Certification of Court and Subcontractor/S Compliance with Family Code Section 3200.5

ATTACHMENT 14 CERTIFICATION OF COURT AND SUBCONTRACTOR/S COMPLIANCE WITH FAMILY CODE SECTION 3200.5 AND STANDARD 5.20

Family Code section 3202(a) requires providers of supervised visitation and exchange services to follow the Uniform Standards of Practice for Providers of Supervised Visitation as set forth under Standard 5.20 of the California Standards of Judicial Administration. Certification: Both the court and its subcontractors certify that any professional provider of supervised visitation under California’s Access to Visitation Grant Program meet and are in compliance with the statutory requirements under Family Code section 3200.5 and Standard 5.20. This includes certification that the professional provider of supervised visitation meets the statutory requirements under Family Code section 3200.5 prior to working on any case and each individual professional provider has signed the required declaration under penalty of perjury that they meet the requirements of Family Code section 3200.5, including sections (c), (d)(1), and (2). 1 The court may choose to use the Judicial Council form FL-324 (Declaration for Supervised Visitation Providers) designed to ensure the professional provider of supervised visitation providers meets compliance requirements under Family Code section 3200.5. The FL- 324 form is an optional form.

In addition, the court and subcontractor acknowledges that the subcontractor must maintain adequate insurance coverage and all staff working on the Access to Visitation Grant Program must complete a criminal background and fingerprinting clearance prior to working on any case. We further understand that meeting the conditions of the funder and federal and state statutory grant requirements is a prerequisite for the release of grant funds and that a violation of federal and state funding requirements can result in a range of penalties, including suspension of future funds under the grant program, suspension or debarment from federal grants.

Name of Authorized Signatory (Applicant Court Title Phone Number Presiding Judge or Court Executive Officer)

Signature Date Signed

Name of Authorized Signatory (Applicant Court Title Phone Number Subcontractor Executive Director)

Signature Date Signed

1 Documentation of compliance means that the court and its subcontractor must be able to show that the individual subcontractor staff (i.e., those individuals working as professional providers of supervised visitation and being reimbursed under the grant program) meet the statutory requirements. This includes the court/subcontractor response to Access to Visitation Grant Program manager information requests regarding the court/subcontractor/s grantee compliance. ATTACHMENT 14 COMPLIANCE STATEMENT FOR FAMILY CODE SECTION 3200.5 AND STANDARD 5.20 OF THE CALIFORNIA STANDARDS OF JUDICIAL ADMINISTRATION California’s Access to Visitation Grant Program—Fiscal Year 2017–2018 (Page 2)

NAME (print or type) SIGNATURE DATE

Multicourt Collaborative: Presiding Judge or Court Executive Officer/Administrator

Multicourt Collaborative: Subcontractor Executive Director

Multiccourt Collaborative: Presiding Judge or Court Executive Officer/Administrator

Multicourt Collaborative: Subcontractor/Executive Director

Multicourt Collaborative: Presiding Judge or Executive Officer/Administrator

Multicourt Collaborative: Subcontractor/Executive Director

Multicourt Collaborative: Subcontractor/Executive Director Revised April 1, 2017