HomeMy WebLinkAboutFEEDBACK FOUNDATION 4 -2002
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~ ~ ~ 8 This Agreement, made and entered into this 15~ day of ~, 2002,
~ ~ ~ ~by a nd between the City of Santa Ana, a charter city and municipal corporation of the State of
Ci2 "";;;! ~lifornia ("CITY") and FEEDBACK FOUNDATION, a California nonprofit corporation
~ ~ ~ d:~UBRECIPIENT"),
AGREEMENT BETWEEN THE CITY OF SANTA ANA AND
FEEDBACK FOUNDATION FOR USE OF
COMMUNITY DEVELOPMENT BLOCK GRANT FUNDS
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Recitals:
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 ofthe
Housing and Community Development Act of 1974, Public Law 93-383, as amended ("ACT"); and
C. The SUBRECIPIENT 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," hereinafter referred to as "said program" and SUBRECIPIENT represents
that it is qualified and willing to operate said program.
D. The CITY and SUBRECIPIENT have duly executed this Agreement for the expenditure of
such funds; and
WHEREFORE, it is agreed by and between the parties, that the foregoing Recitals are a
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 - Reoresentations and Warranties.
(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.
SUB RECIPIENT 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 SUB RECIPIENT has been fully authorized by all requisite actions on the part
of SUBRECIPIENT.
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(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.
(d) No Conflict. To the best of SUBRECIPIENT'S knowledge, SUBRECIPIENT'S
execution, delivery and performance of its obligations under this Agreement will not constitute a
default or a breach under any contract, agreement or order to which SUBRECIPIENT is a party
or by which it is bound.
(e) No Bankruptcy. SUBRECIPIENT is not the subject of any current or threatened
bankruptcy proceeding.
(I) 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.
(h) No Pending Investigation. SUBRECIPIENT is not aware that it is the
subject of any current or threatened criminal or civil action investigation by any public agency,
including without limitation a police agency or prosecuting authority, that would relate to affect
performance ofthe Agreement or provision of services hereunder.
B. Amount of Grant and Ouarterlv Disbursement. The amount granted to
SUBRECIPIENT is $ 45,000 ("CDBG FUNDS"), and such funds shall be expended by
SUBRECIPIENT within a time period not exceeding twelve (12) consecutive months following
the date of this Agreement. The CDBG FUNDS shall be disbursed by CITY to
SUBRECIPIENT on a quarterly basis (October, January, April and July) subject to and upon
receipt and approval of a complete SUBRECIPIENT'S quarterly activity report, with the final
payment subject to the satisfaction of the condition precedent of submittal of complete reporting
information due on or before July 15 of the applicable funding year, as hereinafter more fully set
forth. SUBRECIPIENT shall be obligated to perform such duties as would normally extend
beyond the term, including but not limited to obligations with respect to indemnification, audits,
reporting, data retention/reporting, and accounting.
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 A,"
attached hereto and by this reference incorporated herein. SUBRECIPIENT'S failure to perform as
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required may, in addition to other remedies set forth in this Agreement, result in readjustment of the
amount of funds CITY is otherwise obligated to pay to SUBRECIPIENT under Paragraph II hereof.
D. Allowable Costs. SUBRECIPIENT agrees to complete said program on or before
June 30, 2003 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 funds may be expended
pursuant to the terms and conditions of this Agreement.
E. Licensing. SUBRECIPIENT agrees to obtain and maintain all required licenses,
registrations, accreditation and inspections from all agencies governing its operations.
SUBRECIPIENT shall ensure that its staff shall also obtain and maintain all required licenses,
registrations, accreditation and inspections from all agencies governing SUBRECIPIENT's
operations hereunder.
F. Zoning. SUBRECIPIENT agrees that any facility/property used in furtherance of
said program shall be specifically zoned and permitted for such use(s) and activity(ies). Should
SUBRECIPIENT fail to have the required land entitlement and/or permits, thus violating any local,
state or federal rules and regulations relating thereto, SUBRECIPIENT shall 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
ofpending violations, or to remedy such known violation(s) shall result in termination of grant
funding hereunder. SUBRECIPIENT must make all corrections required to bring the
facility/property into compliance with the law within sixty (60) days of notification of the
violation(s); failure to gain compliance within such time shall result in termination of grant funding
hereunder.
G. Separation of Accounts. All funds received by SUBRECIPIENT from CITY
pursuant to this Agreement shall b e maintained in a n a ccount in a federally insured banking 0 r
savings and loan institution with record keeping of such accounts maintained pursuant to applicable
OMB Circular A-1I0 requirements. SUBRECIPIENT is not required to maintain separate
depository accounts for CDBG FUNDS; provided however, the SUBRECIPIENT must be able to
account for receipt, obligation and expenditure of CDBG FUNDS pursuant to applicable OMB
Circular A-IIO requirements.
H. Audit Report Reauirements. 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 standards as set forth and published by the United States Office of Management
and Budget. SUBRECIPIENT shall provide CITY with a copy of said audit by October I of the
year following the program year in which this Agreement is executed.
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1. Record Keeping/Reporting. SUBRECIPIENT shall keep and maintain complete and
adequate records and reports to assist CITY in meeting and maintaining its record keeping
responsibilities under the CDBG 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 SUBRECIPIENT 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 a 11 contracts 0 r 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.
1. 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: SUBRECIPIENT agrees to keep 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, the number
of female heads of households assisted, new program information and year-to-
date program statistics on expenditures, caseload and activities..
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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
SUB RECIPIENT'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 SUB RECIPIENT are kept. Nothing herein shall be construed to require access to any
privileged or confidential information as set forth in federal or state law.
K. Location of Records/Roouired Length 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., s.
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. 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 LawlProgram 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. Confidentialitv. 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.
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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 or 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. S UBRECIPIENT agrees to maintain a record for each item ofnon-
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.
R. Prohibited Use. SUBRECIPIENT hereby certifies and agrees that it will not use
funds provided through this Agreement to pay for entertainment, meals or gifts.
S. Lobbving. SUBRECIPIENT certifies that it will comply with federal law (31
U.S.c. 1352) and regulations found at 24 CFR Part 87, which provide that no appropriated funds
may be expended by the recipient of a federal contract, grant, loan or cooperative agreement to pay
any person for influencing or attempting to influence an officer or employee of any agency,
Member of Congress, or an officer or employee of a Member of Congress in connection with
awarding of any federal contract, the making of any federal grant or loan, entering into any
cooperative agreement and the extension, renewal, amendment or modification of any federal
contract, grant, loan or cooperative agreement. SUBRECIPIENT shall sign a certification to that
effect in a form as set forth in "Exhibit C," attached hereto and by this reference incorporated herein.
SUBRECIPIENT shall submit said signed certification to CITY prior to performing any of its
obligations under this Agreement and prior to any obligation arising on the part of CITY to pay any
sums to SUBRECIPIENT under the terms and conditions of this Agreement.
If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the
undersigned shall complete and submit a "Disclosure Form to Report Lobbying," in accordance
with its instructions (see C-l).
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,
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or who are in a position to participate in a decision-making process or gain inside information with
regard to such activities, may obtain a financial interest or benefit from a CDBG-assisted activity of
SUBRECIPIENT, either for themselves or those with whom they have family or business ties,
during their tenure or for one year thereafter. This prohibition applies to any person who is an
employee, agent, consultant, officer, or elected or appointed official of CITY, or of
any designated public agencies, or the SUBRECIPIENT.
U. Davis-Bacon Act. All laborers and mechanics employed by contractors or
subcontractors in the performance of construction work, including alterations and repairs, in excess
of $2,000.00, financed in whole or in part with federal funds shall be paid wages at rates not less
than those prevailing on similar construction in the locality as determined in accordance with the
Davis-Bacon Act, as amended, 40 U.S.c. sections 276a - 276a-5. Any such construction contract
shall include and comply with the required contract provisions and rules set forth in 29 C.F.R. ~5.5.
Further, the payroll reports (along with the "Statement of Compliance") and basic records are
required to be maintained and submitted, or made available, pursuant to 29 C.F.R. ~5.5(a)(3). No
payment, advance, grant, loan or guarantee of funds shall be approved by the federal agency unless
there is on file with the agency a certification by the contractor that the contractor and its
subcontractors have complied with the provisions 0 f2 9 C .F.R. ~5.5.. A breach 0 fthe 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 Workplace. 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 SUB RECIPIENT will be required to:
a) Abide by the terms above in statement I.
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,
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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 SUBRECIPIENT from CDBG funds, when, if and to the extent received from HUD, for
CITY's 2002-2003 CDBG program year amounts expended by SUBRECIPIENT in carrying out
said program for fiscal year 2002-2003 pursuant to this Agreement up to a maximum aggregate
payment of FORTY-FIVE THOUSAND Dollars ($ 45,000) in installments determined by CITY.
Payments shall be made to SUBRECIPIENT through the submission 0 f invoices 0 n 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 0 fthis
Agreement and that SUBRECIPIENT is in compliance with the terms and conditions of this
Agreement.
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.
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
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 list
of officers.
V. SPECIAL CERTIFICATION FOR RELIGIOUS ENTITIES
If SUBRECIPIENT is a religious entity, SUBRECIPIENT hereby agrees that in connection
with the provision ofthe services SUBRECIPIENT shall provide with CDBG funds:
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.
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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. SUBRECIPIENT shall NOT provide religious instruction or counseling, conduct
any religious worship or services, or engage in any religious proselytizing, or exert any religious
influence in the provision of the services in said program. The parties agree that this covenant is
intended to and shall be construed for the lirnited 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 SUB RECIPIENT.
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
TO SUBRECIPIENT:
Feedback Foundation
1200 N. Knollwood Circle
Anaheim, CA 92801-1334
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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 Agreement to CITY. No subcontract or assignment shall terminate or alter the legal
obligations of SUB RECIPIENT pursuant to this Agreement.
IX. HOLD HARMLESS
SUBRECIPIENT shall indemnify, defend 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 oflimitation, 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
SUBRECIPIENT's performance of this Agreement.
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, SUBRECIPIENT 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 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
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 SUBRECIPIENT's operations hereunder.
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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 ofthis 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 ofCDBG funds. [24 CFR 570.503(b)(8).]
B. Any real property under SUBRECIPIENT's control that was acquired or improved
in whole or in part with CDBG funds in excess of$25,000.00 must either be:
I. 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 oftime 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 0 f this Agreement w ill vest upon acquisition in SUBRECIPIENT. W hen 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:
I. Items 0 f equipment with a current p er unit fair market value 0 fl ess than
$5,000.00 may be retained, sold or otherwise disposed of with no further obligation to CITY.
2. Items of equipment with a current fair market per unit value of $5,000.00 or
more may be retained or sold and CITY shall have the right to an amount calculated by multiplying
the current market value or proceeds from the sale by CITY's share of federal funds used to acquire
the equipment, in accordance with 24 CFR 85.32(e)(2).
D. SUBRECIPIENT hereby agrees, upon the demand of CITY, to execute,
acknowledge and deliver, or cause any person or entity who may have any claim to rights hereunder
or under any document, instrument or agreement executed in furtherance of the services and
activities to be performed hereunder, to execute, acknowledge and deliver, to CITY assigmnent(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
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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 "XL
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 SUBRECIPIENT, which default and termination shall be effective
on a date stated in the notice which is to be not less than ten (10) days after certified mailing or
personal service of such notice, unless such default is cured before the effective date of tennination
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 (I) 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.
E. In the event this Agreement is terminated as set forth in subparagraphs XILA.
through XILD., 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 "XL REVERSION OF ASSETS" of this Agreement.
12
"""
"""'"
7/6/02LS
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 are not presently anticipated. Accordingly,
CITY reserves the right to revise this Agreement in order to take account of actions affecting HUD
program funding. In the event of funding reduction, CITY may, in its sole and absolute discretion,
reduce the budget of this Agreement as a whole or as to costs category, may limit the rate of
SUBRECIPIENT's authority to commit and spend funds, or may restrict SUBRECIPIENT's use of
both its uncommitted and its unspent funds. Where HUD has directed or requested CITY to
implement a reduction in funding, in whole or as to a cost category, with respect to funding for this
Agreement, CITY's City Manager or delegate is authorized to act for CITY in implementing and
effecting such a reduction and in revising, modifying, or amending the Agreement for such
purposes. Where CITY has reasonable grounds to question SUBRECIPIENT's fiscal
accountability, financial soundness, or compliance with this A greement, CITY may suspend the
operation of this Agreement for up to sixty (60) days upon five (5) days written notice to
SUBRECIPIENT of its intention to so act, pending an audit or other resolution of such questions.
In no event, however, shall any revisions made by CITY affect expenditures and 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.
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.
13
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7/6/02LS
XVII. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature hereinbelow has the power,
authority and right to bind their respective parties to each of the terms of this Agreement, and shall
indemnify CITY fully, including reasonable costs and attorney's fees, for any injuries or damages to
CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn.
b. All Exhibits and Attachments referenced herein and attached hereto shall be incorporated
as if fully set forth in the body of this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the last date and
year written below.
CY~A
.~~
DAVID N. REAM
City Manager
DATED:
ATTEST:
APPROVED AS TO FORM:
PATRICIA E. HEALY
Clerk ofthe Council
~~~
J9., JOSEPH W. FLETCHER
City Attorney
SUBRECIPIENT:
DATE: ,)-/3/ oJ
~~~~
N:iine: ft? c./ U/1//:17)
Title: 676e',tt' /7?/'&- ,D/R>c~.e:
TaxID: c:J..:J--cf) 77/7/S-
14
,..~
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20110
II. APPLICATION SUMMARY
In the space below, summarize the components of your program. This summary should include:
1. A needs statement: What is the purpose of the program/project?
2. A brief description of the program/project with specific goals and objectives.
Goals provide a wide overview; they are broad in scope and are outcome-based.
Objectives relate to specific tasks and are quantifiable. (A more detailed de~cription of your
goals, objectives, and tasks is required in Section V.) .
3 A statement of organizational qualifications to implement the program.
This initial summary is intended to be a BRIEF overview of your organization. Detailed
information concerning these areas of interest will be requested in subsequent pages of this
application
Congregate Meal Program
Feedback Foundation serves lunch at three congregate centers in
Santa Ana. The program addresses the need for older adults to have
a nutritional meal. However, the program is always more than a meal.
Many isolated older adults have the opportunity to socialize, receive
services, and enjoy the company of their peers in a safe and friendly
environment. For some, this is the only socialization they experience
during the day. A donation is requested, but no one is turned away
due to an inability to donate. Feedback Foundation proposes to serve
843 Santa Ana seniors during 2002103. Feedback Foundation anticipates serving 30,492 meals
at the Santa Ana congregate sites which includes; Santa Ana Senior Center, Southwest Senior
Center, and the Vietnamese Community Center.
Homebound Meal Program
The donation based home delivered meals program assists
frail at risk older adults to remain in their home following the on-
set of a chronic or acute physical and/or mentally debilitating
illness. Three meals are served Monday through Friday.
Nutritional needs are addressed and the daily connection with
the driver and case managers allows other needs to be
addressed as well. There is a watchful eye on all recipients
and many receive additional gifts and support from community
agencies and service clubs. This too, decreases feelings of
isolation and loneliness. Feedback Foundation projects to serve 316 homebound older
adults and other services in 2002/03. Feedback Foundation anticipates serving 150,000
meals to Santa Ana seniors.
EXKIBIT A
'-' ....,
FEEDBACK FOUNDATION, INC ATTACHMENT 4
NUTRITION PROGRAM BUDGET
FISCAL YEAR 2001-2002
Total Agency City of City of
Nutrition Santa Ana Santa Ana
Program Program Funds
Requeste!l
6500 798
Budgeted Meals Serviced: 871,080 176,092
percent of tot.costs/income allocated: 20.22%
FEDERAL TITLE III FUNDS 1,606,946 455,732
USDA @53 meal 461,672 93,329
PROJ.INCOMESR. Donations 753,984 39,121
PROJ.INCOME:THIRD PARTY
OTHER DONATIONS 179,249 40,000 4S:000
INKINO: NONMATCH (STEP Prog. etc.)
INKIND: MATCH(volun.,inkind staff support) 204,000 41,239
TOTAL INCOME: 3,205,851 669,421 45,000
EXPENSES:
PERSONNEI-:Admin. 136,397 27,573
Program/Site 508,592 102,814
Kitchen 143,808 29,071
Meal Assemblers 75,179 15,198
Drivers 163,124 32,976
Maintenance 36,604 7,400
SUBTOTAL PAID PERSONNEL 1,063,704 215,032
Benefits 183,232 37,041
Inkind 204,000 41,239
TOTAL PERSONNEL 1,450,936 293,312
TRAVEL-local mileage 8,000 1,617
Training 3,870 782
EQUIPMENT 0 0
FOOD: raw food 980,974 198,307 45:000
catered 27,972 27,972
CONSULTANTS 17,600 3,558
OTHER:Volunteer Exp,
Rent 148,000 29,919
Utilities 84,000 16,981
Telephone 10,400 2,102
Insurance 36,695 7,418
Audit/Accounting 4,000 809
Office( supplies/maintJpost./subscript/memb 42,000 8,490
Program Supplies 237,004 47,911
Vehicle Oper/Maint/Repair 55,000 11,118
Bldg. & Equ i pRepair&Maint. 70,000 14,151
Technology 6,400 1,294
Property taxes(Or. County assess.) 1,200 243
Outreach:Advert.lProgram Promotion 1,400 283
Employee costs: advertise/physicals 3,600 728
Direct Site Costs 12,000 '" 2,426
uues & Subs 4,800 '1 970
TOTAL EXPENSES:(with Inkind) 3,205,851 669,421 4g:000
Cost Per Meal 3.68 3.80 0.23
10/31/0109:35:12 AM santafy2WK4 EXHIBIT B
.....,
'"'"
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:
(I) 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.
re~ A ~c{c nl/l...1J, ~ '"
Grantee/Contactor Organization
Program Title
Signature
EXHIBIT C
Page 1 of2
^ .
'-
'ttoJ'
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 ofrace, color, religion, national
origin, or sex, be excluded from participation in, or be denied the benefits of, or be
subjected to discrimination under any program or activity funded in whole or in part with
community development funds made available pursuant to the ACT.
3. All laborers and mechanics, employed by contractors or subcontractors in the
performance of construction work financed in whole or in part with community
development funds shall be paid wages at rates not less than those prevailing on similar
construction in the locality as determined in accordance with the Davis-Bacon Act, as
amended, 40 U. S. C. Sections 276 a 1-5, except for individuals who perform services for
which they volunteered; do not receive compensation for such services; or are paid
expenses, reasonable benefits, or a nominal fee for such services; and are not otherwise
employed at any time in construction work.
4. SUBRECIPIENT will comply with all Federal statutes applicable to projects funded
with community development funds, except that (a) SUBRECIPIENT does not assume
CITY'S environmental responsibilities described at 24 CFR 570.604; and (b)
SUBRECIPIENT does not assume CITY'S responsibility for initiating the review process
under Executive Order 12372.
EXHIBIT C
Page 2 of2
'JUL 16 2002 9:07AM
"
l
HP LASERJET 3200
p.2
-.
MAGUIRE INSUFt NCE AGEt-ICY
LlC 10377645
26:300 LA ALAME A SUITE 470
MISSION VIEJO, A 92691
---.-..-..
INIUItE"D
...... "'-" Pr -ZOt:);;-- I oS- - I '0
ACORD. (ERTIFICATE OF LIABILITY INSURANCE , 'OOi-f='
THIS C~RTIACATE IS ISSLlED AS A MATTER OF INFORMATION
ONLY AND CONFERS I/O R!GHTS UPON 1lJE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AliENO. EXTEND OR
AL TER THE COVERAGE AFFORDED BY TilE POUCIES BELOW_
.
~-oa25
IN3UP.!;R .~
lNSLlRERS AFFORDING COVERAGE
~ILAlJELP..H'-"-INDEf>.INITY INSURANCE COMPANY.
fEEDBACI, FOUNDATION
1200 N. K OLLWOOD CIRCLE
ANAHEIM CA 92B01
,
COVERAGES
THE POUCIi::SQF INSU ANCE UBTEO BELOW HAVE B6EN.I&SUED TO THE I~StJRED NAMED ABOVE FOR THe pOtU";'( PER\OD INDK;,\,-ED. NOlWITHGTANOING
ANY HEQlIIRE!lAENT. r RM OR CONorrrON OF ANY CONTRACT OR OTHF.R DOCUMENT WITH RESPECT TO WHICH THIS CERTlflCATI: MAY BE ISSUED ~
M,Io,V PF.RTAIN, "THE INS RANCE AFFOrmED BY THE POLICIES DESCR1BEO HEREI'-I15 SUBJECT TO All. THE TERMS, [XQUSIONS ANO CONOlfrONS Of S\JC~
_ _f"OLlCIES. AG_~_~~_~_~T~ L..ItAlTS SHOWN 'M_,!,V HA'\IE~EEIi R~O~C~?_BY PAID ~':"'~:, ,. - - ilfDNr-------.-n----. ...- -- --~------
IUIR T'l'PE Of IN8U ~CE POLlCY "UIIo\'BfK ~ EFFI!CT1YE P UCV EKPfRfmL. LIMITS
~Nl:RALLlIlo&ILITY ~~H,~~~~~~-m. _~_______J'OOO,O(X)__
A 'lEX Xi! (COMMERCIALGEN '1ALUABILlrY PHPK027575 0710112002 07fOl/2003 ~~!!":~i~~~_ $ 10D,OC()._
I Cl""M" MiADE [[]axuR i ~_~~~(~L~.fl''''lMl) $ ___~,OOO_
___ PeRSONPJ..& Af.'N IrtJURY ~_ ____l,9091!Q!L
~ _ _ _ QENERALAGGREGATE ~_ __ 2,000,000
~~'~::,:~f~l ~;~I APr1-Ei ;;; ~~!?-~~~~~~-~ ~ -- - - _~~~~900
~~ER~.__~.. _
INSUReR c:
-.!!.~-~-~~--
INSl..lRfflt:::
i
o\UTOMOBlLE' UAPlllTT I
COMetN!;O SINGLE UMH , 1,000.000
A A "NY "uro PHPK027575 0710112002 0710112003 {Egace~IJ
--------
..~ All OWril;D AurO eOOll'( INJURY
5CHt::U ULED Aura [f'O'~) .
- ------~.---- -----~.
i"',~AUT06 5Q[1llV IN,IURY
N{)Io. OWNED ALlTO (P4/.acc100n'. .
- --------- . .- ._~
-- ------- - ...- PROPERTY IJ,I:.11II"GE ,
(PClfacd.Jent)
~"G' u...'''' .A.lJTO ONl V - EA ACCIDENT ,
. ---
4NVAUTO "THEn '1-"AN EAACC', . ..-
AIJTOONI.Y: AGO .
E.XCiS5 UUILITY EACH OCCIJRRCN:E . 1,000,000
A :AJ OCCUR o ctAIMS MADE PHUB010926 0710112002 0710112003 ~F.~!"'.~_. . 1,r.KlQ.,OOO.
.----
. -
=1 DEOUCIBLE e--- -----~- .
0,000 ----.- .~ ----------
Rl:.1ENT1ON , .
...oM-ERa COMPEN&A OK "-NO ~~Rilf~I__ IVtP-
!!Ml'"lOYEJU'I'LltIUilUTY
E.L EACH .a.rXIUF.tH I ------
E.t..DI:3EPSt'-EA[MPWY~E S --
EL DlSF.A.'''E - POliCY LIMn ,
em...
A CRIME PKPK027575 0710112002 0710112003 EMP DISHONESTY $100,000, $~ ,000 DED
I THEFT IN/OUT $1,000, $250 OED
DEaCRlPt10N OF DPERA110JIIFtLOCATIO~Sl\tElEUlS1EXClUtlIO"SAtCl!D illY fJlOORSEM&.NTmpI!CIAL pROV1610NS
CITY OF SANTA AN ,ITS OfFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE INCLUDED AS ADDITIONAL INSURED AS
RESPECTS THE OP RATIONS OF THE NAMED INSURED.
CERTIFICATE HOLD
I
I X I ADD1TlQNAl.INSUPCD; IMllUftER LE1"Iet: X
CANCELLATION
'CITY Of )ANTA ANA
COMMU ITY DEVELOPMENT AGENCY M-25
P.O.80 1988
S"toIT A I A. CA 92702
,
ACORD 2!l-S (7117)
BHOUl-DAflYOFTHI!.UDVE DUCRI9EOPClUCIESBE CAMCELLED 8EF<:1FlE nlEflCf'lRATlON
DA'I"E "T1IaJlEDF, THE atJlNG Wo/&t1RU. Wll...~ll __ "30 DAYS W'R1TTI!!Il
NCTlCE1Q THI!! CER11F1C,\TEttQLD!RNANSI)TO THELI'!PT~
~"""'"'''lloll."folNl>'''''''
AtJ1HORlZl!D Rl!P',.DENTA.TNE
rl.
,....
xXXXXXXXXXXXXXXX
~ ,1\...... _..~A~
LJ:. 'v no "'-
" AOR:D CORfORA TION 198B
Ad-ROVED AS TO FORNi
~I
\ 11[::\ Sheedy (
pl:t:-,; City Attorney
,
SEP J~ 2002 9:48AM
HP . ASERJET 3200
'-'
p.2
F:R[J'I
FAX NO. :714-647-6549
"""
5..". 09 2002 lil3: 07PM P4
ADDITIONAL INSURED ENDORSEMENT
E9JLG...Q~RCIAL GENERAL LIABILITY POLlCY "
Insurance Company Jl'\i \od~\~"-'\C\ \l\dt\l1l1iN \D~\,(lln vV ~mfa.11 ~
'Ibis endorsement nwdilies such insurance as is afforded by the Jl1'ovi~kms of Policy
It y~'Y-W1515rclating to the following:
I. The City of SlIl1t1\ Ann, 20 Civic Center Plaza, Santa Ana, CalHomia 92701; its
officers, employees, agenls, vulunteers and leprcsentlitives are named as additional insur<lds
("additional insureds") with l'egard to liahility and delensc ofsuits arisinll from tho operations
and uses performed by ur 011 behalfofthc Mmed instlled.
2. With respect to claims arising out oftbe operation. and uses performed by or on
behalf of tile nllll1ed insured. such insurance as is afforded hy thi.s potiey is primary and is not
additional to or contributing with any other insurance canied by or for the benefit oftne
additional insureds.
3. Tbis insurance applies separately to each insured against whom claim is tnade or
suit is brought tlXctlpt with respect to tb.. compal.lY's limits of liability, The inclusiun of any
pcrso" or organization lIS un insU1'Cd .hllll not all'tlct any riGht wbich sucb per.on or organization
would have ll.~ aclaimanl ifno! so included.
4. With respect to the additional insureds, this insurilllCt:l shall not be cancelled, ur
materially reduced in coverage or limiu except after tbirty (30) days writtc:n nutice has been
givon to the City of Santa Ana, 20 Civic Center Plw, Santa Ana, Califomi1l92701.
(Contpletiun of the fol.lowing, including countersignature. is required to make this endorsement
effective.)
Effective 01-01- ').(fYt.1-nYlA 01-DI-~ this endorsement form as a part of
i..~~:~~ ~o ~}m0ndafi}n
Named Insured
Countersigned by
.0, cU AS i U j.ORiYl
~u~,
:-'. ,1[;\ . hcedy (
i",!V Ci\y Attorney
-
-.
'-'
'wi
STATE
COMPENSATIQ,N
INSURANCE
FUN.O
P.O BOX 420807, SAN FRANCISCO, CA 94142-0807
CERTIFICATE OF WORKERS'COMPENSATlON INSURANCE
,1UL Y 8, 2002
POLICY NUMBER;
CERTIFICATE EXPIRES:
1638989 - 02
7-1-03
,-
CITY OF SANTA ANA
ATTN COMMUNITY DEVELOPMENT AGENCY M-25
POBOX 1988
SANTA ANA CA 92702
L
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California
Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer.
We will also give you TEN days' advance notice should HllS policy be cancelled prior to its normal expiration.
This certificate ot insurance is not an insurance policy and does not amend, extendor alter the coverage afforded by the
poliCies listed herein. Notwithstanding anyrequirernl?nt _term, or conditionaf,any contract or Other document with
:respect to'which this certificate of insurance may be iss:ueci or may pertain,the insurance afforded by the policies
desqibed herein is subject to all the terms, exclusions and conditions of such policies.
?7~~~
AUTHO R I ZE DR E PR ES ENTA TI VE
I(~
PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCUf\RENCP
EMPLOYER
FEEDBACK FOUNDATION INC
1200 N KNOLLWOOD CIRCLE
ANAHEIM CA 92801
APl~JWVBD AS TO FORM
-~~~'cIV(
,I C.rv /\Horney
,-
1_
.~12HI
THIS DOCUMENT,HAS A BLUE PATTERNED BACKGROUND selF 10262 (REV 5-01)
'3UL 16 2002 9:07AM
HP LASER JET 3200
p.2
,
'-' '''I'' ---lot:);;'-- , os- - , t?
ACORD~ (ERTIFICA TE OF LIABILITY INSURANCE I OOJ'8i2OO2'
94ll-682-D025 I THIS CERTIACATE IS ISSUED AS A MATTER OF IHFORMJ>.TION
ONLY AND COHF5RS HO RIGHTS UPON nu; CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTENO OR
ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
"
"""",,,E'
llGUlRE INSUR NCE AGEt-ICY
lIC .0377645
26300 LA AlAME A SUITE 470
MISSION VIEJO, A 92691
_u_ _______ --.-
14l'11liUIO:EO
l
INSURERS AFFORDING COVERAGE
INSUP.;r~!':
PHILJ\[lEI.PHIA U~DEM.NI.TY INSURANCE COMPANY
FEEDS"\: FOUNDATION
1200 N. K'rOLlWOOD CIRCLE
ANAHEIM CA 82301
,
COVERAGES
! THE POUCIt;;S OF IN5U ANCt.: liSTED BELOW HA'iE. 3EEN LSSUED TO THE INSURED ~N"'ED ABOVE I'OR THI::. ...our;'( PE:;'::\OO INDICl\l~\.). NOw,oITHSTANOING
'I A"Y H:::O:JIRF.~c.Nr. r RM OR CON!)llrON or- ANV CONT-VloCT OR ~n-lF:R OOCUIo'.i:NT WITH RESPECT TO WHICH TIllS CERTII-ICAT[ MAY 6e: ISSUED OH
, l4A,Y P~TAjN, lllE 1";3 ; RANCE AFfOHDED BY lHE POUCIES DE.SCRIBED HEftEl\IlS SUBJECT TO A<...'-. THE TERMS. cxa_US10NS ;,f\;O CQNOrnONS Ot' SUCH J
POUCI:;:S. ....GGREGATE _tt-At.S SHO....Jl\I M.4.,V r,A.'y~ Lil.::EN. REOUGED ~YPI\1D Cl.NMS.
i~:~1 -T'I',.r;OfINS~~ l,.,.cE :"- --.-.- ~~~~~~------TiiOucw-.Ui"~CTWE tPg~fH:~~.fm1'4r- _._--~. ~;~~~;-------~---1
I Gfr>.ERAl L.....BIlJT'l I I i U..GH aOClA"<:1.Et-ICE {. 1,000,000 I
A ~_ CO~l,!eRCIALC:"; 'V,!...W3ILlrY PHPK027575 I 0710'\12002 D7/01i2OQ3 j FI~.~'~.-~.;I""O~~."'..'.';-.~r.'.~(;:l!' -~." .-' 10D.O~:~'
D Cl('I~IS t/,l,,::E ID O::CIJf1. ~__[?,~(A~'L~ePilrsLol'l S _" u?,OOO
.-J~~-- __ pmSONAl..&.""O'tINJlJRY S_____ 11000,000
__ _ _ QENER./lJ...,lGGRCG,r.TE __ ~_,_.2.QOO,OOO_
r.;.~ I ,o.GG;;~G~!~ ~:A. AP~l!:~.~ r'R~C:OI~PJ9P_~ ~ --- --- 2,OOO~~Q
:j .-ale,.l l'lf \ lu......-
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"~L OWiH:.D AurO
PHPK027575
0710112002
07101f2003
COMerHfn~NGU:UtrlIT
{EaacelOOrl}
. 1,000,000
B001LVIWJUR.Y
(f'Cl'pe<aQ")
,
~--~._-
1_ SCHEOLlLEDAUfO
l1IRED AUTOS
NO" O'NNED I\'JTC
-
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(rcr..a~OOnrI
--. ---.--- .---
PROPEF\.TY OF.MAGE
(Puacdoientl
.
~GEUIIUIIU''f
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.uno ONLY. EA ACCIDENT $:
.
.
OTliB1'"}-,MIl
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P.GG
i.XCE:lISu.t.mlITY
A ];] OCCUR 0 QAr.AS w..o(: PHUB010926
h DEDUCIBlE
II HETENTION :s 0,000
0710112002
0710112003
EACHOCCUR.R:C~~__
~~~~-_._-_.
,
,
,
S
,
1,000.000
1,000,000 _
.---------
1-----
\ltO__KatS COUI"ENSA OK "11IO
BIl'l"lO\(EJIs,'L14Ul.lIJTV
W~~_Liill~___r ~-
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EL OISEISf - EA. [MPlLIYEE $
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EL OlSE:.t..':;E _PDLJGY LIMn $
PHPK027575
I 07f(}112002
07/0112003
,EMP DISHONESTY $100,000. 51,ODD OED
\ THEFT IN/OUT $1,000, $250 DEn
oESCfllP"nON OF 04"E1i.1,110M LOCI.TIO~SlVa.;LES1EXClUllIOtlSAtclEDeY atOOMEWOHTlSPe.t:lI.l PROY'tSIOWS
\. CITY OF SA~T A AN ,ITS OFFICERS, AGEN,S, EMPLOYEES AND VOLUNTEERS ARE INCLUDED AS ADOITIONAL INSURED AS
RESPECT3 THE OP RATIONS OF THE NAMED INSURED.
I
CERTIFICATE HOLO I X IAoOlnaHALlN~p:r.O;IH!lURe-P:LeTTER:. X CAHCELLATION
'CITY CF >ANTA ANA
COMMU ITV DEVELOPMENT AGENCY M.25
P.O.60) 1988
S~,NT A I ~A" CA 92702
I
ACORD 2<;.5 (71971
AUTHORIzED ReI"RESEfHA.TNE
IS1+O\lI-D toNY OF'THl!.ABOve DESCRISroPOLIOESI!IE CA.IIlCELLED BEFORE TIlE fX"'RATlOrc
[lATE THUli:-Qf. THE GSUltlG .,SURal Wa..tJtjI~lL __"'3C OAr.> VfflITT!':l'I
NOTlCE 10 T'HIf CEf[l1AC-A.TEltOLO~R ,,",NeD TO THE LEFT~~~
~~~~J(
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F~ NO. :714-647-6549
ADDITIONAL INSURED ENDORSEMENT
FOR_G...QMMERCIAL GENERAL LIABILITY POLlCY
[nSllrnnce company,tY\\ \(ldd~'n:lo, \nG-e.\1'\i'\itc{ lfll:Uwn ck C,omfClXr ~
This endorsement modi lie.' such inSlltunCe ns is affordcd by lne provi,i<lns of Policy
II V',lr\!V-W1S15 relating to the following
I. The City of Santa Ana, 20 Civic Ceoter Plaza, Santa Ana, Calitornia 92701; its
officers, employees, agenls, volunteers and leprcsen1ll1ives are named as ~ddili(\llal insureds
("ndditional insureds") with regard to liahility and defense of suits nrising from the operations
and uses performed by or on behnlf of the named insllred.
2. With respect to claims arising out of the operation. ood uses perfo\med by OT On
bchalf of th~ nnrn~d insured, such insurance as is aftorded hy this policy is primary and is not
additional to or contributing with nny other insurance eanied by or for lhe benefit of the
additional insured.,
3. 'Ihis insuran,:., applies separately tn each insured against whom claim is made or
suit is brought ".cel't with respcet to the compsuy's limits of liability, Th~ inclusion of any
por.on or organization as 0\1 ;n.,m",d ~hall not allbct any right which such per,on or organization
w()uld hnve as a claimant ifnot:lll included.
4. With rcspect to the additional insureds, this insurance shall not be cancelled, ur
materially reduced in c<>veroge or limits except after thirty (30) days written nolice has been
given to the City of Santa Ana. 20 Civic Cenler Pla7Jl. Santu Am.., California 92701,
(Compktion of the foUowing, including countersignalllrc, is required to make this endorsement
ellcCl.ive.)
Effective
Policy #
Issued to
01-0! - UOz.. .{hru 01-Dh~.6t23, this endorsement fonn as a part of
r~-'.
et!i nda+1]'h:
Named In$1Jrcd
Countersigned by _
eOI~
Ar'r;~O\. l:i.> /-\.s
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STATE
COMPENSATION
INSURANCE
F=UND
P.O: BOX 420807, SAN FRANCISCO, CA 94142'0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
JULY 8, 2002
POLICY NUMBER"
CERTIFICATE EXPIRES:
1638989 - 02
7-1-03
I
CITY OF SANTA ANA
ATTN COMMUNITY DEVELOPMENT AGENCY M-25
POBOX 1988
SANTA ANA CA 92702
This is to certify that we have issued a valId Workers' COllipensatlon Insurance policy in a form approved by the California
Insurance CommIssioner to the employer named below for tlie policy period indicated.
Thts policy IS not subject to cancellation by the Fund except upon ten days' advance written notice to the employer.
We will also give you TEN days' advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance poliCY and does not amend, extend or alter the coverage afforded by the
policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document.)oV.i~h
: respect to- which this certificate of Insurance may be iss:ued or may pertain, ,the" insurance afforded by the policies
described herein is subject to all the terms, exclusions and conditions of such pqlicies.
/7~~~
AUTHORIZED REPRESENTATIVE
I(~
PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE;
Ah"UVu) !\:, j U FORiVJ
,:tJf[! .f,
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(C, "S:Il':":Y 7 -_.._--~
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EMPLOYER
I
FEEDBACK FOUNDATION INC
1200 N KNOLLWOOD CIRCLE
ANAHEII1 CA 92801
" THIS DOCUMENT, HAS A BLUE PATTERNED BACKGROUND se'F !0262IREV. 5.01) ,
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HP LASER.lET 3200
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PIlONCER
MAGUIRE Ii'lSUR NCEAGENCY
LIC #0317645
2B3<lO LA ALAME A SUITE 470
MISSION VIEJO, A 92691
---
949-6l!2-O025
FEEOBAC~ FOUNDATION
1200 N_ K ~LLWOOD CIRCLE
ANAHEIM CA 9280'
INSUREIlS AFFORDING COVERAGE
- ~^,_~PIiILADEL.PBIAINDEMNrfV:INSuAANtECOMPANY ---
~~~~:_---_._-------------------. ~--- --~ -
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INSUFiI!!llt::
1i'llIUIllED
COVERAGES
"THE POLICIES; OF iNSU ANCE USTED BELOW HAVE IlEEN.ISSUED TO THE lNSURED NJWED ABC'NE fOR THt; pOUC'Y PERIOD lNt)K;A1ED. NOiWrTHSTANOIt<<i
AN.Y WEQLJIREUENT, T M OR CONOlllON OF ANV CONTRACT OR OTHER DOCUfljIENT WITH RESPECT TO WH~CH TI-IIS CERTII-lCA"TE MAY BE ISSUED OR
","V PERTAIN, ll-lE ~Nf) RANCE AFFORDED BY lHE pOLlCIE.S DESCRIBED HERE~ 18 SUBJECT TO AU. THE TeRMS, EXCLUSIONS AND CONOfTIO~S Of SUCf-!
...'::'LICIE5_ ~~::,!' :::~TS SHOWNN'W HAV';.:,:;=~~EO BY PAlO ,c,t~;".cnv. ~CY"".~---I.J;;';.- ---------
~......Ll..'''''' ~""""'"E-~--- '00__1,000,000
A XfC~."''''''ALG'N ~UAB"'n' PHPK027515 0110112002 11710112003 ~"""E("''''''''' '00,000__
__ -+-=1 Cl"MS MADE 00 ":cU" .!"'!"""l""'-""'_"'~)' _5~
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2'i'~:~~IOATi~; APP"i:;; P~co""'JO]>~ 1....... 2}!90,~
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01111112002
0110'/2003
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pRQP'ERTYOillIlollAGE
(peratd.;lent)
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A )\] OCCUR D C,l.&JM$ MADE
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WORKatS CONPDISA It 4ND
fllMPLDYER.rLIABLlTY
PHUB010926
011011200Z
071ll'J2.o03
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-;. :~, '.... Attorney
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EL DISE.A..~E _POliCY LlllItT S
OTHER
A CRIME
pHPKOZ7575
07f(J1I2002
07/01/Z003 EMP DISHONESTY $100,000. $1,000 OED
THEFT INIOUT $1,000, $250 OED
l)eecRl~N QF QPE1l:"110M illOCATIl:>>lINetELBIJElCUlSIOMSADIlI!iD SV fJlIDOABEM&MT.H!C,,"L PRQYl6lfJW.8
CITY OF SANTA AN ,ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE INCLUDED AS AlJOITIONAL INSURED AS
RESPECTS THE OP RATIONS OF THE NAMED INSI.IRED-
CERTIFICATEHOLDfR I X [ADDrrJJNAl..lNSUIlllED'IliIS\MERLETTER~ X
CANCELLATION
CITY OF >ANTAANA
COMMU ITY DEVELOPMENT AGENCY M-Z5
P _0_ 80) 198B
SAfoITA ~ ~. CA 927.02
AUlHCWtlZm 1t1!,.It!S&NTATfI,IE
...otJl-bAMYOFTMI!.,d,OVl! DUCRIB!DPClUCIESHCANCEUE.D aEFOliilli me IfKPlIVt'l)ON
DA'II[ TMEIU!OF, THE ..t1IIr1G WlIlIREIl w~1L ."30 DAYS WIIlTTUI
NCl11CE!1G THI! CI!ItT1RC"AiEttClLG!flN"'NeDTOTtlELI!FT~
~~""1~~"LW:W.~.w~~~x..'?~~~WI'
X~
rk -oN --;-;. __ . .7
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Iii AtIlRD CORI'ORA T10N 1988
ACORD 2!l.S (7111)
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,
HP . ~ERJET 3200
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,
SSP 16 2002 9:48AM
FAX NO. :714-547-5549
F)'<OM
e.DDI~IONAL INSlIRED ENDORSEMENT
E9j...QQ.~MERCIAL GENERAL UABIl.lTY POLlCY
Insurancc ComponyY'i\\ \0 ~{\~ ,\\,l^, \n d,(,\'l'\ (\ i N ~D~ \l cJ.; ~m ~a yt ~
This ondorsemcnl nUldilies such insurunce lIS is afforded by tbe provisi(lns of Policy
# 1'm>V-W1515 relating to the following:
1. Tbe City Dr 8011\1\ Ana, 20 Civic Center Plaza. SlII1ta Ana, CalHbmi<l 92701; ilS
off1ecrs, employees, agents, vohmtcers and representatives are named as addi\iClllal insureds
("odditiona\ insureds") with regard to liahility and defense ohllit. arisillg from the operations
Dnd \I5CS porformed by or on behalf of thc named insllred.
2. With respect to claims arising out of the opcrations and uses perfo\1ll.d by Of on
bchalf oftlle nN'lled il\SUrcd, slIch insurance as is aftbrdod by this policy is primary and is not
auditionallo or eontributitlg with llny other in,urance can'led by or for the benefit of Ihe
ndditiol18l insureds.
3. This insurance "pplies sepautel)! to each insured against whom claim is made or
suit is brought except with respcct \0 tbe company's limit. (If liability. The inclusion of any
p~rsoll or Qrganization lIS all in~\ll'ed shall not ll!'t'olct any right which S\leh person or orsanil'-lllion
would nllve Il~ a claimant ifnot so included.
4. With respect 10 Ihe additional insured., thi~ insurlUlCt1 shall not be cllncelled, ur
mat.riDlly reduced in Cllverage or limits eKcept after tllirly (30) days written nolice has been
givon to the City of Santa Ana. 20 Civic Center Plaza, Santa Ana, California 92701.
(Completion of the following, including countersJgnature, is required to make this endorsement
elrective.)
Effective 01 -01 - UX>Z- .~t'lA 01 -DI - ~ tbis endorsement form as a part of
Policy # ~~ d.lHit.-... .----
I:;'<\led to 1'1 .p, Y\ -..
N aroed Insured
Countersigned by
~~
Authorized Rep l~-i~~-r;--
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,
I
I
STATE
COMPENSATiON
INSURANQ-E
FUN.D
P.G. BOX 420807, 'lAN FRANCISCO, C,A 94142.0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
-"" :,," ...
. '
JULY 3, 2002
POLlCV NUMBER:
CERTIFICATE EXPIRES,
1638989 - 02
7-1-03
I
CITY OF SANTA' ANA '
roMMUNI'l'Y DBvEtoamrx AGENCY1t-25'
P.O. BOX 1988
SANTA ANA CA 92702
L
l
I
-\
I
I
,
I
ThiS IS to certify that we have issued a valid Workers' Compensation fnsurance policy in a form approved by the California
Insurance Commissioner tathe empioyer named b~""oIiCYfleTiO'ctind!(;"ted: .. ..."~ ,..- ' .... ...'
This policy is not subject to cancellatIOn by the Fund except upon tl!.Qdays' advance written notice to the employer.
XX '
We will also give you 'flO.J daYs' ad~~nce notice should thiS po_cy be cancelled prior to its normal expiration:
XX, .
This certificate of insurance is not ,In insurance 'policy and does not amend, extend or alter the coverage afforded by the
policies listed herElin. Notwlthstan<;iing any ,requirement, term, or condition of any contract or other document .with.
respect to ,which thiS certificate 'of insurance m'!"'" QIi issl;Ejd or may pertain, ,.the- insurance afforded oy; the policies.
described herein is subject to all the terms,.exclusions a,nd cona~ions of such policies. .,'
:
;7~~~
AUTHORIZED 'REPRESENTATIVE;'
K~
PRESIDENT
.
mfillDYER'S LIABILITY UMIT,INcuIDING~iCX?STS: $1,000,000 PER~.
ENOORSEMENT 12065 mlnlD CERrIFlcATE HOLDiRS'NarICK EFFECTIVE
07/01/02 IS AttACHED TO AND FElRMSA'PARl' OF THIS POLICY'. .
"'PR~ TO ",,,,,,
", ~ 2... -
:.;.... 'ORIS" ...-.:. U;w
.. .... ''''Y Attorney
Oel)\.I.. "" '" "
EM PLOVER
l~u.lQnV All;) Atnil~a
. '. AP~~~r'
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FEEDBACK FOUNDATIoN INC
1200 N KNOLUlOOD CI1~'
ANAHEIM CA 92601' ,
,'\
,
$~1t1,
.
'-"
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STAT,S P.o.. So.X 420807, SAN FRANCISCO., CA94142:0eb7
COMPENSATION
INSURANCE
FUN D CERTIFICATE O~ WORKERS'COMPENSATION INSURANCE
,1UL Y 8, 2002
POLICY NUMBER,
CERTIFICATE EXPIRES,
1638989 - 02
7-1-03
,-
CITY Of SANTA ANA
ATTN COMMUNIfy'DEVELOPMENT AGENCY M-25
POBOX 1988
SANTA ANA CA 92702
L
ThIS is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California
Insurance Commissioner to the employer named below for the policy period..indicated.
This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer.
We will also give you TEt'idayt' advanc? notice should this policy be cancelled prior to its normal expiration.
This certific?te otinsuranc8,is not-an insutance policy and does not amend, e:xtend or 'alter thecoverage afforded by the
policies li~ted herein. NotV"it~~t~nding any Iequir~llJt?nht~rm, or condition of ,Bny contract or other document,wittl
respect to,-,whiCh,:this certificate of insur~nce m&y be,iss'~ed or may pertain",:th~- insurance afforded bydhe poliCIes
described herein IS subject to all the terms; exclusions and cO[ldltions of suchpqllcies.
;7~~~
AUTHORIZED REPRESENTATIVE
I{~
PRESIDENT
EMPLOYER'S LIABILITY tIMIT INCLUDING DEFENS~ Gn~TS: $1,000,000 PER00CCURRENCE.
EMPLOYER
I
FEEDBAtKFOUI\1PAtl0N INC
i~oo N KNOLLWOOD ClRCLE
ANAHEIM CA 92801
ll~ln