HomeMy WebLinkAboutTEMPLO CALVARIO 1 - 2004
INSURANCE ON FILE
WORK MAY PROCEED
UNTIL INSURANCE EXPIRES
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CLERK OF COUNCIL
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A-2004-166
AGREEMENT BETWEEN
THE CITY OF SANTA ANA
AND
TEMPLO CALVARIO
FOR USE OF EMPOWERMENT ZONE FUNDS
This Agreement, made and entered into this 1st day of July, 2004, by and between
the City of Santa Ana a charter city and municipal corporation duly organized and existing
under the Constitution and laws of the State of Califomia ("CITY"), and Templo Calvario
"CONTRACTOR").
Recitals:
I.
WlIN£S§EIH
1.
The City of Santa Ana, 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").
2.
CITY desires to engage CONTRACTOR to provide the services at the cost
set forth in Exhibit A and for the services set forth Exhibit B, hereinafter
referred to as "said program" and CONTRACTOR represents that it is
qualified and willing to operate said program.
WHEREFORE, for and in consideration of the respective and mutual
covenants hereinafter contained and made, and subject to all the terms and
conditions hereof, the parties hereby agree as follows:
CONTRACTOR'S OBLIGATIONS
A.
CONTRACTOR agrees to use all federal funds provided by CITY to
CONTRACTOR pursuant to this Agreement to operate said program, as set
forth in "Exhibit B," attached hereto and by this reference incorporated
herein. CONTRACTOR'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 CONTRACTOR
under Paragraph II hereof.
B.
CONTRACTOR agrees to obtain and maintain all required licenses,
registrations, accreditation and inspections from all agencies governing its
operations. CONTRACTOR shall ensure that its staff shall also obtain and
maintain all required licenses, registrations, accreditation and inspections
from all agencies governing CONTRACTOR operations hereunder.
C.
CONTRACTOR 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 CONTRACTOR fail to have the required land
entitlement and/or permits, thus violating any local, state or federal rules and
Page 1 of 14
regulations relating thereto, CONTRACTOR shall immediately make 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. CONTRACTOR 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. CONTRACTOR 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.
D.
All funds received by CONTRACTOR from CITY pursuant to this Agreement
shall be separately accounted for apart from any other funds of
CONTRACTOR, or of any principal or member of CONTRACTOR.
CONTRACTOR agrees that if CONTRACTOR receives $300,000 or more in
any Federal funds, CONTRACTOR shall have an annual audit conducted by
a certified public accountant in accordance with the standards as set forth
and published by the United States Office of Management and Budget
Circular A-133. CONTRACTOR shall provide CITY with a copy of said audit
by October 1 of the year following the program year in which this Agreement
is executed.
E.
CONTRACTOR shall keep records of all funds received from CITY under
the terms and conditions of this Agreement in accordance with the
procedures set forth in the "Agreement Accounting and Administrative
Handbook", a copy of which shall be provided to CONTRACTOR by CITY.
CONTRACTOR agrees to keep monthly records of all ethnic and racial
statistics of persons and families benefited by CONTRACTOR in the
performance of its obligations under this Agreement, including, but not
limited to, the number of low and moderate income persons and households
assisted in accordance with federal income limits, number of female heads
of households, and number of senior citizens assisted.
CONTRACTOR agrees to provide CITY with written cumulative (year-to-
date) reports of its activities on or before the 15th day of July, October,
January and April for the period beginning October 1, 2004 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, case load and activities. When
appropriate, pictures should be included. This agreement shall terminate on
June 30, 2005, unless extended by mutual consent of the parties. Any
extension shall be in writing, and executed by the Executive Director of the
Community Development Agency and General Counsel on behalf of CITY.
Page 2 of 14
I.
CITY, SAEC and the United State Government and/or their representatives
shall have access for purposes of monitoring, auditing, and examining
CONTRACTOR's activities and performance, to books, documents and
papers, and the right to examine records of CONTRACTOR's
subcontractors, bookkeepers and accountants, employees and participants
in regard to said program. CITY, SAEC 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 CONTRACTOR
are kept. Nothing herein shall be construed to require access to any
privileged or confidential information as set forth in federal or state law.
In the event CONTRACTOR does not make the above-referenced
documents available within the CITY of Santa Ana, California,
CONTRACTOR 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.
F.
All accounting records and evidence pertaining to all costs of
CONTRACTOR and all documents related to this Agreement shall be kept
available at the location where CONTRACTOR conducted the program, as
well as in the County of Orange, for the duration of the Agreement and
thereafter for five (5) years after completion of an audit. 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 resolution or
disposition of such appeals, litigation, claims, or exceptions.
G.
CONTRACTOR 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. CONTRACTOR agrees that it has read, understood and shall
follow the legal obligations referred in Exhibit C.
H.
CONTRACTOR 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
CONTRACTOR shall be reported immediately to CITY.
Subreceipient acknowledges and warrants that it shall at all times comply
with the laws, regulations and policies governing the use of FEZ funds,
including but not limited to, the limitations on use of FEZ funds set forth in
P.L. 106-74 (2000), 24 CFR section 598.215 and Federal Register, April
16,1998.
Page 3 of 14
J.
Without prejudice to any other provisions of this Agreement, CONTRACTOR
shall, where applicable, maintain the confidential nature of information
provided to it concerning participants in accordance with the requirements of
federal and state law. However, CONTRACTOR shall submit to CITY,
SAEC and or HUD or its representatives, all records requested, including
audit, examinations, monitoring and verifications of reports submitted by
CONTRACTOR, costs incurred and services rendered hereunder.
K.
CONTRACTOR 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.
L.
CONTRACTOR agrees that if CONTRACTOR violates any of the terms and
conditions of this Agreement or any prior Agreement whereby FEZ funds
were received by CONTRACTOR, or if CONTRACTOR reports inaccurately,
or if on audit there is a disallowance of certain expenditures, CONTRACTOR
agrees to remedy the acts or omissions causing the disallowance or repay
CITY all amounts spent in violation thereof.
M.
CONTRACTOR 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.
N.
CONTRACTOR hereby certifies and agrees that it will not use funds
provided through this Agreement to pay for entertainment, meals or gifts.
O.
CONTRACTOR certifies 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. CONTRACTOR
shall sign a certification to that effect in a form as set forth in "Exhibit 0,"
attached hereto and by this reference incorporated herein. CONTRACTOR
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 CONTRACTOR 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
Page 4 of 14
S.
T.
II.
shall complete and submit a "Disclosure Form to Report Lobbying," in
accordance with its instructions.
P.
CONTRACTOR agrees that except for the use of FEZ funds to pay salaries
and other related administrative or personnel costs, no persons who
exercise or have exercised any function with respect to FEZ 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
FEZ-assisted activity of CONTRACTOR, 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 CONTRACTOR.
CONTRACTOR acknowledges and warrants that prior to having any
contractor perform work paid for by FEZ funds, that it shall be responsible
(i) for providing such contractor with a copy of this Agreement, and (ii)
ensuring that any such contractor executes and provides to the Executive
Director of the Community Development Agency a letter in substantially
the form of Exhibit E hereto, agreeing to be bound by the terms of this
Agreement.
a.
R.
CONTRACTOR acknowledges and warrants that during the term of this
Agreement it shall to the maximum extent feasible collaborate with other
CONTRACTOR to ensure that duplication of services is avoided. Such
collaboration shall include, but not be limited to, regular attendance (i.e.,
an attendance record exceeding 50%) and active participation in the
appropriate committee or committees established pursuant to the
Strategic Plan.
CONTRACTOR agrees to provide a drug-free work place and to execute a
certification as set forth in "Exhibit F" attached hereto and incorporated
herein by this reference.
CONTRACTOR shall comply with general provisions, assurances, and
certifications attached hereto as "Exhibit G" and incorporated herein.
CITY'S OBLIGATIONS
Upon execution of this Agreement by CONTRACTOR, CITY shall pay to
CONTRACTOR from FEZ funds, when, if and to the extent received from HUD, for
CITY's 2004-05 FEZ program year amounts expended by CONTRACTOR in
carrying out said program for fiscal year 2004-05 pursuant to this Agreement up to
a maximum aggregate payment of forty five thousand twenty five hundred dollars
($45,025) for CONTRACTOR'S performance in accordance with the payment
schedule attached hereto as "Exhibit A". Payments shall be made to
Page 5 of 14
CONTRACTOR through the submission of periodic invoices, in a form prescribed
by CITY, detailing such expenses. CONTRACTOR agrees to submit the above-
stated document to the FEZ Navigator Office, 1000 E. Santa Ana Blvd., Suite 200,
Santa Ana, CA 92701. 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 CONTRACTOR is in compliance with
the terms and conditions of this Agreement.
CITY has the right to de-obligate the funds hereunder and take such funding
back from CONTRACTOR due to any of the following reasons: (a) lack of
performance by CONTRACTOR; (b) lack of fiscal accountability of
CONTRACTOR; or (c) decrease in available funding.
III.
PROGRAM INCOME
A.
B.
C.
For the purposes of this Article (III) "Program income," shall mean gross
income received by the CONTRACTOR directly generated from the use of
FEZ funds, except as provided below in Paragraph III.C. When such income
is generated by an activity that is only partially assisted with FEZ funds, the
income shall be prorated to reflect the percentage of FEZ funds used.
Program income includes, but is not limited to the following:
1.
Proceeds from the disposition by sale or long term lease of real
property purchased or improved with FEZ funds;
Proceeds from the disposition of equipment purchased with FEZ
funds.
Gross income from the use or rental of real or personal property
acquired by the CONTRACTOR with FEZ funds, less the costs
incidental to the generation of such income;
Gross income from the use or rental of real property owned by the
CONTRACTOR that was constructed or improved with FEZ funds,
less the costs incidental to the generation of such income;
Payments of principal and interest on loans made using FEZ funds;
Proceeds from the sale of loans made with FEZ funds;
Proceeds from the sale of obligations secured by loans made with
FEZ funds;
Interest earned on funds held in a revolving fund account;
Funds collected through special assessments made against
properties owned and occupied by households not of low and
moderate income, where such assessments are used to recover all
or part of the FEZ portion of a public improvement.
2.
3.
4.
5.
6.
7.
8.
9.
Program income does not include income on grant advances from the U.S.
Treasury. The following items of income earned on grant advances must be
remitted to HUD for transmittal to the U.S. Treasury.
Page 6 of 14
IV.
1.
Interest earned from the investment of the initial proceeds of a grant
advance by the U.S. Treasury;
2.
Interest earned on loans or other forms of assistance provided with
FEZ funds that are used for activities determined by HUD either to be
ineligible or to fail to meet a national objective or other federal criteria.
3.
Interest earned on the investment of amounts reimbursed to the FEZ
program account prior to the use of the reimbursed funds for eligible
purposes.
D.
The receipt of program income (as defined in Paragraph iliA hereinabove)
by CONTRACTOR in the operation of said program shall be recorded by
CONTRACTOR and reported to CITY.
E.
Program income received by CONTRACTOR shall be returned to CITY
unless otherwise provided for in this Agreement.
NONDISCRIMINATION
CONTRACTOR agrees that no person on the ground of race, color, national origin,
religion 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 FEZ funds.
V.
SPECIAL CERTIFICATION FOR RELIGIOUS ENTITIES
If CONTRACTOR is a religious entity, CONTRACTOR hereby agrees that in
connection with the provision of the services CONTRACTOR shall provide with
FEZ funds:
C.
A.
CONTRACTOR shall not discriminate against any employee or applicant for
employment on the basis of religion and shall not limit employment or give
preference in employment to persons on the basis of religion.
B.
CONTRACTOR shall not discriminate against any person applying for the
services CONTRACTOR agrees to provide under the terms of this
Agreement on the basis of religion and shall not limit such services or give
preference to applicants for such services on the basis of religion.
CONTRACTOR shall NOT provide religious instruction or counseling,
conduct any religious worship or services, or engage in any religious
proselytizing, or exert any religious influence in the provision of the services
in said program.
Page 7 of 14
D.
Where the services to be provided under said program are rendered on
property owned by the primarily religious entity CONTRACTOR, FEZ funds
may also be used for minor repairs to such property which are directly
related to the cost of rendering the services under said program, where the
cost constitutes in dollar terms only an incidental portion of the FEZ
expenditure for rendering the services under said program.
VI.
PROHIBITION OF NEPOTISM
CONTRACTOR 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 CONTRACTOR. For the purposes of
this section, the term "immediate family" means spouse, child, mother, father,
brother, sister, brother-in-law, sister-in-law, father-in-law, mother-in-law, son-in-law,
daughter-in-law, aunt, uncle, niece, nephew, step-parent and stepchild. The term
"administrative capacity" means having selection, hiring, supervisor or management
responsibilities.
VII.
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:
Santa Ana WORK Center
WORK Center Director
1000 E. Santa Ana Blvd., Suite 200
Santa Ana, California 92701
Telefacsimile (714) 565-2602
And,
CLERK:
Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 82702-1988
Telefacsimile (714) 647-6956
TO CONTRACTOR: ~ 0 \ -«.v-"'.o Ci:)~
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Page 8 of 14
VIII.
IX.
ASSIGNABILITY
CONTRACTOR shall not assign nor transfer any interest in this Agreement,
whether by assignment or novation, without the prior written consent of CITY;
provided, however, that claims for money due or to become due CONTRACTOR
from CITY under this Agreement may be assigned to a bank, trust company or
other financial institution, or to a trustee in bankruptcy, without such approval.
Notice of any such assignment or transfer shall be promptly furnished to CITY.
HOLD HARMLESS
CONTRACTOR shall indemnify and save harmless CITY, its officers, employees,
agents, representatives and volunteers from and against any and all damages to or
for loss of use of property and for 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, employees, agents, representatives and
volunteers from and against any and all claims, demands, suits, actions or
proceedings 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 CONTRACTOR, its officers, directors, employees,
agents, subcontractors and suppliers arising out of CONTRACTOR's performance
of this Agreement.
X. INSURANCE
CONTRACTOR shall obtain and maintain for the entire term of this Agreement
comprehensive general public liability insurance, in companies acceptable to the
City, authorized to issue such insurance in the State of California. Said
insurance shall consist of the following:
A.
Commercial General Liabilitv. CONTRACTOR agrees to obtain and keep
in force during the term of this Agreement a policy of comprehensive
commercial public liability insurance insuring the State of California, CITY,
and CONTRACTOR against any liability for accident, injury or death
arising out of or in consequence of this Agreement. Such insurance shall
be in an amount not less than One Million Dollars ($1,000,000.00) for any
injury to or death of any person or persons in any single accident or
occurrence. Said policy of comprehensive public liability insurance shall
be endorsed to provide to CITY and to the State of California, Employment
Development Department, at least thirty (30) days written notice prior to
cancellation; name CITY, its officers, agents, employees, and volunteers,
and the State of California, its officers, employees, and volunteers as
additional insureds; and state that such coverage is primary to any other
coverage or self-insurance of the State of California and CITY.
Governmental entities may substitute a certificate of self-insurance.
Page 9 of 14
XI.
B.
Automobile Liabilitv Coveraae. CONTRACTOR shall also obtain and
maintain, during the effective period of this Agreement, broad form
automobile liability coverage with a $1,000,000 limit unless reduced by
CITY, which applies to both owned/leased and non-owned automobiles
used by CONTRACTOR employees or participants in performance of this
Agreement, or, in the event that CITY will not utilize such owned/leased
automobiles but intends to require employees, participants or other agents
to utilize their own automobiles in the performance of this Agreement,
CONTRACTOR shall secure and maintain on file from all such employees,
participants, or agents as self-certification of automobile insurance
coverage. Governmental entities may substitute a certificate of self-
insurance.
C.
Workers' Compensation. If CONTRACTOR is an "employer", as set forth
in California Labor Code Section 3300 et seq., or utilizes participants as
"employees," as set forth in California Labor Code Section 3350 et seq.,
CONTRACTOR shall obtain and keep in force during the term of this
Agreement full Workers' Compensation insurance coverage for injuries
suffered by participants. Said insurance policy shall guarantee CITY at
least thirty (30) days written notice of cancellation or modification.
CONTRACTOR shall carry medical and accident insurance for those
participants not qualifying as "employees" for Worker's Compensation
Coverage, pursuant to California Labor Code Section 3350, et seq.
D.
Eauipment Coveraae. CONTRACTOR shall purchase a policy or policies
of insurance covering loss or damage to any and all Equipment provided
to or purchased by CONTRACTOR in accordance with this Agreement.
Said insurance shall be in the amount of the full replacement value
thereof, providing protection against the classification of fire, extended
coverage, vandalism, malicious mischief, theft, and special extended
perils. Governmental entities may substitute a certificate of self-insurance.
E.
Proof of Insurance. Certificates and endorsements (Exhibit H) must be
submitted and approved by CITY prior to any work under this Agreement.
CONTRACTOR understands that CITY will make no payments under this
Agreement until the required certificates and endorsements have been
approved by CITY.
REVERSION OF ASSETS
A.
Upon the expiration of this Agreement, CONTRACTOR shall transfer to
CITY any FEZ funds on hand at the time of the expiration of this Agreement
as well as any accounts receivable attributable to the use of FEZ funds.
Page 10 of 14
C.
B.
Any real property under CONTRACTOR's control that was acquired or
improved in whole or in part with FEZ funds in excess of $25,000.00 must
either be:
1.
Used, where CITY has given written approval, to meet one of the
national objectives stated under federal law until five (5) years after
expiration of this Agreement, or for such longer period of time as
determined to be appropriate by CITY; or
2.
If not used in accordance with subparagraph A above,
CONTRACTOR shall pay to CITY an amount equal to the current fair
market value of the property less any portion of the value attributable
to the expenditure of non-FEZ funds for acquisition of, or
improvement to, the property. Such payment is program income to
CITY.
C. Subject to the obligations set forth herein, title to equipment acquired
under the terms of this Agreement will vest upon acquisition in
CONTRACTOR. When said equipment which has been acquired in
accordance with this Agreement and all applicable regulations is no longer
needed for said program, disposition of said equipment will be made as
follows:
1.
Items of equipment with a current per unit fair market value of less
than $5,000.00 may be retained, sold or otherwise disposed of with
no further obligation to CITY.
2.
Items of equipment with a current fair market per unit value of
$5,000.00 or more may be retained or sold and CITY shall have the
right to an amount calculated by multiplying the current market value
or proceeds from the sale by CITY's share of federal funds used to
acquire the equipment.
CONTRACTOR hereby agrees, upon the demand of CITY, to execute,
acknowledge and deliver, or cause any person or entity who may have any
claim to rights hereunder or under any document, instrument or agreement
executed in furtherance of the services and activities to be performed
hereunder, to execute, acknowledge and deliver, to CITY assignment(s),
quit claim deed(s) or such other and further instruments, documents and
agreements as may be necessary, in the sole and absolute discretion of
CITY, to vest in CITY all of CONTRACTOR's right, title and interest (if any it
may have) in and to CITY, SAEC, FEZ or other federal, state and/or local
accounts or program funds or allocation of funds to which CITY is or may be
entitled, either for its own account or as fiduciary or trustee for others, which
were obtained for the purpose of the performance of this Agreement or any
previous agreements relating to the same subject matter or activities as this
Agreement, together with any instruments, loans, grants or advances by
Page 11 of 14
XII.
CONTRACTOR on behalf of CITY, in furtherance of the activities hereunder
or thereof.
CONTRACTOR's obligations and responsibilities set forth in this paragraph
"XI. REVERSION OF ASSETS:' and in paragraphs "XII. TERMINATION"
and "III. PROGRAM INCOME" shall not be affected by the termination of this
Agreement and shall survive the date of termination of this Agreement for
such period of time as CITY and/or HUD deems necessary for the
responsibilities, duties and obligations to be performed and completed to the
satisfaction of CITY and HUD.
TERMINATION
A.
This Agreement may be terminated on thirty (30) days' written notice by
either party. In the event of such termination, CONTRACTOR shall only be
entitled to reimbursement 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 CONTRACTOR of the terms and
conditions of the this agreement or applicable State or Federal
requirements. In the event of such suspension or termination,
CONTRACTOR shall only be entitled to reimbursement for approved
expenses incurred up to the effective date of suspension or termination.
C.
In the event CONTRACTOR defaults by failing to fulfill all or any of its
obligations hereunder, CITY may declare a default and termination of this
Agreement by written notice to CONTRACTOR, 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
notice, 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 payments 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 by CITY to CONTRACTOR pursuant to this Agreement
may be terminated for convenience upon two weeks written notice to
CONTRACTOR.
E.
In the event this Agreement is terminated as set forth in subparagraphs
XII A through XII.D., inclusive, CONTRACTOR agrees to immediately return
to CITY upon CITY's demand and prior to any adjudication of
Page 12 of 14
CONTRACTOR's rights, any and all funds not used, and to comply with
paragraph "XI. REVERSION OF ASSETS" of this Agreement.
XIII.
LIMITATION OF FUNDS
The United States of America, through HUD, may in the future place programmatic
or fiscal limitations on the use of FEZ funds which limitations are not presently
anticipated. Accordingly, 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
CONTRACTOR's authority to commit and spend funds, or may restrict
CONTRACTOR'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 Executive
Director 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 CONTRACTOR'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 CONTRACTOR 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 legally binding commitments made by
CONTRACTOR 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.
XIV.
EXCLUSIVITY AND AMENDMENT OF AGREEMENT
This Agreement supersedes any and all other agreements, either oral or in writing,
between the parties hereto with respect to the use of CITY's FEZ funds by
CONTRACTOR 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 anyone 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 CONTRACTOR.
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
affect the validity of any other provision of this Agreement.
Page 13 of 14
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of
the last date and year written below.
DATED:
PATRICIA E. HEALY,
Clerk of the Council
DATED: -'6 - ) \- Ocf
CITY OF SANTA Ana, a municipal
Go~oaz~~"fum;'
David N. Ream
City Manager
APPROVED AS TO FORM:
~~'''7
{ðiI N KAUFMAN,
City General Counsel
CONTRACTOR:
- IØI
Page 14 of 14
Templo Calvario
FEZ Daisy Wheel Network 2004-05
BUDGET FORM
Match!
Administrative Total FEZ In Kind
Salaries. $4,052.00 $36,052.00 $4,000
Benefits $492.00 $4,380.00 $480
Other (list).
Total Personnel $4,544.00 $40,432.00
Rent or user fee. $1,343.00 $1,343.00
Phones $350.00 $350.00
E ui ment. $1,200.00 $1,200.00
Office expenses
(consumables) $400.00
Marketin $400.00 $400.00
Customer Trainin . $1,300.00 $1,300.00
Su ort services. $5,000.00
Operating Expenses
Sub-total $4,593 $4,593 $6,250
$4,544 $40,481 $45,025 $10,730
EXHIBIT A
PERSONNEL
Administration:
Program Director .8 fie
Benefits at 12.15%
Total Administration
Program:
Employment Specialist I fie
Benefit at 12.15%
Total Program
Total Personnel:
OPERATIONS
Rent:
Phones:
Equipment:
Marketing:
Training Material:
Total Operations:
BUDGET NARRATIVE
$1,343.00
$350.00
$1,200.00
$400.00
$1,300.00
$4,593.00
$4,052.00
$492
$4,544.00
$32,000.00
$3,888.00
$35,888.00
$40,432.00
EXHIBIT A
Templo Calvario
FEZ Daisy Wheel Network Program
Scope of Work
Templo Calvario CDC is pleased to participate with the city of Santa Ana and other
Daisy Wheel partners in providing eligible program participants with family support, job
training and placement and other services. Templo Calvario CDC's specific
commitments to this collaborative/partnership effort are outlined in the following
1.
Term of Agreement
July 1, 2004 through June 30, 2005
2.
Purpose of Program
The FEZ Daisy Wheel will provide vocationaVoccupational training, employment
strategies, education, and supportive services to individuals who reside in the
Federal Empowerment Zone.
3.
Population to be served
The population we will serve are Federal Empowerment Zone residents 18
years and older. Eligibility will be determined by address, age and Right to
Work documentation.
4.
Program Design, Elements, and Outcomes for Templo Calvario CDC
A. Program Design:
a. Provide an intake assessment for screening of each FEZ resident that
would include a review of academic and occupational skills level and
and service needs.
b. Develop an Individual service Plan including notifying achievement
objectives.
B. Program Elements:
c. 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
1. employment strategies,
2. education, and,
3. supportive services
C. Performance Outcomes
a. 50 will be served
b. Of the 50 FEZ residents served, 25 (50%) will be provided additional
services as needed.
c. Of the 50 FEZ residents served, 20 (40%) will be given work
experience, receive On the Job Training, receive retention services,
EXHIBIT B
5.
6.
attend English as a Second Language classes, be provided with skill
upgrades, and have access to paid internships.
d. Of the 50 FEZ residents served, 15 (30%) will be placed in
unsubsidized employment
e.
Planned enrollment by Quarter
1st Qtr.
18
3rd Qtr.
18
4th Qtr
7
2ndQtr.
7
Services will be provided at:
Templo Calvario CDC
2617 W 5th Street
Santa Ana Ca, 90703
WORK Center Responsibilities
I. Develop contracts for partners
2. Provide orientation and training on eligibility, referral process,
assessment, MIS tracking systems, 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
7.
Templo Calvario CDC Responsibilities
I. Templo Calvario CDC 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:
a. Recruitment and enrollment services
b. Employment workshops
c. Job development
d. Placement and retention services
e. WEX / OJT
f. Job fair development
g. Information, service, and referrals to VITA, I-CAN, HRA,
CARE, Food bank, etc.
h. Incentive and donation assistance
2. Evaluate participants for eligibility and assign those eligible for
program services.
EXHIBIT B
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. In corporate all service navigator partners information into each others
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 measurements. The 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 each month. Report should include new enrollments and
a continuous Activity Enrollment Form.
11. Maintain a complete and current 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 of 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; and, f) be adequately documented.
13. Submit in triplicate, a monthly Invoice on City of Santa Ana, Federal
Empowerment Zone Program Sub recipient Request for
Reimbursement, showing in details 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
Madrigal by the 10th day of the following the month in which services
are preformed.
EXHIBIT B
SUB RECIPIENT 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. §2000 ET SEQ.) and implementing regulations in 24 CFR Part 1.
2. No person in the United States shall on the ground of race, COIOI, 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 on the locality as determined in accordance
with the Davis-Bacon Act, as amended, 40 U.S.c. § §276a-276a-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. SUB RECIPIENT 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) SUB RECIPIENT does not assume CITY's responsibility for initiating
the review process under Executive Order 12372.
EXHIBIT C
Certification Regarding Lobbying
Certification for Contracts. Grants. Loans. and CooDcrative AllI'cements
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 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.
~ lo~\~o Œ-'DQ
~¡¿
Grantee/Con actor Organization
Name of Certifying Officer
EXHIBIT D
Part I
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form stiH 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 form 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-LLLMA
Continuation Sheet for additional information if the space on the form is inadequate. Complete a11 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 fo11owup report caused by a material change to the information previously reported,
enter the year and quarter in which the change occuITed. 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 I st tier. Seaboard include but are not limited to subcontracts, subcontracts, subgrants and contract awards
under grants.
5.
If the organization fil1îng the report in item 4 checks "subwardee" then enter the fuB name, address, city, state and zip code of the prime Federal
recipient. Include Congressional District, ifknown.
6.
Enter the name of the Federal agency making the award or loan commitment. Include at 1east 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 (itemI). 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 I (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 awardl10an
commitment for the prime entity identified in item 4 or 5.
10.
(a) Enter the fu11 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 individua1(s) performing services, and include fu11 address if different trom 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 a11 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 a11 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 a11 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 perform, and the date(s) for any
services rendered. Include a11 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 hislher name, title, and telephone number.
Public reporting burden for this co11ection ofinfonnation 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
ACKNOWLEDGEMENT OF
SUB RECIPIENT AGREEMENT
To:
Patricia C. Whitaker
Executive Director
Santa Ana Empowerment Corporation
Prom: 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
daYOf~, ZGb'-f .
BY:
~
Title:
EXHIBIT E
Certification Reaardinq Druq-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 làter
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)
(b)
(c)
(d)
(e)
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;
Establishing a drug-free awarenoss program to inform employees about -
(1 )
(2)
(3)
The dangers of drug abuse in the workplace;
The contractor's policy of maintaining a drug-free workplace;
Any available drug counseling, rehabilitation, and employee assistance
program; and
the penalties that may be imposed upon employees for drug abuse
violatións occurring in the workplace;
(4)
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);
Notifying the employee in the statement required by paragraph (a) that, as a
condition of employment under the contract, the employee will -
(1 )
(2)
Abide by the terms of the statement; and
Notify the employer of any criminal drug statute conviction for a violation
occurring in the workplace no later than five days after such conviction.
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 F
Pg.2
B.
(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 .
Requiring such employee to participate satisfactorily in a drug abuse
assistance or rehabilitation program approved for such purposes by a
Federal, Stat~, or local health, law enforcement, or other appropriate
agency; .
(2)
(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).
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 fund~
(including street address, city, county, state, and zip code). the contractor furthel I
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 Housin~
and Urban Development immediately upon the decision to use such additional sites by
submitting a revised "Place of Performance" form.
Dated:
~~ l \ -o<--f
r gram 0 er tor
.<
DIVISION OF EMPLOYMENT SERVICES
PLACE OF PERFORMANCE
. FOR CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS
E:L~2tW' ~-~ L" L¥\A
Name of Contractor: ~ Id ,Ch..~\k:w';o L'D C
Name:
contractor'Number:
Date:
<2-(\- olf
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:
<2- (p LI
Performance (include street address, city, county,
site):
W' S~ 9.rt-'( ~)CA~{)3.
state, zip code
Place of
for each
4)
6)
Subcontractor agrees that in addition to those agreements and obligations
specified in the contract boiler plate and scope of work, it will also adhere to and
obey the following provisions, assurances, and certifications.
ARTICLES
1 )
Subcontractor 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, parties, and/or
beliefs.
2)
Contractor assures and certifies that where applicable, classroom training
instructors are properly credentialed, and training curriculums comply with
State Education Codes.
3)
Subcontractor assures and certifies that any requested modification to this
agreement must be submitted in writing, explaining requested changes
and rationale. Subcontractor further assures that no modification will be
implemented without prior written approval from the Santa Ana WORK
Center.
Contractor assures and certifies that they are in good standing with the
California Secretary of State Franchise Tax Board and Internal Revenue
Service.
5)
Subcontractor 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 or the Santa
Ana Empowerment Corporation.
Subcontractor agrees to acknowledge (give credit) the Santa Ana WORK
Center and the Santa Ana Empowerment Corporation as the source of
funds in all oral presentations, written document, publicity, and
advertisements regarding any activities that ensue from this agreement.
EXHIBIT G
AdJRDN CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIODNY)
7-16-2004
Pi/OUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Carl L. Dieda Ins. Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
680 Langsdorf Dr. II 210 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fullerton, Ca. 92831 ,
i INSURERS AFFORDING COVERAGE
¡ INSURER A. Gu1deUne ins. ~ompany ~----_._-
INSURED
Templo Calvario and Church of No Walls INSURER B-
2617 W 5th sr. INSURER c:
Santa Ana, ca. 92703 -- -.-
INSURER D'
, INSURER E-
COVERAGES
THE POLtCIES 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.
INSA i TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
~ERAL LIABILITY I
A r -x¡ COMMERCIAL GENERAL LIABILITY - I
F=fJ CLAIMS MADE ~ OCCUR 1135 991 '6-1-2002
~ 6-1-2003
~ 6-1-2004
FIRE DAMAGE (Anyone fire)
$
EACH OCCURRENCE
LIMITS
$
6-1-2003
6-1-2004
6-1-2005
i
MED EXP (Anyone person) $
PERSONAL & ADV INJURY $
i GENERAL AGGREGATE $
PRODUCTS. COMP/OP AGG $
SCHEDULED AUTOS
HIRED AUTOS
Øu#
I
!
I
i
//4
!
,
,,' COMBINED SINGLE lIMI----L-T I $
: (Eaaccident)
r-- .
I BODilY INJURY i $
i (Per person) !
I
$
BODilY INJURY
(Per accident)
ANY AUTO
All OWNED AUTOS
NON.OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
DEDUCTIBLE
RETENTiON
$
AUTO ONLY. EA ACCIDENT $
EA ACC $
AGG $
$
$
$
$
$
OTHER THAN
AUTO ONLY:
EXCESS LIABILITY
OCCUR D CLAIMS MADE
EACH OCCURRENCE
AGGREGATE
OTHER
i
i
i
DESCRIPTION OF OPERATIONSlLOCATlONSNEHIClESJEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
I I WC STATU- OTH.
!-~~-~~:;Z~~~~~~~$--l . 000 ~ÕOO
~SE~SE. EA EMPlOYE~ 1.000 000
, E.l. DISEASE. POLICY LIMIT I $ 1 000 000
I WORKERS COMPEr.¡SATlON A!'!':!
EMPLOYERS' LIABILITY
A
1216 380
I '
! '
i 10-1-2003 110-1-2004
c ~v~t1.es 0
For partnership between Templo Calvario and City of Santa Ana in finding
in the surrounding communities. Thru resource center at the church.
Beginning 7-1-2004
jobs for families
CERTIFICATE HOLDER
i ADDITIONAL INSURED; INSURER LETTER:
CANCELLATION
The City of Santa Ana, its Officers, Agents
and Employees. Santa Ana Work Center
1000 E. Santa Ana Blvd. Suite 200
Santa Ana, Ca. 92701
Attn: Bea Gonzalez
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL EHiIIUIQ(IIIKK) MAil ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE1œÐt](~maxJS QJGK1ICIC
IJII!I:ImtXtX~~JtJaJaX1JP.l J[:mEXŒII8EJI~JRI[
"""""'"
ACORD 2S-S (7/97)
@ ACORD CORPORATION 1988
.
- ..
S7F. FORM
FORM 199.EZ
(Nov. 1957)
<m
ENDORSEMENT
DATED
ATTACHED TO
AND FORMING
""RTOF
P01.ICY NO.
NAME: OF IN8URANCE COMPANY
7-16-2004
1135 991
GuideOne Ins. Co.
AOaNeY AT
¡ISSUED TO
Ca. (INSURED'S NAME ill
MAILING ADDREJiIIl)
Templo Calvario and Church of No Walls, 2617 W 5th St. Santa Ana,
Carl L Dieda Ins. 680 Langsdorf Dr. # 210
Fullerton Ca. 92831
COMMENCEMENT OF POLICY
EXPIRATION OF POLICY
EFFEC
ATE OF THIS ENDORSEMENT
6-1-2004
6-1-2005
7-1-2004
""'OUNT OF INSURANCE
PERIL.S
FIRE
OL.D RATE
NEW RATE
ADDITIONAL PREMIUM
RETURN PREMIUM
EC<
IT IS HEREBY UNDERSTOOD AND AGREED THAT THE
'.fJi::' .ol:;-~ . ct::, 0(;-:0..':" .0" 0
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0 0 0 0 0 0 0 0 0 0 0
IS CORRECTED OR CHANGED TO READ AS FOLLOWS
As recorded the following is added as Additional Insured to the above policy
The City of Santa Ana, its Officers, Agents
and Employees. Santa Ana Work Center
1000 E. Santa Ana Blvd. Suite 200
Santa Ana, Ca. 92701
Attn: Bea Gonzalez
As respects to Community Outreach described on attached certificate of Liability
Insurance
Insured
~¿" 2/2
.Consent by..
.Consent by..
Mortgagee or Payee
*Not required unless policy is reduced or restricted by this endorsement.
cQ.
GuideOne Mutual Insurance Company
GuideOne Life Insurance Company
GuideOne Elite Insurance Company
GuideOne Specialty Mutual Insurance Company
GuideOne L10yds Insurance Company
GuideOne America Insurance Company
FAMILY JACKET
ACCOUNT NUMBER
AGENT 04-301
CARL DIEDA
DBA: CARL L DIEDA INS AGENCY
680 LANGSDORF DR STE 210
FULLERTON, CA 92831
(04 ) (714)870-7752
001135991
001135991-01
Insurance
1111 Ashworth Road, West Des Moines, Iowa 50265-3538
ADDITIONAL INSURED
CITY OF SANTA ANA ITS OFFICERS
EMPLOYEES, AGENTS & REPRESENTV
20 CIVIC CENTER PLAZA
SANTA ANA CA 92701
INSURED
TEMPLO CALVARIO AND CHURCH OF
NO WALLS
2617 WEST 5TH STREET
SANTA ANA CA 92703
A - JfXA -I {{;(f7
NOTICE OF CANCELLATION
COMMERCIAL PACKAGE
Policy Number 1135-991
Perhaps you have overlooked your recent insurance statement. We appreciate your business and
want to continue your coverage. However, because we have not received premium payment, the
policy listed above is canceled, effective at 12:01 a.m. standard time on 12/26/04.
To help us avoid this action and continue your coverage without interruption, please submit the
minimum premium due before the cancellation date. A late charge will be included in your next
billing statement.
If you have already sent your payment, please accept our thanks. If you have any questions
about your policy, please contact your agent listed above. Thank you for insuring with
GuideOne Insurance.
Policies included within this account are:
1135-991
MEMORANDUM COpy
120604
UBCL92
Mar 21 06 04:40p
Templa Calvaria C D C
714 543 2399
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Mar 21 06 04:40p
Templa Calvaria C D C
714 543 2399
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Mal" 21 06 04.42p
Templa Calvaria C D C
714 543 2399
;..Jon profits'
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NONPROFITS' INSURANCE ALLIANCE OF CALIFORNIA
P.O. Box 8507, Santa Cruz, CA 95061
P: (800) 359-6422
F: (831) 459-0853
NONPROFITS OWN
COMMERCIAL LINES COMMON POLICY DECLARATIONS
PRODUCER:
Schweickert & Company
15 Peters Canyon Road
Irvine, CA 92606
NAME OF INSURED AND MAILING ADDRESS:
Templo Calvario Community Development Corporation
2511 W. 5th Streel
Sanla Ana. CA 92703
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Nonprofits' Insurance
Alliance of California
A lEAD FClIINSWHC:! ...J. NWTFOINONPIOIIII
POLICY NUMBER: 2006-17088. NPO
RENEWAL OF NUMBER: 2005-17088- NPO
POLICY PERIOD:
FROM 0210812006 TO 0210812007
AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE
BUSINESS DESCRIPTION: Job Resources and Educational Services for Low Income Families
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS
POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY.
THIS POLICY CONSISTS OF THE FOl.LOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THESE PREMIUMS MAY BE SUBJECT TO ADJUSTMENT.
PREMIUM
$4,176
$150
Not Covered
COMMERCIAL GENERAL LIABILITY COVERAGE PART. OCCURRENCE ..................
COMMERCIAL AUTO LIABILITY COVERAGE PART ..................................................
COMMERCIAL AUTO PHYSICAL DAMAGE COVERAGE'PART ....................................
IMPROPER SEXUAL CONDUCT COVERAGE PART ..........................
COMMERCIAL LIQUOR LIABILITY COVERAGE PART ...................................................
TERRORISM COVERAGE (Certified Acts) .......................................................................
TOTAL:
FORM(S) AND ENDORSEMENT(S) MADE A PART OF THIS POLICY AT TIME OF ISSUE:'
NlAC-Gl~PO NIAc-L.L-NPO NIAC-SC-NPO NIAC-AL-NPO SCHEDULE Go
NIAG-E27J9.98. CG OC 01107 98, NIAC-Xf/08 02, NIAC-E3J1-99. NIAC-E4J1-91,
NlAC-E1117-92, NtAC-E121~92, N1AC-E1S'3-94, NIAC-E22f8..95, N1AC-E2811.99,
NIAC-E32J9-01, N1AC-E33I1-02, CG 00 33101 96, CG 20 11-NP0ID1 96, CG 20 121(J7 98,
CG2Q26J0704, CG 2034107 04, CG2171/1202, 002271111-85, CG2407l11-85,
IL 00 17/11 98, IL 02 70107 02, IL 09 DW05 04,
SCHEDULE L,
NIAC-E5I3-91,
NIA.C-E29/1-99,
CG2018/11.as,
002504111-85,
$2,700
INCLUDED
$52
$7 ,078
SCHEDULE SA.,
NIA.C-E7/10 04,
N1AC-E30/4-00,
CG202OJ11-85,
C07194104 93,
.OMrrs APPLICABLE FORMS AND ENDORSEMENTS IF SHOWN IN
SPECFlC COVERAGE PART f COVERAGE FORM DECLARATIONS.
COUNTERSIGNED: 0211312006 BY
p~ r!. &..
(AUTHORIZED REPRESENTATIVE)
THESE DECLARATIONS AND THE COIIWON POUCY DEClARATIONS, F APPUCABLE, TOGETHER WIT1t THE COMMON POLICY CONDITIONS, COVERAGE FORM(S)
AND FORMS AND ENDORSEMENTS, . AHV, ISSUI!D TO FORM A flART THEREOF, COMPlETE THE ABOVE NUMBERED POUCY.
NIAC-CO .NPO (01844-00)
Mar- 21 06 04:42p
Templo Calvar-io C D C
714 543 2399
l\:onprofits'
~WN
NONPROFITS' INSURANCE ALLIANCE OF CALIFORNIA
P.O. Box 8507, Santa Cruz, CA 95061
P: (800) 359-6422
F: (831) 459-0853
'nnprpfih I"'>lIt,ll1ft'
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Nonprofits' Insurance
Alliance of California
AIE.MlI'OllINSWfCE ...A IDI'TfClNONPlOmI
COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS
PRODUCER:
Schweickert & Company
15 Peters Canyon Road
Irvine, CA 92606
NAME OF INSURED AND MAILING ADDRESS:
Templo Calvaria Community Development Corporation
2511 W. 5th Street
Santa Ana, CA 92703
POLICY NUMBER: 2006-17088 -NPO
RENEWAL OF NUMBER: 2005-17088 -NPO
POLICY PERIOD:
FROM 02/0812006 TO 02/0812007
AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE
BUSINESS DESCRIPTION: Job Resources and Educational Services for Low Income Families
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS
POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY.
LIMITS OF COVERAGE:
GENERAL AGGREGATE LIMIT (OTHER THAN PRODUCTS - COMPLETED OPERATIONS)
PRODUCTS - COMPLETED OPERATIONS AGGREGATE LIMIT .............................
PERSONAL AND ADVERTISING INJURY LIMIT ....................................................
EACH OCCURRENCE LIMIT ...................................................................................
DAMAGE TO PREMISES RENTED TO YOU .........................................................
MEDICAL EXPENSE LIMIT ..............................................,.......................................
ADDITIONAL COVERAGES:
SOCIAL SERVICE PROFESSIONAL LIABILITY
AGGREGATE LIMIT ........................................... ........................,....................
EACH OCCURRENCE LIMIT ............................................................................
CLASSIFICATION(S)
$2,000,000
$1,000,000
$1,000,000
$1,000,000
$100.000 anyone premiseS
10,000 anyone ..",on
$1,000,000
$1,000,000
SEE ATTACHED SUPPLEMENTAL DECLARATIONS SCHEDULE G
PREMIUM
$4,176
FORMS AND ENDORSEMENTS APPLICABLE TO THIS POLlCV ARE INCLUDED IN COMMERCIAL LINES COMMMON POLICY DECLARATIONS
COUNTERSIGNED: 02/1312006
~ ~ ,,(2.
BY
(AUTHORIZED REPRESENTATIVE)
THESE DECLARAl10NS AND 'ffiE COIIIION POLICY DEClARAnoNS. IF APPUCABLE. TOGETHER WITH THE COMMON POUCY CONDITIONS, COVERAGE FORM(S)
AND (lll'QRMS AND ENDORSE_NTI, IF MY, ISSUED TO FORM A. PART THEREOF, COMPLETE THE ABOve NUMBI!RED POLICY.
NIAC . GL. NPO (01844)