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HomeMy WebLinkAboutMERCY HOUSE CENTER 1AGREEMENT TERMINATION Please complete this form when the attached agreement is no longer in effect. Return form to the Deputy Clerk of the Council (M-30). Call 647-6520 if you have any questions. The agreement with / /t �c' was completed on l�x� l_ �3 . Z) Oy and final payment has been made. Department: C-Yt,-� Signature: .� Date: a g Dooq City of Santa Ana Revised 4-16-87 Clerk of the Council A- 2 003 —054o INSURANCE ON FILE ' WORK MAY PROCEED UNTIL INSURANCE EXPIRES CLERK OF COUNCIL AGREEMENT BETWEEN THE CITY OF SANTA ANA DATE:-(S-v3 AND MERCY HOUSE CENTER CAR FOR THE USE OF EMERGENCY SHELTER GRANT FUNDS 0-1&AP*u) (With Provisions Relating to Compliance with Title X and 24 CFR Part 35 Relating to Lead Based Paint) THIS AGREEMENT, made and entered into this 1 st day of July, 2003, by and between the City of Santa Ana, a charter city and municipal corporation of the State of California ("CITY") and MERCY HOUSE CENTER, a California nonprofit organization ("SUBRECIPIENT"). WITNESSETH Recitals: 1. CITY is the recipient of Emergency Shelter Grant ("ESG") funds from the United States Department of Housing and Urban Development ("HUD") pursuant to the Stewart B. McKinney Homeless Assistance Act: Emergency Shelter Grants Program 42 USC 11331 et seq. 2. CITY has approved the provision of federal funds under the ESG to be used in the op- eration of an emergency shelter program for the homeless of the City of Santa Ana ("said pro- gram") as further described by a Scope of Work and Schedule of Performance in Exhibit A, at- tached hereto and by this reference incorporated herein. 3. SUBRECIPIENT represents that it has expertise and experience in the provision of emergency shelter programs for the homeless and is willing to use said federal funds to operate said program. 4. SUBRECIPIENT agrees to assist homeless individuals and families in obtaining: appropriate supportive services including, but not limited to, temporary and permanent housing, medical health treatment, mental health treatment, counseling supervision and other services es- sential for achieving independent living, as well as other federal, state, local and private assis- tance available for such individuals. 5. Title X of the 1992 Housing and Community Development Act (Title X) established requirements relating to lead based paint ("LBP") in housing receiving federal assistance, with particular requirements relating to (i) notification (including pamphlet distribution, disclo- sure to purchasers and lessees, notice of lead hazard presumption or results of evaluation, and/or lead hazard reduction), (ii) lead hazard evaluation (including visual assessment, paint testing, and/or risk assessment), (iii) lead hazard reduction (including paint stabilization, interim con- trols, standard treatments, or abatement depending on the requirements for housing activity type), (iv) ongoing maintenance, if required, and (v) response to children with environmental interven- tion blood lead levels, as required; and 6. On September 15, 1999 HUD adopted implementing regulations to Title X that became effective September 15, 2000 as set forth in 24 CFR Part 35, et seq. ("LBP Regs."), which estab- lish specific r ules r egarding n otification t o o wners and o ccupants a bout t he e xistence o f L BP hazards, identification of LBP hazards, and control of LBP hazards; and 7. Residential structures built after January 1, 1978 are exempt from lead -based paint re- quirements a s t he u se o f 1 cad -based p aint w as b anned for u se in residences after this date by Congress (24 CFR Part 35.115). Therefore, the Title X requirements set forth herein shall not be applicable if the structures involved were built after January 1, 1978. 8. Subpart K - Acquisition, Leasing, Support Services, and Operation of the LBP Regs, sets forth specific requirements relating to housing providers, such as SUBRECIPIENT, who admin- ister local programs that provide supportive housing for special needs populations and are funded by HUD Office of Community Planning and Development ("CPD") programs, including ESG funds, as provided to SUBRECIPIENT under this Agreement; and 9. In connection with the grant of funds under this Agreement, CITY requires that SUBRECIPIENT comply and show evidence of compliance with all applicable requirements of Title X and the LBP Regs, in particular Subpart K relating to acquisition, leasing, support ser- vices, or operations, and Subpart J relating to rehabilitation, as and when applicable; and 10. In connection with the grant of funds under this Agreement, CITY requires that SUBRECIPIENT comply and show evidence of compliance with all applicable requirements of Title X and the LBP Regs, in particular Subpart M relating to tenant based rental assistance, as and when applicable; and 11. Attached and hereby fully incorporated to this Agreement are the following notification attachments: Attachment No. 1 entitled "Protect Your Family From Lead In Your Home", EPA747-K-99-001, Attachment No. 2 entitled "Sample Disclosure Format for Target Housing Sales, Disclosure of Information on Lead -Based Paint and Lead -Based Paint Hazards", and At- tachment No. 3 entitled "Sample Summary Risk Assessment Notice Format'; provided however, that such attachments are not intended to modify or limit SUBRECIPIENT'S obligation to fully comply with all applicable provisions of Title X and the implementing regulations in the LBP Regs; and 12. By this Agreement SUBRECIPIENT will accept assignment from the CITY of all re- sponsibilities set forth in Subpart K of the LBP Regs; and 13. The CITY and SUBRECIPIENT have duly executed this Agreement for the expenditure of such funds; and WHEREFORE, it is agreed by and between the parties, that the foregoing Recitals are a sub- stantive part of this Agreement and the following terms and conditions are approved and together with all exhibits and attachments hereto, shall constitute the entire Agreement between the CITY and SUBRECIPIENT: 2 I. A. Non -Profit Status - Representations and Warranties. (1) SUBRECIPIENT acknowledges that its operations and the services it provides to the community are subject to Subpart K, and, in some instance(s) Subpart J and/or Subpart M, of the LBP Regs. (2) SUBRECIPIENT acknowledges that its operations and the services it provides in- clude: (a) acquisition, leasing, or ownership of residential property for the purpose of providing affordable housing for persons with special needs, such as transitional housing, or (b) housing for persons with special needs, such as the disabled, or (c) financial assistance to assist transitional housing participants to move to permanent housing by paying for the first month's rent or secu- rity deposit, or (d) tenant -based rental assistance to program participants who choose their own housing units, and by provision of such services such housing is subject to the requirements of the LBP Regs. (3) Representations: (a) Authority. SUBRECIPIENT is a duly organized and existing non-profit corporation in good standing and authorized to do business under the laws of the State of California. S UBRECIPIENT has full right, power and lawful authority to accept the funding hereunder and to undertake all obligations as provided herein and the execution, performance and delivery of this Agreement by SUBRECIPIENT has been fully authorized by all requisite actions on the part of SUBRECIPIENT. (b) Experience. SUBRECIPIENT is a qualified provider of the services to be provided hereunder. (c) Familiarity With Services Required. By executing this Agreement, SUBRECIPIENT warrants that (i) it has thoroughly investigated and considered the services to be performed and provided hereunder, (ii) it has carefully considered how the services should be performed, and (iii) it fully understands the facilities, difficulties and restrictions attending performance of the services under this Agreement, inclusive of compliance with the LBP REGS. Should SUBRECIPIENT discover any latent or unknown conditions materially differing from those inherent in the work or as represented by CITY, it shall immediately inform CITY of such fact and shall not proceed except at SUBRECIPIENT'S risk until written instructions are re- ceived from CITY'S representative. (d) No Conflict. To the best of SUBRECIPIENT'S knowledge, SUBRECIPIENT'S execution, delivery and performance of its obligations under this Agreement will not constitute a default or a breach under any contract, agreement or order to which SUBRECIPIENT is a party or by which it is bound. (e) No Bankruptcy. SUBRECIPIENT is not the subject of any current or threat- ened bankruptcy proceeding. (f) No Pending Legal Proceedings. SUBRECIPIENT is not the subject of a cur- rent or threatened litigation that would or may materially affect SUBRECIPIENT'S performance under this Agreement. (g) Application Veracity. All provisions of and information provided in SUBRECIPIENT' S application for funding submitted to CITY including any exhibits are true and correct in all material respects. (h) No Pending Investigation. SUBRECIPIENT is not aware that it is the subject of any current or threatened criminal or civil action investigation by any public agency, including without limitation a police agency or prosecuting authority, that would relate to affect performance of the Agreement or provision of services hereunder. (4) Compliance with Subpart K of LBP Rees. Subpart K — Acquisition, Leas- ing, Support Services, or Operation (a) SUBRECIPIENT acknowledges and agrees that it shall comply with and im- plement the requirements set forth in Title X and the LBP Regs to eliminate, as far as practicable, LBP hazards in all residential property that is under its ownership, possession, or control and/or residential property occupied by persons or families that receive financial or other assistance from SUBRECIPIENT. (b) SUBRECIPIENT shall provide a notice to all residents/occupants of residen- tial property that is under its ownership, possession, or control and/or residential property occu- pied by persons or families that receive financial or other assistance from SUBRECIPIENT in accordance with Section 35.125 of the LBP Regs. (i) SUBRECIPIENT acknowledges that in connection therewith a visual assessment is not considered an evaluation for purposes of the LBP Regs. (c) Notification (24 CFR 35.130). SUBRECIPIENT shall provide the LBP haz- ard information pamphlet in accordance with Section 35.130 of the LBP Regs to all occupants, owners, and purchasers of housing. (i) The pamphlet shall be the EPA/HUD/Consumer Product Safety Commission lead hazard information pamphlet or an EPA -approved equivalent. The current form and version of the pamphlet is attached as Attachment No. 1 to this Agreement. (ii) SUBRECIPIENT shall cause to be disclosed to all purchasers and lessees available information and knowledge regarding the presence of LBP and LBP hazards prior to selling or leasing a housing unit in accordance with 24 CFR 35, Subpart A. The current form and version of such notice is attached as Attachment No. 2 to this Agreement. (iii) SU13RECIPIENT shall ensure that all occupants, owners, and purchasers of housing be notified in writing of the results of the presumption of LBP and/or LBP hazards, and results of any lead hazard evaluation, and any lead hazard reduction work in accordance with 24 CFR 35, Subpart A. The current form and version of such notice is attached as Attachment No. 3 to this Agree- ment. (d) Lead Hazard Evaluation (24 CFR 35.125). SUBREClPIENT shall conduct all activities described in Section 35.1015 relating to visual assessment, paint stabilization, risk assessment, and maintenance with regard to all residential property that is under its ownership, possession, or control and/or residential property occupied by persons or families that receive financial or other assistance from SUBRECIPIENT, except for the exemptions described below in section 4 (d)(i)(1). (i) SUBRECIPIENT shall cause a visual assessment to identify de- teriorated paint in all residential property that is under its ownership, possession, or control and/or residential property occupied by persons or families that receive financial or other assis- tance from SUBRECIPIENT. (1)Section 35.115(a) provides exemptions from Subparts B through R of the LBP Regs. including without limitation, (a) short term emergency assistance lasting less than 100 days cumulatively is exempted from compliance with Subpart K as to such short term rental assistance units, and (b) exemption for zero -bedroom units, including SRO units, for which occupancy by a recipient of SUBRECIPIENT'S services is for less than 100 days, and (c) exemption for residential housing units constructed after January 1, 1978. (ii) To the extent that the assistance provided by SUBRECIPIENT to persons or households meets one or more of the exemptions set forth in the LBP Regs, then compliance with the notification, evaluation, reduction, clearance and other requirements of the LBP Regs is not required related to the subject housing unit due to such exemption. (iii) SUBRECIPIENT shall comply with the applicable provisions of both Subpart K and Subpart M (Tenant Based Rental Assistance) of the LBP Regs. as to all tenant -based long term housing assistance, i.e., assistance to persons/households residing in housing units cumulatively for more than 100 days. If SUBRECIPIENT has knowledge that an assisted family or household will occupy a dwelling unit for more than 100 days, the LBP Regs require evidence of compliance prior to occupancy. Funding to be provided hereunder is condi- tioned upon evidence of compliance. (1) Subpart M applies to all dwelling units occupied to be occupied by families or households that have one or more children of less than 6 years of age, as well as the common areas servicing such dwelling units, and exterior painted surfaces associated with such dwelling units or common areas. LBP compliance requirements relating to such dwell- ing units includes, without limitation: notification, evaluation by visual assessment, paint stabi- lization utilizing safe work practices, and clearance. (2) CITY advises SUBRECIPIENT that in the event the services provided hereunder include rental assistance payments, such as first and last month's rent and/or security deposit, and the assisted tenant executes a lease for long term occupancy, in- cluding occupancy in the same dwelling unit for more than 100 days, then the provisions of Sub- part M (Tenant Based Rental Assistance), will apply (unless otherwise informed and directed by HUD). hi this regard, CITY advises SUBRECIPIENT that Subpart M requires HQS inspection of each dwelling unit prior to occupancy and prior to compliance with applicable notification, evaluation by visual assessment, reduction through paint stabilization utilizing safe work prac- tices, and clearance requirements of the LBP REGS. (e) Lead Hazard Reduction Work. SUBRECIPIENT shall cause LBP hazard reduction, such as paint stabilization, interim controls, standard treatments, or abatement of all residential property that is under its ownership, possession, or control and/or residential property occupied by persons or families that receive financial or other assistance from SUBRECIPIENT, except as exempted as described in subsection 4(d)(i)(1) above. (1) If paint stabilization occurs, SUBRECIPIENT shall cause paint stabi- lization of each deteriorated surface and clearance of residential units pursuant to Section 35.1330(a) and (b) shall occur before occupancy of a vacant dwelling unit, or where a unit is occupied, immediately after receipt of the ESG FUNDS hereunder. (2) Safe Work Practices shall be used in all LBP hazard reduction work. (3) Clearance shall be conducted to confirm that no LBP hazards remain when LBP hazard reduction work is complete. Confirmation of clearance by written certification of a qualified inspector is required on an annual basis in connection with submittal of the April 15 quarterly report. (f) Ongoing Maintenance. SUBRECIPIENT shall incorporate ongoing LBP maintenance activities into regular building operations in accordance with Section 35.1355(a) for all residential property that is under its ownership, possession, or control and/or residential prop- erty occupied by persons or families that receive financial or other assistance from SUBRECIPIENT, except as exempted as described in subsection 4(d)(i)(1) above. (1) Ongoing maintenance includes confirmation of clearance which shall be conducted to confirm that no LBP hazards remain when LBP hazard reduction work is com- plete. (2) Ongoing maintenance also includes confirmation of clearance by writ- ten certification of a qualified inspector on an annual basis in connection with submittal of the April 15 quarterly report. (3) A part of such ongoing maintenance obligation includes notification of the results of clearance confirmation and annual confirmation of clearance. a. SUBRECIPIENT shall cause to be provided a notice to all oc- cupants of all residential property that is under its ownership, possession, or control and/or resi- dential property occupied by persons or families that receive financial or other assistance from SUBRECIPIENT in accordance with Sections 35.125(b)(1) and (c), describing the results of the clearance examination and the results of annual certification. (g) Units Cleared Prior to Date of Agreement, Confirmation of Clearance. hi the event the requirements of the LBP REGS relating to lead hazard evaluation, lead hazard reduction, and lead hazard clearance have been completed on the subject dwelling units prior to the Date of Agreement, then the SUBRECIPIENT shall provide to the CITY with the April 15 quarterly report a certificate from a qualified inspector evidencing a recent inspection and con- firmation of clearance of LBP and LBP hazards from the subject dwelling unit(s). 5. LBP Informational Summary. For purposes of information only and in no respect intended to be a representation or warranty of the provisions of the LBP REGS, the CITY has caused to be prepared an information summary relating to the LBP REGS and application to dwelling units that may be occupied by recipients of services and/or funding from SUBRECIPIENT under this Agreement. Attachment No. 4 to this Agreement, attached and hereby fully incorporated by this reference, is such information summary. CITY staff will coop- erate with and make themselves available to SUBRECIPIENT to assist in implementation of compliance with the LBP REGS as to residential dwelling units to be assisted by SUBRECIPIENT. The parties acknowledge and agree the CITY is and shall not be liable or re- sponsible for the accuracy of such summary, and the SUBRECIPENT is directed to the LBP REGS and implementing guidance published and provided by HUD relating to compliance with such LBP REGS. B. Amount of Grant and Quarterly Disbursement. The amount granted to SUBRECIPIENT is $29,750 ("ESG FUNDS"), and such funds shall be expended by SUBRECIPIENT on or before June 30, 2004. The ESG FUNDS shall be disbursed by CITY to SUBRECIPIENT on a quarterly basis, subject to and upon receipt and approval of a complete quarterly activity report, with the final payment subject to the satisfaction of the condition prece- dent of submittal of complete reporting information due on or before July 15 of the applicable funding year, as hereinafter more fully set forth. SUBRECIPIENT shall be obligated to perform such duties as would normally extend beyond the term, including but not limited to obligations with respect to indemnification, audits, reporting, data retention/reporting, and accounting. Fur- ther, SUBRECIPIENT agrees to match all federal funds provided by CITY to SUBRECIPIENT with an equal amount of funds from sources other than these or other ESG funds. C. Use of Funds. SUBRECIPIENT agrees to use said funds pursuant to this Agreement to pay for necessary and reasonable costs allowable under the federal law and regula- tions to operate said program only. Said amounts shall include and will be limited to, essential services, homeless prevention, and/or operations costs. Allowable program costs are detailed in 7 the Budget, as set forth in "Exhibit B," attached hereto and by this reference incorporated herein. SUBRECIPIENT'S failure to perform as required may, in addition to other remedies set forth in this Agreement, result in readjustment of the amount of funds CITY is otherwise obligated to pay to SUBRECIPIENT pursuant to the terms hereof. SUBRECIPIENT agrees that the homeless shelter and services under said program shall be made available for the entire period during which said funds are provided. D. Allowable Costs. SUBRECIPIENT agrees to complete said program on or before June 30, 2004 and to use said funds to pay for necessary and reasonable costs allowable under the federal law and regulations to operate said program. Said amounts shall include essential services, homeless prevention, and/or operations costs. Other allowable program costs are detailed in the Budget, as set forth in "Exhibit B," attached hereto and by this reference incorporated herein. SUBRECIPIENT s hall u se a 11 i ncome received from s aid funds o my for the same purposes for which said funds may be expended pursuant to the terms and conditions of this Agreement. E. Licensing. SUBRECIPIENT agrees to obtain and maintain all required licenses, registrations, accreditation and inspections from all agencies governing its operations. SUBRECIPIENT shall ensure that its staff shall also obtain and maintain all required licenses, registrations, accreditation and inspections from all agencies governing SUBRECIPIENT's operations hereunder. F. Zoning. SUBRECIPIENT agrees that any facility/property used in furtherance of said program shall be specifically zoned and permitted for such use(s) and activity(ies). Should SUBRECIPIENT fail to have the required land entitlement and/or permits, thus violating any local, state or federal rules and regulations relating thereto, SUBRECIPIENT shall i mmediately in ake good -faith efforts to gain compliance with local, state or federal rules and regulations following written notification of said violation(s) from the CITY or other authorized citing agency. SUBRECIPIENT shall notify CITY immediately of any pending violations. Failure to notify CITY of pending violations, or to remedy such known violation(s) shall result in termination of grant funding hereunder. SUBRECIPIENT must make all corrections required to bring the facility/property into compliance with the law within sixty (60) days of notification of the violation(s); failure to gain compliance within such time shall result in termination of grant funding hereunder. G. Separation of Accounts. All funds received by SUBRECIPIENT from CITY pursuant to this Agreement shall be maintained separate and apart from any other funds of SUBRECIPIENT, or of any principal or member of SUBRECIPIENT,in an account in a federally insured banking or savings and loan institution with record keeping of such accounts maintained pursuant to applicable legal requirements. No monies shall be withdrawn from such account except for expenditures relating to essential services, homeless prevention and/or operations costs, as authorized hereunder. H. Audit Report Requirements. SUBRECIPIENT agrees that if SUBRECIPIENT receives Three Hundred Thousand Dollars ($300,000.00) or more in federal funds, SUBRECIPIENT shall have an annual audit conducted by a certified public accountant in 8 accordance with the standards as set forth and published by the United States Office of Management and Budget. SUBRECIPIENT shall provide CITY with a copy of said audit by October I of the year following the program year in which this Agreement is executed. Further, SUBRECIPIENT shall comply and/or cause compliance with audit report(s) required by applicable provisions of Title X and the LBP Regs. I. Record Keeping/Reporting. SUBRECIPIENT shall keep and maintain complete and adequate records and reports to assist CITY in meeting and maintaining its record keeping responsibilities under the ESG BEGS, Title X, and the LBP Regs, including the following: (1) Records a. Documentation evidencing income level of persons and/or families par- ticipating in or benefiting by the SUBRECIPIENT program. b. Documentation of the number of persons and/or families participating in or benefiting by the SUBRECIPIENT program. c. Household information shall include number of persons, identification of head of household, race/ethnicity, age of children, seniors, income verification. d. Documentation of homelessness pursuant to 42 U.S.C. 11374(a)(4) and 24 CFR 576.21. e. Documentation of all ESG FUNDS received from CITY. f. Documentation of expenses as identified in the Budget Proposal, including evidence of incurring the expense, invoices for goods or services, copies of any and all contracts or documentation pertaining to costs for subcontractors, plus all other invoices for which ESG FUNDS were expended, and payment therefor. g. Any such other related records as CITY shall reasonably require or as required to be maintained pursuant to the ESG REGS. h. Documentation evidencing compliance with all applicable provisions of Title X and the LBP Regs, in particular Subpart K and, as applicable Subpart J and/or Subpart M. (i) Specific documentation, as required, evidencing compli- ance with all applicable provisions of such LBP Regs includ- ing: (i) notification, including distribution of the lead hazard information pamphlet (Attachment No. 1), disclosure and no- tices of hazard evaluation and reduction (Attachments No. 2 and 3); (ii) evaluation of lead hazard(s), including paint test- ing and risk assessment; (iii) reduction of lead hazard(s), in- cluding safe work practices and clearance, and confirmation of clearance; and (iv) ongoing maintenance, as and if appli- cable for multifamily properties. (ii) In this regard SUBRECIPIENT shall track information on all persons/households assisted and the housing units assisted with the ESG FUNDS. Attachment No. 5 hereto is a sample form for tracking persons/households and housing units as- sisted with the ESG FUNDS. All categories of information set forth in such tracking form shall be prepared and submitted to the CITY with the April 15 quarterly report. (iii) In the event that such information and reports are not com- plete and reasonably satisfactory information submitted in order for CITY staff to review and evaluate compliance with applica- ble ESG REGS and LBP Regs., then the final quarterly dis- bursement payment shall be withheld from the SUBRECIPIENT. (iv) Documentation of clearance confirmation as provided herein. (2) Reports (i) Payment Request. Concurrently with the submittal of each quarterly report, on or before the 15th day of October, January, April and July, SUBRECIPIENT shall submit both: an original invoice and true copies of invoices, receipts, agreements or other documentation supporting and evidencing how the ESG FUNDS have been expended during the applicable quarter. (ii) Quarterly Activity Report: Including in such reports evidence of compliance with all applicable provisions of Title X and the LBP Regs, in p articular S ubpart K and, a s applicable Subpart J, as further described in subsection (d) hereinafter, and Subpart M, if SUBRECIPIENT provides long term tenant -based rental assistance. SUBRECIPIENT agrees to provide CITY with written cumulative (year-to-date) reports of its activities on or before the 15th day of October, January, April and July for the period beginning July 1, 2003 and through and including the previous three-month reporting period setting forth the activities, program accomplishments, new program information and year-to- date program statistics on expenditures, caseload and activities. When appropriate, pictures should be included. 10 (iii) Quarterly certification of match, plus documentation of match source. (iv) Any such other reports as CITY (or HUD) shall reasonably require and/or request, including but not limited to the following information: monthly records of all ethnic and racial statistics of persons and families benefited by SUBRECIPIENT in the per- formance of its obligations under this Agreement, including, but not limited to, the activities, program accomplishments, new pro- gram information, match fund certification and current program statistics on expenditures, caseload and activities. When appro- priate, pictures/slides should be included. (3) Recordkeepin of f Ongoing Maintenance under the LBP Regs. If the services and program activities provided by SUBRECIPIENT hereunder establish an ongoing relationship with a property (such as long term tenant based rental assistance program [Subpart M] or transi- tional or permanent housing operated or administered by the SUBRECIPIENT), then the SUBRECIPIENT shall provide a report to the CITY evidencing that SUBRECIPIENT and/or the property owner(s), as applicable, has performed ongoing maintenance of the subject property. Ongoing maintenance shall include evidence of an annual clearance certification of the subject residential property conducted by a DHS certified technician to ensure that LBP hazard reduction measures are maintained. All maintenance activities shall be conducted to ensure the threat of LBP hazards is minimized. (4) Recordkeenine under the LBP Regs. The SUBRECIPIENT shall keep records of dis- tribution of notifications, all visual assessment, evaluations, inspections, repairs, and any other lead hazard evaluation, reduction, safe work practices, and clearance activities. (a) The SUBRECIPIENT shall keep records evidencing distribution of all lead hazard information pamphlet(s). (b) The SUBRECIPIENT shall keep records evidencing each LBP evaluation re- port, LBP hazard reduction documentations, (such as job specifications), and all clearance or abatement report(s). (c) The SUBRECIPIENT shall keep ongoing maintenance records and records of relevant building operations for use during reevaluations of subject property for LBP and/or LBP hazards. 1. Such records shall be maintained for not less than longer of (A) four (4) years after the activities cease or (B) the period re- quired by applicable program regulations. Under the ESG REGS records shall be retained for not less than five (5) years after the ac- tivities cease. 2. The SUBRECIPIENT shall provide a copy of any of the above records to the CITY or to HUD upon request of either or both. (d) Tracking Report. If the SUBRECIPIENT has provided, or is providing, rental assistance payments directed to a housing unit or housing units for more than 100 days, or it is anticipated that during the last quarter of funding that such rental assistance payment will be for more than 100 days, then the April 15 quarterly report shall contain information and evidence of compliance with the requirements herein relating to tracking of housing units, cumulative days of rental assistance, proper notifications to occupants and owners, HQS inspection, visual assess- ment, work write-up, stabilization and clearance of LBP and LBP hazards, if any. The proposed form of such tracking information is attached hereto as Attachment No. 5 and fully incorporated by this reference. In the event such April 15 quarterly report does not fully satisfy the reporting requirements set forth herein and in the LBP Regs, then the final installment payment of the ESG FUNDS shall be withheld from disbursement to SUBRECIPIENT. J. Access to Records. CITY and the United State Government and/or their representatives shall have access for purposes of monitoring, auditing, and examining SUBRECIPIENT's activities and performance, to books, documents and papers, and the right to examine records of SUBRECIPIENT's subcontractors, bookkeepers and accountants, employees and participants in regard to said program. CITY and the United States Government and/or their representatives shall also schedule on -site monitoring at their discretion. Monitoring activities may also include, but are not limited to, questioning employees and participants in said program and entering any premises or any site in which any of the services or activities funded hereunder are conducted or in which any of the records of SUBRECIPIENT are kept. Nothing herein shall be construed to require access to any privileged or confidential information as set forth in federal or state law. K. Location of Records/Required Length of Record Keeping. All accounting records, reports, and evidence pertaining to all costs, expenses and the ESG FUNDS of SUBRECIPIENT and all documents related to this Agreement shall be maintained and kept available at SUBRECIPIENT'S office or place of business for the duration of the Agreement and thereafter for five (5) years after completion of an audit in conformity with the ESG REGS, except as hereinafter provided relating to retention of any records or documentation existing, created, or maintained in compliance with Title X or the LBP Regs. Records which relate to (a) complaints, claims, administrative proceedings or litigation arising out of the performance of this Agreement, or (b) costs and expenses of this Agreement to which CITY or any other governmental agency takes exception, shall be retained beyond the five (5) years until complete resolution or disposition of such appeals, litigation claims, or exceptions. All records relating to, or created or maintained in compliance with, Title X and/or the LBP Regs shall be retained and maintained by SUBRECIPIENT indefinitely, including without limitation, all inspection report(s), disclosure statement(s), and clearance report(s). hi the event SUBRECIPIENT does not make the above - referenced documents available within the city of Santa Ana, California, SUBRECIPIENT agrees to pay all necessary and reasonable expenses incurred by CITY in conducting any audit at the location where said records and books of account are maintained. 12 L. Compliance with Law. SUBRECIPIENT acknowledges that the funds being provided by CITY for said program are received by CITY pursuant to applicable ESG guidelines and that expenditures of these funds shall be in accordance with the ESG guidelines and all pertinent regulations issued by agencies of the federal government. SUBRECIPIENT agrees to comply fully with all federal, state and local laws and court orders applicable to its operation whether or not referred to in this Agreement, and all Program Requirements. SUBRECIPIENT agrees to comply fully with all federal, state and local laws and court orders applicable to its operation whether or not referred to in this Agreement. M. Standing. SUBRECIPIENT shall be in good standing, without suspension by the California Secretary of State, Franchise Tax Board and Internal Revenue Service. Any change in the corporate status or suspension of SUBRECIPIENT shall be reported immediately to CITY. N. Confidentiality. Without prejudice to any other provisions of this Agreement, SUBRECIPIENT shall, where applicable, maintain the confidential nature of information pro- vided to it concerning participants in accordance with the requirements of federal and state law. SUBRECIPIENT certifies that it will develop and implement procedures to ensure the confiden- tiality of records pertaining to any individual provided family violence prevention or treatment services under any project assisted under the Emergency Shelter Grants Program and that the ad- dress or location of any family violence shelter project assisted under the Emergency Shelter Grants Program will, except with written authorization of the person or persons responsible for the operation of such shelter, not be made public. However, SUBRECIPIENT shall submit to CITY and. or HUD or its representatives, all records requested, including audit, examinations, monitoring and verifications of reports submitted by SUBRECIPIENT, costs incurred and ser- vices rendered hereunder. O. hidependent Contractor. SUBRECIPIENT agrees that the performance of obligations hereunder are rendered in its capacity as an independent contractor and that it is in no way an agency of CITY. P. Violation of Terms and Conditions. SUBRECIPIENT agrees that if SUBRECIPIENT violates any of the terms and conditions of this Agreement or any prior Agreement whereby ESG funds were received by SUBRECIPIENT, or if SUBRECIPIENT reports inaccurately, or if on audit there is a disallowance of certain expenditures, SUBRECIPIENT agrees to remedy the acts or omissions causing the disallowance and repay CITY all amounts spent in violation thereof. If SUBRECIPIENT engaged in fraudulent activity to obtain and/or justify expenditure of the ESG funds granted hereunder, SUBRECIPIENT shall be required to reimburse the CITY of all such funds that were obtained/spent under fraudulent circumstances. Q. Equipment. S UBRECIPIENT agrees to maintain a record for each item of non - expendable personal property acquired under the terms of this Agreement. Said record shall be made available to CITY upon request. The term "non -expendable personal property" shall include leased and purchased equipment. 13 R. Prohibited Use. SUBRECIPIENT hereby certifies and agrees that it will not use funds provided through this Agreement to pay for entertainment, meals or gifts. S. LobbvinQ. SUBRECIPIENT certifies that it will comply with federal law (31 U.S.C. 1352) and regulations found at 24 CFR Part 87, which provide that no appropriated funds may be expended by the recipient of a federal contract, grant, loan or cooperative agreement to pay any person for influencing or attempting to influence an officer or employee of any agency, Member of Congress, or an officer or employee of a Member of Congress in connection with awarding of any federal contract, the making of any federal grant or loan, entering into any cooperative agreement and the extension, renewal, amendment or modification of any federal contract, grant, loan or cooperative agreement. SUBRECIPIENT shall sign a certification to that effect in a form as set forth in "Exhibit C," attached hereto and by this reference incorporated herein. SUBRECIPIENT shall submit said signed certification to CITY prior to performing any of its obligations under this Agreement and prior to any obligation arising on the part of CITY to pay any sums to SUBRECIPIENT under the terms and conditions of this Agreement. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit a "Disclosure Form to Report Lobbying," in accordance with its instructions (see C-1). T. Financial hnterest. SUBRECIPIENT agrees that except for the use of ESG funds to pay salaries and other related administrative or personnel costs, no persons who exercise or have exercised any function with respect to ESG activities assisted under the terms of this Agreement, or who are in a position to participate in a decision -making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a ESG-assisted activity of SUBRECIPIENT, either for themselves or those with whom they have family or business ties, during their tenure or for one year thereafter. This prohibition applies to any person who is an employee, agent, consultant, officer, or elected or appointed official of CITY, or of any designated public agencies, or the SUBRECIPIENT. U. Davis -Bacon Act. All laborers and mechanics employed by contractors or subcontractors in the performance of construction work, including alterations and repairs, in excess of $2,000.00, financed in whole or in part with federal funds shall be paid wages at rates not less than those prevailing on similar construction in the locality as determined in accordance with the Davis -Bacon Act, as amended, 40 U.S.C. sections 276a - 276a-5. Any such construction contract shall include and comply with the required contract provisions and rules set forth in 29 C.F.R. §5.5. Further, the payroll reports (along with the "Statement of Compliance') and basic records are required to be maintained and submitted, or made available, pursuant to 29 C.F.R. §5.5(a)(3). No payment, advance, grant, loan or guarantee of funds shall be approved by the federal agency unless there is on file with the agency a certification by the contractor that the contractor and its subcontractors have complied with the provisions of 29 C.F.R. §5.5. A breach of the contract clauses in 29 C.F.R. §5.5 may be grounds for termination of the contract, and for debarment as a 14 contractor/subcontractor, as provided in 29 C.F.R. §5.12. Labor standards interviews/investigations shall be made as necessary to assure compliance [29 C.F.R. §5.6(a)(3)]. V. Homeless Involvement. SUBRECIPIENT certifies that it will involve, to the maximum extent practicable, homeless individuals and families in constructing, renovating, maintaining, and operating facilities assisted under the ESG program, and in providing services for occupants of these facilities. W. Drug Free Workplace. SUBRECIPIENT certifies that it has established the fol- lowing drug -free workplace policy: 1. The unlawful manufacture, distribution, dispensing, possession or use of a con- trolled substance is prohibited in the workplace for any employee involved in a federally funded program. 2. As an employee working in conjunction with a federally funded program, the em- ployees of SUBRECIPIENT will be required to: a) Abide by the terms above in statement 1. b) Notify appropriate officials of SUBRECIPIENT and CITY officials of any criminal drug statute conviction for a violation occurring in the workplace not later than five days after such conviction. 3. The City and the United States Department of Housing and Urban Development will be notified within ten days after receiving notice of any such violation. 4. Within 30 days of receiving such notice, appropriate personnel action will be taken against such employee, up to and including termination. 5. Each such employee shall be required to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a federal, state or local health, law enforcement, or other appropriate agency. X. Expenditure of Funds: SUBRECIPIENT must spend all of its grant amount within 24 months of the grant award (24 CFR 576.35). Any funds not obligated within said timeframe shall be reallocated. II. CITY'S OBLIGATIONS A. CITY shall pay to SUBRECIPIENT from funds received under the ESG when, if and to the extent received from HUD, amounts expended by SUBRECIPIENT in carrying out said program pursuant to this Agreement up to a maximum aggregate amount of Twenty Nine Thou- sand, Seven Hundred and Fifty Dollars ($29,750) in installments determined by CITY. Payments shall be made to SUBRECIPIENT through the submission of quarterly invoices (on or before the 15 15th day of October, January, April and July) in a form prescribed by CITY, detailing such ex- penses. CITY shall pay such invoices within thirty (30) days after receipt thereof, provided CITY is satisfied that such expenses have been incurred within the scope of this Agreement and that SUBRECIPIENT is in compliance with the terms and conditions of this Agreement. Costs incurred prior to the effective date of this Agreement, accrued as of the first day of July 2003, for purposes identified herein will be allowable for reimbursement upon presentation of evidence of and invoices for such expenditures. B. CITY shall include an audit of the account maintained by SUBRECIPIENT in CITY's annual audit of all funds pursuant to the Code of Federal Regulations and other applicable federal laws and regulations. C. Common Rule: Pursuant to CFR 85.40(a), the CITY manages the day-to-day operations of each grant and subgrant supported activities. CITY staff has detailed knowledge of the grant program requirements and monitors grant and subgrant supported activities to assure compliance with Federal requirements. Such monitoring covers each program, function and activity and performance goals are reviewed periodically. D. Environmental Review: In accordance with 24 CFR 58, the CITY is responsible for under- taking environmental review and maintaining environmental review records for each applicable project. III. NONDISCRIMINATION SUBRECIPIENT agrees that no person on the ground of race, color, national origin, re- ligion or sex will be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity funded in whole or in part with ESG funds. IV. CONFLICT OF INTEREST SUBRECIPIENT agrees that no officer, employee, agent or assignee of CITY having direct or indirect control of any ESG monies granted to the CITY, inclusive of the subject ESG FUNDS, shall serve as an officer of SUBRECIPIENT. Further, any conflict or potential conflict of interest of any officer of SUBRECIPIENT shall be fully disclosed in writing prior to the execution of this Agreement and said writing shall be attached and deemed fully incorporated as a part hereof. Notice shall be sent by SUBRECIPIENT to CITY regarding any changes or modifications to its board of directors and list of officers. V. SPECIAL CERTIFICATION FOR RELIGIOUS ENTITIES In addition to, and not in substitution for, other provisions of this Agreement regarding said program using federal funds, SUBRECIPIENT: T A. Represents that it is, or may be deemed to be, a religious or denominational institution or organization or an organization operated for religious purposes that is supervised or controlled by or in connection with a religious or denominational institution or organization; B. Agrees that, in connection with said program: 1. It will not discriminate against any employee or applicant for employment on the basis of religion and will not limit employment or give preference in employment to persons on the basis of religion; 2. It will not discriminate against any person applying for participation in said pro- gram on the basis of religion and will not limit such participation or give preference to persons on the basis of religion; 3. It will provide no religious instruction or counseling, conduct no religious worship or services, engage in no religious proselytizing, and exert no other religious influence in said program; 4. The funds received under this Agreement shall not be used to construct, rehabili- tate, or restore any facility that is owned by SUBRECIPIENT and in which said program is to be implemented; provided that, minor repairs may be made if such repairs (1) are directly related to said program; (2) are located in a structure used exclusively for non -religious purposes and (3) constitute in dollar terms only a minor portion of the federal fund expenditure for said program. VI. CONDITIONS ON PROVISIONS OF DEVELOPMENT AND IMPLEMENTING HOMELESS PREVENTION ACTIVITIES In addition to, and not in substitution for, other provisions of this Agreement regarding said program using federal funds, SUBRECIPIENT: A. Represents that it is, or may be deemed to be, a Homeless Prevention Program; B. Agrees that, in connection with said program, if ESG funds are to be used to assist families that have received eviction notices or notices of termination of utility services, the fol- lowing conditions will be met: 1. The inability of the family to make the required payments must be the result of a sudden reduction in income; 2. The assistance must be necessary to avoid eviction of the family or termination of services to the family; 3. There must be a reasonable prospect that the family will be able to resume pay- ments within a reasonable period of time; and 17 4. The assistance must not supplant funding for preexisting homeless prevention ac- tivities from any other source. VII. PROHIBITION OF NEPOTISM SUBRECIPIENT agrees not to hire or permit the hiring of any person to fill a position funded through this Agreement if a member of that person's immediate family is employed in an administrative capacity by SUBRECIPIENT. For the purposes of this section, the term "immedi- ate family" means spouse, child, mother, father, brother, sister, brother-in-law, sister-in-law, fa- ther-in-law, mother-in-law, son-in-law, daughter-in-law, aunt, uncle, niece, nephew, stepparent and stepchild. The term "administrative capacity" means having selection, hiring, supervisor or management responsibilities. VIII. NOTICES Notices to the parties shall, unless otherwise requested in writing, be sent by U.S. Mail, postage prepaid, and addressed as follows: TO CITY: City of Santa Ana Community Development Agency (M-25) 20 Civic Center Plaza P.O. Box 1988 Santa Ana CA 92702-1988 TO SUBRECIPIENT: MERCY HOUSE CENTER P.O. BOX 1905 SANTA ANA, CA 92702 IX. ASSIGNABILITY None of the duties of, or work to be performed by, SUBRECIPIENT under this Agree- ment shall be subcontracted or assigned to any agency, consultant, or person without the prior written consent of CITY. SUBRECIPIENT must submit all subcontracts and other agreements that relate to this Agreement to CITY. No subcontract or assignment shall terminate or alter the legal obligations of SUBRECIPIENT pursuant to this Agreement. X. HOLD HARMLESS SUBRECIPIENT shall defend, indemnify and save harmless CITY, its officers, agents, employees, representatives and volunteers from and against any and all damages to property or injuries to or death of any person or persons, including property and employees or agents of CITY, and shall defend, indemnify and save harmless CITY, its officers, agents, employees, rep- 18 resentatives and volunteers from and against any and all claims, demands, suits, actions or pro- ceedings of any kind or nature, including, but not by way of limitation, workers compensation claims, and including attorney fees and reasonable expenses for litigation or settlement, resulting from or arising out of the negligent or wrongful acts, errors or omissions of SUBRECIPIENT, its officers, directors, employees, agents, subcontractors and suppliers arising out of SUBRECIPI- ENT's performance of this Agreement. X1. TERMINATION This Agreement may be terminated in accordance with Federal Register 24 CFR Part 576 as follows: A. This Agreement may be terminated by CITY on thirty (30) days' written notice by ei- ther p arty. I n t he a vent o f s uch t ermination, S UBRECIPIENT shall only be entitled to reim- bursement for approved expenses incurred to the effective date of termination. B. This Agreement may be suspended or terminated by CITY upon five (5) days' written notice for violation by SUBRECIPIENT of Federal, state and/or local laws governing the use of Emergency Shelter Grant funds. Furthermore, the SUBRECIPIENT shall comply with the Con- ditional Use permit requirements. For failure to comply with the aforementioned terms, suspen- sion or termination shall result, and SUBRECIPIENT shall only be entitled to reimbursement for approved expenses incurred up to the effective date of suspension or termination. C. In the event SUBRECIPIENT defaults by failing to fulfill all or any of its obligations hereunder, CITY may declare a default and termination of the Agreement by written notice to SUBRECIPIENT, which default and termination shall be effective on a date stated in the notice which is to be not less than ten (10) days after certified mailing or personal service of such no- tice, unless such default is cured before the effective date of termination stated in such notice. If terminated for cause, CITY shall be relieved of further liability or responsibility under this Agreement, or as a result of the termination thereof, including the payment of money, except for payment for approved expenses incurred for services satisfactorily and timely performed prior to the mailing or service of the notice of termination, and except for reimbursement of (1) any pay- ments made for services not subsequently performed in a timely and satisfactory manner, and (2) costs incurred by CITY in obtaining substitute performance. D. The grant of funds under this Agreement may be terminated for convenience. E. In the event this Agreement is terminated as set forth in Section X.A through X.D, in- clusive, SUBRECIPIENT agrees to immediately return to CITY, upon CITY's demand and prior to any adjudication of SUBRECIPIENT's rights, any and all funds not used under this Agree- ment. X1I. LIMITATION OF FUNDS W] The United States of America, through HUD, may, in the future, place programmatic or fiscal limitations on the use of ESG funds which limitations are not presently anticipated. Ac- cordingly, CITY reserves the right to revise this Agreement in order to take account of actions affecting HUD program funding. In the event of funding reduction, CITY may, in its sole and absolute discretion, reduce the budget of this Agreement as a whole or as to costs category, may limit the rate of SUBRECIPIENT's *authority to commit and spend funds, or may restrict SUBRECIPIENT's use of both its uncommitted and its unspent funds. Where HUD has directed or requested CITY to implement a reduction in funding, in whole or as to a cost category, with respect to funding for this Agreement, CITY's City Manager or delegate is authorized to act for CITY in implementing and effecting such a reduction and in revising, modifying, or amending the Agreement for such purposes. Where CITY has reasonable grounds to question SUBRE- CIPIENT's fiscal accountability, financial soundness, or compliance with this Agreement, CITY may suspend the operation of this Agreement for up to sixty (60) days upon five (5) days' written notice to SUBRECIPIENT of its intention to so act pending an audit or other resolution of such questions. In no event, however, shall any revisions made by CITY affect expenditures and le- gally binding commitments made by SUBRECIPIENT before it received notice of such revision, provided that such amounts have been committed in good faith and are otherwise allowable and that such commitments are consistent with HUD cash withdrawal guidelines. XIII. INSURANCE A. SUBRECIPIENT shall furnish CITY's Clerk of the Council with an insurance certifi- cate from its workers' compensation insurance carrier certifying that it carries such insurance and that the policy shall not be canceled nor the coverage reduced except upon thirty (30) days prior notice to CITY. B. SUBRECIPIENT shall obtain, at its sole cost, a policy or policies of commercial gen- eral liability insurance, or equivalent form, with a combined single limit of not less than $1 Million Dollars per occurrence. Such insurance shall: (1) name the City of Santa Ana, its officers, agents, employees and volunteers as additional insureds; (2) be primary with respect to insurance or self-insurance pro- grams maintained by the CITY; (3) contain standard separation of insureds provisions; and (4) give to CITY prompt and timely notice of claim made or suit instituted arising out of SUBRE- CIPIENT's operations hereunder. SUBRECIPIENT shall: (i) prior to exercising any right under this Agreement, furnish properly executed certificates of insurance and additional insured endorsement to the CITY which shall clearly evidence all coverages required above; (ii) provide that such insurance shall not b e in aterially c hanged o r t erminated a xcept o n t hirty (30) days prior written notice to the CITY; (iii) maintain such insurance for the period covered by this Agreement; and (d) replace such certificates for policies expiring prior to the expiration of this Agreement. XIV. EXCLUSIVITY AND AMENDMENT TO AGREEMENT 20 This Agreement supersedes any and all other agreements, either oral or in writing, be- tween the parties hereto with respect to the use of CITY's ESG funds by SUBRECfPIENT and contains all the covenants and agreements between the parties with respect to such employment in any manner whatsoever. Each party to this Agreement acknowledges that no representations, inducements, promises or Agreements, orally or otherwise, have been made by any party, or any- one acting on behalf of any party, which are not embodied herein, and that no other agreement or amendment hereto shall be effective unless executed in writing and signed by both CITY and SUBRECIPIENT. XV. LAWS GOVERNING THIS AGREEMENT This Agreement shall be governed by and construed in accordance with the laws of the State of California, and all applicable federal laws and regulations. XVI. VALIDITY The invalidity in whole or in part of any provision of this Agreement shall not void or af- fect the validity of any other provision of this Agreement. XVII. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify CITY fully, including reasonable costs and attorney's fees, for any injuries or damages to CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits and Attachments referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. c. No delay or omission by either party hereto to exercise any right or power accruing upon any noncompliance or default by the other party with respect to any of the terms of this Agreement shall impair any such right or power or be construed to be a waiver thereof. A waiver by either of the parties hereto of any of the covenants, conditions, or agreements to be performed by the other shall not be construed to be a waiver of any succeeding breach thereof or of any other covenant, condition or agreement herein contained. 21 IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the date and year first above written. DATED: ajt4w;a IIL ATTEST: CITY OF SANTA ANA a municipal corporation DAVID N. REAM City Manager APPROVED AS TO FORM: PATRICIA E. HEALY JOSEPH W. FLETCHER Clerk of the Council City Attorney SUBRECIPIENT: MERCY HOUSE CENTER: DATED: C) SIG ATURE NAME & TITLE 22 MERCY HOUSE CENTER - ESG EXHIBIT A Scope of Work Annual Accomplishment Goal I. Number of unduplicated Santa Ana residents to be served with grant funds during the 12- month contract period = 700 PERSONS II. Description of Work - in space below, describe the program to be funded during the 12-month contract period including, services to be provided, program goals, client characteristics, & how grant funds will be utilized. Funded Programs / Client Characteristics: - Mercy House Center, walk-in outreach center that serves Santa Ana' homeless population. Clients are generally unemployed, and in need of basic emergency services. Services provided: - Crisis intervention / Practical counseling - Food and shelter referral - Clothing, hygiene prescription, transportation & laundry assistance/vouchers - Assistance in obtaining vital records Program goals: - Increase clients' knowledge of and access to resources - Improve the lives of the chronically homeless Fund utilization: - Salaries / benefits for Program Manager position - Operations: Client / office supplies, rent, phone, audit fees, insurance, furniture / equipment, repair / maintenance Schedule of Performance Estimate the number of unduplicated Santa Ana residents to be served during the 12-month contract period per quarter: Quarter 1: July 1 — September 30 Quarter 2: October 1 — December 31 Quarter 3: January 1 — March 31 Quarter 4: April 1 — June 30 Invoicing Schedule 175 Persons 175 Persons 175 Persons 175 Persons Total 700 Persons Estimated the amount of grant funds to be requested during the 12-month contract period on a quarterly basis: Quarter 1: July 1 — September 30 $10,000 Quarter 2: October 1 — December 31 $10,000 Quarter 3: January 1 — March 31 $9,750 Quarter 4: April 1 — June 30 $ Total $29,750 Exhibit A Santa Ana ESG - Program budget for Mercy House Center Fiscal Year 2003 - 2004 Salary & Benefits. i ESG % for Salaries. for this program:, this program Executive Director - L. Haynes $18,040 ESG ...,' ' Amount Other!' Sources $18,040 Program Director - L. Wilson $11,859 $11,859 Administrative Director - H. Fitzgerald $5,960 $5,000 $960 Administrative Associate - A. Pigg $7,348 $7,348 Bookkeeper - C. Nesheim $6,614 $6,614 Program Manager - JH/MHC - P. Long $16,716 30% $5,000 $11,716 Program Coordinator -MHC - K. Ma Gregor or $19,552 0% $19,552 Subtotal $86,089 12% $10,0001 $76,089 Operations Office & Client Supplies Expenses $17,810 ESG % for ESG this program i Amount. $10,000 Other, Sources $7,810 Rent / Lease $3,600 $3,600 $0 Communications $3,000 $2,775 $225 Professional Services - Audit Fees $2,040 $2,040 $0 Conferences & Meetings $500 $0 $500 Travel Expenses $500 $0 $500 Insurance (General Liabililty) $600 $335 $265 Utilities $0 $0 $0 Repair / Maintenance / Furniture / Equip $1,250 $1,000 $250 Homeless Prevention $20,000 $0 $20,000 Motel Assistance $40,000 $0 $40,000 Subtotal 1 $89,300 22% $19,7501 $69,550 Total $175,389 17.0% $29,750 $145,639 Exhibit B $0.00 7/16/2003 Certification Regarding Lobbying Certification for Contracts, Grants, Loans, and Cooperative Agreements The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contact, grant, loan or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontract, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U. S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Grantee/Contactor Organization Program Title Name of Certifying Officer EXHIBIT C Page 1 of 2 Date SUBRECIPIENT warrants the following: 1. SUBRECIPIENT will comply with Public Law 88-352, Title VI of the Civil Rights Act of 1964 (42 U. S. C. section 2000 et seq.) and implementing regulation in 24 CFR Part 1. 2. No person in the United States shall on the ground of race, color, religion, national origin, or sex, be excluded from participation in, or be denied the benefits of, or be subjected to discrimination under any program or activity funded in whole or in part with community development funds made available pursuant to the ACT. 3. All laborers and mechanics, employed by contractors or subcontractors in the performance of construction work financed in whole or in part with community development funds shall be paid wages at rates not less than those prevailing on similar construction in the locality as determined in accordance with the Davis -Bacon Act, as amended, 40 U. S. C. Sections 276 a 1-5, except for individuals who perform services for which they volunteered; do not receive compensation for such services; or are paid expenses, reasonable benefits, or a nominal fee for such services; and are not otherwise employed at any time in construction work. 4. SUBRECIPIENT will comply with all Federal statutes applicable to projects funded with community development funds, except that (a) SUBRECIPIENT does not assume CITY'S environmental responsibilities described at 24 CFR 570.604; and (b) SUBRECIPIENT does not assume CITY'S responsibility for initiating the review process under Executive Order 12372. EXHIBIT C Page 2 of 2 DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 034MO46 (See reverse for public burden disclosure.) 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract ❑a. bid/offer/application ❑ a. initial filing b. grant b. initial award b. material change c. cooperative agreement c. post -award For Material Change Only: d. loan year quarter e. loan guarantee date of last report __________ f. loan insurance 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is a Subawardee, Enter Name ❑ Prime ❑ Subawardee and Address of Prime: TierI if known: Congressional District, if known: Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, if applicable: 8. Federal Action Number, if known: 9. Award Amount, if known: 10. a. Name and Address of Lobbying Entity b. Individuals Performing Services (including address if (if individual, last name, first name, MI): different from No. 10a) (last name, first name, MI): (attach Continuation Sheet(s) SF-LLLA, if necessary) 11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply): $ ____ ❑ actual ❑ planned ❑ a. retainer ❑ b. one-time fee ❑ c. commission 12. Form of Payment (check all that apply): ❑ a. cash ❑ d. contingent fee ❑ b. in -kind; specify: nature ❑ e. deferred value ❑ f. other, specify: _ 14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or Member(s) contacted, for Payment Indicated in Item 11: (attach Continuation Sheet(s) SF-LLLA, if necessary) 15. Continuation Sheets SF-LLLA attached: ❑ Yes ❑ No 16 mfenal requested Nmugh this form B authorized by this 31 U.S.C. section Signature: 1352. This disclosure of lobbying acthines is a material representation of fed print Name: upon which reBan. was placed by the 5ar above when Nis bansacbon was made or widened into. TNs disdosure is rxlWred panswrit to 31 U.S.C. 1352. This Title: Information wit be rationed to the Congress semi-annually and will be available for pubgo Inspection. Any piraan who fags b file the required disclosure shall be subject to a dint penalty of not less that $10,M and not more than $100,000 for each such failure. Telephone No.: _ Date: Federal Use Only: Authorized for Local Reproduction Standard Form LLL (Rev. 7-97) U.S. EPA!`Jashington DC 20160 U.S- CPSC lr;'ash;ngton DC 20207 U.S. HUD V.'ash'.ngtcn DC 20410 Protect Your - Family From Lead I n Your Home United Stags 6ivironinental Protection Arency United States Consumer Product Safety Ccinmisslon United States Department of Housing znd Urban Development EPA7-17-K-99-001 April 1999 Are You Planning To Buy, Rent, or Renovate a Home Built Before 1978? Many houses and apartments built before 1978 have paint that contains lead (called lead -based paint). Lead from paint, chips, and dust can pose serious health hazards if not taken care of properly. Federal law requires that individuals receive certain information before renting, buying, or renovating pre-1978 housing: F LANDLORDS have to disclose known infor- mation on lead -based paint and lead -based paint hazards before leases take effect. Leases must include a disclosure form about lead -based paint. SELLERS have to disclose known informa- tion on lead -based paint and lead -based paint hazards before selling a house. Sales contracts must include a disclosure form about lead -based paint. Buyers have up to 10 days to check for lead hazards. RENOVATORS have to give you this pamphlet before starting work. (After June 1, 1999.) IF YOU WANT MORE INFORMATION on these requirements, call the National Lead Information Clearinghouse at 1-800-424-LEAD. This document is in the public domain. It may be reproduced by an individual or organization without permission. Information provided in this booklet is based upon current scientific and technical understanding of the issues presented and is reflective of'the jurisdictional boundaries established by the statutes governing the co-authoring agencies. following the advice given will not necessarily pro- vide complete protection in all situations or against all health hazards that can be caused by lead exposure. IMPORTANT! Lead From Paint, Dust, and Soil Can Be Dangerous If Not Managed Properly FACT: Lead exposure can harm young children and babies even before they are born. FACT: Even children who seem healthy can have high levels of lead in their bodies. FACT. People can get lead in their bodies by breathing or swallowing lead dust, or by eating soil or paint chips containing lead. FACT, People have many options for reducing lead hazards. In most cases, lead -based paint that is in good condition is not a hazard. FACT. Removing lead -based paint improperly can increase the danger to your family. If you think your home might have lead hazards, read this pamphlet to learn some simple steps to protect your family. 1 Lead Gets in the Body in Many Ways People can get lead in their body if they: In the United ♦ Put their hands or other objects covered with lead dust in their mouths. States, about ♦Eat paint chips or soil that contains lead. 900,000 children ages 9 ♦ Breathe in lead dust (especially during renovations that disturb painted 1 to 5 have a surfaces). blood -lead level above Lead is even more dangerous to children the level of than adults because: concern. ♦ Babies and young children often put their hands and other objects in their Even children mouths. These objects can have lead who appear dust on them. healthy can have danger- ♦ Children's growing bodies absorb more ous levels of lead. lead in their ♦ Children's brains and nervous systems bodies. are more sensitive to the damaging effects of lead. Lead's Effects If not detected early, children with high levels of lead in their bodies can suffer from: ♦ Damage to the brain and nervous system ♦ Behavior and leaming . problems (such as hyperactivity) ♦ Slowed growth ♦ Hearing problems ♦ Headaches Lead is also harmful to adults. Adults can suffer from: ♦ Difficulties during pregnancy ♦ Other reproductive problems (in both men and women) ♦ High blood pressure ♦ Digestive problems ♦ Nerve disorders ♦ Memory and concentration problems ♦ Muscle and joint pain VdUP4 Lead affects the body in many ways- 3 Where Lead -Based Paint Is Found In general, Many homes built before 1978 have lead - the older your y based paint. The federal government banned lead -based paint from housing in home, the 1978. Some states stopped its use even more likely it earlier. Lead can be found: has lead- ♦ In homes in the city, country, or suburbs. based paint. ♦ In apartments, single-family homes, and both private and public housing. ♦ Inside and outside of the house. In soil around a home. (Soil can pick up lead from exterior paint or other sources such as past use of leaded gas in cars.) Checking Your Family for Lead Get your To reduce your child's exposure to lead, get your child checked, have your home children and tested (especially if your home has paint home tested in poor condition and was built before if you think . 1978), and fix any hazards you may have. y our home Children's blood lead levels tend to increase has high lev- rapidly from 6 to 12 months of age, and tend to peak at 18 to 24 months of age. els of lead. Consult your doctor for advice on testing your children. A simple blood test can detect high levels of lead. Blood tests are usually recommended for: ♦ Children at ages 1 and 2. ♦ Children or other family members who have been exposed to high levels of lead. ♦ Children who should be tested under your state or local health screening plan. Your doctor can explain what the test results I ean and if more testing will be needed. 4 Where Lead Is Likely To Be a Hazard Lead -based paint that is in good condition is usually not a hazard. Lead from Peeling, chipping, chalking, or cracking paint chips, lead -based paint is a hazard and needs which you immediate attention. can see, and Lead -based paint may also be a hazard lead dust, when found on surfaces that children can which you chew or that get a lot of wear -and -tear. can't always These areas include: See, can both ♦ Windows and window sills. be serious ♦ Doors and door frames. hazards. ♦ Stairs, railings, and banisters. ♦ Porches and fences. Lead dust can form when lead -based paint is dry scraped, dry sanded, or heated. Dust also forms when painted surfaces bump or rub together. Lead chips and dust can get on surfaces and objects that people touch. Settled lead dust can re-enter the air when people vac- uum, sweep, or walk through it. Lead in soilc an be a hazard when children play in bare soil or when people bring soil into the house on their shoes. Call your state agency (see page 11) to find out about test- ing soil for lead. 5 v Checking Your Home for Lead Hazards Just knowing that a home has lead - based paint may not tell you if there is a hazard. 0 You can get your home checked for lead haz- ards in one of two ways, or both: ♦ A paint inspection tells you the lead content of every different type of painted surface in your home. It won't tell you whether the paint is a hazard or how you should deal with it. ♦ A risk assessment tells you if there are any sources of serious lead exposure (such as peeling paint and lead dust). It also tells you what actions to take to address these hazards. Have qualified professionals do the work. There are standards in place for certifying lead -based paint professionals to ensure the work is done safely, reliably, and effectively. Contact your state lead poisoning prevention program for more information. Call 1-800- 424-LEAD for a list of contacts in your area. Trained professionals use a range of methods when checking your home, including: ♦ Visual inspection of paint condition and location. ♦ A portable x-ray fluorescence (XRF) machine. ♦ Lab tests of paint samples. ♦ Surface dust tests. Home test kits for lead are available, but studies suggest that they are not always accurate. Consumers should not rely on these tests before doing renovations or to assure safety. What You Can Do Now To Protect Your Family t If you suspect that your house has lead hazards, you can take some immediate steps to reduce your family's risk: ♦ If you rent, notify your landlord of peeling or chipping paint. ♦ Clean up paint chips immediately. ♦ Clean floors, window frames, window sills, and other surfaces weekly. Use a mop or sponge with warm water and a general all-purpose cleaner or a cleaner made specifically for lead. REMEMBER: NEVER MIX AMMONIA AND BLEACH PRODUCTS TOGETHER SINCE THEY CAN FORM A DANGEROUS GAS. ♦ Thoroughly rinse sponges and mop heads after cleaning dirty or dusty areas. ♦ Wash children's.hands often, especial- ly before they eat and before nap time and bed time. ♦ Keep play areas clean.W ash bottles, pacifiers, toys, and stuffed animals regularly. ♦ Keep children from chewing window sills or other painted surfaces. ♦ Clean or remove shoes before entering your home to avoid tracking in lead from soil. ♦ Make sure children eat nutritious, low -fat meals high in iron and calcium, such as spinach and dairy products. Children with good diets absorb less lead. 7 How To Significantly Reduce Lead Hazards Removing lead improperly can increase the hazard to your family by spreading even more lead dust around the house. Always use a professional who is trained to remove lead hazards safely. In addition to day-to-day cleaning and good nutrition: You can temporarily reduce lead hazards by taking actions such as repairing dam- aged painted surfaces and planting grass to cover soil with high lead levels. These .actions (called "interim controls') are not permanent solutions and will need ongo- ing attention. �. To permanently remove lead hazards, you must hire a certified lead "abate- ment" contractor. Abatement (or perma- nent hazard elimination) methods include removing, sealing, or enclosing lead -based paint with special materials. Just painting over the hazard with regular paint is not enough. Always hire a person with special training for correcting lead problems —someone who knows how to do this work safely and has the proper equipment to clean up thoroughly. Certified contractors will employ qualified workers and follow strict safety rules as set by their state or by the federal government. Call your state agency (see page 11) for help with locating certified contractors in your area and to see if financial assistance Is available. Remodeling or Renovating a Home With Lead -Based Paint Take precautions before your contractor or you begin remodeling or renovations that disturb painted surfaces (such as scraping off paint or tearing out walls): Have the area tested for lead -based paint. ♦ Do not use a belt -sander, propane torch, heat gun, dry scraper, or dry sandpaper to remove lead -based paint. These actions create large amounts of lead dust and fumes. Lead dust can remain in your home long after the work is done. Temporarily move your family (espe- cially children and pregnant women) out of the apartment or house until the work is done and the area is prop- erly cleaned. If you can't move your family, at least completely seal off the work area. Follow other safety measures to reduce lead hazards. You can find out about other safety measures by calling 1-800-424-LEAD. Ask for the brochur. "Reducing Lead Hazards When Remodeling Your Home." This brocht explains what to do before, during, and after renovations. If you have already completed renova- tions or remodeling that could have released lead -based paint or dust, get your young children tested and follow the steps outlined on page 7 of this brochure. If not conducted properly, certain types of renova- tions can release lead from paint and dust into the air. Other Sources of Lead While paint dust, and soil are the most common lead hazards, other lead sources also exist. 10 ♦ Drinking water. Your home might have plumbing with lead or lead solder. Call your local health department or water supplier to find out about testing your water. You cannot see, smell, or taste lead, and boiling your water will not get rid of lead. If you think your plumbing might have lead in it: • Use only cold water for drinking and cooking. • Run water for 15 to 30 seconds before drinking it, especially if you have not used your water for a few hours. ♦ The job. If you work with lead, you could bring it home on your hands or clothes. Shower and change clothes before coming home. Launder your work clothes separately from the rest of your family's clothes. ♦ Old painted toys and furniture. Food and liquids stored in lead crystal: or lead -glazed pottery or porcelain. ♦ Lead smelters or other industries that release lead into the air. ♦ Hobbies that use lead, such as making pottery or stained glass, or refinishing furniture. ♦ Folk remedies that contain lead, such as "greta" and "azarcon" used to treat an upset stomach. For More Information The National Lead Information Center Call 1-800-424-LEAD to learn how to protect children from lead poisoning and for other information on lead hazards. (Internet: www.epa.gov/lead and www.hud.govllea). For the hearing impaired, call the Federal Information Relay Service at 1-800-877- 8339 and ask for the National Lead A^A Information Center at 1-800-424-LEAD. EPXs Safe Drinking water Hotline Call 1-800-426-4791 for information about lead in drinking water. Consumer Product Safety Commission Hotline To request information on lead in consumer products, or to report an unsafe consumer product or a prod- uct -related injury call 1-800-638- 2772. (Internet: www@cpsc.gov). For the hearing impaired, call TDD 1 - 800-638-8270. State Health and Environmental Agencies Some cities and states have their own rules for lead -based paint activities. Check with your state agency to see if state or local laws apply to you. Most state agencies can also pro- vide information on finding a lead abatement firm in your area, and on possible sources of financial aid for reducing lead hazards. Receive up-to-date address and phone infor- mation for state and local contacts on the Internet at www epa.gov/lead or contact the National Lead Information Center at 1-800-424-LEAD. 11 EPA Regional Offices Your Regional EPA Office can provide further information regard- ing regulations and lead protection programs. EPA Regional Offices Reilion 1 (Connecticut Massachusetts, Maine, New Hampshire, Rhode Island, Vermont) Regional Lead Contact U.S. EPA Region 1 Suite 1100 (CPT) One Congress Street Boston, MA 02114-2023 1 (888) 372-7341 Region 2 (New Jersey New York, Puerto Rico, Wgin Islands) Regional Lead Contact U.S. EPA xxr 2 2890 W R . � Avenue Bu" 209, Mail Stop 225 Edison, NJ 08837-3679 (732) 321-6671 Region 3 (Delaware, Washington DC, Mnd, Pennsylvania, Virginia, West Virgrntal Regional Land Contact U.S. EPA Region 3 (3WC33) 1650 Arch Street Philadelphia, PA 19103 (215)814-5000 Region 4 (Alabama, Florida, Ge�gia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee) Regional Lead Contact U.S. EPA Region 4 . 61 Atlanta, , GA 30303 (404) 562-8998 MiRinnnesota,iOh�a, Indiana, Michigan. Regional Land Canted U.S. EPA Region5 (DT-" 77 West Jackson Boulevard Chicago, IL 60604-3666 (312)886-6003 12 Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma, Texas) Regional Lead Contact U.S. EPA Region 6 1445 Ross Avenue, 12th Floor Dallas, TX 75202-2733 (214) 665-7577 Region 7 (Iowa, Kansas, Missouri, Nebraska) Regional Lead Contact U.S. EPA Region 7 (ARID-RAU) 901 N. 5th Street Kansas City, KS 66101 (913)551-702D Ramon a (Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming) Regional Land Contact U.S. EPA Region 8 99918th Street Suite 500 Deriver, CO 80202-2466 (303) 312-6021 Region 8 (Arizona, California, Hawaii, Nevada) Regional Lead Contact U.S. Region 9 75 Hawthorne Street San Francisco, CA 94105 (415) 744-1124 Region 10 (Idaho, Oregon, Washington, Alaska) Regional Lead Contact U.S. EPA Region 10 Toxics Section WCM-128 1200 Sixth Avenue Seattle, WA 98101-1128 (206)553-1985 CPSC Regional Offices Your Regional CPSC Office can provide further information regard- ti ing regulations and consumer product safety. Eastern Regional Center 6 World Trade Center Vesey Street, Room 350 New York, NY 10048 (212) 466.1612 Central Regional Center 230 South Dearborn Street Room 2944 Chicago, IL 60604-1601 (312) 353-8260 HUD Lead Office Vllastem Regional Center 600 Harrison Street. Room 245 San Francisco, CA 94107 (415) 744-2966 Please contact HUD's Office of Lead Hazard Control for informa- tion on lead regulations, outreach efforts, and lead hazard control and research grant programs. U.S. Department of Housing and Urban Development Office of Lead Hazard Control 451 Seventh Street, SW, P-3206 Washington DC 20410 (202) 755-1785 13 If you think your home has high levels of lead: ♦ Get your young children tested for lead, even if they seem healthy. . ♦ Wash children's hands, bottles, pacifiers, and toys often. ♦ Make sure children eat healthy, low -fat foods. ♦ Get your home checked for lead hazards. ♦ Regularly clean floors, window sills, and other surfaces. • Wipe soil off shoes before entering house. ♦ Talk to your landlord about fixing surfaces with peeling or chipping paint. ♦ Take precautions to avoid exposure to lead dust when remodeling or renovating (call 1-800-424- LEAD for guidelines). ♦ Don't use a belt -sander, propane torch, heat gun, dry scraper, or dry sandpaper on painted surfaces that may contain lead. ♦ Don't try to remove lead -based paint yourself. Sample Disclosure Format for Target Housing Sales Disclosure of Information on Lead -Based Paint and Lead -Based Paint Hazards ILead Warning Statement Every purchaser of any interest in residential real property on which a residential dwelling was built prior to 1978 is notified that such property may present exposure to lead from lead -based paint that may place young children at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities reduced intelligence quotient, behavioral problems, and impaired memory. Lead poisoning also poses a parGcularrisk to pregnant women. The seller of any interest in residential real property is required to provide the buyer with any information on lead -based paint hazards from risk assessments or inspections in the seller's possession and notify the buyer of any known lead -based paint hazards. A risk assessment or inspection forpossible lead -based paint hazards is recommended pd6r to purchase. Seller's Disclosure (initial) (a) Presence of lead -based paint and/or lead -based paint hazards (check one below): Known lead -based paint and/or lead -based paint hazards are present in the housing (explain). Seller has no knowledge of lead -based paint and/or lead -based paint hazards in the housing. (b) Records and reports available to the seller (check one below): Seller has provided the purchaser with all available records andeports pertaining to lead -based paint and/or lead -based paint hazards in the hoeing (list documents below). iSeller has no reports or reords pertaining to lead -based paintand/or lead -based paint hazards in the housing. Purchaser's Acknowledgment (initial) (c) Purchaser has received copies of all information listed above. (d) Purchaser has received the pamphletProtect Your Fanu7y from Lead in Your Home. (e) Purchaser has (check one below): Received a 10-day opportunity (or mutually agreed upon period) to conduct a risk assessmentro inspection for the presence of lead -based paint and/or lead -based paint hazards; or Waived the opportunity to conduct a risk assessment or inspectionnr the presence of lead -based paint and/or lead -based paint hazards. Agent's Acknowledgment (initial) (f) Agent has informed the seller of the sellers obligations under 42 M.C. 4852(d) and is aware of his/her responsibility to ensure compliance. Certification of Accuracy The following parties have reviewed the information above and certify, to the best of their knowledge, thatdh information presided by the signatory is true and accurate. Seller Date Seiler Went Date Purchaser Date Date Agent Date Purchaser Date Sample Disclosure Format for Target Housing Rentals and Leases Disclosure of Information on Lead -Based Paint and Lead -Based Paint Hazards Lead Warning Statement Housing built before 1978 may contain lead -based paint Lead from pain; paint chips, and dust can pose health hazards if not taken care of properly. Lead exposure is especiaNX harmful to young children and pregnant women. Before renting pre-1978 housing, landlords must disclose the presence of known lead -based paint and lead -based paint hazards in the dwelling. Tenants must also receive a Federally approved pamphlet on lead poisoning prevention. Lessor's Disclosure (initial) (a) Presence of lead -based paint or lead -based paint hazards (check one below): Known lead -based paint and/or lead -based paint hazards are present in the housgr (explain). Lessor has no knowledge of lead -based paint and/or lead -based paint hazards in .th housing. (b) Records and reports available to the lessor (check one below): Lessor has provided the lessee with all vailable records and reports pertaining to lead - based paint and/or lead -based paint hazards in the housing (list documents below). Lessor has no reports or records pertaining to lead -based paint and/or lead -bash paint hazards in the housing. Lessee's Acknowledgment (initial) (c) Lessee has received copies of all information listed above. (d) Lessee has received the pamphletProtect Your Family from Lead in Your Home. Agent's Acknowledgment (initial) (e) Agent has irformed the lessorof the lessor's obligations under 42 U.S.C. 4852(d) and is aware of his/her responsibility to ensure compliance. Certification of Accuracy The following parties have reviewed the information above and certify, tthe best of their knowledge, that the information provided by the signatory is true and accurate. Lessor Date Lessor Date Lessee Date Lessee Date Agent Date Agent Date r I A,RACW eI.ff z P% 14 7 - Federal Register/Vol. 64, 178/Wednesday. September 15, 199E Iles and Regulations 50231 Appendix B—Sample Summary Risk Assessment Notice Format Note: This following appendix will not appear in the Code of Federal Regulations Summary Notice of Lead -Based Paint Risk Assessment Address/location of property or structure(s) this summary notice applies to: Lead -based paint risk assessment descriptions Date(s) of risk assessment: Summary of risk assessment results (check all that apply): paint hazards were found lead -based (b) _ Lead -based paint hazards were found. W _ A brief summary of the findings of the risk assessment is provided below Ovgtdred If arry lead -based paint hazards were futmd). Summary of types and locations of lead - based palm hazards. Liu at least the haling unit mambas and common areas (for multifamily housing). bare soil location. dust lad locations, and/or building components type of room or space. and the material underneath the and types of lad -baud paint hazards Contact person for more information about the risk assessment Printed mane Sues and city. State: _ 21P: _ Phone number: (_) Person who prepared this summary notice: Printed name:...- • Signature: Date: Organization: Street and city - State. _ ZIP: ,_ Phone number: U Appendix C—Sample Summary Presumption Notice Format Now The following appendix will not appear in the Code of Federal Regulations Notice That Lead -Based Palm or Lead -Based Paint Hazards Are Presumed to be Present Addressnocation of property or structure(s) this notice of presumption applies to: Type of presumption (check all that apply): (a) _ Lead -based paint is presumed to be present. (b) — Lead -based paint hazard(s)1s(are) presumed to be present. Summary of presumption. Lin at least the housing unit numbers and common areas (for multifamily housing), bare soil locations. dust -lead locations, and/or building components (including type of room or space. and the material underneath the patind. and types of lead -baud paint hazards presumed to be present Contact person for more information about the presumptiow Primed name: Organization Street and city. State: _ ZIP- ,Phone number (_) Person who prepared this notice of presumption: Printed name: Signature: Date., Organization Street and city. State: _ ZIP- _ Phone number. ( 1 Appendix D—Sample Hazard Reduction Completion Notice Format Note: The following appendix will not appear in the Code of Federal Regulations. Summary Notice of Completion of Lead - Based Paint Hazard Reduction Activity AddressIlocatlorY9f property or structure(s) this summary notice applies to: Summary of the hazard reduction activity. Stan and completion date(s): Activity locations and types. List at least the housing unit numbers and common areas (for multifamily housing). bare soil locations. dust -lead locations. and/or building components (including type of room or space. and the material underneath the paint), and types of hazard reduction activities performed at the locations listed: Dates) of clearance testing and/or soil, analyses:_ Locations of building components with lead - baud palm remaining in the mortis. spaces or areas where activities were conducted: Summary of results of clearance testing and soil analyses: (a)_Noclearance testingwas (b)- Clearance testing showed clearance was achieved. (c) _Clarence testing showed clearance was not achieved. Contact person for more information about the hazard reduction Printed time: Organization: . Street and city- State _ zB?: Phone number. (_) Person who prepared this summary notice: Printed name: Signature: Date: Organtzatlon Street and city. State: _ ZIP - Phone number (_j (FR Doc. 99-23016 Filed 9-14-99:8:45 am] f'ii17,r7%-;:-4 iF�M grfActtmta.tr- 3 ATTACHMENT NO.4 LBP INFORMATION SUMMARY ZERO/0 BEDROOM < (LESS THAN) 100 DAYS IN UNIT; ASSISTANCE IN HOMELESS SHELTER • STATUS: EXEMPT TITLE X 2. ZERO/0 BEDROOM > (MORE THAN) 100 DAYS IN UNIT o STATUS: OPEN ISSUE UNDER LBP REGS ZERO/0 BEDROOM > (MORE THAN) 100 DAYS ASSISTANCE IN HOMELESS SHELTER • STATUS: OPEN ISSUE UNDER LBP REGS • SEE SUBPART K • CLEARANCE OF UNIT(S) WILL BE REQUIRED BY CITY FOR ALL HOUSING UNITS (EVEN ZERO BEDROOM) FOR WHICH OCCUPANCY OCCURS BY ASSISTED HOUSEHOLD FOR MORE THAN 100 DAYS, PENDING FURTHER INTERPRETATION/GUIDANCE FROM HUD 3. ONE OR MORE (1+) BEDROOMS OCCUPANCY < 100 DAYS IN RESIDENTIAL UNIT AND/OR OCCUPANCY IN HOMELESS SHELTER • EXEMPT TITLE X 4. 1+ BEDROOMS > 100 DAYS IN RESIDENTIAL UNIT • STATUS: SAME AS #2 ABOVE; CLEARANCE REQUIRED o SEE SUBPART K 5. EMERGENCY RENTAL ASSISTANCE < 100 DAYS EXEMPT TITLE X 6. EMERGENCY RENTAL ASSISTANCE > TO HOUSEHOLD TO BE OCCUPANCY IN RESIDENTIAL UNIT FOR MORE THAN 100 DAYS (SUCH AS LONG TERM LEASE SIGNED AT TIME OF EMERGENCY ASSISTANCE) Attachment NoA LBP Information Summary Page 1 of 2 7niroiLS • CLEARANCE BEFORE ANY MONEY DISBURSED; LBP COMPLIANCE: NOTIFICATION, EVALUATION, REDUCTION THROUGH CLEARANCE REQUIRED BEFORE OCCUPANCY OF UNIT MAY BE CONSIDERED TENANT BASED RENTAL ASSISTANCE (TBRA); THUS HQS INSPECTION AND SUBPART M MAY APPLY SEE SUBPARTS K AND M • PENDING HUD GUIDANCE 7. TBRA < 100 DAYS EXEMPT TITLE X 8. TBRA> 100 DAYS OF HOME ASSISTANCE (SUCH AS WHEN TENANT ENTERS INTO LONG TERM LEASE • SEE SUBPART M • CLEARANCE BEFORE ANY MONEY DISBURSED; LBP COMPLIANCE: NOTIFICATION, EVALUATION, REDUCTION THROUGH CLEARANCE REQUIRED BEFORE OCCUPANCY OF UNIT • HQS INSPECTION REQUIRED BEFORE OCCUPANCY • CLEARANCE BEFORE ANY MONEY DISBURSED 9. TBRA < 100 DAYS —TENANT ENTERS INTO LONG TERM LEASE, CITY GIVES LESS THAN 100 DAYS OF ASSISTANCE. • EXEMPT TITLE X [See HUD interpretative Guidance: Online: Questions M4, K7, K4, for discussion] Attaebmeat NoA LBP luformatlou Summary Page 2 of 2 7111/01 LS CORD_ CERTIFICATE OF LIABILITY INSURANCE CSR DH DATE (MM DDM) A RCY-1 06/04/03 vacs! c_e'R - THIS CERTIFICATL >SUED AS A MATTER OF INFORMATION ONLY AND CONFEKs NO RIGHTS UPON THE CERTIFICATE Huntington Pacific Ins. Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 18672 Florida St. Ste. 302D ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Huntington Beach CA 92648 Phone: 714-841-6283 INSURERS AFFORDING COVERAGE INSURED INSURER A: Great American Insurance Co. INSURER B: Mercy House Transitional Living Center ETAL INSURER C: P.O. BOX 1905 INSURER D: Santa Ana CA 92702 INSURER E: ,.vv,cKAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH - POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.POLICY INSR LTR TYPE OF INSURANCE POLICY NUMBER EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE MM/DDIYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑X OCCUR PAC6536218 05/02/03 05/02/04 EACH OCCURRENCE $1,000 000 FIREDAMAGE (Anyonefire) s200,000 MED EXP(Any one person) $10,000 PERSONAL B AOV INJURY $1,000,000 GENL AGGREGATE LIMIT APPLIES PER: X POLICY PRO- n LOC JECT SENiRAL AGGREGI c S i , "L , CV,.-) PRODUCTS -COMPIOP AGG $1,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS PAC6536218 05/02/03 05/02/04 COMBINED SINGLE LIMIT (Ea accident) S11000,000 BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Par accident) $ GARAGE LIABILITY ANY AUTO APPROVED AS Tv irU AUTO ONLY - EA ACCIDENT $ EA ACC OTHER THAN AUTO ONLY: AGO $ $ EXCESS LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ Lau i Shc: dy Deputy City Al EACH OCCURRENCE S AGGREGATE S l7TR y $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY TWO AV ER RV E.L. EACH ACCIDENT E E.L. DISEASE -E.. -'�I. E.L. DISEASE -POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS With respects to the additional insureds, this insurance shall not be cancelled or materially reduced in coverage or limits except after (30) days written notice has been given to the City of Santa Ana. CERTIFICATE HOLDER I Y I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION City of Santa Ana, Community Development Agency M-25 Att: John Maloney P.O. Box 1988 Santa Ana CA 92702-1988 SANTANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIK I lun DATE THEREOF, THE ISSUING INSURER WILL *y"bolE' MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, WekSfRc(PdAIJ�/�N918� r IyeL�ng�1�4jkl�A�E19/cs141i IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. CLK9cU] rrcu•t rHA NU. . il4—u4l—oJ47 5e, 1� 1 1 - ADDITIONAL INSURED ENDORSCMENI' FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company Great American Insurance Company This endorsement modifies such insurance as is afforded by the provisions or Policy # PAC6536218 relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. 'Ills insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective May 3, 2003 this endorsement form as a part of Policy # PAC6536218 Issued to W-rc:y House Transitional Living Center ETAL Named Insured Countersigned by A(T/ Authorized Represen ative Robin Hatfield - Broker APPROVED AS TO FORM may:. 1-111ra ShcedY_""'—.--__... "'"Y C.ty AlAI p19laY