Summit Academy Vendor Application Instructions & Information UPDATED DOJ INFORMATION Summit Academy (SA) would like to thank you for your interest in partnering with us as a vendor. It is our belief that students should have the opportunity to enrich their educational experience by offering a variety of opportunities to develop their talents and interests. Approved vendors are posted on our website where our parents can find you and see a description of the services you offer to enrich their children's learning plan. Please read, complete and submit the entire application so we can and we can expedite the approval process. Incomplete applications will not be approved. Please email questions to
[email protected] When complete, SCAN & EMAIL completed application and documents to:
[email protected] We look forward to working with you!
WHAT TYPE OF VENDOR ARE YOU? Determining the correct category will help prevent processing delays. Educational Materials Vendor (EMR) is a business that provides curriculum, books and supplies. • • Vendor Course Instructor (VCI) is a person or facility that provides tutoring, art/music lessons, physical education classes and other similar instruction to Summit Academy students. Please submit the following documents required for your vendor type EMR APPLICATION CHECKLIST: □ Vendor Information – Page 3 - Return □ W9 – Page 8 - Return □ Brochure or additional information
9/15 AK-3
VCI APPLICATION CHECKLIST: □ Vendor Information – Page 3 - Return □ Vendor Services Agreement – Page 4 & 5 – Return □ Employer Fingerprint Clearance Certification – Page 6 Return □ Department of Justice Verification – Page 6- select one that applies; Submit a copy of approval documentation. If documentation is pending with DOJ, please complete and return form and select the box 'In Process' ORI Approval – provided by DOJ • One Person Agency – provided by DOJ • • Custodian of Record – provided by DOJ □ W9 - Return □ Brochure or additional information
Email to:
[email protected]
1 of 6
Summit Academy Vendor Application Instructions & Information (cont.)
LIVE SCAN INFORMATION & REQUIREMENTS – For VCI Vendors In accordance with Education Code Section 45125.1, we require Live Scan Clearance for the safety of our students. Every individual who comes into contact with Summit Academy students must have appropriate background checks. The owner of any business whose employees have contact with Summit Academy students, must certify in writing to that none of his/her employees have been convicted of a serious or violent felony and that background checks have been completed. All service vendors must complete the Employer Fingerprint Clearance Certification form. For the 2015-16 school year, Summit Academy has implemented a vendor clearance procedure that does not include the use of our or any other schools LiveScan Fingerprint Form or ORI number. There are three options to provide Summit Academy DOJ Clearance Verification: 1. ORI Number – Provide a copy of the ORI approval letter that includes the ORI number that was assigned to you by the Department of Justice; OR 2. One Person Agency – Provide a copy of the One Person Agency approval letter that was mailed to you by the Department of Justice; OR 3. Custodian of Record – Provide a copy of the Custodian of Record approval letter that was mailed to you by the Department of Justice. If documentation is pending with DOJ, please complete and return Employer Fingerprint Clearance Certification and select the box 'In Process'. For more information, regarding the three options please visit http://oag.ca.gov/fingerprints/agencies and our Vendor FAQs
DO NOT LIVESCAN FINGERPRINT USING SUMMIT ACADEMY OR ANY OTHER SCHOOLS ORI NUMBER/LIVESCAN FORM. DOING SO COULD RESULT IN PENALTIES AND DENIAL OF VENDOR APPLICATION.
***IMPORTANT*** NEW CONTACT INFORMATION
9/15 AK-3
Website:
www.summitacademycs.org
Main Office Phone:
818-450-9810
Main Office Email:
[email protected]
Vendor Relations Phone:
760-571-9770
Vendor Relations Email:
[email protected]
Email to:
[email protected]
2 of 6
Summit Academy Vendor Application Vendor Information 1. Which ONE category best describes the type of materials/service you offer? (For our online search feature) □ □ □ □ □
Art Educational Videos Electives Foreign Language History/Social Studies
□ □ □ □ □
Language Arts Library Literature Manipulatives Math
□ □ □ □ □
Multi-Subject Music Office/School Supply Physical Education Reading
□ □ □ □
Science Special Education Technology Writing
2. Complete both Ordering and Billing sections. Location Information
Billing Information
(View-able online)
(Not view-able online)
Company Name
How you would like to be listed on our website?
Company Address
How would you like to be listed on our website?
Checks payable to:
□
Same
Remittance address
□
Same
Contact Name
□
Same
Email Address
□
Same
Phone Number
□
Same
Fax Number
□
Same
Website
3. If in California, what county are you in? ________________________________________________ 4. Do you charge shipping fees?
□ No
□ Yes
□ N/A
5. Provide a brief description of your products/service. Include the counties you serve (if state/country wide, write All Locations):
9/15 AK-3
Email to:
[email protected]
3 of 6
Summit Academy Vendor Application Vendor Course Instructor Services Agreement This agreement is between Summit Academy (SCHOOL), under the auspices of California Prep., A-3 Education and CalFlex (collectively “SCHOOL”) and (CONTRACTOR). STIPULATIONS REGARDING INDEPENDENT CONTRATOR STATUS A) SCHOOL desires to hire CONTRACTOR to provide educational services pursuant to the terms set forth herein. B) CONTRACTOR represents that he/she is engaged in an independent calling and has compiled with all local, state, and federal laws regarding business permits and licenses that may be required to carry out the independent calling and to perform the services entered under this Agreement. C) CONTRACTOR represents: (1) he/she is engaged in the same or similar activities for others and that SCHOOL is not CONTRACTOR'S sole client or customer; (2) he/she retains the sole right to control or direct the manner in which the services are described; (3) he/she will supply all equipment, tools, materials and supplies necessary to perform the services under this Agreement. In consideration of these recitals and promises set forth in this Agreement, SCHOOL and CONTRACTOR agree to the following: SERVICES RENDERED/GENERAL TERMS Course/Class
Cost p/Unit (Hour/Month/Course)
Duration (# weeks/Semester)
Course/Class
Cost p/Unit (Hour/Month/Course)
Duration (# weeks/Semester)
Course/Class
Cost p/Unit (Hour/Month/Course)
Duration (# weeks/Semester)
Please attach a proposed course description, services brochure or document describing services. INSURANCE The SCHOOL assumes no liability for Worker's Compensation or liability for loss, damage or injury to person(s) or property during or relating to the performance of service under this Agreement. The CONTRACTOR shall conduct a criminal background check of it's employees through the Department of Justice (DOJ) in accordance with Education Code Section 45125.1 and, upon receipt of DOJ clearance, certify to the school that no employee of the CONTRACTOR working with students of he SCHOOL, has been convicted of a violent or serious felony as defined by statute, nor has a criminal action pending upon charges of commission of a violent or serious felony as defined by statute. The CONTRACTOR shall supply SCHOOL with a list of employees who are cleared to work with students of the SCHOOL The CONTRACTOR agrees to hold harmless and to indemnify the SCHOOL: •
Any injury to person or property sustained by the CONTRACTOR or by any person, firm or corporation, employed directly or indirectly by the CONTRACTOR or by any of the individuals participation in or associated with him/her, however caused; and any injury to person or property sustained by any person, firm or corporation, caused by any act, neglect, default or omission, or the CONTRACTOR, or any person ,
9/15 AK-3
Email to:
[email protected]
4 of 6
Summit Academy Vendor Application Vendor Course Instructor Services Agreement (cont.)
firm or corporation directly or indirectly employed by the CONTRACTOR upon or in connection with this Agreement, or any other persons/parties performing services arising in the course of the term of this Agreement, and the instituted against the SCHOOL or chartering district for any such claim or demand, and pay or satisfy any judgment that may be rendered to the SCHOOL or chartering district in any such action, suit or legal proceeding result thereof. Nothing herein provided shall be construed to require the CONTRACTOR to hold harmless or indemnify the SCHOOL for liability or damages resulting from the negligence or willful act or omission of the SCHOOL or chartering district or its officers, agents or employees. SERVICES The CONTRACTOR agrees to perform the services described for the sum as contracted above. The CONTRACTOR agrees that the SCHOOL reserves the right to remove the Vendor for legal violations and/or parent/student complaints of services. The CONTRACTOR may not begin services until PO is completed and approved by a school official. Educational Specialist, Parent, and Vendor do not have authority to authorize the approval of PO on behalf of SCHOOL. The SCHOOL will cancel a student's PO if the student withdraws from the SCHOOL. Nothing contained in this Agreement shall be construed to make CONTRACTOR an employee of SCHOOL or to create an agency relationship between SCHOOL and CONTRACTOR. The SCHOOL intends and CONTRACTOR acknowledges and accepts that CONTRACTOR is and independent contractor during the term or any continuation of this Agreement. CONTRACTOR shall be and is responsible for his/her own actions and conduct as well as his/her own expenses in relation to any services or materials provided by CONTRACTOR in furtherance of this Agreement. PAYMENT TERMS CONTRACTOR acknowledges and agrees to: (1) Accept Purchase Orders (PO); (2) Payment terms are Net 30; (3) SCHOOL will not process payment until services are completed as specified on PO; (4) CONTRACTOR will submit an invoice to SCHOOL to initiate the payment process; (5) The SCHOOL is not responsible for any payments beyond the amount agreed upon as indicated by the Purchase Order (PO) agreement. CONTRACTOR SIGNATURE ACKNOWLEDGES COMPLIANCE WITH ALL PROVISIONS OF AB1610 (Ed Code Sec 45125.1) Contractor Signature
Date
Contractor Name (Print)
Contractor Address
City
Authorized School Representative Signature
state
Zip
Date
School Representative Name (Print)
Instruction may not begin until vendor has received Purchase Order Number(s) for student(s) enrolled.
9/15 AK-3
Email to:
[email protected]
5 of 6
Summit Academy Vendor Application Employer Fingerprint Clearance Certification
I hereby certify that I, the CONTRACTOR (named below) have conducted a criminal background check of all employees/contractors, who will have contact with students, through the Department of Justice (DOJ), in accordance with Education Code Section 45125.1. I certify to the SCHOOL (Summit Academy Charter School), that no employee/sub-contractor of the CONTRACTOR working with students of the SCHOOL has been convicted of a violent or serious felony as defined by statute. I, , will be responsible for consequential damage in connection with providing known employees/sub-contractors with a conviction of a violent or serious felony as defined by statute, or criminal action pending upon charges of commission of violent or serious felony as defined by Education Code Section 44125.1 services to SCHOOL. I, , agree to indemnify SCHOOL, hold it and it's representatives harmless for all losses, damages and other liabilities resulting in any way from errors and omissions may inadvertently or deliberately execute in compliance with Education Code Section 45125.1 I will provide the SCHOOL one or more of the following types of Department of Justice Verification: □ ORI Number – Provide a copy of the ORI approval letter that includes the ORI number that was assigned to you by the Department of Justice. □ IN PROCESS; OR □ One Person Agency – Provide a copy of the One Person Agency approval letter that was mailed to you by the Department of Justice. □ IN PROCESS; OR □ Custodian of Record – Provide a copy of the Custodian of Record approval letter that was mailed to you by the Department of Justice. □ IN PROCESS I, , understand that if I don't have the above mentioned Department of Justice Verification, I will obtain and provide SCHOOL with verification by Monday, February 1, 2016.
Contractor Signature
Date
Contractor Name (Print)
Title
9/15 AK-3
Email to:
[email protected]
6 of 6