Common use of EMPLOYEE JURY SERVICE Clause in Contracts

EMPLOYEE JURY SERVICE. (check one or more boxes) Contractors with original or amended contracts in excess of $100,000 must have and adhere to a written policy that provides its employees living in San Mateo County up to five days regular pay for actual jury service in the County. Contractor complies with the County’s Employee Jury Service Ordinance. Contractor does not comply with the County’s Employee Jury Service Ordinance. Contractor is exempt from this requirement because: the contract is for $100,000 or less. Contractor is a party to a collective bargaining agreement that began on (date) and expires on (date), and intends to comply when the collective bargaining agreement expires. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that I am authorized to bind this entity contractually. Signature Name Date Title 8-7-06 Page 1 of 1 Exhibit D Program Monitoring Shelter Network Outreach and Case Management Services FY 2011-14 Contractor will provide to County on demand, all requested income and demographic data about the recipients of services under this Agreement. This data may include race, family size, income, sex and handicap status, if any, of the head of household. Contractor will participate in regular meetings with HSA-designated staff to develop and monitor Contractor’s progress by providing to HSA monthly financial statements and other required information. Contractor will provide County with an Annual Audit Report. The Audit report must include a statement of compliance with OMB Circular A -133 “Audits of States”, Local Governments and Non-Profit Organizations”. Exhibit E Outcome Based Management Initiative Shelter Network Outreach and Case Management Services FY 2011-14 Responsibilities relating to the County’s OBM Initiative: Contractor Responsibilities Contractor will engage in activities and supply information required to implement the County’s Outcome-Based Management and Budgeting (OBM) initiative. Activities include, but are not limited to: · Attending planning and informational meetings; · Developing program performance and outcome measurements; · Collecting and submitting data necessary to fulfill measurement requirements; · Participating in technical assistance and training events offered by the Human Services Agency and seeking technical assistance and training necessary to fulfill measurement requirements; · Participating in a review of performance and outcome information; and · Complying with OBM Implementation Guidelines as specified in memos released by the Human Services Agency. · Contractor will participate in HOPE (Housing Our People Effectively) activities as mutually agreed upon. HOPE is a ten-year action plan that brings together the business, nonprofit, and public sector communities to address the challenging issue of homelessness at its core, rather than manage it at the margins. County Responsibilities County, through the Human Services Agency, will · Provide technical assistance and support to assist Contractor’s implementation of the County’s Outcome-Based Management and Budgeting (OBM) initiative; · Issue and review OBM Implementation Guidelines; and · Conduct review of performance and outcome information. ATTACHMENT I Assurance of Compliance with Section §504 of the Rehabilitation Act of 1973, as Amended The undersigned (hereinafter called the "Contractor (s)" hereby agrees that it will comply with Section 504 of the Rehabilitation Act of 1973, as amended, all requirements imposed by the applicable DHHS regulation, and all guidelines and interpretations issued pursuant thereto. The Contractor (s) gives/give this assurance in consideration of and for the purpose of obtaining contracts after the date of this assurance. The Contractor (s) recognizes/recognize and agrees/agree that contracts will be extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the Contractor (s), its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Contractor(s). The Contractor(s): (Check a or b)

EMPLOYEE JURY SERVICE. (check one or more boxes) Contractors with original or amended contracts in excess of $100,000 must have and adhere to a written policy that provides its employees living in San Mateo County up to five days regular pay for actual jury service in the County. Contractor complies with the County’s Employee Jury Service Ordinance. Contractor does not comply with the County’s Employee Jury Service Ordinance. Contractor is exempt from this requirement because: the contract is for $100,000 or less. Contractor is a party to a collective bargaining agreement that began on (date) and expires on (date), and intends to comply when the collective bargaining agreement expires. Contractors with original or amended contracts in excess of $100,000 must have and adhere to a written policy that provides its employees living in San Mateo County up to five days regular pay for actual jury service in the County. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that I am authorized to bind this entity contractually. Signature Name Date Title 8-7-06 Page 1 of 1 Exhibit D Program Monitoring Shelter Network Outreach and Case Management North Peninsula Neighborhood Service Center Core Services FY 20112010-14 13 Contractor will provide to County on demand, all requested income and demographic data about the recipients of services under this Agreement. This data may include race, family size, income, sex and handicap status, if any, of the head of household. Contractor will participate in regular meetings with HSA-designated staff to develop and monitor Contractor’s progress by providing to HSA monthly financial statements and other required information. Contractor will provide County with an Annual Audit Report. The Audit report must include a statement of compliance with OMB Circular A -133 “Audits of States”, Local Governments and Non-Profit Organizations”. Exhibit E Outcome Based Management Initiative Shelter Network Outreach and Case Management North Peninsula Neighborhood Service Center Core Services FY 20112010-14 13 Responsibilities relating to the County’s OBM Initiative: Contractor Responsibilities Contractor will engage in activities and supply information required to implement the County’s Outcome-Based Management and Budgeting (OBM) initiative. Activities include, but are not limited to: · Attending planning and informational meetings; · Developing program performance and outcome measurements; · Collecting and submitting data necessary to fulfill measurement requirements; · Participating in technical assistance and training events offered by the Human Services Agency and seeking technical assistance and training necessary to fulfill measurement requirements; · Participating in a review of performance and outcome information; and · Complying with OBM Implementation Guidelines as specified in memos released by the Human Services Agency. · Contractor will participate in HOPE (Housing Our People Effectively) activities as mutually agreed upon. HOPE is a ten-year action plan that brings together the business, nonprofit, and public sector communities to address the challenging issue of homelessness at its core, rather than manage it at the margins. County Responsibilities County, through the Human Services Agency, will · Provide technical assistance and support to assist Contractor’s implementation of the County’s Outcome-Based Management and Budgeting (OBM) initiative; · Issue and review OBM Implementation Guidelines; and · Conduct review of performance and outcome information. ATTACHMENT I Assurance of Compliance with Section §504 of the Rehabilitation Act of 1973, as Amended The undersigned (hereinafter called the "Contractor (s)" hereby agrees that it will comply with Section 504 of the Rehabilitation Act of 1973, as amended, all requirements imposed by the applicable DHHS regulation, and all guidelines and interpretations issued pursuant thereto. The Contractor (s) gives/give this assurance in consideration of and for the purpose of obtaining contracts after the date of this assurance. The Contractor (s) recognizes/recognize and agrees/agree that contracts will be extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the Contractor (s), its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Contractor(s). The Contractor(s): (Check a or b)

EMPLOYEE JURY SERVICE. (check one or more boxes) Contractors with original or amended contracts in excess of $100,000 must have and adhere to a written policy that provides its employees living in San Mateo County up to five days regular pay for actual jury service in the County. Contractor complies with the County’s Employee Jury Service Ordinance. Contractor does not comply with the County’s Employee Jury Service Ordinance. Contractor is exempt from this requirement because: the contract is for $100,000 or less. Contractor is a party to a collective bargaining agreement that began on (date) and expires on (date), and intends to comply when the collective bargaining agreement expires. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that I am authorized to bind this entity contractually. Signature Name Date Title 8-7-06 Page 1 of 1 Exhibit D Program Monitoring Shelter Network Outreach and Case Management City of Xxxx City – Xxxx City Community Service Center Core Services FY 20112010-14 13 Contractor will provide to County on demand, all requested income and demographic data about the recipients of services under this Agreement. This data may include race, family size, income, sex and handicap status, if any, of the head of household. Contractor will participate in regular meetings with HSA-designated staff to develop and monitor Contractor’s progress by providing to HSA monthly financial statements and other required information. Contractor will provide County with an Annual Audit Report. The Audit report must include a statement of compliance with OMB Circular A -133 “Audits of States”, Local Governments and Non-Profit Organizations”. Exhibit E Outcome Based Management Initiative Shelter Network Outreach and Case Management City of Xxxx City – Xxxx City Community Service Center Core Services FY 20112010-14 13 Responsibilities relating to the County’s OBM Initiative: Contractor Responsibilities Contractor will engage in activities and supply information required to implement the County’s Outcome-Based Management and Budgeting (OBM) initiative. Activities include, but are not limited to: · Attending planning and informational meetings; · Developing program performance and outcome measurements; · Collecting and submitting data necessary to fulfill measurement requirements; · Participating in technical assistance and training events offered by the Human Services Agency and seeking technical assistance and training necessary to fulfill measurement requirements; · Participating in a review of performance and outcome information; and · Complying with OBM Implementation Guidelines as specified in memos released by the Human Services Agency. · Contractor will participate in HOPE (Housing Our People Effectively) activities as mutually agreed upon. HOPE is a ten-year action plan that brings together the business, nonprofit, and public sector communities to address the challenging issue of homelessness at its core, rather than manage it at the margins. County Responsibilities County, through the Human Services Agency, will · Provide technical assistance and support to assist Contractor’s implementation of the County’s Outcome-Based Management and Budgeting (OBM) initiative; · Issue and review OBM Implementation Guidelines; and · Conduct review of performance and outcome information. ATTACHMENT I Assurance of Compliance with Section §504 of the Rehabilitation Act of 1973, as Amended The undersigned (hereinafter called the "Contractor (s)" hereby agrees that it will comply with Section 504 of the Rehabilitation Act of 1973, as amended, all requirements imposed by the applicable DHHS regulation, and all guidelines and interpretations issued pursuant thereto. The Contractor (s) gives/give this assurance in consideration of and for the purpose of obtaining contracts after the date of this assurance. The Contractor (s) recognizes/recognize and agrees/agree that contracts will be extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the Contractor (s), its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Contractor(s). The Contractor(s): (Check a or b)

EMPLOYEE JURY SERVICE. (check one or more boxes) Contractors with original or amended contracts in excess of $100,000 must have and adhere to a written policy that provides its employees living in San Mateo County up to five days regular pay for actual jury service in the County. Contractor complies with the County’s Employee Jury Service Ordinance. Contractor does not comply with the County’s Employee Jury Service Ordinance. Contractor is exempt from this requirement because: the contract is for $100,000 or less. Contractor is a party to a collective bargaining agreement that began on (date) and expires on (date), and intends to comply when the collective bargaining agreement expires. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that I am authorized to bind this entity contractually. Signature Name Date Title 8-7-06 Page 1 of 1 Exhibit D Program Monitoring Shelter Network Outreach and Case Management Coastside Hope Core Services FY 20112010-14 13 Contractor will provide to County on demand, all requested income and demographic data about the recipients of services under this Agreement. This data may include race, family size, income, sex and handicap status, if any, of the head of household. Contractor will participate in regular meetings with HSA-designated staff to develop and monitor Contractor’s progress by providing to HSA monthly financial statements and other required information. Contractor will provide County with an Annual Audit Report. The Audit report must include a statement of compliance with OMB Circular A -133 “Audits of States”, Local Governments and Non-Profit Organizations”. Exhibit E Outcome Based Management Initiative Shelter Network Outreach and Case Management Coastside Hope Core Services FY 20112010-14 13 Responsibilities relating to the County’s OBM Initiative: Contractor Responsibilities Contractor will engage in activities and supply information required to implement the County’s Outcome-Based Management and Budgeting (OBM) initiative. Activities include, but are not limited to: · Attending planning and informational meetings; · Developing program performance and outcome measurements; · Collecting and submitting data necessary to fulfill measurement requirements; · Participating in technical assistance and training events offered by the Human Services Agency and seeking technical assistance and training necessary to fulfill measurement requirements; · Participating in a review of performance and outcome information; and · Complying with OBM Implementation Guidelines as specified in memos released by the Human Services Agency. · Contractor will participate in HOPE (Housing Our People Effectively) activities as mutually agreed upon. HOPE is a ten-year action plan that brings together the business, nonprofit, and public sector communities to address the challenging issue of homelessness at its core, rather than manage it at the margins. County Responsibilities County, through the Human Services Agency, will · Provide technical assistance and support to assist Contractor’s implementation of the County’s Outcome-Based Management and Budgeting (OBM) initiative; · Issue and review OBM Implementation Guidelines; and · Conduct review of performance and outcome information. ATTACHMENT I Assurance of Compliance with Section §504 of the Rehabilitation Act of 1973, as Amended The undersigned (hereinafter called the "Contractor (s)" hereby agrees that it will comply with Section 504 of the Rehabilitation Act of 1973, as amended, all requirements imposed by the applicable DHHS regulation, and all guidelines and interpretations issued pursuant thereto. The Contractor (s) gives/give this assurance in consideration of and for the purpose of obtaining contracts after the date of this assurance. The Contractor (s) recognizes/recognize and agrees/agree that contracts will be extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the Contractor (s), its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Contractor(s). The Contractor(s): (Check a or b)

EMPLOYEE JURY SERVICE. (check one or more boxes) Contractors with original or amended contracts in excess of $100,000 must have and adhere to a written policy that provides its employees living in San Mateo County up to five days regular pay for actual jury service in the County. Contractor complies with the County’s Employee Jury Service Ordinance. Contractor does not comply with the County’s Employee Jury Service Ordinance. Contractor is exempt from this requirement because: the contract is for $100,000 or less. Contractor is a party to a collective bargaining agreement that began on (date) and expires on (date), and intends to comply when the collective bargaining agreement expires. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that I am authorized to bind this entity contractually. Signature Name Date Title 8-7-06 Page 1 of 1 Exhibit D Program Monitoring Shelter Network Outreach and Case Management Pacifica Resource Center A Project of Tides Center Core Services FY 20112010-14 13 Contractor will provide to County on demand, all requested income and demographic data about the recipients of services under this Agreement. This data may include race, family size, income, sex and handicap status, if any, of the head of household. Contractor will participate in regular meetings with HSA-designated staff to develop and monitor Contractor’s progress by providing to HSA monthly financial statements and other required information. Contractor will provide County with an Annual Audit Report. The Audit report must include a statement of compliance with OMB Circular A -133 “Audits of States”, Local Governments and Non-Profit Organizations”. Exhibit E Outcome Based Management Initiative Shelter Network Outreach and Case Management Pacifica Resource Center A Project of Tides Center Core Services FY 20112010-14 13 Responsibilities relating to the County’s OBM Initiative: Contractor Responsibilities Contractor will engage in activities and supply information required to implement the County’s Outcome-Based Management and Budgeting (OBM) initiative. Activities include, but are not limited to: · Attending planning and informational meetings; · Developing program performance and outcome measurements; · Collecting and submitting data necessary to fulfill measurement requirements; · Participating in technical assistance and training events offered by the Human Services Agency and seeking technical assistance and training necessary to fulfill measurement requirements; · Participating in a review of performance and outcome information; and · Complying with OBM Implementation Guidelines as specified in memos released by the Human Services Agency. · Contractor will participate in HOPE (Housing Our People Effectively) activities as mutually agreed upon. HOPE is a ten-year action plan that brings together the business, nonprofit, and public sector communities to address the challenging issue of homelessness at its core, rather than manage it at the margins. County Responsibilities County, through the Human Services Agency, will · Provide technical assistance and support to assist Contractor’s implementation of the County’s Outcome-Based Management and Budgeting (OBM) initiative; · Issue and review OBM Implementation Guidelines; and · Conduct review of performance and outcome information. ATTACHMENT I Assurance of Compliance with Section §504 of the Rehabilitation Act of 1973, as Amended The undersigned (hereinafter called the "Contractor (s)" hereby agrees that it will comply with Section 504 of the Rehabilitation Act of 1973, as amended, all requirements imposed by the applicable DHHS regulation, and all guidelines and interpretations issued pursuant thereto. The Contractor (s) gives/give this assurance in consideration of and for the purpose of obtaining contracts after the date of this assurance. The Contractor (s) recognizes/recognize and agrees/agree that contracts will be extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the Contractor (s), its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Contractor(s). The Contractor(s): (Check a or b)

EMPLOYEE JURY SERVICE. (check one or more boxes) Contractors with original or amended contracts in excess of $100,000 must have and adhere to a written policy that provides its employees living in San Mateo County up to five days regular pay for actual jury service in the County. Contractor complies with the County’s Employee Jury Service Ordinance. Contractor does not comply with the County’s Employee Jury Service Ordinance. Contractor is exempt from this requirement because: the contract is for $100,000 or less. Contractor is a party to a collective bargaining agreement that began on (date) and expires on (date), and intends to comply when the collective bargaining agreement expires. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that I am authorized to bind this entity contractually. Signature Name Date Title 8-7-06 Page 1 of 1 Exhibit D Program Monitoring Shelter Network Outreach and Case Management El Xxxxxxxx of San Mateo County Core Services FY 20112010-14 13 Contractor will provide to County on demand, all requested income and demographic data about the recipients of services under this Agreement. This data may include race, family size, income, sex and handicap status, if any, of the head of household. Contractor will participate in regular meetings with HSA-designated staff to develop and monitor Contractor’s progress by providing to HSA monthly financial statements and other required information. Contractor will provide County with an Annual Audit Report. The Audit report must include a statement of compliance with OMB Circular A -133 “Audits of States”, Local Governments and Non-Profit Organizations”. Exhibit E Outcome Based Management Initiative Shelter Network Outreach and Case Management El Xxxxxxxx of San Mateo County Core Services FY 20112010-14 13 Responsibilities relating to the County’s OBM Initiative: Contractor Responsibilities Contractor will engage in activities and supply information required to implement the County’s Outcome-Based Management and Budgeting (OBM) initiative. Activities include, but are not limited to: · Attending planning and informational meetings; · Developing program performance and outcome measurements; · Collecting and submitting data necessary to fulfill measurement requirements; · Participating in technical assistance and training events offered by the Human Services Agency and seeking technical assistance and training necessary to fulfill measurement requirements; · Participating in a review of performance and outcome information; and · Complying with OBM Implementation Guidelines as specified in memos released by the Human Services Agency. · Contractor will participate in HOPE (Housing Our People Effectively) activities as mutually agreed upon. HOPE is a ten-year action plan that brings together the business, nonprofit, and public sector communities to address the challenging issue of homelessness at its core, rather than manage it at the margins. County Responsibilities County, through the Human Services Agency, will · Provide technical assistance and support to assist Contractor’s implementation of the County’s Outcome-Based Management and Budgeting (OBM) initiative; · Issue and review OBM Implementation Guidelines; and · Conduct review of performance and outcome information. ATTACHMENT I Assurance of Compliance with Section §504 of the Rehabilitation Act of 1973, as Amended The undersigned (hereinafter called the "Contractor (s)" hereby agrees that it will comply with Section 504 of the Rehabilitation Act of 1973, as amended, all requirements imposed by the applicable DHHS regulation, and all guidelines and interpretations issued pursuant thereto. The Contractor (s) gives/give this assurance in consideration of and for the purpose of obtaining contracts after the date of this assurance. The Contractor (s) recognizes/recognize and agrees/agree that contracts will be extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the Contractor (s), its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Contractor(s). The Contractor(s): (Check a or b)

EMPLOYEE JURY SERVICE. (check one or more boxes) Contractors with original or amended contracts in excess of $100,000 must have and adhere to a written policy that provides its employees living in San Mateo County up to five days regular pay for actual jury service in the County. Contractor complies with the County’s Employee Jury Service Ordinance. Contractor does not comply with the County’s Employee Jury Service Ordinance. Contractor is exempt from this requirement because: the contract is for $100,000 or less. Contractor is a party to a collective bargaining agreement that began on (date) and expires on (date), and intends to comply when the collective bargaining agreement expires. Contractors with original or amended contracts in excess of $100,000 must have and adhere to a written policy that provides its employees living in San Mateo County up to five days regular pay for actual jury service in the County. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that I am authorized to bind this entity contractually. Signature Name Date Title 8-7-06 Page 1 of 1 Exhibit D Program Monitoring Shelter Network Outreach and Case Management City of Redwood City – Fair Oaks Community Center Core Services FY 20112010-14 13 Contractor will provide to County on demand, all requested income and demographic data about the recipients of services under this Agreement. This data may include race, family size, income, sex and handicap status, if any, of the head of household. Contractor will participate in regular meetings with HSA-designated staff to develop and monitor Contractor’s progress by providing to HSA monthly financial statements and other required information. Contractor will provide County with an Annual Audit Report. The Audit report must include a statement of compliance with OMB Circular A -133 “Audits of States”, Local Governments and Non-Profit Organizations”. Exhibit E Outcome Based Management Initiative Shelter Network Outreach and Case Management City of Redwood City – Fair Oaks Community Center Core Services FY 20112010-14 13 Responsibilities relating to the County’s OBM Initiative: Contractor Responsibilities Contractor will engage in activities and supply information required to implement the County’s Outcome-Based Management and Budgeting (OBM) initiative. Activities include, but are not limited to: · Attending planning and informational meetings; · Developing program performance and outcome measurements; · Collecting and submitting data necessary to fulfill measurement requirements; · Participating in technical assistance and training events offered by the Human Services Agency and seeking technical assistance and training necessary to fulfill measurement requirements; · Participating in a review of performance and outcome information; and · Complying with OBM Implementation Guidelines as specified in memos released by the Human Services Agency. · Contractor will participate in HOPE (Housing Our People Effectively) activities as mutually agreed upon. HOPE is a ten-year action plan that brings together the business, nonprofit, and public sector communities to address the challenging issue of homelessness at its core, rather than manage it at the margins. County Responsibilities County, through the Human Services Agency, will · Provide technical assistance and support to assist Contractor’s implementation of the County’s Outcome-Based Management and Budgeting (OBM) initiative; · Issue and review OBM Implementation Guidelines; and · Conduct review of performance and outcome information. ATTACHMENT I Assurance of Compliance with Section §504 of the Rehabilitation Act of 1973, as Amended The undersigned (hereinafter called the "Contractor (s)" hereby agrees that it will comply with Section 504 of the Rehabilitation Act of 1973, as amended, all requirements imposed by the applicable DHHS regulation, and all guidelines and interpretations issued pursuant thereto. The Contractor (s) gives/give this assurance in consideration of and for the purpose of obtaining contracts after the date of this assurance. The Contractor (s) recognizes/recognize and agrees/agree that contracts will be extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the Contractor (s), its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Contractor(s). The Contractor(s): (Check a or b)

EMPLOYEE JURY SERVICE. (check one or more boxes) Contractors with original or amended contracts in excess of $100,000 must have and adhere to a written policy that provides its employees living in San Mateo County up to five days regular pay for actual jury service in the County. Contractor complies with the County’s Employee Jury Service Ordinance. Contractor does not comply with the County’s Employee Jury Service Ordinance. Contractor is exempt from this requirement because: the contract is for $100,000 or less. Contractor is a party to a collective bargaining agreement that began on (date) and expires on (date), and intends to comply when the collective bargaining agreement expires. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that I am authorized to bind this entity contractually. Signature Name Date Title 8-7-06 Page 1 of 1 Exhibit D Program Monitoring Shelter Network Outreach and Case Management City of Xxxx City – Xxxx City Community Center Core Services FY 20112007-14 10 Contractor will provide to County on demand, all requested income and demographic data about the recipients of services under this Agreement. This data may include race, family size, income, sex and handicap disabled status, if any, of the head of household. Contractor will participate in regular meetings with HSA-designated staff to develop and monitor Contractor’s progress by providing to HSA monthly financial statements and other required information. Contractor will provide County with an Annual Audit Report. The Audit report must include a statement of compliance with OMB Circular A -133 A-133 “Audits of States”, Local Governments and Non-Profit Organizations”. Exhibit E Outcome Based Management Initiative Shelter Network Outreach and Case Management City of Xxxx City – Xxxx City Community Center Core Services FY 20112007-14 2010 Responsibilities relating Relating to the County’s OBM Initiative: Contractor Responsibilities Contractor will engage in activities and supply information required to implement the County’s Outcome-Based Management and Budgeting (OBM) initiative. Activities include, but are not limited to: · Attending planning and informational meetings; · Developing program performance and outcome measurements; · Collecting and submitting data necessary to fulfill measurement requirements; · Participating in technical assistance and training events offered by the Human Services Agency and seeking technical assistance and training necessary to fulfill measurement requirements; · Participating in a review of performance and outcome information; and · Complying with OBM Implementation Guidelines as specified in memos released by the Human Services Agency. · Contractor will participate in HOPE (Housing Our People Effectively) activities as mutually agreed upon. HOPE is a ten-year action plan that brings together the business, nonprofit, and public sector communities to address the challenging issue of homelessness at its core, rather than manage it at the margins. County Responsibilities County, through the Human Services Agency, will · Provide technical assistance and support to assist Contractor’s implementation of the County’s Outcome-Based Management and Budgeting (OBM) initiative; · Issue and review OBM Implementation Guidelines; and · Conduct review of performance and outcome information. ATTACHMENT I Assurance of Compliance with Section §504 of the Rehabilitation Act of 1973, as Amended The undersigned (hereinafter called the "Contractor (s)" hereby agrees that it will comply with Section 504 of the Rehabilitation Act of 1973, as amended, all requirements imposed by the applicable DHHS regulation, and all guidelines and interpretations issued pursuant thereto. The Contractor (s) gives/give this assurance in consideration of and for the purpose of obtaining contracts after the date of this assurance. The Contractor (s) recognizes/recognize and agrees/agree that contracts will be extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the Contractor (s), its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Contractor(s). The Contractor(s): (Check a or b).

EMPLOYEE JURY SERVICE. (check one or more boxes) Contractors with original or amended contracts in excess of $100,000 must have and adhere to a written policy that provides its employees living in San Mateo County up to five days regular pay for actual jury service in the County. Contractor complies with the County’s Employee Jury Service Ordinance. Contractor does not comply with the County’s Employee Jury Service Ordinance. Contractor is exempt from this requirement because: the contract is for $100,000 or less. Contractor is a party to a collective bargaining agreement that began on (date) and expires on (date), and intends to comply when the collective bargaining agreement expires. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that I am authorized to bind this entity contractually. Signature Name Date Title 8-7-06 Page 1 of 1 Exhibit D Program Monitoring Shelter Network Outreach and Case Management Samaritan House Core Services FY 20112010-14 13 Contractor will provide to County on demand, all requested income and demographic data about the recipients of services under this Agreement. This data may include race, family size, income, sex and handicap status, if any, of the head of household. Contractor will participate in regular meetings with HSA-designated staff to develop and monitor Contractor’s progress by providing to HSA monthly financial statements and other required information. Contractor will provide County with an Annual Audit Report. The Audit report must include a statement of compliance with OMB Circular A -133 “Audits of States”, Local Governments and Non-Profit Organizations”. Exhibit E Outcome Based Management Initiative Shelter Network Outreach and Case Management Samaritan House Core Services FY 20112010-14 13 Responsibilities relating to the County’s OBM Initiative: Contractor Responsibilities Contractor will engage in activities and supply information required to implement the County’s Outcome-Based Management and Budgeting (OBM) initiative. Activities include, but are not limited to: · Attending planning and informational meetings; · Developing program performance and outcome measurements; · Collecting and submitting data necessary to fulfill measurement requirements; · Participating in technical assistance and training events offered by the Human Services Agency and seeking technical assistance and training necessary to fulfill measurement requirements; · Participating in a review of performance and outcome information; and · Complying with OBM Implementation Guidelines as specified in memos released by the Human Services Agency. · Contractor will participate in HOPE (Housing Our People Effectively) activities as mutually agreed upon. HOPE is a ten-year action plan that brings together the business, nonprofit, and public sector communities to address the challenging issue of homelessness at its core, rather than manage it at the margins. County Responsibilities County, through the Human Services Agency, will · Provide technical assistance and support to assist Contractor’s implementation of the County’s Outcome-Based Management and Budgeting (OBM) initiative; · Issue and review OBM Implementation Guidelines; and · Conduct review of performance and outcome information. ATTACHMENT I Assurance of Compliance with Section §504 of the Rehabilitation Act of 1973, as Amended The undersigned (hereinafter called the "Contractor (s)" hereby agrees that it will comply with Section 504 of the Rehabilitation Act of 1973, as amended, all requirements imposed by the applicable DHHS regulation, and all guidelines and interpretations issued pursuant thereto. The Contractor (s) gives/give this assurance in consideration of and for the purpose of obtaining contracts after the date of this assurance. The Contractor (s) recognizes/recognize and agrees/agree that contracts will be extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the Contractor (s), its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Contractor(s). The Contractor(s): (Check a or b)

EMPLOYEE JURY SERVICE. (check one or more boxes) Contractors with original or amended contracts in excess of $100,000 must have and adhere to a written policy that provides its employees living in San Mateo County up to five days regular pay for actual jury service in the County. Contractor complies with the County’s Employee Jury Service Ordinance. Contractor does not comply with the County’s Employee Jury Service Ordinance. Contractor is exempt from this requirement because: the contract is for $100,000 or less. Contractor is a party to a collective bargaining agreement that began on (date) and expires on (date), and intends to comply when the collective bargaining agreement expires. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that I am authorized to bind this entity contractually. Signature Name Date Title 8-7-06 Page 1 of 1 Exhibit D Program Monitoring Shelter Network Outreach and Case Management Second Harvest Food Bank Services FY 20112010-14 13 Contractor will provide to County on demand, all requested income and demographic data about the recipients of services under this Agreement. This data may include race, family size, income, sex and handicap status, if any, of the head of household. Contractor will participate in regular meetings with HSA-designated staff to develop and monitor Contractor’s progress by providing to HSA monthly financial statements and other required information. Contractor will provide County with an Annual Audit Report. The Audit report must include a statement of compliance with OMB Circular A -133 “Audits of States”, Local Governments and Non-Profit Organizations”. Exhibit E Outcome Based Management Initiative Shelter Network Outreach and Case Management Second Harvest Food Bank Services FY 20112010-14 13 Responsibilities relating to the County’s OBM Initiative: Contractor Responsibilities Contractor will engage in activities and supply information required to implement the County’s Outcome-Based Management and Budgeting (OBM) initiative. Activities include, but are not limited to: · Attending planning and informational meetings; · Developing program performance and outcome measurements; · Collecting and submitting data necessary to fulfill measurement requirements; · Participating in technical assistance and training events offered by the Human Services Agency and seeking technical assistance and training necessary to fulfill measurement requirements; · Participating in a review of performance and outcome information; and · Complying with OBM Implementation Guidelines as specified in memos released by the Human Services Agency. · Contractor will participate in HOPE (Housing Our People Effectively) activities as mutually agreed upon. HOPE is a ten-year action plan that brings together the business, nonprofit, and public sector communities to address the challenging issue of homelessness at its core, rather than manage it at the margins. County Responsibilities County, through the Human Services Agency, will · Provide technical assistance and support to assist Contractor’s implementation of the County’s Outcome-Based Management and Budgeting (OBM) initiative; · Issue and review OBM Implementation Guidelines; and · Conduct review of performance and outcome information. ATTACHMENT I Assurance of Compliance with Section §504 of the Rehabilitation Act of 1973, as Amended The undersigned (hereinafter called the "Contractor (s)" hereby agrees that it will comply with Section 504 of the Rehabilitation Act of 1973, as amended, all requirements imposed by the applicable DHHS regulation, and all guidelines and interpretations issued pursuant thereto. The Contractor (s) gives/give this assurance in consideration of and for the purpose of obtaining contracts after the date of this assurance. The Contractor (s) recognizes/recognize and agrees/agree that contracts will be extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the Contractor (s), its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Contractor(s). The Contractor(s): (Check a or b)