THE BOARD OF SUPERVISORS OF THE COUNTY OF STANISLAUS ACTION AGENDA SUMMARY

DEPT: Probation zp' BOARD AGENDA # *B-14

Urgent AGENDADATE June 7,201 1

CEO Concurs with Recommendation YES 415VoteRequired YES NO

SUBJECT:

Approval for the Chief Probation Officer to Enter into Agreements with Stanislaus County Office of Education and Riverbank Unified School District to Provide Ongoing School Probation Officer Services

STAFF RECOMMENDATIONS:

1. Authorize the Chief Probation Officer to enter into and sign agreements with Stanislaus County Office of Education and Riverbank Unified School District to provide ongoing prevention and intervention services.

2. Authorize the Chief Probation Officer to enter into and sign extensions to these agreements in subsequent years under the same terms and conditions.

FISCAL IMPACT:

The Probation Department has entered into revenue contracts with various school districts over the years to provide school-based prevention and intervention services. In the Proposed Budget for the 201 1-2012 budget year, the Department has included $207,073 to be received from the Stanislaus County Office of Education and $55,000 from the Riverbank Unified School District. Existing staff is used to provide these services and there are no costs associated with this request to authorize the Chief Probation Officer to sign the revenue-based contracts.

BOARD ACTION AS FOLLOWS: NO. 201 1-343

ATTEST: CHRISTINE FERRARO TALLMAN, Clerk File No.

Approval for the Chief Probation Officer to Enter into Agreements with Stanislaus County Office of Education and Riverbank Unified School District to Provide Ongoing School Probation Officer Services

DISCUSSION:

The Stanislaus County Office of Education (SCOE) has a long history of contracting for probation services. The district has been utilizing the Probation Department's services since the early 1990's. In 2007 Riverbank Unified School District became interested in contracting for services following a community presentation conducted by the Chief Probation Officer where the district learned of the value on-site probation services has in reducing truancy and school disciplinary issues.

As the districts renew their requests for these ongoing services, the Department sees value in authority being granted to the Chief Probation Officer to enter into and sign the agreements. As additional districts seek these contracted services the Probation Department will come back to the Board to request initial approval for the Chief Probation Officer to enter into and sign agreements. As always, whenever additional appropriations or additional staff are needed to meet an increased demand, the Department will bring those requests before the Board.

POLICY ISSUES:

Board approval to authorize the Chief Probation Officer to enter into and sign school-based revenue contracts to deliver education and intervention services supports the Board priorities of a Safe Community and Efficient Delivery of Public Services.

STAFFING IMPACT:

There is no staffing impact associated with this item.

CONTACT INFORMATION: Jill Silva, Assistant Chief Probation Officer. (209) 525-4503

Page 2

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AOR.11BMENT POR SPBCIAL CONTRACT SBRV1CBS(lndc=pendcnt Contractor)

'l'his &gmmlClDt is between lUvarbank Unified School District,~ reftrred to IS~USD" .nd _tsl. Cpunty Pmbatlpn. hereinafter referred to III ~dcmtCoDtraetor."

WBERBAS. kUSO i8 amthorized by Section 53060 oftbe CaUfomia Oovemment Code toooDtl:act with and employ my pcrllODB fbt the fumlsbh1a of epeolJ! aervioea lI1ld advice infinancial, eooDOmio, aooountlng, enaJneering, legal 01' admin!ltrative matters. if such personsIn lpflOially trained and~oed and competent to pcrfonn the apcdal services requtred:end

'WHBRBAS, B.USD is In need ofauoh spcoiat lIOrviccs and advice; BDd

NOW, nmRBFORB, the parties agree IS follows:

1. Services to be provided by hldependant Conttactcn'

Sflel attaduld Probfttion Offioer Duties. .

2, Indcpendeu.t ConUactor will provide the abovI!lICtVlOlll(') IS outlined in Paragraph 1upto a total of Bight m boon I days undox' the terms of 1bisApeme.o.t.

3. RUSD IifIN to pa.)' Independent Con1ractor lot Iet'Vlces ntisfactorlly l'GlIdadpuxwaut to this ApemClD1 a total foe not to~ Pifly.fiye ThO!!"'" DoUm($~S.QOO. ). RUSD to pay Independent Contractor acoon1lD& to the :fulJowingfcrmJ and oooditioDs upon I'l'Oelpt of invoice:_~~ Monthly Lump SwnX QlJartorly Other _

....

87/28/2811 13:83 2898691487 RIVERBANK UNIFIED PAGE 83/86

JWY 1. 2211 and that! tem1iDateS. The teJ:m oftbls Apwmcm.t shall CDmIJlODce onon JunQ aD. 2012

6. This agreement WIt terminate OD the 1IISt day ofICrVice as written b1 Article 5except:a. RUSD may terminate It Ill)' time if In&5pendoDt Contractor doca not perform, or

rcfbscs to perfmm acoordiDg to thb Agreanent.b. 11\ the .event of cady .f.crminetlon, Independent Contlaotor· ah&11 be paid for all. worlc or .ervi0e8 perlonned to 1he date oftermiDation toSe6cr with Bn smonnt of

approved expenses due rmd owing.e. Bttber party may tomdnste this Apement at any time duri2:ag the tmn of this

A£P'f*UC11t upon thirty (30) days written Dodoe.

7. Thi~.·agroc:mcmt Includes the geDQI'I1 tcn:tls' and conditiOD.S u let ftmh on the followingpages, and the hldcpen4cnt Contraotor. by~ this A~t, IlgI:CCS to coxnplywith all such eenera1~ Bnd. oonditlona.

8. Independent COD1rao1or 1haU. at all times, emforce Itrlet discipllne= rmd good ordCII: amongb1sIJw employees and shall Mt employ or work: IU1Y mt1t pet10ll or anyone Dot 11d11ed. inwodc _pad to bUn or her. NJ.y person in tho employ of the Independent Contractor I

whom RlJSD may deeo.n inoompet.eut or uufit aha11 be diImlssed ftom the job lite andshall not Ipin be employed at site without wrlftcn oonent from RUSD.

9. The partlc:s intend that am fD&,pcmc:hut OOntraetof re1Itionabip be Ql'Mted by'fbls oontraetand KUSD asumes no responsibUity for worm' OOJDpensation JiabWty. RUSDlikewite UlUD1es DO reepon.sibUity for liabWty for loIS. damqe. or inJury to pcrson(s) orpropmy durl:og or relatina to the performlDQe of.mice unclO!' this Agroemcm.

IndepoDdant Contractor agrees to bold lumnlcss and to indemnify RUSD for:

Any inJury to person or propony sustatned by IDdopendent Con1:rIctor orby any prnoD, ftun or ooxporatiOD employt:ld direotly or iadkcctly by theIndependent Contractor or by any of tho individual. participating In oraqociated with hUn or her. however caused; and IIDy b\tlUY to penon orproperty austaine4 by IDY potIOn. &In or ocxporstian, aaused by any act.nos1ect~ default or omission. of Independent Contractor, or lIDy penon,firm. or wrporation directly or indh'ectly employed by Indepemc1entCmdractor upon or in ClOIm.ecdon with this Agreement, or lID)' of thepartioipants arlIiDg out of or in the come of tbe term of this~md.1Ddependem CoD.tzaator at his or ber own coat. e.xpemo 8Dd risk, Iballdefend flnY and &1l aodons, IUits, or otbar legal proocediDp bt may beinst:ttu1ed aptolt RUSD for II!lY such c1aho. or d.emaDd, IDd pay or sB1istYany Jw:I&meat that may 1)0 I8Ddored ep1nBt I.USD in II1-Y such actiO1\, suitor lop! prooocdinaB or the result tbtmlof. Notbina herein provided shall beoonstruod to require Indepcmdcnt Contmrt:or to bold harmless orindclmll1Y RUSD h liability ~ damqes rcsu.l_ from the DegUgeocc t1r

willfUl act. or omiuion ofRUSD or l1s oftictltS, qents or em.ploy~es.

...

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2098691487 RIVERBANK UNIFIED PAGE 04/06

A..-ncnt Ibr8pM'*I CciIlIl'MIt 8arvlDal'.J0I'5

10. This Agreem=nt is for the peI80JW services of Indepoudent Con1ractor. and. I'nd~dentContJ:acfm may DOt uaign the petfomJ&DCO ofthe smrlccs to IJJ1 J'l'E'8OIl or peDO!l8 whoIre not parties to this Agreement except for employeell oflDd.ep=d.cnt CoI1tl"Iator.

11. Indepandcmt Con1DCtOr certifies 1hat biB or her current em.ploym'. if any, is fullyco&ntzant of this Ai;J:amncm.t snd that payments hereuDder lItO not In oonfUot with ImY

. federal. state, or local statutes, rules or regulation. or with any policies of IDdepcmdeotCoDttactors' omnmt employer.

12. R17SD IbB1J bcoomc tho owner of IJ1lI eDtitled to exo1ustve possession of B11 J:CCQrds.dooumebtl, gtapbs, photopapbJo or o1her rcprod.uGtWas of &Dy kind produced in thesoope of services perfonabd IIDd DO other USCI thereof wW be pcrmttted except bypermissiO%l ofRUSD. Proprletl1l')' materials will be exempted from this oJBUJe.

13. Independent ContTactor cmti.ties that he or she is not lin employee ofRUSD amd is ac1f..employed in h pex£ormanoe of the serviocs apeclficd. ImtcpendcDtC~ apesthat he or abe aauto.ea alll'elpODBlbility in tc18ion to p:ovtdfnglWSD with an employerldent!floation number or Social ScDUrity number a• .required by IRS regulations mrc1Id:lon to 1he conduct ofhls or bet' bumJess.

DBPARTMBNT OF JUSTICB CLBARANCB REQUlRP.MENTS

RUSD has dctennb1ed tiuJt the foUowiIJa pmvision:

...x- is not applicable to this Agreement pursuant to Bduoation Code section 45125.1

_ 'Ibh provision II applicable to this Agreement pursuant to Bdueation Cock acction. 45125.1 because the ael'Yioea bcdn& provided are:

_Schoollnd. olusroom janitorial_School slto~ve_Soboollite J1'OUIIds and landscape IDI.inton8nce~ublio 'I1'ImSPOrtBtion_School site food"'1'Olil1M.

And are not beina providod in an amerpncy or exceptional sftuation and the Independenteontr.ctor or employees oftho 1Ddependent Contractor will hive more than Ifmltcd contactwi1h pupils.

14.~ Contraotor cerdfiea that helsh~ bas conducted a Dopartmeot ofJustlocfiDprprlnt check BDd none ofhi&'her emplO)'tleJ 1Yho may come in ocm.1Bct withpupilsbas been COllVlcted ofa aerlous or violent felony 18 dcbed by CaU1bmla law (aocJ3ducation Code section 4S122.l(cXl». Attaahed.ls a 1lst oftbe 111m. ofIndopcmdentContractor'B mnplayeos who may come in oontact with pupils.

e7/2e/2ell 13:e3 2e98691487 RIVERBANK UNIFIED PAGE e5/e6

SIGNAroRB

ZIPSTATE

~l tbr"".1CanInIll"""...IltSThat the perd.c:e bcmIto have qreed. promIPd end covcoantcd to perfoml the ObliptiODBhcrdn lICIt fbrth we ha.vc subscrlbcd our Dmlel hento this dayof____ alt lUvorbank, Cmmty ofStaDiilaus, State ofe.tifomIa.

Dr. Kem OoiBlok,~

CONTRAcr OFFICER OF THERJVBRB~ UNlPIBD SCHOOLDIBTRl Ol! STANISLAUS CO.

CONSULTANT soc. sBcuR.rrY', OR. IRS ID 1# 2

I. Wlt__p' t d_ .- ~ I.&,.,...,..,a. __ »:. '_ ....,. ".MoIIol ......,.,

07/20/2011 13:03 2098691487 RIVERBANK UNIFIED PAGE 06/06

1UVB:RBANK UNIPIBD SCHOOL DISTRICT2011-2012 PROBATIONomen DUTIBS

Ovm'all ReBponslbUities:1. Truancy aDd BARB

a. Conduot bomc visits on ItW1mdB who are truant 011dmtifled as high riskb. Deliver1:l'\W1C)' lind SAlUS notioes to students' homese. AIslrn in setting up SARB hearin& date••

2. Assist with campus seour1ly at all litesa. Be an active.mcmber OD oampUSC8 to aasist with seeurlty t.sues and pnmtal

discipline ofaU students.b. Mec:t with puentB cd studcuta wht=n needed.C. 1ntel'aot with students bef«ml 8Ch001, duriDa bJ:cJb, lunoh aDd del' Ichoald. Be avaUable to usiBt with aftc:r sebool BDd evening school events.

3. Active mem.btr ofDAP..T teau1.4. Activo member ofDistrlot PteventioDl1J:ltorvention OptlOJUI Commluec,. Conduct Btud.cmtIparerr information _moDS.6. Provide ongoiDg con:taot IDJd usilltlmce wf1h Idemi1ied bighrisk students.7. Pzovide d CODduct cliveDion clasaeI:.

a. Anger~b. Sub8tlnoe abuaec. Gang awrrrml088

1. The probation officer will taport to schooloampuses by 8:00 a.m. daily unlesswoddna 1Obedu1e is modified to incorporate eveniq events.

2. Ptobatlon ofBoc:r to coordiDatc IChDdulIt with Rivc:rbllDk Unlficd School DistrictDifoctm of 8tudeat Serv1oas.

3. Probation offioer will report to the fi;JUowing schools IS HIted unless uraent,lJlld/orcmerrgenoy issueszeq~ a ohangc of .cbedule:

L Monday AHSIRBSb. 'I'Uelday CA AVBc. Wednesday Mesa VerdeIRHSd. 'I1mtaday Cardozoe. Friday RHS

(wd:ly scheclu1e may be JDOdi1icd to meet 1118 neede of~ol lites)4. RUSD IIba1I proyidc a contract for 40 bourtl per week f.br the school year July 1,

2011, thtouBh lune 30, 2012.~. Office Space and a phono shall be provided by RUBD

I;*' .~. Stanislaus County

~~~~~:t~n_--- ....t.$i..,r --.;..~o;.;..m.;...;c;...ha_n.:::..gn_on...;..~su.:..pe_r1_nte_n_de_nt

BUSINESS SERVICES DIVISION1100 H Street • Modesto, CA 95354 • (209) 525-5054 • FAX (209) 525·5112

AGREEMENT FOR SPECIAL CONTRACT SERVICES(Independent Contractor)

This Agreement is between Stanislaus County Office of Education, hereinafter referred to as "Office,"and Stanislaus County Probation Department , hereinafter referred to as "Independent Contractor."

WHERE.~.s, Office is authorized by ~ection 53060 of the CaliforJ1ia Gov,emment Code to contractwith and emplOy any Persons for the furnishing of special services and advice in financial" economic,accounting, engineering, legal or administrative matters, if such persons are specially trained andexperienced and competent to perfonn the special services reqUired; and

WHEREAS, Office is in need of such special services and advice; and

WHEREAS, Independent Contractor is specially trained and experienced and competent to perfonnthe special services required by the Office. and such services are needed on a limited basis.

NOW, THEREFORE, the parties agree as follows:

1. Services to be provided by Independent Contractor:

See attached 2011-2012 Description of Probation Officer Duties (services for Probation OfficerMirella DeLaHoya).

2. Independe.nt Contractor will provide the above service<IDs outlined in Paragraph 1 up to a totalof (2080 ) [Z] hourslU days under the tenns of this Agreement.

3. Office agrees to pay the Independent Contractor for services satisfactorily rendered pursuant tothis Agreement a total fee not to exceed $103.445 (2,000 to cover travellin-services/workshops)($ 103,445 ). Office shall pay Independent Contractor according to the followingterms and conditions upon receipt of invoi~:_ Io Monthly , D Lump Sumo Quarterly D Other _

4. Office shall not be liable to Independent Contractor for any costs or expenses paid or incurred byIndependent Contractor in perfonning services for Office.

5. The tenn of this Agreement shall commence on __J;...u....ly'-1.:....2_0_1_1__:--_ and shall tenninate onJune 30, 2012

6. This Agreement may be tenninated at any time dUring the tenn by either party upon _n_la _( ) days written notice. (optional)

7. Independent Contractor shall contact Office's designee, Scott Kuykendall ,at (209) 238-1508 ,with any questions regarding performance of the services outlined above.

•i <

Agreement for Special Contract Services(Independent Contractor)Page 2

•Office's designee shall determine if and when Independent Contractor has completed theservices described.

8. The parties intend that an independent contractor relationship be created by this contract andOffice assumes no responsibility for workers' compensation liability. Office likewise assumes noresponsibility for liability for loss, damage, or injury to person(s) or property during or relating tothe performance of service under this Agreement.

Independent Contractor agrees to hold harmless and to indemnify Office for:

Any injury to person or property sustained by Independent Contractor or by any person,firm or corporation employed directly or indirectly by the Independent Contractor or by any ofthe individuals participating in or associated with him or: her, however caused; arid any injury toperson or property sustained by any person, firm or corporation, caused by any act, neglect,default or omission, of Independent Contractor, or any person, firm or corporation directly orindirectly employed by Independent Contractor upon or in connection with this Agreement, orany of the participants arising out of or in the course of the term of this Agreement, andIndependent Contractor at his or her own cost, expense and risk, shall defend any and allactions, suits or other legal proceedings that may be instituted against Office for any suchclaim or demand, and payor satisfy any judgment that may be rendered against Office in anysuch action, suit or legal proceedings or the result thereof. Nothing herein provided shall beconstrued to require Independent Contractor to hold harmless or indemnify Office for liability ordamages resulting from the negligence or willful act, or omission of Office or its officers,agents, or employees.

9. This Agreement is for the personal services of Independent Contractor, and IndependentContractor may not assign the performance of the services to any person or persons who are notparties to this Agreement except for employees of Independent Contractor.

10. Independent Contractor certifies that his or her current employer, if any, is fully cognizant of thisAgreement and that payments hereunder are not in conflict with any federal, state or localstatutes, rules or regUlations, or with any policies of Independent Contractor's current employer.

11. Office shall become the owner of and entitled to exclusive possession of all records, documents,graphs, photographic or other reproductions of any kind produced in the scope of servicesperformed and no other uses thereof will be permitted except by permission of the Office.Proprietary materials will be exempted from this clause.

12. Independent Contractor certifies that he or she is not an employee of the Office and is self­employed in the performance of the services specified. Independent Contractor agrees that he orshe assumes all responsibility in relation to providing the Office with an Employer Identificationnumber or Social Security number as required by IRS regulations in relation to the conduct of hisor her business.

Click on the below link for the required EDD form

EDD Form (Required)

• •Agreement for Special Contract Services(Independent Contractor)Page 3

*****-*OEPARTMENT OF JUSTICE CLEARANCE REQUIREMENTS*****-**

Office has determined that the following provision:

[l] Is not applicable to this Agreement pursuant to Education Code section 45125.1

o This provision is applicable to this Agreement pursuant to Education Code section 45125.1because the services being provided are:

o School and classroom janitorial.o Schoolsite administrative.o Schoolsite grounds and landscape maintenance.o Pupil transportation. ~ .oSchoolsite food-related.

And are not being provided in an emergency or exceptional situation and the IndependentContractor or employees of the Independent Contractor will have more than limited contact withpupils.

13. Independent Contractor certifies that he/she has conducted a Department of Justice fingerprintcheck and none of his/her employees who may come in contact with pupils has been convicted ofa serious or violent felony as defined by California law (see Education Code section45122.1(c)(1». Attached is a list of the names of Independent Contractor's employees who maycome in contact with pupils.

AGREED:

BUSINE$S NAME

CONTRACT OFFICER FOR THE STANISLAUSCOUNTY OFFICE OF EOUCAnON

Social Security or Federall.D. NumberIncorporated 0 Yes [Z] No

, i

DATE DATE

/ / (. 1 / I

ADDRESSINTERNAL USE

EDD Requirement

Owner Name:, _

Social Security #:

01 301005800350039000008000 = $51,222.5001 3025~5800 3500 3900 000 8000 = $51,222.50

-~~--1ei?tJ19N4TDilln&;~Career Charter & Alternative Ed11r-stjoo

BUdget Approval

BUdget ~ram. j! ,/

r --I rl.II \A. (j II. ./r1l\..k S"'-Send all copies to the Business Office.Distribution will be made as follows:

White - Business OfficeYellow - Independent ContractorPink - Department HeadGoldenrod - Originator: Name- Mary M~gr:R:lisk

1 Whenever organizational names are used, the authorized signature must Indude company title. such as President.

Revised -11104

2011 OCT Itt P 2: 2b

·/,~ w'"*, .;~

".... Stanislaus County

~~Office of" ~ Education T_o_m_c_h_an..:;9_no_n_,S_u",:.p_erl_n_te_ncle_nt

BUSINESS SERVICES DIVISION1100 HStreet. Modesto, CA 95354. (209) 525-5054. FAX (209) 525·5112

AGREEMENT FOR"SPECIAL CONTRACT SERVICES. (Independent Contractor)

This Agreement is between Stanislaus County Office of Education, hereinafter referred to as "Office,"and Stanislaus County Probation Department , hereinafter referred to as "Independent Contractor."

WHEREAS; Office is, authorized by Section 53Q60 of~e CalifomiaGovemment Codeto~ontract· '.with and employ any persons for the fumishing of special services and advice.\(l-Ynancial, economic,accounting, engineering, legal or administrative matters, if such persons are speci~1I trained andexperienced and competent to perform the special services reqUired; and I,.,,) I

WHEREAS, Office is in need of such special services and advice; and //

WHEREAS, Independent Contractor is specially trained and experjencedfand pq petent to performthe special services reqUired by the Office, and such services are needed 00 a limited basis.

NOW, THEREFORE, the parties agree as follows: / /I

1. Services to be provided by Independent Contractor:

See attached 2010-2011 Description of Probation Officer Duties (services for Probation OfficerClaudia Rivas)

2. Independent Contractor will provide the above servicews outlined in Paragraph 1 up to a totalof (2080 ) [Z] hours/U days under the terms of this Agreement.

3. Office agrees to pay the Independent Contractor for services satisfactorily rendered pursuant tothis Agreement a total fee not to exceed $107,628($2,000 to cover travel/in-services/workshops)($107,628.00 ). Qffice shall pay Independent Contr~ctor a~rdiQg to thp following

'- terms and conditions Opon receipt ofinvoice: /' .. .,IZJ Monthly D Lump SumDQuarterly D Other _

4. Office shall not be liable to Independent Contractor for any costs or expenses paid or incurred byIndependent Contractor in performing services for Office. '

5. The term of this Agreement shall commence on __J_u.....ly_1~,_2_0_1_1 and shall terminate onJune 30, 2012

6. This Agreement may be terminated at any time during the term by either party upon _n1_a _( ) days written notice. (optional)

7. Independent Contractor shall contact Office's designee, Scott Kuykendall ,at (209) 238-1508 , with any questions regarding performance of the services outlined above.

•'"Agreement for Special Contract Services

(Independent Contractor)Page 2

•Office's designee shall determine if and when Independent Contractor has completed theservices described.

8. The parties intend that an independent contractor relationship be created by this contract andOffice assumes no responsibility for workers' compensation liability. Office likewise assumes noresponsibility for liability for loss, damage, or injury to person(s) or property during or relating tothe performance of service under this Agreement.

Independent Contractor agrees to hold harmless and to indemnify Office for:

Any injury to person or property sustained by Independent Contractor or by any person,firm or corpora~on employed directly pr indir~ctly bYJhe Independent Contractor or by any ofthe individuals participating in or associated with him or her, however caused; and any injury to· ,person or property sustained by any person, firm or corporation, caused by any act, neglect,default or omission, of Independent Contractor, or any person, firm or corporation directly orindirectly employed by Independent Contractor upon or in connection with this Agreement, orany of the participants arising out of or in the course of the term of this Agreement, andIndependent Contractor at his or her own cost, expense and risk, shall defend any and allactions, suits or other legal proceedings that may be instituted against Office for any suchclaim or demand, and payor satisfy any judgment that may be rendered against Office in anysuch action, suit or legal proceedings or the result thereof. Nothing herein provided shall beconstrued to require Independent Contractor to hold harmless or indemnify Office for liability ordamages resulting from the negligence or willful act, or omission of Office or its officers,agents, or employees.

9. This Agreement is for the personal services of Independent Contractor, and IndependentContractor may not assign the performance of the services to any person or persons who are notparties to this Agreement except for employees of Independent Contractor.

10. Independent Contractor certifies that his or her current employer, if any, is fully cognizant of thisAgreement and that payments hereunder are not in conflict with any federal, state or localstatutes, rules or regulations, or with any policies of Independent Contractor's current employer.

11. Office shall become the owner of and entitled to exclusive possession of all records, documents,graphs, photographic or other reproductions of any kind produced in the scope of servicesperformed and no other uses thereof will be permitted except by permission of the Office.Proprietary materials \4(i1l be exempted from this clause.

,>,-,. ~ If"

12. Independent Contractor certifies that he or she 'is not an employee of the Office and is self­employed in the performance of the services specified. Independent Contractor agrees that he orshe assumes all responsibility in relation to providing the Office with an Employer Identificationnumber or Social Security number as required by IRS regulations in relation to the conduct of hisor her business.

Click on the below link for the required EDD form

EDD Form (Required)

• •Agreement for Special Contract Services(Independent Contractor)Page 3

**********DEPARTMENT OF JUSTICE CLEARANCE REQUIREMENTS*********··

Office has determined that the following provision:

[{] Is not applicable to this Agreement pursuant to Education Code section 45125.1

D This provision is applicable to this Agreement pursuant to Education Code section 45125.1because the services being provided are:

oSchool and classroom janitorial.o Schoolsite administrative.o Schoolsite_grounds and landscape maintenance.o Pupil transportation.o Schoolsite food-related.

And are not being provided in an emergency or exceptional situation and the IndependentContractor or employees of the Independent Contractor will have more than limited contact withpupils.

13. Independent Contractor certifies that he/she has conducted a Department of Justice fingerprintcheck and none of his/her employees who may come in contact with pupils has been convicted ofa serious or violent felony as defined by California law (see Education Code section45122.1(c)(1)). Attached is a list of the names of Independent Contractor's employees who maycome in contact with pupils.

AGREED:

DONGAlTlCONTRACT OFFICER FOR THE STANISLAUSCOUNlY OFFICE OF EDUCATION

Socia 'Security or Federall.D. NumberIncorporated 0 Yes IZJ No

DATEl j . I !

DATE<,.- F; ~II

01 30100580035003900.0008000 = $53,814

INTERNAL USE

01 3025~t:5800 3500 3900 000 8000 = $53,814EDD Requirement

Social Security #:

Owner Name:. __

ADDRESS

Send all copies to the Business Office.Distribution will be made as follows:

White - Business OfficeYellow - Independent ContractorPink - Department HeadGoldenrod - Originator: Name- Mary MsCQr:A:lisk

1 Whenever organizational names are used, the authorized signature must Indude company title, such as President.

Revised -11104