HomeMy WebLinkAboutContracts & Agreements_11-2020ecology center
AGREEMENT FOR SERVICES
THIS AGREEMENT ("Agreement") is made and entered into by the Ecology Center, a
nonprofit public benefit corporation organized under the laws of the State of California with offices at
2530 San Pablo Avenue, Berkeley, California, 94702 and City of Redlands with offices at
35 Cajon Street Redlands CA 92373 (hereafter
"Contractor," and together with the Ecology Center, the "Parties") The Ecology Center enters into
this Agreement to carry out a portion of its California Nutrition Incentive Program ("CNIP") Grant
Agreement with the California Department of Food and Agriculture- ("CDFA") grant contract
number 19 -0807 -001 -FR
WHEREAS, Contractor has the required capacity to provide the services sought by the Ecology Center, and
WHEREAS, Ecology Center wishes to utilize Contractor's services and abilities during the term of this
Agreement, and Contractor is willing to offer such services upon the terms and conditions contained in this
Agreement,
NOW THEREFORE, in consideration of the promises contained herein, the Parties agree as follows
1 Tenn, Engagement, and Services. This Agreement is effective as of January 1, 2020 and
terminates on December 31, 2020 unless terminated earlier as provided herein During the term
of this Agreement, the Ecology Center hereby engages Contractor and Contractor hereby agrees
to serve the Ecology Center, as an independent contractor and not as an employee or agent of the
Ecology Center Contractor shall be available to work for reasonable periods of time to perform
the scope of services and provide deliverables according to the budget and schedule as set forth
in Attachment A Budget, Attachment B Scope of Work, and Attachment C Debarment
Certification Form (the "Services"), included with and hereby made a part of this agreement
Either party to this Agreement may terminate this Agreement at any time, with or without cause,
by giving the other party thirty (30) days wntten notice Should Contractor default m the
performance of this Agreement or matenally breach any of its terms, the Ecology Center at its
option, may terminate this Agreement effective immediately upon giving written notice to
Contractor stating the reason for the termination of this Agreement
Contractor's original grant proposal and any revisions thereto, including all supplemental
documentation provided by contractor to document grant deliverables, match, and incentives to
be distnbuted, is incorporated by reference as a part of this agreement
2 Compliance with Terms of the Ecology Center Grant CDFA Agreement 19 -0807 -001 -FR.
Contractor agrees to comply with all terms and conditions applicable to the Ecology
Center's Grant Agreement with CDFA19-0807-001-FR Contractor also agrees to
comply with all applicable Federal and State regulations, including but not limited to, the
Code of Federal Regulations (2CFR 230, 2CFR 200) Research Terms and Conditions
(06/11) and N1FA Agency Specific Terms and Conditions (10/14) at
http.//www nifa.usda.Eov/business/awards/awardterms.html, General Provisions found in
Title 2 2CFR Part 400, 2 CFR Part 415, 2 CFR Part 416, 2 CFR Part 418, 2 CFR Part
2
422 7 CFR 3015 3016 3019 Title 7 7 CFR Part 3430 and allowable cost principles
found in 2 CFR 220, 225, and 230 or Federal Acquisition Regulation 48 CFR 31 2 — all
incorporated by reference and found at
http.//www.apo.gov/fdsys/browse/collectionCfr.action?collectionCode=CFR Contractor
also agrees to comply with the provisions of the Fair Employment and Housing Act (Gov
Code 12990 (a -f) and the applicable regulations promulgated there under California Code
of Regulations, Title2, Section 7285
Contractor is required to provide a non-federal match as stated in Attachments A Budget
All matching funds must directly benefit and be specifically identifiable with approved
project objectives The Contractor is required to maintain complete, accurate, up-to-date
records to support all matching activities under the award Matching requirements may
not be satisfied with Federal funds or with property or services provided under another
Federal assistance award
Ecology Center may withhold payment of funds for expenses deemed unallowable by
CDFA In the event that it is determined by the Ecology Center that a contractor has been
paid for work and expenses that are deemed unallowable, Contractor will be required to
refund to the Ecology Center all grant funds which were disbursed to the Contractor for
unallowable expenses
3 Compensation. Project Expenses. and Payment Terms. A budget that is agreed to by both
parties is attached to this Agreement as Attachment A Total expenses for Services,
excluding incentives, shall not exceed $8,182 Contractor agrees to distribute $6,860 in
incentives on SNAP/CalFresh purchases as set forth m Attachment B Total payment for
Services and Incentives distribution under this Agreement shall not exceed $15,042
In addition, Contractor agrees to contribute non-federal, cash, or in-kind match, of goods or
services equal to or exceeding $21,718.61 in fulfillment of the deliverables of the project
as set forth in Attachment A Budget Contractor certifies that all match sources are
non-federal and all match expenses and in-kind services are for the purposes and
objectives set forth in the terms and conditions of the Federal and State award and meet all
grant award requirements pertaining to project match All original match expense receipts,
invoices, and other back-up documentation must be retained by the Contractor and kept on
file, available on request for audit purposes
Contractor may only distribute incentives at outlets that have been approved for
participation by USDA's Food and Nutrition Services (FNS) via a Memorandum of
Understanding (MOU) A signed MOU between CDFA and each outlet must be reviewed
and approved by FNS prior to the outlet's participation Distributing incentives at outlets
not approved by FNS is a violation of this contract and Contractor will be required to
repay grant funds for incentives distributed through unauthorized outlets
Any changes to the attached budget must be agreed to in writing by the Ecology Center
prior to Contractor incurring costs exceeding the original budgeted amount of any line
item Contractor is entitled to reimbursement for reasonable expenses to the extent that
such expenses are budgeted, necessary for the performance of the Services under this
Agreement, and are considered allowable costs under applicable Federal and State
regulations as outlined and noted in Section 2. of this contract agreement. Monthly
invoices and back-up documentation shall be e-mailed in the provided Excel formats and
submitted by the 7th day of the month following the reporting/invoicing month to receive
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payment within thirty (30) days of the Ecology Center's receipt of the invoice and all
required backup documentation, with the exception that in no case shall the Contractor
receive payment prior to the Ecology Center's receipt of payment from the Grantor foi the
period billed
Monthly invoices must be submitted using the invoice, timesheet and mileage tracking
templates provided by the Ecology Center and must adhere to all procedures and policies
as required by the Ecology Center Invoicing documents must include the dates and hours
worked and the nature of the work performed in the description Contractor shall attach
original or scanned copies of receipts for all expenses billed under this Agreement All
original receipts, invoices, and other back-up documentation must be retained by the
Contractor and kept on file, available on request for audit purposes The invoice and all
required documentation must be submitted before a payment will be processed The
Ecology Center niay withhold payment on an invoice until all required information or
documentation has been provided by Contractor Monthly progress reports are due by the
7'" day of the month following the reporting month and must include a description of the
progress made on grant deliverables as described in Attachment A Progress reports must
also include a description of the amount of incentives distributed by market/site for the
reporting month
4 Independent Contractor Contractor and the Ecology Center agree that Contractor is, and
shall be, an independent contractor and not an employee or agent of the Ecology Center
Nothing in this Agreement shall be interpreted or construed as creating the relationship of
employer and employee between the Ecology Center and Contractor and/or Contractor's
approved employees or subcontractors
Contractor is responsible for all applicable legal and governmental obligations as an
independent contractor, including, without limitation, all business licenses, worker's
compensation and liability insurance requirements and the withholding and transmittal of
all fees and taxes Contractor shall not be an agent of the Ecology Center and shall not
have any authority to sign agreements for the Ecology Center or to bind the Ecology
Center to any agreements or other obligations
Any agreement to be executed for the Ecology Center shall be presented to and be signed
by a duly authorized representative of the Ecology Center
It is expected that Contractor will work directly with the Ecology Center in performing
the Services However, if Contractor wishes to hire subcontractors in performance of
the Services, Contractor must obtain the prior written consent of the Ecology Center
and, in that event (i) each approved subcontractor must agree to terms consistent with
the terms of this Agreement, (ii) approved subcontractors shall be Contractor's sole
responsibility, and (iii) Contractor shall be solely responsible for the approved
subcontractors' compensation and for compliance with all applicable legal and tax
requirements
5 Taxes If Contractor or Contractor's organization is not incorporated the Ecology Center
will inform Contractor of the total amount of payments made to Contractor on a calendar
year basis during January of the following year and report such payments as required by
law Contractor shall be responsible for complying with all applicable national and local
employment, income and other tax laws
6 Indemnification. Contractor agrees to protect, indemnify, defend and hold harmless the
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Ecology Center and its directors, officers, employees and agents from and against any and
all claims, demands, actions, Judgments, fines, penalties, liabilities, losses, settlements,
taxes, damages, injuries, costs or expenses (including, without limitation, attorneys' fees
and all other fees and costs incurred in investigating or defending any claim or action),
either directly or indirectly, which may be asserted against any of the foregoing persons by
Contractor, Contractor's employees, agents or subcontractors, or third parties, in any
manner related to, arising out of or resulting from
(a) Contractor's performance of the Services under this Agreement,
(b) any failure of Contractor to perform its obligations under this Agreement,
(c) any claim that the Services and/or Deliverables infringe the intellectual property
rights of a third person
(d) any acts of Contractor beyond the scope of its authonty under this Agreement,
(e) any negligence, willful misconduct or other wrongful acts or omissions of
Contractor, its employees, agents or subcontractors,
(f) any injury, damage or death to Contractor, its employees, agents, subcontractors,
partners or other representatives, or
(g) any injury, damage or death to any third party
7 Representations and Warranties Contractor represents and warrants that (a) Contractor
has the full power to enter into and perform this Agreement and to make the grant of rights
contained herein, (b) all Services performed hereunder shall be performed in accordance
with the Ecology Center's specifications and requirements and with all necessary care skill
and diligence, (c) the Deliverables will meet the description of Deliverables set forth in
Attachment B, (d) upon delivery of each Deliverable, the Ecology Center will have
marketable title to such Deliverable, free and clear of all liens and encumbrances, and (e)
the use of the Deliverables for the purposes intended will not infringe upon or violate any
rights ofprivacy, publicity, patents copynghts or any other rights of any nature of any
third party
8 Confidentiality. Contractor acknowledges that Contractor will have access to proprietary
and confidential information in order to perform specific duties and provide the Services
Contractor warrants that Contractor will not use or disclose any information received or
obtained by Contractor in connection with Contractor's performance of the Services except
as necessary to perform the Services Contractor shall use at least the same degree of care,
but no less than reasonable care, to avoid disclosure or use of the Ecology Center's
information as Contractor employs with respect to its own Confidential Information of a
like importance Tlus warranty shall not apply in any instance where the Ecology Center
has expressly directed Contractoi, in writing, to disclose information to a third party
9 Leaal Compliance. The laws of the State of California shall govern the interpretation of
this Agreement Any action to enforce this Agreement shall be brought in the Superior
Court for the County of Alameda or in the U S District Court for the Northern Distnct of
California, San Francisco, California
10 Assignment. Contractor may not assign, delegate or subcontract neither this Agreement nor
any of its rights, duties or obligations under this Agreement without the prior written consent
of the Ecology Center Any purported assignment or delegation not consented to by the
Ecology Center shall be void at the Ecology Center's option and shall constitute a material
breach of this Agreement
11 Amendments and Waivers. Any supplement to or modification or waiver of any provision of
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this Agreement must be in writing and signed by authorized representatives of both Parties
A waiver by either party of any breach of this Agreement will not operate as a waiver of any
other breach of this Agreement
12 Notices. All notices required under this Agreement will be delivered in writing to the
recipient's contact designated in the first paragraph of this Agreement, or to such other
contact as designated in writing from time to time Notices shall be by hand delivery,
nationally recognized overnight courier, certified or registered mail, email, or
facsimile and will be effective upon receipt or when delivery is refused, whichever
occurs sooner
13 Records All financial records and documentation pertaining to this contract,
including incentives and match expenses, will be maintained for three years after the
completion of the grant period All original expense receipts, invoices, and other
back-up documentation must be retained by the Contractor and kept on file, available
on request for audit purposes
If any provision of this Agreement is prohibited or is unenforceable, said provision shall be
ineffective to the extent of such prohibition or unenforceability, without invalidating any of the
remaining provisions of this Agreement
This Agreement contains the entire agreement of the Parties and supersedes any and all previous
agreements, which may have been made, whether orally or in writing
WHEREFORE, the Parties have executed this Agreement as of the date(s) set forth below
The Ecology Center
Signed
Execut
Pnnted Name
Date
Director
A-Pti lei Wo
City of Redlands
Sig
Name of Contracting Organization
Executive Director/Authorized Signatory
Printed Name
Date
Attest
Paul W Foster, Mayor
Adisieep•-/
e Donaldson, City Clerk
CNIP GusNIP Attachment A Budget
City of Redlands
MARKET MATCH BUDGET: JAN 1 2020 - DEC 31 2020
SECTION A: SALARIED PERSONNEL tDO NOT INCLUDE VOLUNTEERS)
PERSONNEL TITLE
NAME OF
PERSONNEL
PERFORMING
WORK
PERSONNEL
SALARY
PERCENT
ALLOCATED ON
PROJECT
CAL MONTHS
ON PROJECT
FRINGE RATE (IF
APPLICABLE(
EXPENSE
TOTAL (SAL 8
FB)
GRANT FUNDS
NON-FEDERAL
MATCH
TOTAL
BUDGET JUSTIFICATION INARRATIVE)
MATCH SOURCE (IF APPLICABLE]
Project Manager
Meghan Meade
591,644,00
20 %
12
41 %
$25,843.61
56,033.00
518,910_61
$25.&13.$'1
Meghan will be working 3 hours swiping customer EBT cards and
distributing EBT and Markel Match scrip at the Thursday Night C mined
Farmers Market Meghan will be working 5 hours per weak planning
marketing, outreach, 08enceng wobinars,data collection and Invoicing.
C ah m t h for e m d rev nue from booth le generated
at both markets
30.00
00.00
30.00
00.00
30.00
50.00
00.00
00.00
50.00
$0.00-
0.0030.00
60.00
0040
00.00
00.00
5000
50.90
SECTION TDTAL
823,843.61
16,933.00
018.810.61
MEM
SECTION 8: HOURLY PERSONNEL (DO NOT INCLUDE
VOLUNTEERS)
PERSONNEL TITLE
NAME OF
PERSONNEL
PERFORMING
WORK
PERSONNEL
HOURLY
�' TE
NUMBER OF
HOURS ON
PROJECT IN
PERIOD
FRINGE RATE % (IF APPLICABLE(
EXPENSE
TOTAL (SAL 8
FB)
GRANT FUNDS
NONFEDERAL
MATCH
TOTAL
BUDGET JUSTIFICATION (NARRATWE)
MATCH SOURCE (IF APPLICABLE)
Downtown Attendant
NIA
513.00
104
0%
51,352.00
SO.00
$1,352.00
51,352.00
For 12 months of the year this person will be swiping customer EBT cards
0d distributing EBT rid Markel Match one tth Saturday Morning
Codified Farmers Market (52 Saturdays a year x 2 hours distributing
Market Match a 104 Hours a year),
C sh match for am dr veno from booth fees generated
al both markets.
Events Assistant
Chargee
Macomber
514.00
104.00
0%
57.456.00
SOHO
51,456.00
51,456.00
For 12 months of Oro year Chartee will be swiping customer EST cards
and distribufng EBT and Market Match scnp al the Thursday Night
C din d F no r Market (53 Thursdays a year 2 hours distributing
Market Match 106 hours a year]
Cash match for is earned revenue from booth fees generated
( both m rk Is
50.00
5000
50.00
50.00
00.00
$0.00
SECTION 8 TOTAL
32,60$60
30.00
32.808,00
' 52,506.00
1
CNIP GusNIP Attachment A Budget
SECTIONC: BOIAPMENT `GRF..ATER THANS500
EQUIPMENT ITEM
EXPENSE
GRANT FUNDS
TOTAL
BUDGET JUSTIFICATION (NARRATIVE}
MATCH SOURCE (IF APPLICABLE)
NfA
50.00
3D TRAVEI
TYPE OF TRAVEL (OROPDOWN
MENU}
EXPENSE DESCRIPTION
COST PER UNIT
NUMBER OF
UNITS
EXPENSES
GRANT FUNDS
NONFEDERAL
MATCH
TOTAL
BUDGET JUSTIFICATION (NARRATIVE)
MATCH SOURCE (IF APPLICABLE)
Airfare
Flight for Conference
5246.000
5246.00
5246.00
.5246.00.
Airfare to attend the required CMMC face to taco meeting Adam is to
and from dosgnated aepons
Ground Transportation
Shuttle la airport -Rom
airport to conference from
rnnfarnnra In alrnml and
Hotel 1 Accomodafi0ns
Hotel for Conference
530.000
4
3120,00
5120.00
5120.00
Sh the to airport born airport to conference from conference to airport
and from airport to home
3161.000
2
5322.00
3322,00
5322.00
Hotel accamndat;ans to attend the required CMMC Taco b1 face meeting
Per Diem
Breakfast and Lunch for Day
1 and Dinner far Day 2
541 000
541 00
'341,00
Meas to attend the required CMMC lace to taco meeting Perdiem rams.
57 breakfast 511 lunch and $23 for dinner Thu expanse total 1n0Judes
breakfast and lunch for Monday totaling 515 and Oinne for T esday
totaling $23 Grand total 541
50.00:
50.00.
• $0.00'
50.00
50.00
SECT1aN,D
SECTION E PARTICIPANTJTRAININO COSTS (EXCLUDING INCENTIVES)
EXPENSE DESCRIPTION
COST PER UNIT
EXPENSE $
GRANT FUNDS
,
TOTAL
BUDGET JUSTIFICATION (NARRATIVE)
MATCH SOURCE (IF APPLICABLE)
5000
-'..50.00 -.
5000
6EC.'fioN_E DTJ
EiSik
SECTION x11 OTHER INRECTC
SUBSECTION 3 EXPENSE TYPE
(DROPDOWN MENU)
EXPENSE DESCRIPTION
COST PER UNIT'- NUMBER OF
UNITS
EXPENSES
GRANT FUNDS
NONFEDERAL
MATCH
TOTAL
BIJBGEY JUSTIFICATION (NARRATIVE)
MATCH SOURCE (IF APPLICABLE)
2 Publication Costs
Social Media Advertisement
for Customer Outreach
550.00
4
5200.00
5200.00
5200.00
Social Media outreach for Market Match attracting targeted lora!
consumers 4 ads at 050 each $200
2 Publication Costs
Market Match Flyers for
Customer Outreach
50 16
2,000
.)'5320.00
5320.00
3320.00
Outreach materials wdl be dislnbuted at both markets and at local
rnm ;ty 10 Ledo i clod; 0 YMCA Community Centers Senior
Centers Library Food Pantries and more to inform CalFrash customers
about the Incentive program at Redlands Farmers Markets
50.00
50.00
50.00'
2
CNIP GusNIP Attachment A Budget
3
■
SO 09
MI
Sone
50.00
00 00
SECTION F TOTAL
1526,00
5520.00
5000
1520.00
SECTION H: INDIRECT COSTS
IMMIONAIIIMMIUM
TOTAL GRANT INDIRECT
SECTION H TOTAL
0.00%
58.182.00
50.00
00.00
SECTION I: TOTAL DIRECT E. INDIRECT COSTS
TOTAL GRANT
FUNDS
TOTAL NON
FEDERAL MATCH
TOTAL PROJECT
BUDGET
SECTION I TOTAL
$15,042.01)
$21,718.61
536,766.61
All expenses (grant and match) must directly benefit and be specifically identifiable with approved Market
Match project objectives.
SECTION E• TOTAL INCENTIVES
NON-FEDERAL
MATCH
TOTAL
BUDGET JUSTIFICATION (NARRATIVE)
MATCH SOURCE (IF APPLICABLE)
DOLLAR AMOUNT OF INCENTIVES TO DISTRIBUTE
$6,860.00
06,880.00
Approximately 46.860 in Markel Match incentives 041 be disTbuted over
the 12 months We estimate approximately 7 customers per market day
6 510 receiving 510 incentives each 7 x $10 x 96 markets 05.060
Howells estimate was reached This calendar year we had 473
transactions for 64 markets averaging 5.63 people per market We
accounted for a 15% increase for the 2020 calendar year and that would
put our pro] Cted transaction at 543 divided by 84 markets puts our
average at 6.5 peopple per market. As a half a person doesn't exist we put
the average at 7 people per market per day.
SIGNATURE OF
AUTHORIZING
OFFICIAL
TITLE OF
AUTHORIZING
OFFICIAL
NON -INCENTIVE TO INCENTIVE FUNDING
NON
INCENTIVE
FUNDS
INCENTIVE
FUNDS
INCENTIVES AS
PERCENT OF
TOTAL BUDGET
$8,182.00
$6,860.00
-
TOTAL BUDGET
029,900.61
58,860.00
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CNIP GusNtP Attachment B Scope of Work
D `ct.ml.)(i 2020 Eccilo.„,
Attachment B. Scope of Work
Contractor Name City of Redlands
Start Date January 1, 2020
End Date December 31, 2020
Distribution of Incentives
Contractor will
• Distribute $6,860 Market Match (MM) incentives to SNAP customers at a
minimum of 2 Ecology Center -approved Certified Farmers' Markets between
January 2020 — December 2020,
• Provide incentives that are funded by GusNIP federal dollars or non-federal match
only for SNAP/CalFresh purchases,
• Provide incentives that are funded by GusNIP federal dollars or non-federal match
only at outlets (sites) that have been approved for participation by USDA's Food
and Nutrition Services (FNS) via a Memorandum of Understanding (MOU) A
signed MOU between CDFA and each outlet must be reviewed and approved by
FNS prior to the outlet's participation Distributing incentives at outlets not
approved by FNS is a violation of this contract and Contractor will be required to
repay grant funds for incentives distributed through unauthorized outlets
• Provide the incentives as a dollar -for -dollar SNAP match, up to contractor -set
maximum per household, per day,
• Produce or reuse all MM scrip needed at the markets served by Contractor In the
case where new scrip is produced of printed, the design must first be approved by
the EC's Market Match Program Coordinator, Program Manager, Program
Director or Executive Director prior to production,
• MM scrip must be restricted to the purchase of fresh, California -grown fruits and
vegetables only at the Certified Farmers' Market or other approved Market Match
site No change is to be given on Market Match scrip 100% of the value of the
scrip turned in by the farmers/growers/vendors must be paid at 100% of the value
to said farmers/growers/vendors
Administration and Reporting
Contractor will
• Hire and maintain sufficient staff or volunteers to execute the program as detailed,
• Oversee, track, evaluate, manage, report on any and all Market Match activities
under the contract that Contractor is providing or subcontracting,
• Turn in monthly invoices, back-up documentation and monthly reports no later
than the 7th of each month following the month previous or as requested by the
Ecology Center,
• Attend 4-6 Consortium calls/webinars If Contractor is not able to attend for any
reason, they will be responsible to tell Ecology Center Program Manager in
advance, and read minutes or watch webinat recording following the webinar
1
CNIP GusNIP Attachment B Scope of Work
• Attend the annual in-person Market Match Face -to -Face Meeting/Conference in
Oakland, California
Systems, Tracking, Evaluation
Contractor will work with the Ecology Center to
• Administer a unified data collection and tracking mechanism foi Market Match
participants in order to track all monthly reporting and evaluation metrics
accurately and in a timely fashion,
• Provide input, feedback, and cooperation on the development, implementation,
and execution of State and National evaluation metrics, tools, and systems,
• Carefully track federal and non-federal match budget spending and work with the
Ecology Center on any necessary Line Item Shift adjustments or Grant reporting
requirements
Contractor will
• Carefully and completely track, input, and report on all program metrics that are
deemed useful/needed by the Ecology Center These monthly reports will be
provided by or before the 7th of each month following the month previous,
• Cooperate fully and support data collection and analysis conducted through
Ecology Center and California Department of Food & Agriculture's required
evaluation of the GusNIP project, and any national evaluation conducted through
the GusNIP Training, Technical Assistance, Evaluation and Information Centers
(LATAE)
Promotions & Outreach to Market Match Eligible Customers
• All Market Match promotional and outreach materials and signage must be
approved by the EC's Market Match Program Coordinator, Program Manager,
Program Director or Executive Director prior to printing and distribution,
• All promotional and outreach materials and signage must promote the Market
Match program and align with program branding, messaging, look and feel
Contractor will
• Produce locally -focused, MM branded, outreach materials and advertising in
accordance with approved budget and budget justification,
• Partnei with local media, social service agencies, and community based
organizations to distribute outreach materials to promote the purchase of fruits
and vegetables to SNAP/CalFresh shoppers at Certified Farmers' Markets and
other approved Market Match sites
Contractor will work with the Ecology Center to
• Improve and build upon uniform MM language and statewide materials,
• Participate in any and all statewide, regional or locally focused centralized
promotions or outreach strategies executed by the Ecology Center on behalf of
the statewide MM program
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ATTACHMENT C
DEBARMENT CERTIFICATION FORM
The contractor certifies that, neither the Contractor firm nor any owner, partner, director, officer, or
principal of the Contractor, nor any person in a position with management responsibility or
responsibility of the administration of federal funds
(a) Is presently debarred, suspended, proposed for debarment, and declared ineligible or
voluntarily excluded from covered transactions by any federal or state department/agency,
(b) Has within a three year period preceding this certification been convicted of or had a civil
Judgment rendered against it for commission of fraud ora criminal offense in connection with
obtaining, attempting to obtain, or performing a public transaction contract (federal, state, or
local), violation of federal or state antitrust statutes, or commission of embezzlement, theft,
forgery, bribery, falsification or destruction of records, making false statements, or receiving
stolen property,
(c) Is presently indicted for or otherwise criminally or civilly charged by a governmental entity
(federal, state, or local) with commission of any of the offenses enumerated m paragraph (b)
above; or
(d) Has within a three-year period preceding this certification had one or more public transactions
or contracts (federal, state, or local) terminated for cause or default
The Contractor further certifies that it shall not knowingly enter into any transaction with any
subcontractor, material supplier, or vendor who is debarred, suspended, declared ineligible, or
voluntarily excluded from Covered Transactions by any federal or state department/agency
Dated this 21st day of January, 2020
By ';?k-cJaD
Paul W Foster, Mayor
ATTEST
e Donaldson, City Clerk