Community Agency Contract Forms

Community agencies providing services (including housing rehabilitation services) and entering into contract with the City of Berkeley are required to use the forms provided on this page.  You may either open the documents in html by clicking on the link, or right click on the document, then click on “Save As” and save the document to your computer.  If you have questions on any of these forms or documents, contact your contract monitor.

                  6-30-2016 Community Agency Workshop

                    Community Agency Workshop Presentation


General Documents:
Service Measures and Outcomes (PDF)
 Attachment A - Income Requirements(PDF)
 Attachment B - Required Intake Elements(PDF)
TB Testing Sites (PDF)
Section 504 Checklist (PDF)
ADA Checklist (PDF)
Criminal Background FAQ (Word)
Living Wage Ordinance FAQ  
Procurement Procedures Templates (Word)

Reporting Documents:
Schedule for Reports (Word) 
Equipment Tracking Form (Excel)
Near Relative Notification Form (Word)

Contract Documents:
Workforce Composition (Excel)
Nuclear Free Berkeley Disclosure (PDF)
Certification of Compliance with Living Wage Ordinance (PDF)
Certification of Compliance with Equal Benefits Ordinance (PDF)
ADA Self-Certification Form (Word)
Certification of Anti-Lobbying** (PDF)
Certification of Drug-Free Workplace** (PDF)
Case Management Basic Standards (PDF)

**Agencies receiving CDBG, ESG, and/or HOME funds must submit these forms.