Common use of Exhibit D - Debarment Certification Clause in Contracts

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. EXHIBIT A SCOPE OF SERVICE July 1, 2020 – June 30, 2021 Contractor: Xxxxx Xxxxxxxx D/B/A Amrita Eating Disorder Treatment 00 X. Xxx Xxxxx Xxxx, Suite 265 San Rafael, CA 94903 Telephone: 000-000-0000 Email: xxxxxxxxxxxxx@xxxxxxx.xxx SCOPE OF SERVICES AND DUTIES The services to be provided by Contractor and the scope of Contractor’s duties include the following: Intensive Outpatient Evening Program Mon-Thurs, 5:00-8:00pm Program includes:

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. Page 4 Revised 20150105 EXHIBIT A SCOPE OF SERVICE SERVICES July 1, 2020 – 2022 - June 30, 2021 Contractor2023 Purpose and overview: Xxxxx Xxxxxxxx D/B/A Amrita Eating Disorder Treatment 00 X. Xxx Xxxxx Xxxxserve children and families with children that are at risk of abuse or neglect through community based, Suite 265 San Rafael, CA 94903 Telephone: 000-000-0000 Email: xxxxxxxxxxxxx@xxxxxxx.xxx SCOPE OF SERVICES AND DUTIES supportive services. The services to be provided by Contractor CANAL ALLIANCE (Contractor) ACTIVITIES DELIVERABLES LONG TERM OUTCOMES CHILD ABUSE AND NEGLECT SERVICES Case Management for 20 high risk families Quality and Impact: • Number of families served • Demographic data collected • Number of families completing Program • Services provided • Method of service Family Resource case managers conduct brief interventions and support families with services such as: Making referrals to Center for Domestic Peace for emergency shelter; domestic violence support groups, legal services to file restraining orders and/or custody, housing search, access to emergency financial assistance via the scope Season of Contractor’s duties include the following: Intensive Outpatient Evening Program Mon-ThursSharing Fund (depending on availability of funds), 5:00-8:00pm Program includes:public benefits and job search as well as one on one work referring Improved family functioning insuring that children are safe, and their basic needs are met. Families improve their safety stability and are empowered to advocate on their own behalf

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. EXHIBIT A SCOPE OF SERVICE Page 4 Revised 20150105 Exhibit A: Scope of Work Community Action Marin‌‌ Encampment Resolution Funds-2: Xxxxxxxx Xxxxx July 1, 2020 2023 – June 30, 2021 Contractor: Xxxxx Xxxxxxxx D/B/A Amrita Eating Disorder Treatment 00 X. Xxx Xxxxx Xxxx2025 Purpose The purpose of Marin County’s Division of Homelessness and Whole Person Care is to improve the wellbeing of Marin’s homeless population through evidence-based, Suite 265 San Rafael, CA 94903 Telephone: 000trauma-000-0000 Email: xxxxxxxxxxxxx@xxxxxxx.xxx SCOPE OF SERVICES AND DUTIES informed practices. The services to be provided by Contractor and the included in this scope of Contractorwork serve as a critical element of the County’s duties include the following: Intensive Outpatient Evening Program Monimplementation of a unified coordinated entry and care management system by standardizing screening, assessments, and care coordination; and by promoting bi-Thursdirectional information sharing and care coordination among providers. The goal for this systems-level change is new, 5:00-8:00pm Program includes:coordinated, and sustainable approaches that will improve outcomes for people experiencing homelessness in Marin.

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. EXHIBIT A SCOPE OF SERVICE July 1, 2020 – June 30, 2021 Contractor: Housing Authority of the County of Marin Address: 0000 Xxxxx Xxxxxx Xxxxx Xxx Xxxxxx, XX 00000-0000 Executive Director: Xxxxxxxx D/B/A Amrita Eating Disorder Treatment 00 X. Xxx Xxxxx Xxxx, Suite 265 San Rafael, CA 94903 Xxxxxxx Telephone: (000-) 000-0000 EmailProgram: xxxxxxxxxxxxx@xxxxxxx.xxx SCOPE OF SERVICES Shelter Plus Care (S + C) Program Scope of Work ACTIVITY OBJECTIVE OUTCOME DATA COLLECTION AND DUTIES The services CONTINUOUS QUALITY IMPROVEMENT (CQI) Activities are the specific processes, events and/or actions that are intentionally used to bring about the intended results. Also be provided by Contractor sure to include any evidence-based practices being implemented to achieve the expected outcome. Objectives are specific, measurable, action- oriented, reasonable and time limited (SMART) to achieving the scope goal. At a minimum, they must include projected numbers served. Outcomes are the specific changes in a program participants’ risk factors, protective factors, behavior, knowledge, skills, mental health status or level of Contractor’s duties include functioning. Include what data collection instruments/tools (e.g. database, validated tools, surveys) will be used to measure objectives and outcomes, as well as information on how the following: Intensive Outpatient Evening Program Mon-Thurs, 5:00-8:00pm Program includes:data will be used for CQI.

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. EXHIBIT A SCOPE OF SERVICE July 1, 2020 – June 30, 2021 Contractor: Side by Side (Sunny Hills Services) Contract Services: Therapeutic Behavioral Services (TBS) Executive Director: Xxxx Xxxxxx Clinical Director: Xxxxx Xxxxxxxx D/B/A Amrita Eating Disorder Treatment 00 X. Xxx Xxxxx XxxxCorporate Status: California non-profit corporation with exempt status under Section 501(c)3 of the Internal Revenue Incorporated: June 8, 1895 Tax I.D. Number: 00-0000000 Contractor Address: 0000 Xxxxxx Xxx. Suite 265 San RafaelC Santa Rosa, CA 94903 95401 Telephone: (000-) 000-0000 EmailOfficers, Board of Directors: xxxxxxxxxxxxx@xxxxxxx.xxx SCOPE OF SERVICES AND DUTIES President Xxxxxx Xxxxxxx Vice President: Xxxxx Xxxxx Treasurer: Xxx Xxxxx Members of Board: Xxxxxxxxx Xxxxxxx, Xxxx Xxxxxx, Xxxxxxx Xxxxxxx, Xxx Xxxxxxx, Xxxxxx Xxxxxxx, Xxxxxxxxxx Xxxxxxxxx, Xxxxxxxx Xxxxxxx, Xxxxxx Xxxxx, Xxxxx Xxxxxxxxx, Xxxxx Xxxxx, Xxxxx Xxxxx ITEMS APPLICABLE TO SERVICE: Hours of Operation: 24 Hours a Day 7 Days a Week Geographic Area: Residents of Marin County Target Group: Students between the ages of 13-22 with identified disabilities. The majority of these disabilities have been identified as Emotionally Disturbed (ED). Other student’s disabilities include Other Health Impaired (OHI), and Specific Learning Disability (SLD). Selection for Admission to Service: Upon referral only from Marin County Division of Social Services, Marin County Probation Department, or Marin County Division of Behavioral Health and Recovery Services (BHRS). In the event that the child is referred by an agency other than BHRS, COUNTY shall make no payment for services, and have no obligation to make payment to CONTRACTOR, unless the services to be provided by Contractor CONTRACTOR received prior authorization from the BHRS Contract Officer or designee. A child may be approved for services on the basis of verbal authorization from the COUNTY by mutual consent of the COUNTY and the scope of Contractor’s duties include the following: Intensive Outpatient Evening Program Mon-Thurs, 5:00-8:00pm Program includes:CONTRACTOR.