HomeMy WebLinkAboutCalifornia Conservation Corps 2025-10-15 Docusign Envelope ID:3C494C23-AF06-4EC6-9342-9C9AB30B2071
Mate of i.antornla ,
California Natural Resources Agency COU No. - �02
• CC C CALIFORNIA CONSERVATION CORPS PROJECT EVALUATION
FORM CCC 58
R-25-1715-16277
City of Ukiah Tree Planting
Project Data
Project Title: City of Ukiah Tree Planting Project Number: R-25-1715-16277
Center Information: 1-15 -Ukiah-Mendocino Center
Contract Information: -
Project Description:
The Mendocino Center will assist the City of Ukiah with tree,shrub and grass plantings.Tasks will include:preparations,staking,
mulching,caging,burlap shading,irrigation and tagging.
Sponsor Information
Agency Name: CITY OF UKIAH Agency Code: 40114
Mailing Address Mailing City Mailing State Mailing Zip Code
411 W Clay Street Ukiah CA 95482
Sponsor Contact Information:
First Last Contact Type Title Name Name Phone Number Email Address
Sponsor RepresentativeJechnical Community Services
Neil Davis 707-467-5764 ndavis@cityofukiah.com
Advisor Director
Estimate Information
Estimated Number of Hours: 2240.0 Estimated Start and End Dates: 10/15 2025 -6.30.2027
Work Site Information:
Address City State Zip Code Geolocation Latitude Geolocation Longitude CES 4.0 %
Ukiah CA 95482
Directions to Site Location Special Instructions
101 south to Ukiah.Various locations along the Rail Trail
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Docusign Envelope ID:3C494C23-AF06-4EC6-9342-9C9AB30B2071 2- .
JLaLc ui 1—diuuiaiia COU No.
California Natural Resources Agency
CCC CALIFORNIA CONSERVATION CORPS PROJECT EVALUATION
FORM CCC 58
R-25-1715-16277
City of Ukiah Tree Planting
Fiscal Summary
Total OE&E Total CM Labor Amount IFTotal Fiscal Summary Amount
so.o0 S64,960.00 IF $64,960.00
Equipment, Materials and Labor
Sponsor Supplied Materials, Equipment and Labor:
Materials: All materials for the project
Equipment: Specialty tools as needed.
Labor: Technical oversight for project and irrigation
BY SIGNING THIS DOCUMENT:
The CCC Representative agrees to the following:
• A Sponsor Agreement (CCC 96 or, where applicable, an Inter Agency Agreement or other Master
Agreement) is on file at Headquarters (HQ).
• If the Sponsor is a non-profit entity, a Private Property.°Sponsor Authorization form has been submitted
to HQ.
• If the Sponsor is a for-profit entity, a Private Property,Sponsor Authorization form has been submitted
to HQ.
• The project conforms to the CCC's Injury and Illness Prevention Program (IIPP).
• The signing CCC Representative has the authority to enter into a contractual agreement of this amount
with the Sponsor.
The Sponsor Representative agrees to the following:
• Hazardous Materials
• 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 (MSDS) for hazards that are present at the worksite.
• OR
• To the best knowledge of the Sponsor, the worksite is free of any known hazardous materials.
• All applicable local, state, tribal, and federal permits, approvals, and clearances have been obtained.
• Project Funding
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Docusign Envelope ID:3C494C23-AF06-4EC6-9342-9C9AB30B2071
Ntate of uantornia Cott No 252� I ZG
California Natural Resources Agency
(; C CALIFORNIA CONSERVATION CORPS PROJECT EVALUATION
FORM CCC 58
R-25-1715-16277
City of Ukiah Tree Planting
• For projects funded by the Sponsor or entity other than the CCC, the Sponsor agrees to
reimburse the CCC for estimated costs in accordance with the fiscal details shown in this
document.
• OR
• For projects funded internally by CCC's Environmental Programs or other special fund, the
Sponsor agrees to comply with all applicable program and eligibility criteria to fund the project.
• The signing Sponsor Representative has the authority to enter into a contractual agreement of this type
(and, if any, this amount) with the CCC.
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Docusign Envelope ID:3C494C23-AF06-4EC6-9342-9C9AB30B2071
Mate oT Ualttornta COU No. oCS IO 2�
California Natural Resources Agency
CALIFORNIA CONSERVATION CORPS PROJECT EVALUATION
FORM CCC 58
R-25-1715-16277
City of Ukiah Tree Planting
Sponsor Representative:
Print Name: —SRC v
Title:
Signature: dF
Date: 6- 16.
CCC Representative:
Print Name: Cathy Barr
Title: Conservationist Supervisor
rrnD,00ccu,Signed by:
Signature: "C E7I baw
�F72888E644480...
Date: 10/28/2025
CCC Representative:
Print Name: Gary Whitehouse
Title: Regional Director
DocuSigned by:
Signature: FAn INU,"st,
Date: 10/28/2025
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