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PROPOSAL EVALUATION TRANSMITTAL

PCO 001_V2

Date: 03/12/20

Sent via: Fax U.S. Mail UPS E-mail Hand

To: Angie Nichols Project #: 18048

Firm/Agency: Washington Unified School District Project Name: Southport ES – Prop 39 HVAC Replacement

Address: 2747 Linden Road

West Sacramento, CA95691

File No.: 02-117371

City, State, Zip CC: Jim Moore

From: Brie Gargano

Phone: 916.254.5603

Attachments:

Date Proposal No. Description

03/03/20 01 CCD-A 002 / RFP 001: Fire Alarm Changes Backup received

BCA takes no exception to this proposal Please revise and resubmit this proposal per comments below

The proposal has been rejected for the following reasons: Work is already included in contract for construction

The quote is higher than industry standards

Owner has elected not to proceed with additional work

No back up documentation has been provided

Angie,

BCA has reviewed the attached proposal received on 03/03/2020 in the amount of $13,244.00 and offers the following comments:

The electrical engineer has confirmed that the scope of work is correct and the pricing is reasonable.

BCA recommends approval of COR 01. A change order will follow District acceptance.

Do not hesitate to contact us with any questions or concerns.

Accepted by the Washington Unified School District:

District’s Authorized Agent

Signed: Brie Gargano

Client Leader

BCA REASON CODE

Agency Requirement

Design Error Discovery Item

Field Condition

Inaccurate As-built Plans

Owner Requested

Value Added / Omission

Value Engineering

Proprietary & Confidential Document

Bid Date: JULY 2, 2019

Project: WASHINGTON UNIFIED SCHOOL DISTRICT

PROP 39 HVAC UPGRADE

Prepared for: ACCO ENGINEERED SYSTEMS – IVAN HOOPER

Division: FIRE ALARM & DETECTION SYSTEM

Reference: CCD-02 FIRE ALARM CHANGES

Bid Amount:

$ 13,244 DOLLARS

PREVAILING WAGE RATE: COMMERCIAL INSIDE WIREMAN PER DIR DETERMINATION

FOR FIRE ALARM WORK IN YOLO COUNTY IS INCLUDED

Scope of Work: C10 FIRE is Supplying the electronic Submittals, electronic Design/Engineered Shop Drawings,

Fire Alarm Equipment, Provide/Install all Cable, Install All Field Devices, Panel Terminations,

Programming/Start-Up/Testing Services, Owner Training, AHJ Testing, and Two (2) Year

Warranty.

ELECTRICAL CONTRACTOR shall Provide/Install all Standard Back-Boxes, Install Custom Back-

Boxes & Panels/Enclosures Supplied by C10 Fire or Others, Provide/Install All Conduit/Sleeves,

Raceways & Fire-Stop.

Standard Exclusions: Conduit/Raceways/Sleeves/Firestop, Standard Back-Boxes, Panel/Enclosure Mounting, Duct

Detector Housing & Sampling Tubes Install (by Mechanical or Others), Door Holder & Fire Door

Hardware & Related Power Supplies/Power, Water Flow & Tamper Switches & Adjustment(s),

120V Water Flow Bell, Damper End-Switches & Monitoring, Access Hatches & Signage,

Demolition, Fire Watch, Lifts & Scaffolding, Coring & Cutting, Painting & Patching, Seismic

Engineering & Calculations, Knox Box, Permit & Plan Review Fees, and Agency or Municipality

Inspection Fees.

Bid Expiration: PROPOSAL IS VALID FOR SIXTY (60) DAYS

Labor 8,392

Material 3,648

Equipment 0

Engineering 0

10% OHP 1,204

CHANGE ORDER #01 FIRE ALARM & DETECTION

Submitted by:

Kevin McElwee

C10 Fire, Inc.

President

(530) 802-2760 Direct

(530) 305-7495 Cell

kevin@c10fire.com

STATE LICENSING:

dba C10 Fire Alarm

dba C10 Fire & Security

CA C10 Lic. #1024832

CA ACO Lic. #7681

CA ACM Lic. #5693

CA PWC Reg. #1000047578

CA SBE Cert. #2004157

UL UUFX Listing #S35943

C10 FIRE, INC. 17400 Airport Ave., Hangar #3

Grass Valley, CA 95949-7309

(530) 830-6775 Office

EMAIL: info@c10fire.com

https://www.c10fire.com/

PROJECT: DATE: 7/2/2019

REFERENCE: BY: KM

HOURS RATE BURDEN EXT COST

24 $71.46 $38.24 $2,632.80

8 $71.46 $38.24 $877.60

8 $71.46 $38.24 $877.60

14 $71.46 $38.24 $1,535.80

22.5 $71.46 $38.24 $2,468.25

$8,392.05

OHP MARKUP: 10% $839.21

$9,231.26

QTY EXT COST

1 $3,083.00

1 $177.00

$0.00

$0.00

$0.00

$3,260.00

SHIPPING: GND $119.00

SALES TAX: 8.25% $268.95

OHP MARKUP: 10% $364.80

$4,012.75

UNIT EXT COST

$0.00

$0.00

$0.00

SHIPPING:

SALES TAX: $0.00

OHP MARKUP: $0.00

$0.00

HOURS RATE BURDEN EXT COST

$0.00

$0.00

$0.00

$0.00

$0.00

OHP MARKUP: $0.00

$0.00

QTY EXT COST

$0.00

$0.00

$0.00

$0.00

$0.00

SHIPPING:

SALES TAX: $0.00

OHP MARKUP: $0.00

$0.00

$13,244.00

C10 FIRE, INC.

LABOR

LABOR TOTAL:

MATERIALS

DESCRIPTION UNIT COST

TRADE/TASK

Journeyman Electrician - Commercial Inside Wireman; Field/Circuit Investigation

Journeyman Electrician - Commercial Inside Wireman; Ex. Device Removal

Journeyman Electrician - Commercial Inside Wireman; Device Install

Journeyman Electrician - Commercial Inside Wireman; Device Program/Test

MATERIAL SUBTOTAL:

Edwards Equipment; ** See Attached Vendor Quote for Unit Pricing ** $3,083.00

#16AWG 2-Cond.; FPLR Cable $177.00

SUBCONTRACTOR LABOR

TRADE

SC LABOR TOTAL:

SUBCONTRACTOR MATERIALS

DESCRIPTION UNIT COST

PROJECT CHANGE COST WORKSHEET

WUSD SOUTHPORT ES

CCD-02

Journeyman Electrician - Commercial Inside Wireman; Route SLC Feeds to Ex. IDC

DESCRIPTION

LABOR SUBTOTAL:

UNIT COST

MATERIAL TOTAL:

CHANGE COST TOTAL:

EQUIPMENT

EQUIPMENT SUBTOTAL:

EQUPMENT TOTAL:

MATERIAL SUBTOTAL:

SC MATERIAL TOTAL:

LABOR SUBTOTAL:

Date: 07/02/19

Version: QSP_120_e1_AI v17

Job No: 0

Total: $3,456

Job Name: WUSD Southport Elementary School

Filename: -

To: C10 FIRE, INC.

17400 Airport Ave

Grass Valley, CA 95949

Attn: Kevin McElwee

Qty Cat No Description User Net Extended

EST3 Local Rail Modules

1 3-SSDC1 Single Signature Driver Controller 1,760.66 1,760.66

Signature Series Intelligent Detectors

6 SIGA-PD Photoelectric smoke detector 105.37 632.22

5 SIGA-HRD Heat detector, combination 135F fixed with 15F/min ROR, 79.14 395.70

11 SIGA-SB Standard Detector Base 15.90 174.90

SuperDuct Signature Smoke Detector

1 SIGA-SD SuperDuct Detector 304.08 304.08

1 SD-T60 SuperDuct, Air sample tube, 60 inch 15.55 15.55

1 SIGA-CRH Control Relay Module (High Current) 141.93 141.93

Sub-Total 3,425.04

Comp. Discount -342.50

CA Sales Tax 8.25% 254.31

Shipping 119.00

TOTAL $3,455.85

MS Sans Serif,Bold,7/26/2019

CONSULTING AGREEMENT

THIS AGREEMENT is made and entered into this 1st day of July, 2020 by and between

Clarissa Manning, hereinafter referred to as "Consultant," and the Washington Unified School

District hereinafter referred to as "District."

WHEREAS, the District is in need of special services and advice in administrative matters;

and

WHEREAS, such services and advice are not available at no cost from public agencies;

and

WHEREAS, Consultant is specially trained, experienced and competent to provide the

special services and advice required; and

WHEREAS, such services are needed on a limited basis; NOW, THEREFORE, the parties

hereto agree as follows:

SERVICES TO BE PROVIDED BY CONSULTANT:

1. The Consultant will provide the District expert CALPADS, Master Scheduling,

Gradebook, Attendance, Reporting, Course, Portal, Transcripts, Queries and other typical

student information system functions for this effort. The tasks will be as follows:

(a) Lead all data workflows related to Attendance reporting (Monthly, P1, P2,

CALPADS)

(b) Guide and assist assigned Technology staff with daily routines related to

supporting school site and departments’ data requirements;

(c) Analyze the database roles with Director of Technology to recommended new

practices;

(d) Develop a task and deliverable schedule for the review and approval of the

District; that builds capacity amongst WUSD’s Technology Department,

(e) Assist and train the District IT staff in the conversion process.

2. The Consultant will commence providing services under this AGREEMENT from July 1,

2020 through June 30, 2021. The Consultant will perform said services as an

independent contractor and not as an employee of the District. Consultant shall be under

the control of the District as to the result to be accomplished and not as to the means or

manner by which such result is to be accomplished.

3. The District will prepare and furnish to the Consultant upon request such information as

is reasonably necessary to the performance of the Consultant to the AGREEMENT.

4. The District shall pay the Consultant a total amount not to exceed $6,000 (six thousand

dollars), for services rendered pursuant to this Agreement. Consultant shall submit an

invoice to the District 30 days in advance of each payment due date.

5. Consultant understands that the District may wish to purchase these hours in blocks of

one hour at $100.00 per hour for remote work, with a minimum of four hours daily starting

July 1, 2020, and not be less that 20 hours per calendar week at the discounted rate of

$100.00 per hour.

6. In the event that on-premise work is required, a discounted rate of $150.00 per hour with a

minimum of 16 hours per visit, includes all travel expenses and lodging.

7. If there are additional needs to extend the contracted hours, District will update the contract

with the agreement of the Consultant in hourly increments of 60 hours. This will also be

budgeted at the highest amount of $150.00 per hour to an amount not to exceed $ 9,000.00

US dollars

8. The District may at any time for any reason terminate this AGREEMENT and compensate

Consultant only for services rendered to the date of termination. Written notice by the

District's Chief Business Officer shall be sufficient to stop further performance of services

by Consultant. The notice shall be deemed given when received or no later than three days

after the day of mailing whichever is sooner.

9. Consultant agrees to and shall hold harmless and indemnify the District, its officers,

agents, and employees from every claim or demand and every liability or loss, damage, or

expense of any nature whatsoever, which may be incurred by reason of:

(a) Liability for damages for death or bodily injury to person, injury to property, or

any other loss, damage or expense sustained by the Consultant or any person,

firm or corporation employed by the Consultant upon or in connection with

the Consultant's negligent performance of services called for in this agreement

except for liability for damages referred to above which result from the sole

negligence or willful misconduct of the District, its officers, employees, or

agents.

(b) Any injury to or death of persons or damage to property, sustained by any

persons, firm, or corporation, including the District, arising out of, or in any

way connected with the Consultant's negligent performance of services

covered by this AGREEMENT, whether said injury or damage occurs either on

or off school district property, except for liability for damages which result from

the sole negligence or willful misconduct of the District, its officers, employees

or agents.

The Consultant, at Consultant's expense, cost, and risk, shall defend any and all actions,

suits, or other proceeding that may be brought or instituted against the District, its officers,

agents, or employees on any such claim, demand, or liability and shall pay or satisfy any

judgment that may be rendered against the District, its officers, agents, or employees in

any action, suit, or other proceedings as a result thereof.

10. This AGREEMENT is not assignable without written consent of the parties hereto.

11. Consultant shall comply with all applicable federal, state, and local laws, rules,

regulations, and ordinances including worker's compensation.

12. Consultant, if an employee of another public agency, certifies that Consultant will not

receive salary or remuneration, other than vacation pay, as an employee of another public

agency for the actual time in which services are actually being performed pursuant to this

AGREEMENT.

IN WITNESS WHEREOF, the parties hereto have caused this AGREEMENT to be executed.

CLARISSA MANNING WASHINGTON UNIFIED SCHOOL DISTRICT

By: By: Authorized Signature Authorized Signature

Print Name: Print Name:

Title: Title:

Address: Address:

Date: Date:

Federal Tax ID# or Social Security #:

Clarissa Manning

2405 E Altura Avenue

Orange, CA 92867

6/26/2020

Consultant

Washington Unified School District June 17, 2020

Page 1 of 3

AECOM Project Name: Fallbrook CEQA AECOM Project No.: 60607435

Purchase Order No. 201502 Change Order No.: 2

CHANGE ORDER 2 In accordance with the Consulting Services Agreement dated May 21, 2019 between AECOM Technical Services, Inc., a California corporation (“Consultant”), and the Washington Unified School District (“District”), this Change Order, with an effective date of modifies that Agreement as follows:

1. Changes to the Services:

Existing services included in the Agreement dated May 21, 2019 and described in Change Order 1 are considered complete. Additional Services include: The Phase I ESA will be conducted in general accordance with the ASTM E-1527-13 standard. AECOM's Phase I ESA will provide information as to the potential that a significant hazardous material or petroleum hydrocarbon release may have occurred on or affected the subject property. The Phase I ESA will include the following tasks: Site Reconnaissance and Interview A visual reconnaissance will be conducted of the subject property. AECOM will record observations of the presence or likely presence of conditions that indicate an existing release, a past release, or a material threat of a release of hazardous substances or petroleum products into structures on the subject property or into the ground, groundwater, or surface water of the subject property. Where appropriate, AECOM will record the following observations during the walkthrough of the subject property: • Subject property and area vegetation for environmental stress and other ecological disturbances. • Subject property and area for surface features that would indicate filling, impoundments,

underground storage tanks, pipelines, wells or other surface penetrations. • Subject property for the presence of filling or mounding, pits, ponds, or lagoons. • Areas that are identified that use, treat, store, dispose of, or generate hazardous substances and

petroleum products and review the status of past and current waste generation and management practices at the subject property.

• Subject property and area electrical equipment (e.g., transformers) and substations, as well as labeling that may indicate the owners, polychlorinated biphenyls (PCBs) status, and leakage. (Note: fluorescent light ballasts will not be individually inspected for PCB-content; however, AECOM will note leakage, as observed.)

• Potable water supply and/or on-site wells (including dry wells, irrigation wells, injection wells, and other wells).

• Wastewater treatment source and/or on-site septic systems. • General stormwater discharge routes into a drain, ditch, or receiving body of water on or adjacent

to the subject property. • Subject property for floor drains and sumps. • Stained soil or pavement, including stains or corrosion on floors, walls, or ceiling, except for

staining from water. • Waste handling areas or practices, chemical/industrial processing areas, and general

housekeeping practices. AECOM assumes that we will liaise with a designated Client representative to ensure proper coordination and to answer questions or address concerns during our site visits. As part of the reconnaissance activities, AECOM will make visual observations of immediately adjacent neighboring facilities, to the extent that such observations can be made without entering the premises of the

Washington Unified School District June 17, 2020

Page 2 of 3

neighboring facilities. Physical Setting Information AECOM will establish the physical setting for subject property by reviewing a United States Geological Survey 7.5 Minute Topographic Map showing the areas on which the subject property is located. AECOM will review soil/hydrology and groundwater/ hydrology information to the extent it is provided by the environmental database search company (Environmental Data Resources) or in previously prepared reports provided by Client. Site History AECOM will develop an understanding of the subject property’s history. This may be accomplished through interviews with Client personnel and others identified by Client as familiar with the subject property, a review of locally available land use records, historical photographs, and topographic maps, etc. AECOM will make reasonable attempts to interview individuals with specific knowledge of or familiarity with the subject property, to the extent that such knowledgeable individuals are identified by Client or identified during the course of other ESA activities, and that the information likely to be obtained is not duplicative of information obtained from other sources. These individuals may be queried in person, by telephone, or in writing. AECOM will review documents concerning past land uses, including available site plans, records concerning past industrial and waste disposal practices, and maps when provided by past and present facility owner(s)/occupant(s). Agency Records Review AECOM will order a site-specific environmental database report for the subject property. AECOM will review these reports to evaluate whether the subject property or neighboring properties (within a specified radius search distance from each subject property) are included on the ASTM-specified standard and additional (e.g., local) environmental record sources (e.g., spills, landfills/dumps, leaking underground storage tanks). Where appropriate, AECOM will contact state and/or local governmental sources for relevant documents/file information concerning the subject property and adjoining properties. Freedom of Information Act requests will be made to the appropriate local and/or state agencies requesting information relative to the subject property. Files available at local agencies at the time of the site visit will be reviewed, as time permits. These inquiries may include the following types of governmental agencies: • Federal, State, tribal, and local environmental solid and hazardous waste, wastewater sections,

etc.; • Local fire department; • Local health/environmental department; and • Local agencies responsible for building and groundwater permits that document Activity and Use Limitations, also referred to as Institutional Controls and Engineering Controls, for the subject property. AECOM's record review will include those records that are readily available and reasonably ascertainable per the ASTM standard. Non-ASTM Scope Considerations A formal asbestos-containing building material (ACBM) survey, lead-based-paint (LBP), or mold sampling program will not be conducted. Instead, reliance will be placed upon limited and informal visual observations of readily accessible building areas combined with a review of available building plans, remodeling records, or any previous survey or sampling results available from the property managers. Vapor Migration

Washington Unified School District June 17, 2020

Page 3 of 3

AECOM will evaluate the potential for vapor migration (VM) to impact the subject property as required by the ASTM 1527-13 standard. VM is defined as the movement of volatile chemical vapors in soil or groundwater. AECOM will not evaluate vapor intrusion which is defined as the movement of volatile chemical vapors from a source in the subsurface (soil or groundwater) into the indoor air of overlying buildings through cracks or other openings. AECOM will evaluate the potential for VM to impact the subject property in general accordance with ASTM E2600-15, “Standard Guide for Vapor Encroachment Screening on Property Involved in Real Estate Transactions.” User Responsibilities Per the ASTM standard, it is the report “user's” (i.e., Client) responsibility to perform certain tasks, which do not require the technical expertise of an EP and are generally not performed by Environmental Professionals (EPs) conducting Phase I ESAs. Section 6.0 of the ASTM standard indicates that "reasonably ascertainable recorded land title records and lien records that are filed under federal, tribal, state, or local law should be reviewed to identify environmental liens (ELs) or activity and use limitations (AULs), if any, that are currently recorded against the property" and that "any environmental liens or activity and use limitations so identified shall be reported to the EP conducting a Phase I ESA." If you have this information you are required to provide it to the EP. AECOM has included up to one EL and AUL search (for one parcel/one fee owner) within the cost of this project. Attached for your completion is a User Questionnaire which will assist you in communicating to AECOM the user-provided information. Report Preparation AECOM will compile and prepare a written report for the subject property, documenting the scope of our work activities and summarizing the results of our assessment. AECOM will provide you with a professional opinion as to the potential for there to be a significant on-site contamination problem, and recommendations for further work, if any. The report will include a site location map, site plan, representative site photographs, and supporting documentation, as appropriate. ASSUMPTIONS The cost and schedule was prepared based on the following assumptions: • A site map or equivalent documentation defining the subject property boundaries will be available

to AECOM upon authorization to proceed. • Client will arrange for unrestricted access to all areas of the subject property during normal

business hours, and there are no delays in obtaining access. A single mobilization to the subject property is included in the proposed costs. If a second mobilization is required, additional costs will be incurred. As needed, a Client or property owner/operator representative will be available to provide operational and subject property history data input in a timely manner.

• AECOM is provided information relative to any valuation reduction issues (e.g., structural or environmental concerns that result in a price reduction); ELs or AULs and specialized knowledge of the subject property and surrounding properties, of which Client may be aware.

• Title searches are not included in this proposed scope of work; however, if provided by Client, they will be reviewed.

• AECOM will review relevant and available regulatory files for both the subject property and abutting properties, as appropriate, the day of the site visit, assuming that the regulatory agency is located within a half hour drive of the subject property.

• Should a third-party want to use the report and require a written reliance letter from AECOM for their purposes, that third party will be required to enter into a contract with AECOM and may be required to pay a fee for use of the report. Final determination on whether or not third parties can use the report for reliance purposes will be at the discretion of AECOM.

• Any additional services beyond the scope of work specified in this proposal will be invoiced on a time and materials basis. Client will be notified prior to initiation of additional activities.

• AECOM's scope of work and report format is acceptable to Client. • “Non-scope considerations”, as defined by ASTM E-1527-13, which are not included in the

proposed scope of work, will not be addressed as part of the Phase I ESA. “Non-scope

Washington Unified School District June 17, 2020

Page 4 of 3

considerations” that will be included in this proposed scope of work are: the potential for the presence of asbestos-containing building material (ACBM), lead-based-paint (LBP), and mold.

• An evaluation of indoor air quality, explosion hazards, naturally occurring gases (e.g., radon, hydrogen sulfide, methane), and vapor intrusion will not be addressed as part of the Phase I ESA.

• AECOM will not conduct measurements or collect samples of any environmental media during the Phase I ESA.

• Due to the current and rapidly progressing COVID-19 pandemic, situations outside of AECOM’s direct control may arise that could impact the project schedule. If such situation(s) were to occur, AECOM will work with Client to determine the best course of action in accordance with guidelines from federal, state and/or local public health agencies.

A cost and/or schedule adjustment may be necessary if changes to these assumptions occur during the course of the project. LIMITATIONS Client recognizes that in any project it is not always possible to locate or identify all hazardous materials, substances, or wastes within or surrounding the subject properties. Client agrees that AECOM shall only be required to use reasonable efforts, consistent with the practice of other professionals engaged in similar activity, in the course of fulfilling AECOM’s duties under this proposal. AECOM is not responsible for conditions or consequences arising from relevant facts that were concealed, withheld, or not fully disclosed at the time the project was performed.

2. Change to Deliverables:

See above.

3. Change in Project Schedule (attach schedule if appropriate): Additional scope of services assumed to occur starting in April of 2020 and lasting for no more than four months.

4. Change in CONSULTANT’s Compensation:

AECOM will make use of additional remaining budget in the existing maximum contract value of $38,945 to provide the above described services and AECOM will notify the District if unforeseen circumstances will require additional budget to complete the above described services.

5. Project Impact: See above.

6. Other Changes (including terms and conditions):

None.

7. All other terms and conditions of the Agreement remain unchanged.

8. Each Party represents that the person executing this Change Order has the necessary legal authority to do so on behalf of the respective Party.

Washington Unified School District June 17, 2020

Page 5 of 3

AECOM Technical Services, Inc. District:

Signature Signature J. Matthew Gerken

Printed Name Printed Name Project Manager

Printed Title Printed Title June 17, 2020

Date Date

Address Address 2020 L Street, Suite 400

Sacramento, CA 95811

[End of Agreement]

AMENDMENT TO CONTRACT SERVICES Washington Unified School District

10/17/19 CJ

TO

Amount of IncreaseAmount of Decrease

These signatures attest the parties agreement hereto:

Date Date

DateSite / Department Administrator Title

DISTRICT CONTRACTOR

Total Amount of Increase / Decrease

REVISED CONTRACT AMOUNT

Authorized District Signature Authorizing Signature

BUDGET CODES

AMENDMENTThe contract between Washington Unified School District and the CONTRACTOR is amended as provided herein:

Original Contract Amount

Site / Department

Date Date

The Washington Unified School District and

mutally agree to the following amendment with

AMENDMENT DATEThe effective dates of this amendment to Contract Services are

Contractor

Purchase Order Number Board Approval DateDate Change Order Created

DocuSign Envelope ID: B6BB6E47-80F3-4748-AD7E-7396C1F3E8C7

Procure America, Inc.

06/24/2020

Only if Net Positive

6/28/2020

N/A

12/31/2020

Business Services / MOT

02/13/2020N/A

The time frame of the contract is being extended due to many delays caused by the COVID 19 pandemic and the complications the shut down caused to be able to properly analyze operations.

N/A

N/A

6/29/2020

6/26/2020

Vice President

INDIVIDUAL SERVICES AGREEMENT FOR NONPUBLIC, NONSECTARIAN SCHOOL SERVICES (Education Code Sections 56365 et seq.)

This agreement is effective on June 23, 2020 or the date student begins attending a nonpublic school or receiving services from a nonpublic agency, if after the date identified, and terminates at 5:00 P.M. Oil June 30, 202Q, unless sooner terminated as provided in the Master Contract and by applicable law. Local Education Agency Washington Unified School District Nonpublic School Sierra Upper School of Sacramento

LEA Case Manager: Name Andre Phillips, Ed.D. Director. Special Services Phone Number (916} 375-7 6 00 ext 1351

Pupil Name __ ""

--STUDENT A------------ _________ _ Sex: M O F Grade:_, __ _(Last)

Address (First) (M.I.)

City State/Zip -"'.,__ ___ _

· DOB Residential Setting: D Home Foster D LCI # _________ _ 0 OTHER ________ _

Parent/Guardian _______ _ Phone ( ) � "'" ______ _ (Residence)

Address�-----------------� (If different from student)

AGREEMENT TERMS: 1. Nonpublic Schoot The average number of minutes in the instructional day will be: 1629

2. NonpubUc Schoot The number of school days in the calendar of the school year are: -=-0 _______ _

7

3. Educational services as specified in the IEP shall be provided by the CONTRACTOR and paid at the rates specified below.

(Business) State/Zip _____ _

during the regular school year

during the extended school year

during the regular school year

during the extended school year

A /NCLUSJVE EDUCATION PROGRAM: (Applies to nonpublic schools only): Daily Rate:.__,_,15=0=.22=----- Transportation Rate: NA

Estimated# of Days _lx (Daily Rate 150.22+ Transportation Rate NA due to Covid 19 Shelter at Home mandate (If applicable))= PROJECTED BASICEDUCATION COSTS (A) ____ $._1 .... ,0""'51:...,.54..._ ______ _

B RELATED SERVICES·Provider

SERVICE LEA NPS OTHER # of Times per Cost per Maximum EstimafEd Maximum Specify wk/mo/yr� Duration; session Number of To1al COstfor

orpertEP; Sessions Contracted Period oras needed

Intensive Individual Services (340)

Language/Speech Therapy (415) a Individual b. Grnun

Adapted Physical Ed (425)

Health and Nursing: Specialized Physical Health Care ( 435)

Health and Nursing Services: Other ( 436)

Assistive Technology Services (445)

Occupational The�y (450)

Physical Therapy ( 460)

Individual Counseling (510)

Counseling and guidance (515).

Parent Counseling (520)

1