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HomeMy WebLinkAboutRCS Find Food BankSTATE OF CALIFORNIA DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY (CalRecycle) RELIABLE CONTRACTOR DECLARATION CalRecycle 168 (Revised 9116) This form must be completed and submitted to the Department of Resources Recycling and Recovery (CalRecycle) prior to authorizing a contractor(s) to commence work. Failure to provide this documentation in a timely manner may result in nonpayment of funds to the contractor(s). This form is intended to help the CalRecycle's Grantees comply with the Reliable Contractor Declaration (formerly Unreliable List) requirement of their Terms and Conditions. The Reliable Contractor Declaration (formerly Unreliable List) provision requires the following: Prior to authorizing a contractor(s) to commence work under the Grant, the Grantee shall submit to CalRecycle a declaration signed under penalty of perjury by the contractor(s) stating that within the preceding three (3) years, none of the events listed in Section 17050 of Title 14, California Code of Regulations, Natural Resources, Division 7, has occurred with respect to the contractor(s). Please see the reverse of this page, or refer to the California Code of Regulations (www.calregs.com). If any of the events listed in Section 17050 have occurred, disclosure is required but will not necessarily result in CalRecycle refusing to approve the contractor. A signed statement explaining the facts and circumstances of the events must be attached to and submitted with this form. Contractor: Complete the form and send original to the Grantee. Grantee: Scan the form and upload it to the grant in CalRecycle's Grant Management System. For further instruction about logging into the Grant Management System and uploading this form, reference the Procedures and Requirements. Retain the original form in your grant file. GRANTEE INFORMATION GRANTEE NAME: GRANT NUMBER: City of Palm Desert z4c 2 !_ PRIMARY CONTACT NAME: Trisha S+ CONTRACTOR INFORMATION' 1',:.:., ;s. ' CONTRACTOR NAME: Food In Need of Distribution, Inc. d.b a FIND Food Bank ] AUTHORIZED CONTRACTOR REPRESENTATIVE NAME: Debbie S. Espinosa MAILING ADDRESS: 83-775 Citrus Ave, Indto, CA 92201 As the authorized representative of the above identified contractor, I declare under penalty of perjury under the laws of the State of California that within the preceding three (3) years, none of the events listed in Section 17050 of Title 14, California Code of Regulations, Natural Resources, Division 7, has occurred with respect to the above identified contractor. Alternatively, as the authorized representative of the above identified contractor, I declare under penalty of perjury under the laws of the State of California that within the preceding three (3) years, if any of the events listed in Section 17050 of Title 14, California Code of Regulations, Natural Resources, Division 7, has occurred with respect to the above identified contractor, I have disclosed all such occurrences in an attached signed statement that explains the facts and circumstances of the listed events. Signatu� Date 1g/1 /2Lz STATE OF CALIFORNIA DEPARTMENT OF RESOURCES RF CYCLING AND RECOVERY (CalRecycle) RELIABLE CONTRACTOR DECLARATION CalRecycle 168 (Revised 9/16) Title 14 CCR, Division 7, Chapter 1 Article 5. Unreliable Contractors, Subcontractors, Borrowers and Grantees Section 17050. Grounds for Placement on Unreliable List The following are grounds for a finding that a contractor, any subcontractor that provides services for a CalRecycle agreement, grantee or borrower is unreliable and should be placed on the CalRecycle Unreliable Contractor, Subcontractor, Grantee or Borrower List ("Unreliable List"). The presence of one of these grounds shalt not automatically result in placement on the Unreliable List. A finding must be made by the Executive Director in accordance with section 17054, and there must be a final decision on any appeal that may be filed in accordance with section 17055 et seq. (a) Disallowance of any and/or all claim(s) to CalRecycle due to fraudulent claims or reporting; or (b) The filing of a civil action by the Attorney General for a violation of the False Claims Act, Government Code section 12650 et. seq; or (c) Default on a CalRecycle loan, as evidenced by written notice from CalRecycle staff provided to the borrower of the default: or (d) Foreclosure upon real property loan collateral or repossession of personal property loan collateral by CalRecycle; or (e) Filing voluntary or involuntary bankruptcy, where there is a finding based on substantial evidence, that the bankruptcy interfered with the CalRecycle contract, subcontract, grant or €oan; or (f) Breach of the terms and conditions of a previous CalRecycle contract, any subcontract for a CalRecycle agreement, grant, or loan, resulting in termination of the CalRecycle contract, subcontract, grant or loan by the CalRecycle or prime contractor: or (g) Placement on the CalRecycle's chronic violator inventory established pursuant to Public Resources Code section 44104 for any owner or operator of a solid waste facility; or (h) The person, or any partner, member, officer, director, responsible managing officer, or responsible managing employee of an entity has been convicted by a court of competent jurisdiction of any charge of fraud, bribery, collusion, conspiracy, or any act in violation of any state or federal antitrust law in connection with the bidding upon, award of, or performance under any CalRecycle contract, subcontract, grant or loan; or (i) The person or entity is on the list of unreliable persons or entities, or similar list, of any other federal or California state agency; or (j) The person or entity has violated an Order issued in accordance with section 18304; or, (k) The person or entity has directed or transported to, has or accepted waste tires at, a site where the operator is required to have but does not have a waste tire facility permit: or, (I) The person or entity has transported waste tires without a waste tire hauler registration; or, (m) The person or entity has had a solid waste facility or waste tire permit or a waste tire hauler registration denied, suspended or revoked; or, (n) The person or entity has abandoned a site or taken a similar action which resulted in corrective action or the expenditure of funds by CalRecycle to remediate, clean, or abate a nuisance at the site; or (o) The following are additional grounds for a finding that, a person or entity described below should be placed on the Unreliable List: (1) The person or entity owned 20% or more of an entity on the Unreliable List at the time of the activity that resulted in its placement on the Unreliable List; (2) The person held the position of officer director, manager, partner, trustee, or any other management position with significant control (Principal Manager) in an entity on the Unreliable List at the time of the activity that resulted in its placement on the Unreliable List; (3) The entity includes a Principal Manager who: 1. Was a Principal Manager in an entity on the Unreliable List at the time of the activity that resulted in its placement on the Unreliable List; or, 2. Owned 20% or more of an entity on the Unreliable List at the time of the activity that resulted in its placement on the Unreliable List; (4) The entity has a person who owns 20% or more of the entity, if that person: 1. Was a Principal Manager in an entity on the Unreliable List at the time of the activity that resulted in its placement on the Unreliable List; or, 2. Owned 20% or more of an entity on the Unreliable List at the time of the activity that resulted in its placement on the Unreliable List. (5) The entity has another entity which owns 20% or more of the entity, if that other entity: 1. Is on the Unreliable List; or, 2. Owned 20% or more of an entity an the Unreliable List at the time of the activity that resulted in its placement on the Unreliable List. (6) Subsection (o) is not intended to apply to a person or entity that purchases or otherwise obtains an entity on the Unreliable List subsequent to its placement on the Unreliable List.