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A-2003-o74-19
AGREEMENT BETWEEN THE CITY OF SANTA ANA AND
FEEDBACK FOUNDATION FOR USE OF
COMMUNITY DEVELOPMENT BLOCK GRANT FUNDS
This Agreement, made and entered into this 1st day of July, 2003, by and between the City
of Santa Ana, a charter city and municipal corporation of the State of California ("CITY") and
FEEDBACK FOUNDATION, a California nonprofit corporation ("SUBRECIPIENT").
Recitals:
WHN.!.LS.S.JHH
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 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," in accordance with the schedule of performance included therein,
hereinafter referred to as "said program" and SUBRECIPIENT represents that it is qualified and
willing to operate said program.
D. The CITY and SUB RECIPIENT 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 - Representations and Warranties.
(a) AuthorIty. SUB RECIPIENT 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.
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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,
SUB RECIPIENT 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 SUB RECIPIENT'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 SUB RECIPIENT 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.
(h) No Pending Investigation. SUBRECIPIENT is not aware that it is the
subject of any current or threatened criminal or civil action investigation by any public agency,
including without limitation a police agency or prosecuting authority, that would relate to affect
performance of the Agreement or provision of services hereunder.
B. Amount of Grant and Ouarterlv Disbursement. The amount granted to
SUB RECIPIENT is $ 40,000 ("CDBG FUNDS"), and such funds shall be expended by
SUBRECIPIENT on or before June 30, 2004. 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. SUB RECIPIENT'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 SUB RECIPIENT hereunder.
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D. Allowable Costs. SUBRECIPIENT agrees to complete said program on or before
June 30, 2004 and to use said funds to pay for necessary and reasonable costs allowable under the
federal law and regulations to operate said program. Said amounts shall include, 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. SUB RECIPIENT 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 ofthis 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 notity CITY immediately of any pending violations. Failure to notity CITY
of pending violations, or to remedy such known violation(s) shall result in termination of grant
funding hereunder. SUBRECIPIENT must make all corrections required to bring the
facility/property into compliance with the law within sixty (60) days of notification of the
violation(s); failure to gain compliance within such time shall result in termination of grant funding
hereunder.
G. Separation of Accounts. All funds received by SUBRECIPIENT from CITY
pursuant to this Agreement shall be maintained 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
account for receipt, obligation and expenditure of CDBG FUNDS pursuant to applicable OMB
Circular A-I 10 requirements.
H. Audit Report Requirements. SUBRECIPIENT agrees that if SUBRECIPIENT
receives Three Hundred Thousand Dollars ($300,000.00) or more in federal funds,
SUBRECIPIENT shall have an annual audit conducted by a certified public accountant in
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 SUB RECIPIENT program.
b. Documentation of the number of persons and/or families participating
in or benefiting by the SUB RECIPIENT 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.
(2) Reports
(i) Payment Request. Concurrently with the submittal of each
quarterly report, on or before the 15th day of October, January,
April and July, SUB RECIPIENT shall submit both: an original
invoice and true copies of invoices, receipts, agreements, copies
of any and all contracts or documentation pertaining to costs for
subcontractors 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 oflow and moderate income persons
and households assisted in accordance with federal income limits, the number
offemale 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 is conducted or in which any of
the records of SUBRECIPIENT are kept. Nothing herein shall be construed to require access to any
privileged or confidential information as set forth in federal or state law.
K. Location of RecordslRequired 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 Law/Program Income. SUBRECIPIENT acknowledges that the fimds
being provided by CITY for said program are received by CITY pursuant to the ACT as amended
and that expenditures of these fimds 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
SUB RECIPIENT shall be returned to CITY unless otherwise provided for in this Agreement.
SUB RECIPIENT 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. SUB RECIPIENT 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 SUB RECIPIENT 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 offederal 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 is rendered in its capacity as ao independent contractor and that it is in no way
ao agency of CITY.
P. Violation of Terms and Conditions. SUBRECIPIENT agrees that if
SUBRECIPIENT violates aoy 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 disallowaoce 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 graoted 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 aod purchased equipment.
R. Prohibited Use. SUBRECIPIENT hereby certifies aod 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) aod regulations found at 24 CFR Part 87, which provide that no appropriated funds
may be expended by the recipient of a federal contract, graot, loao or cooperative agreement to pay
aoy person for influencing or attempting to influence ao officer or employee of any agency,
Member of Congress, or an officer or employee of a Member of Congress in connection with
awarding of aoy federal contract, the making of any federal graot or loao, 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 aod by this reference incorporated herein.
SUBRECIPIENT shall submit said signed certification to CITY prior to performing any of its
obligations under this Agreement aod 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 aoy funds other thao 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, loao, or cooperative agreement, the
undersigned shall complete aod 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,
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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.P.R. 95.5.
Purther, 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.P.R. 95.5(a)(3). No
payment, advance, grant, loan or guarantee of funds shall be approved by the federal agency unless
there is on file with the agency a certification by the contractor that the contractor and its
subcontractors have complied with the provisions of 29 C.P.R. 95.5. A breach of the contract
clauses in 29 C.P.R. 95.5 may be grounds for termination of the contract, and for debarment as a
contractor/subcontractor, as provided in 29 c.P.R. 95.12. Labor standards interviews/investigations
shall be made as necessary to assure compliance [29 C.P.R. 95.6(a)(3)].
V. Drug Pree Workolace. SUBRECIPIENT certifies that it has established the following
drug-free workplace policy:
I. 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 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 City and 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 ofreceiving such notice, appropriate personnel action will be
taken against such employee, up to and including termination.
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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. Pavment 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 2003-2004 CDBG program year amounts expended by SUBRECIPIENT in carrying out
said program for fiscal year 2003-2004 pursuant to this Agreement up to a maximum aggregate
payment of Forty Thousand Dollars ($ 40,000) in installments determined by CITY. Payments
shall be made to SUB RECIPIENT 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.
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 grant and subgrant supported activities to assure
compliance with Federal requirements. Such monitoring covers each program, function and activity
and performance goals are reviewed periodically.
D. Environmental Review: In accordance with 24 CFR 58, the CITY is responsible for
undertaking environmental review and maintaining environmental review records for each
applicable project.
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 SUB RECIPIENT 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.
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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:
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
SUB RECIPIENT 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 limited purpose of assuring compliance with respect to the
use of CITY funds by SUBRECIPIENT with applicable constitutional limitations respecting the
establishment ofreligion 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.
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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 SUB RECIPIENT:
Feedback Foundation
1200 N. Knollwood Cir.
Anaheim, CA 9280 I
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 SUBRECIPIENT 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 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
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
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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 insured's; (2) be primary with respect to
insurance or self-insurance programs maintained by the CITY; (3) contain standard separation of
insured's provisions; and (4) give to CITY prompt and timely notice of claim made or suit
instituted arising out of SUBRECIPIENT'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 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 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:
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1. Items of equipment with a current per unit fair market value of less than
$5,000.00 may be retained, sold or otherwise disposed of with no further obligation to CITY.
2. Items of equipment with a current fair market per unit value of $5,000.00 or
more may be retained or sold and CITY shall have the right to an amount calculated by multiplying
the current market value or proceeds from the sale by CITY's share of federal funds used to acquire
the equipment, 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 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 HOD
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, SUB RECIPIENT 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, SUB RECIPIENT
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 SUB RECIPIENT, 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
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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 XII.A.
through XII.D., 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 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
SUB RECIPIENT's authority to commit and spend funds, or may restrict SUB RECIPIENT'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 Agreement, CITY may suspend the
operation of this Agreement for up to sixty (60) days upon five (5) days written notice to
SUBRECIPIENT of its intention to so act, pending an audit or other resolution of such questions.
In no event, however, shall any revisions made by CITY affect expenditures and 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
13
'-'
~
amendment hereto shall be effective unless executed in writing and signed by both CITY and
SUB RECIPIENT .
XV. LAWS GOVERNING THIS AGREEMENT
This Agreement shall be governed by and constmed 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 warrants that its signature herein below has the power,
authority and right to bind their respective parties to each ofthe 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 constmed 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.
14
.....,
"'"
.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the last date and
year written below.
DATED:
9-.30 -03
CITY OF SANTA ANA
f2Me
DAVID N. REAM
City Manager
ATTEST:
/~-'-
~PATRICIA E. ~AL Y
Clerk of the Council
~'v~
r JOSEPH W. FLETCHER
City Attorney
APPROVED AS TO FORM:
SUBRECIPIENT:
DATE:
c/(t~
itle: Execul1ve DIrector
TaxID: 95-2771715
15
Au~-25-2003 02:42pm From-
"-'
...."
T-465 P.002/002 F-140
611&'03 LIlS
:BXHmIT A
Scope of Work
. Annual Accomplishment Goal
L Number ofnnduplicated Santa Ana residents to be served with grant funds during the 12-
month contract period - i 1 fi PERSONS
n. Description of Work - in sp&ee below, dea:ribe tbD ptogna:a to be :I'taI&d Ouri:og the 12-month ccmtract
period iDc\lvli'l.. savicw III be provided, pmgmnpb, client ~1Ilics, &: how pm fi1llds will be utilized.
Ttle scvioes pl"OITided will be meals deli vereCl to clients 3 meals a day. for a
five day period. Regular or diabetic meals will be delivered as needed. Case
Management With. client asseBSIIleIlt as well as m::ci:tQring and resource referral.
PrOgram goals will be to alleviate poor nutrition, prevent premature institu,=
tionalization, reduce sociU isolation and help with outreach to the camn.m-
ity. to educate aboUt available services.
Client characteristic;S Will be 60+ and unable or have significant difficulty
securing: meals and aWtVj,n:iate nuitrition for thenise1ves. Priorityi.will be
given to lc;J!1 incane, m1llority am assessment of i.rmllldiate need.
Grant will be utilized to provide daily meals thro1:igfi client intake, assess-'
ment and staff delivery. Asseslll\Vi!llt and \rollitoring on-90ing assistance on a ;.
quarterly basis or as needed. As well as providi.ng case management for needs
beyond meal delivery.
SchedJI.le of Perf'fJr7lftlllce
Estimate the number ofunduplicated Santa Ana residents to be served during the 12-month
contract period per quarter: .
Quarter I: July 1- September 30 79 ~ersons
, Quarter 2: October 1 - December 31 79 Persons
Quarter 3: January 1 - March 31 79 Persons
Quarter 4: April 1- June 30 7'3 Persons
Total )1 t; ...Persons
"
Invoicing Schedule
Estimated the amount of grant funds to be requested during the 12-month contract period on a
quarterly basis: .
Quarter 1: July 1 - September 30 $ 11,250
Quarter 2: October 1 - December 31 $ 1 L 250 ".
Quarter 3: January 1 - March 31 $ 11 , '''0
Quarter 4: April 1 - June 30 $ 11 .250
Total 5 4.5 (Inn
,
Exhibit A
~'P-0!-Z003 10:46am
From-
'-'
FEEDBACK FOUNDATION, INC
NUTRITION PROGRAM BUDGET
FISCAL.YEAR 2003-2004
Budgeted Meals Serviced:
pereent of tot.eosttlincome allocated:
FEDERAL TITLE III FUNDS
USDA @.53 meal
PROJ.INCOME:SR. Donations
PROJ.INCOME:THIRD PARTY
OTHER DONATIONS
INKIND: NONMATCH (STEP Prog. eto.)
INKINO: MATCH volun.,inkind staff au
TOTAL INCOME:
EXPENSES:
PERSONNEL:Admln.
ProgramlS~e
K~ehen
Meal Assemblers
Drivers
Malntenanee
SUBTOTAL PAID PERSONNEL
Benefits
Inkind
TOTAL PERSONNEL
TRAVEL-local mileage
Training
EQUIPMENT
FOOD: raw food
catered
CONSULTANTS
OTHER:Volunteer Exp.
Rent
utll~IK
Telephone
Insurance
Audit/Aeeountlng
Offiee(supplieslmaint.lpost.lsubscrlpti
Program SuppliK
Vehiele Oper/MaintlRepair
Bldg.&EquipRepalr&Mainl.
T eehnOlogy
Property taxes(Or. County __.)
Outreaoh:Advert./Program Promotion
Employee costs: advertise/physicals
Direct Site Coats
Dues & Subs
TOTAL EXPENSES:(with Inklnd)
COlI! Per Meal
09/09/03 08:54:41 AM santaty3-4WK4
ATTACHMENT 4
Total IIQency City of
Nutrition Santa Ana
Program Program
8,700
880,000
1,730,496
466,400
763,200
205,216
282.000
3,467,314
164,458
429,325
185.438
68,206
187,050
16.550
1.053,027
201,836
282,000
1,536,863
10,000
5,000
10,453
1,068,000
32,000
32,000
148,000
68,000
18,800
46,400
6,000
42,000
269,998
54,000
95,000
8,000
600
4,800
4,200
7.200
2,800
3,467,314
3.94
810
178,000
20.23%
419,702
94,340
106,800
45,000
57,041
722,
33,265
82,852
37,509
13,796
37,835
3,752
209.010
40,826
57,041
306,877
2,023
1,011
2,114
216,027
32,000
6.473
29,936
13,755
3,803
9,385
1,214
8,495
54,613
10,923
19,216
1,618
121
971
850
1,456
566
722.882
4.06
EXHIBIT B
City of
Santa Ana
Funds
Requested
45,000
45,000
45,000
45,000
0.25
.."
o
T-S5! P OOZ
HOZ
'-"
,..,
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 ofthis 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.
h.!?d~a~ 1:: /5w /t/a1? h .?J/l/
cfranteelContactor Organization
/}///;~/i>/5 t?/tV
Program Title
-N~Uy~~
/
L5c:r k~.-rr~
Signature ate
EXHIBIT C
Page 1 of2
'-'
....,I
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 I.
2. No person in the United States shall on the ground of race, color, religion, national
origin, or sex, be excluded from participation in, or be denied the benefits of, or be
subjected to discrimination under any program or activity funded in whole or in part with
community development funds made available pursuant to the ACT.
3. All laborers and mechanics, employed by contractors or subcontractors in the
performance of construction work financed in whole or in part with community
development funds shall be paid wages at rates not less than those prevailing on similar
construction in the locality as determined in accordance with the Davis-Bacon Act, as
amended, 40 U. S. C. Sections 276 a 1-5, except for individuals who perform services for
which they volunteered; do not receive compensation for such services; or are paid
expenses, reasonable benefits, or a nominal fee for such services; and are not otherwise
employed at any time in construction work.
4. SUBRECIPIENT will comply with all Federal statutes applicable to projects funded
with community development funds, except that (a) SUBRECIPIENT does not assume
CITY'S enviromnental 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
, '
'-' '...I
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U,S,C, 1352
Approved by OMB
0348-0046
See reverse for nublic burden disclosure,)
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
o a, contract Da, bid/offer/application D a, initial filing
b, grant b, initial award b, material change
c, cooperative agreement c, post-award For Material Change Only:
d, loan year _________quarter_________
e, loan guarantee date of last report ______________
f, loan insurance
4. Name and Address of Reporting Entity: 5. If Reporting Entity in No.4 is a Subawardee, Enter Name
Op'lme o Subawardee and Address of Prime:
Tier ----. if known:
Conllressional District, if known: Conllressional District, if known:
6. Federal Department/Agency: 7. Federal Program Name/Description:
CFDA Number, if applicable: ____________
8. Federal Action Number, if known: 9. Award Amount, ifknown:
$
10. a. Name and Address of Lobbying Entity b. Individuals Performing Services (including address if
(ifindividual, last name, first name, M/): different from No. 10a)
(last name, first name, M/):
(attach Continuation Sheet(s) SF-LLLA, if necessary)
11. Amount of Payment (check all that appiy): 13. Type of Payment (check all that apply):
$ ---------- o actual o plenned o 8. retainer
o b. one-time fee
12. Form of Payment (check all that appiy): D c. commission
o a. cesh o d. contingent fee
o b. in-kind; specify: nature --------- o e. deferred
value -------- o f. other; specify: ___________________
14. Brief Description of Services Perfonmed or to be Perfonmed and Date(s) of Service, including officer(s),
employee(s), or Member(s) contacted, for Payment Indicated in Item 11:
(attach Confinuation Sheet(s) SF-LLLA, if necessary)
15. Continuation SheeUsl SF-LLLA attached: DYes ONe
16 Information requested through this form is autholized by title 31 U.S.C. section Signature:
. 1352, thIS dlSclostlfll of lobbYing aclIViije5 is a mElteria! representation of fact
upon which reliance was placed by the tier above when this transaction was made Print Name:
or entered into. This di&dosure is required pursuant to 31 U.S.C. 1352. This
information will be reported to the Congress semi-annually and wi~ be available for Titie:
public Inspection. Any pl!l'SOO who fails to file the required disclosure shall be
subjecl to a civil penalty of not less that $10,000 and not more than $100,0 00 for Telephone No.: Date:
each such failure.
Federal Use Only: I Authorized for Local Reproduction
Standard Form Lll (Rev. 7-97)
.IACOR'D..
CERTIFICA\.,.... JF LIABILITY INSU.:: ~~M3';2~
Serialtl B1221 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
""""""""
MAGUIRE INSURANCE AGENCY
Lie 1\10377545
26300 LA ALAMEDA, SUITE 470
MISSION VIEJO, CA 92691
INSUlIED FEEDBACK FOUNDATION
1200 N. KNOLLWOOD CIRCLE
ANAHEIM, CA 92801
INSURERS AFFORDtNG COVERAGE
PHILADELPHIA INDEMNITY INSURANCE COMPANY
INSUReR A:.
IHStIREA 8:
INSURER c~
INSURER D:
INSURER E:
COVERAGES
nE POUClES Of INSURANCE USTEO IlEI.OW HAVE BEEN ISSUEOTO THE INSLl'lED~ Mt::NE FOR THE POlICY PERIOD INlICATED, NOlVI1THSTANDlNG
NN FleQlJREMENT, TERM OR CONOmON Of NN CONTRACT OR OTHER DOCUMENT v.rni REsPECT TO lfI+lICH lHlS Cl;RTIFICA TE MAY BE ISSUEO OR
MAY PERTAIN. THE INSlJRANOE AFFOAOeD BY THe POUOIES llESORlBEO HEREIN IS SUBJECT TO,lJ.L mE TERMs, EXClUSIONS AND CONtllTlONS OF SUCH
POlJClES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAlO~, _.'
m TYPEOF~ POUCYNUMUm ~ EFFECl' POUOYmcAlUt11ON LIMITS.
~ENEfUL llA8l.tTY EACH OCCI.JRftt:rCE S
A X COMMERCINoDeNORAlUNllUlY PHPK052307 711,u3 711104 """""""'DElAny......'.
I CLAIMS MADe [K] OCCUR NEO EX? (Any DM ":".-":::.'L $.
X PROFESSIONAL LIAS. I'fMONAl. & lorN INJUllY .
2,000,000 AGG GENERAl. """""""TE .
PROOUCT"S. COMP,QP AGG t
I T'O.rr lIMITS I IO;\."
ELEACHACCIOEHT S
E.L otSEASf; a EA eJPlOyg: $
E"~.POlICYUtM .
BUILDING $1.247.200
EMPLOYEE DISHONESTY $100,000
THEFT INIOUT $1.000
GEN'LAGG~UMIT~PI!A:
Xl POlK:Y I I ~ I I LOO
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A .15. AN'fAUTO
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~ """.Q>M<ED AUTOS
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COMBINED S1NGLElMIT
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AUTO ONLY . EA AcaceNT
~~ LIA_ITY
A 2SJOOCUfl OClAlMSMADI!
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WOAKEM c:ot/i"EN.1AllON~""
&MPl.QYEIitS' L1AlIlUTV
EN;H 0CCUIIflENCE
AGGREGATIi
s
S
MO'
.
OTHER THN\I
AUTO ONt Y:
E'KX
PHua019670
APPROVED AS
V 9J. HAI/"
711103
o FORM
711104
Laura Sheedy . (
Deputy City Al1orl1ey
A ant...
PROPERTY
CRIME
PHPK052307
7/1104
711103
1,000,000
100,000
5,000
1,000,000
2,000,000'"
2.000,000
.
, ,000,000
.
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.
.
.
.
.
.
1.000,000
..-
onauPTJON OF ~TlOfiIIu..OCATfOtiN'.1IC1.E:tIE)((::IllitOHiADtEDBY &~ PROWION6
ADDITIONAL INSURED WITH RESPECT TO CLAIMS ARISING OUT OF THE OPERATIONS AND USES PERFORMED BY OR ON BEHALF
OF THE NAMED INSURED, SUCH INSURANCE AS IS AFFORDED BY THIS POI.ICY IS PRIMARY AND IS NOT ADDITIONAL TO OR
CONTRIBUTING WITH ANY OTHER INSURANCE CARRIED BY OR FOR THE BENEFIT OF THE ADDITIONAL INSUREDS. WITH THE
EXCEPTION OF SOLE NELlGENC~ OR WILLFUl MISCONDUCT BY THE CITY OF SANTA ANA.
CANCEl'LATON EXCEPTION: 10 DAY NOTICE FOR NON.PAYMENT OF PREMIUM.
CERTIFICATE HOLDeR I X 1_1NSM""...,....LETTSt CANCELLATION
HOLDER NAME " AOCREBS
CITY OF SANTA ANA
COMMUNITY DEVELOPMENT AGENCY M-25
ATTN: CARLA THOMPKINS
P.O. BOX 1888
,SANTA ANA, CA 92702
ACORD 25-9 (7/97)
O:If'MPROICfiRTPROS.FF'5
~o AWf OF 111EAeove CESCRIBEI) POUCE:sBE CAHCB..LED DEFORE; THE EXPIRATlON
MTE THIlR!OF. THE lSSUlHG "SI.IREII WILL 30 MY$ WRITTEN
NO'l'ICE:: TO THeCBRTlFtCAT'E HOLDeR NAMED TO THI:; LEFT
U1 .~ ..- - 1 -
-
AUrttORIza>_ATM"~~
V iDACORJ,CORPORATION 1968
~
~
"
''1"":
.
POLICY NUMBER: PH PI" . - )7
FEEDBACK f'OUNDATI~
COMMERCIAL GENERAL UABILlTY
THIS ENDORSEMENT CHANGES THE POLICY. PlEAsE READ IT CAREFULLY.
""'"
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZATION
This endol1lement modifies insurance provided under the follOWing:
COM'v1ERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization:
CITY OF SANTA ANA
COMMUNITY DEVELOPMENT AGENCY M-25
ATTN: CARLA THOMPKINS
P.O. BOX 1988
SANTA ANA, CA 92702
RE: Additional insu....d wilh respect 10 claims arislng OLII of tha operations and usee performed by or on behalf of the named
lI'lsured, such Insurance as is 8f!grded by lI1is po/ioy is primary and Is not additional to or COntributing with any other insurance
carried by or for the benefrt of the addition'" insured's, wilh the exception of sole negligence or Wilful misconduct by the City of
Santa Ana.
(If no entry appears above, information required to complete this endorsement Will be shown In the DeClarations as
applicable to this endorsement.)
WHO IS AN INSURED (Section 10 Is amended to include as an insured the person or organization shown in the
Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or
rented to you.
. CG20261185
COpyrlght, Insurance ~ervlces Of!k:e, Inc., 1984
o
APPROVED AS -10 tORIvI
In Ilfa Sheedy
lJ~j' l', C"\'.>\ ft rney
ACORD", CERTIFICAU OF LIABILITY INSURA.."CE I """' (MMtODIYY)
0612312003
I'I<<lDU<:ER Serial # B1221 THIS CERTIFICATE IS ISSUED AS A MAnER OF INFORMATION
MAGUIRE INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
LIC 1\f0317645 ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW_
26300 LA ALAMEDA, SUITE 470 INSURERS AFFORDING COVERAGE
MISSION VIEJO, CA 92691
........, FEEDBACK FOUNDA nON IHSUReR A:. PHILADELPHIA INDEMNITY INSURANCE COMPANY
1200 N_ KNOLLWOOD CIRCLE INSlJRER B:
ANAHEIM, CA 92801 INSUAERC: ,.
INSURER 0: .. -_.
I tNSIJRER E:
COVJ:RAGJ:S
'floE POLICIES Of INSUWICE USTED BeLOW HAVE BeN ISSUED TO 1HE INSle!DNAMEO ABOIIE FOR T1-lE F'OUCY PERIOOIN:ll~TEO_ NOlWlTHSTANOING
NN RIOQlIREMENT, TERM OR CONOmON OF NN CONTRACT OR OTHER [)(lCl.U;NT 1MTH RESF>ECT TO VHCH THIS camFI~TE MAY BE ISSUED OR
MAY PERTIIIN, THE INSURANCE AFFOACEO BY THE POLICIES DESCRIIlED HEREIN IS SUBJECT TO ^ll THE TERMs, EXClUSIONS mo CONDITIONS OF SUCH
POliCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID ClAIMS.
Ir:t TlPEOF~ POUCYNUII8SR .~~EffE011VE POUOVEXPI ~ -'." lllVTa
GENERAL llA8IUTY EACH occl...lMeNCE $
A rx COMME,qClN.Ce....I<.L""'1UTY PHPK052307 7/1oU3 7/1104 RRECAMAGE(.....,....In) ,
JOI.AlMSMAOe [KJOCCUR MeD_("",..._':."~,t '
X PROFESSIONAL L1AB_ PSlSONAL & AD'i I/WRY I
2,000,000 AGG GENERAL AGGREGATE I
PROOUcTs. COMP,op;.GG $;
7/1104 COMQINED SINGLE LNIT I 1,000,000
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$
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EL.EACHACCID9IT S
E.LDl~.EAEMPl.DY5Ii S
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BUILDING $1,247,200
EMPLOYEE DISHONESTY $100,000
THEFT INIOUT $1,000
GEH'l AGGR~ UMlT APPlies PeA;
"Xl POlICY..Li~ n LOC
AUTOMOAU L1ACIlUTY
A X A""AurO
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WOAKEM CClMf"B'.JATJQflI AND
EMPLOYERS'LIAEItUT'f
PHUS01S670
APPROVED AS
VU ,,,I,
7/1103
o FORM
711104
AGGREGATi'
Laura Sheedy I
Deputy City A tlorney
A ""'..
PROPERTY
CRIME
PHPK052307
7/1oU3
7/1104
1,000,000
100,000
5,000
1,000,000
2,000, oo~(r'
2,000,000
1,000,000
.-
IlOIClI11'TIOOlCF""""ATIONOL_~~"'IlOED/JYENIlDR~I'IIO\""_
ADDITIONAL INSURED WITH RESPECT TO CLAIMS ARISING OUT OF THE OPERATIONS AND USES PERFORMED BY OR ON BEHALF
OF THE NAMED INSURED, SUCH INSURANCE AS IS AFFORDED BY THIS POLICY IS PRIMARy AND IS NOT ADDITIONAL TO OR
CONTRIBUTING WITH ANY OTHER INSURANCE CARRIED BY OR FOR THE BENEFIT OF THE ADOITIONAL INSURffiS, WITH THE
EXCEPTION OF SOLE NELlGENCE OR WlLlf'Ul MISCONDUCT BY THE CITY OF SANTA ANA.
CANCELtATON EXCEPTION, 10 DAY NOTrCE FOR NON-PAYMENT OF PREMIUM_
CJ:RTIFICATE HOLDER -.l X-.lADOlTlOl/Al. IN_INSURER LIfmiJl: CANCELLATION
HOl.DER NAME & ADDRESS
CITY OF SANTA ANA
COMMUNITY DEVELOPMENT AGENCY M-25
AnN: CARLA THOMPKINS
P,O. BOX lil86
..J.SANT A AN!\, CA 9Z702
ACORD 2,.a (7197)
O:\fMPROICERTPROS.FPS
~AHYOF1M!!Al!IOVI!~lK- 'T POUOIEsBeCAHCB..UnDEFORI; THESfoARATlOH
MTE 1llIIRtOI'. THE ISSWNO _ WILl. 30 MYS WRlTWI
NOrIa'::ro THEClRt1F1OAT'G HOLDER trlAMED TO THI!LEFT ~U
II "U I _
~
AUTHOR_~"'TlvE~ ,. -.;r'dttf
. v qpACOR......ORPORATION 1983
~
"
,
POLICY NUMBER: PHPl j!307
FEEDBACKFOUNDATIO~
COMMERCIAL GENERAL LIABILITY
"""
THIS ENDORSEMENT CHANGES THE POLICY. PlEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL L1ABIUTY COVERAGE PART.
SCHEDULE
Name of PelliOn or Organization:
CITY OF SANTA ANA
COMMUNITY DEVELOPMENT AGENCY M-25
ATTN: CARLA THOMPKINS
P.O. BOX 1966
SANTA ANA, CA 92702
RE: Additional insured INith resptlCt to lllaims arising out of the operations end uees performed by or on behalf of the named
Insured, euoh Insurance as Is efIorded by thill policy is Primary and Is not ad<itional to or contributing with any other insurance
oarried by or for the benefrt of the additional insured's, with the exception of sole negligence or willful misconduct by the City of
Santa Ana,
(If no entry appears above, information required to Complete this endorsement will be shown In the Declarations as
applicable to this endorsement.)
WHO IS AN INSURED (Section II) Is amended to Include as an insured the pelliOn or organization shown in the
Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or
rented 10 you.
.' CG20261185
COpyright, Insurance ~ervlces Ofllce, Inc., 1984
o
APPROVED AS 'lU ~ORrvl
Loura Sheedy
U~i" I> <.."'1'_ .0\. ft rney