HomeMy WebLinkAboutCA HISPANIC COMISSION ALCOHOL 2
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AGREEMENT TERMINA nON
Please complete this form when the attached agreement is no longer in effect.
Return form to the Sr. Deputy Clerk of the Council (M-30). Call 647-5238 if you have any
questions.
The agreement with (1 tJD6V(;,-I~?lLt. (VO(}lrn/$iOn ,No.A-a023.-.;l51
was completed on ({;- 3(}-~005 ,and final payment has been made.
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Date:
Revised 8-7-03
City of Santa Ana
Clerk of the Council
INSURANCE ON fiLE
WORK MAY PROCEED
UNTIl. INSURANCE EXPIRES
I / - J S ~ 01-
Cl.ERK OF COUNCI.!:. 02
DATE: IJ...-I"! :7
Contract No. A-2003-254
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AGREEMENT UNDER THE WORKFORCE INVESTMENT ACT
THIS AGREEMENT, made and entered into this 1" day of October, 2003, by
and between the City of Santa Ana, a charter city and municipal corporation duly organized and
existing under the Constitution and laws of the State of California ("CITY") and California Hispanic
Commission on Alcohol & Drug Abuse, Inc. ("CONTRACTOR/PROVIDER ").
W-I-T-N-E-S-S-E-T -H
Recitals:
A. CITY has been designated a Local Workforce Investment Area (LWIA) under
the Workforce Investment Act of 1998, Public Law 105-220 ("the Act").
B. The State of California has created the L WIA to administer the Act programs
operated by the State of California pursuant to the Act.
C. As a L WIA, CITY is entitled to receive federal funds to establish programs to
prepare economically disadvantaged youths for entry into the labor market and to provide basic skills
development to those individuals who are economically disadvantaged or otherwise face serious
barriers to succeeding in life. One goal of California's Workforce Investment System is to provide
youth with the opportunities to achieve career goals that will allow them to successfully compete in the
labor market and prepare them for higher education.
D. CONTRACTOR is experienced in operating education, occupational
development and employment programs for economically disadvantaged youths for entry into the labor
market ("said program").
E.
California law.
CONTRACTOR is willing to operate said program pursuant to the Act and
WHEREFORE, for and in consideration of the respective and mutual covenants and
promises hereinafter contained and made, and subject to all the terms and conditions hereof, the parties
hereto do hereby agree as follows:
Page 1 of15
I.
CONTRACTOR'S OBLIGATIONS
A. CONTRACTOR agrees to provide the following services pursuant to said
program, as more specifically set forth in CONTRACTOR'S program narrative contained in "Exhibit
A" as the Proposal. "Exhibit B" as the Program Activity Plan. "Exhibit C" as the Statement of Work,
attached hereto and by this reference incorporated herein:
California Hispanic Commission on Alcohol & Drug Abuse, Inc.
WIA Youth Service / Out-of-School Youth
Fuerzas Unidas Program
CONTRACTOR'S failure to provide said services may be grounds for CITY to readjust
the level of payment to CONTRACTOR otherwise provided for hereinafter.
B. CONTRACTOR agrees to provide benefits to individuals who participate in the
activities and services funded by this Agreement ("participants") in accordance with the standards and
requirements set forth in Workforce Investment Act of 1998, Public Law 105-220. "
C. CONTRACTOR agrees to perform the services set forth herein in a professional,
timely and diligent manner.
D. CONTRACTOR shall provide wages and benefits to individuals who participate
in the activities and services funded by this Agreement ("participants") in accordance with the
standards and requirements of the Act, including Section 181 of the Act.
E. CONTRACTOR shall adhere to the Labor Standards described in the Act
including Section 181 of the Act.
F. CONTRACTOR agrees to comply with the "Complaint Handling Procedures under
the WIA", attached hereto as "Exhibit D" and incorporated herein as though fully set forth in 20 CFR
S667.200, Subpart F. CONTRACTOR shall advise participants of their rights to file complaints under
the Act and the procedures for resolution of any complaints. CITY's procedures for handling
complaints alleging a violation of the Act, regulations, grants, or other agreements under the Act shall
be followed and any decision of CITY, the State or the federal government relating to the complaint
shall be binding and followed by CONTRACTOR. CONTRACTORS who are employers shall
operate a grievance system that incorporates CITY's procedures for resolution of complaints relating to
the terms and conditions of employment; these procedures shall be approved in writing by CITY.
G. As a condition ofthis award of financial assistance under the Act to
CONTRACTOR from CITY, CONTRACTOR assures, with respect to operation of all programs or
activities funded with funds provided pursuant to the Act, and all agreements or arrangements to carry
out such programs or activities, that it will comply fully with the nondiscrimination and equal
opportunity provisions of the Act (Section 188); the Nontraditional Employment for Women Act of
1991; Title VI of the Civil Rights Act of1964, as amended; section 504 of the Rehabilitation Act of
1973, as amended; the Age Discrimination Act of 1975, as amended; the Americans with Disabilities
Act of 1990; and with all applicable requirements imposed by or pursuant to regulations implementing
those laws, including, but not limited to, 29 CFR part 37. The United States, the State of California
and CITY have the right to seek judicial enforcement of this assurance.
Page 2 of 15
H. CONTRACTOR agrees that no participant(s) shall commence training prior to the
approval of funding pursuant to Section 123 of the Act.
1. CONTRACTOR agrees to maintain such records and submit such reports, data and
information, on the form and containing such information, at such times as CITY may request or
require regarding the performance of CONTRACTOR'S services or activities, costs or other data,
including but not limited to, participants' attendance, payroll records and job duty statements.
CONTRACTOR agrees to forward to the SA WC Administrative Office, 1000 East
Santa Ana Blvd., Suite 200, Santa Ana, California 92701 a completed Workforce Investment Act
Enrollment/Registration form (WIA EWIE) within 5 days of approval of WIA Youth Application;
Workforce Investment Act Goals (WIA EWIG) within 15 days of enrollment date; Workforce
Investment Act Exit (WIA EWIT) within 10 days of completion/termination of active enrollment of
trainee; and the Workforce Investment Act Follow-Up Information (WIA EWIF) within 10 days
following 30, 60, 90,180, 270, and 360 days of placement.
CITY, the State of California and the United States government and/or their
representatives shall have access for purposes of monitoring, auditing and examining of
CONTRACTOR'S activities, performance, books, documents, papers, and records of CONTRACTOR
subcontractors, bookkeepers and accountants, and employees and participants related to this
Agreement. Such agencies or representatives shall also schedule on-site monitoring in their discretion.
Monitoring activities may also include, but are not limited to, questioning employees and participants
and entering any premises or onto any site in which any of the services or activities funded hereunder
are conducted or in which any of the records of CONTRACTOR are kept. Nothing herein shall be
construed to require access to any privileged or confidential information as set forth in federal or state
law.
In the event CONTRACTOR does not make the above-referenced documents available
within the City of Santa Ana, California, CONTRACTOR agrees to pay all necessary and reasonable
expenses incurred by CITY in conducting any audit at the location where said records and books of
account are maintained.
All accounting records and evidence pertaining to all costs of CONTRACTOR and all
documents related to this Agreement shall be kept available at the location where CONTRACTOR
conducted the program, as well as in the County of Orange, for the duration of this Agreement and
thereafter for three (3) years after completion of an audit. Records which relate to (a) complaints,
claims, administrative proceedings or litigation arising out of the performance of this Agreement, or (b)
costs and expenses of this Agreement to which CITY, the State of California or the United States
Government take exception, shall be retained beyond the three (3) years until resolution of disposition
of such appeals, litigation, claims, or exceptions.
J. Without prejudice to any other section of this Agreement, CONTRACTOR
shall, where applicable, maintain the confidential nature of information provided to it concerning
participants in accordance with the requirements of federal and state law. Notwithstanding the
foregoing, CONTRACTOR agrees to submit to CITY, the State of California and/or the United States
Government or their representatives, all records requested for administrative purposes, including
audits, examinations, monitoring and verification of records submitted by CONTRACTOR, costs
incurred and services rendered hereunder.
Page 3 of 15
K. CONTRACTOR agrees to complete in triplicate, a monthly InvoiceN oucher on
CITY's InvoicelVoucher form, showing in detail the amount of money already expended by
CONTRACTOR hereunder, as this is a cash reimbursement contract. Accounting records must be
supported by such source documentation such as cancelled checks, paid bills, payrolls, time and
attendance records, contract and subgrant award documents [29 CFR-Subpart C, Section 97.20 (b)(6)].
CONTRACTOR agrees to submit the above-stated documents to the WIB Administrative Office, 1000
East Santa Ana Blvd., Suite 200, Santa Ana, California, 92701, by the tenth (10th) day of the month
following the month in which CONTRACTOR'S services are performed. Should CONTRACTOR fail
to deliver said documents to CITY, CITY shall have the option to cancel this Agreement by giving
CONTRACTOR ten (10) days written notice thereof. CONTRACTOR shall either return to the CITY
excess revenues over costs or use such excess revenues as program income by utilizing such program
income for additional training activities authorized under the Act.
L. CONTRACTOR agrees to expend all funds in accordance with all applicable
federal, state and local laws and regulations. CONTRACTOR also agrees to provide at
CONTRACTOR'S own expense supplies and other costs of said PROGRAM.
M. CONTRACTOR shall arrange independently for an audit that includes WIA
funds received from CITY, in accordance with the Act, 20 CFR Section 667.200 and OMB Circular A-
133. CONTRACTOR shall submit one original of each required audit report to CITY within (30) days
after the date received by CONTRACTOR. Should CONTRACTOR fail to comply with these
requirements, CITY may at its option withhold payment of funds, or disallow funds or suspend
additional grant funds.
N. CONTRACTOR shall not expend funds pursuant to this Agreement to provide
services to any participant where costs of training are paid for by any other person or entity.
O. CONTRACTOR shall comply with the provisions of Circular A-I02 of the U.S.
Office of Management and Budget (OMB) and the related "Common Rule" entitled "Uniform
Administrative Requirements for Grants and Cooperative Agreements to State and Local
Government", Subpart C, paragraphs 37 and 42, Circular A-128, and all other applicable federal
statutes and executive orders and their implementing regulations, including regulations at 29 CFR Part
97.
P. CONTRACTOR shall comply with the requirements of federal regulations
found at 29 CFR 93 which provide that no appropriated funds may be expended by the recipient of a
federal contract, grant, loan or cooperative agreement to pay any person for influencing or attempting
to influence an officer or employee of any agency, member of Congress or an officer or employee of a
member of Congress in connection with awarding of any federal contract, the making of any federal
grant or loan, entering into any cooperative agreement and the extension, renewal, amendment or
modification of any federal contract, grant, loan or cooperative agreement. CONTRACTOR shall sign
a certification to that effect in a form as set forth in "Exhibit E," attached hereto and by this reference
incorporated herein. CONTRACTOR shall submit said signed certification to CITY prior to
performing any of its obligations under this Agreement and prior to any obligation arising on the part
of CITY to pay any sums to CONTRACTOR under the terms and conditions of this Agreement.
Q. CONTRACTOR agrees to provide a drug-free work place and to execute a
certification as set forth in "Exhibit F" attached hereto and incorporated herein by this reference.
R. CONTRACTOR, in accordance with the Child Support Compliance Act,
recognizes and acknowledges the importance of child and family support obligations and shall fully
Page 4 of 15
comply with all state and federal laws relating to child and family support enforcement.
S. CONTRACTOR agrees to comply with all applicable provisions of the ACT and
the federal regulations, including but not limited to the regulations found at 20 CFR part 629.
II.
CITY'S OBLIGATIONS
A. CITY agrees to pay to CONTRACTOR when, if and to the extent federal funds
are received under the provisions of the Act a sum not to exceed Eight-five thousand. one hundred
sixty-two Dollars ($85,162) for CONTRACTOR'S performance in accordance with the payment
schedule attached hereto as "Exhibit G" during the period of this Agreement. Said sum shall be paid
after CITY receives invoices submitted by CONTRACTOR as provided hereinabove.
B. CITY agrees to provide for on-site monitoring reviews of said
program operation at least twice annually. In addition, monthly desk-top reviews of pertinent
information will be conducted.
C. CITY has the right to de-obligate the funds hereunder and take such funding
back from CONTRACTOR due to any of the following reasons: (a) lack of performance by
CONTRACTOR; (b) lack of fiscal accountability of CONTRACTOR; or (c) decrease in available
funding.
III.
TIME PERIOD OF AGREEMENT
This Agreement shall commence on October I, 2003 and all duties arising under this
Agreement shall have been performed by June 30. 2004. The term of this Agreement may be
extended by a writing executed by the Executive Director of the Community Development Agency and
the City Attorney.
IV.
INDEPENDENT CONTRACTOR
Consultant shall, during the entire term of this Agreement, be construed to be an
independent contractor and not an employee of the City. This Agreement is not intended nor shall it be
construed to create an employer-employee relationship, a joint venture relationship, or to allow the
City to exercise discretion or control over the professional manner in which Consultant performs the
services which are the subject matter of this Agreement; however, the services to be provided by
Consultant shall be provided in a manner consistent with all applicable standards and regulations
governing such services. Consultant shall pay all salaries and wages, employer's social security taxes,
unemployment insurance and similar taxes relating to employees and shall be responsible for all
applicable withholding taxes.
Page 5 of 15
V.
WORKER'S COMPENSATION AND EMPLOYER'S RIGHTS
A. CONTRACTOR shall use appropriate funds received from CITY to provide
workers' compensation to all those hired by CONTRACTOR under this Agreement.
B. CONTRACTOR shall have the right to hire, dismiss, or promote its employees
or contract personnel hired under this Agreement so long as its hiring or dismissal policy or standard
does not violate Title VII of the Civil Rights Act of 1964, Fair Labor Standards Act of 1938, or any
other applicable law, and CONTRACTOR maintains itself as an Equal Opportunity employer.
VI.
APPLICABLE GUIDELINES
A. The parties hereto agree that CONTRACTOR shall comply with all applicable
federal and state laws and regulations, including, but not limited to the Performance Standards
(Exhibit B) and general program requirements described in Sections 106 and 141 of the Act (29 USC
Sections 1516 and 1551) and applicable regulations, and the U.S. Department of Labor guidelines and
regulations, including amendments or revisions made during the terms of this Agreement. Said
applicable laws are hereby incorporated by reference and made as part of this Agreement as though
fully set forth herein.
B. CONTRACTOR also assures and certifies that:
1. CONTRACTOR shall comply with Title VII of the Civil Rights Act of
1964 (P.L. 83-354) and in accordance with Title VII of the Act, no person shall, on the grounds of race,
color, religion, sex, age, handicap or national origin be excluded from participation in, be denied the
benefits of, or be otherwise subjected to discrimination under this Agreement.
2. CONTRACTOR shall comply with any and all federal laws limiting the
political activity of employees hired under this Agreement.
3. CONTRACTOR shall comply with the requirements that no program
under the Act shall involve political activities.
4. RECORD INSPECTION. CONTRACTOR shall provide the U.S.
Department of Labor and the Controller General, by and through any authorized representative, as well
as the WIB Administrative Office, access to and the right to examine all records, books, papers or
documents relating to the accounting and use of fimds under this Agreement for a three-year period
from and after the effective date of this Agreement.
5. No person with responsibilities in the operation of any program under the
Act shall discriminate with respect to any program participant or any application for participation in
such program because of race, creed, color, national origin, sex, political affiliation or beliefs.
6. CONTRACTOR shall maintain appropriate standards for health and
safety in work and training situations.
7. CONTRACTOR shall comply with general provisions, assurances, and
Page 6 of 15
certifications attached hereto as "Exhibit H" and incorporated herein.
8. EQUAL OPPORTUNITY. Any literature distributed by CONTRACTOR
for the purpose of apprising businesses, participants, or the general public of its programs under this
Agreement shall state that its programs are supported by the City of Santa Ana and the Santa Ana
Workforce Investment Board, and shall state that the program is an "equal opportunity
employer/program" and that "auxiliary aids and services are available upon request to individuals with
disabilities."
9. CONTRACTOR certifies that all property, finished or unfinished
documents, data, studies and reports prepared or purchased under this Agreement, will be disposed of
in accordance with the direction of the CITY. In addition, any tools and/or equipment furnished to the
CONTRACTOR by the CITY and/or purchased by the CONTRACTOR with funds pursuant to this
Agreement, will be limited to use within the activities outlined in this agreement and will remain the
property of the United States Government and/or CITY. Upon termination of this Agreement,
CONTRACTOR will immediately return such tools and/or equipment to the CITY or dispose of them
in accordance with the direction of the CITY.
10. CONTRACTOR certifies that this Agreement does not provide
for the advancement or aid to any religious sect, church or creed, or sectarian purpose nor does it help
to support or sustain any school, college, university, hospital or other institution controlled by any
religious creed, church, or sectarian denomination, as specified by Article XVI, Section 5, of the
Constitution of the State of California, regarding separation of church and state.
II. PATENT, COPYRIGHTS AND RIGHTS IN DATA. The
CONTRACTOR will disclose to the CITY any invention, written product, computer program
developed or data assembled as a result of performance of work under this Agreement within seventy
four (74) days of invention, development or assembly. The CITY, State of California, and U.S.
Department of Labor will have the right to patent any invention and copyright any written product or
computer program or data generated by CONTRACTOR. Upon written request, CONTRACTOR will
transfer all pertinent information, specifications and right, title and interest to the designated agency.
12. INVENTIONS, PATENTS AND COPYRIGHTS.
A. Reporting Procedure. If any project produces patentable items,patent rights, processes, or
inventions in the course of work under a U.S. Department of Labor (DOL) grant or agreement, the
CONTRACTOR shall report the fact promptly and fully to the CITY. The CITY shall report
the fact to the Grant Officer, at the DOL. Unless there is a prior agreement between the CITY and the
DOL and its representative on these matters, the DOL shall determine whether to seek protection on
the invention or discovery. The DOL and its representative shall determine how the rights
in the invention or discovery, including rights under any patent issued thereon, will be allocated and
administered in order to protect the public interest consistent with the "Govermnental Patent Policy"
(President's Memorandum for Heads of Executive Departments and Agencies, August 23, 1971,
and Statement of Government Patent Policy as printed in 36 FR 16889).
B. Copyright Policy.
I. Unless otherwise provided in the terms of the grant or agreement, when copyright-able
material is developed in the course of or under a DOL Grant or agreement, the author and the CITY
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which developed the work is free to copyright material or to permit others to do so. The
CONTRACTOR and the Workforce Investment Board (WIB) shall have a royalty-free, nonexclusive
and irrevocable license to reproduce, publish, use and to authorize others to use all copyrighted
material.
2. The DOL reserves a royalty-free, nonexclusive, and irrevocable license to reproduce,
publish or otherwise use, and to authorize others to use, for Federal Government purposes: (a) The
copyright in any work developed under any grant, sub-grant, or contract under a grant or sub grant; (b)
Any right of copyright to which a grantee, subgrantee or a CONTRACTOR purchases ownership with
grant support; and (c) CONTRACTOR shall comply with the requirements of29 CFR Part 97.34.
C. Rights to Data. The DOL and the CITY shall have unlimited rights to any data first
procured or delivered under this Agreement.
13. CLEAN AIR / CLEAN WATER ACT. If the grant hereunder exceeds
$100,000, CONTRACTOR must comply with Section 306 of the Clean Air Act [(42 USC I 875(h)];
Section 508 of the Clean Water Act (33 USC 1368); Executive Order 11738 and Environmental
Protection Agency ("EP A") regulations (40 CFR Part 15) as any may now exist or be hereafter
amended. Under these laws and regulations, the CONTRACTOR assures that:
(a) No facility to be utilized in the performance of the proposed grant has been listed
on the EP A List of Violating Facilities;
(b) It will notify CITY prior to award of the receipt of any communication from the
Director, Office of Federal Activities, U.S. EP A, indicating that a facility to be
utilized for the grant is under consideration to be listed on the EP A List of
Violating Facilities;
(c) It will notify the CITY and the EP A about any known violation of the above laws
and regulations.
Page 8 of 15
CONTRACTOR agrees to adhere to the following STANDARDS OF CONDUCT:
I. General Assurance. Every reasonable course of action will be taken by CONTRACTOR in
order to maintain the integrity of this expenditure of public funds and to avoid favoritism. This
Agreement will be administered in an impartial manner, free from errors to gain personal, financial
political gain. CONTRACTOR, its officers and employees, in administering this Agreement, will
avoid situations which give rise to a suggestion that any decision was influenced by prejudice, bias,
special interest or desire for personal gain.
2. Emplovment of Former State or CITY Employees. CONTRACTOR will ensure that any of
its employees who were formerly employed by the State of California or CITY, in a position that
could have enabled such individuals to impact policy regarding or implementation of programs
covered by this Agreement, will not be assigned to any part or phase of the activities conducted
pursuant to this Agreement for a period of not less than two years following the termination of such
employment.
3. Conducting Business Involving Relatives. No relative by blood, adoption or
marriage of any executive or employee of CONTRACTOR will receive favorable treatment when
considered for enrollment in programs provided by, or employment with, CONTRACTOR.
4. Conducting Business Involving Close personal Friends and Associates.
Executives and employees of CONTRACTOR will be particularly aware ofthe varying degrees of
influence that can be exerted by personal friends and associates and, in administering this Agreement,
will exercise due diligence to avoid situations which give rise to an assertion that favorable treatment is
being granted to friends and associates. When it is in the public interest for CONTRACTOR to
conduct business with a friend or associate of an executive or employee of CONTRACTOR, an elected
official in the area or a voting or non-voting member ofthe Workforce Investment Board (WIB), a
permanent record of the transaction will be retained.
5. Avoidance of Conflict of Economic Interest. No executive or employee of
CONTRACTOR elected official in the area, or voting or non-voting member of a WIB, will solicit or
accept money or any other consideration from a third person, for the performance of an act reimbursed
in whole or part by CONTRACTOR or CITY. Supplies, materials, equipment or services purchased
with Agreement funds will be used solely for purposes asserted or allowed under this Agreement. No
voting member of the WIB will cast a vote on the provision of services or vote on any matter which
would provide direct financial benefit to that member or any business or organization which the
member directly represents.
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VII.
HOLD HARMLESS
A. CONTRACTOR shall indemnify and save harmless CITY, its officers, agents
and employees, from and against any and all damages to property or injuries to or death of any person
or persons, including property and employees or agents of CITY, and shall defend, indemnify and save
harmless CITY, its officers, agents and employees, from any and all claims, demands, suits, actions or
proceedings of any kind or nature, including, but not by way of limitation, workers' compensation
claims, resulting from or arising out of the negligent acts, errors or omission of CONTRACTOR, its
employees or subcontractors.
B. CONTRACTOR shall indemnify and save harmless CITY, its officers, agents
and employees, from and against any and all damages to property or injuries to or death of any person
or persons, including property and employees or agents of CITY, and shall defend, indemnify and save
harmless CITY, its officers, agents and employees, from and against any and all claims, demands,
suits, actions or proceedings therefore, resulting from or arising out of the intentional or malicious acts
of CONTRACTOR, its employees or subcontractors.
VIII.
INSURANCE
I. Commercial General Liability. CONTRACTOR agrees to obtain and keep in force
during the term of this Agreement a policy of comprehensive commercial public liability insurance
insuring the State of California, CITY, and CONTRACTOR against any liability for accident, injury or
death arising out of or in consequence of this Agreement. Such insurance shall be in an amount not
less than One Million Dollars ($1,000,000.00) for any injury to or death of any person or persons in
any single accident or occurrence. Said policy of comprehensive public liability insurance shall be
endorsed to provide to CITY and to the State of California, Employment Development Department, at
least thirty (30) days written notice prior to cancellation; name CITY, its officers, agents, employees,
and volunteers, and the State of California, its officers, employees, and volunteers as additional
insured; and state that such coverage is primary to any other coverage or self-insurance of the State of
California and CITY. Governmental entities may substitute a certificate of self-insurance.
2. Automobile Liability Coverage. CONTRACTOR shall also obtain and maintain,
during the effective period of this Agreement, broad form automobile liability coverage with a
$1,000,000 limit unless reduced by CITY, which applies to both owned/leased and non-owned
automobiles used by CONTRACTOR employees or participants in performance of this Agreement, or,
in the event that CITY will not utilize such owned/leased automobiles but intends to require
employees, participants or other agents to utilize their own automobiles in the performance of this
Agreement, CONTRACTOR shall secure and maintain on file from all such employees, participants,
or agents as self-certification of automobile insurance coverage. Governmental entities may substitute
a certificate of self-insurance.
3. Workers' Compensation. If CONTRACTOR is an "employer", as set forth in
California Labor Code Section 3300 et seq., or utilizes participants as "employees," as set forth in
California Labor Code Section 3350 et seq., CONTRACTOR shall obtain and keep in force during the
term of this Agreement full Workers' Compensation insurance coverage for injuries suffered by
participants. Said insurance policy shall guarantee CITY at least thirty (30) days written notice of
Page 100f15
cancellation or modification. CONTRACTOR shall carry medical and accident insurance for those
participants not qualifying as "employees" for Worker's Compensation Coverage, pursuant to
California Labor Code Section 3350, et seq.
4. Equipment Coverage. CONTRACTOR shall purchase a policy or policies of
insurance covering loss or damage to any and all Equipment provided to or purchased by
CONTRACTOR in accordance with this Agreement. Said insurance shall be in the amount of the full
replacement value thereof, providing protection against the classification of fire, extended coverage,
vandalism, malicious mischief, theft, and special extended perils. Governmental entities may
substitute a certificate of self-insurance.
5. ProofofInsurance. A certificates of insurance with a fully executed additional
insured endorsement in substantially the same form as attached hereto as Exhibit I must be submitted
and approved by CITY prior to any work under this Agreement. CONTRACTOR understands that
CITY will make no payments under this Agreement until the required certificates and endorsements
have been approved by CITY.
IX.
CORPORATE STATUS
All corporate CONTRACTORS shall be in good standing, without suspension by the
California Secretary of State, Franchise Tax Board and Internal Revenue Service. Any change in
corporate status or suspension shall be reported immediately to CITY.
X.
ASSIGNABILITY
None of the duties of, or work to be performed by, CONTRACTOR under this Agreement
shall be subcontracted or assigned to any agency, consultant, or person without the prior written
consent of CITY. CONTRACTOR must submit all subcontracts and other agreements that relate to
this Agreement to CITY. No subcontract or assigrunent shall terminate or alter the legal obligations of
CONTRACTOR pursuant to this Agreement.
XI.
LAWS GOVERNING THIS AGREEMENT
In its performance under this Agreement, CONTRACTOR shall fully comply with the
requirements of the following, whether or not otherwise referred to in this Agreement:
I. The Act and all applicable federal statutes, regulations, policies, procedures and directives,
including but not limited to, 20 C.F.R. Parts 652 and 660 through 671.
2. All applicable State statutes, regulations, policies, procedures and directives;
3. All applicable CITY policies, procedures and directives;
4. All applicable local ordinances and requirements, including use permits and licensing;
5. Court orders applicable to its operation; and,
6. The terms and conditions of this Agreement.
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If any of the foregoing is enacted, amended, or revised, CONTRACTOR will comply with
such or will notify CITY after enactment or modification that it cannot so comply. CITY may
thereupon terminate this Agreement, if necessary.
XII.
EXCLUSIVITY AND AMENDMENT OF AGREEMENT
This Agreement supersedes any and all other agreements, either oral or in writing,
between the parties hereto with respect to the employment of CONTRACTOR by CITY, and contains
all the covenants and agreements between the parties with respect to such employment. Each party to
this Agreement acknowledges that no representations, inducements, promises or agreements, orally or
otherwise, have been made by any party, or anyone acting on behalf of any party, which are not
embodied herein, and that no other agreement or amendment hereto shall be effective unless executed
in writing and signed by both CITY and CONTRACTOR.
XIII.
FRAUD
CONTRACTOR shall immediately report to CITY all instances and facts concerning
possible fraud, abuse or criminal activity relating to expenditure or receipt of funds under this
Agreement.
XIV.
CONTINGENCY OF FUNDS
CONTRACTOR acknowledges that approval of and funding for this Agreement is
contingent upon State approval, and funds received or obligated from the State of California to CITY.
If such approval of funds is not forthcoming, or is otherwise limited, CITY shall immediately notify
CONTRACTOR. Within twenty (20) days of receipt of such notice, CONTRACTOR shall modify or
cease operations as directed by CITY and negotiate necessary modification to this Agreement and/or
reimbursement of costs incurred hereunder.
XV.
TERMINATION
This Agreement may be terminated by either party at its sole discretion, upon thirty (30)
days written notice to the other party. Notice shall be deemed served on the date of mailing. However,
CONTRACTOR may not terminate this Agreement if undue hardship will result to any participant.
XVI.
DISPUTES
Except as otherwise provided in this Agreement, any dispute concerning any question
arising under this Agreement shall be decided by CITY. In such a case CITY shall reduce its decision
to writing and mail or otherwise furnish a copy thereof to CONTRACTOR. The decision of the City
shall be final and conclusive unless within thirty (30) calendar days from the mailing or delivery of
such copy, CITY receives from CONTRACTOR written request to appeal said decision.
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Procedures governing the appeal shall be prescribed by CITY and/or the State of
California in accordance with the Act and all corresponding regulations and OMB circulars. Pending
final disposition of the appeal, CONTRACTOR shall act in accordance with CITY's decision unless
the dispute involves a change order.
XVII.
BREACH - SANCTIONS
If, through any cause, CONTRACTOR violates any of the terms and conditions of this
Agreement, and/or prior agreements whereby grant funds were received by CONTRACTOR pursuant
to this Agreement, or if CONTRACTOR reports inaccurately or if any Audit Report makes
disallowances, CONTRACTOR shall promptly remedy its acts or omissions and/or repay CITY all
amounts due CITY as a result of CONTRACTOR's violation. For any such failures or violations,
CITY shall also have the right at its sole discretion to either: (1) discontinue program support until
such time as CONTRACTOR fulfills its obligations or remedies all violations of this agreement or
prior agreements; and/or (2) collect outstanding amounts as determined by CITY due CITY by
offsetting or debiting from current claims or invoices, if after thirty (30) days' written notice
CONTRACTOR has failed to repay same or a repayment schedule has not been made; and/or (3)
terminate this Agreement by giving written notice to CONTRACTOR of such termination in
accordance the notice provision in Paragraph XVIII herein below.
XVIII.
NOTICES
All notices, reports and correspondence between the parties hereto respecting this
Agreement shall be in writing and deposited in the United States Mail, postage prepaid, addressed as
follows:
CITY:
City of Santa Ana
WIB Administrative Office
P.O. Box 1988-M-73
Santa Ana, CA 92702
and,
CLERK:
Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
telefacsimile (714) 647-6956
CONTRACTOR:
Boys & Girls Club of Santa Ana
950 E. Highland Street
Santa Ana, CA 92703
(714) 5652636
Page 13 of 15
XIX.
MERGER
This Agreement, together with the attachments hereto, expresses the total understanding
of the parties. There are no oral understandings of the parties or terms and conditions other than as
stated herein.
xx.
VALIDITY
The invalidity in whole or in part of any provision of this Agreement shall not void or
affect the validity of any other provision of this Agreement.
XXI.
MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature herein below has the power,
authority and right to bind their respective parties to each of the terms of this Agreement, and shall
indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to CITY
in the event that such authority or power is not, in fact, held by the signatory or is withdrawn.
b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in
the body of this Agreement.
Page 14 of 15
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first
above-written.
ATTEST:
CITY OF SANTA ANA, a municipal
corporation of the State of California
"CITY"
/
/--c-2~-e:
1___-._
Patricia E. Healy
Clerk of the Council
L\)
By:
cu~
David N. Ream
City Manager
APPROVED AS TO FORM:
California Hispanic Commission on Alcohol &
Drug Abuse, Inc.
BY: d~ - ;jl';'4
J~' Joseph W. Fletcher
City Attorney
RECOMMEND FOR APPROVAL:
~(~~~
11 John P. R k III
~ Executive irector
Page 150f15
PROGRAM NARRATIVE
Original proposal is included for reference (Exhibit A)
Program Year 2003/04 Work Plan (Exhibit B)
Statement Of Work (Exhibit C)
Supplemental Information
The Santa Ana Youth Council's 2004 Plan is to maintain all providers within the Youth
Service Provider Network delivering the same program as specified in their proposal,
Exhibit A. Therefore a new RFP was not released. In place, providers submitted a
revised Work Plan establishing 2004 Enrollment Goals and Performance Outcomes,
Exhibit B.
EXHIBIT A
Fl!EUZ.\S 'Y~IH\S
Providing Comprehensive Services To Out Of School Latino
Youth Through the Youth Provider Network
l.O. Executive Summary
Both statewide and in the City of Santa Ana. County of Orange, Latino youth
have the highest rate of dropout, the highest probability of low-wage employment, and
the greatest risk of an encounter with the criminal justice system. While such statements
are applicable to all Latino youth, they are particularly descriptive of the status of low-
income Latino youth (ages 19 to 21) who are already out of school. Thus, this program
will serve low-income, Latino youth age 19 to 21. These youth may be school dropouts,
skills deficient, or high school graduates and/or GED recipients. These youth may be
either unemployed and/or employed at minimum wage or below. Approximately 100
percent of the services offered will be directed toward out-of-school Latino youth who
meet one or more of the eligibility criteria - basic literacy skills-deficient (below 8.0),
school dropout; homeless, runaway, or foster child; pregnant or parenting; offender; has
never held a job; is a court/agency referral; has a core GPA of less than 1.5; has been
suspended five or more times; has been expelled; has a learning/developmental
disability; and/or is monolingual.
The proposed comprehensive six-month program with a 12-month follow-up will
directly address several of the WIA elements - tutoring, leadership development,
supportive services, adult mentoring, follow-up services, and comprehensive guidance
and counseling, including A TOD counseling. However, a system of active referrals will
be used to link participants with alternative secondary schools services, summer
employment, paid and unpaid work experience, and occupational skills training. As a
consequence of the participation of out-of-school Latino youth ages 19 to 21 in this
intensive Monday through Saturday, 8:00 am to 7:30 pm, highly structured program, the
out-of-school youth will achieve all WIA Outcome Goals. That is, at the end of one year
70 percent or more of the youth shall have been placed in unsubsidized employment
with an annual earnings gain of $2,580. Approximately 84 percent of the youth placed:::.
will remain employed for a minimum of six months or more, and approximately 50
CHCADA's Response to RFP# PY2002
Page 6
percent of the participants will receive a training certificate from an industry and/or a
recognized provider. The customer satisfaction outcomes will equal 70 percent or higher
for both the youth and their employers. Approximately 60 youth will be served in two
service cycles.
1.1. Main Purpose of the Program
The purpose of Fuerzas Unidas is that of expanding the life opportunities for low-
income, out-of-school youth in Santa Ana by simultaneously addressing the numerous
risk factors that can prevent them from forming and maintaining a long-term relationship
with the labor market. Through the use of comprehensive guidance and counseling,
adult mentoring, supportive services, leadership development opportunities, tutoring,
and employment readiness training, La Familia will renorm the youth regarding the labor
market while simultaneously linking the youth to employment training, La Familia will
also link 99 percent of the youth to jobs after the completion of their training.
The accomplishments of the program will be directly measured by the degree to
which each WIA goal is met. More specifically, La Familia's goal is that of ensuring that
70 percent or more of the youth are trained and placed in employment that pays $8,00
or more per hour by their completion of the six-month program, with a one-year follow-
up, However, the adult mentoring component will last for one year. The ratio of adult
interaction to WIA participants for the structured workshops will be one (1) adult to every
15 youth. The mentoring program will have a ratio of two adults to four youth. The WIA
participant will have adult interaction with La Familia's staff at least six times per week.
Interaction with mentors will occur at least twice per month.
1.2. Goals/Objectives and Performance Levels
Figure 1 below provides expanded performance goals for this program. It also
includes process objectives for each of the identified outcomes.
J;'i ure 1: Goals and Ob'ectives
The followin em 10 ment-related oals and ob'ectives will be achieved:
Overall Goal: To retain 60 or more low-income, out-of-school youth through the entire training program
and place 99% of these youth in jobs that pay $8,00 per hour or higher and/or in a fulltime college
ro ram,
Outcome Ob 'ective #1: To recruit, assess, and face 60 unem 10 ed outh over the eriod of one ear.
CHCADA's Response to RFP# PY2002
Page 7
Figure 1: Goals and Oh.iectives
r Process Objective 1: Slrengthen linkages with the Youth Provider Network by referring lhe participants
to other partners for services;
r Process Objective 2 Create marketing materials about the program and distribute them in areas that
are centers of population for out-of-school Latino youth;
r Process Objective 3 Work closely with parents to recruit the unemployed children into the program;
r Process Objective 4 Refer approximately 90% of unemployed parents of the youth to other training
programs; and
r Process Objective 5 Ensure that approximately 200 youth are recruited in order to retain 60 eligible
outh.
Outcome Objective #2: Place approximately 80% of youth who complete the program into jobs that pay
$8.00 er hour or more.
r Process Objective 1: Utilize a full-time job development counselor to create a continuous flow of work
opportunities 100% of the time;
r Process Objective 2: Add at least ten employers as secondary partners in this effort; and
r Process Objective 3: Market and educate at least 50 new employers in order to increase their
rece tivit to hirin oun, inex erienced, low-income outh.
Outcome Ob'ective #3: Ensure that at least 80% of outh laced retain the;r 'obs for six months or more.
';> Process Objective 1: Provide job retention counseling to 100% of the youth placed in jobs; and
';> Process Objective 2: Assist 90% or more of the youth to enroll in educational programs and work-
related courses.
Outcome Objective #4: Approximately 30% of the youth will experience a wage gain of 60% or more from
ro ram be innin to ro ram com letion.
';> Process Objective 1: Approximately 30% of the negotiated wages will include performance-related
increases; and
';> Process Objective 2: Approximately 90% of the youth will be trained to deliver high performance
services so that the robabilit of wa e ain is elevated.
Outcome Objective #5: Approximately 70% of youth who did not graduate from high school will be enrolled
in aGED ro ram.
Outcome Objective #6: Approximately 30% of youth with a high school diploma will enroll in a program 01
hi her education.
As mentioned, approximately 60 youth will be served per year through this
program. The specific WIA program elements that La Familia will offer have been
summarized in Figure 2 below.
Fi ure 2: WIA Pro ram Elements that La Familia Will Offer
. Comprehensive Guidance and Counseling - All participanls will complete an intensive assessment of
psychological and social functioning. Based upon this assessment, each youth will be provided general
counseling, life work counseling, occupational counseling, and, as required, mental health and/or
substance abuse counseling.
. Adult Mentoring - The risks that characterize the participants in this program will be many. Some of the
target group will already be parents. Others may engage in at-risk sexual behaviors while still others may
be members of gangs. One strategy that simultaneously reduces risk in multiple areas is mentoring.
However, CHCADA will apply a unique small group mentoring model that consists of one adult male and
one adult female and four out-of-school youth. This extended family model is highly effective with
CHCADA's Response to RFP# PY2002
Page 8
Fi urc 2: WIA Pro ram Elcmcnts that La Familia Will Offer
Latinos.
. Leadership Development Opportunities - The youth will participate in a common community
subprogram as a part of the leadership development component. In addition to the inclusion of
leadership skills in the workshops that will be offered, CHCADA will also utilize youlh as part of our
outreach team and as part of the prevention teams in other Orange County programs.
. Tutoring - Literacy and mathematics skills are critical to our target group. Similar differentials exist in
terms of mathematics skills. Thus, one of the workshops offered will involve tutorials in literacy and
mathematics. The parents of the youth will also be referred to the adult literacy programs offered by
other providers.
. Supportive Services - CHCADA will provide a broad range of supportive services so that each youth's
chance of programmatic success is enhanced. Child care, transportation, health care referrals and
support in other basic need areas will be made available through the services of a fulltime case
manager.
. Follow-up Services - An intensive follow-up program will be offered after the completion of the initial six
months. The Phase I follow-up period will include weekly attendance at group meetings where day-to-
day job occurrences can be discussed. At the end of the first six-month period, monthly sessions will be
held. The follow-up will also include weekly telephone interviews with employers for the first month and
monthly follow-up with employer for the next six months.
. Work Readiness Activities - Every activity offered will be focused upon the development of work
readiness skills.
. Referrals to Other Network Providers and One-Stops for Job Training - Both in Santa Ana and
nationwide, One-Stops tend to be under-subscribed. A critical service that will be provided is that of
bringing the youth into a relationship with the short-term job training programs and apprenticeships
available through One-Stops.
. Job Development and Placement - A primary service that will be offered is the identification of
em 10 ers who will artici ate in this ro ram. A fulltime Job Develo er will offer these services.
While all youth will participate in the core services offered given the intensity of
need among low-income, Latino, out-of-school youth in this age group, services will be
customized to meet the unique needs of each youth. In order to address individual
needs, an intensive screening and assessment will take place. The tools listed in Figure
3 below will be used.
Fi urc 3: Assessmcnt Areas
D Screening for Substance Use and General Functioning
Youth Addiction Severity Index
D Screening for Literacy and Math Skills
D Mental Health Screening
D Occu ationallnterests
CHCADA's Response to RFP# PY2002
Page 9
Figurc 3: Asscssmcnt A,'eas
D Occupational Skills
. Skillcheck
o Other
An intensive program of recruitment will take place. CHCADA will engage in
extensive outreach activities. Currently, outreach services are conducted through three
strategic approaches First, our contracts with local institutions including juvenile courts,
probation departments, church youth groups, and family preservation projects serve as
a primary source of youth clients. Second, we use trained youth outreach workers to
introduce the services to the community, stimulate their interest, and encourage
individuals in need of our services to participate. Third, we encourage walk-ins by
directing our outreach workers to distribute carefully designed printed materials at
shopping malls, parks, recreational areas, and other places where youth tend to
congregate. Brochures, posters, and buttons will also disseminated at these locations.
Because our selected outreach workers are intimately familiar with the demographics of
the targeted community, the existing agencies that serve youth, and the social world of
the community, CHCADA's outreach workers are in an optimal position to conduct
grassroots outreach efforts for this program as well. While we utilize print materials and
mailings to youth-based organizations, our outreach workers also schedule
appointments directly with school officials, heads of youth service CBOs, etc. and utilize
person-to-person and group sessions to arrange referrals to our programs. According to
several reports, these measures are among the most effective methods of delivering
outreach services to the community youth.1
y Direct Mailings - CHCADA has a database of other service providers, faith
institutions, schools, and other community organizations. We will send out
direct mailings to these organizations.
y Special Print Materials - Special print materials will be designed to inform
the youth and their parents/guardians about the program. We will also make
these materials available to schools, youth programs, and other providers
who serve youth.
I Friedman, Alfred S. et al.. 1985, op.cit.
CHCADA's Response to RFP# PY2002
Page 10
Figure 4 below summarized specific strategies that will be included as part of the
generalized outreach effort.
Figure 4: Outreach Strateqies
DIRECT OUTREACH WILL INCLUDE:
. Visits to parks, laundromats, markets, mini-malls, street corners and other places frequented by youth in the
targeted service areas;
. Literature produced in English and Spanish will be distributed to families informing them about our services
and/or inviting them to participate in informal focus groups about their lifestyles; and
. During visits to our sites, youth and adults will gather for group discussions and workshops that offer an
opportunity for "word-of-mouth: outreach about our program.
OUR COMPREHENSIVE OUTREACH CAMPAIGN WILL CONSIST OF:
. Marketing to youth in the County of Orange - We will develop colorful flyers informing youth of the
services provided by CHCADA. These flyers will be sent home with youth from the schools in the area;
. Marketing to adults and parents in order to excite an interest among the potential participants about
the numerous activities - In order to accomplish this task, the Project Director may arrange to speak at
convocations Whenever possible, a "celebrity" artist, i.e., actor, musician, dancer, visual artist, etc. will
accompany the Project Director; and
. Marketing to youth and their families in the community in order to ensure participation. Public
service announcements, telephone outreach to parents, and print media are used to accomplish this
marketing objective.
OUTREACH SUPPORT PROVIDED BY COMMUNITY-BASED ORGANIZATIONS ICBO) AND OTHER LOCAL INSTITUTIONS WILL
INCLUDE:
. Low-Income housing-related CBOs, which oftentimes serve as unofficial hubs for other groups;
. CBOs operating programs that bring them in direct contact with youth will be contacted to determine their
willingness to post flyers, placards, and/or distribute materials about our efforts; and
. Faith institutions that may allow some of their members to serve as volunteers and participants in outreach
efforts.
Through the above plan, a successful outreach effort will be sustained and
strengthened. Additionally, the described activities will begin to generate a word-of-
mouth discussion about the services that will be available through this program.
However, CHCADA expects this aspect of the campaign to generate a low "yield"
relative to youth who call and/or apply at a site for services. In this regard, CHCADA will
launch a specialized campaign that will be designed to be highly effective in meeting the
needs of youth who have never before received our services. This outreach strategy will
consist of several components.
Outrcach to Social Services lInd Other Puhlic Agencies - CHCADA currently
conducts outreach to Social Services and other public agencies. CHCADA's outreach staff will
meet with key personnel from these agencies in order to increase the number of youth referrals to
our program.
CHCADA's Response to RFP# PY2002
Page 11
-I
Outreach to Substance Abuse and Mental Health Treatment Programs -CHCADA
will develop a brochure, posters and fliers, a database of substance abuse treatment and mental
health programs in the targeted areas and conduct an intensive mail and e-mail outreach campaign
to these programs.
Through the above component, CHCADA's outreach goals will be met.
The services that will be offered will meet WIA performance standards by
providing the level of direction of psychosocial support that out-of-school youth need to
reach the "breakthrough" point that will allow them to alter the course of their lives.
CHCADA will, through the services offered, provide a platform that is facilitative to goal
achievement.
The entire program will be highly ritualized. Youth accepted into each class of 30
will participate in a formal ceremony at which they sign a Pledge to alter the course of
their lives. At the completion of the first six months and at least six months of the one-
year follow-up period, youth will formally graduate and receive a certificate of
completion. They will also receive certificates from the training programs to which they
are referred.
Continuous improvement will be assured through several processes. The Project
Director will meet weekly with the counselors to determine the status of their work,
problems encountered, solutions to any issues, and anticipated work schedules for the
coming week. A general overview of future requirements will also be discussed. The
goals of these reviews will be to ensure that performance standards are achieved,
ensure that the client and employer satisfaction is high, to inform the Project Director of
the overall task status, and provide a problem-solving forum. There will be a standard
agenda that covers all key areas. CHCADA will also conduct a quarterly internal
program review with the program staff. This review will involve the Project Director
preparing a project overview briefing for senior management. Key personnel will also be
invited to participate. The Project Director will prepare a program review, highlighting
current and future work efforts, staffing, technical issues, near and long-term events. A
major component of these quarterly reviews will be to perform a total quality assurance
assessment of the program. CHCADA's Senior Management will develop
recommendations for improving the overall quality and efficiency of the project. A free
exchange of ideas and constructive evaluation by all team members will be encouraged.
CHCADA's Response to RFP# PY2002
Page 12
CHCADA has found that these periodic reviews build trust and a cooperative spirit
among all personnel and can ensure efficiency and avoid duplicative effort. All
evaluative research and input on each client will be kept in their files.
1.3. Program Description
The schedule of services that CHCADA will offer to the youth as a part of the
Youth Service Provider Network will be designed to synergistically address the
interactive needs of the participants. Thus, while each of the WIA elements identified
have been included, they have been integrated into a holistic program that can, over a
period of six months, address the full range of factors that serve as barriers to low-
income, Latino out-of-school youth obtaining and maintaining employment that pays a
"living wage."
Utilizing best practices from a range of fields, CHCADA has designed a program
that is inclusive of services to address risk factors that directly and/or indirectly affect
the levels of out-of-school youth. For example, the design of the program includes
counseling support in order to strengthen the youth's resilience in key areas. Likewise,
because weakened or fragile familial relationships often correspond with dysfunctional
behavior, the program also includes training in parenting skills for the youth's parents.
Because the level of stress experienced by the youth and subsequently, his/her
vulnerability to socially dysfunctional behavior, can be reduced by addressing material
needs, case management support and referral services are mandatory under this
programmatic design.
Given the criticality of investment in human capital in the youth's ability to
achieve economic independence, services that strengthen the youth's linkages to WIA
training and/or traditional education are required. Given the positive outcomes that
have occurred with at-risk youth through the application of one-on-one mentoring, this
program design also includes mandatory mentoring as a mechanism for extending the
support systems available to the youth. In order to diminish the involvement and/or
relnvolvement of youth in the alternative and illegal economic system, the program
design also mandates the provision of job preparation, career planning, and job
retention skills both directly or through referrals to other providers in the youth network.
CHCADA's Response to RFP# PY2002
Page 13
..,
Given an emerging body of research that documents the effectiveness of faith-based
social interventions, the program design also provides faith activities as an option to
participating youth and their families. Because some participants will have unique needs
that are associated with their foster care status, special services must be made
available to assist these youth in transitioning from a camp into independent living.
Finally, frequent meetings with parents will be provided as a follow-up to the parenting
training. These meetings will reinforce the parents' role and responsibilities to their
youth.
CHCADA's proposed program, Fuerzas Unidas, includes all of the programmatic
components outlined in the RFP application. Additionally, we will integrate into the core
services several new elements based upon our experience in working with out-of-school
youth. All of the above programmatic components have been tested and retested In
CHCADA's other prevention/intervention programs with low-income, Latino youth.
Task 1: Designate a Program Manager
Preliminary to the process of service delivery will be the creation of an
organizational structure that will facilitate service delivery. A Project Manager will be a
key component of CHCADA's service delivery mechanisms. This full time CHCADA
employee will perform duties and activities such as those summarized in Figure 5
below.
Fi!!nre 5: Duties and ResDonsibilities of the Proiect Mana!!er
Under the direction of the Project Director, the Project Manager will:
. Coordinate and schedule all services provided by CHCADA's staff;
. Be physically present at each site when services are being provided;
. Train CHCADA's staff regarding policies, procedures, and regulations at each site;
. Participate in monthly meetings with CHCADA's Project Director, the WIA Youth
Network and other key entities;
. Meet with Youth Provider Network members on an as-needed basis;
. Remain informed regarding all youth in the program;
. Intake other youth in collaboration with other Network members;
. Observe youth and make case notes based upon the observational data as part of
the assessment process;
CHCADA's Response to RFP# PY2002
Page 14
. Provide input to CHCADA's service team regarding the service mix and intensity of
services required by each youth;
. Make logistical arrangements associated with the provision of services to youth by
other Network members, i.e., transportation, service location, etc.;
. Maintain inventories of materials and items needed for service delivery;
. Serve as a counselor; and
. Complete other duties as requested by CHCADA's Project Director, WIA, and lor the
youth and hislher family.
The Project Manager for this position will be Ms. Maureen K. Amaya. The Project
Manager's qualifications include each item listed in Figure 6 below.
Fi ure 6: Re uired Qualifications ofPro'ect Mana
'.' An Associate's Degree in a Social Services area;
':' Two or more years in a youth program;
.:' One or more years of experience with at-risk youth;
.:' Two or more years of experience as a youth counselor;
.:' Bilingual/Bicultural in English and Spanish; and
'.' Skilled in the use of Microsoft EXCEL and/or another data mana
Task 2: Aid in the Collection, Maintenance, Storage, Retrieval, and Reporting
of Applicable Data to WIA
With the support of the entire counseling team, the Project Manager will also
assume another important duty - that of serving as Data Management Coordinator for
all participants who receive the W1A ten core services from CHCADA andlor other
Youth Network members, In the role of Data Management Coordinator, the Project
Manager will perform all duties and responsibilities listed in Figure 7 below.
. Ensure that CHCAOA reserves copies of all files for all youth admitted to the program;
. Complete all CHCADA Intake Forms for the participants and enter these into the juveniles'
files:
. Create document control numbers for each file and related alphanumerical coded control
numbers for each document in each tile;
. Inventory youth files monthly to ensurc completeness:
. Maintain 10 s of all CHCADA stall visits servicc contacts;
CHCADA's Response to RFP# PY2002
Page 15
-I
. Creatc a record of all files and their documents in a Microsol1 Access database and upload
softcopy with attachments to CIICADA's file repository [llr the youth;
. Recall and/or verify all outstanding hard copy files;
. Maintain hard copy files fl)r the participants arranged in alphanumeric sequence at
CI-JCADA's administrative sitc far the program;
. Eliminate or avoid duplicate controlnumbcrs;
. Perform periodic audits to ensure the accuracy of each file relative to the softcopy repository;
. Maintain distribution logs for all records retricved;
. Handle, store, protect and control documentation throughout the life cyclc ofthe program;
and
. Other duties as assigned by the Project Director.
Task 3: Collaborate With Youth }Jroyidcr Nctworl{
In addition to managing the files of participants, the Project Manager will maintain
data on the number of participants, entry and exit date from the program, services
received, problems encountered, problem resolution strategies, and on other areas.
CHCADA will utilize data collection forms required by the Youth Provider Network
and/or customized instruments designed by CHCADA.
Task 4: Establish a Process that Ensures the Timely Submission of Case and
Activity/Service Data from other Network Providers
All internal CHCADA service providers will provide weekly data on the services
and service units provided as a prerequisite to the receipt of paychecks. Services
provided by other Network members will also be closely tracked. CHCADA's
Counselor/Case Manager, with the support of the other staff, will schedule all service
appointments. These appointments will be logged. We will then call the provider to
confirm that the participant and/or his/her family kept the appointment. This information
will be entered into a Service Data Form. Additionally, CHCADA will give multiple copies
of the Service Data Form to all Network providers to whom the youth will be regularly
referred. The form will be faxed to CHCADA's office each time youth and/or their family
receive services.
CHCADA's Response to RFP# PY2002
Page 16
-I
Task 5: [)rovide an AJlJlnlved Monthly ReJlort to the County that Descr'ibes
and Summarizes CHCADA's Activities
If the Youth Network provides an MIS form that will be used across service
providers on this contract, CHCADA will comply with its use. If not, CHCADA will create
an automated Activity Report for submission monthly with a brief narrative The report
will include all information listed in Figure 8 below.
Fi ure 8: CHCADA's Monthl 'Re ort
The monthly reports will cover all areas listed below:
. Number of youth served;
. Type and number of units of scrvice provided to youth;
. Type and number of units of service provided to the parents;
. Case Management and referral activities completed on behalf of the youth;
. Problems encountered and how resolved; and
. Other data.
Task 6: ImJllement Program
As the service provider for this program, CHCADA will offer primary group
counseling, mentoring, tutoring, leadership development, support services, follow-up
services, employment readiness support, and other services from our La Familia
program in Orange County.
GENERAL CHARACTERISTICS:
. CI-lCADA will schedule at least 300 minute-per-day for the youth to participate in a training
program through the Youth Network and/or an educational program;
. CHCADA will utilize unique pedagogics that nevertheless reflect the program's employment
focus, For example, for some youth we may use an aJis and drama focus, i.e., the youth may
be asked to stage a psychodrama that highlights how to avoid gang involvement and/or
prepare posters and artwork that reveals positivc aspects of their family relationships.
Likewise, youth may be asked to write a short story about the dangers of gang involvement.
CHCADA will meet the counseling and leadership development requirements by
providing two-hour group sessions/mini courses each day on key topics. Each group
session/mini course will have no more than 15 participants. CHCADA's curriculum for
the program will include thirteen (13) courses - ten (10) core courses and three (3)
specialized courses that will have relevance for the selected youth. Figure 10 below lists
the group counseling/mini courses that will be offered.
CHCADA's Response to RFP# PY2002
Page 17
~
Figurc HI: Program Rcquircmcnts -GrouJl Counscling Scssions/Mini Courscs
THE 10 GROUP COUNSELING SESSIONS/MINI COURSES ARE:
. Fuerzas Unidas: A Program Overview
. That Ihing Called School: School Readiness and Vocational Nccds
. Interpersonal Skills: Improving Family Skills
( Session for Youth (1 Hour)
() Scssion for Youth and Their Parents (1 Hour)
. Uncovering My Histol)!, Uncovering !l1ysell Heritage, Cultural Diversity and Conflict
Resolution
. Saying NO! to Gangs: Avoiding Gang Involvement
. Constructing a Behavioral Guidance S)istem: Developing Needed Life Skills
. I Need a Job!: Analyzing Your Marketing Offering and .Job Preparation
. Anger Management Being Violence-Frce
. The Ball is in MY Court- And it '.I' Going to Stay There ,: Being Substance-Free
. Your Personal Growth Plan
SPECIALIZED GROUP COUNSELING SESSIONSIMINI COURSES
. Parenting Skills for Teen Parents
. The Meaning and Responsibility of Emancipation: Transitioning to Foster Care or
Emancipation
. Am I A Woman? Gender Specific Issues For Girls
. To Be A Man: Gender Specific Issues For Boys
In order to provide the above sessions/courses, CHCADA will utilize the site
support listed in Figure 11 below.
Figure 11: CHCADA's Site Requirements
CHCADA's site requirements will include:
. Use of a space that can comfortably seat the] 5 youth and which is small enough to promote
dialogic sharing;
. A vailable audio/visual equipment for the films and videos;
. Space for meeting with the youth for additional discussions and session follow-up;
. Chalkboards;
. Access to computers; and
Other equipment and materials.
In addition to the provision of service at La Familia, CHCADA will also offer
community-based services to youth and their families at other community sites. The
services that CHCADA will provide at these sites are listed in Figure 12 below.
.
Figure 12: Other Scrviccs to bc Providcd at La Familia and/or Othcr Community Sitcs
Active Case Managcment in enrolling each participant into a community school and/or
vocational program within 24 hours ofthcir intake into tbe program;
CHCADA's Response to RFP# PY2002
Page t8
-I
Fi!'ure 12: Other Services to he Provided at La Familia and/or Other Community Sites
. Monitoring school/vocational program attendance on a daily basis during the first four weeks
aller enrollment, hi-weekly during month two and wcckly during month three;
. Identifying academic tutoring as rcquesled to address acadcmic problems;
. Promoting the involvement of the youth in work or playas a means ofbeller integrating them
into the workplace environment;
. Encouraging parents to allend PTA meetings and other school activities;
. Provide continuing career counseling to the youth, including follow-up counseling;
. Providing substance abuse treatment/recovery and/or prevention activities for youth who
require such services;
. Within 48 hours of their intakc, actively place youth in health programs, mental hcalth
program, literacy programs, etc., as necdcd;
. Before and after program completion, actively assist the families of the youth in accessing
other services as needed;
. Within two days of intake, hold an orientation meeting that reiterates areas covered in the
group counseling/mini courses with cach youth;
. Identify paired male/female adult mentors, train mentors, pair them with three to four youth,
and hold two ha]j~hour sessions per week per participant begirming within 48 hours of intake;
· Provide job-readiness training onsite at La Familia and through referrals to appropriate One-
Stops;
. Provide job development support directly and through refelTa]s to One-Stops;
. I.Iost collective faith-based activities at least thrce times over the 120-day program for youth
and families who wish to participate;
. Link youth who wish to participate with faith-based programs in their neighborhoods through
direct contacts with the faith leaders;
. Provide leadership opportunities for youth;
. Meet with families within the home environment at least four (4) times over the course of the
program;
. Link the families and mentors with low-cost recreation at least once a week; and
. Complete other activities needed to fully engage the youth.
In the next section we describe the methodologies that will be applied in the
delivery of the full range of services offered.
TllSk 7: Providing G.'oup Workshops/Counseling Senices
The California Hispanic Commission on Alcohol and Drug Abuse, Inc. (CHCADA)
currently has tested curriculum and course materials in each of the service areas
CHCADA's Response to RFP# PY2002
Page 19
outlined in the previous section. Additionally, through our extensive experience with low-
income, at-risk youth, we have also developed workshop delivery methods that are
highly effective with our target market For example, CHCADA's counselors will follow
guidelines such as those In Figure 13 below In delivering the group
counseling/workshop sessions.
Fil!ure 13: Leading Group Counseling Sessions with At-Risk Youth
Utilize exercises to allow the youth to feel comfortable in thc group;
Introduce an overall hamework for the topic before opcning the floor to discussion;
Ask questions during the conceptual overview as part of the cngagement process;
Utilize vivid imagery and hard data in order to force the youth to consider the costs of
dysfunctional bchavior and the importance of labor market participation;
Do not prcach, or pass judgment, etc.;
Apply directive counscling;
Listen to the youth;
Move the discussion along a logical progression in small sequences so that by the end of the
counseling sessions, the workshop's objectives can be achieved; and
Others.
.
.
.
.
.
.
.
.
.
The above guidelines are illustrative and not exhaustive.
The contents of the group sessions will, as mentioned, cover a broad range of
topics. Each subsection below includes the proposed syllabus for each of the proposed
workshops.
Core Course #1: The Fuerzas Un/lias Pro!!ram: All Overview
1. COURSE DESCRIPTION
This introductory workshop will serve as an orientation for the youth to the WIA
program. It will define the purpose of the program, goals and objectives, strategies, intake
processes, and thc program components.
11. Course Objectives
After completing this session, each participant will be able to:
,f List four or more benefits that will accrue to themselves and their families from the
receipt of services through Fuerzos Un/dos;
,f Review printcd materials on Fuerzas Unidos and summarize all services that they and
their parcnts will rcccive;
,f Identify anticipated barriers to their full participation;
,f Articulate lactors that led to their joblessness;
,f Outline their fears and apprehensions regarding their future;
,f Complete all input and additional assessmcnts for their participation; and
,f Provide a sell~assessment of the support(s) needed.
Ill. Course Orientation
This first workshop will be highly intcractive. The objective ofCI-ICADA's staff will be
that of generating cxcitement aboullhc program.
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Core Course #1: The FuerZlls Ul1idllS PI'O ram: An Overview
IV. Course Activities
During the first half-hour, the youth will introducc thcmselves and describe key
circumstances to their lives. The second two hours will be dedicated to lntake and Assessment.
The last hour of thc session will consist of a rcview of all printed materials about the program
and its components. The scssion will culminate with a signed contract betwecn the youth and
CHCADA's FlIcrzas Unidas staff.
Core Course #2: That Thill" Clllled EdllClllioll ~ Education Readiness and Vocational Needs
1. COURSE DESCRIPTION
The youth in the program should have spent 30 to 35 of their waking hours each week in
an educational institution. This course will bc designed to inform the participants regarding the
specific role that education plays or can play in their lives. These units will be designed to
encourage the youth to examine their interpersonal relationships with their education and to
identify factors in the educational environment that may contribute to their problems. These
sessions will also allow the youth to identify barriers within their environment that serve as
impediments to their efforts to be productive.
II. Course Objectives
After completing this session, each pal1icipant will be able to:
./ Compare and contrast the differences in income and earnings of persons by educational
lcvel;
./ Compare and contrast differences in marriage and divorce rates by educational level;
./ Compare and contrast differences in mortality and morbidity rates by educational level;
./ Compare and contrast differences in rates of reportcd happiness and life satisfaction by
educational level;
./ List other dilTerences in lifc outcomes by educational level;
./ Extract ii'om within themselves their "true" feelings about education;
./ Identify and describe the experience within the educational environment that helped to
shape thcse feelings;
./ Describe what the youth feel about their future;
./ Write a Personal Education Plan that outlines what their educational objectives are and
how these will be achieved.
./ Collect applications and catalogs so that they can begin learning about the application
process; and
./ Begun to disassociate education from their particular experiences at their school.
UI. Course Activities
CHCADA will invite a Professor of Labor Economics or a Human Resources Manager to
give a presentation to the participants on the benefits of investing in human capital. The
obJective of this activity is that of convincing the youth that independently of what they may
think of school, cducation is an instrumcnt of change, growth, and improvement. The activities
in this segment must also emphasizc that education is even more important to minorities than it is
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Core Course #2: Tllalntill!: Called Edllcal;oll- Education Readincss and Vocational Needs
to the majority population. Thus. we will invite some Latino and other minority speakers who
have excclled in the world of higher education. In ordcr to achievc the described objectives, we
use the questions below to guide the discussion.
Did you like school?
Why or why nor)
1I0w prevalent is/was drug use among students at your school~
I-low prevalent is/was drug trafficking at your school?
,~' What percentage of your friends and associates from your school engaged in criminal behavior
according to your best estimation?
Did your teachers seem to truly care about you?
Did the counselors at your school appcar to truly care about you?
Did YOll feel that the school officials favor some groups of students over other groups?
What were your extracurricular activities?
If YOtl have none, why not?
Ho\v many OfYOll had an "A" average? A "B" average? A "C" average? A ""D" or lower
average?
What could have helped your academic performance?
Do you feel that the Fuerzas Unidas Program is helpful?
What are your educational goals?
What are your career goals?
How do you plan to achieve them?
'_ What can this program do to help you achieve these goals?
The areas listed above will also be covered with the youth on an individualized basis. CI-ICADA
will ensure that all participants are always treated like "royalty" so that their already-fragile self-
esteem will be strengthened.
Core Course #3: Illter ersollal Skills: 1m
1. COURSE DESCRIPTION
Family interaction is a primary interpersonal relationship. And, indeed, the participant
camlot truly advance his/her individual status without the application of therapeutic assistance to
the whole of his/her family. The individual counseling time slots will be subdivided into
individual family groups and individual sessions. This temporary structure will allow the
counselor to more easily cover a subject that is broad in scope and simultaneously quickly carry
thematic issues from Forum to Family Group to the participant. All family members have
interacted with each other by using poor intcrpersonal skills from time to time. Parents have not
always been there flw their children and children have failed to meet parental expectations.
Siblings havc sometimes competed with each other rather than provide much needed support and
understanding. The purposc of this course is that of allowing jamily members to point out to
each other behaviors that have caused them pain.
II. COURSE OBJECTIVES
After completing this session, each participant will be able to:
. Define family and describe the historic role that the family has played in Latino and other cultures:
. Family as a source of socialization and acculturation;
. Family as a source of companionshi ;
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Core Course #3: Interpersonal Skills: Imnrovin!! Fmnily Skills
. Family as a source orrole modeling;
. Family as a source of genetic predisposition~
. Family as a social support s~\'stell1; and
. Family as a source of material and economic support.
. Identify the patlerns of social .interaction that prevail in the individuars families;
. List the numerous ways in which their criminal behavior has affectcd the family;
. Identify specific enabling behavioral patlerns that exist in their individual families; and
. List hov.1 future social interactions with individual families can be augmented.
III. COllRSE ACTIVITIES
Counselors may wish to invite scveral speakers who cover a large body ofresearch-based
conceptual information about family in general and family in Latino culture in particular. After
the lecture, the Forum will be subdivided into the participants who are 111 the same
Mentor/Mentee groups and their family members for the initial discussions. These group
sessions will primarily involve remnllScence about happy family times. During the
individualized Camily treatment sessions, critical family issues will be discussed. These will
place a burden on the counselor to create an emotional, yet fact-based, experience that assists the
re-knitting process and leads to the permanent adoption of cooperation and accommodation
within the family unit.
Core Course #4: Uncovering My History, Uncovering Myse!/: Heritage, Cultural Diversity and
Conflict Resolution
1. COllRSE DESCRIPTION
Youth are sometimes alienated from the labor market in response to numerous forces in
the external environment. This module is designed to begin uncovering the external forces that
adversely affect the participants.
II. Course Objectives
After completing this session, each participant will be able to:
. Describe how their racial/etlmicity affects their self-concept;
. Outline how they feel others respond to them because of their ethnic heritage;
. Synthesize any linkages between their criminal behavior and feelings and responses to their
ethnicity;
. List, discuss and summarize the lives often ethnic role models who overcame ethnic barriers
and accomplished their lifc goals;
. List key facts about the socioeconomic status of various Spanish-speaking subgroups in the
United States; and
. Other social interactions with individual families can be augmented.
Ill. COllRSE ACTIVITIES
Therc is a popular adage that says "Onc must never criticize another until one has walked
ten steps in the other's moccasins." This course and thc corresponding activities are designed to
bettcr undcrstand the rocky road trod and the nature of the moccasins worn by each Fuerzas
Unidas participant. It IS important to usc this session to allow the participants to begin
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~I
,
Core Course #4: Uncovering l'rl.y ]listory, Vllc(wering Myse(f: Heritagc~ Cultural Diversity and
Conflict Resolntion
articulating their feelings because as they discuss their thoughts with the group, they will gain
insight into themselves and how tbcy perceive tbemselves as lilting into the broader society.
However, it is important that tbc counselor not allow a "victim" framework to color the
di scussion. Emphasize choices, decision-making, and options as tbe directed discussion occurs.
Consider using a role-play in which the youtb present switcb etbnicity so tbat they can begin to
perceive themselves through others' eyes
Core Course #5: SaFilll' NO! to GallI's: Avuidin!' Gall!' Involvement
I. COURSE DESCRIPTION
For some youth in the program, the primary social support group may be a gang. This
course is designed to sUPPOli the youtb in the process of extricating themselves from their gang
affiliations so tbat they can enter into the labor market.
II. COURSE OB.JECTlVES
After completing this scssion, each participant will be able to:
0 Describe the history and growth of "gangs" within the United States;
0 Outline barriers encountered in attempting to separatc themselves from their gang
affiliations:
0 Identify other suppOli needed to fully "Say NO to Gangs;" and
0 Assess the costs and benefits of continued affiliation with gangs.
III. COURSE ACTIVITIES
Activities will include a presentation by a member of the criminal justice system who has
specialized expertise with gangs; a group discussion regarding problems associated with leaving
gangs; individual counseling regarding gang affiliations; and a strategizing session with the
youth and their family regarding the issues covered.
Core Course #6: COllstructill!! a Behavioral Guidallce SI'stem: Develoninl! Needed Life Skills
I. COURSE DESCRIPTIO1\"
These scssions involve working closely and tediously with the youth to prod them toward
greater progress. This course is designed to introduce tbe participants to choice behavior and
assist them in constructing their own behavioral guidance system. When one begins discussing a
behavioral guidance system, the Issue of decision-making inevitably anses. Resisting
compulsion; remaining distant 11'om friends and peers who continue to use demonstrate criminal
bebavior; and changing one's attitudes and behaviors towards friends and family, require that
decisions be made. These units are designcd to strengthen the participants' decision-making
skills.
II. COURSE OB.JECTlVES
After completing this session, each jJarticipant will be able to:
CHCADA's Response to RFP# PY2002 Page 24
Core Course #6: COllstructi",! i/ Belllll'ioral Guidi/lice S"stem: Develolliu!! Needed Life 81<ills
. Discuss how decision-making relates to a behavioral guidance system;
. Define the concept of decision-making;
. Explain why a non-decision is a decision;
. Discuss decision-making through dcl~lUlt;
. Describc how research can support the decision-making process;
. Compare and contrast high-involvement and low-involvement decision-making; and
. Outline and discuss each step in the decision-making process.
III. COURSE ACTIVITIES
After establishing where decision-making skills fit into the larger program, the counselor
may wish to cover each area in the objectives through a lecture. First, however, hold a guided
discussion about the youth's decision-making process. As the final activity, create some
alternative scenarios that require individual decision-making. Require each participant to go
through each step that they used in order to make the decision.
Core Course #7: I Need i/ Job!: Analyzing Your Marketing Offering and Job Preparation
A Life Skills A roach to Findin and Kee lin a Job
I. COURSE DESCRIPTION
The youth unemployment rate, even under conditions of prosperity, is always double the
rate that prevails amongst adults. Additionally, for Latino and African American youth, the
disparities are even greater. Thus, while an objective of the program is that of increasing
employment among participants who are old enough for employment, Fucrzas Unidas staff are
aware of the fact that such a goal will encounter difficulties. First, the lower-income urban
neighborhoods in which the youth live may hold few opportunities for legitimate employment.
Second, the youth themselves may have adopted behavioral styles that do not reflect those
compatible with the overall labor market workplace culture. Third, the youth may be poorly
equipped for employment relative to saleable skills. Fourth, as numerous economic studies
continue to document, an employment/wage differential that suggests the operation of
discriminatory practices continues to exist. This unit is designed to teach the youth teclmiques
that can support them in finding employment in spite of the existence of the described barriers.
II. COURSE OU,IECTIVES
After cOl11plcting this session, each participant will bc able to:
[;2] List at least six (6) factors that can adversely affect their search for part-time employment;
[;2] Write a "We Can Overcome" Plan to outline how each factor will be addressed;
[;2] Complete a skills audit in order to identify skills that can be used in ajob search;
[;2] Identify occupational areas that are compatible with their skills;
[;2] Access employment opp0l1unities tlu'ough newspapers, employment agencies, word-oJ~
mouth, and by using web sites;
[;2] Writc a cover letter for his/her application and resume;
[;2] Complete a job application and/or crcate a resume;
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Core Course #7: I Need a .lob!: Analyzing Vonr Marketing Offering and .lob Preparation
A Life Skills Approach to Finding lllld Keeping l\ Job
[;'] Role-playa telephonc call to a prospective employer;
[;'] Demonstrate knowlcdge of how to drcss for an interview;
[;'] Demonstrate interviewing techniques; and
[;'] Be hired for a part-time job that pays minimum wage or bctler.
Ill. COllRSE ACTIVITIES
A number of activities will be used to support this course. For example, an employer
from CHCADA's Friends of the Youth will be invited to speak to the youth regarding what
employees look for in an applicant. Additionally, occupational skill-testing will be conducted in
order to discover jobs for which the youth qualify. Youth will also spend time reviewing and
discussing job opportunities identificd through the newspapcrs. The participants will also
complete a newspaper and an electronic search for employment oppOliunities. Role-playing will
be used to prepare the youth [or interviews. Finally, each participant will go on a job interview or
a "mock" interview and share the experience with the group. Youth will also repOli on their
training programs.
Core Course #8: Beinf! Violent-Free: A/wer Ma/laf!ement
1. COURSE DESCRtPTION
"Anger" is defined as "an emotional state that varies in intensity from mild irritation to
intense fury and rage." However, it is also a physiological state that can cause blood pressure to
rise and adrenaline flow to heighten. One in five Americans has an anger management problem.
In this course, we will explore the identification of types of anger and anger management
techniques.
II. COllRSE OBJECTIVES
The objective of this unit is to identify the signs of the onset of anger. Potentially volatile
situations can be avoided by identification and behavior modification.
III. COURSE ACTIVITIES
In this unit, pmiicipants will learn to identify situations that could lead to angry confrontation.
They will answer questions such as those I isted in the figure below to identify when angry
feelings are most likely to occur.
Characteristics of Mv Anger:
. I was last angry when
. I am always angry when
. I seem to get angry most at
. When I am angry, 1
. After I get angry I feel
By answering the above questions, the participant can more easily idcntify situations in
which they are most likely to become angry. Participants will also be asked to "draw" what they
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Core Course #8: Beinf! Violent-Free: Anf!eI" Manaf!ement
think anger looks like. Does it have a face? Shape? Spccific color? Now that we have identj lied
the kinds of anger, let us identify the signs of angcL There are many signs that either takcn alone
or with each othcr, can indicate that an angry cpisode is looming. Some of these signs are listed
below.
Signs of Anger
. Head. stomach and backachcs
. Rapid speech
. Screaming aud Yelling
. Sarcasm or criticism
. Fantasies of revenge
. Avoidance of others
. Thoughts of drinking or using drugs
. Isolation
. Becoming violent
. Compulsive behavior
. Becoming silent or withdrawn
. Becoming argumentative
While there are a myriad of signs of anger, the signs listed above are the most common
and could well indicate that anger is present or imminent.
Core Course #9: Substance Abuse: The Abyss of Addiction - I am a Drug User, but the Ball
is in Mv Court
, 1. COllRSE DESCRIPTION
This is the course in which substance abuse counselors literally begin the drug treatment
component in substance abuse programs. Before the youth can begin to "grow" toward recovery,
his/her interpsychic attitudes about chemical use must be extricated. The youth must consciously
and verbally acknowledge that he/she is in an abyss that can/will lead to self-destruction and that
he/shc wants to begin ascending from this abyss. This course session should be focused upon the
youth's honestly and openly addressing whether there is a true desire for change.
II. COllRSE OBJECTIVES
After completing this session, each patiicipant will be able to:
. Openly discuss their drug-using bchavior~
. Describe their own use stage;
. Identify factors that correlate with their drug use~
. List the antecedents of a specific incident of drug-using behavior;
. Share how their drug use led to their assignment to the drug comi;
. Relate their drug use to their "crimes"
III. COURSE ACTIVITIES
The counselor will utilize directed counseling and facilitation skills to create an intense
period of sharing. The objective of this looscly managed discussion is to allow the youth to
begin to conf1'ont and analyzc his/her behavior. Youth with dependencics will be referred to
CI-ICADA's youth substance abuse treatment program.
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Core Course #lU: YOUI' Pel'sOI;ol G/'Owtlt PIIIII: Devcloninl!: Intra-ncrsonal Skills
1. COURSE Ih:sCRIPTlON
One arca of emotional growth that lags in at-risk youth is the area of intra-personal skills.
Unemployed persons olten anger quickly. Thcy also exhibit impatience and other traits that
reduce intra-personal effectiveness. This unit is designed to allow the youth to improve his/her
relationship with himself or herself.
II. COURSE OIl.JECTIVES
After completing this session, each participant will be ablc to:
o Assess and improve their degrce of sell~discipline;
o Assess and improve their degree of self-control;
o Engage in regular and continuing self-assessment;
o Adopt and embrace the value of honesty; and
o Elevate their ability to cope with stress.
III. COURSE ACTIVITIES
This session will consist of all role-plays. Role-plays will be used to allow the youth to
explore their intra-personal skills in each area listed in below.
. SELF-DISCIPLINE - Self-discipline involves the applying of skills to get things done which
need to be done and done in a timely manner. Get the youth to role-playa situation
involving procrastination. Then teach them to write daily TO-DO lists.
. SELF-CONTROL - Self-control involves the youth's ability to personally manage different
aspects of his/her life including language, dress, appearance, sexual behavior, and abstinence
from criminal behavior. Self-control also references the youth's ability to display
appropriate behavior in relationships.
. SELF-ASSESSMENT - The youth must learn to introspect, identify their personal feelings in
each situation, and learn to manage them. Self-assessment also involves the youth learning
about their own personal talents and strengths, and verbally recognizing their weaknesses and
mistakes. Only then can the youth define realistic goals and objectives. This unit will allow
the youth to revisit their Asset and Liability plans from the unit on self-esteem and to begin
to engage in sell~assessment as a routine component of their lives.
. HONESTY - Honesty is critical. The youth must be trained to be totally and brutally honest
with themselves first and with others second. A workable activity that can be used is a board
game such as Scruplcs. Coping with stress is so broad that it will be covered in the next unit.
Again, this is a session that will include parents, siblings, and friends so that the youth's
social circle is included.
T:lsk 8: Parcnting Skills Development for Parcnts of thc Youth
Independently of family structure, parenting styles that are supportive of the
positive development of youth can be adopted. Oekovic and Janssens (1992) found that
youth who were reared by parents who offer a controlled environment, engage in clear
CHCADA's Response to RFP# PY2002
Page 28
communications, provide nurturance, and guide their children into age-appropriate
behavior, have better developmental outcomes than children reared using authoritarian
or permissive parenting styles2 Children reared by highly demanding parents who
require instant obedience and utilize severe punishments may rear children with low
self-esteem, an absence of confidence, and who are at risk of rebellion3 In contrast,
permissive or indifferent parents - parents who are not interested in their children's life,
disproportionately rear children who are impulsive, aggressive, and less than
responsible4 Such youth also display low self-reliance, low self-control and low
maturity5 Parents who are characterized by low income, migrant status, and other
special characteristics also experience unique child-rearing problems. In this regard,
CHCADA will provide parenting skills training for the parents of youth participating in
Fuerzas Unidas.
The curriculum that will be used for this course is the highly regarded Parenting
Skills Workshop Series.6 Figure 14 below summarizes some of the topics that will be
covered in this curriculum.
Figure 14: Sample Topics to be Covered in the Parenting Skills Classes
Fi ve Core Skills that are taught tbrough this curriculum are:
I} Encouragement - Fosters self-esteem and builds trust between parent and child;
2) Can-Do - A guidance technique tbat teaches parents to teach children what types of
behaviors are acceptable;
J) Choices - Builds on these skills by encouraging parents and youth to work together to solve
problems and make decisions;
4) Sclf Control- An anger management skill for adults; and
5) Rcspectinl! Feelings - An empathy building skill.
These skills become routine through the structured leadership process.
As mentioned, CHCADA has several sites in the targeted service area. The Parenting
Skills Development workshop will include 15 sets of parents and/or guardians per
session. Classes will meet for 1-1/2 hours once per week for 12 weeks. CHCADA will
also provide each administrative service listed in Figure 15 below.
~ Dekovic, M. & Janssens, J., Parents' Child-Rearing Style and Child's Sociometric Status. Develonmental
Psychology, 28, PI'. 925-932, 1992.
3 BaumrincL D., Familial Antecedents of Social Competence in Middle Childhood, unpublished manuscript, 1986.
~ Santrock, J. and Yussen, S., Child DeveloJJll1cnt, Dubuque, lA, Wm. C. Srolll, 1992.
) ibid
6 Wilkins, S.E., Robin, E.P, and Potter, N.B, Parenting Skills Workshop Series, Innovations in Community and
Rural Development, Cornell Community and Rural Development Institute, December 1995.
CHCADA's Response to RFP# PY2002
Page 29
Figure 15: Administratin Tasks Associated with the Par-entin" Skills Trainin.?:.
CIICADA will:
. Case manage thc services provided to the youth and coordinate them with those provided to
the parent:
. Asscss overall needs of each family aftcr the first parenting workshop and ensure that the
parents receive case management support and referrals;
. Maintain documentation of parental participation in not only the parenting class but in case
management as well:
. Provide to the Network a written assessment not only of the parent's progress in improving
parental skills, but of the overall familial network as a social support to the youth with
recommendations lor remediation strategies;
. Provide a "Graduation" ceremony for parents completing the parenting training at which timc
parents will receive a copy ofthe Certificate of Completion;
. Utilize the "graduation" as an opportunity to formally and ceremonially prepare parents to
support their youth; and
. Schedule workshops, work with the Network, counselors, mentors, etc. in preparing parents
to support youth.
Task 9: Provide Mentorjng and Othet' Services
Most youth will complete the program and reenter the precise social-economic
environment that initially served as an incubator for their dysfunctional behavior. Thus,
initiatives that create cognitive change are needed so that the youth, confronted with
choice, will alter the direction of their decision-making and their behavior. The
mentorship program will be designed to achieve such an outcome. However, the youth
and their families will need support in negotiating relationships with the labor market and
other institutions so that needed services can be accessed. Last, the youth will be
monitored and guided along a new behavioral trajectory. In order to facilitate these
outcomes, the services in the subsections below will be provided.
9.1. Provide Services as Deyeloped in Each Youth's Case Plan
CHCADA will complete a comprehensive assessment of the youth's mental,
emotional, social, health, academic, and other needs. Utilizing structured assessment
tools, interviews with the youth's family and schools, observational data gathered by the
counselors, and self-reported information, CHCADA's staff will provide a Case Plan.
This plan will serve as a road map to the provision of customized services to the youth.
CHCADA's Project Director, Project Manager, the youth's assigned Counselor, the
youth's Mentor, the Counselor/Case Manager, and the Counselor/Job Developer will
CHCADA's Response to RFP# PY2002
Page 30
hold periodic meetings to review the Case Plan for all youth assigned to Fuerzas
Un/das. While the entire team will support each case, a Counselor will be assigned to
the youth based upon the youth's needs. For example, youth with strong job
development needs will be assigned to the Counselor/Job Developer. Youth with a
multiplicity of case management needs will be assigned to the Counselor/Case
Manager. Youth with pressing mental health needs will be assigned to the Project
DirectorlTherapist Because the entire team will provide onsite group counseling
services, CHCADA's continuity requirements will be met However, all of CHCADA's
counseling team will review the Case Plan and make recommendations regarding the
customization of services to respond to the identified needs. These meetings will be
held once weekly throughout the course of the program. During the initial meeting,
however, appropriate service providers will be discussed and selected based upon the
youth's needs. The counselor will meet each selected service provider and make
arrangements for the youth's inclusion in the selected program of services. Regular
verbal and written feedback will be provided to the counselor regarding the youth.
9.2. Provide Services as Deyeloped in the Case Plan
In spite of the emphasis upon skills rather than education triggered by the
technological revolution, education remains the primary engine and conduit for
economic advancement Thus, immediately reconnecting the youth to an educational
institution as well as to training will be a primary service that each counselor will
complete. However, CHCADA is also aware of the high incidence of the working poor
that characterizes the families of a number of the youth who will participate in this
program. Observing the experiences of their parents can lead the youth to lose
confidence in the ability of mainstream economic institutions to address their material
needs. Thus, whether enrolling the youth into a community school and/or a vocational
program, the Counselor will meet with each youth on a regular basis. Then, using
occupational projections from the Department of Labor, they will assist the youth in
selecting potential careers in occupational areas that can, even during periods of
economic decline, ultimately provide them with an above-poverty lifestyle.
The Counselor will also go to a school or employer with the youth and make all
arrangements for the youth's enrollment and/or hiring. Through this advanced planning,
CHCADA's Response to RFP# PY2002
Page 31
the youth will, within 24 hours of intake, be enrolled in an appropriately selected
educational institution and/or training program and will begin the pursuit of an
appropriate career.
Because the first day on the job or back in school can be a defining moment for
the youth, the Counselor will schedule a meeting with the youth immediately after the
day has ended. The Counselor, in a one-on-one counseling session, will seek to
determine the youth's affective and experiential responses to the very important first
day. After the meeting with the youth, the Counselor will also hold an in-home meeting
with the youth's family. CHCADA will also, through the youth prevention network,
attempt to identify at least two cross-age mentors so that the youth will not feel awkward
and/or excluded.
CHCADA will also, through volunteers, ensure that each youth has a work
wardrobe that is clean, neat and current so that they will not be subjected to the ridicule
of their peers. CHCADA shall have also held a meeting with each of the youth's
employers to encourage them to adopt a welcoming attitude toward all Fuerzas Unidas
participants.
The Counselor will meet with the youth who become employed at least once
more during the first week of their release. However, contact will be made by phone on
every single day during this period. Contact will also be made with the youth's
employers by phone at least weekly during the 120-day program. However, during the
first two weeks after the youth's entry into the labor market or school, CHCADA will
work diligently to ensure that the participant "catches up" vocationally or academically,
does not "fall behind," and has access to support when problems emerge.
9.3. Support and Assist the Youth's Access to Referral Services
Within seven (7) days of contract award, CHCADA's staff will update its database
of Network providers who offer youth-specific services in the Santa Ana area.
CHCADA's case management referral database will then be used to download youth-
based providers by type of services offered and location. As is always true, CHCADA
does not add new providers to our referral database without completing not only a
review of their written literature, but a site visit as well. Our provider database will allow
us to match youth with the health, mental health, literacy, anger management, gang
CHCADA's Response to RFP# PY2002
Page 32
intervention, and/or other services needed by type of program, geographic area, age,
and culture-based factors. The identification of service providers will begin upon receipt
of the Case Plan. Within 48 hours of the youth's intake, the youth will be "enrolled" in a
training program and/or school.
9.4. Meet Individually with Each Youth to Proyidc Mentoring, Guidance, and
Advocacy
Whether the mentoring relationship occurs through natural or planned processes,
sustained interactions through youth of all ethnicities and committed adults can create
positive and enduring results7 Recent data from an evaluation of the nationwide
personal development mentoring programs operated by Big Brothers/Big Sisters
document astounding outcomes. Youth who participated in a sustained mentoring
relationship were 46 percent less likely to use illicit substances, 53 percent less likely to
have unauthorized absences from school. and 27 percent less likely to consume alcohol
than their similarly-positioned peers who were unmentored. Still another study of the
outcomes associated with mentoring among Big Sisters of Central Indiana indicates that
160 of 200 mentored juvenile offenders did not experience another arrest within the
timeframe of the studyB Similarly, a study of the Baltimore mentoring effort, PROJECT
RAISE, discovered that a continuous and intensive mentoring effort can increase school
attendance and improve grades in English9 Other studies have found that youth
mentored over a long-term period:
. Experience heightened life goals and expectations;
. Become more interested in completing high school and, in some cases, going to
college;
. Are less prone toward violent behavior;
. Report feelings of increased confidence;
. Demonstrate augmented personal skills;
7 Flaxman, E.and C. Ascher, Mentorinl2. in Action. New Yark Institute for Urban and Minority Education, Teachers
College, Columbia University, 1997.
8 Flaxman, E., Evaluating Mcntoring Programs. New York lnstitute for Urban and Minority Education, Teachers
College, Columbia University, 1992.
9 McPartland. James M. and Saundra M. Nettles, "Using Community Adults as Advocates on Mentors for At-Risk
Middle School Students. ^ Two-Year Evaluation of Project Raise," American Journal of Education, 199], 99(4),
pp.568-86.
CHCADA's Response to RFP# PY2002
Page 33
. Are less likely to engage in early sexual activity and/or to become pregnant; and
. Experience improved human relations skills when interacting with adults as well as
their peers.
Thus, researchers have confirmed what parents and grandparents have instinctively
known: children, youth, and young adults require guidance, emotional and social
support, and general assistance in gaining the life skills needed for survival.
Given the above discussion, it can be seen that the mentoring component is one
of the most important aspects of this program. As mentioned, CHCADA will schedule
the first Counselor/Mentor/Mentee meeting with the youth within 24 hours of intake.
While the minimum number of sessions is two per month mentors will be instructed to
meet with the youth additional hours during the first two weeks after intake since these
are the most critical in the transition process.
9.5. Support and Assist the Youth with Job Preparation, Career Planning, Job
Placement and Job Retention Skills
CHCADA's Counselor/Job Developer and the Counselor/Case Manager will work
together in ensuring that all youth access employment and training through the
appropriately located One-Stops.
9.6. Assist in Creating Linkages to Faith-Based Organizations
CHCADA will, for families interested in faith services, directly introduce the youth
and their families to the faith leaders and ensure that they are welcomed by the
members of each referred institution. We will particularly make referrals to faith-based
institutions that also offer supportive social services including additional family
counseling.
9.7. Assist Foster Youth in Going into the Independent Living and
Emancipation Progl'ams
Foster youth are disproportionately represented among out-of-school youth.
These youth have higher rates of teen pregnancies, a higher prevalence and incidence
of substance abuse, and are generally at greater risk than their colleagues who live with
one or both parents. However, cognizant of such social realities, a range of services
CHCADA's Response to RFP# PY2002
Page 34
unique to the needs of this target group is available. CHCADA will include specialized
case management/referral services for these youth.
9.S. Meet with Families in Their Homes to Snpport Setting Limits, Pwviding
Adequate Supervision, Ete.
The Parenting Skills workshops offered before release from the camps alone are
insufficient to alter the parenting behavior of the children's parents and/or guardians.
Thus, CHCADA's counselors will meet with the parent of their assigned mentee on a
monthly basis to review progress in altering parenting styles, identify ongoing problems
with the youth and offer input relative to the management of these problems, and to
discuss the overall progress of the youth As required, at least four (4) in-home
meetings will occur with the parents of each youth. As previously mentioned, CHCADA
will also schedule four (4) group sessions with the younger and older siblings of the
youth.
Finally, CHCADA's staff will maintain attendance books/sign-in sheets on all of
the above activities. Copies of these documents will be forwarded to the Network. At the
conclusion of the program, a narrative report will be forwarded to the County of Orange
that documents the youth and his/her family's participation in all required and non-
required programmatic components, assesses the youth's progress relative to the Case
Plan, and makes recommendations regarding additional interventions. Again, at the end
of the program, a formal graduation ceremony will be scheduled and Certificates of
Completion/ Attendance will be awarded.
1.4. Staffing Plan
CHCADA has designed a highly efficient staffing plan to support this contract.
This plan is summarized in Figure 16 below.
Figure J(" Staffing Plan
Project Director - A Master's-level Project Director will oversee this Project.
Approximately 10 percent ofthe Project Dircctor's time will be directed toward this project.
Project Manager/Counselor - Responsibility for day-to-day project activities will be
assigned to a 100 percent Project Manager/Counselor.
CHCADA's Response to RFP# PY2002
Page 35
Figurc ] 6: Staffing Plan
. Onc 100 percent-time Counselor/Outreach Worker will also be assigned to this program.
. One 100 percent-time Counselor/Casc Manager will be assigned to thc program.
. One 100 percent-time Counselor/.lob Developer will be assigned to the program.
. An Administroative Assistant will be assigned (50'X,-time) to this projcct and will provide
support to the counsclors in data collection and storage, file maintenancc, and report
completion.
1.5. Facilities
Approximately 80 percent of services will be offered from CHCADA's La Familia
Family Center, located at 1910 Bush Street in Santa Ana, California. As mentioned,
however, services will also be offered from selected sites within the community. All sites
will be approved as safe before the scheduling of activities.
1.6. Ahout... CHCADA
CHCADA, a highly respected organization, has a 27-year history of service to
youth and a 15-year history of service in Santa Ana. CHCADA currently offers
prevention services to youth in several areas. Our evaluation reports confirm our
success rate. CHCADA has an internal Research, Evaluation and Program
Development Division that tracks our success.
I. 7. Experience
It is highly acknowledged that there is no substitute for organizational and/or staff
experience. The California Hispanic Commission on Alcohol and Drug Abuse, Inc.
brings to this project more than 27 years of experience in the planning, design,
implementation, management, and assessment of programs of prevention/intervention
for at-risk families. Additionally, CHCADA's expertise is so extensive and its capability
so exceptional that through the Latino Training Institute, we have provided startup,
program design and development, and training and technical assistance to more than
150 other programs for at-risk families throughout the State of California. Additionally,
the Latino Training Institute provides a wide range of courses that allow social services
agency staff to become certified in areas such as assessrnent; case management and
referrals; individual, group, and family in-home and onsite counseling; mentoring; job
development and employment training; anger management;; preventing gang
CHCADA's Response to RFP# PY2002
Page 36
involvement; etc. Through our newly organized Faith Institute, CHCADA provides
training and technical assistance in areas such as those listed above to faith leaders
from throughout the country.
All of our youth programs have achieved programmatic goals. All of our youth
programs incorporate parents. CHCADA employs a quality improvement program that is
based upon continual review and service monitoring.
1.8. Fiscal Capacity
CHCADA utilizes a highly sophisticated electronic system to capture and report
fiscal data. Financial statements have been included as requested.
1.9. Subcontracting
CHCADA will refer youth to the One-Stops for occupational training. These costs
will be covered by the service providers.
1.10. SUMMARY
CHCADA is pleased to submit this proposal. We look forward to service initiation.
CHCADA's Response to RFP# PY2002
Page 37
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EXHIBIT C
STATEMENT OF WORK
Scope of Work. City hereby engages Provider as an independent contractor
to perform the following described work, and Provider hereby agrees to
perform said work upon the terms and conditions here-in-after set forth.
A. Specifically, Provider shall perform the following services:
1. Provider shall recruit their own participants within a reasonable
amount of time to allow for full delivery of program services as
specified in the Work Plan.
2. Provider shall assess each participant using a standardized
assessment tool within thirty (30) days of enrollment. If
assessment supports a Basic Skills deficiency, reading and math
must be the first service to be delivered to participant.
3. Provider shall identify through prescribed assessment which of
the ten elements as noted below will be prescribed for each
participant. Chosen elements will be noted in each participant's
Individual Service Strategy (ISS). Services needed but not
provided by Provider must be coordinated with the Service
Navigator and other youth partners.
The ten W1A elements are:
a. Tutoring, study skills and instruction leading to
completion of secondary school, including dropout
prevention strategies;
b. Alternative secondary school services, as appropriate;
Summer employment opportunities directly linked to
academic and occupational learning;
c. Paid and unpaid work experiences including OJT, job
shadowing and internships as appropriate;
d. Occupational skills training as appropriate;
e. Leadership development opportunities, which may
include community service and peer-centered activities
encouraging responsibility and other positive social
behaviors during non-school hours as appropriate;
J
,
f. Supportive services (linkages to community services,
transportation, childcare, housing, medical referrals,
uniforms or other appropriate work attire and/or tools;
g. Adult mentoring for a duration of at least 12 months,
(may occur both during and after program participation);
h. Follow-up services for not less than 12 months after the
completion of participation;
i. Comprehensive guidance and counseling, which may
include pregnancy prevention, drug and alcohol abuse,
counseling and referrals, as appropriate.
4. Provider shall establish at least one goal for each participant as
related to the elements identified in their 155. If the participant
is deficient in basic reading and/or math skills, one prirnary goal
must be for basic skills and must be the first service provided.
Goals are to be based on appropriate age standards and entered
in participant's 155.
5. Provider shall maintain and share with other Youth partners the
Individual Service Strategy (155) for each participant from time
of enrollment through and including twelve (12) months after
he/she is exited from the program.
6. Provider shall review program objectives with participant using
one-to-one method. At a minimum. review must include the
following information:
a. Program goals and objectives
b. Length of program period
c. Complaint handling procedures
d. Available supportive services
e. Anticipated exit date
f. Available services at the Santa Ana WORK Center
g. Follow-up phone calls & documentation requests
7. Provider shall provide participant services in accordance with
the program schedule and curriculum attached hereto as the
program proposal and Work Plan (Exhibit A & B). Neither the
program schedule nor curriculum may be altered in any way
during the term of this agreement, without prior written
approval given to Provider by the Santa Ana WIB Youth
Council.
.
8. Provider shall follow and abide by the proposal submitted and
approved by the Santa Ana Workforce Investment Board Youth
Council. Any changes to the proposal must be submitted in
writing to the Santa Ana WIB Youth Council for consideration.
9. Provider shall maintain daily, weekly, and monthly classroom
and internship training time and attendance records for all
participants. Copies of attendance records shall be placed in
participant's file upon completion of program.
10. Provider shall maintain individualized case management records
and shall make these records available for review and
inspection upon request by City staff. All such records shall
remain otherwise confidential and shall be kept in a form
approved by The Santa Ana WIB Youth Council.
11. Full completion of the program and its elements shall be defined
as and determined by individual participant attainment of the
learning objectives and demonstrated achievement of the
standards for evaluation listed in the training curriculum verified
and approved by the Santa Ana WIB Youth Council.
12. Provider shall provide each participant who attains full
completion of the program with a certificate of completion.
Such certificate shall serve as contractor's assurance to the
City that the recipient of said certificate has satisfied the
conditions of full completion as set forth in conditions identified
in the Work Plan.
13. Provider shall, upon request by WIB staff or in accordance with
schedules and/or procedures stipulated by WIB staff at the
outset of the program, transmit to state electronic reports
and/or forms containing all appropriate data and any other
pertinent information available on each participant and program
operations in general.
14. Provider shall report on progress of program to Youth Council
on a regular basis.
Exhibit b
COMPLAINT HANDLING
UNDER THE
WORKFORCE INVESTMENT ACT
SANTA ANA
WIA
Santa Ana Local Workforce Investment Area
July 1, 2001
Table of Contents
I. Information Regarding Complaints......................................... ............ ............................ ........... 2
A. Nondiscrimination and Equal Opportunity Complaints ..........................................................2
1. Policy Statement ............ ...... ....................... ...... ..................... ....................... ..................... 2
2. Civil Rights............. ........ ................. .......... ........ ......... ..... ................................ ................... 3
3. Nondiscrimination Laws under WIA ................................................................................... 4
4. How to File Your Complaint ...............................................................................................5
B. Criminal Complaints ......... ..... ...... .... ........... ..... ... ................ ...... ..... ............. .......... ................. 6
II. General Procedures for Handling Non-Criminal Violations of the Act ....................................... 6
III. Procedures for Handling Complaints at the SDA Level.............................................................8
IV. Procedures for Handling Complaints at the State Level.......................................................... 13
V. Procedures for Handling Discrimination Complaints by Participants....................................... 15
VI. Procedures for Handling Handicap Complaints by Participants .............................................. 16
GLOSSARY OF WIA TERMS ........................................................................................................18
1
I. Information Regarding Complaints
A. Nondiscrimination and Equal Opportunity Complaints
1. Policy Statement
In carrying out the purpose of the Workforce Investment Act (WIA), the City of
Santa Ana Local Workforce Investment Area (LWIA) will establish programs to
prepare youth and unskilled adults for entry into the labor force and to afford
job training to those individuals facing serious barriers to employment. Every
effort will be made to provide services necessary for eligible individuals to
obtain productive employment.
In implementing WIA, all contractors in the Santa Ana LWIA will foster equal
opportunity and non-discrimination, as provided in State and Federal equal
opportunity and non-discrimination laws including, but not limited to:
. Title VI of the Civil Rights Act of 1964
. Title VII of the Civil Rights Act of 1964
. The Age Discrimination Act of 1975, as amended
. Section 503 of the Rehabilitation Act of 1973
. Section 504 of the Rehabilitation Act of 1973
. Title IX of the Education Amendments of 1972
· Section 188 of the Workforce Investment Act of 1998
In keeping with our commitment, no individual shall be excluded from
participation in, denied benefits of, subjected to discrimination under, or denied
employment, in the administration or of in connection with any WIA funded
program because of race, color, religion, sex, national origin, age, handicap, or
political affiliation or belief.
Participation in programs and activities financially assisted in whole or in part
under WIA shall be open to citizens and nationals of the United States, lawfully
admitted permanent resident aliens, lawfully admitted refugee, parolees, and
other individuals authorized by the Attorney General to work in the United
States.
No individual will be intimidated, threatened, coerced, or discriminated against
because of filing a complaint, furnishing information, or assisting or
participating in any manner in an investigation, compliance review, hearing, or
any other activity related to the administration of WIA.
2
Administration responsibility for this Equal Opportunity/Affirmative Action
(EO/AA) Program is delegated to the Equal Employment Opportunity (EEO)
Officer for the Santa Ana Local Workforce Investment Area. Equal opportunity
and non-discrimination, however, will only be achieved through leadership and
implementation of a viable Affirmative Action Equal Opportunity Program.
Patricia Nunn, Executive Director
Santa Ana Local Workforce Investment Area
2. Civil Rights
No one applying for or enrolled in the Workforce Investment Act (WIA)
Programs may be discriminated against because of race, color, creed,
handicap, national origin, sex, age, political affiliation, or beliefs.
This means that - for any of the characteristics listed above:
You may not be denied the opportunity to enroll in WIA.
No benefits or services may be denied you for discriminatory
reasons.
You may not be segregated or treated any differently from other
applicants or participants, while you are being registered,
interviewed, counseled or tested; or while you are working or
attending classes as part of the program.
You must be provided an equal chance to use all facilities
available in the program.
Fair employment practices must be provided to all staff with
regard to recruiting, hiring, transferring, promotions, training,
compensation, benefits, layoff, and termination.
You have the right to make a complaint if you feel you have been denied any
of the above opportunities. You cannot in any way be penalized for filing a
complaint. Your WIA sponsor has established a mechanism for handling
complaints or grievances. Your complaint must be filed within 180 days. All
complaints will be handled confidentially.
3
3. Nondiscrimination Laws under WIA
Title VI of the Civil Riqhts Act of 1964
Prohibits discrimination on the basis of race, color, national origin, or
religion.
The Age Discrimination Act of 1975
Prohibits arbitrary discrimination against persons age 40-70.
The Rehabilitation Act of f 1973
Prohibits discrimination based on handicap.
Title IX of the Education Amendments of 1972
Prohibits discrimination in any education or training program or activity
receiving federal financial assistance.
OTHER CIVIL RIGHTS LAWS:
Title VII of the Civil Riqhts Act of 1964
Prohibits discrimination in employment based on race, color, religion,
sex, or national origin in all terms and conditions of employment and
establishes the Equal Employment Opportunity Commission as the
administrative agency.
White House Executive Order No. 11246 as Amended bv Executive
Order No. 11375
Creates the office of Federal Contract Compliance and prohibits
discrimination based on race, color, sex, religion, or national origin.
Department of Labor Secretarv's Order no. 4-73
Prohibits discrimination based on sex.
Equal Pav Act of 1963
Prohibits pay differential solely because of sex.
4
Emerqencv Emplovment Act of 1971
Prohibits discrimination based on race, creed, national origin, political
affiliation, or beliefs.
4. How to File Your Complaint
a. Put your complaint in writing.
b. Have it sworn to before a notary public, if possible.
c. Provides details that tell what happened, where it happened, and when
it happened.
d. Give the name and addresses of all persons who were present or who
had anything to do with the matter.
.. .Complaints on the basis of race, color, or national origin, age, sex,
religion, political affiliation or belief, retaliation and citizenship, must be
filed within 180 days of the alleged occurrence directly with:
Director
Civil Rights Center
U.S. Department of Labor, Room N-4123
200 Constitution Ave., NW
Washington, D.C. 20210
Complaints on the basis of handicap must be filed within 180 days of
the alleged occurrence. These complaints must be filed directly with
the WIA administrative entity. The WIA administrative entity shall issue
a written decision within 30 days of the filing of the complaint. If the
complaint is still unresolved, an appeal may be made to the Chief of
State Workforce Investment Division Office.
The Department of Labor, the Civil Service Commission, the Equal
Employment Opportunity Commission, and many other offices and agencies
are committed to assuring equal employment opportunities for all persons.
They will protect you.
A case may be taken to court if the other processes do not yield satisfactory
results.
You may hire your own lawyer, or if you cannot afford one, the court may
appoint one for you.
5
It is unlawful for an employer, union, or employment agency to punish you or
any witness for attempting to present the facts in a case.
YOUR CIVIL RIGHTS UNDER THE
WORKFORCE INVESTMENT ACT
Santa Ana Local Workforce Investment Area
1000 E. Santa Ana Blvd., Suite 200
Santa Ana, CA 92701
(714) 565-2600
B. Criminal Complaints
In accordance with the WIA (P.L. 105-200) and the implementing code of Federal
section 667.600.... Federal handling of criminal complaints and report offraud, abuse
and other criminal activity. "All information and complaints involving fraud, abuse or
other criminal activity shall be reported directly and immediately to the City of Santa
Ana and the Secretary of Labor."
II. General Procedures for Handling Non-Criminal Violations of the Act
The following procedure is promulgated to meet the requirements of Title 20, of the Code of
Federal Regulations, Section 667.600 through 667.640 of the WIA regulations, and Section
181(c) of the Act (Public Law 105.200: 29 U.S. Code Sec. 2931 et seq.) at the State and
LWIA level for the receipt, investigation, hearing, and resolution of complaints by WIA
participants, subrecipients, applicants for participation, or financial assistance, labor unions,
community based organizations, or any other persons,
These procedures provide for resolution of non-criminal complaints arising from the
operation of the Santa Ana L WIA.
A complaint is defined here as a written expression by a party alleging a violation of the
Act, regulations promulgated under the Act, recipient grants, subagreements, or other
specific agreements under the Act, including terms and conditions of employment of such
participants in employment training programs. All complaints, amendments and
withdrawals shall be in writing. These procedures are intended to resolve matters which
concern policies, procedures or action(s) arising in connection with WIA programs operated
by each LWIA grant recipient and subrecipient under the Act.
These procedures shall not be construed as affecting any other available legal remedy
outside of the WIA complaint process (Le., disputes regarding terms and conditions of
employment of any employee who is not a participant), either separately or simultaneously,
that a person may wish to pursue in the resolution of a non-WIA complaint. Also, these
procedures do not restrict the LWIA grant recipient staff in carrying out informal discussion
6
procedures do not restrict the LWIA grant recipient staff in carrying out informal discussion
and resolution of any problems outside of and without resort to the formal complaint
procedure.
A. The following principles and rules apply to all complaints at all steps of the complaint
procedures:
1. All complaints must be made in writing within 180 days of the alleged
occurrence, except complaints alleging fraud or criminal activity.
2. All persons filing a complaint shall be free from restraint, coercion, reprisal, or
discrimination. Good faith efforts shall be made to informally resolve the
complaint prior to the scheduled hearing. Complainants have the right to
withdraw their complaints (in writing) at any time prior to the hearing. A
complainant may amend his/her complaint to correct technical deficiencies but
not to add issues.
3. Complainants shall have the right to be represented at their own expense by
person(s) of their choosing at all levels of the complaint process.
4. Upon enrollment into employment or training, participants shall be provided
with a written description of these procedures, including notification of their
right to file complaints and instructions for filing.
An employer of participants, including private-for-profit employers of
participants, may use this or other complaint resolution procedures so long as
the participant is informed of the complaint resolution procedure they are to
follow and the time frames governing review of complaints are met.
A "participant", within the meaning of these procedures, is an individual who
receives employment-training services under a program funded by Santa Ana
LWIA. The Complaint Resolution Procedures contained herein (or the
alternative procedures which an employer may use) shall be available to
participants to resolve disputes regarding items and conditions of employment
of such participants in employment training programs. However. such
procedures shall not be used to resolve disputes reqardinq terms and
conditions of employment of any employee who is not a participant. as defined
herein.
5. If a complaint does not receive a decision at the LWIA grant recipient level
within 60 days offiling the complaint or receives an unsatisfactory decision,
the complainant then has a right to request a review of the complaint by the
Governor.
7
6. Complainants must initially file and exhaust LWIA grant recipient/hearing
procedures prior to appealing to the State except where the State determines
that the LWIA grant recipient's procedures are not in compliance with the
State's procedures.
III. Procedures for Handling Complaints at the LWIA Level
A. Receipt of Complaints
Pursuant to the WIA regulations found at 20 CFR, Section 667.600, the LWIA
administrative entities have the responsibility to conduct hearings and resolve
complaints made by individuals about the administration of programs in the LWIA.
"LWIA level" encompasses LWIA administrative entity and employers to which the
administrative entity has delegated the complaint resolution process. The following
comprise the guidelines for resolving issues arising in connection with WIA programs
operated by the Santa Ana LWIA including resolutions of complaints arising from
actions, such as audit disallowances or the imposition of sanctions taken by the
Governor with respect to audit findings, investigations or monitoring reports.
1. Form and Filing of Complaint
Official filing date of the complaint is the date the written complaint is received.
The filing of the complaint with the Santa Ana L WIA Equal Employment
Opportunity Officer shall be considered as a request for hearing and a
decision must be issued within 60 days. The complaint must be in writing and
must be signed and dated. The complaint should also contain the following
information:
a. Full name, telephone number, if any, and mailing address of the
complainant;
b. Full name, telephone number, and mailing address of the agency
involved (respondent);
c. Clear and concise statement of facts including dates constituting
alleged violation;
d. What provisions under the Act, regulations, grant or other agreements
under the Act, are believed to have been violated;
e. Remedy sought by the complainant; and
f. lfthe complainant is a private or public entity or corporation, and not a
natural person, the filing of the complaint must be duly authorized by
the governing body of such entity or corporation.
8
The absence of any of the requested information shall not be a basis for
dismissing the complaint.
A copy of the complaint must be sent to the respondent and both parties
notified of the opportunity for an informal resolution. At each step of the
complaint process, the complainant must be notified in writing of the next
procedural step.
2. Informal Conference
Informal conferences will be utilized by the Santa Ana LWIA to resolve
complaints; however, such informal conferences shall not extend the time
within which a decision must be issued after receipt of a complaint. Attempts
at informal resolution will commence with two (2) weeks of the date of filing of
the complaint.
a. The EEO Officer will review the case and ascertain facts prior to the
conference so that appropriate resolution can take place at the time of
this meeting whenever possible.
b. Although the complaintant should be encouraged to attend this
conference, his/her failure to do so should not preclude his/her right to
request a hearing on the matter.
c. If mutually satisfactory resolution results and the Santa Ana LWIA
concurs, the EEO Officer will write a brief report for the file stating the
issues and resolution. The matter shall then be considered closed.
d. If resolution does not result, the complainant shall be provided the
necessary information and assistance to request a hearing if he/she so
desires.
3. Request for Hearing
a. As in the case of the complaint, the request for a hearing should be put
in writing and be filed in person or by mail. A governing board
resolution of authorization to appeal should also be submitted when
appropriate. The request should be filed with:
Lydia H. Morgan
EEO Officer
Santa Ana Local Workforce Investment Area
1000 E. Santa Ana Blvd., Suite 200
Santa Ana, CA 92701
9
b. A hearing will be scheduled by the EEO Officer within thirty (30) days of
the date of filing of the complaint.
4. Notice of Hearing
Upon receipt of the request for hearing. the complainant and the respondent
will be notified in writing of the hearing ten (10) calendar days prior to the date
of the hearing. The ten-day notice may be shortened with the written consent
of the parties. A decision will be issued by the Santa Ana LWIA within sixty
(60) days of the date of filing of the complaint.
The hearing notice shall be in writing and contain the following information:
a. The date of notice. name of the complainant, and the name of the party
against whom the complaint is filed.
b. The date. time, and place of hearing before an impartial hearing officer.
c. A statement(s) of the alleged violation(s)
d. Advise as to where information or assistance may be obtained. and the
name. address, and telephone number of the Santa Ana LWIA Equal
Employment Opportunities (EEO) Officer who can answer inquiries.
8. Conduct of Hearing
The hearing shall be conducted in an informal manner with strict rules of evidence
not applicable. Unnecessary technicalities should be avoided. It should provide the
flexibility to enable adjustment to the circumstances presented.
1. The hearing officer shall have complete independence to obtain facts and
make decisions. The hearing officer shall be in a position to render impartial
decisions and thus should not be subordinate to the Santa Ana LWIA or its
subrecipients. The hearing officer will be selected from a list of names on file
with the EEO Officer.
2. Full regard must be given to the requirements of due process to insure a fair
and impartial hearing.
3. The hearing office designated by the EEO Officer to function in a quasi-judicial
capacity should begin the hearing by summarizing the record and the issue
and should explain the manner in which the hearing will be conducted, making
sure that everyone involved understands the proceedings. Such explanations
should be adapted to the needs of the specific situation. The hearing officer
might take testimony under oath or affirmation to give some assurance of
veracity to the hearing.
10
4. The burden of proof should be reasonable and flexible, dependent upon the
circumstances of the case involved. The hearing officer determines the order
of proof. Generally, the party making the complaint has the obligation of
establishing his or her case and should be examined first.
5. The party involved should have the right to be represented (at their own
expense) if he/he so desires. Other he/she is limited to his/her own abilities
and those of the hearing officer in obtaining testimony in the case.
6. It is important that the hearing officer obtain the fullest information for the
record. If the parties involved, or their representatives, do not know how to
ask the right or pertinent questions in pursuing their right to due process, it
shall be necessary for the hearing officer to step in to have all the materials
and relevant facts elicited.
7. The practice in informal hearings is generally not to apply strict rules of
evidence in obtaining facts. However, the quantity of evidence required to
support a decision on an issue should be sufficiently credible that the state (or
other appropriate agency), upon reviewing the decision, would conclude that
the decision is supported by substantial evidence.
8. The hearing officer should attempt to negotiate a resolution of the issue at any
time prior to the conclusion of the hearing.
9. Within ten (10) days of the conclusion of the hearing, the hearing officer will
issue a recommended decision to the LWIA for final determination. The
recommended decision shall be in writing and may be accepted, rejected or
modified by the Santa Ana Workforce Investment Board.
C. Issuance of Decision
Within sixty (60) calendar days of filing of the complaint, the Santa Ana LWIA shall
issue a written decision to all parties by first class mail. The final decision shall
contain the following information:
1. The name of the parties involved.
2. A statement of the alleged violation and issues related to the alleged violation.
3. A statement of the facts.
4. The decision and the reasons for the decision.
5. A statement of corrective action, if any, to be taken.
6. Notice of the right to request, within ten (10) calendar days of receipt of the
decision, a review of the decision by the State Review Panel.
11
D. Record of Hearing
An administrative file containing support documents on the complaint resolution
process hearing conducted will be retained by the Santa Ana LWIA. The purpose of
a record is to serve as substantiation of the process followed by the Santa Ana LWIA
on the resolution of the issues and the results. This information would then be
available for subsequent review in the event the matter is raised with the State. Such
records must be retained for a three-year period after the grant has been officially
closed out.
The Santa Ana LWIA's written decision will be included in the record. Evidence
received at the hearing, notes by the hearing officer, stenographer's notes and tape
recordings may also be used.
E. Establishment of Complaint Procedures
In accordance with Section 667.600, each employing agency including private-for-
profit employers of participants under the Act is required to establish a complaint
procedure for resolving matters relating to the terms and conditions of employment.
Employers may operate their own grievance system or may utilize the Santa Ana
LWIA's established procedures under Section 667.600. At a minimum these
procedures must include:
1. Written notice, upon enrollment into employment training services, of the scope
and availability of such procedures. Employer's grievance procedures shall be
set forth in a written document and must meet the regulation mandate that a
complaint will be resolved with sixty (60) days from the date the complaint was
filed. A copy of employer's grievance procedure shall be provided to each
participant upon enrollment in employment training.
2. Written notice, at the time the grievance is filed, of the procedures under which
the grievance will be processed.
3. Written notification of the disposition of the grievance and a written decision shall
be issued within thirty (30) days of the filing of the grievance unless a present and
long established grievance specifically provides other limits; and
4. Written notification of the participant's right to request a review of the employer's
decision by the Santa Ana LWIA and the State Review Panel in accordance with
Section 667.600.
12
IV. Procedures for Handling Complaints at the State Level
Section 181 (c) of the Act and the WIA regulations at 20 CFR, Section 667.600(d) requires
the Governor to establish a State Review process of complaints filed at the LWIA grant
recipient level and of complaints initially filed at the State level.
Appeals of decisions issued at the LWIA level including audit disallowances and sanctions
shall be reviewed by the State Review Panel. The State Review Panel shall review the
record established at the LWIA level and shall issue a decision based on the information
contained therein.
Complaints which may be initially filed at the State level will be heard by an independent
hearing officer designated by the State Workforce Investment Division (WID). The hearing
officer shall conduct a hearing and issue a recommended decision to the State Panel. The
recommended decision shall be in writing and may be accepted, rejected or modified by the
State Review Panel.
A. Form and Filing of Complaint.
1. Request for State Review of LWIA Level Decisions
On receipt of a complainant's request for review because of an unsatisfactory
decision, the State shall provide for an independent state review.
2. Filing of Requests for State Review
The State Review Panel shall review all LWIA level decisions when a request
for review is filed within 10 days of receipt of the adverse decision. Such
requests must be filed in writing with the Chief of the WID Office. The request
for review should contain the following information:
a. Full name, address, telephone number of the party requesting the
review
b. Full name, address, telephone number of the other party
c. A copy of the decision
d. Brief statement of reasons for review or the section of the L WIA
decision to be reviewed including regulatory and statutory citations
e. A statement of the relief sought.
13
3. Complaintant Responsibility
It is the responsibility of the complainant to include in the request for review a
written statement setting forth the facts presented at the LWIA hearing which
support the requested relief.
The Chief, WID, shall mail a copy of the request for review to the other party
and to the LWIA. It shall be the responsibility of the LWIA to submit the
complete record including a typed record of the hearing to the Chief, WID,
within ten (10) days.
B. Conduct of Hearings.
1. Request for Hearing at the State Level
If no decision has been issued at the LWIA level or the State has determined
an audit disallowance or imposed sanctions, the complainant may request a
hearing. The hearing officer will then issue a recommended decision to the
State's Review Panel for final determination.
2. Filing for Request for Review
The request for a State hearing shall be filed within ten (10) days after LWIA
should have issued a decision or ten (10) days after the issuance of the audit
disallowance or sanction. The request shall be filed directly with the Chief of
the WID in writing and should include the following:
a. Full name, address, and telephone number of the party requesting the
review
b. Name, address, and telephone number of the LWIA
c. Copies of complaints made at LWIA level from which no decisions were
issued or sanctions imposed
d. A statement of basis for the request for hearing.
3. Evidentiary Hearing
Upon receipt of the request for a State level hearing, a hearing before a
designated hearing officer will be scheduled.
14
The hearing will be recorded mechanically or by court reporter.
Both parties concerned will have the opportunity to present oral and written testimony
under oath, to call and question witnesses in support of his/her position, to present
oral and/or written arguments, to examine records and documents relevant to the
issue(s), and to be represented,
The hearing officer shall issue a written decision, which shall be forwarded to the
State Review Panel for final determination.
The State Review Panel may accept, reject or modify this recommendation. The
decision of the State Review Panel is final except for audit disallowances, which must
be approved by the Secretary of Labor.
C. State Review Panel
The State Review Panel will consist of a panel of three representatives from the
Employment Development Department: one from the Legal Offices, one from the
WID, and one from the Director's office. The panel will issue a written decision,
which will be sent to the appropriate parties within thirty (30) days of receipt of the
request for State review.
Decisions issued by this panel, under the authority of the Governor, are final.
D. Issuance of State Review Decision.
The State review will be limited to violations of the WIA, implementing WIA
regulations or the grant agreement. This review shall be limited to the record
established at the LWIA hearing.
V. Procedures for Handling Discrimination Complaints by Participants
A. Complaints on the basis of race, color, or national origin, age, sex, religion, political
affiliation or belief, retaliation, and citizenship, where appropriate, must be filed within
180 days ofthe alleged occurrence.
1. It is the responsibility of the Santa Ana LWIA's Equal Employment Opportunity
(EEO) Officer to determine jurisdiction and to make the complainant aware of
and provide assistance in filing a complaint in accordance with the Santa Ana
LWIA's procedure under Section II (A).
15
PROCEDURES FOR HANDLING NON-CRIMINAL COMPLAINTS
No later than 180
days oj alleged
discrimination
Handling of complaints filed at L WIA level arising in
connection with WlA programs operated by LWlAs
.
.
.
.
Informal Resolution Process
.
.
.
.
Filing of Complaint / Request for Hearing
Notice of Hearing issued by L WIA
w
c
b
~
'"
c-
c
b
~
'"
Hearing Conducted
L WIA Decision within 60 days
.
.
.
.
Unsatisfactory Decision or L WIA Decision not
issued within 60 days
Within 10 days oj
receipt oj
unsatisJactory
decision or 10 days
from date L WIA
decision should have
been issued
.
.
.
.
Request for State Review I
Governor's Decision issued by State Review
Panel
w
c
b
~
'"
.
.
.
.
Ifno decision issued bv State Review Panel
.
.
.
.
Appeal to DOL
2. In cases where areas of authority overlap, it is the responsibility of the EEO
Officer to advise the complainant of the existence of State, Federal and other
proper action agencies, which may also have a bearing.
3. Complainants alleging discrimination under this part will be made aware of
their right to file directly with the Office of Civil Rights (OCR), U.S. Department
of Labor and applicable procedures.
4. Complainants must file their complaint directly with:
Lydia H. Morgan
EEO Officer
Santa Ana Local Workforce Investment Area
1000 E. Santa Ana Blvd., Suite 200
Santa Ana, Ca 92701
VI. Procedures for Handling Handicap Complaints by Participants
Complaints alleging discrimination on the basis of handicap will be filed and processed
under the Department of Labor regulations implementing Section 504 of the Rehabilitation
Act of 1973 at 29 Code of Federal Regulations Section 32.
1. Complaints must exhaust the Santa Ana L WIA's informal resolution
procedures before filing their complaint with OCR.
2. Complainants will be made aware of the 180 days requirement in which to file
his/her complaint.
A. Procedures at the LWIA level
1. The complainant shall file his/her complaint directly with the Santa Ana LWIA.
Upon receipt of the complaint, the EEO Officer shall investigate and gather
information concerning the complaint.
2. An informal conference will be held with the parties concerned in an effort to
resolve the issue(s). The complainant has the right to be present and may be
represented during the conference.
3. The Santa Ana LWIA shall issue in writing its decision to the complainant no
later than thirty (30) days after the filing of the complaint.
16
B. Procedures at the State Level
1. The complainant may appeal to the State if he/she is not satisfied with the
decision of the Santa Ana LWIA.
2. The Complainant must file his/her appeal as a request for review directly with
the Chief WID within ten (10) calendar days after the receipt of the Santa Ana
LWIA's decision.
3. The Chief-WID, shall issue a decision no later than thirty (30) calendar days
after receipt of the request for review.
4. After the complainant has received a decision or no decision has been
received from the Director of Employment Development Department (on
behalf ofthe Governor), the complainant has the right to appeal his/her
complaint within thirty (30) calendar days to the Office of Civil Rights (OCR)
with the Department of Labor.
17
PROCEDURES FOR HANDLING HANDICAP COMPLAINTS
No later than 180
days of alleged
discrimination
Filed within 30
days of
L WIA/State
Decision or 90
days ji-om date of
initial filing of
complaints
Filing of complaint on the basis
Of Handicap with L WIA
Informal Resolution
.
.
.
.
If no resolution reached
.
.
.
.
Request for Hearing
Notice of Hearing
Hearing Conducted
L WIA Decision
.
.
.
.
Unsatisfactorv Decision or No Decision
.
.
.
.
State Review I
Governor's Decision
Appeal to Assistant Secretary
Department of Labor
Day 1
Day/45 Day
60 Days
PROCEDURES FOR HANDLING NON-CRIMINAL COMPLAINTS
No later than 180
days of alleged
discrimination
Handling of complaints filed at L WIA level arising in
connection with WIA programs operated by L WIAs
.
.
.
.
Informal Resolution Process
.
.
.
.
Filing of Complaint / Request for Hearing
Notice of Hearing issued by L WIA
u.,
'"
b
~
'"
0,
'"
b
~
"
Hearing Conducted
L WIA Decision within 60 days
.
.
.
.
Unsatisfactory Decision or L WIA Decision not
issued within 60 days
Within 10 days of
receipt of
unsatisfactory
decision or 10 days _
from date LWIA
decision should have
been issued
.
.
.
.
Request for State Review
Governor's Decision issued by State Review
Panel
u.,
'"
b
~
"
.
.
.
.
Ifno decision issued bv State Review Panel
.
.
.
.
Appeal to DOL
2. In cases where areas of authority overlap, it is the responsibility of the EEO
Officer to advise the complainant of the existence of State, Federa[ and other
proper action agencies, which may also have a bearing.
3. Complainants alleging discrimination under this part will be made aware of
their right to file directly with the Office of Civil Rights (OCR), U.S. Department
of Labor and applicable procedures.
4. Complainants must file their complaint directly with:
Lydia H. Morgan
EEO Officer
Santa Ana Local Workforce Investment Area
1000 E. Santa Ana Blvd., Suite 200
Santa Ana, Ca 92701
VI. Procedures for Handling Handicap Complaints by Participants
Complaints alleging discrimination on the basis of handicap will be filed and processed
under the Department of Labor regulations implementing Section 504 of the Rehabilitation
Act of 1973 at 29 Code of Federa[ Regulations Section 32.
1. Complaints must exhaust the Santa Ana LWIA's informal resolution
procedures before filing their complaint with OCR.
2. Complainants will be made aware of the 180 days requirement in which to file
his/her complaint.
A. Procedures at the LWIA Level
1. The complainant shall file his/her complaint directly with the Santa Ana LWIA.
Upon receipt of the complaint, the EEO Officer shall investigate and gather
information concerning the complaint.
2. An informal conference will be held with the parties concerned in an effort to
resolve the issue(s). The complainant has the right to be present and may be
represented during the conference.
3. The Santa Ana LWIA shall issue in writing its decision to the complainant no
later than thirty (30) days after the filing of the complaint.
16
B. Procedures at the State Level
1. The complainant may appeal to the State if he/she is not satisfied with the
decision of the Santa Ana LWIA.
2. The Complainant must file his/her appeal as a request for review directly with
the Chief WID within ten (10) calendar days after the receipt of the Santa Ana
LWIA's decision.
3. The Chief-WID, shall issue a decision no later than thirty (30) calendar days
after receipt of the request for review.
4. After the complainant has received a decision or no decision has been
received from the Director of Employment Development Department (on
behalf of the Governor), the complainant has the right to appeal his/her
complaint within thirty (30) calendar days to the Office of Civil Rights (OCR)
with the Department of Labor.
17
PROCEDURES FOR HANDLING HANDICAP COMPLAINTS
No later than 180
days of alleged
discrimination
Filed within 30
days of
L WIA/State
Decision or 90
days from date of
initial filing of
complaints
Filing of complaint on the basis
Of Handicap with L WlA
Informal Resolution
.
.
.
.
If no resolution reached
.
.
.
.
Request for Hearing
Notice of Hearing
Hearing Conducted
LWIA Decision
.
.
.
.
Unsatisfactorv Decision or No Decision
.
.
.
.
State Review
Governor's Decision
Appeal to Assistant Secretary
Department of Labor
Day I
Day/45 Day
60 Days
GLOSSARY OF WIA TERMS
AGE DISCRIMINATION ACT - A law passed by Congress in 1975 which prohibits discrimination
on the basis of age by any program or activity receiving Federal funds.
APPLICANT - An individual who applies to a subrecipient or contract for services provided under
WIA and who has no yet transitioned to the status of participant.
ASSESSMENT - Services designed to determine each participant's employability, aptitudes,
abilities and interests and to develop a plan to achieve the participant's employment and related
goals; also to identify the available employment and training activities appropriate for the
participant. Testing and counseling may also be used during the assessment process.
CHARGING PARTY (CPl. COMPLAINANT, GRIEVANT, OR AGGRIEVED PERSON - The
person who charges that he/she has been discriminated against under Department of Justice
nondiscrimination and civil rights regulations and/or guidelines.
DISCRIMINATION -In general, a failure to treat all equally, whether intentional or unintentional;
the effect of an action, policy or practice which selects an individual or class of persons to receive
unequal treatment.
ELIGIBLE NON-CITIZEN - Lawfully admitted permanent resident, aliens, lawfully admitted
refugees, and parolees and other individuals authorized by the Attorney General to work in the
United States.
EMPLOYER - An employer subject to the provisions of the Civil Rights Act of 1964, as amended,
including state and local governments and any Federal agency subject to the provisions of Section
717 of the Civil Rights Act, as amended; and any Federal contractor or subcontractor covered by
Executive Order 11246, as amended.
GRIEVANCE - An allegation that something imposes an illegal obligation or burden or denies
some equitable or legal right, or causes injustice.
HANDICAPPED INDIVIDUAL - Any individual who has a physical or mental disability that
constitutes or results in a substantial handicap to employment.
18
INTAKE -Includes screening to determine eligibility; to select from eligible applicants those
individuals who are most in need and can benefit from program services; to complete procedural
requirements necessary to enroll an individual into the program and to refer those not enrolled to
other programs.
JOINT COMPLAINT - A complaint of employment discrimination covered by Title VII or the Equal
Pay Act and by Title VI or Title IX. Individual "joint complaints" are normally investigated by EEOC
unless OCR has a compelling reason to investigate. "Joint complaints" alleging discrimination in
employment and other practices and pattern or practice "joint complaints" are normally investigated
by OCR.
JURISDICTION - Authority to investigate and resolve complaints against an institution subject to a
law or statute which has been assigned to OCR for enforcement, i.e., Title VI, Title IX, etc.
PARTICIPANT - Any applicant who has: (1) Been determined eligible for participation upon intake;
and (2) Who is receiving subsidized employment, training or services (except post-termination
services) funded under the Act, following intake, except for an individual who receives only
outreach and/or intake and assessment services.
19
Exhibit E
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS
and COOPERATIVE AGREEMENTS
The undersigned cenifies, to the best of his or her knowledge and belief, that:
1) No Federal appropriated funds have been paid or will be paid, by or on behalf
of the undersigned, to any person for influencing or attempting to influence
an officer or employee of an agency, a Member of Congress, an 9fficer or
employee of Congress, or an employee of a Member of Congress in
connection with the awarding of any Federal contracts, 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 contract, grant, loan or
cooperative agreement.
2) If any funds other than Federal 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 contract, grant, loan or cooperative agreement, the undersigned shall
complete and submit Standard Form - LLL, "Disclosure Form to Report
Lobbying," in accordance with its instructions.
3) The undersigned shall require that the language of this certification be
included in the award documents for all subawards at all tiers (including
agreements) and that all subrecipients 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
31 U.S.C. 1352. Any person who fails to file the required certification shall be
subject to a civil penalty of not less than $10,000 and not more that $100,000 for
each such failure.
California Hispanic Commission
on Alcohol and Drug Abuse, Inc.
Grantee/Contractor Organization
(2../ q / 03
Name of Certifying Official Si
iIVnu.S J.. /-t-1.
G 'j./,CAAf i /I.l J) i rukY
.
,
Exhibit F
Certification ReQarding DruQ-Free Workplace Requirements
The certification set out below is a material representation upon which reliance is
placed by the U.S. Department of Labor in awarding the grant. If it is later
determined that the contractor knowingly rendered a false certification, or
otherwise violates the requirements of the Drug-Free Workplace Act, the U.S.
Department of Labor, in addition to any other remedies available to the Federal
Government, may take action authorized under the Drug-Free Workplace Act.
CERTIFICATION
A. The contractor certifies that it will provide a drug-free workplace by:
(al Publishing a statement notifying employees that the unlawful
manufacture, distribution, dispensing, possession or use of a
controlled substance is prohibited in the contractor's wor kplace and
specifying the actions that will be taken against employees for
violation of such prohibition;
(b) Establishing a drug-free awareness program to inform employees
about -
(1) The dangers of drug abuse in the workplace;
(2) The contractor's policy of maintaining a drug-free workplace;
(3) Any available drug counseling, rehabilitation, and employee
assistance program; and
(4) The penalties that may be imposed upon employees for drug
abuse violations occurring in the workplace;
(c) Making it a requirement that each employee who will be engaged in
the performance of the grant be given a copy of the statement
required by paragraph (a);
(d) Notifying the employee in the statement required by paragraph (a)
that, as a condition of employment under the contract, the employee
will-
(1) Abide by the terms of the statement; and
(2) Notify the employer of any criminal drug statute conviction for
a violation occurring in the workplace no later than five days
after such conviction.
Pg. 2
(e) Notifying the U.S. Department of Labor within ten days after receiving
notice under subparagraph (d)(2) from an employee or otherwise
receiving actual notice of such conviction;
(f) Taking one of the following actions, within 30 days of receiving notice
under subparagraph (d)(2), with respect to any employee who is so
convicted -
( 1) Taking appropriate personnel action against such an employee,
up to and including termination; or
12) Requiring such employee to participate satisfactorily in a drug
abuse assistance or rehabilitation program approved for such
purposes by a Federal, State, or local health, law enforcement,
or other appropriate agency;
Ig) Making a good faith effort to continue to maintain a drug-free
workplace through implementation of paragraphs la), (b), Ic), (d), (e)
and (f).
B. The contractor shall insert in the space provided on the attached "Plac e of
Performance" form th e site(s) for the performance of work to be carried out
with the grant funds (including street address, city, county, state, and zip
code). The contractor further certifies that, if it is subsequently determined
that additional sites will be used for the performance of work under the
contract, it shall notify the U.S. Department of Department of Labor
immediately upon the decision to use such additional sites by submitting a
revised "Plac e of Performance" form.
Dated:
J~
DIVISION OF EMPLOYMENT SERVICES
PLACE OF PERFORMANCE
FOR CERTIFICATION REGARDING DRUG-FREE WORKPLACE
REQUIREMENTS
Name:
Name of Contractor:
Contractor Number:
Date:
California Hispanic Commission
on Alcohol and Drug AOUse, Inc.
Iz/q/o3
The Contractor shall insert in the space provided below the site(s) expected to be
used for the performance of work under the contract covered by the certification:
Place of Performance (include street address, city, county, state, zip code for each
site):
Street Address
City
Phone Number
/qo~
N. ~11.tjt-
SMI m, ka.. I tit cp ~"
tlc!- 1/.1tf-t;IU
~
4
SELF-CERTIFICATIONS
Location of Records - ~itial
I understand, all accounting records and evidence pertaining to all costs of CONTRACTOR and all documents related to
this Agreement shall be kept available at the location where CONTRACTOR conducted the program, as well as in the
County of Orange, for the duration of this Agreement and thereafter for three (3) years after completion of an audit.
Records which relate to (a) complaints, claims, administrative proceedings or litigation arising out of the performance of
this Agreement, or (b) costs and expenses of this Agreement to which CITY, the State of California or the United States
Government take exception, shall be retained beyond the three (3) years until resolution of disposition of such appeals,
litigation, clauDS, or exceptions. ~.
Clean Air I Clean Water Act - ~ Initial
I understand, if the grant hereunder exceeds $100,000, CONTRACTOR must comply with Section 306 of the Clean Air
Act [(42 USC 1875(h)J; Section 508 of the Clean Water Act (33 USC 1368); Executive Order 11738 and Environmental
Protection Agency ("EP A") regulations (40 CFR Part 15) as any may now exist or be hereafter amended. Under these laws
and regulations, the CONTRACTOR assures that:
(a) No facility to be utilized in the performance of the proposed grant has been listed on the EPA List
of Violating Facilities;
(b) It will notify CITY prior to award of the receipt of any communication from the Director, Office of
Federal Activities, U.S. EPA, indicating that a facility to be utilized for the grant is under
consideration to be listed on EPA List of Violating Facilities;
(c) It will not' the TY the EP A about any known violation of the above laws and regulations.
Drug Free Environment-
Initial
My organization agrees to provide a drug-free work place and to execute a certification as set forth in the contract.
WILL SUBMIT
Single Audit - _Initial
My organization has has or has not expended $300,000 or more of federal funds in
fiscal year ending on or before December 31, 2002, has or will conduct an audit in accordance with Section 184 of the
WIA, Title 20 CFR Section 667.200, Title 29 CF Part 95 or 97 (as applicable), and Title 31 USC Chapter 75. If
applicable, submit eopy of 2002 Audit.
Commercial General Liability -
itial
CONTRACTOR agrees to obtain and k ep in force during the term of this Agreement a policy of comprehensive
commercial public liability insurance insuring the State of California, CITY, and CONTRACTOR against any liability for
accident, injury or death arising out of or in consequence of this Agreement. Such insurance shall be in an amount not less
than One Million Dollars ($1,000,000.00) for any injury to or death of any person or persons in any single accident or
occurrence. Said policy of comprehensive public liability insurance shall be endorsed to provide to CITY and to tlle State
of California, Employment Development Department, at least thirty (30) days written notice prior to cancellation; name
CITY, its officers, agents, employees, and volunteers, and the State of California, its officers, employees, and volunteers as
additional insured; and state that such coverage is primary to any other coverage or self-insurance of the State of California
and CITY. Governmental entities may substitute a certificate of self-insurance. Submit Copy of Policy
I
Automobile Liability Covera
CONTRACTOR shall also obtain d maintain, during the effective period of this Agreement, broad form automobile
liability coverage with a $1,000,000 limit unless reduced by CITY, which applies to both owned/leased and non-owned
automobiles used by CONTRACTOR employees or participants in perfonnance of this Agreement, or, in the event that
CITY will not utilize such owned/leased automobiles but intends to require employees, participants or other agents to
utilize their own automobiles in the perfonnance of this Agreement, CONTRACTOR shall secure and maintain on file
from all such employees, participants, or agents as self-certification of automobile insurance coverage. Governmental
entities may substitute a certificate of self-insurance. Submit Copy of Policy
Workers' Compensation Cover e-
I understand, if CONTRACTOR is an "em 1 s set forth in California Labor Code Section 3300 et seq., or utilizes
participants as "employees," as set fort Cali 0 ia Labor Code Section 3350 et seq., CONTRACTOR shall obtain and
keep in force during the term of this Agreement full Workers' Compensation insurance coverage for injuries suffered by
participants. Said insurance policy shall guarantee CITY at least thirty (30) days written notice of cancellation or
modification. CONTRACTOR shall carry medical and accident insurance for those participants not qualifying as
"employees" for Worker's Compensation Coverage, pursuant to California Labor Code Section 3350, et seq.
Submit copy of Policy
I certify that my or ation will comply with the all stated language and that I am the person authorized to sign such
agreements on aIf 0
{ob(~
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 prospective recipient of federal assistance funds certifies, by submission of this
proposal, 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 prospective 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 proposal.
~~s 7, Hev,uMde:>
Name and Title of Authorized Representative
Signature
J
. Program Name: California Hispanic Commission on Alcohol & Dru2 Abuse, Inc.
EXHIBIT G
EJ OIJT-OF-SCHOOL BUDGET
o IN SCHOOL BIJDGET
Separate Budget if serving both In-
School and Out-If-School Youtb
Line Item Budget
10/1/03-6/30/04
Administrative Program Total WIA Match/In Kind
Personnel ...... > ..... .... ...... ....i.. .... .... I ... ....... ..'
Salaries' $ 2,766 $ 35,063 $ 37,828
Benefits $ 806 $ 10,221 $ 11,027
Other (list)'
Total Personnel $ 3,572 $ 45,283 $ 48,855 $ -
Operating Expenses . . .... ..
Rent or user fee" $ 12,000 $ 12,000
Utilities $ 675 $ 675
Phones $ 450 $ 450
Internet fees $ -
Parking fees $ -
Security $ -
Maintenance $ 315 $ 315
Insurance $ -
Equipment' $ - $ 6,880
Rental fees $ -
Purchase $ -
Vehicle lease charges $ - $ 1,000
(Vehicles may not be
purchased)
Office expenses $ 450 $ 450
(consumables)
Accounting Services $ - $ -
Legal services $ - $ -
Auditing services $ - $ -
Indirect costs $ 8,742 $ 8,742
(attach indirect cost
rate plan'")
Staff training $ - $ -
Staff travel/mileage $ 900 $ 900
Customer Training" $ 1,000 $ 1,000
Support services" $ 9,950 $ 9,950
Profit (for profits only) $ - $ -
Other (list)" $ 1,825 $ 1,825
Total Operating Expenses $ 8,742 $ 27,565 $ 36,307 $ 7,880
GRAND TOTAL $ 12,313 $ 72,848 $ 85,162 $ 7,880
(Total Personnel + Total
Operating Expenses)
" attach a separate sheet detailing these costs
Note: Total amount ofrol! over tram previous year
$
13,2lS3
)
J
DETAILED PROJECTED PROPOSED BUDGET FOR
WIA Youth - Fuerzas Unidas
October 1, 2003 to June 30, 2004
SALARIES:
Pro;ec:tDireclor
Adm;n;stra~,e A.sistant
Secretary
DataC~lkIRecepliQniSI
CoordioalOrlCounselor
CounselorlJobDeoeloper
TDTALSALARIES
Total SALARY RANGE
m
0,02
0,02
0,02
0,02
1.00
0,50
1.58
70,000
35.000
2B,ooo
20.000
30,000
25.000
BENEFITS:
FICA
SUTA
HEALTH
WORKER'SCOMP
RETIREMENT
TOTAL BENEFITS
(BENEFIT PERCENTAGE)
SUB_TOTAL SALARIES & BENEFITS
OPERATIONAL EXPENSES
FACILlTYRENTILEASE
RENT
TOTAL RENT
EQUIPMENT ANDIOR OTHER ASSETS LEASES:
VAN LEASEIS500lMONTHfor2 months)
TELEPHQNE SYSTEM (200IMONTH' 10%)
COMPUTER AND PRINTER
COMPUTER FORCLlENTSll)
COPIER (2001MONTW 10%)
TOTAL EOUIPMENT & OTHER ASSETS
SUPPORTIVE SERVICES:
CERTIFIED TRAINING
BOOKS AND SUPPLIES
CLOTHING
BUSPASSESrTOKENs
INCENTIVES
SOBERLlVINGllclients@$500lmo~lhfor5monll1s)
TOTAL SUPPORTIVE SERVICES
SERVICESANDsUPPLlES:
ACTIVITIES. RECREATIONAL
ADVERTISING
AUTO EXPENSE
BOOKS AND PUBLICATIONS
CONsUMMABLElHOUSEHOLD SUPPLIES
CONFERENCE
EDUCATIONAL MATERIALS
FACILITY MAINTENANCE (3501MONTH"10%)
INSURANCE
LlCENSEII'ERMITFEES
MATERIALOEVELOPMENT
MISCELANEOUSEXPENSES
OFFICE MACHINE MAINTENANCE
OFFICE SUPPLIES
POSTAGE
PRINTING
OFFICEEQUIPMENTIFURNITURE
TV
VCR
Bookcases (2x 300 ea.}
Oesk (2x400 ea.}
FHing Cabinets (2 x200ea)
Chairs (2x150 ea.}
Chairs {parllclpants-groupsessions}
Tables (participants)
TELEPHONE {501monlh)
TRAVEUMILEAGE(10DlMONTH)
UTILITIES (75IMDNTHI
TOTAL SERVICES AND SUPPLIES
SUB-TOTAL OPERATIONAL EXPENSES
TOTAL SALARIESlBENEI'lTS, SUPPORTIVE SERVICES AND OPERATIONAL EXPENSES
ADMINISTRATIVE OVERHEAD
INDIRECT COSTS (12 OF TOTAL SAUBEN, AND OPER EXPI
TOTAL ADMINISTRATIVE OVERHEAD
TOTALSUB.cONTRACT
TOTAL GROSS COST OF PROGRAM
TOTAL FUNDS FOR OCTOBER 1, 2003 TO JUNE 30, 2004
TOTAL AMOUNT ROLL OVER FROM PRIOR YEAR
7.65%
1.00%
10,50%
3.00%
7,00%
29.15%
84,460
43.260
30,000
25.750
34,000
30.000
PROGRAM
9 months
PropoMd
BudOI!
ADMINISTRATIVE
9mon!hs Malching
Propolld In kind
BudOI!
1.267
,,,
'"
,,,
25,500
9.563
35,063
2,766
2,582
'"
3,582
1,052
2,454
m
'"
'"
"
'"
10.221
806 $
45,283
3,572
12.000
12.000 $
1,000
'""
1,200
'"
'"
3,480
,
S
S
,
I
I
,
I
I
I
,
I
,
I
I
I
1,00ll
'"
'"
9,000
10,950
'"
'"
'"
'"
'"
'"'
'"
'"
'"
'"
'"
'"
'"
'"
'"0
'"0
'"
''"
'"
m
4.615 4,400
27,565 7,880
72.848 3.572 7,880
8,742
8,742
1$
$
$
72,8481$
71,879
13,283
12,313157,8801
,
Exhibit H
Provider agrees that in addition to those agreements and obligations specified
in the contract boilerplate and scope of work, it will also adhere to and obey
the following provisions, assurances, and certifications.
ARTICLES
1) Provider agrees to serve target population specified in the Work Plan.
2) Provider agrees to recruit youth with ample time to deliver full program
objectives as specified in the Work Plan.
3) Provider agrees to meet or exceed Performance Benchmark Goal
Projections specified in the Work Plan.
4) Provider agrees to invoice Santa Ana WIB for all program
services/activities on a monthly basis. Provider will attach all supportive
documentation.
5) Provider agrees to provide participant the following W1A elements:
a. Work Experience / Internships (Paid & Unpaid)
b. Leadership Development
6) Provider agrees to provide participant access to all 10 WIA elements
through participation in the Youth Service Provider Network.
7) Provider assures debarment action has not been taken against named
organization.
8) Provider assures and certifies that it will not use any funds appropriated
under this agreement for religious activity or anti-religious activity, or to
promote or oppose any political candidate, parties, and/or beliefs.
9) Provider agrees to comply with the Americans with Disabilities Act by
providing equal access to individuals with disabilities in the public and
private sector services, transportation, communications and
employment.
10) Provider assures and certifies that any requested modification to this
agreement must be submitted in writing, explaining requested changes
and rationale. Provider further assures that no modification will be
implemented without prior written approval from the Santa Ana WIB
Youth Council.
11) Provider agrees to cooperate with any monitoring, inspection, audit, or
investigations of activities related to this agreement as may be
scheduled and/or conducted by the Santa Ana WIB/Youth Council.
12) Provider assures and certifies that where applicable, classroom
instructors are properly credentialed, and training curriculums comply
with State Education Codes.
13) Provider agrees to acknowledge (given credit) the Santa Ana WIB Youth.
Council as the source of funds in all oral presentations, written
document, publicity, and advertisements regarding any activities that
ensue from this agreement.
EXHIBIT I
INSURANCE
Df':-10-201, 1!:4',
FRCM-ALL CAL INS
9167840 58
'r..m Fi:11/1:[; Hi<
l~ii;C')Ji 0.. CERTIFICATE OF LIABILITY IJ~SliIP.ANC:IEi-'--""'-"'-'-'-T~;;~;;::::;,:;;~;;'"
___~___,__,_""",,_, _._.J..___._..... ,,"",_.,_
.,,,,m":ER'(<:'161 784-9070 THIS CERTIFHlATE' IS ISSlIm ~.ll ,n r41l.HEI;t '.)F,u.q:m',','Of\l
. ON~Y AND (:ONI'''I~S Ml ftlOI,m UFON TH1, lJr.:FTI:,'HE
,AJ.l-Ca.'l. :Nn,a"QJ:;'a.tl.Qe Agen.cy HOLDER., nUl> 'CI~Rr!FIC'''T1~ DOI;~l; ]fIOlf" .~rt~I:'l'i(l, li~Yr!lJl: OF~
eOl. Ri,,,,,r.sido> Ave. Ste. 11105 ALTER.!!!ru:!2JI!!'.!~~~::!;f;!!~Uc:.l!:L" r~~k~"I!~i.y~,g':',.,_._...
Atb;, n;"",, ,,,, Jleve~ly
R~.~~5~:h~"__ CA 95678- INSURE~:SAfF,!:H!;!!!I'~COVI~"'~~,!;_.._... __ !~!',!';;L..
INSlI~I:[) INa.lRERA:~!~:~_~:=! :Ir~~J!~!:!~~~;~. _,..""~._.___.._
Ca.l:ifoj:'n~i ilr:liapanio C-;mnia8ion On Alcohol l~__._._______.____________ ._____.__......... _
Iii D;~'UgP.:l;l;l.i$e INSU~C: _._.__.._______...__ ._~,..._,..._~..___
2:1.0:]- Cilp.:i-t.ol Avenue: IkSURERD: __'___.~_'____.__"_". ._ _.._..._......_...._.
s!=:!:!!!!!!!!!:'~__....5A 958H- '_ASAS__.____._.__.__.._ ,. ......_...__...... _..,"."_"
COVI;RAflF-S; __ _._.______._._____.__ ..__..__.__._.,,__._.,~_.._-__, m" ,.'''_._._...
'ij:iEi-oo<:'f:ii j~FiNSU~Aft.lCE I-IS1EO selOW HAVE BEEN IssueD TO lHe IN$UREC NAMED ,AUOVf, 'QP: "~IE POUf:-r :ER1C[; IP. ['JCAT_::lJ:. N:1rMr,-\S; J,.'lI: I' i:;i l\N't'
I~EQlIIREMENr,n:RM CRCONOnlONOFAr.tvCONTRACTOROlHER OOCUMENTWllH RESPE:CTj(lwI1ICH THIS C:Efmfil,r~l:rf. r '1"'ft'F.I$$UJE:~; Ij" t'~'( ;1: I;,-:Altl,
'1l'1I::: :N$I..::FlA~ CI= AFFORDeD !I'Y THe POUCIES DeSCRIBI!O HEFt~IN IS SUB..II!CT TO p.J.J.. THE "ERMB. r~XCL!..It:;[(JNS' .AH~ ~:'ONI>TIC)t.~:; 0::- mKI ITI.. c;~F.:,~
J\G-GfIEGtlt: 1 ,IMI-S $HC:M'N MP-YH!l,.V! BeeN RfOUCfO I3Y PAID CLAIMS,
ItUftiiitl'C---' -.. _
L':B..!!:!iU3.Q......... ._...:rYF~ 01- IfoISUIV\Nc::e
J\. :r. ..:!J~ iA,'~l. L.IA....I.IT'(
Jt C(W~ERCIAL'3EN=I~JABlUTY
, rt=:::J cL""mlle [!:] occL,A
~~ ~~SSJ;OWAL loI.i\S.
. =C ':~oflI'ROnR. SEXUAL CONI)
.~~;' ~ ,1~GGF:~\TE UMI'r AffuI;SPER:
._J ~~ E:5~CV I J !18i 1 LOC
A :!I: ,!\.!:!T >.:03ILEU-.B'L.1T"t
!/-J,lYAL1'O
_-' hLl OlJIINED AIJiOS
,2L BGM'!:OULED AU1'OS
.~~ ttl ~.l':o 4,l/f~
.~f.. N()f\:.o'M>lE:C AUTOEi
."~ ~~c-__:!:,:;o_.
:!C: ~ COI.L:tS3: OM; $::;00
-, l- ~f;.~;~;;:;n--
'--l/~4Y AUTO
'-"'~'i
_.. _ __.i __
.1\ }:' 1:X1: ~5S'UMItREJ.L.A uMtlUT'
:~~I OGC:\J~ [J Cl.AU.. MADE
FJOI.Ic::Y NUMBER
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(l3JElil:/\L ,1.';::iR!t!,::\"l: .~; ,1Ji:'1)! ODr)
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C'E:sc~':pnC"1 01 O?E:RIITION~LOCATIO~;SN8tI~QL.USlONS AOOED 9V aNDORSEMENTISPECIAI. PR01j151ON~
~'E:f::;I'I'~( -:i:~ 3.i.u:l''rA ANAl I!',s: OFFICERS, AG3ftS, Oi'i'I~.-u.s, EHPLOYDS, ilW il~)lJ~1N'l:'B:Jl.:r..s hJU: ;,iJ,l1]W J"a ill :'IU::::':!(~j},,=.r. rl;-.JI~:~I: A~: ,!\.
E'U~D:lr.-NO -30'l'.P:c:2 TO TUB nTSt~. FaRM OG 2028 - J1f.INO!I:R. APPLIES.AS 1I1I.U, jU' 11XIUaI'I'!it ;;~"rA.c:BTlCI:
~;!:~~!lfl\?I\T1~i...~~L-.._
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CANCEL~IL.____________.. _.. _ .___.. ,__..ocu__........,. ...,.,
.,-.---...-\
E\.ECTRONIC LASER FORMS, I
SHOULD AIIfY or- THE M!O\r1! t)fS:R'13~:C1 'Itil~'::JE.[i u; '-;)VJ(lEH.~H> ,.I;r;llR! TIlE
EXPIRATI(;)t,l !;IAn 'Itll<F:GOF, TI-tl~ 'S~lt1I~': ':~.~IRI:';: W~L.I.. 1i]l~Mi'(P[}CI:11 MAlt.
~ E::A"SWfilJlTEI\I Nmy,;i; rf; ~.HE;f;EI:t..: ~Jr: ~ 1'1:: I-lr.I.IE;~ ~IJlt~':::1 'iQ r I:: ."I~r, ~~lr:)i!
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1./ "
(:1: Cl: or SANTA J.NA WIC/-:lC
}~l If'F.LL l3l\.~!l
P.'l. BOX 1.98B-H-73
__..__~~~1' .~
ACORJ:l2~; (2101/flSI
~~.,..,- I hlS(lI;~li (G 100}::15
CA 92701-
12/18/2883 17:18 7148357338
WORK CENTER BlSC
DEc-IO-ZOOl lS'42 FROM-ALL tAL Ift$
8167840' 58
PAGE 85
T-m F cos/oe,s ,-592
PIlUCY NUMIlEfllIClO:J03lI2S
COMMEFlClllL GllNl;'>Al-I.lA6IUTY
,~-
ntQ; ENDORSEMENT CHANGES THE POUCY. PLEA~E REAO 1"CI\REI~lU.Y.
ADDITIONAL INSURED - DESIGNATED PERSON .oR
ORGANIZATION
'IhIa..darseme'1l_ -..._ provided underll.~'
OOMMERCIA. ClI!NE/W. UABlUTY IlOVEIWII PART.
tCIIEIlULE
_ qf!'e'l"" or 0rp/lIZIlII0Ic '!liE CITY 0" SANTA ANA. rrs OFl'lOl!l'l8. ,~GeNl1\ 01'l'lC /\/,$, e 1>1 ;-LOYaL.,
AND VOl.IJf{Ta:R8.
.,
'.
(!fOG"'" Opp..... _. ~......_ '" compIoto..is .,"I"""'mont'IriII b.""""", i.,1l9 """Ir""~."'
..aflplilaIIIolollll$_J
WHO" "'" NUlleD (SllCI9n IQ IS llII\""""1ll _llIun -111" pe.1OfI or llr!l",,/id:n ~~'.r in 11,.
_...._'0I0111y__'" ~-"9 OUlol,'"''_a1'OM,orp''''''''';'''''.''' ~V"
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OoPJrit.... _co SllIVI<lll 0lII0ll. Inc. 1384
P3g<1 " Or!
DEI;-IO-ZO'i3 15:41
FROM-ALL CAL INS
91S784058
T..7a p (:,/1)(; F-[J'1
~:'
EXBlBlT B
ADDmONAt, INSURED ENDOlj~:l~MEN"C
FOR COMMERCIAL G~~"BRAL I.J.AB.I!..IQY POLK:~:
~. 'I /,'/,~. 1 "f
~~'"l.. i .. /f~~fI.'-'i ,/ ,. i ..
rnsunmcec..,,~y ~-'l;I.~;~L~.~:=&i:,!:ft,'I!--"-1:;'I!' c.(lc,j:JJ.C ;...,.",._"" ..'
. I~ f
".
This c:ncqrseinrmt l1'....itl- such insurance as is affimled by tile }:lrovisiOr.~1 of I', ) liC)
# ~ ()t'lS ~..lJ~lJ:l"'re1aD.ngtotbe followiIl8:
1. . The City of Santa Ana, 20 Civic Center Plaza, S:snlifL Am. 1::a1lil!;'I1lj'l ~. 'n':l~ ;i'~f
offic:ers. qrnpkyees. agents, volunteen. 0UKi reprCiClrtati:ves llDl1~ ,Iumed ~~;tcldi'tjlllal i:ilP.I!I~6s
("addilio~ i2uiuredsj with regacd to liability and defense Ohll.its, a.risi~ nrcll:!l rb= cI";rr,r,atioJ:ll
and l.1S<:S pafOJmed by or on bel!alf of the lWlled insurcxl. .
2. With .~ to cJ.jms ari!5i:ng out oftbe openrtioXl1' .and. t1S'~; 1)1' rl:llntt,d Il]' 01" 1':1
behalf of~ nuned iDsured. such ~ce as is affOnl.ed b)' tJ:Li:IJlolic,' is ptilll j '11' " luli;;; :;:,,,
additioual to 0:: Wlltnlnrtiug V"itb any other insluance call1ied by ~'r fOr t~l: b'~:I::1 i: of tlll::
additiOIl31 iWlllreds_
3. This. ~e applies sepmatl::ly to each inm.we:l a.g~t wllCllr; (;I~lT. il rJla<l~, m
suit is brouglit C1Xcept with respo::ct to the company's lUtti:1s oni:unility. ~[lle bl':: h~~I: 11 1:lf:al:l)'
I:~"<m orlorga-oization lIS an insured. shall not affect an)' :rigb.l wMeh slId:, t,er;; :ill m, 'qi'"Dj;~:~I:i';T"
~VO\1ld have lis a cb,/".,an! if not so included.
4. With RlSpIlCl: to the additional icsu.reds. rllis ir I$llr.m-ce shallllJot. b: 1;a:1,'cc::lIIllJ, ,,':'
materially reduced in coverage or limil$ except after thirty (:\0) '~[ys ~,ri'tl:il.l:1 ~11 i::l: 1: :I!. btlr.n " , ."
. ..si Vl:Q to the Ci:ty of Santa Ana, 20 Civic:: Centa Pm.. :Smta .1L:qp" CaUifo rpia I; \i: ;1) l"I~!"i;~~';~ ~!,., . .
"'kf<..?;(~.LA.<.L.:.:e- ~ ~ ~~ ",<,~":~I(......ee..~t~...~.. /,.;1 ...:I.-'~'A1.lj."
(C::ompl~on ll.fthe ~llowing. includinS countersignature, is re:q'~ired tCltO:ll~,: 'I: l:g f;ijdtIJi"'J:nIII:rl:
llf!ccti.vp..)
Effoective:.../l:..J K~
l"'~llcr Ii' _~~
.I[$$uec1 to
~t
<; TO I:...)..
.,c,"'" r\~ .
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- l.\,J,..... Att0\ i~'- .,.
'"\'I"t ~.Ity
,.c,le '0 0 f V
, this en:Lo:n!:~'lD.enl, Jiml1. II! l 'pall I' v-f
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~~ed Insur~~. :'___,
~....AA.._....~~
C-'dbt4.r::!b~::I~I._'."'~::!"-'--' -."...,
A on '~c:sJ.:l"qm:s,m:;atl.'l "~
I.....
....
NF
POLICYHOLDER COpy
STATE
COMPENSATIO....
INSURANCE
FUND
P.O. BOX 807, SAN FRANCISCQ,CA 94142-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 04-01-2003
COUNTY OF ORANGE
HEALTH CARE AGENCY
515 WEST SYCAMORE
SANTA ANA CA 92701
NF
CONTRACT SERVICES
GROUP: 000488
POLICY NUMBER: 0000381-2003
CERTIFICATE ID: 3
CERTIFICATE EXPIRES: 04-01-2004
04-01-2003/04-01-2004
JOB: FILES NO EMPLOYEES
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer.
We will also give you 30days'advance notice should this policy be cancelled prior to its normal expiration.
This certificate ofinsufance is not an insurance policy and does not amend. extend or alter the coverage afforded
by the policies listed herein. Notwithstanding any requirE!:rnent, term, or condition of any contract or other document
with respect to which this certificate of insurance msy be issued or may pertaIn. the insursnce afforded by the
policies described herein is subject to all the terms, exclusions and conditions of such policies.
p:~~
~~t
&b-
AUTHORIZED REPRESENTATIVE PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUOING OEFENSE COSTS: $1,000,000.00 PER OCCURRENCE.
ENOORSEMENT #2065 ENTITLEO CERTIFICATE HOLOERS' NOTICE EFFECTIVE 04-01-2003 IS ATTACHEO TO ANO
FORMS A PART OF THIS POLICY.
\iED ASTU
~_._..
.+----- . USA -C'~;-():">
(',Ity /\: ,,'Ii
EMPLOYER
LEGAL NAME
CALIF HISPANIC COMM ON ALCOHOL
AND DRUG ABUSE. lNC.
2101 CAPITOL AVE
SACRAMENTD CA 95816
CALIFORNIA HISPANIC COMMI~ION ON
ALCOHOL ANO DRUG ABUSE, INC.
A NON-PROFIT CORPORATION
03-17-2003
.:tlo:1l.I.Ie.t'I~lll:::l~..:"J..""''':l..I~:I''.II::t:I~I~II;J;:.'te3'~<ej:{.].J~I.~. 'l""iI=-fl1'~:1-"'I~
J
12-13-'04 12:38 FROM-ALL-CAL INSURANCE
9167840158
T-358 P002/007 F-682
i!CORD~ CERTIFICATE OF LIABILITY INSURANCE 1 DATI;: (MMlDDNYYY)
12/13/2004
PRoDUceR (916) 784-9070 fr- 2ab-1A-\. THIS C~RTlFICAT~ IS ISSU~D AS A MATTER OF Ii'4FORMATION
ONLY AND CONF~RS NO RIGHTS UPON THE CERTIFICATE
All-Cal Insurance Agency HOLD~R. THIS C~RTIFICA T~ DO~S NOT AMEND, EXTEi'40 OR
BOl River$~de Avenue #105 Pr -~ -14 (j AL T~R TH~ COV~RAG~ AFFORD~D BY TH~ POLICIES BELOW.
Attn: Beve~ly
RosQvil1e CA 95678- INSURERS AFFORDIi'4G COVERAG~ , i'4AIC#
INSURED IN......R I< NON PROFI~S INS ALLIANCE A VI
Ca1ifornia H~spanic Commission on Alcohol INsu.E.",NOR~H AMERICAN ELITE lNS.
and Drug Abuse Prevent~on INSURER C: , ,
2101 Capitol Avenue INSURER 0:
Sacramento CA 95816- INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BElOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AN~
REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT Wln-l RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR '~'i:~ POl.leV NUMIilIiR ~'-+'i";Jt&~ POLICY IiXPIRAnON LlMlT$
LT. INS TV,.e O~ INSURANOli DATEfMMI~
A X ~Ne.RAl. LIABILITY / / / / EACH OCCuRRENCE . l,OOO,OC
DAMA:i,E JD RENTEO
~ ~r"EflClAL OeNl:RA1..llASlulY PREMI E l tEa OOCUmln08' . 50/0C
- CLAIMS MACE ~ OCCUR. 2004-03026 n/18/2004 11/18/2005 MEO EXp fMv 011& DBrloon} . s,oe
X PROFESSIONAL LIAB. PERSONAL &M>V INJURV . 1,OOO/OC
X ~OYEE aEN1Fl~S / / / / GE:NERAL AGGReGAtE . 2/000jOC
-;Z;~ AGG~nE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $, 2,OOO,OC
X POl.ICY ~~ - n l.oe / / / / IMPROPER SEXUAL COHO 1,OOO/OC
A X ~TOMOBIl.E LIABILITY / / / / COMB1NED SINGLE UMIT 1/00010C
(Ea iU:x:id'ant) .
- ANY AUTO
- ALL QIMolEO AUTOS 2004-0302t5 n/1B/2004 n/18/2005 8001L Y INJURY
(Par person) .
.!- SCHEDUl.ED AUTOS
.!- HIRED AUTOS ,d / / / BODILY INJURY
.
.!- NON-Q\l\NEDAIJTOS ,\:U " (P<< acddtir"ll)
X C(!Id:lI' D2D: $250 !,>-'P {V' / / PROPERTY DAMAGE
X $500 _.....t\> ,H l' (Pet'~dlM\l) $
COLLISION 0110:
~~GO LIABILITY ,<:~~~ (,'f-. e~ AUTO ONLY -EAACCIOENT .
ANY AUTO V. '( S,O \\0\1' / / / .
~p" \Sl'- S'C;\\~ OTf..Il:R THAN ""ACC .
AUTOONl.Y: AGG $
A X ~E5SlUM8RElL.A UA,8IUTY ./ ,,/,,'(0' P / / / / EACH OCCuRRENCe . 4/000/0C
X OCCUR. 0 CkAlMS MADE 1'-'0 G}OOO/OC
/) AOl3F1EGATE $
"
.
;:l ~EDUCTIBLE 2004-03026UMB \ 11/18/2004 11/1B/2005 $
X RETENTION $10,000 .
WORKIiRS COMPENSATION AND / / / / I~L'llHsl 1'1!,\'
EMPLOYIiRS' UABlLlTY
~y F'ROPRIElORlf'AA'(Nf:M:XeCuiIVE E.l. EACH ACCIDENT .
OFFICERlMEMBER EXClUDED? / / / / EL. DISEASE - EA eMPL,OY~E $
ltY8&,<!escribeunder
SPECIAL PROVISIONS ~Iow E:.L. DISeASe:. POUCYUMJT $
Il OTHO. l'INt'LOnl'l DISHONES'rY CWB 000 2271 02 03026 11/18/2004 11/18/2005 LIMI' $100,OC
FORGERY/ALTERATION OWB 000 2271 O' 03026 11/18/2004 11/18/2005 OEDUCTION $5C
A DIRECTORS & OFFICERS 2004-03026Do 11/18/200' 11/1B/2005 LIMI' $ 1,000/00
DESGRJP110NOF OPERATJONSlLOGA1l0NSlViHlGLESJEXGLUSlONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
THE CITY OF SANTA ANA, ITS on-leERS, AGmNTS, OFFICIAt.S, EMPLOYEES, .MID 'V'O!.UNl'EERS AltE NAMED AS ADDITIONAL :rNSURlilD AS
FUNDIN'G SOURCE TO 'I!HE INStmED _ FORM CG 2026 APPLIES_
ANABELL !lA~ES
CANC~LLA 1101'4
SHOULD ANY OF THE ABOYa DEBCRlElIiC POI.lOliS BE CANOIeI.I.E!c sEFOm: THE
EXPIRA110N DATE THEREOF. THI! ISSUING INSURER WILL ~ MAIL
~ DAYS WRITTeN NOTICE TO THE CERTIFICATE HOLOER NAMIt:O TO THIi I.EFT, tfOO
~_I!I_lfl(lOOIlOOiC~ltII,
~ ~llI/Ilill~_KOlll:
AlI'l'HO ED REPftU "lIVE
..ACORD CORPORATION'9
Psg.. 1 '
CERTIFICATE HOLD~R
( )
CITY OF SAN~A ANA
P,O. BOX 1988 M-73
20 CIVIC CEN~ER PLAZA
SAN~A ANA CA
. ACORO 25 (2001/08)
ftr~-li'4S025 (0108).05
92701
ELECTRONIC lASER fORMS. I
.~ t2-13-'04 12:38 FROM-ALL-CAL INSURANCE
9167840158
T-358 P003!007 F-682
ADDITIONAL INSURED I=NDORSEMENT
Insurance Company\.J....^\'n--.C.~ .:LnS A\\io..'I\e..t- cR LA
This endorsement modifies such insurance as is afforded by the provisions of PoliCy
# ~C>~- OOC>!:l(n relating to the followirg:
1. The City of Santa Ana. 20 Civi,; Center Plaza, Santa Ana, California
92702; its officers, employees. agents and vol~:Tieers are named as additional insureds
("additional insureds") with regard to liability and defense of suits arising from the
operations and uses performed by or on behalf .::[ the named insured.
2. With respect to claims arising out:;[ the operations and uses perfonned by
or on behalf of the named insured. such in:>.lrance as is afforded by this policy is
primary and is not additional to or contributing ',Iith any other Insurance carried by or for
the benefit of the additional insureds.
3. ThiS Insurance applies separately to each insured against whom claim is
made or suit is brought except with respect Ie the company's limits Of liability. The
inclusion of any person or organization as an insured shall not affect any right which
such person or organization would have as a C:.3imant if not so included.
4. With respect to the ad,jitional insureds, this insurance shall not be
c:anceled. or materially reduced in coverage or limits except after thirty (30) days written
notice has been given to the City of Santa Fna, 20 Ciyic Center Plaza. Santa Ana.
California 92702.
(Completion of the following, including cou;'.tersignature, is required to make this
endorsement effective.)
Effective 1/"- If -~o'O t.J /;/..-,f .::<'OIJb, this endorsemenlform as a part of
Policy# r:2/)!)t.f- 0 ~ D~1_ in _-
Issued to CAL/tOIUYLll II/SfltltH!..CO/vfJvfJ5~/{)tll{J.lll1/.lfJlf~L
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y.~~tersi by /1- ~.... - -
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