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HomeMy WebLinkAboutCC Resolution 8508 (Education Funding)RESOLUTION NO. 8508 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN RAFAEL APPROVING THE CERTIFICATION OF PROGRAM APPLICATION TO THE STATE DEPARTMENT OF EDUCATION FOR FUNDING IN FISCAL YEAR 1992-93 WHEREAS, the State Department of Education is required by Title 5, California Code of Regulations, Division 19, Chapter 1, Article 5, Section 18010, to certify all programs providing child development services; and WHEREAS, the State Department of Education requires the submittal of a Certification of Services Application package from each agency eligible for State funding; and WHEREAS, the City of San Rafael is eligible for State funding. NOW, THEREFORE, BE IT RESOLVED that the San Rafael City Council hereby authorizes the submittal of a Certification of Program application to the State Department of Education, and authorizes execution of said application by the City Manager. I, JEANNE M. LEONCINI, 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 Council of said City on MONDAY , the 16TH day of SEPTEMBER 1991 , by the following vote, to wit: AYES: NOES: ABSENT: COUNCILMEMBERS: Boro, Shippey, Thayer & Vice Mayor Breiner COUNCILMEMBERS: None COUNCILMEMBERS: mayor Mulryan JE NE M. LEONCINI, City Clerk 0 R I ru" I N A I O� CO 1.ainorma Lepartment U1 ruucatiP- Child, Development Division CD -3704 (Revised 7/91) CERTIFICATION OF APPLICATION FOR FISCAL YEAR 1992-93 Send : dim. 3) Certifccat on: packages, one with origuuuil signature by October -1, 1991 to Child Development Division Attention: Lucy Rhodes 5601 Street,. Suite 220 Sacramento, C,4 95814 Instructions for completing this form and other helpful information are included in the accompanying REPORTER 91- 09 and Instructions. Read the statements, and select Statement A or Statement B, as appropriate. The signature of an authorized agent is required. For continued funding to provide child development services in fiscal year 1992-93, I certify as the authorized agent, that all applicable state and federal statutes and regulations will be observed. I also certify to the following statement. [ XX ] Statement A. The information contained in the most recent application and subsequent certifications submitted to the Child Development Division is correct and complete. [ J Statement B. Except for the modifications indicated on the attached legal status and/or program narrative change page(s), the information contained in the remaining pages of our most recent application and subsequent certifications submitted to the Child Development Division is correct and complete. Project Number: (See enclosed CDD Information sheet for correct project number.) KW=01 2 11 Legal Name of Agency Address P. 0. BOX N( 9 1 11 6+ 0 CIT:t OF SAN RAFAEL 151560 SAN RAFAEL, Executive Officer/Superintendent PAMELA NICOLAI, City Manager 0 I I 0 13 15 16 I 3 I i .....:>;:;:;;.::> City Zip Code SAN RAFAEL 94915-1560 Telephone 615) 485-3070 Address 1400 FIFTH STREET SAN RAFAEL, CA. 94901 P. 0. BOX .1.51.560 SAN RAFAEL, CA. 94915-1560 Program Director Telephone BILL SCHARF I (41J 485-3386 Address 35 MARIN STREE'.' SAN RAFAEL, CA. 94901 F. 0. BOX 151560 SAN RAFAEL, CA. 94915-1560 Board Chairperson Telephone LAWRENCE MULRYAN, Mayor 615) 485-3070 Address 1400 FIFTH STREET SAN RAFAEL CA. 94901 P. 0. BOX 151560 SAN rtz_FAEL, CA. 94915-1560 SIGNATURE OF PMORIZED AGENT Name and Title of Authorized Agent PAMELA NICOLAI, City Manaqer DATE 9/16/91 ATTEST: k_ JE IN'E M. LEONCINI, City Clerk Zj 1 A I L Ur %,AL11-UMNIA STATEMENT OF COMPLIANCE .STD. 19 (Rev. 3-87) COMPANY NAME CITY OF SAN R-AFAEL The company named above (hereinafter referred to as "prospective contractor") hereby certifies, unles specifically exempted, compliance with Government Code Section 12990 and California Administrative Code Title 2, Division 4, Chapter 5 in matters relating to the development, implementation and maintenance of nondiscrimination program. Prospective contractor agrees not to unlawfully discriminate against any employe( or applicant for employment because of race, religion, color, national origin, ancestry, physical handicap medical condition (cancer related), marital status, sex or age (over forty). CERTIFICATION I, the official named below, hereby swear that I am duly authorized to legally bind the prospective contractor tc the above described certification. I am fully aware that this certification, executed on the date and in the county below, is made under penalty of perjury under the laws of the State of California. NAME OF OFFICIAL PAMELA NICOLAI DATE EXECUTED 9/16/91 ` PROSPECTIVE C6N ACTOR SIG U PROSPECTIVE CONTRACTOR TITLIV CITY MANACy,�F moSPECTIVE CONTRACTOR FEDERAL EMPLOYER I.D. NUMBER 94-6000-424 I EXECUTED IN THE COUNTY OF M.A. 1 T TNT ATTEST: ('ITY Cr,FRx 67 Aw7 California Department of Education Chid Development Division CD -9730 (Revised 7/91) CALENDAR - FISCAL YEAR 1992-93 (Legal Name of Agency CITY OF SAN RAFAEL (Put an "X" on every day your program will be open for service. I Su I M I Tu I W I Th I F IS, JULY 1992 �(1X 3*4 5;?C�`9 10 11 12 X13 74 b XX7 18 19 20 -22 : .�4 25 26 '27 29 3p 134 — Month total:: OCTOBER 6 3 4 , . ` 10 11 * j3 W1 4i 1 17 18)� �i1` 2P 12 124 25 2S 31 Month total:: JANIZARY 1992 *1 21 10 .16 17 *1& 23 24 , E V8 1W9 31 1 Month total: APRIL 18I '�(I��21 231 24 �257��\�I9.�+3� Month total *Legal Holidays ISuIMITuIWIThIFISa1 AUGUST 1 2 `/4� X7 8 9 �1 1\1 /X2 /13 , r1,4 15 16 22 23 X1.\5 �67 8 29 30 Month total NOVEMBER � y� 15 "}6, 20 21 22 '3�4 '2q *2622 2 *26 *27 2828 29 ' 3p Month total: FEBRUARY ,X2 ;A1 61 7 �,� ' -V L1 ` 2 13 14 x.15 a(� 20 21 *22 $�3' 27 28 1 Month total:: MAY 1I 1 2..�7 81 i 9 } X12 ,13 ik 151 1 161 /t+l �1 11 221 23 29 30 *31 Month total NOTE: °Leese print or type clearly. 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I N N I r I Y "' cC is r•�f U U) E H H H b _O -O v' ; •'i Nrz H rJ �✓ W > �4 q�4 EI j �4 �+ Q' W H R N � +J u) w O n U U) U to H c: cti b m NU v (i1 m • A U] U) U) W z -P —4 N E-1U E-1 m .G J Ir C - rn 0 a a c o �` 1 iia o Ul < UI �Ul 3 O4 tr E V r - O U O H Pl H W N +-1 �4 +1 �4 O, N U 4. L• :r C r:4 zK� — 44 1" c� U E Ce z faz 3 o v m '-' o 0. U En `j q w Q Ij U U California Department of Educat Child Development Division CD -3704B (Revised 7/91) FY 1992-93 Certification of Application Package Completeness Checklist Agency Name: CITYOF SAN RAFAEL Project Number: 21-N916-00-03563 FY 1991-92 CD -Number: CD -9154 Date: 9-12-91 Prior to submitting the three copies of the Certification package to the Child Development Division, review each package for the following contents. Indicate "completeness" by writing "YES" in the space provided or N/A for not applicable. 1. All forms are complete and submitted: ES I CD -3704 Rev. 7/91 - Certification of Application for Fiscal Year 1992-93. One with original signature. LF_ 1 • STD -19 Statement of Compliance with original signature. ES ■ CD -3701 Rev. 7/91 - Personnel Roster for center -based and family child care home programs OR CD -3702 Rev. 7/91 - Personnel Roster For Center -Based Latchkey Programs (03252 and 03563). (Not applicable to AP and R&R programs.) E S . CD -9730 Rev. 7/91 - Calendar - Fiscal Year 1992-93. [YES I ■ Data Report. Y[ ES Facility license for each site listed on Data Report (submit only one [1] copy). ES I ■ CD -3704B (Revised 7/91) FY 1992-93 Certification of Application Package Completeness Checklist. 2. Requests for Approvals, if applicable. 1/`/AA ] ■ If Statement B on the CD -3704 is checked, a completed CD -3704A Rev. 7/91 - Legal Status and/or Program Narrative Changes for FY 1991-92 is included. Request for change in minimum days of operation (MDO) below 246 or 175, as applicable to your program. Provide justification on the reverse side of CD -9730 - Calendar - FY 92-93. j` / A I CD -7701 - Child Care and Development Programs Waiver Request. F/A I CD -7701A - Child Care and Development Programs Program Director or Site Superivisor Qualifications Waiver Request. D . CD -3700 - School Age Community Child Care Program (Latchkey) Request for a Waiver of the State Participation Limit. PI / A 1 . Request for subcontract approval (submit a letter requesting approval of subcontract, proposed unexecuted subcontract language, budget, and other items as required in the Funding Terms and Conditions. NANCY PERCY, Crild Care Program Manager /1 /- , �.�� �l�% •/ Name of Person Completing Form (Type or Print) Signature of Person Completing Form _ T o L * O {##1 'O W13 41 O Q: � � u 41 # C W d Z # Z 2 L C U O L O) # Q. C # OI # C u T N Co L. 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V - C U O , L w T t C `�- 5 O N U X d 11 11 II it d Y ti p N x 01 Pepurtatmt of $urial �Siertlim Facility Number: 21CLO9025 Effective Date: 03/16/91 Total Capacity 50 Expiration Date: 08/111/92 In accordance with applicable provisions of the H(ialth and Safety Code of California, and its rules and regulations, the Department of Social Services, Hereby issues Q:1Tir 13�= Sa'ff'1 € AFAEL RECREA11 101d 9t=PARTKE-149 to operuto and maintain a SCHUDL—AGE DC CE14TEt7 6 3' CIT'7 OF SAUJ RAFAE@_—ElEIANQ'D0 CHI6I4RE::°5 ;.'Elt1TEF' 25 HEST CASTLEii001) SAM RAFAEIL CA 91�got This License is trot transferable and is granted solely uf:on the following f., AMMILl"<lft:'aPMv IdELIL CHI dDREPUs EDGES ra N :9 TO 11 WEARS. Client Groups S-erved: CHILDREN Complaints regarding ser ;ces provided to this faculty should be d,re:ted to SGtPdTA R[l! R DISTRICT OFFICE d 7,r179 576-22LO 1--80 6:6_��S[36i ^• Deputy Director, Autho)I:ed Representative n Community Care Licensing Division of Licensing Agency +'nyy� �� y )Y'r'•:;JL 11v i.i ii'f !tf.9')f'Kly'� i,fy!.f�i( JY 11 r 1 Ml X1:1: tl✓Mii)).. l.iRl,Mfili 1� - 411'i41A�11 l.� Ii.r+ s-� ' • w :{:. e941.. 1 .:.Je.31 ._�+� L-1a.ilLp9''�S . ' - POST IN A PR0NIINENT PLACE r Z ").- c1 1 Issuo Date b - ,�.•�1 p•' - ,1�1'! Ifs? ""J I Y:+J�F�L'u�'-�..'.LL.�:Y.YiuG.l"i•���.`r..�.M.,'I:.,l`•..u�; 'L�L.:�..ei :'�S�:i� tali' of Tati finita jBrpartment of �nrial `;erbirps Facility Plumber: 210106730 ---�' Effective Date: 10/23/33 Total Capacity 42 Expiration Date: 10/22/91 In accordance with applicable provisions of the Health and Safety Code of = California, and its rules and regulations, the Department of Social Services, hereby issues i UPI 1 CITY CF a,iN RAFAELr RECREATfON DEPA-.TiiEW to operate and maintain a LAY CARE CENTER 'Nalar, of arilily CITY OF SAN RAFAEL--13ALLINAS Ct:It_DRE-N0 S C.E,aTr"R 177 NOR,TrI SAN PEDhO ROAD SAN RAFAEL CA 9At*903 This License is not transferable and is granted solely upon the following: AMBULATORY* HELL CHILDRENT AGES 5 TO 11 YEARSo Client Groups Served: CHILDREN Complaints regarding services provided in this facility should be directed to: SANTA ROSA DISTRICT OFFICE t707B 576-2210 1-900-4—CCL.—NOW FRED N. D4ILLER Deputy Director, Community Care Licensing Division __ "01: � � UC 203A (1/87( PUBLIC 7~aut—7 - Authorized horized Representative Issue Date of Licensing Agency I�;�•ss�# ;��t�:, �,-;e�«,u�nnr,�.,,,,r,.•y�;h;;x�,��r"'Yea�,w", fir, ,�•t,� IPOST IN A PROMINENT PLACE j ;rye; W c 'a+rarrt+.lq^t ��?'� �'T1�F•�TV+�`i..:�"�4;;,r, .Si.,l— 'fS.kr,•'bia11C.' c's- ��.�.r..�.�..,��...�.1•r � _i,.d:1....:a3r:ti",�� . ^Zf►� p0r%�' '54talp of Tali funtia Department of a9ccibl $rrbirro Facility Number -210109023 Effective Date 08/15/89 Total Capacity S Expiration Date: 08/]L§/92 In accordance with applicable provisions of the Health and Safety Code of California, and its rules and regulations, the Department of Social Services, hereby issues , e'er ''�'•.� t14 CITY OF SAN RAFAEtL WEt' REATION DISTRICT to operate and maintain a SCHOOL—AGE IDC CENTER A. Nump of ,, PICKfLEUEEU CHILqRENGS CENTER 50 CANAL STREET SAN RAFAU CA 94901 This License is not transferable and is granted solely upon the following: TWO 14AY BE NON AMOULATURYip WELL CHRLIDREf:Io AGES Tm R1 Ur`APSo Client Groups Served: CHILDREN Complaints regarding servicea provided in this facility should be directed to: SANTA ROSA DISTRICT OFFICE lI�®�'D 576-922LO n'G'J 0 ft=k1CD He NXI.lCL3 Deputy Director, Authorized tiepresentntive lssu9 Date Community Care Uceru:ing Division of Licensing Agency - POST IN A PROMINENT PLACE *9 tatr of Tai irnin clBeparfanmt of social �$erbim Facility Number: 230$07225 l Effective Date- 05/05/99 Total Capacity- 85 Expiration Date. 05/04/92 In accordance with applicable provisions of the Health and Safety Code of California, and its rules and regulations, the Department of Social Services, hereby issues ti t1lis fi CITY OF SAN RAFAEL to operate and maintain a DAY CARE CENTER DUN TI4 OTEU CHILDREM"S. CENTER 39 TRELLIS DRIVE SAN RAFAEL CA 94903 This License is not transferable and is granted solely upon the following: AHBULAT©RYe WELL CHILDREMP AGES 2-1YEARSo Client Groups Served: CHILDREf•J Complaints regarding services provided in this facility should be directed to: SANVA RCSA DISTRICT WFICIE 9WOTD 57&Zaaaa liG=800_^1-:'(rxL_Mw FRED Mo HILLER Deputy Director, Community Care Licensing Division Authorimd Repro anmitm Izzw Mto cf Licensing AgawvMAN p :�Ik]�.iSL�I.LYi-L•'ai1�46 IK NSd�['. 11�1IrM4�.i�!'�!f'� W'Y•9 :1'� 9 .,J.. Y fife of Taftforitia Pepartmmt of �$orial $rrbirro 4K 4 i S Facility Number: 210109737 Effective Date: 07/03/90 Total Capacity: 120 - Expiration Date: 07/02/93 = In accordance with applicable provisions of the Health and Safety Code of California, and its rules and regulations, the Department of Social Services, hereby issues 140 �rtCF113P CITY OF SAN RAFAEL to operate and maintain a SCHOOL—AGE DC CENTER Nalur of 3afility �L SHORT SCHOOL CHILDRENS CENTER SCHOOL AGE 35 HARIN STREET m SAN RAFAEL CA 94915 This License is not transferable and is granted solely upon the following AMBULATOR'• WELL CHILDRENS AGES 409 TO 500 YEARS OLD* Client Groups Served: CHILDREN Complaints regarding services provided in this facility should be directed to: SANTA ROSA DISTRICT OFFICE 67079 5762210 I-1300®4-CCL-NOU FRED We MILLER �s(t�-(�.�11/IY) 7 �� Deputy Director, Authorized Representative Issue Date Community Care Licensing Division of Licensing Agency �I 11191W�il�tli L' IIIII i�i I�il iii�Vha .+f ];hL:G61c�T ���)dEi114iirl,l��.; e`: i!.:$Jifii ill.:w ' e UC 203A 11/871 PUBLIC POST IN A PROMINENT PLACE