08.d. Grace Lane Fire Hazard Reduction ProjectMEMORANDUM
TO: CITY COUNCIL
FROM: DOUG PERRIN, DIRECTOR OF RECREATION & MAINTENANCE
SERVICES 0-fi
SUBJECT: CONSIDERATION OF APPROVAL OF A SPONSOR AGREEMENT
WITH THE CALIFORNIA CONSERVATION CORPS AND AN
AGREEMENT ADDENDUM FOR THE GRACE LANE FIRE HAZARD
REDUCTION PROJECT
DATE: FEBUARY 28,2012
RECOMMENDATION:
1. ,Approve the proposed Sponsor Agreement and Agreement Addendum between
the City of Arroyo Grande and the California Conservation Corps (CCC) in an
amount not to exceed $20,667 over a four year period;
2. Appropriate $5,500 from the Grace Lane Assessment District for Contractual
Services in FY 201 1-1 2 and FY 201 2-1 3; and
3. Designate the Director of Recreation and Maintenance Services as the City's
Sponsor Representative, with authority to sign the Sponsor Agreement
(attachment 1) and Agreement Addendum (attachment 2).
IMPACT ON FINANCIAL AND PERSONNEL RESOURCES:
The Grace Lane Assessment District has a fund balance of $54,000. Of this amount,
$4,800 is collected annually for Fuel ManagemenVFire Suppression. The current CCC
cost for one crew of twelve Corps members, one supervisor, tools, and workers comp
coverage is $1,802 per day. Work the first year is expected to take three days at a cost
of approximately $5,400. Subsequent years are expected to take two days at a cost of
approximately $3,600. City staff will spend a few hours providing training and orientation
for the project and administering the agreement.
BACKGROUND:
In 201 0, the City accepted maintenance responsibilities for the Grace Lane Assessment
District. Funds are collected for fuel management, road maintenance, and maintenance
of the trails, slopes and storm drains. Fuel modification specifications state that annual
maintenance shall be done in zones 1, 2, and 3 (attachment 3). Maintenance includes
mowing grasses, removing shrubs and brush, and eliminating ladder fuels beneath the
Oak trees.
Agenda Item 8.d.
Page 1
CITYCOUNCIL
CONSIDERATION OF APPROVAL OF A SPONSOR AGREEMENT WITH THE
CALIFORNIA CONSERVATION CORPS AND AN AGREEMENT ADDENDUM FOR
THE GRACE LANE FIRE HAZARD REDUCTION PROJECT
FEBRUARY 28,2012
PAGE 2
The site has been reviewed by a CCC representative, who also reviewed the Engineers
Report for the Assessment District and submitted a Project Evaluation (attachment 4),
Sponsor Agreement and Agreement Addendum for the City's consideration. New
Sponsor Agreements are recommended every three to five years. Agreement
Addendums are for current specific projects. The last major project the City sponsored
with the CCC1s was ivy removal in 2007. It should be noted that the CCC periodically
perform projects for the City at no cost, when they don't have paid projects in progress.
The CCC provides training to young men and women in job skills and environmental
education. As a "Sponsor", the City provides opportunities for CCC public service
through meaningful and productive work projects; opportunities for public use of project
areas; engagement in projects which preserve, maintain and enhance environmentally
important lands and waters; and accomplishment of useful and needed public works
projects. In the past, the CCC has worked with the City of Arroyo Grande on a variety of
projects, including ivy removal along Arroyo Grande Creek, sidewalk clearance along ,
the James Way Oak Habitat, and assistance with installation of the irrigation system at
Strother Park.
ANALYSIS OF ISSUES:
The City's Municipal Code requires all grass, weeds, brush and other combustibles to
be maintained in a safe condition that will make it unlikely that it will become easily
ignited or support the spread of fire. Cutting grasses and weeds, removal of brush and
shrubs, and pruning of Oak trees to reduce the fire ladder will help keep the area
compliant with the City's Code.
It is estimated that in the first year of fire suppression work by the CCC, it will take three
full days to complete the project, at a cost of approximately $5,400. The first year will
take longer because more tree and brush maintenance will be necessary. In
subsequent years, the Conservation Supervisor anticipates the work may take only two
days. However, staff still recommends allocating sufficient funds for three days of work.
Although only $4,800 is collected annually for fuel management, there is a balance of
approximately $54,000 in the assessment district account. Due to the importance of fire
suppression, staff recommends using some of the reserves for this project.
According to the City's purchasing policy, projects in an amount exceeding $5,000
would normally require soliciting bids. However, an agreement between the CCC and
other government entity does not require the competitive bid process. Pursuant to the
provisions of the Joint Exercise Powers Act (JEPA) California Government Code
sections 6500, et. Seq., CCC Sponsor Agreements are considered a Joint Exercise of
Powers Agreement between government agencies.
Agenda Item 8.d.
Page 2
CITY COUNCIL
CONSIDERATION OF APPROVAL OF A SPONSOR AGREEMENT WITH THE
CAI-IFORNIA CONSERVATION CORPS AND AN AGREEMENT ADDENDUM FOR
THE GRACE LANE FIRE HAZARD REDUCTION PROJECT
FEBRUARY 28,2012
PAGE 3
ALTERNATIVES:
The following alternatives are provided for the Council's consideration: - Approve the proposed Sponsor Agreement and Agreement Addendum between
the City of Arroyo Grande and the California Conservation Corps (CCC);
appropriate $5,500 per year from the Grace Lane Assessment District for
contractual services; and designate the Director of Recreation and Maintenance
Services as the City's Sponsor Representative, with authority to sign the Sponsor
Agreement and Agreement Addendum; - Do not approve staffs recommendation to approve the Sponsor Agreement and
Agreement Addendum;
- Modify as appropriate and approve staffs recommendation; or
- Provide direction to staff.
ADVANTAGES:
Approving the agreement with the CCC will enable the City to fulfill its fire suppression
responsibilities for the Grace Lane Assessment District. In addition, the project will keep
the City compliant with its own Code and will provide training and job skills for young
men and women. Utilization of the CCC is the most cost effective way to complete this
work.
DISADVANTAGES:
Some staff time will be required for training, orientation and administration of the
agreement.
ENVIRONMENTAL REVIEW:
Staff has reviewed this project in compliance with the California Environmental Quality
Act (CEQA), the CEQA Guidelines and the City of Arroyo Grande Rules and
Procedures for Implementation of CEQA. Based on the review, staff has determined
that the proposed project is exempt per Section 15304(i) of the CEQA Guidelines for
minor alterations of land to conduct fuel management activities.
PUBLIC NOTIFICATION AND COMMENTS:
The Agenda was posted in front of City Hall on Thursday, February 23d, 2012. The
Agenda and staff report were posted on the City's website on Friday, February 24m1
2012. No public comments were received.
Attachment:
1. Agreement
2. Agreement Addendum
3. Fuel Modification Specifications
4. Project Evaluation
Agenda Item 8.d.
Page 3
ATTACHMENT 1
STATE OF CALIFORNIA--NATURAL RESOURCES AGENCY JERRY BROWN, GOVERNOR
CCC-96 (REV. 11/98)
CALIFORNIA CONSERVATION CORPS
171 9 24th Street, Sacramento, CA 9581 6
(91 6) 341-31 12
SPONSOR AGREEMENT (CCC-96)
(PubliclGovernmental Entity)
CCC District:
This agreement is made and entered into by and between the California Conservation Corps, State of
California, hereinafter referred to as "CCC", and
Sponsor's Name:
hereinafter called "Sponsor:"
WHEREAS, the CCC wishes to provide training in job skills and environmental education to young
men and women of California through a program which includes projects in public service
conservation work, and
WHEREAS, the Sponsor can provide opportunities for public service through meaningful and
productive work projects, and
WHEREAS, the Sponsor shall provide opportunities for public use of project areas, and
WHEREAS, the CCC shall generally be engaged in projects which preserve, maintain and enhance
environmentally important lands and waters, and
WHEREAS, the CCC shall accomplish useful and needed public works projects in both urban and
rural areas, and
WHEREAS, the CCC may execute contracts for furnishing the services of the Corps to any federal,
state, or local agency and any local or statewide private organization concerned with the objectives of
the Corps, and
WHEREAS, the CCC may be reimbursed by the federal government, any state or local public agency,
or any private organization for actual expenses incurred by the Corps for any project.
NOW THEREFORE, in consideration of the above, the parties hereto agree as follows:
A. The Sponsor shall submit project proposals on a form provided by CCC. By so doing, with
reference to any such proposals subsequently approved by the District Director, CCC, Sponsor
agrees to:
1. Pay for all negotiated costs directly related to and necessitated by such projects. This
may include, but not be limited to, reimbursement for CCC labor at the CCC's current
fiscal year rate or at a negotiated rate on such projects. In the event that reimbursement
is negotiated, further documentation will be necessary.
2. Demonstrate the availability of adequate plans and specifications, sufficient funds,
materials, supplies, and equipment, adequate technical supervision and any special
labor requirements to complete such project.
3. Obtain the approvals and permits required by any other state, federal , or local agency
necessary to commence construction or operation of such projects.
Page 1 of 4 Agenda Item 8.d.
Page 4
4. Obtain any clearances and meet any other requirements of trade unions or other labor
organizations occasioned by the participation of the CCC in such projects.
5. When necessary, provide acceptable temporary living facilities for the duration of any
such projects located more than one hour's driving time from a CCC base center for
CCC personnel actually engaged in working on such projects.
6. Hold an orientation meeting with CCC personnel at the commencement of such projects
to explain the technical aspects, safety considerations, and any other aspects
necessary for successful execution of such projects.
7. Present or arrange for an additional educational program or training opportunity at the
CCC base center or project site. This presentation may have emphasis on the history of
the project site or area, the public benefit to be derived from this or a similar project, the
relationship of such projects to resources or wildlife management, or similar subjects.
B. The CCC shall select, from proposals submitted by the Sponsor, those projects meeting the
priorities and resources of the CCC, as well as meeting the legislatively mandated criteria. The
CCC shall submit to the sponsor, evaluations setting forth any special requirements or
conditions occasioned thereby. By so doing, with reference to any such evaluations
subsequently approved by Sponsor, the CCC agrees to provide labor, crew supervision,
transportation(if within one hour's driving time by two-wheel drive vehicle from the nearest
CCC base center),food and such tools as the CCC Project Coordinator determines to be
available. Upon receipt of Sponsor's acceptance of such evaluations, projects will be
scheduled in accordance with the priorities and resources of the CCC.
C. In accordance with Section 14304 of the Public Resources Code, CCC projects shall be
directed toward providing opportunities to the public for the use of these natural resources and
environmentally important public lands and waters, while at the same time providing young
men and women with an opportunity for personal development in a variety of basic skills.
Projects shall be undertaken in both urban and rural areas shall be selected on the basis of the
environmental and natural resource benefits each offers, the opportunities for public use each
offers, and the on-the-job training value of each.
D. The Sponsor recognizes that the CCC exists undera legislative mandate to act under the
direction and control if the State Office of Emergency Services, Department of Forestry and
other agencies to assist the people of the State of California in times of emergencies arising
from fire, flood, wind, and other naturdl or man-caused disasters and emergencies.
Projects will be performed within the rules and regulations of the CCC, which may require
temporary suspension or permanent cessation of projects due to emergency conditions as
defined by such rules and regulations.
The Sponsor further recognizes that the resources of the CCC are limited, and the public
service conservation work of the CCC may be altered in priority from time to time.
The parties agree that delays by either party shall be excused and costs caused by such
delays shall be borne by the party incurring such costs. Sponsors contracting with the CCC for
emergency services may be required to reimburse exceptional costs; e.g., overtime.
E. Work performed under this agreement will be under the immediate supervision of the CCC
officials. The sponsor will provide such supervision, technical assistance, guidance and
inspection as it considers necessary to properly complete the work.
F. All improvements constructed in whole or in part on lands owned or controlled by Sponsor will
remain the property of the Sponsor.
Page 2 of 4 Agenda Item 8.d.
Page 5
G. Permission to camp and perform work on lands owned or controlled by Sponsor does not in
any way convey to the CCC, its staff, or any person or persons working with the CCC in the
performance of said work, employee status that would extend to them the benefits afforded to
permanent employees of Sponsor.
H. Upon completion of each project, or any phase thereof, permission is hereby granted to the
CCC to place upon the project site a sign or emblem, consistent in size and design to its
surroundings, indicating the participation of the CCC and the year thereof.
I. The CCC and Sponsor each agree to indemnify and hold harmless the other, its officers,
agents and employees from any and all claims, or demands of liability caused by the
indemnifying party during or after completion of the project, which is the subject of this
agreement. .
The State of California has elected to cover its motor vehicle and general liability exposure
through claims procedures instituted in accordance with the California Government Code
provisions and the other provisions of the law relating to such liability. Pursuant to those
procedures, tort liability claims should be submitted to the State Board of Control
(headquarters office: 630 K Street, Sacramento, California 95814; government claims
division: P.O. Box 3035, Sacramento, California 95812-3035) in accordance with the
California Government Code provisions and the other provisions of the law governing
submission of such claims. In addition, unless notified otherwise or on behalf of the California
Conservation Corps, motor vehicle liability claims may be forwarded to the California
Department of General Services, Office of Risk and Insurance Management (hereinafter
referred to as AORIM~), Claims Unit, 1325 J Street, Suite 1800, Sacramento, California
95814. It should be noted, however, that the willingness of ORlM to receive such motor
vehicle liability claims does not constitute a waiver by the State of California or the California
Conservation Corps of the time limits or procedures provided by law or the filing of claims
relating to such motor vehicle liability. It also should be noted that the addresses set forth in
this paragraph are subject to change; any claimant is advised to verify the accuracy and
currency of addresses for filing claims, and by setting forth addresses in this paragraph,
neither the State of California nor the California Conservation Corps is waiving any time limits
or procedures provided by law for filing claims related to alleged motor vehicle or general
liability or any other alleged liability.
The California Department of Personnel Administration has entered into a Master Agreement
with the State Compensation Insurance Fund to administer workers= compensation benefits
for State employees as required by the California Labor Code.
J. Neither party may assign this contract or any interest therein without the written consent of
the other party.
K. All contracts relating to the construction or operation of the project, including those executed
following completion of the project, shall contain a clause prohibiting discrimination against
any employee or employee applicant engaged in project work or project operation, on the
basis of race, reiigion, sex, color, ancestry, age, physical handicap or national origin. Such
clause shall include all aspects of employer-employee and employer-employee applicant
relations.
Page 3 of 4 Agenda Item 8.d.
Page 6
.. Subject to provisions herein, all remedies allowed by law are available to either party for
enforcement of this contract. Any waiver of rights by either party or any matter relating to this
contract shall not be deemed to be a waiver on any other matter relating to this contract.
M. If any part of this contract is found to be invalid the remainder of the contract shall continue in
effect.
N. This contract may be modified by mutual written agreement of the parties.
0. This agreement shall remain in effect unless terminated upon sixty (60) days written notice
from either party to the other.
P. No member of, or delegate to, Congress, or Resident Commissioner, shall be admitted to any
share or part of this agreement, or to any benefit that may arise there from; but this provision
shall not be construed to extend this agreement if made with a corporation for its general
benefit. (Applicable only if Sponsor is an agency of the United States Government).
JB] SIGNATURE BLOCK
IN WITNESS WHEREOF, the parties have agreed to the conditions of this Agreement as of the date
shown below.
Print Sign
Sponsor Representative: Date:
District Director: Date:
JA] SPONSOR INFORMATION
Page 4 of 4
Agreement #:
Sponsor Name:
Agency Code: Index #:
Address:
Sponsor Department:
City: State: County: ZIP:
Contact Person: Phone:
Agenda Item 8.d.
Page 7
STATE OF CALIFORNIA
AGREEMENT ADDENDUM
cccw (REV. OWO) Page 1 of 2
Agreement #
I (CCC Contrad Officer Wns)
ATTACHMENT 2
6603
(Center Index Cade is Four digb)
CALIFORNIA CONSERVATION CORPS
CCC Work Code
Rl2-6039
(Center Pmjed Manager Assigns)
A] The California Conservation Corps (CCC), agrees to provide crew labor for the project titled:
City of Arroyo Grande - Grace Lane Fire Reduction
See CCW: Pmjed Evaluation Form for delaii.
1~1 The term of this aareement shall be:
~~reement Start ate: January 1, 2012 Icheck here if multi-year
Agreement Expiration Date: December 31, 201 5
El The CCC shall forward billing for labor andlor operating expenses with supporting documentation in triplicate to sponsor
(X~onthl~ (~uarterl~ n~t end of contract
Sponsor agrees to pay CCC within 50 days from receipt of bill. Negotiated Advanced payments: 1 $
C] Sponsor agrees to reimburse the CCC for
estimated costs in accordance with the Fiscal
summary. (Fiscal Year displays are shown on page 2.)
NOTE TO SPONSOR: Budget detail will not be
provided on performance based contracts.
9 24th Street, Sacram
Sacramento, CA 95816
LABOR
CM Regular Time:
CM Overtime:
Sponsor
Dl The total amount payable by Sponsor to CCC under this agreement shall not exceed:
Organization:
Date:
Signature:
Print:
Title:
$ 20,667.12
City of Arroyo Grande Parks & Recreation
Doug Penin
Director of Parks and Recreation
Totals
$ 19,821 .I2
$
Performance-Based Labor:
Staff BILLABLE Regular Time :
Staff Overtime :
EXPENSES
Equipment (greater than $5,000):
Tools (includes equipment less than $5,000):
Materials:
Vehicle Operations:
Consulting:
Other:
Hours
1056.00
0.00
SPONSOR EMAIL ADDRESS
dpenin@arroyogrande.org
SPONSOR MAILING ADDRESS
P.O. Box 550
Arroyo Grande, Ca. 93421
SPONSOR BILLING ADDRESS:
$
$
$
$ -
$ 846.00
$
$
$
$ -
RatelHr
$ 18.77
$ -
Agenda Item 8.d.
Page 8
ATTACHMENT 3
Grace Lane Assessment Dktrict
Flscal Year 2008-07
EXHIBIT D: FUEL MODIFICATION SPECIFICATIONS
In accordance with Munldpal Se&on 8.44.020 all grass. weeds. brush. and other combustibles
will be maintained in a coridfllon that wlll make it uilikely that It will become easily Ignited or
supwrl the spread of fire. The Fire De~arlment encouraoes the wowrty owner to consider the
useof livest& (goats, cattle, etc.) to &logically mainGn the Ge Safeiy of thls land.
Zone 1
Grasses shall be cut down to a length of 4 lnches or less yearly, or as required by the City of
Arroyo Grande Flre Department. All brush and pampas grasses wlll also be cut down In thls zone.
Zone 2
Shrubs under oaks and withln 10 feet of tree canopies shall be removed. Brush in this area shall
be thlnned to the satlsfection of the Arroyo Grande Fire Department to allow for mlnimal spread of
fire and to allow adequate access for RreRghting suppression efforts. Grasses and brush shall be
kept mowed in this zone as well.
Zone 3
To elhlnate ladder fuels beneath oak trees, oak tree limbs to be considered for removal shall be
less than 4 Inches in diameter and within 4 feet of the ground. Branches must be chipped for . mulch and spread on site.
Grasses In this zone shall be kept mowed where practical.
Trees with shrubs adjacent to the canopy shall likewise have limbs 4 lnches or less removed until
clearance is achieved between canopy and shrubs.
Some shrubs In thls area may be indicated In the neld to be thinned.
Wing fallen branches located in treated zones shall be chipped and used as mulch.
Removal of larger tree limbs over 4 inches in diameter which pose a hazard or are within 4 feet of
vertical clearance zone must be approved by en arborlst and the Director of Parks, Recreation.
and FacUlUes. .
All prunlng work done on oak trees In thls zone shall be done only after the issuance of a Pruning
Permlt by the Dlredor of Parlcs, Recreation, and Facilities.
Notes
A site walk with the owner or Homeowners Association's Representative and the City of Arroyo
Grande Flre Marshall Is requlred prior to the commencement of any work In the defined open
space areas.
All work on and around existing oak trees shall conform to the conditions of the City of Arroyo
Grande Community Tree Ordinance 431 C.S. All Pruning d oak trees shall be executed per
documented recommendations by a cerWled arborkt using ISA approved pruning standards. All
contractors and subcontractors shall have read the comrnunlty tree ordlnam and be familiar with
the conditions therein.
eda - Design Professionals
Agenda Item 8.d.
Page 9
Grace Lane Asessmenl District
Fiscal Year 2006-07
MHlBlT E: FUEL MODlFlCATlON ZONES
Agenda Item 8.d.
Page 10
Al-rACHMENT 4
CALIFORNIA CONSERVATION CORPS PROJECT EVALUATION CCC- 58
Project Description:
CCC crews will annually remove dead and downed limbs, achieve clearence
between canopy and shrubs and remove limbs less than 4 inches that act as
ladder fuels. This work will be performed within the Grace Lane Assesment
[A] PROJECT DATA
I~roject/~ork Code: R-12-6039
District.
Center Code: 603 LOS PADRES
Location Code:
ARRA Funding: N 1 I
- -
[Bl SPONSOR INFORMATION
Icontract: - - l~esource Category: FHR
I Project Title: CITY OF ARROYO GRANDE - GRACE LANE FIRE REDUCTION
[C] EMERGENCY RESPONSE INFORMATION
Agency Code: Sponsoring Agency: I Address : 1 40000 I CITY OF ARROYO GRANDE P.O. BOX 550
I~ity: ARROYO GRANDE ( State: CA ( ZIP: 93421- I
-- - -
(CDF Incident # - I Request # - 1 OES # - ( HQRef. # -
+ I CCC Index # ( Corpsmember Overtime Pay Serial #
Sponsor Representative:
DOUG PERRIN
Technical Supervisor:
DOUG PERRIN
[Dl ESTIMATE INFORMATION [El WORKSITE INFORMATION
Title:
DIRECTOR OF PARKS AND RECREATI
+ +
Title:
DIRECTOR OF PARKS AND RECREATI
Hours : 481
Start Date: 01/01/2012
Directions to Worksite Location:
100 Rodeo Dr. Arroyo Grande 93420
IZIP: 93420- l~ounty Code: 40ICounty: SAN LUIS OBI
[F] FOR HQ USE ONLY MIKE ANDERSON 12/21/2011, 1:03pm
I~eceived: ( Logged : I~erified:
+ +
( Analyst : I ~ntered : 1 Checked:
Field Operations Database System Ver: 2.8.8 (11/15/2011)
Agenda Item 8.d.
Page 11
CCC-58 Project/Work Code: R-12-6039 CITY OF ARROYO GRANDE - GRACE LANE Page: 2
[GI EDUCATIONAL ACTIVITIES
Sponsor: Educational presentation to increase Corpsmember understanding of
the natural environment. Length of time scheduled: 0.50 Hrs.
City staff will talk about assesment area, what they are and how the City is
responsible.
CCC: The CCC will be doing the following work/learn activities.
Length of time scheduled: 0.50 Hrs.
CCC Staff will talk about WUI (wildland urban interface) and fuel modification
zones.
[HI EQUIPMENT , MATERIALS, AND LABOR
Field Operations Database System Ver: 2.8.8 (11/15/2011)
To be supplied by Sponsor: To be supplied by CCC:
Supervision
Transportation
Tools
Chipper
Porta Pottie
Special SPIKE equipment needed by crew: ,
SPIKE Information (description and location of housing):
Agenda Item 8.d.
Page 12
CCC-58 Project/Work Code: R-12-6039 CITY OF ARROYO GRANDE - GRACE LANE Page: 3
[I] NARRATIVE ON HOW PROJECT WILL MEET ALL LEGISLATIVELY MANDATED OBJECTIVES
(Assign a numerical rating: O=none, l=low, 2=medium, 3=high)
Conserving, improving, developing natural resources, maintaining
environmentally important lands or waters. RATING: 3
CCC work will reduce hazard to public thereby allowing area to remain open
space with amplified public threat.
Providing public benefit or access (Estimated visitor use, increased safety,
reduced maintenance costs, etc. RATING: 3
Fuel Reduction will increase safety to several hundred.homes in the area.
Providing Corpsmembers with opportunities for training in employable skills
(e.g. specific tools and use, fire control, carpentry) RATING: 2
Chainsaw use, Chipper use, brushing techniques and teamwork,
[J] PROJECT CHECKLIST & SIGNATURE BLOCKS ................................................................................
SIGNING THIS DOCUMENT VERIFIES THAT: •
A Sponsor Agreement (CCC 96) is on file at Headquarters. .
If a reimbursable project, a CCC-96A or STD-13 agreement has been .
submitted to Headquarters. .
If the Sponsor is a non-profit entity, a statement of non-profit status .
and Private Property/Sponsor Authorization form have been submitted to HQ.
If the Sponsor is a for-profit entity, a Private Property/Sponsor .
Authorization has been submitted to HQ. .
The project conforms to CCC's Injury and Illness Prevention Program (IIPP)
*Project Coordinator: Print1 Sign Date: .
• MIKE ANDERSON I • . + .
-Center Director: I . . . ................................................................................
THE SPONSOR REPRESENTATIVE AGREES TO THE FOLLOWING: •
If there are hazardous materials present, the sponsor has provided the .
location, identity, and amounts of any hazardous substances at the worksite*
and provided all Material Safety Data Sheets for hazardous materials that
are present at the worksite .
OR
To the best knowledge of the sponsor, the worksite is free of any
known hazardous materials. .
*AND
That all applicable local, state, and federal permits, approvals, and
clearances have been obtained. .
*Sponsor Representative: Print1 Sign
I
Date:
. . ................................................................................
Field Operations Database System Ver: 2.8.8 (11/15/2011)
Agenda Item 8.d.
Page 13
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Agenda Item 8.d.
Page 14