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Housing and Community Services Department
Housing and Community Services Department

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.

6-27-2019 Community Agency Workshop

Coming Soon! Workshop slides will be posted post-workshop.   



FY 18 Insurance Sample (PDF)

General Documents:
Attachment A - Income Requirements(PDF)

Attachment B - Required Intake Elements(PDF)

Attachment C - Required Client Satisfaction Survey Questions (Word) - Coming Soon!

TB Testing Sites (PDF)

Section 504 Checklist (PDF)

Criminal Background FAQ (Word)

Living Wage Ordinance FAQ  

Procurement Procedures Templates (Word)

CIty of Berkeley ADA Compliance 

City of Berkeley ADA Grievance Procedure and Form (PDF)


Reporting Documents:
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 (PDF)

Certification of Anti-Lobbying** (PDF)

Certification of Drug-Free Workplace** (PDF)

Evaluation Commitment (Word) 

Additional Homeless Information and Documentation - Coming Soon!

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




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Housing and Community Services Department, 2180 Milvia Street, 2nd Floor, Berkeley, CA 94704
Questions or comments? Email: Phone: (510) 981-5400
(510) 981-CITY/2489 or 311 from any landline in Berkeley
TTY: (510) 981-6903