HomeMy WebLinkAbout32372PROJECT CONTACT INFORMATION
Reci pient Fresno County Sherfl"I Office Gra�Number
Provide 1he rmme, tftla, addrn9, 111epho1W runtier, Mid Hild a� fart,e pn,jed contacta n1mld bal!Mo. NOTE: If ,au UH• PO Box Ndresa, a street lddNn 18 uo Nqllfld for pacage dlllvery llld 1111 visit purpONS.
1.The Pror,cc Q(ppctpr for the project:
Narna: Mlc:haet D. Koop Tltle: Director of Forensic Services
T•phone t: 5592330308 Fad: 6692331149 EmallAddra..: mlchael.koop@fralnosheriff.org
AddrneleilJIZlp: 1256 Dfvfladero. FJNno, CA 93721-1111
2.The Flnanclal Ofllcar for the project:
Mirna: Tom Treater
Telephone f: (569)488,3939 Fld: EmBIIAddrell: Thomaa.�rfff.o,g ----Addme#CIIJIZl p: 2200 Fraano Streat F.raano, CA 93721-1703
3.l'he amgn havlnQ Routln• PrpgDIDDJds reeponllblllty tor the project
Name: Mfc:hael D. Koop nae: DJreclDr ot Fontnalc 8etvlce8
Telephone I: (659)233-0308 Fm: 5592331149 Enw.11 Mb.: mlchaal.kDopOfrasnoaherfff.org
Add....CilJIZlp: 12fi6 Dlvlaadero Fraano, CA 93721-1111
4. The� Rout(o• f'IFlf BIIP9QllbVHy for the pn,Je«
Name: Bruce Roberts 1111,: Senior Account
Telephone t: (5 59)48&-3939
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Fad: EnwlJAddreN: bruce.roberta@frasnoaherffl.org ----Addl'IIIICltylZl�---------�---------------------------------------------
5.The fewfly• Qfr,eptpr of a nonpraftt organization or the Chia( Exp;uaye Offlmr (I.e., Chief of police,superintendent of sehoola) of the lmplementi,g agency:
Name: Margaret Mimi nae: Stwttr-County of Freano
Telep hone,: (!559) 488-3939 Fad: Emall AddrNS: rnargaret.mlms@flaenosherlff.org ----Add....cftylZ!p: 2200 Fr&1no straat.Frasno CA 93721-1111
6.The OffJclll Pt!kJDIW by the Goveml� Boenf to enter ln1D the Grant Award Agreement for the clylcountyor Community-Based Organlzatfon, aa stated In Block 14 of the Grant Award Face Sheet
Name: Stave Forker 11tfe: Admfnlatrative Services Dlrec:IDr -Sheriff
Telephone,: (569) 488-3939 Fm: ·• Email Addrw: a�.forker.cttieenoehertff.org ---'�-:---AddrNIIIC fty /Zip: 2200 Fresno Streat Fraano CA 9312'M 11 �
1.The Sibllr.of the GovfrnJnq Body of the 1'8Cfplent
Tiiie: Chlllrman -----------------------�---------Name: Erneat Buddy Mendes
Tele phone t: (800) 8Q0..600p Fad: Emlll .Addrn9: dlstrrcM@co.fresno.ca.ua
Adcte.Clty�: Hall of Records 2281 Tulare Room #300, Fresno CA 93721
Pmject Cantaat lnrurmdon C.11 OES 2-102 (Rtvleed 7/2013)
I
All appropriate documentation must be maintained on file by the project and available for Cal OES
or public scrutiny upon request. Failure to comply with these requirements may result in
suspension of payments under the grant or termination of the grant or both and the Subrecipient
may be ineligible for subaward of any future grants if the Cal OES determines that any of the
following has occurred: (1) the Subrecipient has made false certification, or (2) violates the
certification by failing to carry out the requirements as noted above.
CERTIFICATION
I, the official named below, am the same individual authorized to sign the Subaward [Section 14 on
Grant Subaward Face Sheet], and hereby swear that I am duly authorized legally to bind the
contractor or grant Subrecipient to the above described certification. I am fully aware that this
certification, executed on the date and in the county below, is made under penalty of perjury under
the laws of the State of California.
Authorized Official's Signature: .J<:::::/ L~
Authorized Official's Typed Name: Steve Forker
Authorized Official's Title: Sheriffs Administrative Services Director
Date Executed: 1/15/2016
Federal Employer ID #: 94-600051 Federal DUNS # 613665769
Current Central Contractor Registration Expiration Date:
Executed in the City/County of: Fresno
AUTHORIZED BY: (not applicable to State agencies)
D City Financial Officer D County Financial Officer
D City Manager D County Manager
[{] Governing Board Chair
Signature: s ;;t-/J ~ ~ ~
Typed Name: Ernest Buddy Mendes
Title: Chairman -Fresno County Board of Supervisors
ATIEST:
BERNICE E. SEIDEL, Clerk
Board of Supervisors
Byk~&sb~
Depu
Certification of Assurance of Compliance-FSIA Cal OES 2-104e (Rev. 11/2015) 8
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1
2
COVERDELL. GR~NT 2015 ($2,744) FY 2015;..16
3 REVIEWED & RECOMMENDED
4
7
8
9'
to
11
FOR APPROVAL .
MARGARET MIMS, Sheriff
12 APPROVED AS TO LtGAL FORM:
13 Dari'iel G. Ced~rborg, County Counsel
14
1.5
16
17
18 APPROVED AS TO ACCOUNTING FORM:
By:
~~~
Ernest Buddy Mendes, Chairman,
B.oard of Supervisors
ATTEST:
Bernice E:. Seidel, Clerk' to the ,
Board of Supervisors
~,~~~0))-~
VICKI CROW, Auditor-Conlroller!Treasurer-Tax Collector
19
'20
21 ss-·~c~
22
23 Fund
Subclass
24 ORG
Account
25
26
21
28
0001
10000
31116339
3575
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