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SCO ID: 7120-521587120-A2 <br />STATE OF CALIFORNIA <br />AGREEMENT SUMMARY <br />STD 215 (Rev. 04/2020) <br />OPTIONAL USE <br />18/19 004/415-44150-701 $1,013,128.00 <br />19/20004/415-44150-701 $1,497,722.00 <br />AGREEMENT NUMBER AMENDMENT NUMBER <br />M0113521 1 2 <br />AMOUNT ENCUMBERED BY THIS DOCUMENT <br />$2,510,850.00 <br />AMOUNT ENCUMBERED FOR THIS AGREEMENT <br />I certify upon my own personal knowledge that the budgeted funds for the current TOTAL AMOUNT ENCUMBERED TO DATE <br />budget year are available for the period and purpose of the expenditure stated above. $2,510,850.00 <br />ACCOUNTING OFFICER'S SIGNATURE JACCOUNGG OFFICER'S NAME (Print or Type) I DATE SIGNED <br />AGREEMENT <br />TERM <br />TERM <br />TOTAL COST OF <br />BID, SOLE SOURCE, EXEMPT <br />FROM <br />THROUGH <br />THIS TRANSACTION <br />Original <br />9/1/2019 <br />3/31/2022 <br />$2,510,850.00 <br />NOT BID- Subvention Grant <br />Amendment <br />9/1/2019 <br />3/31/2022 <br />$0.00 <br />NOT BID- Subvention Grant <br />Amendment <br />9/1/2019 <br />3/31/2022 <br />$0.00 <br />NOT BID- Subvention Grant <br />dAmendment <br />TOTAL <br />$2,510,850.00 <br />13. BIDDING METHOD USED <br />Q Request for Proposal (RFP) (Attach justification if secondary method is used) Use of Master Service Agreement <br />n Invitation for Bid (IFB) Q Exempt from Bidding (Give authority for exempt status) LJ Sole Source Contract (Attach STD. 821) <br />Q Other (Explain) CWDB RFA No. 84049 <br />Note: Proof of advertisement in the State Contracts Register or an approved form STD. 821, Contract Advertising Exemption Request, must be attached <br />14. SUMMARY OF BIDS (List of bidders, bid amount and small business status) (If an amendment, sole source, or exempt, leave blank) <br />15. IF AWARD OF AGREEMENT IS TO OTHER THAN THE LOWER BIDDER, EXPLAIN REASON(S) (If an amendment, sole source, or exempt, leave blank) <br />16. WHAT IS THE BASIS FOR DETERMINING THAT THE PRICE OR RATE IS REASONABLE? <br />Research and CWDB RFA No.84049 <br />17a. JUSTIFICATION FOR CONTRACTING OUT (Check one) Contracting out is justified based on Government Code 19130(b). When this box <br />E] Contracting out is based on cost savings per Government Code is checked, a completed JUSTIFICATION - CALIFORNIA CODE OF <br />19130(a). The State Personnel Board has been so notified. REGULATIONS, TITLE 2, SECTION 547.60 must be attached to this document. <br />Not Applicable (Interagency I Public Works I Other ) <br />17b. EMPLOYEE BARGAINING UNIT NOTIFICATION <br />n By checking this box, I hereby certify compliance with Government Code section 19132(b)(1). <br />AUTHORIZED SIGNATURE SIGNER'S NAME (Printor Type) <br />Emily Sunahara <br />rUM HUKCCIVICIV 10 [IN =AI 1C00 Vr . u,uvv. flab lI 1C VIM llf VI IIIU ayl CCI IICIII <br />been reported to the Department of Fair Employment and Housing? 0 No Q Yes [] N/A <br />HAVE CONFLICT OF INTEREST ISSUES BEEN IDENTIFIED AND RESOLVED <br />AS REQUIRED BY THE STATE CONTRACT MANUAL SECTION 7.10? © No Yes NIA <br />FOR CONSULTING AGREEMENTS( bid you review any contractor evaluations on file with the DGS Legal Office? None on file ©No n Yes n( NIA <br />A. Contractor Certification Clauses B. STD 204 Vendor Data Record <br />No 0 Yes [] N/A El No L:J Yes M N/A <br />SIGNED <br />ATTACHED <br />n No (1 Yes n N/A <br />A DISABLED VETERAN BUSINESS <br />CERTIFIED BY DGS? <br />0 No [] Yes <br />SBIDVBE Certification Number: <br />Page 2 of 4 <br />