ITY OF LOS ANGELE 12~09

Transcription

1 LAURA TREJO GENERAL MANAGER ITY OF LOS ANGELE 12~9 DEPARTMENT OF AGING CALIFORNIA AN AREA AGENCY ON AGING 358 WILSHIRE BLVO. STE. 3 Los ANGELES. CA ) ANTOf\11 R. VILLARAIGOSA MAYOR C.F. No.: Council District: Citywide Contact Persons: Laura Trejo: (213) James Don: (213) 252~435 October 17,212 Honorable Antonio R. Villaraigosa Mayor, City of Los Angeles City Hall, Room 33 Los Angeles, CA 912 Los Angeles City Council c/o City Clerk's Office City Hall, Room 395 Los Angeles, CA 912 Attention: Ms. Mandy Morales, Legislative Coordinator ARTS, PARKS, HEALTH, AND AGING COMMITTEE TRANSMITTAL: REQUEST APPROVAL OF AMENDMENT 1 TO FISCAL YEAR BUDGET AND STANDARD AGREEMENT TV FOR THE SENIOR COMMUNITY SERVICE EMPLOYMENT PROGRAM SUMMARY The Los Angeles Department of Aging (LADOA) requests approval of Amendment 1 to the Fiscal Year Senior Community Service Employment Program (SCSEP) Budget and Standard Agreement with the State of California, Department of Aging. The State of California has made available an additional $21,574 in funding, changing our total grant award from $1,555,311 to $1,576,885 for Fiscal Year The general breakdown of expenses is as follows: Contractual Services Office and Admin Ex ense Subtotal: SCSEP Participant Stipends SCSEP Participant Trans ortation Grand Totals: 14,187 5, 4, 322,163 1,228,696 3,852 21,574 ~-~-~ t t-"~ ~555,311 1,576,885 21,514 AN EQUAL li:mf'i...oyment OPPORTUNITY- AFFIRMATIVE ACTION EMPLOYER

2 Page2 Honorable Antonio R. Vi!laraigosa Los Angeles City Council October 17, 212 Adoption of the report recommendations will result in no additional impact on the General Fund. Since program expenses are fully funded by the SCSEP grant and appropriated General Fund dollars, the report recommendations comply with the City's Financial Policies. Both Amendment 1 to the FY 212~ 13 SCSEP Budget, and Amendment 1 to Standard Agreement TV are included as attachments to this report. Background SCSEP provides classroom training and part-time work experience to approximately 2 city residents who are at least 55 years old, unemployed, and have annual incomes that are no more than 125% of the federal poverty guidelines. The grant funded work experience occurs within non-profit community services agencies all across our city. Program participants, who are technically trainees, are paid under the City classification of Community Administrative Support Worker L Participants perform a variety of training duties that include clerical and office functions, food service, stocking/merchandising, and other community support work. RECOMMENDATIONS The LADOA recommends that the City Council, subject to the approval of the Mayor: 1. Approve Amendment 1 to the FY SCSEP Budget included as an attachment to this report, and Amendment 1 to Standard Agreement No. TV with the State of California, Department of Aging; 2. Authorize the General Manager, Los Angeles Department of Aging (or designee) to: a. Execute the FY SCSEP Budget Amendment 1 Application (attached) and Standard Agreement No. TV Amendment 1 subject to the review and approval of the City Attorney as to form and legality; b. Accept from the State of California, Department of Aging the additional $21,574 in SCSEP Program funds associated with Amendment 1 to Standard Agreement No. TV ; c. Authorize the General Manager, LADOA, or designee, to prepare Controller accounting instructions and any necessary technical adjustments that are consistent with the Mayor and Council actions on this matter, subject to the approval of the City Administrative Officer, and authorize the Controller to implement those instructions; and, 3. Authorize the Controller to increase the appropriation within the other programs for Aging Fund No. 41, as follows: ACCOUNT NO. ACCOUNT TITLE 2121 Enrollee Wages -- Total ~~-~-- AMOUNT ----j_ $21, '$_2_1,

3 Page 3 Honorable Antonio R. Villaraigosa Los Angeles City Council October 17, 212 FISCAL IMPACT STATEMENT The LADOA's proposed action authorizes the receipt of an additional $21,574 in Federal grant dollars for the SCSEP program. Adoption of the report recommendations result in no material impact on the General Fund and the report recommendations materially comply with the City's Financial Policies. A copy of this transmittal with attachments is being forwarded to the City Attorney for review and approval. ~ ~4~ LAU TREJ General Manager L T:JD:MP:JK:mn:m:clerical/transmittals!Title V Budget Attachments cc: City Attorney City Administrative Officer Chief Legislative Analyst President, Council on Aging

4 '""'ate of CaUfornia Senior Community Services Employmen! Program (Title V) Budget CDA 35 (Rev 1/21} Page 1 of 4 Department of Aging EXHIBIT B-1 BUDGET SUMMARY BUDGET PERIOD: 7/U1/212-6/3/213 SECTION A COST CATEGORIES [ ] ORIGINAL [X j REVISION NO.: 1 PSA NO.: 25 TOTAL COSTS SECTION B Date

5 State of California Senior Community Services Employment Program (Title V) CDA 35 (Rev 1/21) Page 2 of 4 Department of Aging AAA ADMINISTRATION BUDGET NARRATIVE* BUDGET PERIOD: /31213 I [X 1 DIRECT [ 1 CONTRACTED I [ 1 ORIGINAL [X] REVISION NO.: 1!CONTRACT NO.: TV SECTION A: PERSONNEL COSTS I slots: 173 I DATE: IPsA N.:--25 (a) (b) (c) Annual %of Time Position Classification: Wage Rate Devoted Total Sr. Management Analyst I $88,4 1.% Sr. Accountant II $82,67 6.% ;.4...:<.. >. :.-.:.4,956 Sr. Clerk Typist $56, %.: 1,814 Accountant II $65,71 4.%... ' >2,628 Senior Management Analyst II $122,524 4.%.. 4;91..;;;S;:;:u;;:.:bt;;;.:ot;:;:.al:;_:..;;;C;:;:o:.:,:nt;;,;in;;;;ua;;,:,ti:;;:,on~of.l:' P:;;:,'Os;;;:,it~io;;,;n;;;.s ;,;,fro;;;:,m:.:..:,.:aa:.,::a~ad:;:,:m.:,:;i::,:,n,;_p~g:2:;.,.,x (:2;,t..~) ~ L-...::$:,.:..7~,5::::;38::._-L_..!..:1::;;;:,;:;.~,.::%:.._~.;,;_;.,~,.;.:,:..,:.7.f~~ TOTAL PERSONNEL 11,:... SECTION B: OPERATING COSTS Travel:... ; :}''!.',: : :;::> :_:;:::; < :... :... : ,..... Equipment (List): FRINGE BENEFITS 41,747 TOTAL PERSONNEL COSTS. :: ,984 Total Supplies:.. : o,.. ' c, ; : U>i,:;,[:;:.'(( :)",: : )'.' 'i''h;;:~;;,:,;::{'<.. Contractual: (:'..:<;;;(: ::,; Other (List): ~Complete this page if AAA retains federal funds for administrative costs. TOTAL OPERATING COSTS INDIRECT COSTS o!-----'--- 43,73'1 f TOTAL COSTS AAA ADMINISTRATION :. 195,715

6 State of California Senior Community Services Employment Program (Title V) CDA 35 (Rev 1121) Page 2 of 4 Department of Aging AAA ADMINISTRATION BUDGET NARRATIVE* BUDGET PERIOD: I [ X l DIRECT [ I CONTRACTED I! I ORIGINAL [X J REVISION NO.: 1!coNTRACT NO.: TV SECTION A: PERSONNEL COSTS Position Classification: General Manager Assistant General Manager [slots: 173 I DATE: [PSA NO.: 25 (a) (b) (c} Annual %of Time Wage Rate Devoted Total $16,296 2.% ,26 $144,47 3.%.. 4, """"""----..! ,...,~' : J1 TOTAL PERSONNEL.: 7;[ ~-----~---'-' FRINGE BENEFITS ~---~~- TOTAl PERSONNEl COSTS. f:538 SECTION B: OPERATING COSTS Travel: Total :.. Equipment (List): Supplies:....,,:: ~::.'~ ~':,. \ : } :. ' :. ;:,. " :... :: o. : ''\<: j:;,,r :,::; ::::,: ::.::;<! (?;: 1'/:. t :e::,.,...::,.,,,. : :!;, >z< q;;i..',,. ::.,:;:...,...,.,.,,...,,,. c '{i ::>, ~ : "':'i:' :....::::! : ;~:>;). ; :<:..:;; :.;;:::. ::",: ::t: : c.t:'i:':::,::,.:< : ~..;;::'\>,: ;;,,;!"' ::,; :;'{:.'~;,;':}:~ ~ >O Contractual: l'\:',,:: <,.. ::x ;;:o: Other (List) r----- <~ * Complete this page if AAA retains federal funds for administrative costs. TOTAL OPERATING COSTS 1---'---~"-'- INDIRECT COSTS TOTAl COSTS- AAA ADMINISTRATION: ) 1:~38

7 State of California Senior Community Services Employment Program (Title V) CDA 35 (Rev 1121) Page 3 of 4 Depa rtmen! of Aging PROJECT ADMINISTRATION BUDGET NARRATIVE* BUDGET PERIOD: 7/ I[X J DIRECT []CONTRACTED ~~ ] ORIGINAL! X] REVISION NO.: 1!cONTRACT NO.: TV SECTION A: PERSONNEL COSTS Position Classification: lst..ors: 173 ioate: IPsA NO.: 2s (a) Annual Wage Rate (b) %of Time Devoted (c) Total TOTAl PERSONNEl... f-'...-~-'-'-'---'-'~ FRINGE BENEFITS TOTALPERSONNELCOSTS.. SECTION B: OPERATING COSTS Total Travel:.. :.:.:,,,,..\.> ,.:.: > \. :... :: :.::. :., :.>",.. :.::- > :; ::.-. :.:;: : :-..: :.... : > >.,,.; :.... ;:; Equipment (list): :.y::.::;::;o:: ;:.:: :.: :>:. : : : ; : ~± :.:.: : : " ' : Quantity >L: ;:: ;i:;::~ ;::.:.::::: ::; Unit Price :....,: ::::::<:. ><..: ::.'!::: :.. :c : :...,:.;, :::.. :...: ::... <. : : ;:: :::: : :. : :: ;:: ::.:.:.-:... :: <:::.;.,:.,)i'',: : ~: :::: :: :.,:,... :: o; \.;. ;.;;;;:<: :./}i.. c;::.;;:..::;;,;;!t!i ':;: ::.,.. :o ::~:: i Y 'C:} '. ::;;::.....: ::.>.... :. : ;::::.:::: :. ;:, :;:;:::;:.)iii :. i''g; :,:.. :: ~ : ~::\ :;.; ~,::;) :: ::: ;;;?: : ' \\c ::. Supplies: Contractual: Other (list): <';c. <:; :: :> ; ;:O' '~ K t.:... :..;.,... * Do not include AAA administrative costs. o 1-'"---~'--'---- TOTAL OPERATING COSTS INOIRECT COSTS I TOTAL COSTS- PROJECT ADMINISTRATiON :

8 State of California Senior Community Services Employment Program (Title V) CDA 35 {Rev 1121) Page 4 of 4 Department of Aging PROGRAM COSTS BUDGET PERIOD: [X] DIRECT [ ) CONTRACTED CONTRACT NO.: TV SLOTS: 173 DATE: PSA NO.: 25 PROGRAM/PARTICIPANT WAGES AND FRINGE BENEFITS {PWFB) SECTION A: PERSONNEL (a) (b) (c) (d) (e) Number Average Work Average Number Participant Classification of Participants Wage per Hour Week Hours of Weeks Total Community Administrative Support Worker I (Hourly Rate of $8. ) 162 $ '. ' Community Administrative Support Worker I {Monitor) (Hourty Rate of $1.) 11 $ ,655 SECTION 8: FRINGE BENEFITS... :. c... :<' _:", ,...-;...:".:"_.... TOTAL PERSONNEL. <. :. \. 1,25,27. Categories Number of Participants Total Physicals 173 6,5 FICA 84,268 Workers Compensation 5,761 Other: SECTION C: OPERATING COSTS PROGRAM/OTHER TOTAL FRINGE BENEFITS ~ / TOTAL PERSONNEL COSTS- PROGRAM/PWFB i.... +,~91,799 Categories Staff Costs Other Total -;r;.:o~c::r~"'pi~p:la;.:_l~:.::~u:..::n:' ~ t~;;;;;... ~._,.~..."". +.,.. ;;;:;;.,.:"",... ::';,,...!z:;.;',.:;;z. ':~,r""i"~;.'.;;'igj.,..,.i ~~~:~~~~~!- _--'-~--'-.'-... '"".:..-.. ;:'s.~~f... Orientation 26, ;581 Assessment 5,722 <.. 5;722 Training* 78, ;53.8 Supportive Services * 53, 176 < < $3,176 Job Development* 52,18... <......:..< ".52;18 Transportation* o Other (Lis1): :::. o......:.o :.: o * Lis! Program Staff: (Optianal) TOTAL OPERATING COSTS 2z3;893 INDIRECT COSTS 75,1111 TOTAL OPERATING AND INDIRECT COSTS- PROGRAM/OTHER! i. i 34$:Qo:4

9 FY Title V Allocations Federal Funds Revision 1 Contract- MATCH REQUIREMENTS PSA Grantee SLOTS 5 Marin 1 8 San Mateo 18 9 Alameda 17 1 ~111con yalley San Joaqui~ Fresno/Madera 2 15 Kings-Tulare Ventura 9 19 LA County 22 2 San Bernardino Riverside ()ra~gel San Diego 5 25 LA City Stanislaus 9 Total 785 Federal Funds Increase 89,92 1, ,824 2, ,834 2,12 359,69 4, ,863 1, ,85 2,494 98,893 1,371 8,912 1,122 1,816,27 25, ,6 5, ,16 1, ,17 1,6 449,512 6,235 1,555,311 21,574 8,912 1,124 7,57,334 97,896 Total 9'1, ,69 154, , ,69 182,299 1,264 82,34 1,841, , , ,77 455,747 1,576,885 82,36 7,155,23 Match Total Grant 11.82% 1,772 19,389 18,312 43,87 15,8 21,543 11,849 9, ,588 44,164 92,636 91,559 53, ,35 9 ; 695' 'I 845,576 State Operations Withheld Total Grant 454,957 7,61,187 Minimum 1% Match 845,576 AAA Percent of funding 11.82%

10 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY EDMUND G. BROWN JR. Governor CALIFORN~DEPARTMEN~t~O~F~A~G~IN~-G-.~~~~~~ ~~--~~~~~~-~~ 13 National Drive, Suite 2 SACRAMENTO, CA Internet Home Page: TDD Only FAX Only (916) (916} To: CiTY OF LOS ANGELES September 1, 212 Enclosed are four Standard Agreements for Contract Number TV , Amendment i, in the amount of $1,576,885. which increases the contract amount by$ 21,574.. Any additional documents that need to be submitted with this contract are checked below: insurance Certificate or letter of self-insurance for: General liability (7/1/213) D Auto (7/1/213) D Professional (7t1t213) ~solution (T11.1e) D No Documents Required D No Resolution (False) Please sign and return all four copies of the Contract and any additional documents required to: California Department of Aging 13 National Drive, Suite 2 Sacramento, CA If you have any questions, please contact me at (916) 4 i Thank you. Don Fingado Contract Analyst California Department of Aging Do Your Part to Help California Save Energy To learn more about saving energy, visit the CDA web site at

11 State of California Agreement#: TV~ California Department of Aging Date: 7/1/212 CDA 276 (Rev Di/6) Amendment#: 1 Amendment Date: 9/5/212 Exhibit B- Budget Detail, Payment Provisions, and Closeout SENIOR COMMUNITY SERVICE EMPLOYMENT PROGRAM Budget Display Fiscal Year 212/13 City of Los Angeles NET TOTAL CHANGE FEDERAL FUND PROGRAMS: Federal Title V * 1,576,885 21,574 Subtotal 1,576,885 21,574 * Maximum of 8% allowed for Administration * Minimum of 79% for participant wages and fringe benefits TOTAL FEDERAL TITLE V 1,576,885 21,574 # of Participant Slots ~~~ **Funds for this contract are provided by using the following U.S. Department of Labor grant: CFDA# Grant# Effective Date AD A-6 7/1/212 Page

12 . s ra.te OF CALIFORNIA STANQARD AGREEMENT AM._.~DMENT STD. 213 A [Rov 613) D CHECK ltere w ADDITIONAL PAGES ARE ATTACHED Pages AGREEMENT NUMBER AMENDMENT NUMBER I-T.::_V m..:..:12::...::'1-"--3---=2..::..5 ~-:--~-I 1 ~~EGISTRATION NUMBER 1. This Agreement is ant~red into between the State Agency and Contractor named be::.:.lo=-w'-":'-----~------~- state AGENCY'S NAME California Department of Aging CONTRACTOR'S NAME 2. The term of this 3. The maximum amount of this $ 1,576,885. Agreement after thi~ a111endmen! is: One million, five hundred seventy-sixthosand, eight hundred eighty-five dollars 4. The parties mutuahy agree to this amendment as follows. All actions noted below are by ihis reference made a part of the Agreement and incorporated herein: This amendment reflects an increase in federal funds and services based on the grant from the U. S. Department of labor. Exhibit B~1, Budget Detail, Payment Provis!ons and Closeout, page 7, is attached and incorporated, and replaces the original Exhibit B, Budget Detail and Payment Provisions, page 7; The Budget, amendment 1, is hereby incorporated by reference and replaces the original Budget. All other terms and conditions shall remain the same. IN WITNESS WHEREOF, this Agreement has been executed by the partles hereto. CONTRACTOR CONTRACTOR'S NAME (II other than an indlvkfua/, slate wilelhet a corpora/ion, partnership, eto.) ~~--- BY (Aulhorizecl Signature).I DATE SIGNED (Do not type) X!S PRINTED NAME AND TITLE OF PERSON SIGNING CALIFORNIA Department of General Services Use Only f\ddress 358WILSH!RE BLVD. STE 3 LOSANGELES CA91 - ~ --- A_GENCY NAME California Department of Aging BY (Authorized Signature} I'K STATE OF CAliFORNiA I DATE SIGNED (Do nottype) P_RINTED NAME AND TITLE OF PERSON SIGNING IX] Exempt per: AG OP Rachel de Ia Cruz, Manager, Contracts and Business Services Section ADDRESS 13 National Drive, Sacramento, CA ~-~---~er:;_~!!~ July 1, 212 through June 3, 21} ~~~~- --nn~~on n-..._~--n -- ~: -

13 Use nn ~ ~~ ~ nn. S" 'ATE OF CALIFORNIA STAN[}ARD AGREEMENT AIV~o.... ~DMENT STD. 2"13 A [Rev 6/3) D CHECK HERE IF ADDITIONAL PAGES ARE ATfACHED Pages AGREEMENT NUMBER TV~1213"25 REGISTRATION NUMBER AMENDMENT NUMBER 1 1.,_This Agreement is entered into~_between the State Agency and Contractor named below: STATE AGENCY'S NAME California DeQ.rtment of Ag=i"-'-ng., _ CONTRACTOR'S NAME 2. The term of this ~--~:49~~.::me_~~~--~~-- July 1, 212 through June ~Q~]Qi"-'.3= The maximum amount of this $ 1,576,885. Agreement after this amendment is: One million, five hundred seventy-six thosand, eight hundredeighty-flve dollars 4. The parties mutually agree to this amendment as follows. All actions noted below are by this reference made a part of the Agreement and incorporated herein: This amendment reflects an increase in federal funds and services based on the grant from the U. S. Department of Labor. Exhibit B~1, Budget Detail, Payment Provisions and Closeout, page 7, is attached and incorporated, and replaces the original Exhibit B, Budget Detail and Payment Provisions, page 7. The Budget, amendment 1, is hereby incorporated by reference and replaces the orlglnal Budget All other terms and conditions shall remain the same. ln WITNESS WHEREOF, this Agreement has been executed by the parties hereto. CONTRACTOR CONTRACTOR'S NAME (If other /han an individual, slate whelhet a corporation, patftmrsliip, e/c.} -- BY (Authorized Signature) I DATE SIGNED (Dono/type) Jif5 PRINTED NAME AND TITLE OF PERSON SIGNING. "~ CAL.IFORNIA Department of General Services Only f\ddress 358 WILSHIRE BLVD. STE 3 LOS ANGELES CA 91. _ STATE OF CALIFORNIA AGENCY NAME California Department of Aging BY (Alilhorized Signatwe) I DATE SIGNED (Do notlype) ff!s - PRINTED NAME AND TITLE OF PERSON SIGNING ~ Exempt per: AG OP RaQhel de Ia Cruz, Manager, Contracts and Business Services Section ADDRESS 13 National Drive, Sacramento, CA ~ ----~~~~~ ~"" ~ ~ ""

14 - ~ S',"i\TE OF CALIFORNIA. STANQARD AGREEMENT Afii~---~DMENT STO. 213 A (Rev 613) [] CHECK HERE.IF ADDITIONAL PAGES ARE ATrACHED Pages AGREEMENT NUMBER AMENDMENT NUMBER ~~~ - - nnn- TV REGISTRATION NUMBER -.,~---a < ><C<O<CO on-c--o --c----- om - i. Th1s Agreement IS entered mto between the State Agency and Contractor nam~d~b-=-e.:..::lo;...:.wc...:.:~~ state AGENCY'S NAME _California Department of Aging CONTRACTOR'S NAME 2. The term of this Agreement is July 1, 212 through June 3, The maximum amount of this $ i,576,885. Agreement after this amendment is: One million, five hundrod seventy-sixthosand, e!ghll~tmdred eigllty-five dollars 4. The parties mutuahy agree to this amendment as follows. All actions noted below are by this reference made a part of the Agreement and incorporated herein: This amendment reflects an increase in federal funds and services based on the grant from the U. S. Department of Labor. Exhibit B-1, Budget Detail, Payment Provis(ons and Closeout, page 7, is attached and incorporated, and replaces the original Exhibit B, Budget Detail and Payment Provisions, page 7. The Budget, amendment 1, is hereby incorporated by reference and replaces the original Budget. All other terms and conditions shall remain the same. IN WITNESS WHEREOF, thls Agreement has been executed by the parties :.. = hereto. CONTRACTOR CONTRACTOR'S NAME (If o111er Ill an an Individual, state whether a corporetion, partnership, etc.) BY (Authorized Signature).] DATE SIGNED (Do no/type)! S PRINTED NAME AND TITLE OF PERSON SIGNING CA!..!FORNIA Departmen1 of General Servlces - Use Only ADDRESS 358 WILSHIRE BLVD. STE 3 LOS ANGELES CA 91 STATE OF CALIFORNIA AGENCY NAME California Department of Aging BY (Atilhor/zecl Signature).fffS I DATE SIGNED (Do notlype) P"RINTED NAME AND TITlE OF PERSON SIGNING Rachel de Ia Cruz, Manager, Contracts and Business Services Section ADDRESS '13 National Drive, Sacramento, CA ~ ~" -- ''-----~- "-~--~~-~-~ ,..,...,...,... - ~ -.,., - [Sl Exempt per: AG OP

15 . s,-ate OF CALIFORNIA - -STANQARD AGREEMENT AI'IJ'l.... JDMENT STD. 213 A (Rev 6/3) CHECK HERE IF ADDITIONAL PAGES ARE ArfACHED Pages AGREEMENTNUMBER AMENDMENT NUMBER f-tv-'---"---~--=-1 =--21.::...:3'--'~ 2=5: c l 1 REGISTRATION NUMBER i. This Agreement is entered into betweerlj!le. State Agency and Contractor named below: STATE AGENCYS NAME California Department of Agln~ ~ CONTRACTOR'S NAME 2. The term of this ~---- -~~ ,~,---~~~~ ~~~~-,---~-~ ' -~~--i!~ee~~!:~ ~-)uly 1, 212 through June 3, The maximum amount of this $ 1,576,885. Ag_Eeei!!_El_Cl! after this amend men! is: One million, five hundred se~enty-six thosand, eight hundred eighty-fiv~~~lar~~ The parties mulualfy agree to this amendment as follows. All actions noted below are by this reference made a part of tht:) Agreement and incorporated herein: This amendment reflects an increase in federal funds and services based on the grant from the U. S. Department of Labor. Exhibit B-1, Budget Detail, Payment Provisions and Closeout, page 7, is attached and incorporated, and replaces the original Exhibit B, Budget Detail and Payment Provisions, page 7. The Budget, amendment 1, is hereby incorporated by reference and replaces the original Budget. All other terms and conditions shall remain the same. IN WITNESS WHEREOF, this Agreem~nt has been executed by tha parties hereto. CONTRACTOR CONTRACTOR'S NAME (If other 1/Jan an individual, state whelhet a corporaiion, partnership, etc.) BY (Authorized Sigrwturc) I DATE SIGNED (Do noltype) JES PRINTED NAME AND TITLE OF PERSON SIGNING - CALIFORNIA Department of General Services Use Only c ADDRESS. '" 3s8o WILSHIRE BLVD. STE 3 LOS ANGELES CA 91 STATE OF CALIFORNIA AGENCY NAME California Department of Aging BY (Aolhorized Signature) 15 I DATE SIGNED (Donotlype) PRINTED NAME AND TITLE OF PERSON SIGNING l2j Exemptper: AG OP Rachel de Ia Cruz, Manager, Contracts and Business Services Section ADDRESS 13 National Drive, Sacramento, CA ~~ " '" =-=::~----~~ ~~"'"