD-HLTH 10) Projected Program Budget ATTACHMENT B Reporting Period FY: 2019-2020 Agency Name: City of San Rafael Project Name: Pickleweed Preschool Funding Allocation from MCFC: $101,978 Revenues Total Cash Income Total In -Kind Income Total Cash & In-kind Income First 5 Marin $101,978.001 $101,978.00 Other income, list $27,395 $ $ - Teacher $ TOTAL INCOME $101,978.001 $ - $ 101,978.00 Expense Categories A. Project Personnel, list position, % offidl time, and monthly salary Center Director 30% Total Cash Expenses $16,708 In -Kind Expenses Total Cash & In-kind Expenses $ 16,708.00 Teacher $27,395 $ 24,538.00 Teacher $11,005 $ 11,005.19 Aide $11,005 $ 11,005.19 Subtotal, personnel costs 66,113.00 - 63,256.38 B1. Benefits, as %salary 18,692.00 $ 11,517.36 B2. Wrlas Comp Ins & Tares - $ 15,657.84 Total, personnel costs $ 84,805.00 $ - $ 90,431.58 Project Operating Expenses: C. Professionial dues $ 485.00 $ 485.00 Maintenance building and improvement 6,520.00 6,520.00 Rapair and Maint 1,000.00 1,000.00 Contractual Sery 600.00 600.00 Licensing fee 461.00 461.00 Office supplies 200.00 200.00 Recreation supplies 5,250.00 5,250.00 Utiliites 1,200.00 1,200.00 Subtotal Operating Expenses $ 15,716.00 $ - $ 15,716.00 Total Personnel & Operating Expenses $ 100,521.00 1 $ - $ 100,521.00 J. Indirect, not to exceed 10% of budget 10% $ 1.457.001$ - TOTAL EXPENSES $ 101,978.00 $ - Is 100,521.00 t;ommenw C:\Users\kellya.CS4BVLFZI\OneDrive - City of San Rafael\Documents\Excel Folder\First 5 Budget\First 5 budget 19- 20Proiect Budqet EXHIBIT C TOBACCO CONTROL POLICY A. Attach proof of a Comprehensive Tobacco -Free Environment Policy All agencies receiving grant funding over $10,000 annually from the Marin Children and Families Commission will provide to the Commission a written copy of an established comprehensive tobacco -free policy. This policy shall prohibit the use of tobacco products at any time in agency vehicles or buildings, or 20 feet from entrances, windows or outdoor common areas. The policy shall have clear procedures for implementation, protocols for monitoring compliance, reporting of violation and instituting sanctions. The following activities should be included in the implementation of the policy: a) Information about the policy and enforcement procedures shall be communicated by administration clearly to staff, parents, and/or clients with in the larger community. b) Signs stating "NO SMOKING" shall be prominently displayed at all entrances of building property. Additional "NO SMOKING" signs shall be posted in restrooms and other areas as appropriate, such as windows through which secondhand smoke can enter. c) When appropriate, information about smoking cessation and support programs shall be made available and promoted for staff, parents and/or clients. d) The agency shall encourage families with small children to not allow smoking in their homes and cars whenever and wherever children are present, including outdoors. B. Submit Disclosbre of Tobacco Industry Funding or Attach Proof of Non -Acceptance All agencies receiving grant funding over $10,000 annually from Marin Children and Families Commission will be required to disclose in writing the known acceptance of funds, goods or services from any tobacco company or its subsidiaries. C. Attach Proof of Divestment from Tobacco Companies Before receiving grant funding over $10,000 annually from the Commission, agencies will be required to divest any investments in companies that are known to the Contractor to derive more than 15% of their revenues from tobacco products. A list of such companies will be provided with all applications and/or proposals for funding that are submitted to the Commission. 1. I have attached a copy of a Comprehensive Smoke-free Environment Policy for my agency. 2. 1 have attached a board policy of Non Acceptance of Tobacco Company Funding. OR I have attached a copy of my agency's financial records indicating all income sources. 3. 1 have attached a board policy of Non -investment in Companies that are Known to Derive Greater than 15% of Profits from Tobacco Products. OR I have attached a copy of my agency's financial records/auditlinvestment portfolio as proof that our agency does not receive over 15% of revenue from tobacco products. Name of Authorized Signer, Title Date Name of Contractor Page 10 P� RA f �, y0 /ry WITH P e��5 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: Library Recreation and Child Care Project Manager: Kelly Albrecht Extension: 3386 Contractor Name: First 5 of Marin Contractor's Contact: Amy Reisch Contact's Email: amy@first5marin.org ❑ FPPC: Check if Contractor/Consultant must file Form 700 Step=DEPARTMENT NSIBLE 1 : Project Manager 2 City Attorney 3 Department Director DESCRIPTION COMPLETED DATE a. Email PINS Introductory Notice to Contractor Click here to enter a date. b. Email contract (in Word) and attachments to City 7/31/2019 Attorney c/o Laraine.Gittens@cityofsanrafael.org a. Review, revise, and comment on draft agreement and return to Project Manager b. Confirm insurance requirements, create Job on PINS, send PINS insurance notice to contractor_ Approval of final agreement form to send to contractor 4 Project Manager Forward three (3) originals of final agreement to _ contractor for their signature 5 Project Manager When necessary, contractor -signed agreement agendized for City Council approval * *City Council approval required for Professional Services Agreements and purchases of goods and services that exceed $75,000; and for Public Works Contracts that exceed $175,000 Date of City Council approval PRINT CONTINUE ROUTING PROCESS WITH HARD COPY 6 Project Manager Forward signed original agreements to City _ City Attorney Attorney with printed copy of this routing form 7 Review and approve hard copy of signed agreement Review and approve insurance in PINS, and bonds 8 City Attorney (for Public Works Contracts) 9 City Manager/ Mayor Agreement executed by City Council authorized official 10 City Clerk Attest signatures, retains original agreement and forwards copies to Project Manager 8/2/2019 8/2/2019 Click or tap to enter a date Click here to enter a date. ® N/A Or Click here to enter a date. 8/9/19 1z/1q REVIEWER Check/Initial El El ® LG ® LG (N/A) 0