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{"sheet":"Vendor Worksheet Instructions","index":0,"n_rows":101,"n_cols":2,"rows_kept":101,"cut":false,"hidden":false,"merged":[[0,0,0,9],[1,0,1,9],[2,0,2,9],[4,0,8,9],[91,0,96,9],[84,0,87,9],[66,1,68,9],[74,1,74,9],[76,1,76,9],[78,1,80,9],[82,1,82,9],[100,0,104,9],[18,1,18,9],[20,1,22,9],[27,1,28,8],[34,1,34,8],[24,1,25,9],[32,1,33,9],[37,1,42,9],[44,1,45,9],[47,1,48,9],[49,1,49,9],[51,1,52,9],[54,1,54,9],[56,1,56,9],[58,1,58,9]]}
["NORTH LOS ANGELES COUNTY REGIONAL CENTER"]
["MINIMUM WAGE RATE ADJUSTMENT - JANUARY 1, 2024"]
["WORKSHEET INSTRUCTIONS"]
[]
["These instructions are for the Minimum Wage.  After you read these instructions, please go to the spreadsheet “Vendor Worksheet” tab to begin.  You will ONLY be able to fill-in  the shaded fields on this worksheet.  The information you submit  will be reviewed by North Los Angeles County Regional Center (NLACRC).  If additional information is needed, NLACRC will contact you.  After the review, NLACRC will respond to your request accordingly. Rate adjustment requests must be submitted no later than March 1, 2024."]
[]
[]
[]
[]
[]
["SECTION A:  PROGRAM INFORMATION"]
[]
["Row 1","Please enter the Service Provider Name."]
[]
["Row 2","Please enter the six-digit Vendor Number."]
[]
["Row 3","Please enter the three-digit Service Code."]
[]
["Row 4","Please enter the Sub code if applicable. This field is mandatory for consumer-specific rates."]
[]
["Row 5","The review period is from January 1, 2023 through March 31, 2023.  If data is not available for this period, please enter an applicable Review Period of up to three (3) months, thereafter, for which actual data is available."]
[]
[]
[]
["Row 6 ","Please enter the current rate as established by NLACRC and select the Unit Type, either Daily or Hourly, from the drop-down list."]
[]
[]
["Row 7&8","Do not make changes to this field."]
[]
[]
["Row 9","NLACRC has been entered here as your vendoring regional center."]
["Row 10","Enter number of employees."]
["Row 11","Select the User Regional Center(s) from the drop-down list.  If you need to list additional user regional centers, put your cursor on cell A24 and click the designated button. "]
[]
[]
["SECTION B:  EMPLOYEE WAGE INFORMATION"]
[]
["Column A","Please enter the complete name of the employee(s) who were paid wages less than the new minimum wage per hour during the Review Period.  For any employee who received two or more different wages less than the new minimum wage per hour in the review period being reported, please list this employee as many times as necessary to separately reflect each wage paid with the requested information in columns B through H.  If additional rows are needed, put your cursor on row 25 and click on the designated button."]
[]
[]
[]
[]
[]
[]
[null,"Please DO NOT submit costs associated with staff hired to supplement staffing ratios for non-mobile consumers pursuant to Title 17, CCR, section 56756(b). "]
[]
[]
["Column B","Please enter the Current Hourly Wage paid to the employee(s) reported during the Review Period."]
[]
["Columns C & D","Do not make changes to this field - Wage information will calculate automatically."]
[]
["Column E","Please enter the Actual Hours Worked During the Review Period by each of the reported employee(s). Do not consider Vacations, Sick time or Holidays."]
[]
[]
["Column F","Do not make changes to this field  -Wage information will calculate automatically."]
[]
["Column G","Please calculate the Workers' Compensation Employer Rate and enter as a percentage."]
[]
["Column H","Worker’s Compensation Employer Cost information will calculate automatically here."]
[]
["Row I","Wage and Worker’s Compensation totals will calculate automatically."]
[]
["SECTION C:  PAYROLL TAXES, WORKER’S COMPENSATION INSURANCE, AND OTHER"]
[]
["Rows J-O","Payroll  & Liability Costs will calculate automatically."]
[]
["Rows P & Q","Please enter the total dollar amount and describe any other applicable mandated employer costs.  ONLY costs associated with the increase in the employee’s hourly wage to the new minimum wage per hour should be included.   DO NOT include Federal, State Unemployment Insurance Taxes and Health Insurance-related costs. For the Unemployment Insurance in the cell F65 type the rate as percentage."]
[]
[]
[]
["Row R","Mandated employer costs will calculate automatically."]
[]
["SECTION D:  RATE ADJUSTMENT CALCULATION"]
[]
["Row S","Total wages, payroll taxes, workers' compensation, and other mandated employer costs will calculate automatically."]
[]
["Row T","Total Actual Number of Units of Services Billed to all Regional Centers will calculate automatically."]
[]
["Rows 1 - 5","Please select the individual regional center(s) billed in the Review Period and enter the total units billed in the Review Period for the selected regional center(s).  If you need to list additional regional centers, put your cursor on row 5 and click the designated button."]
[]
[]
[]
["Row U","The rate change will calculate automatically and populate Row 7 in Section A, Program Information."]
[]
["Please review ALL the information you have entered on the worksheet, and specifically row 6 in Section A, and row U in Section D.  These rows should have calculated rate information based on the data you have entered.  If there is an error message in these rows, you may need to re-enter the information in Sections B, C, and/or or D."]
[]
[]
[]
[]
["CONSUMER-SPECIFIC RATES:"]
[]
["A separate Minimum Wage Calculation Worksheet must be submitted for rate increase requests received for services with consumer-specific rates.  Each worksheet should include all employee(s) paid less than the new minimum wage per hour during the Review Period based on the instructions provided above. If an employee provides services to multiple consumers, the employee’s total hours for the review period must be allocated based on the actual hours worked under each specific service sub-code.  Timesheets may be requested to validate the hours reported. "]
[]
[]
[]
[]
[]
[]
["SERVICE CODE 062:"]
[]
["Submit only one Minimum Wage Calculation Worksheet for rate increase requests for service code 062.  All employee(s) paid less than the new minimum wage per hour during the review period should be included in the Minimum Wage Calculation Worksheet based on the instructions provided above. "]

{"sheet":"Vendor Worksheet","index":1,"n_rows":178,"n_cols":23,"rows_kept":178,"cut":false,"hidden":false,"merged":[[9,2,9,6],[0,0,0,8],[5,2,5,6],[6,2,6,6],[7,2,7,6],[8,2,8,6],[1,0,1,8],[2,0,2,8],[18,2,18,6],[10,3,10,5],[11,3,11,5],[12,3,12,5],[13,2,13,6],[14,2,14,6],[15,2,15,6],[16,2,16,6],[17,2,17,6],[19,2,19,6],[20,2,20,6],[33,1,34,1],[141,2,141,5],[142,2,142,5],[21,2,21,6],[22,2,22,6],[23,2,23,6],[146,2,146,5],[149,2,149,5],[147,2,147,4],[145,2,145,5],[148,2,148,4]]}
["NORTH LOS ANGELES COUNTY REGIONAL CENTER"]
["Minimum Wage Increase Calculation Worksheet"]
["Effective January 1, 2024"]
[]
["SECTION A:  PROGRAM INFORMATION",null,"(You will ONLY be able to fill-in and select from the shaded fields on this worksheet)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Daily"]
[1,"Service Provider Name",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Hourly"]
[2,"Vendor Number",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Monthly"]
[3,"Service Code"]
[4,"Subcode (if Applicable)"]
[5,"Review Period Between January-March 2023: (Enter Beginning & End) (Note A)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ACRC"]
[6,"Current Rate:",0,"Select Unit Type: Daily, Hourly or Monthly",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CVRC"]
[7,"Rate Change (Will Calculate Automatically based on Information Entered Below):",{"$f":"+G165","v":{"$error":"#DIV/0!"}},null,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ELARC"]
[8,"New Rate (Will Calculate Automatically based on Information Entered Below):",{"$f":"+C11+C12","v":{"$error":"#DIV/0!"}},null,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FDLRC"]
[9,"Vendoring Regional Center","NLACRC",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FNRC"]
[10,"Total number of employees in the organization",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"GGRC"]
[11,"Select User Regional Centers from Drop Down Menu (Please List All)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HRRC"]
[{"$f":"A16+1","v":12},"Select User Regional Centers",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"IRRC"]
[{"$f":"A17+1","v":13},"Select User Regional Centers",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"KRRC"]
[14,"Select User Regional Centers",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NBRC"]
[15,"Select User Regional Centers",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NLACRC"]
[16,"Select User Regional Centers",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"RCEB"]
[17,"Select User Regional Centers",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"RCOC"]
[18,"Select User Regional Centers",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"RCRC"]
[19,"Select User Regional Centers",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SARC"]
[{"$f":"A24+1","v":20},"Select User Regional Centers",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SCLARC"]
[]
[]
[]
[]
["SECTION B:  EMPLOYEE WAGE INFORMATION",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"WRC"]
[null,"A","B","C","D","E","F","G","H"]
[null,null,null,null,null,null,"Actual","Workers'","Workers'"]
[null,"Name or Initials of Employee(s) Paid less than $16.00 per Hour",null,"New","Hourly","Hours Worked","Total Change","Compensation","Compensation"]
[null,"(Please See Instructions for Listing Employees Receiving more than One Wage at less than $16.00 per Hour)","Hourly","Hourly","Wage Change","During","In Wages","Employer","Employer Cost"]
[null,null,"Wage","Wage","(C-B)","Review Period","(D x E)","Rate as %","(F x G)"]
[1,null,null,{"$f":"IF(AND(C36>=15.5,C36<=15.99),16,0)","v":0},{"$f":"IF(D36-C36>0,D36-C36,0)","v":0},null,{"$f":"ROUND(+E36*F36,2)","v":0},null,{"$f":"+G36*H36","v":0}]
[2,null,null,{"$f":"IF(AND(C37>=15.5,C37<=15.99),16,0)","v":0},{"$f":"IF(D37-C37>0,D37-C37,0)","v":0},null,{"$f":"ROUND(+E37*F37,2)","v":0},null,{"$f":"+G37*H37","v":0}]
[3,null,null,0,0,null,0,null,0]
[4,null,null,0,0,null,0,null,0]
[5,null,null,0,0,null,0,null,0]
[6,null,null,0,0,null,0,null,0]
[7,null,null,0,0,null,0,null,0]
[8,null,null,0,0,null,0,null,0]
[9,null,null,0,0,null,0,null,0]
[10,null,null,0,0,null,0,null,0]
[11,null,null,0,0,null,0,null,0]
[12,null,null,0,0,null,0,null,0]
[13,null,null,0,0,null,0,null,0]
[14,null,null,0,0,null,0,null,0]
[15,null,null,0,0,null,0,null,0]
[16,null,null,0,0,null,0,null,0]
[17,null,null,0,0,null,0,null,0]
[18,null,null,0,0,null,0,null,0]
[19,null,null,0,0,null,0,null,0]
[20,null,null,0,0,null,0,null,0]
[21,null,null,0,0,null,0,null,0]
[22,null,null,0,0,null,0,null,0]
[23,null,null,0,0,null,0,null,0]
[24,null,null,0,0,null,0,null,0]
[25,null,null,0,0,null,0,null,0]
[26,null,null,0,0,null,0,null,0]
[27,null,null,0,0,null,0,null,0]
[28,null,null,0,0,null,0,null,0]
[29,null,null,0,0,null,0,null,0]
[30,null,null,0,0,null,0,null,0]
[31,null,null,0,0,null,0,null,0]
[32,null,null,0,0,null,0,null,0]
[33,null,null,0,0,null,0,null,0]
[34,null,null,0,0,null,0,null,0]
[35,null,null,0,0,null,0,null,0]
[36,null,null,0,0,null,0,null,0]
[37,null,null,0,0,null,0,null,0]
[38,null,null,0,0,null,0,null,0]
[39,null,null,0,0,null,0,null,0]
[40,null,null,0,0,null,0,null,0]
[41,null,null,0,0,null,0,null,0]
[42,null,null,0,0,null,0,null,0]
[43,null,null,0,0,null,0,null,0]
[44,null,null,0,0,null,0,null,0]
[45,null,null,0,0,null,0,null,0]
[46,null,null,0,0,null,0,null,0]
[47,null,null,0,0,null,0,null,0]
[48,null,null,0,0,null,0,null,0]
[49,null,null,0,0,null,0,null,0]
[50,null,null,0,0,null,0,null,0]
[51,null,null,0,0,null,0,null,0]
[52,null,null,0,0,null,0,null,0]
[53,null,null,0,0,null,0,null,0]
[54,null,null,0,0,null,0,null,0]
[55,null,null,0,0,null,0,null,0]
[56,null,null,0,0,null,0,null,0]
[57,null,null,0,0,null,0,null,0]
[58,null,null,0,0,null,0,null,0]
[59,null,null,0,0,null,0,null,0]
[60,null,null,0,0,null,0,null,0]
[61,null,null,0,0,null,0,null,0]
[62,null,null,0,0,null,0,null,0]
[63,null,null,{"$f":"IF(AND(C98>=15.5,C98<=15.99),16,0)","v":0},{"$f":"IF(D98-C98<0,0,(IF(D98-C98>1,1,D98-C98)))","v":0},null,{"$f":"ROUND(+E98*F98,2)","v":0},null,{"$f":"+G98*H98","v":0}]
[64,null,null,0,0,null,0,null,0]
[65,null,null,0,0,null,0,null,0]
[66,null,null,0,0,null,0,null,0]
[67,null,null,0,0,null,0,null,0]
[68,null,null,0,0,null,0,null,0]
[69,null,null,0,0,null,0,null,0]
[70,null,null,0,0,null,0,null,0]
[71,null,null,0,0,null,0,null,0]
[72,null,null,0,0,null,0,null,0]
[73,null,null,0,0,null,0,null,0]
[74,null,null,0,0,null,0,null,0]
[75,null,null,0,0,null,0,null,0]
[76,null,null,0,0,null,0,null,0]
[77,null,null,0,0,null,0,null,0]
[78,null,null,0,0,null,0,null,0]
[79,null,null,0,0,null,0,null,0]
[80,null,null,0,0,null,0,null,0]
[81,null,null,0,0,null,0,null,{"$f":"+G116*H116","v":0}]
[82,null,null,0,0,null,0,null,0]
[83,null,null,0,0,null,0,null,0]
[84,null,null,0,0,null,0,null,0]
[85,null,null,0,0,null,0,null,0]
[86,null,null,0,0,null,0,null,0]
[87,null,null,0,0,null,0,null,0]
[88,null,null,0,0,null,0,null,0]
[89,null,null,0,0,null,0,null,0]
[90,null,null,0,0,null,0,null,0]
[91,null,null,0,0,null,0,null,0]
[92,null,null,0,0,null,0,null,0]
[93,null,null,0,0,null,0,null,0]
[94,null,null,0,0,null,0,null,0]
[95,null,null,0,0,null,0,null,0]
[96,null,null,0,0,null,0,null,0]
[97,null,null,0,0,null,0,null,0]
[98,null,null,0,0,null,0,null,0]
[99,null,null,0,0,null,0,null,0]
[100,null,null,0,0,null,0,null,0]
[null,"Total Actual Wages for the Review Period",null,null,null,{"$f":"SUM(F36:F135)","v":0},{"$f":"SUM(G36:G135)","v":0},null,{"$f":"SUM(I36:I135)","v":0}]
[]
[]
[]
[]
["SECTION C:  PAYROLL &  LIABILITY COSTS (8.35% TOTAL)"]
["J","Employer Social Security Tax @ 6.2%",null,null,null,null,{"$f":"+G136*0.062","v":0}]
["K","Employer Medicare Tax @1.45%",null,null,null,null,{"$f":"+G136*0.0145","v":0}]
["L","State & Federal Unemployment Tax @ 0.60%",null,null,null,null,{"$f":"+G136*0.006","v":0}]
["M","ETT (CA Unemployment Training tax) @ 0.10%",null,null,null,null,{"$f":"+G136*0.001","v":0}]
["N","Total Payroll Taxes for the Review Period",null,null,null,null,{"$f":"SUM(G142:G145)","v":0}]
["O","Workers' Compensation Insurance for the Review Period",null,null,null,null,{"$f":"+I136","v":0}]
["P","Unemployment  Insurance",null,null,null,null,{"$f":"+F148*G136","v":0}]
["Q","Other Mandated Employer Costs (Describe Expense) (See Note B):",null,null,null,null,{"$f":"+F149*G136","v":0}]
["R","Total Other Payroll Expenses for the Review Period",null,null,null,null,{"$f":"+G149+G148","v":0}]
[]
["SECTION D:  RATE ADJUSTMENT CALCULATION"]
["S","Total Wages, Payroll Taxes, Workers' Comp, and Other",null,null,null,null,{"$f":"+G136+G146+G147+G150","v":0}]
["T","Actual Number of Units of Services Billed to all Regional Centers for the Review Period:",null,null,null,null,{"$f":"SUM(G155:G164)","v":0}]
[1,"Vendoring Regional Center:","NLACRC",null,null,"Enter Total No. of Units for Review Period"]
[2,"Select User Regional Center:",null,null,null,"Enter Total No. of Units for Review Period"]
[3,"Select User Regional Center:",null,null,null,"Enter Total No. of Units for Review Period"]
[4,"Select User Regional Center:",null,null,null,"Enter Total No. of Units for Review Period"]
[5,"Select User Regional Center:",null,null,null,"Enter Total No. of Units for Review Period"]
[6,"Select User Regional Center:",null,null,null,"Enter Total No. of Units for Review Period"]
[7,"Select User Regional Center:",null,null,null,"Enter Total No. of Units for Review Period"]
[8,"Select User Regional Center:",null,null,null,"Enter Total No. of Units for Review Period"]
[9,"Select User Regional Center:",null,null,null,"Enter Total No. of Units for Review Period"]
[{"$f":"A163+1","v":10},"Select User Regional Center:",null,null,null,"Enter Total No. of Units for Review Period"]
["U","Rate Change (Q x R)",null,null,null,null,{"$f":"+G153/G154","v":{"$error":"#DIV/0!"}}]
[]
[]
[]
[]
["Note A:  If information is not available for January 1, 2023 through March 31, 2023, please enter an applicable Review Period, thereafter, for which actual data is available."]
["Note B:  Please include only mandated employer costs impacted by minimum wage increase."]
["Note C: Rate adjustment requests must be submitted no later than March 1, 2024."]
[]
[]
[]
[]
[" "]
[" "]

{"sheet":"Certification Instructions","index":2,"n_rows":41,"n_cols":2,"rows_kept":41,"cut":false,"hidden":false,"merged":[[25,1,25,8],[26,1,26,8],[39,0,39,8],[40,0,40,8],[12,0,14,8],[27,1,27,8],[37,0,37,8],[38,0,38,8],[16,0,16,8],[18,0,18,8],[20,0,23,8],[24,1,24,8],[0,0,0,8],[1,0,1,8],[2,0,2,8],[8,0,10,8],[4,0,4,8],[6,0,6,8]]}
["NORTH LOS ANGELES COUNTY REGIONAL CENTER"]
["MINIMUM WAGE RATE ADJUSTMENT - JANUARY 1, 2024"]
["SUMMARY & CERTIFICATION INSTRUCTIONS"]
[]
["These instructions are for the Vendor Summary & Certification.   After you read these instructions, please go to the “Summary & Certification” tab.  Rate adjustment requests must be submitted no later than March 1, 2024."]
[]
["Please review the Program Information and enter the service address associated with the information submitted on this workbook.  If your program has a different mailing address than the service address, please enter this information."]
[]
["Please enter the requested Contact Information for the individual responsible for completing this workbook.  This information will include Contact Name, Contact Phone Number, Email Address, and Executive Director/Owner."]
[]
[]
[]
["Please review the current rate, proposed rate change, and the proposed new rate, which are calculated based on the information you have entered on the worksheet.  If there is an error message in the rate information, go back and review the information in the worksheet. "]
[]
[]
[]
["Please read the certification.  If you agree to the certification statements, please click on the \"I AGREE\" checkbox prior to saving or sending the workbook.  Print and sign the certification; and send it by email."]
[]
["PLEASE NOTE:  By submitting the completed  Minimum Wage Worksheet and Summary & Certification Sheet to NLACRC, you certify that information provided is specific to payroll costs associated with any increase necessary to adjust employee pay only to the extent necessary to bring pay into compliance with the new minimum wage per hour, and shall not be used as a wage enhancement for employees paid above the increased minimum wage.  You additionally certify that to the best of your knowledge and belief, all information and documentation submitted are true and correct, and subject to verification by all record keeping and audit processes, procedures, and guidelines under the Lanterman Act and Title 17 of the California Code of Regulations (CCR)."]
[]
["NO SUPPORTING DOCUMENTATION IS REQUIRED:  In case of an audit from DDS or NLACRC you must keep the following supporting documentation with the completed forms:  "]
[]
[]
[]
[null,"1.  Documentation, including but not limited to, employee status forms, payroll registers, payroll labor distribution reports, etc., to document each employee listed, the employee's rate of pay AND the actual hours worked during the review period by the employee.  Payroll information should reflect the Review Period as indicated on the Minimum Wage Calculation Worksheet."]
[null,"2.  Documentation of workers compensation expense, including but not limited to, workers compensation insurance policy and the self-reporting worksheet provided to the insurance carrier for which the policy was based OR the total workers compensation premium paid and total payroll cost incurred during the review period for which the workers compensation rate reported was based."]
[null,"3.  Documentation of other payroll related expenditures listed. "]
[]
["EMAIL ADDRESS:"]
["raterequest@nlacrc.org"]
[]
["MAILING ADDRESS:"]
["North Los Angeles County Regional Center"]
["Attention: Matthew Dandan"]
["9200 Oakdale Ave, Suite 100"]
["Chatsworth, CA 91311"]
[]
["FOR ADDITIONAL QUESTIONS, PLEASE CONTACT:  "]
["Matthew Dandan"]
["Junior Accountant"]
["(818)-756-6244"]

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["NORTH LOS ANGELES COUNTY REGIONAL CENTER"]
[{"$f":"+'Certification Instructions'!A2:I2","v":"MINIMUM WAGE RATE ADJUSTMENT - JANUARY 1, 2024"}]
["SUMMARY & CERTIFICATION SHEET"]
[]
["PROGRAM INFORMATION"]
[]
["Service Provider Name:",null,{"$f":"+'Vendor Worksheet'!C6:G6","v":0}]
["Vendor Number:",null,{"$f":"+'Vendor Worksheet'!C7:G7","v":0}]
["Service Code:",null,{"$f":"+'Vendor Worksheet'!C8:G8","v":0}]
["Subcode (if applicable):",null,{"$f":"+'Vendor Worksheet'!C9:G9","v":0}]
[]
["Service Address:"]
[]
[]
[]
[]
["MAILING ADDRESS"]
["(if different than service address)"]
[]
[]
[]
["CONTACT INFORMATION"]
[null,null,"Individual Responsible for Completing Worksheet:"]
["Contact Name:"]
["Contact Phone Number:"]
["Email Address:"]
["Executive Director/Owner:"]
[]
["Current Rate:",null,{"$f":"+'Vendor Worksheet'!C11","v":0}]
["Proposed Rate Change:",null,{"$f":"+'Vendor Worksheet'!C12","v":{"$error":"#DIV/0!"}}]
["Proposed New Rate:",null,{"$f":"+'Vendor Worksheet'!C13","v":{"$error":"#DIV/0!"}}]
["Unit Type:",null,{"$f":"+'Vendor Worksheet'!G11","v":0}]
[]
["CERTIFICATION BY OWNER OR ADMINISTRATOR:"]
["By signing and checking the box below, I certify that to the best of my knowledge, all information submitted for this rate increase request is true and accurate. If the rate increase request includes an adjustment for minimum wage, I certify that all employees will be paid at or above the minimum wage of $16.00 effective January 1, 2024.   I acknowledge that any and all information submitted in this rate increase request is subject to audit and verification and subject to all record keeping and audit processes, procedures, and guidelines under the Lanterman Act and Title 17 and Title 17 of the California Code of Regulations.  "]
[]
[]
[]
[]
[]
[]
[null,null,null,null,"I AGREE"]
[]
[]
["Certified by (SIGNATURE)",null,null,"Print Name & Title",null,null,null,"Date"]
["This form must be certified by an owner, officer or other individual with the appropriate authority to certify on behalf of the agency."]
[]
["To submit this completed ' Summary & Certification' and 'Minimum Wage' electronically please save the document and email the completed file in Excel with the PDF of the 'Summary & Certification' signed to: raterequest@nlacrc.org.  Rate adjustment requests must be submitted no later than March 1, 2024. Please note that the worksheet in electronic format is required. You do not need to submit originals. Retain originals for your records."]