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HomeMy WebLinkAboutCOMMUNITY ACTION PARTNERSHIP 1AGREEMENT TERMINATION Please complete this form when the attached agreement is no Ionger in effect. Return form to the Deputy Clerk of the Council (M-30). Call 647-6520 if you have any questions. The agreement with was completed on _ Revised 4-16-87 ---------------------------- and final payment has been made. City of Santa Ana Clerk of the Council INSURANCE ON FILE A-2003-159 WORK MAY PROCEED UNTIL INSURANCE EXPIRES 7- ( -olf CLERK OF COUNCIL DATE: 0-4—u3 CONSULTANT AGREEMENT C 1CM THIS AGREEMENT, made and entered into this 1-1-�4- day of J(A- i. �� (xv�zplez) 2003 by and between Community Action Partnership of Orange County (he ire nafter "Consultant'), and the City of Santa Ana , a municipal corporation organized and I IJ existing under the Constitution and laws of the State of California (hereinafter "City"). RECITALS A. The City desires to retain a consultant having special skill and knowledge in the field of providing vocational/occupational training, employment strategies, education and supportive services to individuals who reside in the Federal Empowerment Zone. B. Consultant represents that Consultant is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable in its field and that any services performed by Consultant under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting firm in the field. D. The City, through the Santa Ana Empowerment Corporation (SAEC), is the recipient of Empowerment Zone ("FEZ") funds from the United States Department of Housing and Urban Development ("HUD"). E. The City and Consultant have duly executed this Agreement for expenditure of such funds. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: SCOPE OF SERVICES Consultant shall perform those services as set forth in Exhibit A to this Agreement. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services, the rates and charges identified in Exhibit B. The total sum to be expended under this Agreement, shall not exceed $56,150.00 during the term of this Agreement. b. Payment by City shall be made within thirty (30) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Page I of 9 Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. 3. TERM This Agreement shall commence on July 1, 2003 and terminate on June 30, 2004, unless terminated earlier in accordance with Section 12, below. The term of this Agreement may be extended upon a writing executed by the Executive Director of the Community Development Agency and the City Attorney. 4. INDEPENDENT CONTRACTOR Consultant shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer-employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Consultant performs the services which are the subject matter of this Agreement; however, the services to be provided by Consultant shall be provided in a manner consistent with all applicable standards and regulations governing such services. Consultant shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. INSURANCE Prior to undertaking performance of work under this Agreement, Consultant shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Consultant shall maintain commercial general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Consultant's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1,000,000 per occurrence. Consultant shall supply City with a fully executed additional insured endorsement in substantially the form attached hereto as Exhibit F upon execution of this Agreement and shall be approved in form by the City Attorney. b. Business automobile liability insurance, or equivalent form, with a combined single limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for owned, hired and non -owned automobiles. Page 2 of 9 c. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the Labor Code, Consultant, if Consultant has any employees, is required to be insured against liability for worker's compensation or to undertake self- insurance. Prior to commencing the performance of the work under this Agreement, Consultant agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. d. The following requirements apply to the insurance to be provided by Consultant pursuant to this section: (i) Consultant shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. (ii) Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved in form by the City Attorney. (iii) Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. e. If Consultant fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the City with required proof that insurance has been procured and is in force and paid for, the City shall have the right, at the City's election, to forthwith terminate this Agreement. Such termination shall not effect Consultant's right to be paid for its time and materials expended prior to notification of termination. Consultant waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 6. INDEMNIFICATION Consultant agrees to and shall indemnify and hold harmless the City, its officers, agents, employees, consultants, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including health, and claims for property damage, which may arise from the direct or indirect operations of the Consultant or its contractors, subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. The Consultant further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party challenging the validity of this Agreement, or asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property Page 3 of 9 rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. 7. CONFIDENTIALITY If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Consultant agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Consultant without reference to information disclosed by the City. 8. CONFLICT OF INTEREST CLAUSE Consultant covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 9. SOURCE OF FUNDS a. Consultant acknowledges that the FEZ funds being provided by City for Consultant's services are received by City from HUD, and warrants that expenditures of these funds shall comply with the laws, regulations and policies governing the use of said funds as set forth in P.L. 106-74 (2000), 24 CFR 598.215 and Federal Register, April 16, 1998. b. Consultant has received and read a copy of the City's SUBRECIPIENT Agreement with the Santa Ana Empowerment Corporation and agrees to be bound by all of the terms and conditions of said SUBRECIPIENT Agreement, as set forth in Exhibit C, Acknowledgement of Subrecipient Agreement, attached hereto and by this reference incorporated herein. 10. CONSULTANT CERTIFICATIONS a. Consultant has read and shall comply with any and all restrictions on lobbying as set forth in the Certification Regarding Lobbying, attached hereto as Exhibit D and incorporated herein by reference. Page 4 of 9 b. Consultant shall maintain a drug free workplace as set forth in the Certification regarding Drug Free Workplace Requirements, attached hereto as Exhibit E, and incorporated herein by reference. c. Consultant assures and certifies that it will not use any funds appropriated under this agreement for religious activity or anti -religious activity, or to promote or oppose any political candidate, party and/or belief. d. Consultant assures and certifies that where applicable, classroom training instructors are properly credentialed, and training curriculums comply with State Education Codes. e. Consultant assures and certifies that it is in good standing with the California Secretary of State Franchise Tax Board and Internal Revenue Service. f. Consultant agrees to cooperate with any monitoring, inspection, audit, or investigations of activities related to this agreement as may be scheduled and conducted by the Santa Ana WORK Center of the Santa Ana Empowerment Corporation. g. Consultant agrees to acknowledge the Santa Ana WORK Center and Santa Ana Empowerment Corporation as the source of funds in all oral presentations, written documents, publicity and advertisements regarding any activities that ensue from this agreement. 11. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by telefacsimile or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 telefacsimile (714) 647-6956 With courtesy copy to: Santa Ana WORK Center 1000 E. Santa Ana Boulevard, Suite 200 Page 5 of 9 Santa Ana, California 92701 telefacsimile (714) 565-2602 To Consultant: Community Action Partnership of Orange County Human ServicesNVeatherization Dept. 5015 W. Edinger Street Santa Ana, California 92704 A party may change its address by giving notice in writing to the other party. Thereafter, any notice, tender, demand, delivery, or other communication shall be addressed and transmitted to the new address. If sent by mail, any notice, tender, demand, delivery, or other communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by telefacsimile, any notice, tender, demand, delivery, or other communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 12. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Consultant. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Consultant nor the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein. 13. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Consultant, Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other consultants retained by City. Page 6 of 9 14. TERMINATION This Agreement may be terminated upon thirty (30) days written notice by either party. In such event, Consultant shall be entitled to receive and the City shall pay Consultant compensation for all services performed by Consultant prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, the Executive Director may require Consultant to deliver to the City all work product completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Consultant consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 15. DISCRIMINATION Consultant shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 16. JURISDICTION -VENUE This Agreement and all questions relating to its validity, interpretation, performance, and enforcement shall be governed and construed in accordance with the laws of the State of California. This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 17. PROFESSIONAL LICENSES Consultant shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and in writing of her inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. Page 7 of 9 18. 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 referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. // // // // // // Page 8 of 9 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the last date and year written below. DATED:31 ATT PATRICIA E. HEALY, Clerk of the Council CITY OF SANTA Ana, a municipal Corporation of the State of California David N. Ream City Manager APPROVED AS TO FORM: O—City KAUFMAN, JCity General Counsel CONTRACTOR: DATED: 9/22/03 FederalTaXID: 95-2452787 RECOMMENDED FOR APPROVAL A JohWP. Reekstin, Executive Director Community Development Agency Page -9 od 9 Community Action Partnership of Orange County FEZ Daisy Wheel Network Program Scope of Work I. TERM July 1, 2003 through June 30, 2004 II. PURPOSE The FEZ Daisy Wheel Network Program will provide vocational/occupational training, employment strategies, education, and supportive services to individuals who reside in the Federal Empowerment Zone. III. POPULATION TO BE SERVED The population to be served are Federal Empowerment Zone residents 18 years and older. Eligibility will be determined by age, address, and by Right to Work documentation. IV. PROGRAM DESIGN, ELEMENTS, AND OUTCOMES FOR COMMUNITY ACTION PARTNERSHIP OF ORANGE COUNTY A. Program Design: a. Provide an intake assessment (for screening) of each FEZ resident that includes a review of academic and occupational skills levels as well as service needs; b. Develop an Individual Service Plan including notifying achievement objectives. B. Program Elements: a. The following program elements will be made available to eligible residents expected to enroll in the FEZ Daisy Wheel Network Program for participation in activities aimed at providing a comprehensive strategy that addresses employment and training needs. i. vocational/occupational training, ii. employment strategies, iii. education, and iv. supportive services C. Performance Outcomes a. 170 will be served b. Of the 170 FEZ residents served, 85 (50%) will be provided additional services as needed c. Of the 170 FEZ residents served, 68 (40%) will be placed in jobs, given work experience, receive On -the -Job Training, receive retention services, attend English as a Second Language classes, be provided with skill upgrades, and have access to paid internships. d. Planned enrollments by Quarter: V. SERVICES WILL BE PROVIDED AT: Community Action Partnership of Orange County 5015-Z W. Edinger Ave. Santa Ana, CA 92704 EXHIBI"I - A Ise tr. 2 n tr. 36a Qtr. 4'h Qtr. 60 1 25 60 25 V. SERVICES WILL BE PROVIDED AT: Community Action Partnership of Orange County 5015-Z W. Edinger Ave. Santa Ana, CA 92704 EXHIBI"I - A VI. WORK CENTER RESPONSIBILITIES 1. Develop contracts for partners 2. Provide orientation and training on eligibility, referral process, assessment, MIS tracking system, joint policies and procedures, fiscal billing, documentation, etc. 3. Develop joint forms such as application, screening/intake tool, ISP, referral form, MIS forms, etc. 4. Perform Program Monitoring 5. Perform Program Reporting 6. Provide partners with on-going technical assistance 7. Provide a quarterly FEZ newsletter 8. Facilitate monthly meetings VII. COMMUNITY ACTION PARTNERSHIP OF ORANGE COUNTY RESPONSIBILITIES 1. Community Action Partnership of Orange County will provide eligible FEZ residents with services designed to meet the FEZ Board requirements. A participant will be provided with one or more of the following services to assist them in obtaining unsubsidized employment and self-sufficiency: • 5 clients with EITC • 5 clients enrolled in Food Stamp Program • 10 clients enrolled in utility assistance program • 10 clients enrolled into universal lifeline program • 20 clients enrolled in health insurance program • 35 clients enabled to access other support services and community resources 2. Evaluate participants for eligibility and assign those eligible for program services. 3. Perform client assessments. Assess education level of FEZ participants through TABE test and using ISP form. 4. Report progress and job placements to WORK Center FEZ staff. 5. Incorporate all service navigator partners' information into each other's marketing materials. 6. Attend monthly partner meetings. 7. Provide WORK Center FEZ staff with monthly and quarterly progress reports. 8. Provide WORK Center FEZ staff with necessary information for conducting informal and formal monitoring of program progress. 9. Meet performance measures. All staff and agencies participating in this project will be held accountable for achieving their agency FEZ performance measures. 10. Submit Monthly Statistics Report documentation to FEZ Liaison staff by the 5th of every month. Report should include new enrollments and a continuous Activity Enrollment Form. 11. Maintain a current and complete file (electronic as well as a hard copy) for each FEZ participant: eligibility documentation; registration form; enrollment form; assessment; Individual Service Plan (ISP); EEO/Grievance; case notes; supportive services documentation; attendance records; training documentation; etc. 12. Comply with allowable expenses. To be allowable, costs must: a) be reasonable for the performance of the program; b) conform to any limitations or exclusions set forth in the program as to types or amount of cost items; c) be consistent with policies and procedures that apply uniformly to both federally -financed and other activities of the organization; d) be determined in accordance with generally accepted accounting principles (GAAP); e) not be included as a cost or used to meet cost sharing or matching requirements of any other federally -financed program in either the current or a prior period; and, f) be adequately documented. EXHIBIT A 13. Submit in triplicate, a monthly Invoice on City of Santa Ana, Federal Empowerment Zone Program Subrecipient Request for Reimbursement, showing in detail the amount of money already expended. Accounting records must be supported by source documentation such as cancelled checks, paid bills, payrolls, and attendance records. Submit the above stated documents to Osiel "Ozzie" Madrigal by the tenth (10th) day of the month following the month in which services are performed. EXHIBIT A Community Action Partnership of Orange County Pathway BUDGET FORM Attach a separate sneet detailing these costs. ** Please Note: pursuant to audit requirements, states, local governments and non-profit institutions that receive $300,000 or more in federal funds in a fiscal year shall meet the audit requirements of the OMB Circular A-133, "Audits of States, and Local Governments and Non -Profit Institutions." EXHIBIT # Administrative Program Total WIA Match/In Kind Personnel Salaries* One 0.05 FTE Project Director One 1.0 FTE Outreach/Pathway Navigator ' One 0.05 FTE Planning Director One 0.05 FTE Finance Director Sub total $3,640 $28,000 $3,640 $28,000 $3,640 $4,000 $31,640 $31,640 $7,640 Benefits (@ 25%) $7,910 $7,910 $1,910 Other (list)* Total Personnel $39,550 $39,550:$6,000 ,550 Operating Expenses a' Rent or user fee* Utilities 240Phones .200Internet fees ,200 Parking fees Security Maintenance Insurance $1,000 $1,000 -0- E ui ment* Rental fees (1 Cell hone) $1,200 $1,200 Purchase (1 lap tops) $2,500 $2,500 Vehicle lease charges vehicles may not bepurchased) -0- -0- -0- -0- Office expenses (consumables) $900 $900 Accounting Services Legal services $500 $500 -0- Auditing services $500 $500 -0- Indirect costs (attach indirect cost rate lan" Staff training $1,200 $1,200 Staff travel/mileage $800 $800 Job Training Support services* $8,000 $8,000 Profit (for profits only) -0-0- Other (list) Total Operating Expenses $0 $16,600 $16,600 $8,640 GRAND TOTAL (Total Personnel + Total Operating Expenses) $56,150 $56,150 $18,190 Attach a separate sneet detailing these costs. ** Please Note: pursuant to audit requirements, states, local governments and non-profit institutions that receive $300,000 or more in federal funds in a fiscal year shall meet the audit requirements of the OMB Circular A-133, "Audits of States, and Local Governments and Non -Profit Institutions." EXHIBIT # ACKNOWLEDGEMENT OF SUBRECIPIENT AGREEMENT To: John P. Reekstin Executive Director Santa Ana Empowerment Corporation From: Subcontractor/Assignee Subcontractor/Assignee hereby stipulates that it has been provided with a copy, has read, and is familiar with all of the terms of SUBRECIPIENT's Agreement with the Santa Ana Empowerment Corporation. Subcontractor/Assignee further agrees to be bound to all of the terms and provisions of SUBRECIPIENT's Agreement with the Santa Ana Empowerment Corporation. Executed this 22nd dayof September , 2003 BY: Name: Title: EXHIBIT C 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 funSis 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 malting of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperaive 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 subcontracts, 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/Contractor Clarence W. Ray, Exec. Dir. ((% I? �.,� 9/22/2003 Name of Certifying Officer Signature EXKMIT D Part I Project INSTRUCTIONS FOR COMPLETION OF SF -LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure forth still be completed by the reporting entity, whether subawardee or prime Federal recipient, at the Initiation or receipt of a covered Federal action, or a material change to a previous filling, pursuant to title 31 U.S.C. section 1352. The filling of a forth be required for each payment or agreement to make payment for any lobbying entity 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 a Federal Action. Used the SF -LLL -A Continuation Sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filling and material change report. Refer to the Implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered Federal Action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. 2. Identify the status of the covered Federal action. 3. Identify the appropriate classification of this report. If this is a followup report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action. 4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g, the first subawardee of the prime is the 1" tier. Seaboard include but are not limited to subcontracts, subcontracts, subgmnts and contract awards under grants. 5. If the organization filling the report in item 4 checks "subwardee" then enter the full name, address, city, state and zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Gaurd. 7. Enter the Federal program name or description for the covered Federal action (iteral). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g.) Request for Proposal (RFP) number; invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Include prefixes, e.g. "RFP -DE -90-001." 9. For a covered Federal action where these has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influence the covered Federal action. (b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name, First Name, and Middle initial (MI). 11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply, if this is a material change report, enter the cumulative amount of payment made or planned to be made. 12. Check the appropriate box(es). Check all boxes that apply, if payment is made through an in-kind contribution, specify the nature and value of the in-kind payment. 13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature. 14. Provide a specific and detailed description of the services that the lobbyist has performed, or will be expected to perforin, and the date(s) for any services rendered. Include all preparatory and related activity, not just time spent in actual contact with Federal officials. Identify the Federal official(s) or employee(s) contacted or the officer(s), employee(s), or Member(s) of Congress that were contacted. 15. Check whether or not a SF -LLL -A Continuation Sheet(s) is attached. 16. The certifying official shall sign and date the form, print his/her name, title, and telephone number. Public reporting burden for this collection of inf rmtation is estimated to average 30 minutes per response, including time for reviewing instructions searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, D.C.20503. EXHIBIT D Part II Certification Regarding Drug -Free Workplace Requirements The certification set out below is a material representation upon which reliance is placed by the U.S. Department of Housing and Urban Development in awarding the grant. If it is later determined that the contractor knowingly rendered a false certification, or otherwise violates the requirements of the Drug -Free Workplace Act, the U.S. Department of Housing and Urban Development, in addition to any other remedies available to the Federal Government, may take action authorized under the Drug -Free Workplace Act. CERTIFICATION A. The contractor certifies that it will provide a drug-free workplace by: (a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the contractor's workplace and specifying the actions that will be taken against employees for violation of such prohibition; (b) Establishing a drug-free awareness program to inform employees about - (1) The dangers of drug abuse in the workplace; (2) The contractor's policy of maintaining a drug-free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance program; and (4) the penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; (c) Making it a requirement that each employee who will be engaged in the performance of the grant be given a copy of the statement required by paragraph (a); (d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the contract, the employee will - (1) Abide by the terms of the statement; and (2) Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction. (e) Notifying the U.S. Department of Housing and Urban Development within ten days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction; EXHIBIT E Pg. 2 (f) Taking one of the following actions, within 30 days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted - (1) Taking appropriate personnel action against such an employee, up to and including termination; or (2) Requiring such employee 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; (g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e) and (f). B. The contractor shall insert in the space provided on the attached "Place of Performance" form the site(s) for the performance of work to be carried out with the grant funds (including street address, city, county, state, and zip code). the contractor further certifies that, if it is subsequently determined that additional sites will be used for the performance of work under the contract, it shall notify the U.S. Department of Housing and Urban Development immediately upon the decision to use such additional sites by submitting a revised "Place of Performance" form. Dated: September 22, 2003 Program Operator `J EXHIBIT E DIVISION OF EMPLOYMENT SERVICES PLACE OF PERFORMANCE FOR CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS Name: Kathy Kifaya Name of Contractor: Community Action Partnership of orange County Contractor Number: Date: The Contractor shall insert in the space provided below the site(s) expected to be used for the performance of work under the contract convered by the certification: Place of Performance (include street.address, city, county, state, zip code for each site): Human Services 5015 W. Edinger #Z Santa Ana, CA 92701 EXHIBIT E EXHIBIT F ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company This endorsement modifies such insurance as is afforded by the provisions of Policy # 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. This 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 Policy # _ Issued to this endorsement form as a part of Named Insured Countersigned by Authorized Representative APG-DNOF LIABILITY DATE(MMIDDY) INSUWCE 06/27/2003 PRODVCER (949) 709-8800 FAX (94W709-1668 Comprehensive Insurance Services 22342 Avenida Empresa Suite 200 RSM, CA 92688 THIS CERTIFICATE 15 13111111IFED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED Orange County Community Development Council, II DBA: Community Action Partnership of Orange CountyNSURER 12640 Knott Street - a ©v3 -15 g Garden Grove, CA 92641 INSURERA: NONPROFITS' INSURANCE ALLIANCE OF CA INSURER B: NATIONAL UNION FIRE INS CO C: INSURER D: 1 INSURER E: COVERAGES 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. INSR TR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE GATE MM/DDIYY POLICY EXPIRATION DATE MMIDD/YY LIMITS GENERAL LIABILITY 003 -00441 -NPO 07/01/2003 07/01/2004 EACH OCCURRENCE $ 1,600,00 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 100,000 CLAIMS MADE � OCCUR MED EXP (Any one person) $ 10,000 PERSONAL B ADV INJURY $ 1,000,00 A X Owner & Contr. Pro GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2,000,00 X POLICY PRO LOC JECT AUTOMOBILE X LIABILITY ANY AUTO 2003-00441—NPO 07/01/2003 07/01/2004 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,06 BODILY INJURY $ (Per person) A ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per accident) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGO $ EXCESS LIABILITY 003-00441-UMB-NPO 07/01/2003 07/01/2004 EACH OCCURRENCE $ 4,000,00 X OCCUR ❑ CLAIMS MADE AGGREGATE $ 4,600,000 A $ XIDEDUCTIBLE$ X RETENTION $ 10, 00C S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY TORYST LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ B TYR - EMPLOYEE ISHONESTY 05118772 07/01/2003 07/01/2004 LIMIT $700,000 DEDUCTIBLE $5,000 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED PER ATTACHED CITY ENDORSEMENT `EXCEPT 10 DAYS FOR NON-PAYMENT �`•�•••.--.- I II La I IUNML INSUNCUi 1NSUMEN LC 11 CK: V•/11YVrCLLN11Vry CITY OF SANTA ANA COMMUNITY REDEVELOPMENT AGENCY RESIDENT OMBUDSMAN M-21 CIVIC CENTER PLAZA SANTA ANA, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL *)%X%XM MAIL `3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Kpd06KML�fdNflfllXiYIYLXKdIi10�7k104XXraH(�IECi(d(MdfYdWfd6l061EYIXi4lSi6KXX AUTHORIZED REPRESENTATIVE Richard Fvnon. CIC/TFRFMY .J� 0 0 ADDITIONAL INSURED ENDORSEMENT Insurance Company NONPROFITS INSURANCE ALLIANCE OF CA This endorsement modifies such insurance as is afforded by the provisions of Policy #2003 -00441 -NPO relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents and volunteers 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. This 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 canceled, 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 7/1/03 this endorsement forth as a part of Policy # 2003 -00441 -NPO Issued to COMMUNITY ACTION PARTNERSHIP OF ORANGE COUNTY Named Insured Countersigned by Authorized Representative