HomeMy WebLinkAboutAgreement A-22-350 with FRWDB.pdf DocuSign Envelope ID:23BA81DE-2497-4BB5-98B7-30F09D69E188
Agreement No. 22-350
Contractor Agreement
Parties
FRWDB: Fresno Regional Workforce Development Board
Contractor: County of Fresno
Administrative Information
Agreement No. 634 MOD # CFDA#: 17.258/17.278/17.259
Title/Program Clean Slate Program
Term of Agreement July 1, 2022 -June 30, 2023
- Funding Allocation $45,000
Contact Person I Cheri Yau Telephone 559-600-1543 Fax 559-600-1570
Address 12135 Fresno Street, Suite 100, Fresno CA 93721 zip
Email I cyau@fresnocountyca.gov
Employer Identification Number 94-6000512
Internal Revenue Code I Government
Therefore, in consideration of the above Administrative Information and Funding Allocation, which are
incorporated into this Agreement by reference, the Parties agree as follows:
1. Exhibits
The following exhibits attached as indicated, incorporated by reference, and are subject to all of the
terms and conditions of this Agreement:
(1) Exhibit A—Work Statement
(2) Exhibit B — Cost Projection/Budget/Invoicing
(2) Exhibit C — 1 - Assurances & Certification
2 - Standards of Conduct
(4) Exhibit D — 1 - Part 200 Appendix II
2 - Insurance Requirements
(5) Exhibit E — 1 - Insurance Certificates
2 - Signatory Authorization
3 - Supporting Documentation
2. Term
The term of this Agreement (the "Term") may not exceed the period stated on page 1 unless modified or
extended in writing by FRWDB.
3. Services
Contractor must timely perform the services described in the Work Statement (Exhibit A) (the"Services"),
in accordance with this Agreement. Contractor, its employees, subcontractors, and assigns, agree to
avoid unnecessary and duplicative efforts in performing the Services.
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4. Compensation
4.1 FRWDB will compensate Contractor for the Services at a rate and method of compensation that
complies with the Budget and Cost Projection sheet (Exhibit B). FRWDB is not obligated to
compensate Contractor for any services not described in this Agreement without the prior written
consent of FRWDB. Furthermore, FRWDB is not obligated to compensate Contractor for any work,
services, or functions relating to Contractor's efforts to obtain FRWDB's business or for negotiating
with FRWDB to enter into this Agreement.
4.2 FRWDB will compensate Contractor for any Services provided only after submission of an itemized
invoice by Contractor. Contractor must provide FRWDB with all documentation, explanations, or
justifications requested by FRWDB concerning the adequacy or accuracy of its invoices for the
performance of the Services to FRWDB's reasonable satisfaction.
4.3 FRWDB agrees to pay and Contractor agrees to accept as full compensation for performance of
tasks under this Agreement a sum not to exceed not to exceed the amount listed in the Funding
Allocation table above as more fully described in Exhibits A and B.
4.4 Any costs not contained in the Budget and Cost Projection Sheet (Exhibit B) associated with the
performance of these services shall be borne by the Contractor irrespective of whether or not such
tasks were performed to the benefit of FRWDB or expenses incurred by the Contractor or its
employees, agents, or subcontractors.
4.5 In no event shall the maximum compensation including, but not limited to, fees, reimbursement,
costs, and expenses, paid to the Contractor under this agreement exceed not to exceed the amount
listed in the Funding Allocation table above without the prior written consent of FRWDB.
5. Record Keeping
Contractor must submit all invoices no later than the 5th day of the month following the month Services
were completed. All invoices must have sufficient detail as may be required by FRWDB in its sole
discretion, including, but not limited to, (i) the specific nature of each task performed as services under
this Agreement and (ii) the number of hours worked by each person for each task. Contractor must
prepare all invoices in an organized manner that facilitates an efficient and thorough review of the
Services it performs under this Agreement. Contractor must give FRWDB, or its duly authorized
representatives, reasonable access to any and all records in Contractor's possession, and its employees,
agents, and subcontractors. Contractor is subject to the examination and audit of all records directly or
indirectly related to Contractor's the Services by FRWDB, the City or County of Fresno, the State of
California, or the federal government for a period of up to 5 years after the final payment under this
Agreement. FRWDB reserves the right to invoice Contractor for all expenses, including but not limited
to, staff time, consulting fees, and copying costs, directly or indirectly attributable to FRWDB's, or its
agents, examination of records related to Contractor's performance of the Services.
6. Administration
FRWDB may delegate certain responsibilities to the Fresno Area Workforce Investment Corporation
("FAWIC")from time to time, as FRWDB considers appropriate in its sole discretion. Contractor
acknowledges that FAWIC may oversee certain aspects of this Agreement. Contractor must comply
with all requests by FAWIC, including, but not limiting to, any requests to communicate or provide
records to FAWIC. Contractor must treat all requests made by FAWIC as if made by FRWDB and
acknowledges that FRWDB may vest in FAWIC any of its authority under this agreement.
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7. Non-Discrimination Clause
During the performance of this Agreement, both Parties must comply with applicable federal and state
laws and regulations. Accordingly, neither Party may, because of ethnic group identification, age, sex,
color, disability, medical condition, national origin, race, ancestry, marital status, sexual orientation,
religion, religious creed, or political belief exclude from participation, deny benefits to, or discriminate
against any person benefiting from this Agreement.
8. Defense, Indemnity, and Hold Harmless
8.1. Contractor. Contractor must defend, indemnify, and hold harmless Fresno Regional Workforce
Development Board "FRWDB", the City and County of Fresno, and their directors, officers, boards,
commissions, employees, volunteers, agents, and independent contractors, from and against all
losses, costs, expenses, demands, damages, penalties, liabilities, interests, recoveries, claims, and
judgments, including, without limitation, attorneys' fees and costs, to defend against any claims,
demands, causes of action, suits, charges, or legal or administrative proceedings, caused by,
arising out of, or in any way connected with any act or omission of Contractor or Contractor's
directors, officers, employees, agents, independent contractors, or volunteers, directly or indirectly
related to the performance of the Services under this Agreement. Contractor must reimburse
FRWDB any funds expended due to those acts or omissions from non-federal funds. Any approval
for payment, actual payment, or advance made to Contractor will not constitute a waiver of
FRWDB's claims, defenses, or indemnification rights provided under this Agreement.
8.2 FRWDB will defend, indemnify, and hold harmless Contractor, and its directors, officers, boards,
commissions, employees, volunteers, and agents, from and against all losses, costs, expenses,
demands, damages, penalties, liabilities, interests, recoveries, claims, and judgments, including,
without limitation, attorneys' fees and costs, to defend against any claims, demands, causes of
action, suits, charges, or legal or administrative proceedings, caused by, arising out of, or in any
way connected with any act or omission of FRWDB or FRWDB's directors, officers, employees,
agents, independent contractors, or volunteers, directly or indirectly related to the performance of
the Services under this Agreement.
9. Insurance
Contractor must comply with all insurance requirements described in Exhibit D, as amended, or as
otherwise provided in this agreement.
10. Limitation of Liability
As required under that Joint Exercise of Powers Agreement, the City and County of Fresno are not liable
to Contractor or its employees, contractors, or other third parties.
11. Independent Contractor
11.1. Status. Contractor is an independent contractor. No person employed by Contractor to furnish the
Services is an employee of FRWDB. In performing the Services, Contractor, including any of
Contractor's owners, officers, partners, officers, agents, employees, and independent contractors,
will at all times be acting and performing as an independent contractor, and will act in their
independent capacity and not as an officer, agent, employee, joint venturer, partner, or associate
of FRWDB. FRWDB has no right to control or supervise or direct the manner or method by which
Contractor performs its obligations under this Agreement. However, FRWDB may administer this
Agreement so as to verify that Contractor is providing the Services and performing its obligations
in accordance with this Agreement.
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11.2 Employer Duties. Contractor has the sole obligation to provide its employees with all legally
required notices and postings, as well as all employee wages and benefits, and will make all Social
Security and other withholdings required by applicable federal or state laws and regulations.
11.3 Compliance. Contractor must ensure that all of its staff and its third-party subcontractors abide by
and strictly comply with FRWDB policies, procedures, and directives, including, but not limited to,
FRWDB's zero tolerance policy on harassment as described in FRWDB's personnel manual.
12. Termination
12.1 By FRWDB. FRWDB may immediately suspend or terminate this Agreement when FRWDB, in its
sole discretion, determines that:
(1) Contractor illegally used any funds provided under this Agreement;
(2) Contractor failed to comply with any provision of this Agreement;
(3) Contractor submitted a substantially incorrect or incomplete report;
(4) Contractor improperly performed any of the Services; or
(5) The Federal Government or the State of California suspended or terminated, in full or in
part, a grant under which FRWDB receives money to compensate Contractor for the
Services;
(6) Termination for convenience of the FRWDB, by 30 day written notice, in full or in part,
when it is in the FRWDB's interest.
12.2 By Contractor. Contractor may suspend or terminate this Agreement when circumstances beyond
Contractor's control have made compliance with this Agreement impossible or impracticable. In
such an event, Contractor must give FRWDB 30 days written notice, complete with an explanation,
acceptable to FRWDB in its sole discretion, of these circumstances. This notice will serve as a
request to terminate the Agreement. Within 5 business days of receiving this written notice,
FRWDB will provide written notice to Contractor either approving or denying Contractor's request
and the terms and conditions of its approval or denial. If FRWDB fails to provide this written notice
to Contractor within 5 business days, Contractor must treat its request as denied by FRWDB and
continue to perform the Services in accordance with this Agreement.
12.3 Payment
A. FRWDB may demand in writing that Contractor repay any funds disbursed to Contractor under
this Agreement if FRWDB determines, in its sole discretion, that Contractor did not expend
these funds in accordance with the terms of this Agreement. On receiving FRWDB's demand,
Contractor must promptly refund these funds, or at FRWDB's option, FRWDB may deduct any
repayment from future payments by FRWDB owing to Contractor under this Agreement or any
other agreement, as may be applicable and otherwise due.
B. In no event will any payment to Contractor constitute a waiver of any breach of this Agreement
or any default that may then exist on the part of Contractor. Neither will any payment impair or
prejudice any remedy available to FRWDB with respect to the breach or default.
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13. Copyrights, Patents, Rights in Data
In accordance with 2 CFR Part 200 Subpart A - § 200.59 and Subpart E - § 200.448, and Appendix II to
Part 200, FRWDB, as a federal funds awarding agency, reserves a royalty-free, nonexclusive, irrevocable
license to reproduce, publish, or otherwise use, and authorize others to use, for Federal government
purposes, the copyright, patent, or rights in data in any work developed or purchased with funds under
this Agreement.
14. Additional Laws and Regulations
Contractor must comply with all applicable laws and regulations listed in Part 200 Appendix II —Contract
Provisions. Contractor must read Exhibit D to determine which of these laws and regulations apply to
Contractor in the context of this agreement.
15. Notices
All notices under this Agreement must be in writing and may be delivered in person (by hand or by courier)
or may be sent by regular, certified, or registered mail, or U.S. Postal Service Express Mail, with postage
prepaid, by facsimile transmission, or by electronic transmission (email) and will be deemed sufficiently
given if served in a manner specified in this section. The addresses and addressees noted below are
that Party's designated address and addressee for delivery or mailing of notices. Either Party may, by
written notice to the other, specify a different address for notice. Any notice sent by registered or certified
mail, return receipt requested, will be deemed given on the date of delivery shown on the receipt card, or
if no delivery date is shown, 3 days after the postmark date. If sent by regular mail, the notice will be
deemed given 48 hours after it is addressed as required in this section and mailed with postage prepaid.
Notices delivered by United States Express Mail or overnight courier that guarantee next day delivery will
be deemed given 24 hours after delivery to the Postal Service or courier. Notices transmitted by facsimile
transmission or similar means (including email) will be deemed delivered upon telephone or similar
confirmation of delivery (confirmation report from fax machine is sufficient), provided a copy is also
delivered via personal delivery or mail. If notice is received after 4:00 p.m. or on a Saturday, Sunday, or
legal holiday, it will be deemed received on the next business day.
County of Fresno, Clean Slate Program Fresno Regional Workforce Development
2135 Fresno St. Ste 100 Board
Fresno CA 93721 2125 Kern Street, Suite 208
Attention: Brian Pacheco Fresno, California 93721
Chairman of the Board of Supervisors of the County Attention: Blake Konczal, Executive Director
of Fresno Facsimile: (559) 490-7199
Email: bkonczal workforce-connection.com
16. General
16.1 Assignment and Subcontracting. Neither Party may assign, transfer, or subcontract this
Agreement nor its rights or duties hereunder without the prior written consent of the other Party.
16.2 Agreement Binding on Successors. This Agreement shall be binding upon FRWDB and
Contractor and their successors, executors, administrators, legal representatives, and assigns with
respect to all the covenants and conditions set forth herein.
16.3 Entire Agreement. This Agreement, including all attachments, exhibits, regulations and policies
incorporated or referenced within, constitutes the entire agreement between the Parties regarding
the subject matter within and supersedes all prior and contemporaneous agreements,
representations, or understandings of any nature whatsoever unless expressly included in this
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Agreement.
16.4 No Authority to Bind FRWDB. Contractor, in its performance of the services or any other duties
under this Agreement, has no authority to bind FRWDB to any agreements or undertakings.
16.5 Non-Exclusive. This Agreement is not an exclusive agreement and FRWDB, at its sole discretion,
has the right to negotiate with and enter into contracts with others providing the same or similar
services to those provided by Contractor.
16.6 Modifications. FRWDB may, from time to time, initiate a change to the scope of the Services. Any
such changes are subject to Contractor's approval, which shall not be unreasonably withheld.
16.7 Waiver. No covenant or condition of this Agreement may be waived except by FRWDB's written
consent.
16.8 Governing Law and Venue. This Agreement will be governed by and construed in accordance
with the laws of the State of California. Venue for any dispute or litigation arising under this
Agreement will be in the County of Fresno, State of California, if instituted in the state courts, or the
Eastern District of California (Fresno), if instituted in the federal courts.
16.9 Remedies. FRWDB may pursue any and all remedies available by law as needed to enforce its
rights under this Agreement.
16.10 Partial Invalidity. If any provision of this Agreement, or any portion of a provision, is held by a
court of competent jurisdiction to be invalid, void, or unenforceable, the remaining provisions of this
Agreement, including, without limitation, the portions of any provision not held to be invalid, void, or
unenforceable, will nevertheless continue to be in full force and effect without being impaired or
invalidated in any way.
16.11 Headings and Construction. The subject headings of the sections and paragraphs of this
Agreement are included for purposes of convenience only and do not affect the construction or
interpretation of any of its provisions. All words used in this Agreement include the plural as well
as the singular number, and vice versa; words used in this Agreement in the present tense include
the future as well as the present; and words used in this Agreement in the masculine gender include
the feminine and neuter genders, whenever the context so requires. No provision of this Agreement
will be interpreted for or against a Party because that Party or its legal representative drafted the
provision, and this Agreement will be construed as if jointly prepared by the Parties.
16.12 Time. Time is of the essence in this Agreement.
16.13 Non-Collusion Covenant. Contractor represents and warrants that it has in no way entered into
any contingent fee arrangement with any firm or person in an effort to obtain this Agreement with
FRWDB. Contractor has not received from FRWDB any incentive, special payments, or
considerations not related to payment or reimbursement for the provision of the Services.
16.14 Lobbying Activity. Contractor may not use any funds provided under this Agreement for the
support, defeat, or influence of legislation or appropriations pending before the Congress.
16.15 Costs and Expenses. Each Party will pay all costs and expenses incurred, or to be incurred, by it
in negotiating and preparing this Agreement and its exhibits, and in closing and carrying out the
transactions contemplated by this Agreement, including, without limitation, its attorneys',
paralegals', and other professionals' fees and costs.
16.16 Signature Authority. Contractor represents and warrants that it has capacity, full power, and
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authority to enter into and perform this Agreement, and that the person signing this Agreement on
behalf of Contractor has been properly authorized and empowered to enter into this Agreement.
16.17 Counterparts. The Parties may execute this Agreement simultaneously or in counterparts, each
of which will be deemed an original, but all of which together will constitute one and the same
Agreement.
16.18 Attorneys' Fees. If an action at law or in equity is necessary to enforce or interpret the terms of
this Agreement, the prevailing Party is entitled to reasonable attorneys', paralegals', and other
professionals' fees and costs in addition to any other reasonable relief to which it may be entitled.
Signatures
"Contractor"
Brian Pacheco Chairman of the Board of Supervisors of the County of Fresno
NaLe )L Title
Signature Date ATTEST:
BERNICE E.SEIDEL
"FRWDB" Clerk of the Board of Supervisors
County of Fresno, State of California
Fresno Regional Workforce Development Board By
Deputy
Blake Konczal Executive Director
Mg,991dQfficer Title
6/29/2022
Ignature Date
For accounting use only:
Org: 28809999
Account No.: 4841
Fund No.: 0001
Subclass No.: 10000
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Exhibit A
r�Adl"� COUNTY OF FRESNO
Antoinette Taillac
Public Defender
MEMORANDUM
To: Ka Xiong, Special Projects Program Coordinator
From: Antoinette Taillac, Public Defender
Date: June 13, 2022
RE: Statement of Work
Clean Slate Program
Overall Goal:
The Public Defender's Office (PD)will provide a Clean Slate Program in Fresno County. The
program's post-conviction legal services are for low-income and indigent persons with
misdemeanor or felony convictions in Fresno County. In addition, the program would help
connect participants to either employment and training services or housing services based on
need.
Proposal:
To provide post-conviction legal services, limited family law services as it relates to child
support and arrears, and limited legal services as it relates to driver license suspensions to adult
and youth Workforce clients. Clients would be referred from Workforce based on whatever
criteria the program deems appropriate in conjunction with basic legal requirements. Services
provided under this contract will only be given to WIOA/grant eligible participants as screened
and referred by Workforce.
Workforce will perform initial screening of clients to determine applicable relief. Clients will be
referred to the program and given an appointment to meet with the Clean Slate Attorney. Initial
appointments will occur at an office provided by Workforce. Workforce will provide a list to
the Clean Slate Attorney at least two (2) weeks prior to each appointment day. Once analysis has
been completed for the client, all applicable petitions will be drafted and filed on the client's
behalf. In the case where a client must provide supporting documentation, a separate
appointment to complete petitions may be made. Workforce clients should be encouraged to
bring all supporting documentation to the initial appointment to expedite the process. Follow-up
appointments may occur at the Workforce office or the PD's office. The PD will ensure that all
applicable relief is filed and served timely.
Clients will receive assistance with: Expungements (1203.4, 1203.4a, 1203.41, 1203.42,
1203.43, 1203.49 Petitions), Penal Code 17b Motions, Prop 47 Applications/Petitions, Prop 64
cop
2220 Tulare Street,Suite 300/Fresno,California 93721
t Telephone(559)600-3546/Fax(559)600-1570
o O Equal Opportunity Employer
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
Applications/Petitions (reduction to misdemeanor or dismissal). It is preferred that the client
come in with a rap sheet' but not required.
Period of Performance:
This proposal is based on a twelve (12) month term and is estimated to serve 200 clients.
Defense Attorney III—9 hours/week—in-person consultations for referred Workforce clients and
preparation of any applicable applications/petitions.
Paralegal—10 hours/week—file and serve documents, make copies,pull records from databases,
and track data/outcomes.
This contract would include the Defense Attorney, Paralegal, office space, office supplies for the
project, software, and any necessary administrative time.
1 A"rap sheet"is a defendant's record of arrest or conviction history in California.
cop
2220 Tulare Street,Suite 300/Fresno,California 93721
t Telephone(559)600-3546/Fax(559)600-1570
o O Equal Opportunity Employer
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
Description of Motions:
1. 1203.4 Petition: Defendants convicted of a misdemeanor, or felons sentenced to
probation and/or local county time may be eligible to file for an expungement.
Defendants may file this petition once they are no longer on probation and have no
open/active cases. Relief can be mandatory or discretionary depending on the
circumstances.
2. 1203.4a Petitions: Misdemeanants who were denied probation may file for expungement
one year from the date of sentencing. Relief can be mandatory or discretionary
depending on the circumstances.
3. 1203.41 Petitions: Defendants convicted of a felony and sentenced to AB 109 may be
eligible to file for expungement. Defendants sentenced to local prison and mandatory
supervision are eligible for expungement one year after their release from supervision.
Defendants sentenced to local prison only, are eligible for expungement two years after
their release from custody. This relief is always discretionary.
4. 1203.42 Petitions: Defendants convicted of a felony who would have been sentenced to
AB 109 had it been eligible at the time of sentencing. The includes eligible offenses prior
to October 1, 2011. Defendant may be eligible to file for expungement. This relief is
always discretionary.
5. 1203.43 Petitions: Defendants who satisfactorily completed a Diversion Program (also
referred to as PC 1000) is eligible to file for expungement and in essence erase the drug
conviction from their record.
6. 1203.49 Petitions: Defendants may petition the court to have their conviction for
solicitation or prostitution to be set aside if they can establish by clear and convincing
evidence that the conviction was the result as his/her status as a human trafficking victim.
7. 17B Motion: A reduction to a misdemeanor is available to those defendants who were
convicted of a felony"wobbler offense" and were placed on felony probation. A
"wobbler" is an offense that could have been charged as a felony or misdemeanor. If the
Defendant's sentence was stayed or suspended for a term they are ineligible for 17B
relief.
8. Prop 47 Application/Petition: Defendants with felony convictions for certain property
and drug crimes outlined under the statute may apply for a reduction to misdemeanor.
Theft offenses must be valued at $950 or lower.
9. Prop 64 Application/Petition: Defendants with felony convictions that are marijuana
related may apply for a reduction to a misdemeanor, dismissal, or sealing depending on
the circumstances of the case.
2 These descriptions only apply to criminal convictions obtained in California and are brief summaries of the
relevant law. Additional requirements may affect eligibility.
cop
2220 Tulare Street,Suite 300/Fresno,California 93721
t Telephone(559)600-3546/Fax(559)600-1570
o O Equal Opportunity Employer
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
Applications/Petitions (reduction to misdemeanor or dismissal). It is preferred that the client
come in with a rap sheet' but not required.
Period of Performance:
This proposal is based on a twelve (12) month term and is estimated to serve 200 clients.
Defense Attorney III—9 hours/week—in-person consultations for referred Workforce clients and
preparation of any applicable applications/petitions.
Paralegal—10 hours/week—file and serve documents, make copies,pull records from databases,
and track data/outcomes.
This contract would include the Defense Attorney, Paralegal, office space, office supplies for the
project, software, and any necessary administrative time.
1 A"rap sheet"is a defendant's record of arrest or conviction history in California.
cop
2220 Tulare Street,Suite 300/Fresno,California 93721
t Telephone(559)600-3546/Fax(559)600-1570
o O Equal Opportunity Employer
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
Description of Motions:
1. 1203.4 Petition: Defendants convicted of a misdemeanor, or felons sentenced to
probation and/or local county time may be eligible to file for an expungement.
Defendants may file this petition once they are no longer on probation and have no
open/active cases. Relief can be mandatory or discretionary depending on the
circumstances.
2. 1203.4a Petitions: Misdemeanants who were denied probation may file for expungement
one year from the date of sentencing. Relief can be mandatory or discretionary
depending on the circumstances.
3. 1203.41 Petitions: Defendants convicted of a felony and sentenced to AB 109 may be
eligible to file for expungement. Defendants sentenced to local prison and mandatory
supervision are eligible for expungement one year after their release from supervision.
Defendants sentenced to local prison only, are eligible for expungement two years after
their release from custody. This relief is always discretionary.
4. 1203.42 Petitions: Defendants convicted of a felony who would have been sentenced to
AB 109 had it been eligible at the time of sentencing. The includes eligible offenses prior
to October 1, 2011. Defendant may be eligible to file for expungement. This relief is
always discretionary.
5. 1203.43 Petitions: Defendants who satisfactorily completed a Diversion Program (also
referred to as PC 1000) is eligible to file for expungement and in essence erase the drug
conviction from their record.
6. 1203.49 Petitions: Defendants may petition the court to have their conviction for
solicitation or prostitution to be set aside if they can establish by clear and convincing
evidence that the conviction was the result as his/her status as a human trafficking victim.
7. 17B Motion: A reduction to a misdemeanor is available to those defendants who were
convicted of a felony"wobbler offense" and were placed on felony probation. A
"wobbler" is an offense that could have been charged as a felony or misdemeanor. If the
Defendant's sentence was stayed or suspended for a term they are ineligible for 17B
relief.
8. Prop 47 Application/Petition: Defendants with felony convictions for certain property
and drug crimes outlined under the statute may apply for a reduction to misdemeanor.
Theft offenses must be valued at $950 or lower.
9. Prop 64 Application/Petition: Defendants with felony convictions that are marijuana
related may apply for a reduction to a misdemeanor, dismissal, or sealing depending on
the circumstances of the case.
2 These descriptions only apply to criminal convictions obtained in California and are brief summaries of the
relevant law. Additional requirements may affect eligibility.
cop
2220 Tulare Street,Suite 300/Fresno,California 93721
t Telephone(559)600-3546/Fax(559)600-1570
o O Equal Opportunity Employer
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
Exhibit B
Budget Summary
Applicant: Fresno County Public Defender, Clean Slate Program
Funding: 201/301/501
BUDGET EXPENSE ITEM BUDGET LEVERAGE TOTAL
LINE#
1 Staff Salaries $ 33,601.35
Number of full-time equivalents 0.48
2 Staff Travel
3 Communications
4 Facilities Rent
5 Facilities Utilities
6 Facilities Maintenance
7 Office Supplies $840.30
8 Testing/Instructional
Materials
9 Equipment Purchases
10 Equipment Leases/Use-
Charge
11 Tools and Supplies $1,416.00
12 Supportive Services
13 Indirect Costs $8,627.35
14 "Other" Costs $515.00
15 Costs of Sub-Grants
TOTAL 1 $45,000.001 $0.001 $0.00
Indirect costs are calculated by adding Salaries, travel,
office supplies and tools and supplies and multiplying by
24.06%.
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
Budget Detail
Applicant: Fresno County Public Defender, Clean Slate Program
Funding: 201/301/501
BUDGET EXPENSE ITEM NARRATIVE DETAIL
LINE#
1 Staff Salaries: List job titles of Salaries charged to Fringe Benefits FTEs
staff working on project project charged to project
Defense Attorney $21,500 $1,645 23%
Paralegal $9,714 $743 25%
Totals $ 31,213.52 $ 2,387.83 48%
2 Staff Travel
3 Communications
4 Facilities Rent
5 Facilities Utilities
6 Facilities Maintenance
7 Office Supplies Postage, stationary, etc 840.30
8 Testing/Instructional Materials
9 Equipment Purchases
10 Equipment Leases/Use-Charge
11 Tools and Supplies Lawyaw legal drafting software ($59/month*2*12)=$1416
12 Supportive Services
13 Indirect Costs-- Provide rate, 24.06%(see attached document for calculation) $8,627.35
direct cost(s) and calculation
14 "Other" Costs *Use table below for Line Item 14.
15 Costs of Sub-Grants, list cost of *Use table below for Line Item 15
each sub-grant
Line 14: "Other" Costs Total
California Bar Dues (1 Attorney) $515.00
Tota Is 1 $515.00
Line 15: Sub-Grants Total
Totals 1 $0.00
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
C4lj� INTEROFFICE MEMORANDUM Oscar J. Garcia, CPA
Auditor-Controller/Treasurer-Tax Collector
Enedina Garcia
Deputy Auditor-Controller
Megan Marks
FREcj Deputy Treasurer-Tax Collector
DATE: September 20, 2021
TO: Antoinette Taillac, Public Defender
FROM: Oscar J. Gargja,"CPA, Auditor-Controller/Treasurer-Tax Collector
SUBJECT: Public Defender Indirect Cost Rate Proposal for Fiscal Year 2021-2022
The Auditor-Controller/Treasurer-Tax Collector's Department(ACTTC) has reviewed the
Indirect Cost Rate Proposal (ICRP) for the Public Defender for Fiscal Year (FY) 2021-
2022.
Based on our review, the attached ICRP was prepared and calculated using the 2020-
2021 actual costs and budget information for Department 2880. The allocation of
allowable indirect cost of Service and Supplies expense was based on actual costs
incurred during the Fiscal Year 2020-2021 as direct or indirect costs in compliance with
2 CFR 200 — Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Awards, Subpart E. The allocation of allowable indirect cost
of Salaries and Benefits was based on a narrative provided by the department with a
description of certain administrative staff's job duties. The requirements for time clock
reporting as described in the Handbook of Cost Plan Procedures for California Counties
is as follows:
1. Reflect an after-the-fact distribution of each employee's actual activity;
2. Account for the total activity for which each employee is compensated;
3. Provide full and complete substantiation of the distribution of effort and support the
imposition of any direct charges for services;
4. Be prepared at least monthly, and fully account for the total labor hours of each
month;
5. Be signed and dated by the employee no later than the end of the pay period that
follows the pay period covered by the report; and
6. Document, by signature or initials and date, after-the-fact supervisory review and
approval of each activity report. "
Based on these requirements, we recommend the Department utilize PeopleSoft
Human Resources to properly record activities accurately.
P.O. Box 1247/ Fresno, California 93715-1247/(559) 600-3496/ FAX(600) 600-1444
Equal Employment Opportunity Employer
DocuSign Envelope ID:23BA81DE-2497-4BB5-98B7-30F09D69E188
September 20, 2021
Page 2
The ICRP's can be used for any program, provided that your funding entities have not
limited your indirect cost recovery to specific percentages. Therefore, we recommend
that each grant contract be reviewed for indirect cost guidelines.
If you have any questions, please contact Ganna Monastyrsky at (559) 600-1709 of our
Special Accounting Division.
OJG: kh
Enclosure
P.O. Box 1247/ Fresno, California 93715-1247/(559) 600-3496/ FAX(600)600-1444
Equal Employment Opportunity Employer
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
INUIKEU I COST RATE PROPOSAL
Public Defender Org 2880
FISCAL YEAR 2021-2022
BASED ON ACTUALS FROM FISCAL YEAR 2020-2021
(1) (2) (3) (4) (5)
Total Cost Components
Total Costs Total Unallowable Total Allowable Total Allowable Remaining Costs
(Based on Actual Excludable Indirect Direct Should be
Description of Costs Costs Incurred) Costs Costs Costs Zero(0)
+(1)-(2)-(3) (1)-(2)-(3)-(4)
Salaries&Benefits:
Salaries/Wages 12,109,303 $1,576,042 $10,533,261 $0
Overtime/Comp.Time 1,540 1,540 $0
Benefits 9,643,216 1,318,403 8,324,813 $0
Total Salaries&Benefits 21,754,059 0 2,894,445 18,859,614 0
+(1)-(2)-(3) (Data is manually entered.)
Services&Supplies:
Communications 0 0
Liability/Other Insurance 35,210 35,210 0 0
Medical,Dental&Lab Supplies 0 0
Maintenance 5,097 4,700 397 0
Memberships 47,630 47,630 0
Office Expense 137,222 110,472 26,751 0
Interoffice messenger mail 3,375 3,094 281 0
Postage 5,628 5,233 395 0
Prof.&Spec.Services 378,000 378,000 0
Peoplesoft Charges 34,903 31,445 3,458 0
Data Processing 707,615 649,165 58,450 0
End User Software 118,256 114,238 4,018 0
Printing 16,250 14,822 1,428 0
Publications&Legal Notices 55,708 2,393 53,315 0
Operating Lease buildings 7,560 7,560 0
Facilitv Operations&Maint 326,307 296,324 29,983 0
Small Tools 33,177 33,177 0
Spec.Dept.Expense 1,728 1,728 0
Commissions/Advisory Boards 0 0
Education 47,514 47,514 0
Transportation/Travel/Mileage 166,054 166,054 0
Utilities 157,028 146,445 10,583 0
Security Services 87,907 82,082 5,825 0
Total Services&Supplies 2,372,169 0 1,495,624 876,545 0
+(1)-(2)-(3)
Other Expenditures 0 0
Intangible Assets +(1)-(2)-(3)
Capital Expenditures(Fixed Assets) 0 0 0
Total Budgetary Expenditures 24,126,228 0 4,390,069 19,736,159 0
Cost Plan Costs:
Equipment Use Allowance 0 0
Building Use Allowance A 77,048 77,048 0
Building Use Allowance B 11,696 11,696 0
Building Costs 0 0
County Administrative Office 51,500 51,500 0
Parks 0 0
Bldg&Grounds Maint./Security 0 0
Auditor-Controller/Treas.(RRD) 165,464 165,464 0
Purchasing 11,398 11,398 0
County Counsel 30,434 30,434 0
Personnel 66,733 66,733 0
Capital Projects 0 0
Archives/Storage 8,595 8,595 0
Roll Forward/Adjustments (274,397) (274,397) 0
Total Cost Plan Costs 148,471 0 148,471 0 0
Total Allowable Indirect Costs(AIC) 4,538,540
Dist.of AIC Based on Salary/Wages 0 (4,538,540) 4,538,540 0
Totals $24 274 699 $0 $0 $24 274 699 $0
Indirect Cost Rate(AIC/Sal.&Wages) 24.06% Benefits Ratio= Benefits/Salary&Wages 79.63%
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
Exhibit C-1
Instructions for Certification —Workforce Innovation and Opportunities Act (WIOA)
By signing this agreement, the recipient of federal assistance funds is providing the
certification as set out below.
1. The certification in this clause is a material representation of fact upon which reliance was
placed when this transaction was entered into. If it is later determined that the recipient of
federal assistance funds knowingly rendered an erroneous certification, in addition to other
remedies available to the federal government, the Department of Labor(DOL) may pursue
available remedies including suspension and/or debarment.
2. The recipient of federal assistance funds shall provide immediate written notice to the
Fresno Regional Workforce Development Board (FRWDB) if, at any time, the recipient of
federal assistance funds learns that its certification was erroneous when submitted, or has
become erroneous by reason of changed circumstances.
3. The terms "covered transaction," "debarred,""suspended," "ineligible," "lower-tier covered
transaction," "participant," "person," "primary covered transaction," "principal," "proposal,"
and "voluntarily excluded," as used in this clause, have the meanings set out in the
Definitions and Coverage sections of rules implementing Executive Order 12549. You may
contact the FRWDB staff for assistance in obtaining a copy of those regulations.
4. The recipient of federal assistance funds agrees it shall not knowingly enter into any lower-
tier covered transaction with a person who is debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this covered transaction, unless authorized by
the DOL.
5. The recipient of federal assistance funds further agrees it will include the clause titled
"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion —
Lower-Tier Covered Transactions," without modification, in all lower-tier covered
transactions, and in all solicitations for lower-tier covered transactions.
6. A participant in a covered transaction may rely upon a certification of a participant in a
lower-tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily
excluded from the covered transaction, unless it knows that the certification is erroneous.
A participant may decide the method and frequency by which it determines the eligibility
of its principals. Each participant may, but is not required to, check the "List of Parties
Excluded from Procurement or Non-Procurement Programs."
7. Nothing contained in the foregoing shall be construed to require establishment of a system
of records in order to render, in good faith, the certification required by this clause. The
knowledge and information of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business dealings.
8. Except for transactions authorized under paragraph 5 of these instructions, if a participant
in a covered transaction knowingly enters into a lower-tier covered transaction with a
person who is suspended, debarred, ineligible or voluntarily excluded from participation in
this transaction, in addition to other remedies available to the federal government, the DOL
may pursue available remedies, including suspension and/or debarment.
FRWDB Assurances&Certs Revised 8-12-2021
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ASSURANCES AND CERTIFICATIONS
The provider of WIOA services provides the assurances and certifications set forth below:
• General Assurances
• Debarment and Suspension Certification
• Certification Regarding Lobbying
• Drug-free Workplace Certification
• Certification of Non-delinquency
• Nondiscrimination and Equal Opportunity Requirement of the Workforce Innovation and
Opportunities Act (WIOA)
• Confidential Information and Data
• Signatory Authorizations, Debarment & Suspensions
• Fraud And Abuse Incident Reporting
A. GENERAL ASSURANCES
The provider of WIOA services assures that it:
1. Has the legal authority to apply for federal assistance, and the institutional,
managerial, and financial capability (including funds sufficient to pay the non-federal
share of any project costs)to ensure proper planning, management, and completion
of the project described in this Agreement.
2. Have adequate administrative controls, personnel standards, evaluation procedures,
availability of in-service training and other policies as may be necessary to promote
the effective use of WIOA funds.
3. Will not permit participants to be employed on the construction, operation, or
maintenance of any facility used, or to be used, for sectarian instruction or as a place
for religious worship. (Public Law 105-220 Aug. 7, 1998, as amended)
4. Will not permit any participant to displace a currently employed worker (including
partial displacement such as a reduction in the hours of non-overtime work, wages,
or employment benefits). (Public Law 105-220 Aug. 7, 1998, as amended)
5. Will not impair existing agreements for services or collective bargaining agreements,
unless the employer and the labor organization concur, in writing, with respect to any
elements of the proposed activities that affect such agreement, or either such party
fails to respond to written notification requesting its concurrence within 30 days of
receipt thereof. (Public Law 105-220 Aug. 7, 1998, as amended)
6. Will ensure that where a labor organization represents a substantial number of
employees, who are engaged in similar work or training in the same area as that
proposed, an opportunity shall be provided for such labor organization(s) to submit
comments. (Public Law 105-220 Aug. 7, 1998, as amended)
7. Will work with the FRWDB to promote on-site, industry-specific training programs
supportive of industrial and economic development. (Public Law 105-220 Aug. 7,
1998, as amended)
8. Will not use WIOA funds to assist, promote, or deter union organizing.
9. Will not use WIOA funds for public service employment.
10. Will not use WIOA funds for contribution, on behalf of any participant, to retirement
systems or plans.
11. Will establish controls to ensure that no WIOA funds will be used to assist in
relocating establishments/employers, or parts thereof, from one area to another,
unless the Secretary of Labor determines that such relocation will not result in an
increase of unemployment in the area of original location, or in any other area.
12. Will comply with the provisions of the Military Selective Service Act (50 USC App.
453, Section 3, as amended), which limits participation to persons who have
presented proof of submitted registration or will register at time of enrollment.
FRWDB Assuranccs&Cuts Rcviscd 8-12-2021
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13. Has not duplicated building/office rental/lease costs associated with this Agreement
in any other agreement, contract, grant, lease, rental, gift, or budget under the
stewardship of the provider of WIOA services.
14. Will, if operating programs for youth, further assure the following:
a. Training and work experience for eligible youth will be coordinated with school-
related programs, including the award of academic credit, pursuant to the WIOA.
b. The Federal Child Labor Standards or the California Child Labor Standards,
whichever is stricter, will be applied to the employment of youth under 18 years
of age.
15. Will comply with the Intergovernmental Personnel Act of 1970 (42 USC 4728-4763),
relating to prescribed standards for merit systems, for programs funded under one
of the nineteen statutes or regulations specified in Appendix A of Office of
Management and Budget's (OMB) Standards for a Merit System of Personnel
Administration (5 CFR 900, Subpart F).
16. Will comply with all federal statutes relating to nondiscrimination. These include, but
are not limited to: (a) Title VI of the Civil Rights Act of 1964 (PL 88.352) which
prohibits discrimination on the basis of race, color or national origin; (b) Title IX of
the Education Amendments of 1972, as amended (20 USC 1681-1683 and 1685-
1686), which prohibits discrimination on the basis of disabilities; (c) the Age
Discrimination Act of 1975, as amended (42 USC 6101-6107), which prohibits
discrimination on the basis of age; (d) the Drug Abuse Office and Treatment Act of
1972 (PL 92.255), as amended, relating to nondiscrimination on the basis of drug
abuse; (e)the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment
and Rehabilitation Act of 1970 (PL 91.616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or alcoholism; (f) 523 and 527 of the
Public Health Service Act of 1912 (42 USC 290 dd.3 and 290 ee.3), as amended,
relating to confidentiality of alcohol and drug abuse patient records; (g) Title VIII of
the Civil Rights Act of 1968 (42 USC 3601 et seq.), as amended, relating to
nondiscrimination in the sale, rental, or financing of housing; (h) any other
nondiscrimination provisions in the specific statute(s) under which this federally-
funded Agreement exists; and (i) the requirements of any other nondiscrimination
statute(s), which may apply to this Agreement.
17. Maintains its intake and/or operational headquarters as accessible to the disabled,
pursuant to Section 504 of the Rehabilitation Act of 1973 and the Americans with
Disabilities Act of 1990, and comply with California Occupational Safety & Health
Administration (Cal/OSHA)Workplace Safety requirements.
18. Will comply, or has already complied, with the requirements of Titles II and III of the
Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970
(PL 91.646), which provides for fair and equitable treatment of persons displaced or
whose property is acquired as a result of federal or federally-assisted programs.
These requirements apply to all interests in real property acquired for project
purposes, regardless of federal participation in purchases.
19. Will comply with the provisions of the Hatch Act(7 U SC 1501-1508 and 7324-7328),
which limit the political activities of employees whose principal employment activities
are funded in whole or in part with federal funds.
20. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 USC 276a
through 276a.7), the Copeland Act (40 USC 276c and 18 USC 874), and the
Contract Work Hours and Safety Standards Act (40.327-333), regarding labor
standards for federally-assisted construction subcontracts. Pursuant to the Davis-
Bacon Act, all laborers and mechanics employed by contractors or sub-contractors
in any construction, alteration, or repair, including painting and decorating, of
projects, buildings and works that are federally assisted under the WIOA, shall be
paid wages at rates not less than those prevailing on similar construction in the
locality, as determined by the Secretary.
21. Will comply, if applicable, with Flood Insurance Purchase Requirements of Section
102(A) of the Flood Disaster Protection Act of 1973 (PL 93.234) which requires
FRWDB Assurances&Certs Revised 8-12-2021
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
recipients in a special flood hazard area to participate in the program and to
purchase flood insurance if the total cost of insurable construction and acquisition is
$10,000 or more.
22. Will comply with environmental standards which may be prescribed pursuant to the
following:
(a) institution of environmental quality control measures under the National
Environmental Policy Act of 1969 (PL 91.190) and Executive Order (EO) 11514; (b)
notification of violating facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in flood plains in accordance
with EO 11988; (e) assurance of project consistency with the approved State
management program developed under the Coastal Zone Management Act of 1972
(16 USC 1452 et seq.); (f) conformity to federal actions to State (Clean Air)
Implementation Plans under Section 176(c) of the Clean Air Act of 1955, as
amended (42 USC 7401 et seq.); (g) protection of underground sources of drinking
water under the Safe Drinking Water Act of 1974, as amended (PL 93.523); and (h)
protection of endangered species under the Endangered Species Act of 1973, as
amended (PL 93.205).
23. Will comply with the Wild and Scenic Rivers Act of 1968 (16 USC 1271 et seq.),
related to protecting components or potential components of the national wild and
scenic rivers system.
24. Will assist the FRWDB in assuring compliance with Section 106 of the National
Historic Preservation Act of 1966, as amended (16 USC 470), EO 11593
(identification and protection of historic properties) and the Archaeological and
Historic Preservation Act of 1974 (16 USC 469a.1 et seq.)
25. Will comply with PL 93-348 regarding the protection of human subjects involved in
any research, development and related activities under this Agreement.
26. Will comply with the Laboratory Animal Welfare Act of 1966 (PL 89.554), as
amended (7 USC 2131 et seq.), pertaining to the care, handling and treatment of
warm-blooded animals held for any research, teaching, or other activities supported
by this Agreement.
27. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 USC 4801 et
seq.), which prohibits the use of lead-based paint in construction or rehabilitation of
residential structures.
28. Will comply with the provisions of the Nontraditional Employment for Women Act(PL
102-235) and the regulations or standards adopted by the Job Training Partnership
Division to implement such provisions. The provider of WIOA services will work with
FRWDB to promote the goals of(a)the training of and the training-related placement
of women in nontraditional employment; and (b) a description of efforts to increase
awareness of such training and placement opportunities.
29. Will cause to be performed the required financial and compliance audits, in
accordance with the Single Audit Act of 1984, and will submit such audit report(s) as
required under the provider of WIOA services Agreement.
30. Will comply with all applicable provisions of the Brown Act contained in section
54950 et seq., of the California Government Code, as amended accordingly, and all
statutory references therein.
B. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY,
VOLUNTARY EXCLUSION AND OTHER RESPONSIBILITY MATTERS
1. The provider of WIOA services 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 Agreement, been convicted
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
FRWDB Assurances&Certs Revised 8-12-2021
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
a public (federal, state, or local) transaction or agreement; violation of federal or
state antitrust statutes; embezzlement; theft; forgery; bribery; falsification or
destruction of records; making false statements; or receiving stolen property.
c. Are not presently indicted, or otherwise criminally or civilly charged, by a
government entity(federal, state, or local)with commission of any of the offenses
enumerated in paragraph B.1.b. of this certification.
d. Have not, within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, or local) terminated for cause or default.
2. Where the provider of WIOA services is unable to certify to any of the statements in
paragraphs 1(a-d) of this certification, the provider of WIOA services shall attach an
explanation to this Agreement.
3. The provider of WIOA services agrees to sign and abide by the attached
"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary
Exclusions — Lower-Tier Covered Transactions."
C. CERTIFICATION REGARDING LOBBYING — FOR AGREEMENTS, GRANTS, LOANS
AND COOPERATIVE AGREEMENTS
The provider of WIOA services hereby certifies that:
1. No federal appropriated funds have been paid or will be paid, by or on behalf of the
provider of WIOA services, to any person for influencing or attempting to influence
an officer or employee of Congress, or an employee of a member of Congress in
connection with the awarding of any federal agreement, the making of any federal
grant, the making of any federal loan, the entering into of any cooperative agreement
and the extension, continuation, renewal, amendment or modification of any federal
agreement, grant, loan, or cooperative.
2. If any other than federally-appropriated funds have been paid, or will be paid, to any
person for influencing or attempting to influence an officer or employee of any
agency, a member of Congress, an officer or employee of Congress, or an employee
of a member of Congress, in connection with this federal Agreement, grant, loan or
cooperative agreement, the provider of WIOA services shall complete and sign a
Standard Form—LLL, "Disclosure Form to Report Lobbying," in accordance with its
instructions.
3. The provider of WIOA services shall require that the language of this certification be
included in the award documents for all sub-awards at all tiers (including sub-
agreements, sub-grants and agreements under grants, loans and cooperative
agreements,) and that all sub-recipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for
making or entering into this transaction imposed by Title 31, U.S. Code, and section 1352.
Any person who fails to file the required certification shall be subject to civil penalty of not less
than $10,000 and not more than $100,000 for each such failure.
D. DRUG-FREE WORKPLACE
The provider of WIOA services certifies that it will provide a drug-free workplace by
implementing the provisions of 29 CFR 98.630.
E. NONDISCRIMINATION AND EQUAL OPPORTUNITY REQUIREMENTS OF WIOA
(29 CFR PART 38) and (Section 188),
1. The provider of WIOA services assures that it has the ability to and will comply fully with
the nondiscrimination and equal opportunity provisions outlined in 29 CFR Part 38 and §
FRWDB Assurances&Certs Revised 8-12-2021
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
188 of the WIOA of 2014, as amended, including, but not limited to, the following: Title VI
of the Civil Rights Act of 1964, as amended; Section 504 of the Rehabilitation Act of 1973,
as amended; the Age Discrimination Act of 1975; and Title IX of the Education
Amendments of 1972.; during the full term of the agreement. The provider of WIOA
services understands that the United States has the right to seek judicial enforcement of
this assurance.
2. The provider of WIOA services certifies that it has developed and will maintain a
"Nondiscrimination Plan" pursuant to 29 CFR 38.54.
3. The provider of WIOA services certifies that during the two (2) years preceding this
Agreement, it has incurred no findings of noncompliance with laws or regulations
regarding civil rights or discrimination based on race, color, religion, sex (including
pregnancy, childbirth, and related medical conditions, gender identity and transgender
status), national origin (including limited English proficiency), age, disability(temporary or
permanent), unlawful harassment, political affiliation or belief, citizenship, or participation
in WIOA.
F. CONFIDENTIAL INFORMATION AND DATA
The provider of WIOA services understands the necessity to protect all customer information
and will establish special precautions to protect it from unauthorized use, access, disclosure,
modification and destruction.
G. SIGNATORY AUTHORIZATIONS, DEBARMENT&SUSPENSIONS
The provider of WIOA services offers signatory authorization, and debarment & suspension
as attached.
H. FRAUD AND ABUSE INCIDENT REPORTING
The provider of WIOA services acknowledges their responsibility to be alert for incidents of
fraud and/or abuse and will comply with all local, state and federal regulations for reporting
such incidents, as outlined in FRWDB policy.
I. SUBMISSION OF DOCUMENTATION UPON AWARD
These assurances are made with the full knowledge and consent of the signing agency, and
in the event all required documentation is not submitted as required herein the Fresno Area
Workforce Investment Corporation (FAWIC), at its option, may recommend termination of
agreement to the FRWDB.
Name and Title of Authorized Representative (please print or type):
Brian Pacheco Chairman of the Board of Supervisors of the County of Fresno
Te Title
g-ao-2a
Signature: Date
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
County of Fresno,State of California
By Deputy
FRWDB FRWDB Assurances&Certs Revised 8-12-2021
DocuSign Envelope ID:23BA81DE-2497-4BB5-98B7-30F09D69E188
Certification Regarding
Debarment, Suspension, Ineligibility and Voluntary Exclusion
Lower-Tier Covered Transactions
This certification is required by the regulations implementing Executive Order 12549, "Debarment
and Suspension," 29 CFR Part 98, Section 98.510, "Participants' Responsibilities." The
regulations were published as Part VII of the May 26, 1988, Federal Register (pages 19160-
19211).
1. The recipient of federal funds certifies the Assurances and Certifications have been read
and understood, and that neither it, nor its principals are presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded from participation in
this transaction by any federal department or agency.
2. Where the recipient of federal assistance funds is unable to certify to any of the statements
in this certification, such prospective participant shall attach an explanation to this
Agreement.
Name and Title of Authorized Representative (please print or type):
Brian Pacheco Chairman of the Board of Supervisors of the County of Fresno
Lme Title
Signature: Date
ATTEST:
BERNICE E. SEIDEL
Clerk of the Board of Supervisors
County of Fresno,State of California
By d/
Deputy
FRWDB Assurances&Certs Revised 8-12-2021
DocuSign Envelope ID:23BA81DE-2497-4BB5-98B7-30F09D69E188
Exhibit C-2
Fresno Regional Workforce Development Board
2125 Kern Street, Suite 208 • Fresno, Ca 93721 • 559.490.7100 • Fax 559.490.7199 • www.workforce-connection.com
Standard of Conduct
The Service Provider hereby agrees that:
It shall pursue every reasonable course of action in order to maintain the integrity of this
expenditure of public funds and to avoid real or apparent favoritism or questionable or
improper conduct. It shall perform its duties set forth in this Agreement in an impartial
manner and free from illegal personal, financial or political gain. The Service Provider, its
executive staff, employees and sub-contractors, in performing its duties pursuant to this
Agreement, shall avoid giving the appearance that any decision was influenced by prejudice,
bias or special interest.
Without first obtaining prior FRWDB approval, it shall prohibit family members and
dependents of its officers or employees from enrolling in a program to receive services to be
provided pursuant to this Agreement.
"Family" is defined as individuals related by blood, court decree, or marriage and shall
include wife, husband, daughter, son, mother, father, sister, brother, mother-in-law, father-in-
law, daughter-in-law, son-in-law, sister-in-law, brother-in-law, grandmother, grandfather,
aunt,uncle,niece,nephew, stepparent, stepchild or dependent.
"Dependent" is defined as an individual who, both currently and during the previous 6
months,has received fifty(50)percent of his/her support from a family member.
It, its staff, subcontractor or assignee will neither create an economic conflict of interest nor
solicit or accept money or any other consideration from a third person in exchange for the
performance of an act reimbursed in whole or part pursuant to this Agreement.
It will use supplies, materials, equipment or services purchased with Agreement funds solely
for purposes allowed under this Agreement.
It will assure that any of its employees who were formerly employed by the FAWIC or
FRWDB in a position that enabled them to influence decisions about programs described in
this Agreement, will not participate in any part or phase of the activities conducted pursuant
to this Agreement for a period of not less than one year following the termination of such
employment from the FAWIC or FRWDB, provided it being understood that in any event,
the Service Provider may employ, in any capacity, said employees of FAWIC whose
employment is terminated due to reduction or loss of funding to, or the organizational re-
structuring of,FAWIC.
Fresno Regional Workforce Development Board
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
Exhibit D-1
Part 200 Appendix II —Contract Provisions for Non-Federal Entity Contracts Under Federal Awards
In addition to other provisions required by the Federal agency or non-Federal entity, all contracts made by the
non-Federal entity under the Federal award must contain provisions covering the following, as applicable.
(A) Contracts for more than the simplified acquisition threshold currently set at $150,000, which is the
inflation adjusted amount determined by the Civilian Agency Acquisition Council and the Defense Acquisition
Regulations Council (Councils) as authorized by 41 U.S.C. 1908, must address administrative, contractual, or legal
remedies in instances where contractors violate or breach contract terms, and provide for such sanctions and
penalties as appropriate.
(B) All contracts in excess of $10,000 must address termination for cause and for convenience by the non-
Federal entity including the manner by which it will be effected and the basis for settlement.
(C) Equal Employment Opportunity. Except as otherwise provided under 41 CFR Part 60, all contracts that meet
the definition of "federally assisted construction contract" in 41 CFR Part 60-1.3 must include the equal
opportunity clause provided under 41 CFR 60-1.4(b), in accordance with Executive Order 11246, "Equal
Employment Opportunity" (30 FR 12319, 12935, 3 CFR Part, 1964-1965 Comp., p. 339), as amended by Executive
Order 11375, "Amending Executive Order 11246 Relating to Equal Employment Opportunity," and implementing
regulations at 41 CFR part 60, "Office of Federal Contract Compliance Programs, Equal Employment
Opportunity, Department of Labor."
(D) Davis-Bacon Act, as amended (40 U.S.C. 3141-3148). When required by Federal program legislation, all
prime construction contracts in excess of $2,000 awarded by non-Federal entities must include a provision for
compliance with the Davis-Bacon Act (40 U.S.C. 3141-3144, and 3146-3148) as supplemented by Department of
Labor regulations (29 CFR Part 5, "Labor Standards Provisions Applicable to Contracts Covering Federally
Financed and Assisted Construction"). In accordance with the statute, contractors must be required to pay
wages to laborers and mechanics at a rate not less than the prevailing wages specified in a wage determination
made by the Secretary of Labor. In addition, contractors must be required to pay wages not less than once a
week. The non-Federal entity must place a copy of the current prevailing wage determination issued by the
Department of Labor in each solicitation. The decision to award a contract or subcontract must be conditioned
upon the acceptance of the wage determination. The non-Federal entity must report all suspected or reported
violations to the Federal awarding agency. The contracts must also include a provision for compliance with the
Copeland "Anti-Kickback" Act (40 U.S.C. 3145), as supplemented by Department of Labor regulations (29 CFR
Part 3, "Contractors and Subcontractors on Public Building or Public Work Financed in Whole or in Part by Loans
or Grants from the United States"). The Act provides that each contractor or subrecipient must be prohibited
from inducing, by any means, any person employed in the construction, completion, or repair of public work, to
give up any part of the compensation to which he or she is otherwise entitled. The non-Federal entity must
report all suspected or reported violations to the Federal awarding agency.
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
(E) Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708). Where applicable, all contracts
awarded by the non-Federal entity in excess of$100,000 that involve the employment of mechanics or laborers
must include a provision for compliance with 40 U.S.C. 3702 and 3704, as supplemented by Department of Labor
regulations (29 CFR Part 5). Under 40 U.S.C. 3702 of the Act, each contractor must be required to compute the
wages of every mechanic and laborer on the basis of a standard work week of 40 hours. Work in excess of the
standard work week is permissible provided that the worker is compensated at a rate of not less than one and a
half times the basic rate of pay for all hours worked in excess of 40 hours in the work week.The requirements of
40 U.S.C. 3704 are applicable to construction work and provide that no laborer or mechanic must be required to
work in surroundings or under working conditions which are unsanitary, hazardous or dangerous. These
requirements do not apply to the purchases of supplies or materials or articles ordinarily available on the open
market, or contracts for transportation or transmission of intelligence.
(F) Rights to Inventions Made Under a Contract or Agreement. If the Federal award meets the definition of
"funding agreement" under 37 CFR §401.2 (a) and the recipient or subrecipient wishes to enter into a contract
with a small business firm or nonprofit organization regarding the substitution of parties, assignment or
performance of experimental, developmental, or research work under that "funding agreement," the recipient
or subrecipient must comply with the requirements of 37 CFR Part 401, "Rights to Inventions Made by Nonprofit
Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements,"
and any implementing regulations issued by the awarding agency.
(G) Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act(33 U.S.C. 1251-1387), as
amended—Contracts and subgrants of amounts in excess of$150,000 must contain a provision that requires the
non-Federal award to agree to comply with all applicable standards, orders or regulations issued pursuant to the
Clean Air Act (42 U.S.C. 7401-7671q) and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251-
1387). Violations must be reported to the Federal awarding agency and the Regional Office of the Environmental
Protection Agency(EPA).
(H) Debarment and Suspension (Executive Orders 12549 and 12689)—A contract award (see 2 CFR 180.220)
must not be made to parties listed on the government wide exclusions in the System for Award Management
(SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR part
1986 Comp., p. 189) and 12689 (3 CFR part 1989 Comp., p. 235), "Debarment and Suspension." SAM Exclusions
contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties
declared ineligible under statutory or regulatory authority other than Executive Order 12549.
(1) Byrd Anti-Lobbying Amendment (31 U.S.C. 1352)—Contractors that apply or bid for an award exceeding
$100,000 must file the required certification. Each tier certifies to the tier above that it will not and has not used
Federal appropriated funds to pay any person or organization for influencing or attempting to influence an
officer or employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a
member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31
U.S.C. 1352. Each tier must also disclose any lobbying with non-Federal funds that takes place in connection with
obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the non-Federal award.
DocuSign Envelope ID:23BA81DE-2497-4BB5-98B7-30F09D69E188
(J) Procurement of recovered materials — A non-Federal entity that is a state agency or agency of a political
subdivision of a state and its contractors must comply with section 6002 of the Solid Waste Disposal Act, as
amended by the Resource Conservation and Recovery Act. The requirements of Section 6002 include procuring
only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR part 247 that
contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory
level of competition, where the purchase price of the item exceeds $10,000 or the value of the quantity
acquired during the preceding fiscal year exceeded $10,000; procuring solid waste management services in a
manner that maximizes energy and resource recovery; and establishing an affirmative procurement program for
procurement of recovered materials identified in the EPA guidelines.
[78 FR 78608, Dec. 26, 2013, as amended at 79 FR 75888, Dec. 19, 2014]
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
Exhibit D-2
Fresno Regional Workforce Development Board
2125 Kern Street, Suite 208 • Fresno, Ca 93721 • 559.490.7100 • Fax 559.490.7199 • www.workforce-connection.com
Insurance Requirements
A. The Service Provider,at its sole cost and expense,shall maintain in full force and effect the following insurance
coverage as required under the Agreement at all times during the term of this Agreement:
Comprehensive/Commercial General Liability insurance, including contractual, products and completed
operations coverage and bodily injury and property damage liability insurance,with combined single limits
of not less than One Million Dollars ($1,000,000) naming the Fresno Area Workforce Investment
Corporation (FAWIC), Fresno Regional Workforce Development Board (FRWDB) the County of Fresno
and the City of Fresno named as additionally insured.
Comprehensive Automobile Liability insurance endorsed for"any auto" with combined single limits of not
less than One Million Dollars ($1,000,000) naming the FAWIC, FRWDB the County of Fresno and the
City of Fresno named as additionally insured.
❑ Directors and Officers (Errors and Omissions) insurance with a limit of liability of not less than One
Million Dollars ($1,000,000) naming the FAWIC, FRWDB the County of Fresno and the City of Fresno
named as additionally insured, provided that FAWIC or FRWDB funds shall not be used to acquire
insurance policies offering protection against debts established by the federal government.
❑ Fidelity in an amount not less than ten percent (10%) of the total of all amounts payable to the
Service Provider pursuant to this Agreement but in no event less than Five Thousand Dollars ($5,000),
naming the FAWIC,FRWDB the County of Fresno and the City of Fresno named as co-obligees,provided,
however, that if that total amount payable pursuant to this Agreement is less than Five Thousand Dollars
($5,000),the amount of the bond shall be equal to that total amount.
Workers Compensation insurance in accordance with the California Labor Code covering all employees
hired or employed under the Agreement for which the Service Provider is the employer of record such as in
work experience programs and limited internships.
❑ Property Insurance covering direct physical loss or damage to FRWDB property with a limit of liability of
not less than the full replacement value of FRWDB property that the Service Provider possesses or
maintains during the term of this Agreement,naming the FRWDB as Loss Payee.
❑ Self-Insurance If the Service Provider proposes to provide any of the above stated coverage by way self-
insurance,it shall address a written request to the FRWDB representing and warranting that:
1. It agrees to the insurance requirements as stated herein;
2. It will maintain a minimum reserve not less than one hundred twenty-five percent(125%)of the
amount of self-insurance coverage as specified above in excess of all known claims filed against
the self-insurance fund of the Service Provider;
3. The reserve is fully funded: and,
4. No federal funds awarded or allocated under this agreement will be called upon to fund any losses
resulting from any claims made pursuant to this Agreement.
B. Service Provider must obtain endorsements to the general liability and auto insurance policies, giving the
FAWIC, FRWDB the County of Fresno and the City of Fresno an unrestricted thirty (30) day prior written
notice of cancellation or change in terms or coverage. The Service Provider will also obtain an endorsement to
the workers' compensation policy giving the FAWIC, FRWDB the County of Fresno and the City of Fresno an
unrestricted ten(10)day prior written notice of any cancellation or change in terms or coverage.
DocuSign Envelope ID:23BA81DE-2497-4BB5-98B7-30F09D69E188
C. If a Service Provider's insurance is not in place prior to the effective date and commencement of the term of this
Agreement, the Service Provider shall not commence performance hereunder. If any insurance coverage to be
provided by the Service Provider expires during the term of this Agreement and the Service Provider fails to
obtain new replacement coverage and present to the FAWIC appropriate certificates or endorsements prior to
the expiration date of the applicable insurance coverage,the FAWIC may suspend and withhold any payment(s)
otherwise due to the Service Provider as of the expiration date. Service Provider shall suspend performance
until it secures and delivers new insurance certificates(s)to the FAWIC.
D. If claims-made forms are used for errors and omissions coverage,either;
1. The Service Provider will obtain an endorsement to the policy that provides not less than a two-year
discovery period,or
2. Will maintain the coverage for at least two years following the termination of the Agreement. The
requirements of this section relating to errors and omissions coverage shall survive the termination or
expiration of the Service Provider Agreement. Service Provider will deliver a new certificate of insurance
to the FAWIC not less than fifteen (15) days prior to the expiration of any policy or immediately upon
cancellation of the policy.
E. The Service Provider shall submit to the FAWIC certificates of general liability and automobile liability
insurance naming the FAWIC, FRWDB, the County of Fresno and the City of Fresno, their officers, agents,
employees, officials,commissions and volunteers, individually and collectively, as additionally insured(except
Workers' Compensation). Further, the Service Provider shall provide to the FAWIC insurance certificates and
applicable endorsements for all required insurance. This Agreement shall not be effective or commence until
such time that satisfactory proof of all applicable insurance coverage required hereby is received.
F. The Service Provider shall notify the FAWIC in writing within five (5) working days of any claims that are
submitted to their liability insurance involving funds awarded under this Agreement. The Service Provider shall
include in any notice it gives to FAWIC pursuant to this subparagraph copies of any reports generated with
respect to the incident or claim and any known or estimated financial costs.
G. The FRWDB reserves the right to require the funded Service Provider to obtain additional insurance coverage
should the FRWDB determine that the activities of the Service Provider require additional coverage.
H. If any coverage is cancelled, revoked, reduced, or in any manner questioned or compromised, no further
disbursements shall be made to the Service Provider until the Service Provider provides satisfactory proof that
the appropriate coverage has been reinstated.
I. The Service Provider shall fully comply with the FRWDB procurement policy when acquiring all insurance
coverage required hereunder.
K. All insurance coverage to be established and maintained by Service Provider shall apply as primary insurance
and any other insurance, or self-insurance, maintained by the County of Fresno, the City of Fresno, FRWDB,
FAWIC or their respective officers, agents or employees shall be excess only and not contributing with
insurance provided under the Service Provider's policies required hereby.
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88 Exhibit E-1 ISSUE DATE
WC-1344 CERTIFICATE OF COVERAGE 06/25/2021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO
PUBLIC RISK INNOVATION, RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS
SOLUTIONS, AND MANAGEMENT CERTIFICATE OF COVERAGE DOES NOT CONSTITITUE A CONTRACT BETWEEN THE
ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE
C/O ALLIANT INSURANCE SERVICES, INC. CERTIFICATE HOLDER
PO BOX 6450 IMPORTANT:If the certificate holder is requesting a WAIVER OF SUBROGATION,the
NEWPORT BEACH, CA 92658-6450 Memorandums of Coverage must be endorsed.A statement on this certificate does not confer
PHONE(949)756-0271 /FAX(619)699-0901 rights to the certificate holder in lieu of such endorsement(s).
LICENSE#OC36861 COVERAGE
AFFORDED BY: A-See attached Schedule Of insurers
Member: COVERAGE
FRESNO COUNTY AFFORDED BY: B
ATTN:STEPHEN JOHNSON
2220 TULARE STREET, 16TH FLOOR COVERAGE
FRESNO,CA 93721-2108 AFFORDED BY: C
COVERAGE
AFFORDED BY: D
Coverages
THIS IS TO CERTIFY THAT THE MEMORANDUMS OF COVERAGE AND POLICIES LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER
NAMED ABOVE FOR THE PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR
OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE COVERAGE AFFORDED
BY THE MEMORANDUMS AND POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS,AND CONDITIONS OF
SUCH MEMORANDUMS AND POLICIES.
CO TYPE OF COVERAGE MEMORANDUM/ COVERAGE EFFECTIVE COVERAGE EXPIRATION LIABILITY LIMITS
LTR POLICY NUMBER DATE DATE
A EXCESS WORKERS' See attached 07/01/2021 07/01/2022 WORKERS'COMPENSATION:
COMPENSATION& Schedule of Insurers Difference between
EMPLOYER'S LIABILITY for policy numbers Statutory and Member's
$500,000 Retention
EMPLOYERS'LIABILITY:
Difference between
$5,000,000 and Member's
Retention
LIMITS APPLY PER OCCURRENCE FOR ALL PROGRAM MEMBERS COMBINED.
Description of Operations/Locations/Vehicles/Special Items:
AS RESPECTS EVIDENCE OF COVERAGE AGREEMENT BETWEEN FRESNO COUNTY AND FRESNO REGIONAL WORKFORCE DEVELOPMENT
BOARD FOR PROVIDING POST-CONVICTION SERVICES BY AN ATTORNEY.
Cancellation
Certificate Holder
SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUMS OF COVERAGE/POLICIES
BE CANCELLED BEFORE THE EXPIRATION THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE MEMORANDUMS OF COVERAGE/POLICIES PROVISIONS.
FRESNO REGIONAL WORKFORCE DEVELOPMENT BOARD
2125 KERN STREET,STE 208 AUTHORIZED REPRESENTATIVE
FRESNO,CA 93721
Public Risk Innovation,Solutions,and Management
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
PUBLIC RISK INNOVATION, SOLUTIONS, AND MANAGEMENT
EXCESS WORKERS' COMPENSATION PROGRAM
2021/2022 SCHEDULE OF INSURERS
FRESNO COUNTY
PROVIDER MEMORANDUM / LIMIT
POLICY NUMBER
Public Risk Innovation, Solutions, PRISM 21 EWC-04 Workers' Compensation:
and Management $50,000,000 each accident/each employee
for disease
(Difference between $50,000,000 and the
individual member's retention)
Employers' Liability:
$5,000,000 each accident/each employee
for disease
(Difference between $5,000,000 and the
individual member's retention)
Liberty Insurance Corporation EW7-64N-444785-011 Statutory each accident/each employee
for disease excess of
$50,000,000
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
CERTIFICATE NO. ISSUE DATE
GL1-11702 Al CERTIFICATE OF COVERAGE 06/25/2021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE
CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR
Public Risk Innovation, ALTER THE COVERAGE AFFORDED BELOW.THIS CERTIFICATE OF COVERAGE DOES NOT CONSTITUTE A
CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE
Solutions, and Management CERTIFICATE HOLDER.
C/O ALLIANT INSURANCE SERVICES, INC.
PO BOX 6450 IMPORTANT:If the certificate holder is an ADDITIONAL INSURED and/or requesting a WAIVER OF
NEWPORT BEACH, CA 92658-6450 SUBROGATION,the Memorandums of Coverage must be endorsed.A statement on this certificate does
not confer rights to the certificate holder in lieu of such endorsement(s).
PHONE(949)756-0271 /FAX(619)699-0901
LICENSE#OC36861 COVERAGE A-Public Risk Innovation,Solutions, and Management
AFFORDED
Member: COVERAGE
FRESNO COUNTY AFFORDED B
ATTN: STEPHEN JOHNSON COVERAGE
2220 TULARE STREET, 16TH FLOOR AFFORDED C
FRESNO, CA 93721-2108
COVERAGE
AFFORDED D
Coverages
THIS IS TO CERTIFY THAT THE MEMORANDUMS OF COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR
THE PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH
RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE COVERAGE AFFORDED BY THE MEMORANDUMS
DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS,AND CONDITIONS OF SUCH MEMORANDUMS. LIMITS SHOWN MAY
HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF COVERAGE MEMORANDUM COVERAGE EFFECTIVE COVERAGE EXPIRATION LIABILITY LIMITS
LTR NUMBER DATE DATE
A ❑X Excess General Liability PRISM 21 EL-03 07/01/2021 07/01/2022 $1,000,000
❑X Auto Liability $1,000,000
Limits inclusive of the Member's
Self-Insured Retention of
$750,000
Description of Operations/Locations/Vehicles/Special Items:
AS RESPECTS AGREEMENT BETWEEN FRESNO COUNTY AND FRESNO REGIONAL WORKFORCE DEVELOPMENT BOARD FOR PROVIDING
POST-CONVICTION SERVICES BY AN ATTORNEY.
FRESNO AREA WORKFORCE INVESTMENT CORPORATION(FAWIC), FRESNO REGIONAL WORKFORCE DEVELOPMENT BOARD(FRWDB),
FRESNO COUNTY AND THE CITY OF FRESNO ARE INCLUDED AS ADDITIONAL COVERED PARTIES, BUT ONLY INSOFAR AS THE
OPERATIONS UNDER THIS CONTRACT ARE CONCERNED.
THIS INSURANCE SHALL BE PRIMARY AND NO OTHER INSURANCE SHALL CONTRIBUTE PURSUANT TO ENDORSEMENT NUMBER U-9.
Cancellation
Certificate Holder SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUMS OF COVERAGES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF,NOTICE WIL BE DELIVERED IN ACCORDANCE
WITH THE MEMORANDUMS OF COVERAGE PROVISIONS.
FRESNO REGIONAL WORKFORCE DEVELOPMENT BOARD
2125 KERN ST.,SUITE 208
FRESNO,CA 93721 AUTHORIZED REPRESENTATIVE
Public Risk Innovation,Solutions,and Management
PAGE 1 OF 2
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
ENDORSEMENT NO. U-1
PUBLIC RISK INNOVATION, SOLUTIONS, AND MANAGEMENT
GENERAL LIABILITY 1
ADDITIONAL COVERED PARTY AMENDATORY ENDORSEMENT
It is agreed that the 'Covered Party, Covered Persons or Entities" section of the Memorandum is amended
to include the person or organization named on the Certificate of Coverage, but only with respect to liability
arising out of premises owned by or rented to the Member, or operations performed by or on behalf of the
Member or such person or organization so designated.
Coverage provided under this endorsement is limited to the lesser of the limits stated on the Certificate of
Coverage or the minimum limits required by contract.
ADDITIONAL COVERED PARTY:
NAME OF PERSON OR ORGANIZATION SCHEDULED PER ATTACHED CERTIFICATE OF COVERAGE
AS RESPECTS:
PER ATTACHED CERTIFICATE OF COVERAGE
It is further agreed that nothing herein shall act to increase PRISM's limit of liability.
This endorsement is part of the Memorandum and takes effect on the effective date of the
Memorandum unless another effective date is shown below. All other terms and conditions
remain unchanged.
Effective Date: Memorandum No.: PRISM 21 EL-00
Issued to: ALL MEMBERS
Issue Date: June 25, 2021
Au orized Representative
Public Risk Innovation, Solutions, and Management
PAGE 2 OF 2
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
ENDORSEMENT NO. Ua-
PUBLIC RISK INNOVATION, SOLUTIONS, AND MANAGEMENT
GENERAL LIABILITY 1
AMENDATORY ENDORSEMENT - PRIMARY/NON-CONTRIBUTORY
It is understood and agreed that Condition 7. OTHER COVERAGE of the Memorandum to
which it is attached, is deleted in its entirety and replaced by the following:
7. OTHER COVERAGE
If collectible insurance with an insurer, or collectible group coverage through another joint
powers authority, interlocal cooperative agreement, self-insurance or other public entity
group coverage is available to the covered party covering a loss also covered hereunder
(whether on a primary, excess or contingent basis), the coverage hereunder shall be: (a)
in excess of, and shall not contribute with, such insurance; and (b) shall contribute only
with any excess group coverage available through another joint powers authority
according to a pro-rata, time on the risk basis. However, this clause does not apply with
respect to excess insurance purchased specifically to be in excess of this Memorandum,
or to insurance or reinsurance which is intended to provide the remainder of the limit of
liability stated in the Declarations of this Memorandum when the coverage afforded under
this Memorandum provides less than 100 percent of the limit set forth in the Declarations.
However, if the covered party has entered into a written agreement, prior to any loss
event, in which it is agreed that this coverage shall be primary and/or non-contributory with
respect to an additional covered party as specified in Endorsement U-1 of this
Memorandum, then this coverage shall respond as primary and/or non-contributory, but
shall be limited to the lesser of the limits stated on the Certificate of Coverage or the
minimum limits required by the written agreement.
Notwithstanding the foregoing paragraph, if coverage for a claim or suit is available under
this Memorandum and a memorandum of coverage issued in connection with the
PRISM's Medical Malpractice Program, this Memorandum shall afford primary coverage
only where the gravamen of the claim or suit involves liability covered hereunder. EIA
staff will preliminarily assess the gravamen of the claim or suit and refer it to the
committee responsible for the coverage believed to be applicable under this paragraph.
Where that committee disputes PRISM's assessment of the gravamen of the claim or suit
and rejects primary coverage, PRISM will thereafter refer the claim or suit to the
committee responsible for the other applicable coverage. If that committee also rejects the
primary coverage responsibility, the Executive Committee will determine which of PRISM's
coverages is primary under this paragraph.
If the Member disputes the acceptance of primary coverage by a committee of PRISM's
responsible for the coverage, the Member may appeal that decision to the Executive
Committee. Appeal must be requested within 60 days of the coverage acceptance by
PRISM.
DocuSign Envelope ID:23BA81DE-2497-4BB5-98B7-30F09D69E188
If the Member is not satisfied with the outcome of the Executive Committee appeal or the
determination by the Executive Committee as to which of PRISM's coverages is primary
where no committee agreed to accept primary responsibility, the Member may invoke
Section (d) and (e) of Article 31 of PRISM's Joint Powers Agreement and proceed to
arbitration and, if necessary, litigation. For purposes of this paragraph, the Member must
request to invoke Article 31 dispute resolution process within 60 days of the Executive
Committee's determination as to which of PRISM's coverages is primary.
Where a memorandum of coverage issued in connection with PRISM's Medical
Malpractice Program is determined to afford primary coverage pursuant to this section, the
exhaustion of PRISM's limit of liability under the Medical Malpractice Program will satisfy
the covered party's self-insured retention under this Memorandum.
Coverage for the additional covered party under this endorsement is limited to the written
contract or agreement as specified on the Certificate of Coverage and Endorsement U-1
of this Memorandum.
It is further agreed that nothing herein shall act to increase PRISM's limit of liability.
This endorsement is part of the Memorandum and takes effect on the effective date of
the Memorandum unless another effective date is shown below. All other terms and
conditions remain unchanged.
Effective Date Memorandum No.: PRISM 21 EL-00
Issued to: ALL MEMBERS
Issue Date: June 25, 2021
Authorized Representative
Public Risk Innovation, Solutions, and Management
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
CERTIFICATE NUMBER EVIDENCE OF PROPERTY COVERAGE ISSUE DATE
PROP-1576 03/26/2022
THIS EVIDENCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST.THIS EVIDENCE DOES NOT
AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BELOW.THIS EVIDENCE OF COVERAGE DOES NOT CONSTITUTE A
CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND ADDITIONAL INTEREST.
Public Risk Innovation,Solutions,and Management COVERAGE
AFFORDED A-Public Risk Innovation,Solutions, and
C/O ALLIANT INSURANCE SERVICES, INC. BY: Management
18100 Von Karman Avenue, 1 Oth Floor
Irvine,CA 92612 COVERAGE
AFFORDED B
PHONE(949)756-0271 /FAX(619)699-0901 BY:
LICENSE#OC36861
MEMBER TOWER NUMBER MEMORANDUM NUMBER
FRESNO COUNTY VII PRISMPR 22-23
ATTN:STEPHEN JOHNSON EFFECTIVE DATE EXPIRATION DATE CONT.UNTIL
2220 TULARE STREET, 16TH FLOOR 03/31/2022 03/31/2023 IFTERMINATED
❑
FRESNO,CA 93721-2108
THIS REPLACES PRIOR EVIDENCE:
PROPERTY INFORMATION
LOCATION 1 DESCRIPTION
AS RESPECTS AGREEMENT BETWEEN FRESNO COUNTY AND FRESNO REGIONAL WORKFORCE DEVELOPMENT BOARD FOR PROVIDING
POST-CONVICTION SERVICES BY AN ATTORNEY.
FRESNO REGIONAL WORKFORCE DEVELOPMENT BOARD IS NAMED AS LOSS PAYEE AS THEIR INTEREST MAY APPEAR.
THIS IS TO CERTIFY THAT THE MEMORANDUMS OF COVERAGE LISTED ABOVE HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE PERIOD INDICATED,NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENCE MAY BE ISSUED OR MAY PARTAIN.THE COVERAGE
AFFORED BY THE MEMORANDUMS DESCRIBED HEREIN IS SUBJECT TO ALL TERMS,EXCLUSIONS,AND CONDITIONS OF SUCH MEMORANDUMS.LIMITS SHOWN MAY HAVE BEEN
REDUCED BY PAID CLAIMS.
COVERAGE INFORMATION
COVERAGE/PERILS/FORMS AMOUNT OF INSURANCE
ALL RISK OF DIRECT PHYSICAL LOSS OR DAMAGE,INCLUDING FLOOD. $25,000,000 PER OCC FOR
ALL RISK AND
$25,000,000 ANN AGG FOR FLOOD
IF SCHEDULED AND PURCHASED,EARTHQUAKE IS INCLUDED AS RESPECTS THIS LOCATION.
$25,000,000 PER OCC/ANN AGG FOR
REPAIR OR REPLACEMENT COST VALUATION SUBJECT TO MEMORANDUM OF COVERAGE PROVISIONS. EARTHQUAKE
VEHICLE/BUSES ARE SUBJECT TO ACTUAL CASH VALUE OR REPLACEMENT COST PER SCHEDULE ON FILE WITH
PRISM.
ALL LIMITS ARE SHARED.
REMARKS(INCLUDING SPECIAL CONDITIONS)
DEDUCTIBLES
ALL RISK OF DIRECT PHYSICAL
LOSS OR DAMAGE(EXCLUDING
FLOOD AND EARTHQUAKE): $25,000 PER OCCURRENCE AS PER SCHEDULE ON FILE WITH PRISM.
FLOOD: $25,000 EXCEPT FOR CRITICAL FLOOD(LOCATIONS IN FEMA FLOOD ZONE A OR V)DEDUCTIBLE IS$100,000.
EARTHQUAKE: IF COVERAGE IS SCHEDULED AND PURCHASED,DEDUCTIBLE APPLIES AS FOLLOWS:
5%OF TOTAL INSURABLE VALUES PER UNIT,PER OCCURRENCE,SUBJECT TO$100,000 MINIMUM PER OCCURRENCE. A
DEDUCTIBLE BUYDOWN REDUCES THIS TO 2%OF TOTAL INSURABLE VALUES PER UNIT,PER OCCURENCE SUBJECT TO
TERMS AND CONDITIONS WITHIN THE MEMORANDUM.
VEHICLES&MOBILE EQUIPMENT: IF COVERAGE IS SCHEDULED AND PURCHASED,DEDUCTIBLE APPLIES PER SCHEDULE ON FILE WITH PRISM.
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUM(S)OF COVERAGE BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE
DELIVERED IN ACCORDANCE WITH THE MEMORANDUM(S)OF COVERAGE PROVISIONS.
ADDITIONAL INTEREST
NAME AND ADDRES NATURE OF INTEREST
FRESNO REGIONAL WORKFORCE DEVELOPMENT MORTGAGEE
BOARD
2125 KERN ST., SUITE 208 LOSS PAYEE (OTHER
FRESNO, CA 93721
AUTHORIZED REPRESENTATIVE
ubli�novation,Solutions,and Management
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
ENDORSEMENT NO. U-7
PUBLIC RISK INNOVATION, SOLUTIONS, AND MANAGEMENT (PRISM)
PROPERTY PROGRAM
LENDER'S LOSS PAYABLE ENDORSEMENT
It is understood and agreed by PRISM that:
Loss or damage, if any, under this Memorandum, shall be paid to the payee named in this
Memorandum, its successors and assigns, hereinafter referred to as the lender, in whatever form
or capacity its interests may appear and whether said interest be vested in said lender in its
individual or in its disclosed or undisclosed fiduciary or representative capacity, or otherwise, or
vested in a nominee or trustee of said lender.
The coverage under this Memorandum, or any rider or endorsement attached thereto, as to the
interest only of the lender, its successors and assigns, shall not be invalidated nor suspended:
A By any error, omission, or change respecting the ownership, description,
possession, or location of the subject of the coverage or the interest therein, or the
title thereto;
B By the commencement of foreclosure proceedings or the giving of notice of sale of
any of the property covered by this Memorandum by virtue of any mortgage or trust
deed; or
By any breach of warranty, act, omission, neglect, or non-compliance with any of the
provisions of this Memorandum, including any and all riders now or hereafter attached
thereto, by the covered party, the borrower, mortgagor, trustor, vendee, owner, tenant,
warehouseman, custodian, occupant, or by the agents of either or any of them or by the
happening of any event permitted by them or either of them, or their agents, or which they
failed to prevent, whether occurring before or after the attachment of this endorsement, or
whether before or after a loss, which under the provisions of this Memorandum of coverage
or of any rider or endorsement attached thereto would invalidate or suspend the coverage as
to the covered party, excluding any acts or omissions of the lender while exercising active
control and management of the property.
In the event of failure of the covered party to pay any premium or additional premium which shall be
or become due under the terms of this Memorandum or on account of any change in occupancy or
increase in hazard not permitted by this Memorandum, PRISM agrees to give written notice to the
lender of such non-payment of premium after sixty (60) days from and within one hundred and
twenty (120) days after due date of such premium and it is a condition of the continuance of the
rights of the lender hereunder that the lender when so notified in writing by PRISM of the failure of
the covered party to pay such premium shall pay or cause to be paid the premium due within ten
(10) days following receipt of PRISM's demand in writing therefore. If the lender shall decline to pay
said premium or additional premium, the rights of the lender under this lender's loss payable
endorsement shall not be terminated before ten (10) days after receipt of said written notice by the
lender.
Whenever PRISM shall pay to the lender, any sum for loss or damage under this Memorandum
and shall claim that as to the covered party no liability therefore exists, this Memorandum, at its
option, may pay to the lender the whole principal sum and interest and other indebtedness due or
to become due from the covered party, whether secured or unsecured, (with refund of all interest
not accrued), and PRISM, to the extent of such payment, shall thereupon receive a full assignment
and transfer, without recourse, of the debt and all rights and securities held as collateral thereto.
DocuSign Envelope ID:23BA81DE-2497-4BB5-98B7-30F09D69E188
If there be any other coverage upon the described property, PRISM shall be liable under this
Memorandum as to the lender for the proportion of such loss or damage that the sum hereby
covered bears to the entire coverage of similar character on said property under policies held by,
payable to and expressly consented to by the lender. Any contribution clause included in any fallen
building clause waiver or any extended coverage endorsement attached to this Memorandum is
hereby nullified except contribution clauses for the compliance with which the covered party has
received reduction in the rate charged or has received extension of the coverage to include hazards
other than fire and compliance with such contribution clause is made a part of the consideration for
covering such other hazards. The lender upon the payment to it of the full amount of its claim, will
subrogate PRISM (pro rata with all other insurers/coverage provides contributing to said payment) to
all of the lender's rights of contribution under said other insurance of contribution under said other
insurance.
Should legal title to and beneficial ownership of any of the property covered under this Memorandum
become vested in the lender or its agents, coverage under this Memorandum shall continue for the
term thereof for the benefit of the lender but, in such event, any privileges granted by this lender's
loss payable endorsement which are not also granted the covered party under the terms and
conditions of this Memorandum and/or under other riders or endorsements attached thereto shall not
apply to the coverage. hereunder as respects such property.
All notices herein provided to be given by PRISM to the lender in connection with this Memorandum
and this lender's lender payable endorsement shall be mailed to or delivered to the lender at its
office or branch described on the first page of this Memorandum.
It is further agreed that nothing herein shall act to increase PRISM's Limit of Liability.
This endorsement is part of the Memorandum and takes effect on the effective date of the
Memorandum unless another effective date is shown below. All other terms and conditions remain
unchanged
Effective Date: Memorandum No. PRISMPR 22-23
Issue Date: March 26, 2022
orized Representative
Public Risk Innovation, Solutions, and Management
DocuSign Envelope ID:23BA81 DE-2497-4BB5-98B7-30F09D69E1 88
Exhibit E-2
SIGNATORY AUTHORIZATION
I HEREBY CERTIFY THAT Brian Pacheco, Chairman of the Board of Supervisors of the County of Fresno
(Name&Title)
IS AUTHORIZED TO SUBMIT PROPOSALS FOR,AND BY VIRTUE OF HIS/HER SIGNATURE, BIND
County of Fresno
(Organization Name)
TO CONTRACTUAL AGREEMENTS FOR THE PERIOD
July 1,2022 THROUGH June 30, 2023
Signature of Governing Body Official & L L
Date Signed:
Typed Name: Brian Pacheco
Title: Chairman of the Board of Supervisors of the County of Fresno
Signature of Official Authorized Above &
Date Signed: iL
Typed Name: Brian Pacheco
Title: Chairman of the Board of Supervisors of the County of Fresno
Note: Should circumstances require a change
in the above, a new signatory authorization
shall be completed and forwarded to
FRWDB. Failure to provide the information
above may result in the disqualification of
your proposal.
ATTEST:
BERNICE E. SEIDEL
Clerk of the Board of Supervisors
County of Fresno,State of Callfornia
Deputy
DocuSign Envelope ID: 23BA81 DE-2497-4BB5-98B7-30F09D69E188
Exhibit E-3
Form W"9 Request for 'Paxpayer Give Form to the
(Rev.October2018) Identification Number and Certification requester.Do not
Department of the Treasury send to the IRS.
Internal Revenue Service ►Go to www.1rs.gov/FormW9 for instructions and the latest information.
1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank.
COUNTY OF FRESNO
2 Business name/disregarded entity name,if different from above
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1.Check only one of the 4 Exemptions(codes apply only to
following seven boxes. certain entitles,not Individuals;see
instructions on page 3):
o ❑ Individual/sole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑Trust/estate
a o single-member LLC Exempt payee code(if any)
❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)►
0 1 Note;Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check
b 9 Exemption from FATCA reporting
LLC if the LLC is classified as asingle-member LLC that Is disregarded from the owner unless the owner of the LLC is code(if any)
> 2 another LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC that
o .2 is disregarded from the owner should check the appropriate box for the tax classification of its owner.
❑
r ✓ Other(see instructions)► GOVERNMENT (Applies to accounts maintained outside the U.&)
U) 5 Address(number,street,and apt.or suite no.)See instructions. Requester's name and address(optionali
PO BOX 1247
6 City,state,and ZIP code
FRESNO,CA 93715
7 List account number(s)here(optional)
Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid Social security number
backup withholding.For individuals,this is generally your social security number(SSN.However,fora m _am
resident alien,sole proprietor,or disregarded entity,see the instructions for Part I,later.For other _
entities,it is your employer identification number(EIN).if you do not have a number,see How to get a
TIN,later. or
Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and Employer identification number
Number To Give the Requester for guidelines on whose number to enter.
Certification
Under penalties of perjury,I certify that:
1.The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and
2.1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue
Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am
no longer subject to backup withholding;and
3.1 am a U.S.citizen or other U.S.person(defined below);and
4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct.
Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply,For mortgage interest paid,
acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments
other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN,See the instructions for Part II,later.
Sign Signature of t' f�j l j
Hero U.S.person► 1 r �'t�, 1 /{ i � '.�` ��/ Date I- t _., I?
2 AX
/ _ c
General Instructions 1` funds,Form 1099-DIV(dividends,including those from stocks or mutual
Section references are to the Internal Revenue Code unless otherwise .Form 1099-MISC(various types of income,prizes,awards,or gross
noted. proceeds)
Future developments.For the latest information about developments .Form 1099-B(stock or mutual fund sales and certain other
related to Form W-9 and its instructions,such as legislation enacted transactions by brokers)
after they were published,go to www.irs.gov/FormW9.
•Form 1099-S(proceeds from real estate transactions)
Purpose of Form •Form 1099-K(merchant card and third party network transactions)
An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage interest),1098-E(student loan interest),
information return with the IRS must obtain your correct taxpayer 1098-T(tuition)
identification number(TIN)which may be your social security number •Form 1099-C(canceled debt)
(SSN),individual taxpayer identification number(ITIN),adoption .Form 1099-A(acquisition or abandonment of secured property)
taxpayer identification number(ATIN),or employer identification number
(EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident
amount reportable on an information return.Examples of information alien),to provide your correct TIN,
returns include,but are not limited to,the following. If you do not return Form W-9 to the requester with a TIN,you might
•Form 1099-INT(interest earned or paid) be subject to backup withholding.See What is backup withholding,
later.
Cat.No.10231X Form W-9(Rev.10-2018)