HomeMy WebLinkAboutPaint Your Heart Out 1
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AGREEMENT TERMINATION ~~''~"~ ~
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Please complete this form when the attached agreement is no longer.neffect. '~ 8' a-
Return form to the Sr. Deputy Clerk of the Council (M-30). Call 647-5238 if you haue~agy
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Department
Signature:
Date:
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City of Santa Ana
Revised 8-7-03 Clerk of the Council
INSURAPJGE 1'dOT ~~~+ rl ~C A-loos-121
VJOr~K rv1^l' 'u0T ~>!?(JCEEO
CLERK 0~ COUNOIL
DATF; cos o0 os sros
AGREEMENT BETWEEN THE CITY OF SANTA ANA AND
Cb~ PAINT YOUR HEART OUT, INC. FOR USE OF
~F Ej.eyy~dti~~ COMMUNITY DEVELOPMENT BLOCK GRANT FUNDS
(With Provisions Relating to Compliance with Title X
and 24 CFR Part 35 Relating to Lead Based Paint)
This Agreement, made and entered into this 30th day of June, 2005, by and between the
City of Santa Ana, a charter city and municipal corporation of the State of California ("CITY") and
Paint Your Heart Out, Inc.; a California nonprofit corporation ("SUBRECIPIENT"),
Recitals:
WITNESSETH
A. The CITY, as an entitlement recipient and grantee of the United States Department of
Housing and Urban Development ("HUD") Community Development Block Grant ("CDBG")
Program, desires to enter this Agreement with the SUBRECIPIENT for the expenditure of CDBG
funds in accordance with Title 24, Part 570 of Code of Federal Regulations 24 CFR 570.000, et seq.
("CDBG REGS"); and
B. CITY has applied for and received CDBG funds from HUD pursuant to Title I of the
Housing and Community Development Act of 1974, Public Law 93-383, as amended ("ACT"); and
C. The SUBRECII'IENT is a private nonprofit agency that has been selected by the CITY to
receive CDBG funds and administer such financial assistance; and to provide the services described
in Exhibit A, in accordance with the schedule of performance included therein, hereinafter referred
to as "said program". SUBRECIPIENT represents that it is qualified and willing to operate said
program and certifies that the activities carried out with funds provided under this Agreement will
meet one or more of the CDBG program's National Objectives (24 CFR Part 570.208).
D. SUBRECIPIENT agrees that it will adhere to the performance measurements and
outcomes as indicated on Exhibit B ("Scope of Work"). Failure to fallow the measurements and
meet the stated outcomes may constitute breach of contract that could result in termination of
this Agreement or serve as reason for the City to recapture the grant funds awarded to
SUBRECIPIENT pursuant to this Agreement.
E. Title X of the 1992 Housing and Community Development Act (Title X) established
requirements relating to lead based paint ("LBP") in housing receiving federal assistance,
in particular requirements relating to (i) notification (including pamphlet distribution, disclosure to
purchasers and lessees, notice of lead hazard presumption or results of evaluation, and/or lead
hazard reduction), (ii) lead hazard evaluation (including visual assessment, paint testing and/or risk
assessment), (iii) lead hazard reduction (including paint stabilization, interim controls, standard
treatments, or abatement depending on the requirements for housing activity type), (iv) ongoing
maintenance, if required, and (v) response to children with environmental intervention blood lead
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levels, as required; and
F. On September 15, 1999 HUD adopted implementing regulations to Title X that became
effective September 15, 2000 as set forth in 24 CFR Part 35, et seq. ("LBP Regs', which establish
specific rules regarding notification to owners and occupants about the existence of LBP hazards,
identification of LBP hazards, and control of LBP hazards; and
G. Residential structures built after January 1, 1978 are exempt from lead-based paint
requirements as the use of lead-based paint was banned for use in residences after this date by
Congress (24 CFR Part 35.115). Therefore, the Title X requirements set forth herein shall not be
applicable if the structures involved were built after January 1, 1978.
H. Subpart K -Acquisition, Leasing, Support Services, and Operation of the LBP Regs,
sets forth specific requirements relating to housing providers, such as SUBRECIPIENT, who
administer local programs that provide supportive housing for special needs populations and are
funded by HUD Office of Community Planning and Development ("CPD") programs, including
CDBG funds, as provided to SUBRECIPIENT under this Agreement; and
I. In connection with the grant of funds under this Agreement, CITY requires that
SUBRECIPIENT comply and evidence of compliance with all applicable requirements of Title X
and the LBP Regs, in particular Subpart K relating to acquisition, leasing support services, or
operations, and Subpart J relating to rehabilitation, as and when applicable; and
J. In connection with the grant of funds under this Agreement, CITY requires that
SUBRECIPIENT comply and show evidence of compliance with all applicable requirements of
Title X and the LBP Regs, in particular Subpart M relating to tenant based rental assistance, as and
when applicable; and
K. Attached and hereby fully incorporated to this Agreement are the following notification
attachments: Attachment No. 1 entitled "Protect Your Family From Lead In Your Home",
EPA747-K-99-001, Attachment No. 2 entitled "Sample Disclosure Format for Target Housing
Sales, Disclosure of Information on Lead-Based Paint and Lead-Based Paint Hazards", and
Attachment No. 3 entitled Sample Summary Risk Assessment Notice Format"; provided however,
that such attachments are not intended to modify or limit SUBRECII'IENT'S obligation to fully
comply with all applicable provisions of Title X and the implementing regulations in the LBP Regs;
and
L. By this Agreement SUBRECIPIENT will accept assignment from the CITY of all
responsibilities set forth in Subpart K of the LBP Regs; and
M. The CITY and SUBRECIPIENT have duly executed this Agreement for the expenditure
of such funds; and
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WHEREFORE, it is agreed by and between the parties, that the foregoing Recitals are a substantive
part of this Agreement and the following terms and conditions are approved and together with all
exhibits and attachments hereto, shall constitute the entire Agreement between the CITY and
SUBRECIPIENT:
I. SUBRECIPIENT'S OBLIGATIONS
A. Non-Profit Status - Representations and Warranties.
(1) SUBRECIl'IENT acknowledges that its operations and the services it provides to the
community are subject to Subpart K (and, in some instance(s) Subpart Jand/or Subpart M) of the
LBP Regs.
(2) SUBRECIPIENT acknowledges that its operations and the services it provides
includes: (a) acquisition, leasing, or ownership of residential property for the purpose of
providing affordable housing for persons with special needs, such as transitional housing, or
(b) housing for persons with special needs, such as the disabled, or (c) financial assistance to
assist transitional housing participants to move to permanent housing by paying for the first
month's rent or security deposit, or (d) tenant-based rental assistance to program participants
who choose their own housing units, and by provision of such services such housing is subject to
the requirements of the LBP Regs.
(3) Representations:
(a) Authority. SUBRECIPIENT is a duly organized and existing non-profit
corporation in good standing and authorized to do business under the laws of the State of
California. SUBRECIPIENT has full right, power and lawful authority to accept the funding
hereunder and to undertake all obligations as provided herein and the execution, performance
and delivery of this Agreement by SUBRECIPIENT has been fully authorized by all requisite
actions on the part of SUBRECIPIENT.
(b) Experience. SUBRECIPIENT is a qualified provider of the services to be
provided hereunder.
(c) Familiarity With Services Required. By executing this Agreement,
SUBRECIPIENT warrants that (i) it has thoroughly investigated and considered the services to
be performed and provided hereunder, (ii) it has carefully considered how the services should be
performed, and (iii) it fully understands the facilities, difficulties and restrictions attending
performance of the services under this Agreement, inclusive of compliance with the LBP REGS.
Should SUBRECIPIENT discover any latent or unknown conditions materially differing from
those inherent in the work or as represented by CITY, it shall immediately inform CITY of such
fact and shall not proceed except at SUBRECIPIENT'S risk until written instructions are
received from CITY'S representative.
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(d) No Conflict. To the best of SUBRECII'IENT'S knowledge,
SUBRECIPIENT'S execution, delivery and performance of its obligations under this Agreement
will not constitute a default or a breach under any contract, agreement or order to which
SUBRECIPIENT is a party or by which it is bound.
(e) No Bankruptcy. SUBRECIPIENT is not the subject of any current or
threatened bankruptcy proceeding.
(f) No Pending Legal Proceedings. SUBRECIPIENT is not the subject of a
current or threatened litigation that would or may materially affect SUBRECIPIENT'S
performance under this Agreement.
(g) Application Veracity. All provisions of and information provided in
SUBRECIPIENT'S application for funding submitted to CITY including any exhibits are true
and correct in all material respects.
(b) No Pending Investigation. SUBRECIPIENT is not aware that it is the
subject of any current or threatened criminal or civil action investigation by any public agency,
including without limitation a police agency or prosecuting authority, that would relate to affect
performance of the Agreement or provision of services hereunder.
(4) Compliance with Subpart K of LBP ReQS. Subpart K-Acquisition,
Leasing, Support Services, or Operation
(a) SUBRECIPIENT acknowledges and agrees that it shall comply with and
implement the requirements set forth in Title X and the LBP Regs to eliminate, as faz as
practicable, LBP hazards in all residential property that is under its ownership, possession, or
control and/or residential property occupied by persons or families that receive financial or other
assistance from SUBRECIPIENT.
(b) SUBRECIPIENT shall provide a notice to all residents/occupants of
residential property that is under its ownership, possession, or control and/or residential property
occupied by persons or families that receive financial or other assistance from SUBRECIPIENT
in accordance with Section 35.125 of the LBP Regs.
(i) SUBRECIPIENT acknowledges that in connection therewith a visual
assessment is not considered an evaluation for purposes of the LBP Regs.
(c) Notification (24 CFR 35.1301. SUBRECIPIENT shall provide the LBP
hazard information pamphlet in accordance with Section 35.130 of the LBP Regs to all
occupants, owners, and purchasers of housing.
(i) The pamphlet shall be the EPA/HUD/Consumer Product
Safety Commission lead hazard information pamphlet or anEPA-approved
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equivalent. The current form and version of the pamphlet is attached as
Attachment No. 1 to this Agreement.
(ii) SUBRECIPIENT shall cause to be disclosed to all purchasers
and lessees available information and knowledge regarding the presence of LBP
and LBP hazards prior to selling or leasing a housing unit in accordance with 24
CFR 35, Subpart A. The current form and version of such notice is attached as
Attachment No. 2 to this Agreement.
(iii) SUBRECIPIENT shall ensure that all occupants, owners, and
purchasers of housing be notified in writing of the results of the presumption of
LBP and/or LBP hazards, and results of any lead hazard evaluation, and any lead
hazard reduction work in accordance with 24 CFR 35, Subpart A. The current
form and version of such notice is attached as Attachment No. 3 to this
Agreement.
(d) Lead Hazard Evaluation (24 CFR 35.125). SUBRECIl'IENT shall conduct
all activities described in Section 35.1015 relating to visual assessment, paint stabilization, risk
assessment, and maintenance with regard to all residential property that is under its ownership,
possession, or control and/or residential property occupied by persons or families that receive
financial or other assistance from SUBRECIPIENT, except for the exemptions described below
in section 4 (d)(i)(1).
(i) SUBRECIPIENT shall cause a visual assessment to identify
deteriorated paint in all residential property that is under its ownership, possession, or control
and/or residential property occupied by persons or families that receive financial or other
assistance from SUBRECIPIENT.
(1)Section 35.115(a) provides exemptions from Subparts B
through R of the LBP Regs including without limitation, (a) short term emergency assistance
lasting less than 100 days cumulatively is exempted from compliance with Subpart K as to such
short term rental assistance units, and (b) exemption for zero-bedroom units, including SRO
units, for which occupancy by a recipient of SUBRECII'IENT'S services is for less than 100
days, and (c) exemption for residential housing units constructed afrer January 1, 1978.
(ii) To the extent that the assistance provided by SUBRECII'IENT
to persons or households meets one or more of the exemptions set forth in the LBP Regs, then
compliance with the notification, evaluation, reduction, clearance and other requirements of the
LBP Regs is not required related to the subject housing unit due to such exemption.
(iii) SUBRECIPIENT shall comply with the applicable provisions
of both Subpart K and Subpart M (Tenant Based Rental Assistance) of the LBP Regs as to all
tenant-based long term housing assistance, i.e., assistance to persons households residing in
housing units cumulatively for more than 100 days. If SUBRECIPIENT has knowledge that an
assisted family or household will occupy a dwelling unit for more than 100 days, the LBP Regs
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require evidence of compliance prior to occupancy. Funding to be provided hereunder is
conditioned upon evidence of compliance.
(1) Subpart M applies to all dwelling units occupied to be
occupied by families or households that have one or more children of less than 6 years of age, as
well as the common areas servicing such dwelling units, and exterior painted surfaces associated
with such dwelling units or common areas. LBP compliance requirements relating to such
dwelling units includes, without limitation: notification, evaluation by visual assessment, paint
stabilization utilizing safe work practices, and clearance.
(2) CITY advises SUBRECIPIENT that in the event the
services provided hereunder include rental assistance payments, such as first and last month's
rent and/or security deposit, and the assisted tenant executes a lease for long term occupancy,
including occupancy in the same dwelling unit for more than 100 days, then the provisions of
Subpart M (Tenant Based Rental Assistance), will apply (unless otherwise informed and directed
by HUD). In this regard, CITY advises SUBRECIPIENT that Subpart M requires HQS
inspection of each dwelling unit prior to occupancy and prior to compliance with applicable
notification, evaluation by visual assessment, reduction through paint stabilization utilizing safe
work practices, and clearance requirements of the LBP REGS.
(e) Lead Hazard Reduction Work. SUBRECIPIENT shall cause LBP hazard
reduction, such as paint stabilization, interim controls, standard treatments, or abatement of all
residential property that is under its ownership, possession, or control and/or residential property
occupied by persons or families that receive financial or other assistance from SUBRECIPIENT,
except as exempted as described in subsection 4(d)(i)(1) above.
(1) If paint stabilization occurs, SUBRECII'IENT shall cause paint
stabilization of each deteriorated surface and clearance of residential units pursuant to Section
35.1330(a) and (b) shall occur before occupancy of a vacant dwelling unit, or where a unit is
occupied, immediately after receipt of the CDBG FUNDS hereunder.
(2) Safe Work Practices shall be used in all LBP hazard reduction work.
(3) Clearance shall be conducted to confirm that no LBP hazards remain
when LBP hazard reduction work is complete. Confirmation of clearance by written certification
of a qualified inspector is required on an annual basis in connection with submittal of the April
15 quarterly report.
(f) Ongoing Maintenance. SUBRECII'IENT shall incorporate ongoing LBP
maintenance activities into regular building operations in accordance with Section 35.1355(a) for
all residential property that is under its ownership, possession, or control and/or residential
property occupied by persons or families that receive financial or other assistance from
SUBRECIPIENT, except as exempted as described in subsection 4(d)(i)(1) above.
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(1) Ongoing maintenance includes confirmation of clearance which shall
be conducted to confine that no LBP hazards remain when LBP hazard reduction work is
complete.
(2) Ongoing maintenance also includes confirmation of clearance by
written certification of a qualified inspector on an annual basis in connection with submittal of
the April 15 quarterly report.
(3) A part of such ongoing maintenance obligation includes notification of
the results of clearance confirmation and annual confirmation of clearance.
a. SUBRECIPIENT shall cause to be provided a notice to all
occupants of all residential property that is under its ownership, possession, or control and/or
residential property occupied by persons or families that receive financial or other assistance
from SUBRECIPIENT in accordance with Sections 35.125(b)(1) and (c), describing the results
of the clearance examination and the results of annual certification.
(g) Units Cleared Prior to Date of Agreement; Confirmation of Clearance.
In the event the requirements of the LBP REGS relating to lead hazard evaluation, lead hazard
reduction, and lead hazard clearance have been completed on the subject dwelling units prior to
the Date of Agreement, then the SUBRECIPIENT shall provide to the CITY with the April 15
quarterly report a certificate from a qualified inspector evidencing a recent inspection and
confirmation of clearance of LBP and LBP hazards from the subject dwelling unit(s).
5. LBP Informational Summary. For purposes of information only and in no
respect intended to be a representation or warranty of the provisions of the LBP REGS, the CITY
has caused to be prepared an information summary relating to the LBP REGS and application to
dwelling units that maybe occupied by recipients of services and/or funding from
SUBRECIPIENT under this Agreement. Attachment No. 4 to this Agreement, attached and
hereby fully incorporated by this reference, is such information summary. CITY staff will
cooperate with and make themselves available to SUBRECIPIENT to assist in implementation of
compliance with the LBP REGS as to residential dwelling units to be assisted by
SUBRECIPIENT. The parties acknowledge and agree the CITY is and shall not be liable or
responsible for the accuracy of such summary, and the SUBRECIPENT is directed to the LBP
REGS and implementing guidance published and provided by HUD relating to compliance with
such LBP REGS.
B. Amount of Grant and Ouarterly Disbursement. The amount granted to
SUBRECIPIENT is $91,792.00 ("CDBG FUNDS"), and such funds shall be expended by
SUBRECIPIENT on or before June 3Q 2006. The CDBG FUNDS shall be disbursed by CITY
to SUBRECIPIENT on a quarterly basis, subject to and upon receipt and approval of a complete
quarterly activity report from SUBRECIPIENT, with the final payment subject to the satisfaction
of the condition precedent of submittal of complete reporting information due on or before July
15th of the applicable funding year, as hereinafter more fully set forth. SUBRECIPIENT shall be
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obligated to perform such duties as would normally extend beyond the term, including but not
limited to obligations with respect to indemnification, audits, reporting, data retention/reporting,
and accounting.
C. Use of Funds. SUBRECIPIENT agrees to use all federal funds provided by CITY to
SUBRECIPIENT pursuant to this Agreement to operate said program, as set forth in "Exhibit B",
attached hereto and by this reference incorporated herein. SUBRECIPIENT'S failure to perform as
required may, in addition to other remedies set forth in this Agreement, result in readjustment of the
amount of funds CITY is otherwise obligated to pay to SUBRECII'IENT under Paragraph II hereof.
D. Allowable Costs. SUBRECIPIENT agrees to complete said program on or before
June 3Q 2006 and to use said funds to pay for necessary and reasonable costs allowable under the
federal law and regulations to operate said program. Said amounts shall include, but not be limited
to, wages, administrative costs, and employee benefits comparable to other similarly situated
employees. Other allowable program costs are detailed in the Budget, as set forth in "Exhibit B",
attached hereto and by this reference incorporated herein. SUBRECIPIENT shall use all income
received from said funds only for the same purposes for which said fimds may be expended
pursuant to the terms and conditions of this Agreement.
E. Licensin¢. SUBRECTPIENT agrees to obtain and maintain all required licenses,
registrations, accreditation and inspections from all agencies governing its operations.
SUBRECIPIENT shall ensure that its staff shall also obtain and maintain all required licenses,
registrations, accreditation and inspections from all agencies governing SUBRECIPIENT's
operations hereunder. Such licensing requirements include obtaining a City business license, as
applicable.
F. Zoning. SUBRECIPIENT agrees that any facility/property used in furtherance of
said program shall be specifically zoned and permitted for such use(s) and activity(ies). Should
SUBRECIPIENT fail to have the required land entitlement and/or permits, thus violating any local,
state or federal rules and regulations relating thereto, SUBRECIPIENT shall 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.
SUBRECIPIENT shall notify CITY immediately of any pending violations. Failure to notify CITY
of pending violations, or to remedy such known violation(s) shall result in termination of grant
funding hereunder. SUBRECIPIENT must make all corrections required to bring the
facility/property into compliance with the law within sixty (60) days of notification of the
violation(s); failure to gain compliance within such time shall result in termination of grant funding
hereunder.
G. Separation of Accounts. All funds received by SUBRECII'IENT from CITY
pursuant to this Agreement shall be maintained in an account in a federally insured banking or
savings and loan institution with record keeping of such accounts maintained pursuant to applicable
OMB Circular A-110 requirements. SUBRECIPIENT is not required to maintain separate
depository accounts for CDBG FUNDS; provided however, the SUBRECIPIENT must be able to
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account for receipt, obligation and expenditure of CDBG FUNDS pursuant to applicable OMB
Circular A-110 requirements.
H. Audit Renort Requirements. SUBRECIPIENT agrees that if SUBRECIPIENT
receives Three Hundred Thousand Dollars ($300,000.00) or more in federal funds,
SUBRECIPIENT shall have an annual audit conducted by a certified public accountant in
accordance with the standazds as set forth and published by the United States Office of Management
and Budget. SUBRECIPIENT shall provide CITY with a copy of said audit by October 1 of the
year following the program year in which this Agreement is executed. Further, SUBRECIPIENT
shall complyand/or cause compliance with audit report(s) required by applicable provisions of Title
X and the LBP Regs.
I. Record Keeping/Renorting. SUBRECIPIENT shall keep and maintain complete and
adequate records and reports to assist CITY in meeting and maintaining its record keeping
responsibilities under the CDBG REGS, Title X, and the LBP Regs, including the following:
(1) Records
a. Documentation evidencing program income requirements in
conformity with 24 CFR 570.504(b((2)(i), (ii) and 24 CFR 570.503(b)(3) and 24
CFR 570.208(a)(2)(B) of the income level of persons and/or families participating
in or benefiting by the SUBRECIPIENT program.
b. Documentation of the number of persons and/or families participating
in or benefiting by the SUBRECII'IENT program.
c. Household information shall include number of persons, identification
of head of household, race/ethnicity, and income verification.
d. Documentation of all CDBG FUNDS received from CITY.
e. Documentation of expenses as identified in the Budget Proposal,
including evidence of incurring the expense, invoices for goods or services, copies
of any and all contracts or documentation pertaining to costs for subcontractors,
plus all other invoices for which CDBG FUNDS were expended, and any payments
therefor.
f. Any such other related records as CITY shall reasonably require or as
required to be maintained pursuant to the CDBG REGS.
g. Documentation evidencing compliance with all applicable provisions
of Title X and the LBP Regs, in particulaz Subpart K and, as applicable Subpart J
and/or Subpart M.
(i) Specific documentation, as required, evidencing
compliance with all applicable provisions of such LBP Regs
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including: (i) notification, including distribution of the lead
hazazd information pamphlet (Attachment No. 1), disclosure
and notices of hazard evaluation and reduction (Attachments
No. 2 and 3); (ii) evaluation of lead hazazd(s), including paint
testing and risk assessment; (iii) reduction of lead hazard(s),
including safe work practices and clearance, and
confirmation of clearance; and (iv) ongoing maintenance, as
and if applicable for multifamily properties.
(ii) In this regard SUBRECII'IENT shall track information on
all persons/households assisted and the housing units assisted
with the CDBG FUNDS. Attachment No. 5 hereto is a sample
form for tracking persons/households and housing units
assisted with the CDBG FUNDS. All categories of
information set forth in such tracking form shall be prepazed
and submitted to the CITY with the April 15 quarterly report.
(iii) In the event that such information and reports are not
complete and reasonably satisfactory information submitted in
order for CITY staff to review and evaluate compliance with
applicable CDBG REGS and LBP Regs, then the final quarterly
disbursement payment shall be withheld from the
SUBRECIPIENT.
(iv) Documentation of clearance confirmation as provided in
Section L(1)(g) hereinabove.
(~) Reports
(i) Payment Request. Concurrently with the submittal of each
quarterly report, on or before the 15th day of October, January,
April and July, SUBRECIPIENT shall submit both: an original
invoice and true copies of invoices, receipts, agreements or
other documentation supporting and evidencing how the CDBG
FUNDS have been expended during the applicable quarter.
(ii) Quarterly Activity Report: Including in such reports
evidence of compliance with all applicable provisions of Title X
and the LBP Regs, in particular Subpart K and, as applicable
Subpart J, as further described in subsection (d) hereinafter, and
Subpart M, if SUBRECIPIENT provides long term tenant-based
rental assistance. SUBRECII'IENT agrees to provide CITY with
written cumulative (yeaz-to-date) reports of its activities on or
before the 15th day of October, January, April and July for the
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period beginning July 1, 2003 and through and including the
previous three-month reporting period setting forth the activities,
program accomplishments, new program information and yeaz-to-
date program statistics on expenditures, caseload and activities.
When appropriate, pictures should be included.
(iii) Any such other reports as CITY (or HUD) shall
reasonably require and/or request, including but not limited to
the following information: the receipt of program income [as
defined at 24 CFR 570.500(a)] by SUBRECIPIENT in the
operation of said program shall be recorded by SUBRECIPIENT
and reported to CITY; monthly records of all ethnic and racial
statistics of persons and families benefited by SUBRECIPIENT 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 and the number of female heads of
households.
(3) RecordkeepinQ of On¢oine Maintenance under the LBP Regs. If the services and
program activities provided by SUBRECIPIENT hereunder establish an ongoing relationship
with a property (such as long term tenant based rental assistance program [Subpart M] or
transitional or permanent housing operated or administered by the SUBRECIPIENT), then the
SUBRECIPIENT shall provide a report to the CITY evidencing that SUBRECII'IENT and/or the
property owner(s), as applicable, has performed ongoing maintenance of the subject property.
Ongoing maintenance shall include evidence of an annual clearance certification of the subject
residential property conducted by a DHS certified technician to ensure that LBP hazard reduction
measures are maintained. All maintenance activities shall be conducted to ensure the threat of
LBP hazards is minimized.
(4) Recordkeepin~ under the LBP Regs. The SUBRECIPIENT shall keep records of
distribution of notifications, all visual assessment, evaluations, inspections, repairs, and any other
lead hazard evaluation, reduction, safe work practices, and clearance activities.
(a) The SUBRECIPIENT shall keep records evidencing distribution of all lead
hazard information pamphlet(s).
(b) The SUBRECIPIENT shall keep records evidencing each LBP evaluation
report, LBP hazard reduction documentations, (such as job specifications), and all cleazance or
abatement report(s).
(c) The SUBRECII'IENT shall keep ongoing maintenance records and records of
relevant building operations for use during reevaluations of subject property for LBP and/or LBP
hazards.
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1. Such records shall be maintained for not less than longer of
(A) three (3) years after the activities cease or (B) the period
required by applicable program regulations. Under the CDBG
REGS records shall be retained for not less than four (4) years after
the activities cease.
2. The SUBRECIPIENT shall provide a copy of any of the
above records to the CITY or to HUD upon request of either or
both.
(d) Tracking Report. If the SUBRECIPIENT has provided, or is providing, rental
assistance payments directed to a housing unit or housing units for more than 100 days, or it is
anticipated that during the last quarter of funding that such rental assistance payment will be for
more than 100 days, then the April 15 quarterly report shall contain information and evidence of
compliance with the requirements herein relating to tracking of housing units, cumulative days of
rental assistance, proper notifications to occupants and owners, HQS inspection, visual
assessment, work write-up, stabilization and clearance of LBP and LBP hazards, if any. The
proposed form of such tracking information is attached hereto as Attachment No. 5 and fully
incorporated by this reference. In the event such April 15 quarterly report does not fully satisfy
the reporting requirements set forth herein and in the LBP Regs, then the final installment
payment of the CDBG FUNDS shall be withheld from disbursement to SUBRECIPIENT.
J. Access to Records. CITY and the United State Government and/or their representatives
shall have access for purposes of monitoring, auditing, and examining SUBRECIPIENT's activities
and performance, to books, documents and papers, and the right to examine records of
SUBRECIPIENT's subcontractors, bookkeepers and accountants, employees and participants in
regard to said program. CITY and the United States Government and/or their representatives shall
also schedule on-site monitoring at their discretion. Monitoring activities may also include, but are
not limited to, questioning employees and participants in said program and entering any premises or
any site in which any of the services or activities funded hereunder are conducted or in which any of
the records of SUBRECIPIENT are kept. Nothing herein shall be constmed to require access to any
privileged or confidential information as set forth in federal or state law.
K. Location of Records/Reuuired Leneth of Record Keeping. All accounting records,
reports, and evidence pertaining to all costs, expenses and the CDBG FUNDS of
SUBRECIPIENT and all documents related to this Agreement shall be maintained and kept
available at SUBRECIPIENT'S office or place of business for the duration of the Agreement and
thereafter for five (5) years after completion of an audit in conformity with the CDBG REGS,
except as hereinafter provided relating to retention of any records or documentation existing,
created, or maintained in compliance with Title X or the LBP Regs. Records which relate to (a)
complaints, claims, administrative proceedings or litigation arising out of the performance of this
Agreement, or (b) costs and expenses of this Agreement to which CITY or any other
governmental agency takes exception, shall be retained beyond the five (5) years until complete
resolution or disposition of such appeals, litigation claims, or exceptions. All records relating to,
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or created or maintained in compliance with, Title Xand/or the LBP Regs shall be retained and
maintained by SUBRECIPIENT indefinitely, including without limitation, all inspection
report(s), disclosure statement(s), and clearance report(s). In the event SUBRECIPIENT does not
make the above-referenced documents available within the city of Santa Ana, California,
SUBRECIPIENT agrees to pay all necessary and reasonable expenses incurred by CITY in
conducting any audit at the location where said records and books of account are maintained.
L. Compliance with Law/ProQram Income. SUBRECIPIENT acknowledges that the funds
being provided by CITY for said program are received by CITY pursuant to the ACT as amended
and that expenditures of these funds shall be in accordance with the ACT and all pertinent
regulations issued by agencies of the federal government, including, but not limited to, all
regulations found at Title 24 of the Code of Federal Regulations. Program income received by
SUBRECIPIENT shall be returned to CITY unless otherwise provided for in this Agreement.
SUBRECIPIENT agrees to comply fully with all federal, state and local laws and court orders
applicable to its operation whether or not referred to in this Agreement.
M. Standing. SUBRECIPIENT shall be in good standing, without suspension by the
California Secretary of State, Franchise Tax Board and Internal Revenue Service. Any change in
the corporate status or suspension of SUBRECIPIENT shall be reported immediately to CITY.
N. Confidentiality. Without prejudice to any other provisions of this Agreement,
SUBRECIPIENT shall, where applicable, maintain the confidential nature of information provided
to it concerning participants in accordance with the requirements of federal and state law. However,
SUBRECIPIENT shall submit to CITY and or HUD or its representatives, all records requested,
including audit, examinations, monitoring and verifications of reports submitted by
SUBRECIPIENT, costs incurred and services rendered hereunder.
O. Independent Contractor. SUBRECIPIENT agrees that the performance of
obligations hereunder are rendered in its capacity as an independent contractor and that it is in no
way an agency of CITY.
P. Violation of Terms and Conditions. SUBRECIPIENT agrees that if
SUBRECIPIENT violates any of the terms and conditions of this Agreement or any prior
Agreement whereby CDBG funds were received by SUBRECIPIENT, or if SUBRECIPIENT
reports inaccurately, or if on audit there is a disallowance of certain expenditures, SUBRECIPIENT
agrees to remedy the acts or omissions causing the disallowance and repay CITY all amounts spent
in violation thereof. If SUBRECIPIENT engaged in fraudulent activity to obtain and/or justify
expenditure of the CDBG funds granted hereunder, SUBRECIPIENT shall be required to reimburse
the CITY of all such funds that were obtained/spent under fraudulent circumstances.
Q. Equipment. SUBRECIPIENT 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.
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R. Prohibited Use. SUBRECII'IENT hereby certifies and agrees that it will not use
funds provided through this Agreement to pay for entertainment, meals or gifts.
S. Lobbvine. SUBRECIPIENT certifies that it will comply with federal law (31
U.S.C. 1352) and regulations found at 24 CFR Part 87, which provide that no appropriated funds
maybe expended by the recipient of a federal contract, grant, loan or cooperative agreement to pay
any person for influencing or attempting to influence an officer or employee of any agency,
Member of Congress, or an officer or employee of a Member of Congress in connection with
awarding of any federal contract, the making of any federal grant or loan, entering into any
cooperative agreement and the extension, renewal, amendment or modification of any federal
contract, grant, loan or cooperative agreement. SUBRECIPIENT shall sign a certification to that
effect in a form as set forth in "Exhibit C," attached hereto and by this reference incorporated herein.
SUBRECfl'IENT shall submit said signed certification to CITY prior to performing any of its
obligations under this Agreement and prior to any obligation arising on the part of CITY to pay any
sums to SUBRECIPIENT under the terms and conditions of this Agreement.
If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the
undersigned shall complete and submit a "Disclosure Form to Report Lobbying," in accordance
with its instructions (see C-1).
T. Financial Interest. SUBRECIPIENT agrees that except for the use of CDBG funds
to pay salaries and other related administrative or personnel costs, no persons who exercise or have
exercised any function with respect to CDBG activities assisted under the terms of this Agreement,
or who are in a position to participate in adecision-making process or gain inside information with
regard to such activities, may obtain a financial interest or benefit from aCDBG-assisted activity of
SUBRECIPIENT, either for themselves or those with whom they have family or business ties,
during their tenure or for one year thereafter. This prohibition applies to any person who is an
employee, agent, consultant, officer, or elected or appointed official of CITY, or of
any designated public agencies, or the SUBRECIPIENT.
U. Davis-Bacon Act. All laborers and mechanics employed by contractors or
subcontractors in the performance of construction work, including alterations and repairs, in excess
of $2,000.00, financed in whole or in part with federal funds shall be paid wages at rates not less
than those prevailing on similar construction in the locality as determined in accordance with the
Davis-Bacon Act, as amended, 40 U.S.C. sections 276a - 276a-5. Any such construction contract
shall include and comply with the required contract provisions and rules set forth in 29 C.F.R. §5.5.
Further, the payroll reports (along with the "Statement of Compliance") and basic records are
required to be maintained and submitted, or made available, pursuant to 29 C.F.R. §5.5(a)(3). No
payment, advance, grant, loan or guarantee of funds shall be approved by the federal agency unless
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there is on file with the agency a certification by the contractor that the contractor and its
subcontractors have complied with the provisions of 29 C.F.R. §5.5.. A breach of the contract
clauses in 29 C.F.R. §5.5 may be grounds for termination of the contract, and for debarment as a
contractor/subcontractor, as provided in 29 C.F.R. §5.12. Labor standards interviews/investigations
shall be made as necessary to assure compliance [29 C.F.R. §5.6(a)(3)].
V. Drug Free Workulace. SUBRECIPIENT certifies that it has established the
following drug-free workplace policy:
1. The unlawful manufacture, distribution, dispensing, possession or use of a controlled
substance is prohibited in the workplace for any employee involved in a federally funded program.
2. As an employee working in conjunction with a federally funded program, the
employees of SUBRECIPIENT will be required to:
a) Abide by the terms above in statement 1.
b) Notify appropriate officials of SUBRECIPIENT and CITY officials of any
criminal drug statute conviction for a violation occurring in the workplace not later than five
days after such conviction.
3. The United State Department of Housing and Urban Development will be notified
within ten days after receiving notice of any such violation.
4. Within 30 days of receiving such notice, appropriate personnel action will be
taken against such employee, up to and including termination.
Each such employee shall be required to participate satisfactorily in a drug abuse assistance or
rehabilitation program approved for such purposes by a federal, state or local health, law
enforcement, or other appropriate agency.
II. CITY'S OBLIGATIONS
A. Payment of Funds. Upon execution of this Agreement by SUBRECIPIENT, CITY shall
pay to SUBRECIl'IENT from CDBG funds, when, if and to the extent received from HUD, for
CITY's CDBG program year amounts expended by SUBRECIPIENT in carrying out said program
for fiscal year pursuant to this Agreement up to a maximum aggregate payment of ninety-one
thousand, seven hundred ninety-two Dollars ($ 91,792.00) in installments determined by CITY.
Payments shall be made to SUBRECIPIENT through the submission of invoices on a quarterly
basis (October, January, April and July) in a form prescribed by CITY, detailing such expenses.
CITY shall pay such invoices within thirty (30) days after receipt thereof provided CITY is satisfied
that such expenses have been incurred and documented within the scope and provisions of this
Agreement and that SUBRECIPIENT is in compliance with the terms and conditions of this
Agreement, and in compliance with Title X and the LBP Regs.
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B. Audit of Account. CITY shall include an audit of the account maintained by
SUBRECIPIENT in CITY's annual audit of all CDBG FUNDS in accordance with Title 24 of
the Code of Federal Regulations and other applicable federal laws and regulations.
C. Common Rule: Pursuant to CFR 85.40(a), the CITY manages the day-to-day
operations of each grant and subgrant supported activities. CITY staff has detailed knowledge of
the grant program requirements and monitors grants and subgrant supported activities to assure
compliance with Federal requirements. Such monitoring covers each program, function and
activity and performance goals aze reviewed periodically.
D. Environmental Review: In accordance with 24 SFR 58, the CITY is responsible
for undertaking environmental review and maintaining environmental review records for each
applicable project.
E. Performance Monitorine: CITY shall monitor the performance of the
SUBRECII'IENT against goals and performance standazds required herein. Substandard
performance as determined by the CITY will constitute non-compliance with this Agreement. If
action to correct such substandazd performance is not taken by the SUBRECII'IENT within a
reasonable period of time after being notified by the CITY, contract suspension or termination
procedures will be initiated.
III. NONDISCRIMINATION
SUBRECIPIENT agrees that no person on the ground of race, age, 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 CDBG funds.
IV. CONFLICT OF INTEREST
Pursuant to the conflict of interest requirements set forth in 24 CFR 576.5 and OMB
Circulazs 1-102 and A-1107, SUBRECIPIENT agrees that no officer, employee, agent or assignee
of CITY having direct or indirect control of any CDBG monies granted to the CITY, inclusive of
the subject CDBG FUNDS, shall serve as an officer of SUBRECIPIENT. Further, any conflict or
potential conflict of interest of any officer of SUBRECIPIENT shall be fully disclosed in writing
prior to the execution of this Agreement and said writing shall be attached and deemed fully
incorporated as a part hereof. Notice shall be sent by SUBRECIPIENT to CITY regarding any
changes or modifications to its board of directors and list of officers.
V. SPECIAL CERTIFICATION FOR RELIGIOUS ENTITIES
If SUBRECIPIENT is a religious entity, SUBRECIPIENT hereby agrees that in connection
with the provision of the services SUBRECIPIENT shall provide with CDBG funds in accordance
with 24 CFR 570.200(j):
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A . SUBRECIPIENT 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. SUBRECIPIENT shall not discriminate against any person applying for the services
SUBRECIPIENT 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.
C. SUBRECII'IENT shall NOT provide religious instmction 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. The parties agree that this covenant is
intended to and shall be constmed for the limited purpose of assuring compliance with respect to the
use of CITY funds by SUBRECIPIENT with applicable constitutional limitations respecting the
establishment of religion as set forth in the establishment clause under the First Amendment of the
United States Constitution and Article I, Section 4 of the California Constitution, and is not in any
manner intended to restrict other activities of SUBRECIPIENT.
D. Where the services to be provided under said program are rendered on property
owned by the primarily religious entity SUBRECIPIENT, CDBG 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 CDBG
expenditure for rendering the services under said program.
VI. PROHIBITION OF NEPOTISM
SUBRECIPIENT agrees not to hire or permit the hiring of any person to fill a position
funded through this Agreement if a member of that person's immediate Family is employed in an
administrative capacity by SUBRECIPIENT. For the purposes of this section, the term "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, stepparent 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: City of Santa Ana
Community Development Agency (M-25)
20 Civic Center Plaza
P.O. Box 1988
Santa Ana, California 92702-1988
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Paint Your Heart Out, Inc.
1209 W Lincoln Avenue
Anaheim, CA 92805
VIII. ASSIGNABILITY
None of the duties of, or work to be performed by, SUBRECIPIENT under this Agreement
shall be subcontracted or assigned to any agency, consultant, or person without the prior written
consent of CITY. SUBRECIPIENT must submit all subcontracts and other agreements that relate
to this Ageement to CITY. No subcontract or assignment shall terminate or alter the legal
obligations of SUBRECIPIENT pursuant to this Ageement.
IX. HOLD HARMLESS
SUBRECIPIENT 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 SUBRECIPIENT, its
officers, directors, employees, agents, subcontractors and suppliers arising out of
SLTBI2ECIPIENT'sperformance ofthis Ageement.
X. INSURANCE
A. In accordance with the provisions of Section 3300 of the Labor Code, if
SUBRECIPIENT has any employees it is required to be insured against liability for worker's
compensation or to undertake self-insurance. Prior to commencing performance of this
Agreement, SLTBRECIPIENT agrees to obtain and maintain employer's liability insurance with
limits not less than $1,000,000 per accident. If SUBRECIPIENT has no employees, nor workers'
compensation coverage, it must execute a Declaration available from the CITY, and update as is
necessary.
B. SUBRECIPIENT shall undertake self-insurance, or shall obtain, at its sole cost, a
policy or policies of commercial general liability insurance, or equivalent form, with a combined
single limit of not less than $1,000,000 per occurrence.
Such insurance shall: (1) name the City of Santa Ana, its officers, agents,
representatives, employees and volunteers as additional insureds; (2) be primary with respect to
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insurance or self-insurance programs maintained by the CITY; (3) contain standard separation of
insureds provisions; and (4) give to CITY prompt and timely notice of claim made or suit
instituted arising out of SUBRECII'IENT's operations hereunder.
SUBRECIPIENT shall (a) prior to exercising any right under this Agreement,
furnish properly executed certificates of insurance and additional insured endorsement to the
CITY which shall clearly evidence all coverages required above; (b) provide that such insurance
shall not be materially changed or terminated except on 30 days prior written notice to the CITY;
(c) maintain such insurance for the period covered by this Agreement; and (d) replace such
certificates for policies expiring prior to the expiration of this Agreement.
XI. REVERSION OF ASSETS
A. Upon the expiration of this Agreement, SUBRECIPIENT shall transfer to CITY any
CDBG funds on hand at the time of the expiration of this Agreement as well as any accounts
receivable attributable to the use of CDBG funds. [24 CFR 570.503(b)(8).]
B. Any real property under SUBRECII'IENT's control that was acquired or improved
in whole or in part with CDBG 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 in 24 CFR 570.208 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, SUBRECIPIENT
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-CDBG 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 SUBRECIPIENT. 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 mazket value of less than
$5,000.00 maybe 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, in accordance with 24 CFR 85.32(e)(2).
D. SUBRECII'IENT 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
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or under any document, instrument or agreement executed in fin-therance 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 SUBRECIPIENT's
right, title and interest (if any it may have) in and to CITY, CDBG 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
SUBRECIPIENT on behalf of CITY, in furtherance of the activities hereunder or thereof.
SUBRECIPIENT's obligations and responsibilities set forth in this paragraph "XI.
REVERSION OF ASSETS," and in paragraph "XII. TERMINATION" and other requirements
pertaining to 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.
XII. TERMINATION
A. This Agreement may be terminated on thirty (30) days' written notice by either
party. In the event of such termination, SUBRECIPIENT 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 SUBRECIPIENT of Federal Laws governing the use of Community
Development Block Grant Funds. In the event of such suspension or termination, SUBRECIPIENT
shall only be entitled to reimbursement for approved expenses incurred up to the effective date of
suspension or termination.
C. Pursuant to 24 CFR 85.43, in the event SUBRECIPIENT 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 SUBRECII'IENT, 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 under this Agreement may be terminated for convenience in
accordance with 24 CFR 85.44.
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E. The grant of funds under this Agreement may be terminated due to the non-
performance of SUBRECIPIENT and/or failure of SUBRECIPENT to perform the work described
in Exhibits A and B or failure to meet the performance standards and program goals set forth
therein.
F. In the event this Agreement is terminated as set forth in subparagraphs XILA.
through XILE, inclusive, SUBRECIPIENT agrees to immediately return to CITY upon CITY's
demand and prior to any adjudication of SUBRECIPIENT's rights, any and all funds not used, 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 CDBG funds which limitations aze 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
SUBRECIPIENT's authority to commit and spend funds, or may restrict SUBRECIPIENT's use of
both its uncommitted and its unspent funds. Where HUD has directed or requested CITY to
implement a reduction in funding, in whole or as to a cost category, with respect to funding for this
Agreement, CITY's City Manager or delegate is authorized to act for CITY in implementing and
effecting such a reduction and in revising, modifying, or amending the Agreement for such
purposes. If such a reduction in funding occurs, SUBRECIPIENT shall be permitted to de-scope
accordingly. Where CITY has reasonable grounds to question SUBRECIPIENT'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
SUBRECII'IENT 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 SUBRECIPIENT before it received notice of such revision, provided that
such amounts have been committed in good faith and are otherwise allowable and that such
commitments are consistent with HUD cash withdrawal guidelines.
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 CDBG funds by SUBRECIPIENT 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
SUBRECIPIENT.
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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.
XVII. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and wanants that its signature hereinbelow has the power,
authority and right to bind their respective parties to each of the terms of this Agreement, and shall
indemnify CITY fully, including reasonable costs and attorney's fees, for any injuries or damages to
CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn.
b. All Exhibits and Attachments referenced herein and attached hereto shall be incorporated
as if fully set forth in the body of this Agreement.
c. No delay or omission by either party hereto to exercise any right or power accruing
upon any noncompliance or default by the other party with respect to any of the terms of this
Agreement shall impair any such right or power or be construed to be a waiver thereof. A
waiver by either of the parties hereto of any of the covenants, conditions, or agreements to be
performed by the other shall not be construed to be a waiver of any succeeding breach thereof
or of any other covenant, condition or agreement herein contained.
fN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the last date and
year written below.
ATTEST:
~~ ~
_.
(`~~ ~ -,~
PATRICIA E. HEALY
Clerk of the Council
APPROVED AS TO FORM:
JOSEPH W.FLETCHER
CITY OF SANTA ANA
c ~--
DAVID N. RE
City Manager
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City Attorney
v r - G LJ'w!~`h-~
By: LISA E. STORCK
Assistant City Attomey
SUBRECIPIENT:
DATE: i~/ ~~' `-' ~.~
Boudsakhone Sund a-Niuiez
Title: Interim Executive Director
Tax ID: 33-0915612
23
CITY OF SANA ANA
Community Development Block Grant
Scope of Work
Annual Accomplishment Goal
I. Total number of clients anticipated to be served during 12-month contract period=
30-35 HOUSEHOLDS
II. Number of unduplicated Santa Ana residents to be served with grant funds during the 12-
month contract period = 3030=35 HOUSEHOLDS
III. Below is the City performance outcome that our organization will be tracking.
COMMi7NITY PRIORITY NEEDS: Public Services
Activit /Yro ram Outcome Trackin Goal
Owner-Occupied Housing Number of owners assisted to Physical safety and comfort will be
Rehabilitation rehabilitate their primary residence improved for Low and Moderate
for the following income categories: income households by improving
-Extremely Low Income homes to a level that meets or exceeds
-Very Low Income HUD housing quality standards.
-Low Income
-Moderate Income
Special Needs Categories
-Large Families
IV. Description of Work - in space below, describe the program to be funded during the 12-
month contract period including, services to be provided, program goals, client
characteristics, & how grant funds will be utilized.
Paint Your Heart Out Inc. is a 15 year old California non-profit that paints and refurbishes homes
for qualified seniors and/or disabled homeowners in the communities of Anaheim, Santa Ana
and Brea. In addition to being seniors and/or disabled each applicant must meet HUD income
guidelines and prove homeownership status to be eligible for our paint and refurbishment
services. Once all the criteria have been met our Program Director qualifies the homeowners.
Our Board then selects the homeowners/households who will be receiving our paint and repair
services. Our paint and repair services are limited to the Exterior of the home. The repair work
includes but may not be limited to the following depending on available funding and manpower
to complete the work: gate and fence replacement, window replacement, side door replacement,
gutter/rain downspout replacements, and fascia board repair. In addition to the repair work
mentioned above, the selected homeowners will be receiving lead testing, abatement and
clearance service in addition to our paint and repair services. Our paint services will be provided
by teams of volunteer painters. Because we do not have the staffing knowledge and manpower
available to do such work, PYHO will be subcontracting the lead testing and clearance work to
HomeSafe Environmental, Inc. and the abatement work to the Orange County Conservation
Corps, two organizations with whom we have worked with in the past. With regard to all other
repairs, if and when possible, PYHO will try to leverage its volunteers' resources and skills to
complete such repair services. However, in such instances where our volunteers do not possess
the skills to complete the needed repairs, PYHO will subcontract out the necessary repairs to
Taller San Jose and Orange County Conservation Corps, again, two organizations which we have
collaborated and partnered with in the past, with whom we are able to leverage resources and
receive services at a discounted rate. All grant funds will be utilized to administer and
implement all facets of the programs as indicated by the Program Budget Sheet. The paint and
repair improvements will make it safer for our homeowners to continue in their homes thus
allowing them to live on their own and independently in the comfort of their home and familiar
surroundings for as long as possible.
Due to Paint Your Heart Out's limited scope of services (i.e. exterior painting and minor exterior
repair for qualified homeowners, no rentals, leases, sales, nor rental assistance) HUD housing
quality standards does not apply, nor do Attachment 2, Attachment 5.
Schedule of Performance
Estimate the number of unduplicated Santa Ana residents to be served during the 12-month
contract period per quarter:
Quarter 1: July 1 -September 30
Quarter 2: October 1 -December 31
Quarter 3: January 1 -March 31
Quarter 4: April 1 -June 30
0 Households
0 Households
0 Households
30-35 Households
Total 30-35 Households
Invoicint Schedule
Estimate the amount of grant funds to be requested during the 12-month contract period on a
quarterly basis
Quarter 1: July 1 -September 30 $6,980.00
Quarter 2: October 1 -December 31 $10,467.00
Quarter 3: January 1 -March 31 $29,367.00
Quarter 4: April 1 -June 30 $44,978.00
Total $91,792.00
EXHIBIT A
2004-2005
CITY OF SANTA ANA
COMMUNITY DEVELOPMENT BLOCK GRANT
FINAL PROGRAM BUDGET
Organization Name: Paint Your Heart Out. Inc.
Program Name: Paint Dav Santa Ana
Program Year: 2005-2006
EXPENDITURES
CATEGORY SANTAANA CDBG OTHER TOTAL PROGRAM
GRANT RESOURCES BUDGET
Administrative Staff
$
$53,258.00
$53,258.00
Salaries & Benefits
Program Staff Salaries 8 25,092.00 0 25,092.00
Benefits
Office Su lies 3,600.00 0 3,600.00
RenULease 5,200.00 0 5,200.00
Communications 0 0 0
Utilities 0 3,320.00 3,320.00
Co n tract u a IlProfessio na l
Services 56,900.00 8,150.00 65,050.00
Please S ecif
Insurance 0 1,800.00 1,800.00
Other (Please Specify)
Mileage
Bank Charges
Community Relations
Volunteer Recognition 1,000.00 21,080.00 22
080.00
Volunteer T-Shirts ,
PYHO House Tiles
TOTAL $91,792.00 $87,608.00 $179,400
OTHER PROGRAM RESOURCES
ACTUAL FUNDING SOURCE AMOUNT
Restoring Hope Breakfast $2,300.00
General Fundraising (Individuals, Corporations) 28,208.00
In-Kind Donations 57,100.00
TOTAL $67,608.00
EXHIBIT B
Name of Organization:
CDBG FUNDED PERSONNEL
ADMINISTRATIVE STAFF
Position
Title
Annual
Salary
Annual
Benefits
Total
Compensation CDBG
Funds
Requested % of Time
Position is
Dedicated
to
Pro ram
Executive
Director 73000 3600 76600 0
Executive
Assistant 49000 3600 52600 0
PROGRAM STAFF
CDBG % of Time
Total Funds Position is
Position Title Annual Annual Compensation Requested Dedicated
Salary Benefits to
Pro ram
Associate 50000 3600 53600 25092
Director/Program
Mana er 7L ,!
CONTRACT PERSONNEL
Position
Title
Annual
Salary
Annual
Benefits
Total
Compensation CDBG
Funds
Requested % of Time
Position is
Dedicated
to
Pro ram
Operations
Mana er 9000 0 9000 0 100°/,
Certification Regarding Lobbying
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with the awarding of any Federal
contract, the making of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any Federal contact, grant, loan or cooperative
agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with this Federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure
Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the
award documents for all subawards at all tiers (including subcontract, subgrants, and
contracts under grants, loans, and cooperative agreements) and that all subrecipients shall
certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed
when this transaction was made or entered into. Submission of this certification is a
prerequisite for making or entering into this transaction imposed by Section 1352, Title
31, U. S. Code. Any person who fails to file the required certification shall be subject to
a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
j- NQ A,YT V 1M ~~GPI {Yl ~>(C~~VL°
Organization
Program Title
GtNR~, /t/ ~-' 7~
of Certifying Officer Signature
Date
EXHIBIT C
Page 1 of 2
SUBRECIPIENT warrants the following:
1. SUBRECIPIENT will comply with Public Law 88-352, Title VI of the Civil Rights
Act of 1964 (42 U. S. C. section 2000 et seq.) and implementing regulation in 24 CFR
Part 1.
2. No person in the United States shall on the ground of race, color, religion, national
origin, or sex, be excluded from participation in, or be denied the benefits of, or be
subjected to discrimination under any program or activity funded in whole or in part with
community development funds made available pursuant to the ACT.
3. All laborers and mechanics, employed by contractors or subcontractors in the
performance of construction work financed in whole or in part with community
development funds shall be paid wages at rates not less than those prevailing on similar
construction in the locality as determined in accordance with the Davis-Bacon Act, as
amended, 40 U. S. C. Sections 276 a 1-5, except for individuals who perform services for
which they volunteered; do not receive compensation for such services; or are paid
expenses, reasonable benefits, or a nominal fee for such services; and are not otherwise
employed at any time in construction work.
4. SUBRECIPIENT will comply with all Federal statutes applicable to projects funded
with community development funds, except that (a) SUBRECII'IENT does not assume
CITY'S environmental responsibilities described at 24 CFR 570.604; and (b)
SUBRECIPIENT does not assume CITY'S responsibility for initiating the review process
under Executive Order 12372.
EXHIBIT C
Page 2 of 2
~nACttucFJ-n ~-
r f~
Are You Planning To Buy, Rent, or Renovate
a Home Built Before 1978?
any houses and apartments built before 1978 have
paint that contains lead (called lead-based paint). Lead
from paint, chips, and dust can pose serious health
hazards if not taken care of properly.
Federal law requires that individuals receive certain information
before renting, buying, or renovating pre-1978 housing:
P
W_.~a'?.
'
~
~
~>g
SELLERS have to disclose known informa-
~ tion on lead-based paint and lead-based
paint hazards before selling a house. Sales
contracts must include a disclosure form
about lead-based paint. Buyers have up to
10 days to check for lead hazards.
RENOVATORS have to give you this
pamphlet before starting work. (After
June 1, 1999.)
IF YOU WANT MORE INFORMATION
on these requirements, call the
National Lead Information Clearinghouse
at 1-800-424-LEAD.
This document is in the public domain. It may be reproduced by an individual ar
organization without permission. Information provided in this booklet is based
upon current scientific and technical understanding of the issues presented and
is reflective of the jurisdictional boundaries established by [he statutes governing
the co-authoring agencies. Folbwing the advice given will not necessarily pro-
vide complete protection in all situations or against all health hazards that can
be caused by lead exposure.
~~ .,~
F~~..~c~ LANDLORDS have to disclose known infor-
R~~%~. mation on lead-based paint and lead-based
paint hazards before (eases take effect.
Leases must include a disclosure form
about lead-based aint.
z d~ i6
i f1lIIPORTAIVT!
Lead From Paint, Dust, and
Soil Can Be Dangerous If Not
Managed Properly
FACT: Lead exposure can harm young
children and babies even before they
are born.
FACT: Even children who seem healthy can
have high levels of lead in their bodies.
FACT: People can get lead in their bodies by
breathing or swallowing lead dust, or by
eating soil or paint chips containing
lead.
FACT: People have many options for reducing
lead hazards. In most cases, lead-based
paint that is in good condition is not a
hazard.
FACT: Removing lead-based paint improperly
can increase the danger to your family.
If you think your home might have lead
hazards, read this pamphlet to learn some
simple steps to protect your family.
3 ~~' %~
Lead Gets in the Body in Many Ways
People can get lead in their body if they:
In the
United
4 Put their hands or other objects
covered with lead dust in their mouths.
States,
about
O Eat paint chips or soil that contains
lead.
900,000
children ages •: Breathe in lead dust (especially during
renovations that disturb painted
1 to 5 have a surfaces}.
blood-lead
level abOVe Lead is even more dangerous to children
the level of than adults because:
concern. 0 Babies and young children often put
their hands and other objects in their
Even children mouths. These objects can have lead
who appear dust on them.
heaifhy can
have danger- • Children's growing bodies absorb more
ous -evels of Lead.
(ead in their • Children's brains and nervous systems
bodies. are more sensitive to the damaging
effects of lead
y a ~' /~
Lead's Effects
If not detected early, children with high -
levels of lead in their bodies can suffer
from:
• Damage to the brain and
nervous system
• Behavior and learning
problems (such as hyperactivity)
• Slowed growth
• Hearing problems
• Headaches
Lead is also harmful to adults. Adutts
can suffer from:
• Difficulties during pregnancy
• Other reproductive problems (in both
men and women)
• High blood pressure
• Digestive problems ~r~aa~
• Nerve disorders ~10d~1b
Pw3hnxs
• Memory and concentration problems ~~~
• Muscle and joint pain
Lead affects
the body in
many ways.
3
s 6~` ( V
Where Lead-Based Paint Is Found
In general,
the older your
home, the
more likely it
has lead-
based paint.
Many homes built before 1978 have lead-
based paint. The federal government
banned lead-based paint from housing in
1978. Some states stopped its use even
earlier. Lead can be found:
• In homes in the city, country, or suburbs.
• In apartments, single-family homes, and
both private and public housing.
• Inside and outside of the house.
• In soil around a home. (Soil can pick up
iead from exterior paint or other sources
such as past use of leaded gas in cars.)
Checkir-g Your Family for Lead
To reduce your child's exposure to lead,
Get Our
y get your child checked, have your home
children and tested (especially if your home has paint
home tested in poor condition and was built before
if you think 197s), and fix any hazards you may have.
'
our home
y s blood lead levels tend to increase
Children
haS high leV- rapidly from 6 to 12 months of age, and
tend to peak at 18 to 24 months of age.
els Of lead. Consult your doctor for advice on testing
your children. A simple blood test can
detect high levels of lead. Blood tests are
usual{y recommended for:
• Children at ages 1 and 2.
• Children or other family members who
have been exposed to high levels of lead.
• Children who should be tested under
your state or local health screening plan.
Your doctor can explain what the test results
mean and if more testing will be needed.
~ ~ ~' / ~
Where Lead Is Likely To Be a Hazard
Lead-based paint that is in good condition
is usually not a hazard. Lead fcOm
Peeling, chipping, chalking, or cracking Palnt ChIPS,
lead-based paint is a hazard and needs Wh1Ch y0U
immediate attention. Can See, and
Lead-based paint may also be a hazard lead dust,
when found on surfaces that children can WhlCh you
chew or that get a lot of wear-and-tear. Can't alWayS
These areas include: See, can both
• Windows and window sills. be Set'IOUS
• Doors and door frames. haZardS.
• Stairs, railings, and banisters.
® Porches and fences.
Lead dust can form when lead-based paint
is dry scraped, dry sanded, or heated. Dust
also forms when painted surfaces
bump or rub together. Lead chips and
dust can get on surfaces and objects
that people touch. Settled lead dust
can re-enter the air when people vac-
uum, sweep, or walk through it.
Lead in soilc an be a hazard when
children play in bare soil or when
people bring soil into the house on
their shoes. Call your state agency
(see page 11) to find out about test-
ing soil for lead.
~.
7 Gt ~~
Checking Your Home for Lead Hazards
Just knowing
that a home
has tead-
based paint
may not tell
you if there
is a hazard.
6
You can get your home checked for lead haz-
ards in one of two ways, or both:
~ A paint inspection tells you the lead
content of every different type of painted
surtace in your home. It won't felt you
whether the paint is a hazard or how you
should deal with it.
• A risk assessment tells you if there are
any sources of serious lead exposure
(such as peeling paint and lead dust). It
also tells you what actions to take to
address these hazards.
Have qualified professionals do the work.
There are standards in place for certifying
lead-based paint professionals to ensure the
work is done safely, reliably, and effectively.
Contact your state lead poisoning prevention
program for more information. CaII 1-800-
424-LEAD for a list of contacts in your area.
Trained professionals use a range of methods
when checking your home, including:
• Visual inspection of paint condition and
location.
~ A portable x-ray fluorescence (XRF)
machine.
~ Lab tests of paint samples.
~ Surface dust tests.
Home test kits for lead are available, but
studies suggest that they are not always
accurate. Consumers should not rely on
these tests before doing renovations or to
assure safety.
~~~ ~~~
What You Can Do Now To Protect
Your Family
If you suspect that your house has lead
hazards, you can take some immediate
steps to reduce your family's risk;
A If you rent, notify your landlord of
peeling or chipping paint.
• Clean up paint chips immediatety.
• Cleart floors, window frames, window
sills, and other surfaces weekly. Use a
mop or sponge with warm water and a
general all-purpose cleaner or a cleaner
made specifically for lead. REMEMBER:
NEVER MIX AMMOMA AND BLEACH
PRODUCTS TOGETHER SINCE THEY
CAN FORM A DANGEROUS GAS.
• Thoroughly rinse sponges and mop
heads after cleaning dirty or dusty
areas.
~ wash children's hands often, especial-
ly before they eat and before nap time
and bed time.
e Keep play areas clean.VV ash bottles,
pacifiers, toys, and stuffed animals
regularly.
• Keep children from chewing window
sills or other painted surfaces.
• Clean or remove shoes before
entering your home to avoid
tracking in lead from soil.
• Make sure children eat
nutritious, low-fat meals high
in iron and calcium, such as
spinach and dairy products.
Children with good diets absorb
less lead.
'•I. ~-
s
..-- '•
-~ .~
. .
,~ ~ ~. .~
~,a~ ~~
How To Significantly Reduce Lead Hazards
Removing
lead
improperly
can increase
the hazard to
your family
by spreading
even more
lead dust
around the
house.
Always use a
professional who
is trained to
remove lead
hazards safely.
In addition to day-to-day cleaning and good
nutrition:
~ You can temporarily reduce lead hazards
by taking actions such as repairing dam-
aged painted surfaces and planting grass
to cover soil with high lead levels. These
,actions (calved "interim controls") are not
permanent solutions and will need ongo-
ing attention.
To permanently remove lead hazards,
you must hire a certified lead "abate-
ment" contractor. Abatement (or perrna-
nent hazard elimination) methods
include removing, sealing, or enclosing
lead-based paint with special materials.
Just painting over the hazard with regular
paint is not enough.
Always hire a person with special training
for correcting lead problems-someone
who knows how to do this work safely and
has the proper equipment to clean up
thoroughly Certified contractors will employ
qualified workers and follow strict safety
rules as set by their state or by the federal
government.
Cal! your state agency (see page 11) for
help with locating certified contractors in
your area and to see if financial assistance
is available.
/G' ~ ~' /6
Remode{ing or Renovating a Home With
Lead-Based Paint
Take precautions before your conVactor or
you begin remodeling or renovations that
disturb painted surtaces (such as scraping
off paint or tearing out walls):
• Have the area tested for lead-based
paint.
• Do not use abelt-sander, propane
torch, heat gun, dry scraper, or dry
sandpaper to remove lead-based
paint. These actions create large
amounts of lead dust and fumes. Lead
dust can remain in your home long
after the work is done.
• Temporarily move your family (espe-
cially children and pregnant women)
out of the apartment or house until
the work is done and the area is prop-
erly cleaned. If you can't move your
family, at least completely seal off the
work area
• Fotlow other safety measures to
reduce lead hazards. You can find out
about other safety measures by calling
1-800-424-LEAD. Ask for the brochu~°
"Reducing Lead Hazards When
Remodeling Your Home." This brochi
explains what to do before, during,
and after renovations.
tf you have already completed renova-
tions or remodeling that could have
released lead-based paint or dust, get
your young children tested and follow
the steps outlined on page 7 of this
brochure.
If not
conducted
properly,
certain types
of renova-
tions can
release lead
from paint
and dust into
the air.
9
// a~ /~
Other Sources of Lead
• Drinking water. Your home might have
C~ plumbing with lead or lead solder. Call
- your local health department or water
' supplier to find out about testing your
-; ` ~,'1 water. You cannot see, smelt, or taste
lead, and boiling your water will not get
rid of lead. If you think your plumbing
might have lead in it:
While paint dust,
and soil are the
most common
lead hazards,
other lead
sources also exist.
~..~,~
.3 ~ f
. , t_
j
l0
• Use only cold water for drinking and
cooking.
• Run water for 15 to 30 seconds
before drinking it, especially if you
have not used your water for a few
hours.
• The job. If you work with lead, you
could bring it home on your hands or
clothes. Shower and change clothes
before coming home. Launder your work
clothes separately from the rest of your
family's clothes.
• Old painted toys and fumiture.
~ Food and liquids stored in lead crystal
or lead-glazed pottery or porcelain.
~ Lead smelters or other industries that
release lead into the air.
• Hobbies that use lead, such as making
pottery or stained glass, or refinishing
furniture.
~ totk remedies that contain lead, such as
"greta" and "azarcon" used to treat an
upset stomach.
~ z ~, >C /~
For More Information
The National Lead Information Center
Call 1-800-424-LEAD to learn how to protect
children from lead poisoning and for other
information on lead hazards. (Internet:
www.epa.gov/lead and vvww.hud.govAea).
For the hearing impaired, call the Federal
Information Relay Service at 1-800-877-
8339 and ask for the National Lead
Information Center at 1-800-424-LEAD.
EPAs Safe Drinking Water Hotline
Catl 1-800-426-4791 for information about
lead in drinking water.
Consumer Product Safety
Commission Hotline
To request information on lead in
consumer products, or to report an
unsafe consumer product or a prod-
uct-related injury call 1-800-638-
2772. (lntemet: wwwCacpsc.gov).
For the hearing impaired, call TDD 1-
800-638-8270.
_-~r
State Health and Environmental Agencies
Some cities and states have their own rules for lead-based
paint activities. Check with your state agency to see if state
or local laws apply to you. Most state agencies can also pro-
vide information on finding a lead abatement firm in your
area, and on possible sources of financial aid for reducing
lead hazards. Receive up-to-date address and phone infor-
mation for state and local contacts on the Internet at
www.epa.gov/lead or contact the National Lead Information
Center at 1-800-424-LEAD.
11
l3 ~~' r~
EPA Regions{ Offices
Your Regional EPA Office can provide further information regard-
ing regulations and lead protection programs.
EPA Regional Offices
Region 1 (Connecticut, Massachusetts,
Marne, New Hampshire, Rhode lslarxd,
Vermorx)
Regional Lead Conrad
U.S. EPA Region 1
Suite 1100 (CPT)
One Corrgess Street
Boston, MA 02114-2023
1 {888) 372-7341
Region 6 (Arkansas, Louisiana, New
Mexico. Oklahoma, Texas)
Regional Lead Contact
U.S. EPA Regicxt 6
1445 Ross Avenue, 12th Floor
Dapas,TX 75202-2733
(214) 665-7577
Region 2 (New krsey New York,
Puerto Rico, Vlgin Islands)
Regional Lead Contact
U.S. EPA Reeggan 2
2890 Woo[lbridge Avenue
Building 209, Mail Stop 225
Edison, Nl 08837-3679
(732) 321-6671
Region 3 (Delaware, Wasdung[on DC,
Maryland, Pennrylvarua, Yrginia, Wes[
Yrcgutia)
Regional Lead Contact
U,S. EPA Region 3 (3WC33)
1650 Arch Street
PhBadelphia, PA 19103
(215)814-5000
Region 4 (Alabama, Florida, Georges,
Kentucky Mississippi. North Carolina,
South Carolina. Tennessee)
Regional Lead Conrad
U.S. EPA Region 4
61 Forsyth Street, SW
Atlarrta, GA 30303
(404) 562-8998
Region 5 (Illinois, fnrAana, Michigan,
Minnesota, Ohb, Wisconsin)
Regional Lead Con[ad
U.S. EPA Region 5 (DT-81)
77 West Jackson Boulevard
Chicago, IL 60604-3666
(312) 886-6003
l2
Region? (k~wa, Kansas, Missouri,
Nebraska)
ReggTOnal Lead Contact
U.S. EPA Region 7
(ARID-RAU)
901 N. 5th Street
Kansas City, KS 66101
(913) 551-7020
Region 8 (Colorado, Montana, North
Dakota, South Dakota, Utah, Wyoming)
Reg'artal lead Contact
U.S. EPA Region 8
999 18th Street Suite 500
Deriver, CO 80202-2466
(303)312-6021
Region 9 i/vizona, Cadifomia, Hawaii,
Nevada)
Reganal Lead Contact
U.S. Region 9
75 Hawthorne Stmt
San Francisco, CA 94105
(415) 744-1124
Region 10 (klaho, Oregon, Washington,
Alaska)
Regional Lead Contact
U.S. EPA Region 10
Toxics Section WCM-128
1200 Sixth Avenue
Seattle, WA 981 01-1 1 28
(206) 553-1985
~~ a ~- ~ L'
CPSC Regional Offices
Your Regional CPSC Office can provide further information regard-
ing regulations and consumer product safety.
Eastern Regional Center
6 World Trade Center
Vesey SVeet, Room 350
New York, NY 10048
(212) 466-1612
Wkstem Regional Center
600 Harrison Stree4 Room 245
San Francisco, CA 94107
(475) 744-2966
Central Regional Center
230 South Dearborn Street
Room 2944
Cfiicago,IL 60604-1607
(312) 353-8260
HUD Lead Office
Please contact HUD's Office of Lead Hazard Control for informa-
tion on lead regulations, outreach efforts, and lead hazard control
and research grant programs.
U.S. Department of Housing and Urban DevelopmerK
Office of Lead Hazard ConVOI
451 SeverNh Street, SW, P-3206
Washington, DC 20410
(202) 755-7785
l3
S n -/- ~C
If you think your home has high
levels of lead:
• Get your young children tested for lead, even if
they seem healthy.
• Wash children's hands, bottles, pacifiers, and toys
often.
• Make sure children eat healthy, low-fat foods.
• Get your home checked for lead hazards.
• Regularly clean floors, window sills, and other
surfaces.
• Wipe soil off shoes before entering house.
• Talk to your landlord about fixing surfaces with
peeling or chipping paint.
• Take precautions to avoid exposure to lead dust
when remodeling or renovating (call 1-800-424-
LEAD for guidelines).
• Don't use abelt-sander, propane torch, heat gun,
dry scraper, or dry sandpaper on painted surfaces
that may contain lead.
• Don't try to remove lead-based paint yourself.
~~ ~ ~~ /6
Sample Disclosure Format for Target Housing Rentals and Leases
Disclosure of Information on Lead-Based Paint and Lead-Based Paint Hazards
Lead Warning Statement
Housing built before 1978 may contain lead-based paint. Lead from paint paint chips, and dust can
pose health hazards if not taken care of propedy. Lead exposure is especiaA~~armful to young
children and pregnant women. Before renting pre-1978 housing, landlords must disGose the
presence of known lead-based paint and lead-based paint hazards in the dwelling. Tenants must
also receive a Federally approved pamphlet on lead poisoning prevention.
Lessor's Disclosure (initial)
(a) Presence of lead-based paint or lead-based paint hazards (check one below):
Known lead-based paint and/or lead-based paint hazards are present in the housgi
(explain).
Lessor has no knowledge of lead-based paint andlor read-based paint hazards in ~
housing.
(b) Records and reports available to the lessor (check one below):
Lessor has provided the lessee with all Bailable records and reports pertaining to lead-
based paint and/or lead-based paint hazards in the housing (list documents below).
Lessor has no reports or records pertaining to lead-based paint and/or lead-bast;
paint hazards in the housing.
Lessee's Acknowledgment (initial)
(c) Lessee has received copies of all information listed above.
(d) Lessee has received the pamphletProtect Your Family from Lead in Your Home.
Agents Acknowledgment Initial)
(e) Agent has irfonned the lessor of the Iesso~s obligations under 42 U.S.C. 4852(d) and
is aware of his/her responsibility to ensure compliance.
Certification of Accuracy
The folbwing parties have reviewed the information above and certify, tthe best of their knowledge,
that the information provided by the signatory is true and accurate.
Lessor Date Lessor Date
Lessee Date Lessee Date
Agent Date Agent Date
k-rtAC+t~e~.s: z P°l ~ ~ ~
Sample Disclosure Format for Target Housing Safes
Disclosure of Information on Lead-Based Paint and Lead-Based Paint Hazards
®~ead Warning Statement
Every purchaser of any interest in residenfial real property on which a residen&al dwelling was built prior to 1978
is notified that such property may present exposure to lead from lead-based paint that may place young children
of risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological
damage, including learning disabilities, reduced intelligence quotient behavioral problems, and impaired memory.
Lead poisoning also poses a particular risk to pregnant women. The sel/er of any inferest in residen&a! real property
is required to provide the buyer with any informaSon on lead-based paint hazards firim risk assessments or
inspections in the seller's possession and notrfy the buyer of any known lead-based paint hazards. A risk
assessment or inspection for possible lead-based paint hazards is recommended prior to purchase.
Seller's Disclosure Initial)
(a) Presence of lead-based paint and/or lead-based paint hazards (check one below):
Known lead-based paint and/or lead-based paint hazards are present in the housing (explain).
Seller has no knowledge of lead-based paint and/or lead-based paint hazards in the housing.
(b) Records and reports available to the seller (check one below):
Q Seller has provided the purchaser with aA available records and'eports pertaining to lead-based paint
and/or lead-based paint hazards in the hoeing (list documents below).
r
Seller has no reports or repors pertaining to lead-based pain~nd/or lead-based paint hazards in the
housing.
Purchaser's Acknowledgment Initial)
(c) Purchaser has received copies of all information listed above.
(d) Purchaser has received the pamphlelPratect Your Family from Lead in Your Home_
(e) Purchaser has (check one below):
Q Received a 1(lday opportunity (or mutually agreed upon period) to conduct a risk assessmentro
inspection for the presence of lead-based paint and/or lead-based paint hazards; or
Q Waived the opportunity to conduct a risk assessment or inspectioior the presence of lead-based paint
and/or lead-based paint hazards.
Agents Acknowledgment Initial)
(f) Agent has informed the seller of the seller's obligatiorts under 42 t$.C_ 4852(d) and is aware of his/her
responsibility to ensure compliance.
Certification of Accuracy
The follow~g parties have reviewed the information above and certify, to the best of their knowledge, thatdh
information provided by the signatory is true and accurate.
Seller Date Seller Date
gent Date Agent Date
Purchaser Date Purchaser Date
2 G ~' 1
Federal Register/Vol. 64, .8/Wednesday, September 15, 199! r and Regulations 50231
Dale: Street and dty
' ~ Organization: _ State: _ ZIP: _ Phone number. ~~
Street and city.
Appendix D-Sample Hazard
State: _ ZIP: _ Phone number: (_, Reduction Completion Notice Forma[
Nolc The following appendix will not
Appendix C-Sample Summary appear in the Code oC Federal Regulations.
Presumption Notice Fot-mat - Summary Nonce of Completion of Lead-
Appendix B-Sample Sttmmary Risk
Note: The following appendix wi11 not Based Paint 1{azard Reduction Activity
Assessment Notice Format appear in the Code of Federal Regulations Addrus/ltxatiorl'Bf property or swdure(s)
Note This following appendix wilt not Notice That Lead-Based Paint or Lead-Based this summary rotice applies to:
appear inihe Code of Federal Regutatiorss paint ]iazards pro presumed to be Present
Stmtnwy Notice of teal-Based Paint Risk Address/Iootion of property or srtuaure(s)
Assessment
Address location of property or structure(s) this nonce of presumption applies to:
Summary of the hazard reduction activity.
this summary nonce applies to: Start and completion date(s):
Activity locations and types. Ilu at least the
Type of presumption (check all that apply): hawing emit numbers and common areas (ftx
(a) ,Lead-based paint is presumed to be multifamily Iwusittg). bare soil lncauotts.
tee-based t risk assessment desai s
l~
~ present dun-lead loratioru, and/or building
Date(s) of t
Wt assessment lb) _ Lead-based paint hazard(s) Is(are) cornponems (Including type of room or
Stanmary oCrisk assessrttent rrurlts (dick preseuned to be present space. and the material untiemeath the
all that apply): Stmunazy of presumption. liu az least the paint). and types oC hazard redution
(a) _ No lead-based patr# hazards were housing uNt numbers and common areas (for activities performed az tite lootiorss listed:
found multifamily houslttg), bare soil lootioru,
(b) _ Lead-based paint hazards were dust-lead locatioru, and/or building
found. components (indud6tg type of loom w
(e) _. A brMtsuntmary oC the findings of space, and the material underneath the
the rLsk assessment is provided blow paint). and types of lead-based paint hazards
(requbed Y arty lead-based paint ttamrtis presumed to be present
were fotmiQ.
Date(s) of dearartce testbtg and/or soil
Stmunary ~ types and locations o[ lead- -
. based pairK hazards. List at least the housing Lor ti u of building components with lead-
urdt nturtbe[s and contmwt areas (for
multifamlly housing). bare soil locations, based palm remaining in the rooms. spaces
dust-lead locauorts and/or building or areas where activities were conducted:
components (utduding type of room or
span, and the material urxMirteath the
paint). and types of lead-based paint hazards -
touttd
Summary of results of dearance testing and
soil analyses:
(a) ^ No clearance testing was
performed.
- (b) _ Clearance testing showed
clearance was atltleved
(c) _ Cltatarxe testing showed dearaoce
Contatt person for more information about was not achieved
the presumption Corttau person for mae information abom
Printed name the hazard reduction:
Printed name:
lhg:mizauon Cganization:
. Contact. person Ctx Hare information about Street and dry.
- ~ the risk assessment Street and dry. S~-, yam;
Printed name: Phone number. (_,~ -
State: ~ ZIP: _ Phone number. (_) Person who prepared this summary notice:
Organization Printed name:
Person who prepared this nonce of
- Signature:
Sweet and dry. presumption: Date:
Printed name: Organization
State: _ 21P: _ phone number. (_, Street and dty.
Signature: Scare: gyp:
Person who prepared this sutntltary notice: Date: _ Phone ntunber. (
,
Printed name: _
Organization lFR Doc 99-23016 Filed 9-14-99: 8:95 amj
. Signature: - otttx+c coos azto-az-r
Ana~k~tEt,~f- 3
ATTACHMENT NO. 4
LBP INFORMATION SUMMARY
1. ZERO/0 BEDROOM < (LESS THAN) 100 DAYS IN UNIT; ASSISTANCE IN
HOMELESS SHELTER
• STATUS: EXEMPT TITLE X
2. ZERO/0 BEDROOM > (MORE THAN) 100 DAYS IN UNIT
• STATUS: OPEN ISSUE UNDER LBP REGS
ZERO/0 BEDROOM > (MORE THAN) 100 DAYS ASSISTANCE IN
HOMELESS SHELTER
• STATUS: OPEN ISSUE UNDER LBP REGS
• SEE SUBPART K
• CLEARANCE OF UNIT(S) WILL BE REQUIRED BY CITY FOR ALL HOUSING
UNITS (EVEN ZERO BEDROOM) FOR WHICH OCCUPANCY OCCURS BY
ASSISTED HOUSEHOLD FOR MORE THAN 100 DAYS, PENDING FURTHER
INTERPRETATION/GUIDANCE FROM HUD
3. ONE OR MORE (1+) BEDROOMS OCCUPANCY < 100 DAYS IN
RESIDENTIAL UNIT AND/OR OCCUPANCY IN HOMELESS SHELTER
• EXEMPT TITLE X
4. 1+ BEDROOMS > 100 DAYS IN RESIDENTIAL UNIT
• STATUS: SAME AS #2 ABOVE; CLEARANCE REQUIRED
• SEE SUBPART K
5. EMERGENCY RENTAL ASSISTANCE < 100 DAYS
• EXEMPT TITLE X
6. EMERGENCY RENTAL ASSISTANCE > TO HOUSEHOLD TO BE
OCCUPANCY IN RESIDENTIAL UNIT FOR MORE THAN 100 DAYS (SUCH AS
LONG TERM LEASE SIGNED AT TIME OF EMERGENCY ASSISTANCE)
7/1INIIS
Attachment No.4
LBP ]nformation Summary
Page 1 Of 2
• CLEARANCE BEFORE ANY MONEY DISBURSED;
LBP COMPLIANCE: NOTIFICATION, EVALUATION, REDUCTION THROUGH
CLEARANCE REQUIRED BEFORE OCCUPANCY OF UNIT
• MAY BE CONSIDERED TENANT BASED RENTAL ASSISTANCE (TBRA); THUS
HQS INSPECTION AND SUBPART M MAY APPLY
• SEE SUBPARTS K AND M
• PENDING HUD GUIDANCE
7. TBRA < 100 DAYS
• EXEMPT TITLE X
8. TBRA > 100 DAYS OF HOME ASSISTANCE (SUCH AS WHEN TENANT
ENTERS INTO LONG TERM LEASE
• SEE SUBPART M
• CLEARANCE BEFORE ANY MONEY DISBURSED;
LBP COMPLIANCE: NOTIFICATION, EVALUATION, REDUCTION THROUGH
CLEARANCE REQUIRED BEFORE OCCUPANCY OF UNIT
• HQS INSPECTION REQUIRED BEFORE OCCUPANCY
• CLEARANCE BEFORE ANY MONEY DISBURSED
9. TBRA < 100 DAYS -TENANT ENTERS INTO LONG TERM LEASE, CITY
GIVES LESS THAN 100 DAYS OF ASSISTANCE.
• EXEMPT TITLE X
[See HUD Interpretative Guidance: Online: Questions M4, K7, K4, for discussion]
7111/OILS
Attachment No.4
LBP In(ormatioo Summary
Page 2 of 2
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TIES CANCEIS AND REPLACES CERTIFICATE L9$UED DBYm105 ~ _. o~UGfi-!'e+ S
CERTIFICATE OF INSURANCE° ~ 81EQ"'E
s
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PRODDER
Driver. ARlant Insurance Services
Ina THIS CERTi7GTE LS ISSUED AS A MATTER OF INFORMATION ONLY AND
, CONFERS NO RIOSiTS lJPON THE CERTIFICATE HOLDER THIS CERTIFICATE
P.O. BO% 25664 DOES N07 AMEND, EXTElB) OR ALTER THE COVERAGE AFFORDED BV THE
Sams Ana, CA 92799 POLN:IES BELOW.
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INSYn~ar[tw' ~ c~ANY q EV/WSTON INSURANCE COMPANY
PAINT YOUR HEART OUT, INC.
7TAB W UNCOLNAVENUE ~rt ANV B
gNAHEIM, CA 9780.5 '
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AS RESPECTS TO THE AGREEhENT WITH THE CITY OF SANTAANA THE CITY OF SAHTAANIA, rtS OFRGERS, AGENBAND EMPLDYEF$ SHALL BE
NAMED AS ADDRpNAL MJSXIRED. TIES POUCVAPPLIES FOR IUIBttIrYJTRLSING OUT OF THE INSUREDS OPERATIONS ON A PRSMRY BA31S, AND
NISURAWCE MAIN7AWED BY SUCH ADOR101ML BiSI1RFDS 1S EXCESS AND 1WNCONIRIBUZING WfR1 THIS POLCY. TWS POLN.'V COMMNS A
STANINIIiD CROSS LIABBTIY OR GEVEMBMY OF RTTEIiESr CIAUCE ADDRIOIMi NLSURED ENIXN25E),ENiATTACHED. SUb,IECT TO POLICY
TERMS, CONDrt10NS AIA EJ(CLUSIONS.
CERTIFN;gTE HOLDER CANCELLATION
S/IDVIA ANY OF THE ABOVE DESCRIBED POLKTES BE CANCELLED BEFORE THE
EXPIRATON DATE THEREOF, THE LSSlnNO COMPANY WILL ENDEAVOR TO MAIL
~. ~ SANIAANA '70 DAYS WRITIBi NOTCE TO THE CERTIFICATE XOLDER MAMEP TO THE LEFT,
ATTN: fRANK HERNANDEZ BU7 FAN.URE TO MAIL SUCH NOTICE SHALL SIPOSE NO OEDIPATNJN OR LIABILITY
MANAG9ENTAIDE
OF ANY qND UPON THE COMPANY, fT5 AGENTS OR REPRESENTATIVE3
2G CMC CENTER RAZA
SANTA ANA, GA 92707 'EXCEPT 10 DAYS FOR -PA Ni
AUTIKJRLZED REP A
iD- 3-05; 3:30P61; Paint Your Heart Out ;7i4 ?5F i3?8 # D
Ettdtttsement. No. 3
ADDITIONAL INSLIItED - D~NA~D PERSON OR ORGANIZATION
I7' IS AGREED THAT TIIE FOLLOWING ARE ADDID AS ADDITIONAL INSURfiD (S) HEREUNDbR
BUT QNLY AS RESPECTS LIABILITY ARISING OUT OF THE OPERATIONS OF THE NAMED
INSURfiD, AND FURTHER PROVIDED THAT THE INCLUSION OF SUCH ADDITIONAL INSURED
SHALL NOT SERVE TO INCREASfi THE COMPANY'S LIMIT OF LIABILITY AS SPECIFIED IN THE
DECLARATIONS OF TFtE POLICY.
SC1EiEDIILE
NADiED INb'UItED: PAtNr YOURHEART OUT, INC.
12W W. LiNCOLNAVENUE
ANgyEIM, CA 92E05
NAME OF PERSON Ol't
OItGANI7.ATION/CF.It7TFtCATE HOLDER crty of sAxrA ANA
ATTN:FRANLCBERNANbFL
MANAGEMENT AA)E
20 CMC C.EN1'kR PI.A7A
SANTA ANA, CA 92901
TAE C11Y OF SANTA ANA, r75 OFFICERS, AGENTS pND EMPLOYEES,
TII1S POLICY APPLIES FOR LJABII.r1Y ARISING OUT OP THE 1NSURED'S
OPERATIONS ON A DIRECT AND PRIMARY BASIS, AND INSURANCE
MA1NTAiNED BY SUCH ADDrIIONAL INSUAEDS>S EXCESS nND
NONCONTRIBUTING WrrH IRIS POLICY
PER CERTiPTCAT'ES OP INSURANCE APPROVED BY THE COMPANY, AND ON FILE WITH THE COMPANY
EFFECTIVE DA'I'S OF TFIIS ENDORSEMENT: 09/29ro5
ATTACHED TO AND FORMING A PART OF t?OLICY NO.:
Alt other terms and conditiolu tanain luichallged.
Insurer: EVANSTONINSURANCECOMPANY
Special Liability Insurance Program (SLIP)
Effective September 29, 2005 to September 29, 2006
DATE ISSUED: 10/3/05
SLIP3000-05
,,:y r.5 TO FOi?i:4.
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• 10- 3-05; 3:30PM; Paint Your Heart Out
;714 758 1378 # 2- 5
.. ISSVE GATE (M
CER'iIFICATE OF
INSURANCE``
.
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PROOUCaL
Driver . Alliam Insurance Services
Inc. ~` CERTIFICATE IS ISSUED AS A MATYER OF INFORMATION ONLY AND
,
P
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BO% 25884 CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFIGTE
.
.
Sams Ana
CA 97199 ODES trot AMEND, F_ICTEiD OR AL1FR THE COVERAGE AF40RDE0 BY THE
, POLICIES BELOW.
leool b2t~9283 Ext taD. fax lase? use-z/ta COMpAN1E5 AFFORDING COVERAGE
liter»e Nw OCiM67
wwREO ercEUt s ~~~ ~~ A ILLINOIS UNION INSURANCE CO
PNM YOUR HEART OUT, INC. .
7208 W. LINCOLN AVENUE tmrl~ B
ANAHEIM, CA X805
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aoTVmxsrAxrnq Axr RsrnnReetPrc, TDAI CR cOxwTron OFANY WNIRACTOR DTtIFR t10CIxbiNL WDH ReSPGCTt'D WNxkf TEIR oEw,sICATE W1Y ee AWED
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L~ 1YPE OFINSURANCE POIIDY IIIIIIelA ~fIDMDDnY) EIOT~RAI~gN LINTS
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AS RESPEI`TS 70 THEAGNEL•ME/TT WTTIL THE CTTY OF SANTA ANA THE (TIY OF SANTAANA, r15OFFHEr;S
AGf373S AHD EZ1PlAYEES SHALL BE
,
NAMED AS AODRLONAL EJSUNED. TIES POLICY APPl.ffS FWL UABILRYARL~'4N[' OUF OFTLE MJSTIREDTi OPERATIONS ON A PRRAARY BASIS
AND
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WSURANCE MAINTANED BY SUClIAOpIpINL INSUREDS IS E7fC65S AND NONCONTREIIfi1N0 WRH THIS POLICY. T'W$ POLICY CONTADIS A
STANDARD CROSS LNBRTTY OR SEVERABILftt OF MfTEiIEST CLAUSE ADORbNAL INSUR® EIIDORSBIEHC ATTACLIED. SUBJECT TO POLICY
7ERA1.5, CONORIOItS AND IXCLUSIONS.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF TILE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EIfPIRATION GATE THEREOF, THE ISSVRW COMPANY NRLL ENDEAVOR TO MAIL
Cm' OF SANTA ANA '~ DAYS WRITYEN NOTICE 1b THE CERTIfrCATE HOLDER NAMED TD THE LEFT,
ATTPL' FRANK 1¢}WANDQ BUT FHLURE TO MAa. SUCH NOTICE SHALL IMPOSE NO OBLIGA7TON OR LIAx]utt
MANAGEMENT AIDE
OF ANY IOND UPON THE COMPANY, IIS AGENTS OR REPRESENTATNES
ZO CIVIC CENTER PLAZA
SANTA ANA G7 02707 'EXCEPT 76 DAYS FOR PA M
A AP
,I
~0= 3-C5; 3:8CPM; Paint Your Heart Out f714 758 13?8 # 3~ 5
Endorsement. No. 3
ADDiTTONAi. INSIJRI:D -DESIGNATED PERSON OR ORGANIZATION
IT IS AGREED THAT THE FOLLOWING ARE ADDED AS ADDITIONAL INSURED (S) HEREUNDER
BUT ONLY AS RESPECTS LIABILITY ARISING OUT OF. THE OPERATIONS OF THE NAMED
-NSURED,-AND FURTHER PROVIDED THAT THE INCLUSION OF SUCH ADDlT1pNAL INSURED
SHALL NOT SERVE TO INCREASE THE COMPANY'S LIMIT OF LIABILITY AS SPECIFIED IN THE
DECLARATIONS OF THC POLICY.
SCHEDULE
NAMED ENSURED: PAINT YUI1R HEART OUT, INC.
1209 W,LTNCOT.N AVENUE
ANAHEIM, CA 92805
NAME OF PERSON OR
ORGANIZATION/CERTiFiCATE HOLDER: crrY OF SAN"l'A ANA
ATTN: FRANK iIERNANDF7
MANAGF.MF.NT ATDF,
20 CMC CENTER PLALA
SANTA ANA, CA 9270 ]
T11E CITY OF SANTA ANA, 7TS OFFICERS, AG£N1"S AND EMPLOYEPC,
THfS VOT,iCY APPLIES FOIL L1AB1Ll'lY ARISING OUT OF THE. INSURED'S
OPERAIIUNS UN A DIRECT AND PRIMARY BASi$, AND 1NSUItANCE
MAQJ'CAINED IIY SUCH ADDITIONAL INSUREDS 1S EXCESS AND
NONCONTRIRITI'ING WITH THIS POLICY
PFR CP.RTIFICATL• S OF INSURANCE APPROVED BY THE COMPANY, AND ON FILE WITH THE CUMPANY
EFFF,CTiVF, DATE OF THIS ENDORSEMENT: 09/29/04
ATTACHED TO AND FORMING A PART OF POLICY NO.: 622078458
All othzr terms and conditions remain unchanged.
Insurer: ILLINOIS UNION INSURANCE COMPANY
Special Liability Insurance Program (SLIP)
EIT'ective September 29, 2004 to September 29, 2005
DATE ISSUED: l0/3/05
. , .., i'L3 t.t?h;vl
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