HomeMy WebLinkAboutMERCY HOUSE LIVING CENTERS (ESG 2002)
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or ~ ~ ~ \J 'YfJjv AGREEMENT BETWEEN THE CITY OF SANTA ANA
~'S~ ~ ~ '\5 'ill AND MERCY HOUSE TRANSITIONAL LIVING CENTERS
~'\5 ~ ~ FOR THE USE OF EMERGENCY SHELTER GRANT FUNDS
~~ (With Provisions Relating to Compliance with Title X
and 24 CFR Part 35 Relating to Lead Based Paint)
THIS AGREEMENT, made and entered into this ~ day of ~ ' 2002,
by and between the City of Santa Ana, a charter city and municipal corporation of the State of
California ("CITY") and MERCY HOUSE TRANSITIONAL LIVING CENTERS, a California
nonprofit organization ("SUBRECIPIENT").
-...I
A-2002-043_08
WITNESSETH
Recitals:
1. CITY is the recipient of Emergency Shelter Grant ("ESG") funds from the United
States Department of Housing and Urban Development ("HOO") pursuant to the Stewart B.
McKinney Homeless Assistance Act: Emergency Shelter Grants Program 42 USC I 133 I et seq.
2. CITY has approved the provision of federal funds under the ESG to be used in the op-
eration of an emergency shelter program for the homeless of the City of Santa Ana ("said pro-
gram") as further described in Exhibit A, attached hereto and by this reference incorporated
herein.
3. SUBRECIPIENT represents that it has expertise and experience in the provision of
emergency shelter programs for the homeless and is willing to use said federal funds to operate
said program.
4. SUBRECIPIENT agrees to assist homeless individuals and families in obtaining:
appropriate supportive services including, but not limited to, temporary and permanent housing,
medical health treatment, mental health treatment, counseling supervision and other services es-
sential for achieving independent living, as well as other federal, state, local and private assis-
tance available for such individuals.
5. Title X ofthe 1992 Housing and Community Development Act (Title X) established
requirements relating to lead based paint ("LBP") in housing receiving federal assistance,
with particular requirements relating to (i) notification (including pamphlet distribution, disclo-
sure to purchasers and lessees, notice of lead hazard presumption or results of evaluation, and/or
lead hazard reduction), (ii) lead hazard evaluation (including visual assessment, paint testing,
and/or risk assessment), (iii) lead hazard reduction (including paint stabilization, interim con-
trols, standard treatments, or abatement depending on the requirements for housing activity type),
(iv) ongoing maintenance, if required, and (v) response to children with environmental interven-
tion blood lead levels, as required; and
6. On September 15, 1999 HUD adopted implementing regulations to Title X that became
effective September 15, 2000 as set forth in 24 CFR Part 35, et seq. ("LBP Regs."), which estab-
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lish specific rules regarding notification to owners and occupants about the existence of LBP
hazards, identification ofLBP hazards, and control ofLBP hazards; and
7. Residential structures built after January I, 1978 are exempt from lead-based paint re-
quirements as the use of lead-based paint was banned for use in residences after this date by
Congress (24 CFR Part 35.115). Therefore, the Title X requirements set forth herein shall not be
applicable if the structures involved were built after January 1, 1978.
8. Subpart K - Acquisition, Leasing, Support Services, and Operation of the LBP Regs, sets
forth specific requirements relating to housing providers, such as SUBRECIPIENT, who admin-
ister local programs that provide supportive housing for special needs populations and are funded
by HUD Office of Community Planning and Development ("CPD") programs, including
ESG funds, as provided to SUBRECIPIENT under this Agreement; and
9. In connection with the grant of funds under this Agreement, CITY requires that
SUBRECIPIENT comply and show evidence of compliance with all applicable requirements of
Title X and the LBP Regs, in particular Subpart K relating to acquisition, leasing, support ser-
vices, or operations, and Subpart J relating to rehabilitation, as and when applicable; and
10. In connection with the grant of funds under this Agreement, CITY requires that
SUBRECIPIENT comply and show evidence of compliance with all applicable requirements of
Title X and the LBP Regs, in particular Subpart M relating to tenant based rental assistance, as
and when applicable; and
II. Attached and hereby fully incorporated to this Agreement are the following notification
attachments: Attachment No. I entitled "Protect Your Family From Lead In Your Home",
EPA747-K-99-001, Attachment No.2 entitled "Sample Disclosure Format for Target Housing
Sales, Disclosure of Information on Lead-Based Paint and Lead-Based Paint Hazards", and At-
tachment No.3 entitled "Sample Summary Risk Assessment Notice Format"; provided however,
that such attachments are not intended to modify or limit SUBRECIPIENT'S obligation to fully
comply with all applicable provisions of Title X and the implementing regulations in the LBP
Regs; and
12. By this Agreement SUBRECIPIENT will accept assignment from the CITY of all re-
sponsibilities set forth in Subpart K ofthe LBP Regs; and
13. 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 sub-
stantive 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:
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I. SUBRECIPIENTS'S OBLIGATIONS
A. Non-Profit Status - Reoresentations and Warranties.
(1) SUBRECIPIENT acknowledges that its operations and the services it provides to
the community are subject to Subpart K, and, in some instance(s) Subpart J and/or Subpart M, of
the LBP Regs.
(2) SUBRECIPIENT acknowledges that its operations and the services it provides in-
clude: (a) acquisition, leasing, or ownership of residential property for the purpose of providing
affordable housing for persons with special needs, such as transitional housing, or (b) housing for
persons with special needs, such as the disabled, or (c) financial assistance to assist transitional
housing participants to move to permanent housing by paying for the first month's rent or secu-
rity deposit, or (d) tenant-based rental assistance to program participants who choose their own
housing units, and by provision of such services such housing is subject to the requirements of
the LBP Regs.
(3) Representations:
(a) Authority. SUBRECIPIENT is a duly organized and existing non-profit
corporation in good standing and authorized to do business under the laws of the State of
California. SUBRECIPIENT has full right, power and lawful authority to accept the funding
hereunder and to undertake all obligations as provided herein and the execution, performance and
delivery of this Agreement by SUBRECIPIENT has been fully authorized by all requisite actions
on the part of SUBRECIPIENT.
(b) Experience. SUBRECIPIENT is a qualified provider of the services to be
provided hereunder.
(c) Familiarity With Services Required. By executing this Agreement,
SUBRECIPIENT warrants that (i) it has thoroughly investigated and considered the services to
be performed and provided hereunder, (ii) it has carefully considered how the services should be
performed, and (iii) it fully understands the facilities, difficulties and restrictions attending
performance of the services under this Agreement, inclusive of compliance with the LBP REGS.
Should SUBRECIPIENT discover any latent or unknown conditions materially differing from
those inherent in the work or as represented by CITY, it shall immediately inform CITY of such
fact and shall not proceed except at SUBRECIPIENT'S risk until written instructions are re-
ceived from CITY'S representative.
(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.
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(e) No Bankruptcy. SUBRECIPIENT is not the subject of any current or threat-
ened bankruptcy proceeding.
(I) No Pending Legal Proceedings. SUBRECIPIENT is not the subject of a cur-
rent or threatened litigation that would or may materiaIly 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.
(4) Comnliance with Subnart K of LBP Rel!s. Subpart K - Acquisition, Leas-
ing, Support Services, or Operation
(a) SUBRECIPIENT acknowledges and agrees that it shaIl comply with and im-
plement the requirements set forth in Title X and the LBP Regs to eliminate, as far as practicable,
LBP hazards in all residential property that is under its ownership, possession, or control and/or
residential property occupied by persons or families that receive financial or other assistance
from SUBRECIPIENT.
(b) SUBRECIPIENT shall provide a notice to all residents/occupants ofresiden-
tial property that is under its ownership, possession, or control and/or residential property occu-
pied by persons or families that receive financial or other assistance from SUBRECIPIENT in
accordance with Section 35.125 of the LBP Regs.
(i) SUBRECIPIENT acknowledges that in connection therewith a
visual assessment is not considered an evaluation for purposes of the LBP
Regs.
(c) Notification (24 CFR 35.130). SUBRECIPIENT shaIl provide the LBP haz-
ard information pamphlet in accordance with Section 35.130 of the LBP Regs to all occupants,
owners, and purchasers of housing.
(i) The pamphlet shaIl be the EP A/HUD/Consumer Product Safety
Commission lead hazard information pamphlet or an EPA-approved equivalent.
The current form and version of the pamphlet is attached as Attachment No. 1
to this Agreement.
(ii) SUBRECIPIENT shaIl cause to be disclosed to all purchasers
and lessees available information and knowledge regarding the presence of LBP
and LBP hazards prior to seIling or leasing a housing unit in accordance with 24
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CFR 35, Subpart A. The current form and version of such notice is attached as
Attachment No.2 to this Agreement.
(iii) SUBRECIPIENT shall ensure that all occupants, owners, and
purchasers of housing be notified in writing of the results of the presumption of
LBP and/or LBP hazards, and results of any lead hazard evaluation, and any lead
hazard reduction work in accordance with 24 CFR 35, Subpart A. The current
form and version of such notice is attached as Attachment No. 3 to this Agree-
ment.
(d) Lead Hazard Evaluation (24 CFR 35.125), SUBRECIPIENT shall conduct
all activities described in Section 35.1015 relating to visual assessment, paint stabilization, risk
assessment, and maintenance with regard to all residential property that is under its ownership,
possession, or control and/or residential property occupied by persons or families that receive
financial or other assistance from SUBRECIPIENT, except for the exemptions described below
in section 4 (d)(i)(I).
(i) SUBRECIPIENT shall cause a visual assessment to identifY de-
teriorated paint in all residential property that is under its ownership, possession, or control
and/or residential property occupied by persons or families that receive financial or other assis-
tance from SUBRECIPIENT.
(I)Section 35.115(a) provides exemptions from Subparts B
through R of the LBP Regs. including without limitation, (a) short term emergency assistance
lasting less than 100 days cumulatively is exempted from compliance with Subpart K as to such
short term rental assistance units, and (b) exemption for zero-bedroom units, including SRO
units, for which occupancy by a recipient of SUBRECIPIENT'S services is for less than 100
days, and (c) exemption for residential housing units constructed after January 1,1978.
(ii) To the extent that the assistance provided by SUBRECIPIENT
to persons or households meets one or more of the exemptions set forth in the LBP Regs, then
compliance with the notification, evaluation, reduction, clearance and other requirements of the
LBP Regs is not required related to the subject housing unit due to such exemption.
(iii) SUBRECIPIENT shall comply with the applicable provisions
of both Subpart K and Subpart M (Tenant Based Rental Assistance) of the LBP Regs. as to all
tenant-based long term housing assistance, i.e., assistance to personslhouseholds residing in
housing units cumulatively for more than 100 days. If SUBRECIPIENT has knowledge that an
assisted family or household will occupy a dwelling unit for more than 100 days, the LBP Regs
require evidence of compliance prior to occupancy. Funding to be provided hereunder is condi-
tioned upon evidence of compliance.
(I) Subpart M applies to all dwelling units occupied to be
occupied by families or households that have one or more children of less than 6 years of age, as
well as the common areas servicing such dwelling units, and exterior painted surfaces associated
with such dwelling units or common areas. LBP compliance requirements relating to such dwell-
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ing units includes, without limitation: notification, evaluation by visual assessment, paint stabi-
lization utilizing safe work practices, and clearance.
(2) CITY advises SUBRECIPIENT that in the event the
services provided hereunder include rental assistance payments, such as first and last month's
rent and/or security deposit, and the assisted tenant executes a lease for long term occupancy, in-
cluding occupancy in the same dwelling unit for more than 100 days, then the provisions of Sub-
part M (Tenant Based Rental Assistance), will apply (unless otherwise informed and directed by
HUD). In this regard, CITY advises SUBRECIPIENT that Subpart M requires HQS inspection
of each dwelling unit prior to occupancy and prior to compliance with applicable notification,
evaluation by visual assessment, reduction through paint stabilization utilizing safe work prac-
tices, and clearance requirements of the LBP REGS.
(e) Lead Hazard Reduction Work. SUBRECIPIENT shall cause LBP hazard
reduction, such as paint stabilization, interim controls, standard treatments, or abatement of all
residential property that is under its ownership, possession, or control and/or residential property
occupied by persons or families that receive financial or other assistance from SUBRECIPIENT,
except as exempted as described in subsection 4(d)(i)(I) above.
(1) Ifpaint stabilization occurs, SUBRECIPIENT shall cause paint stabi-
lization of each deteriorated surface and clearance of residential units pursuant to Section
35.1330(a) and (b) shall occur before occupancy of a vacant dwelling unit, or where a unit is
occupied, immediately after receipt of the ESG FUNDS hereunder.
(2) Safe Work Practices shall be used in all LBP hazard reduction work.
(3) Clearance shall be conducted to confirm that no LBP hazards remain
when LBP hazard reduction work is complete. Confirmation of clearance by written certification
of a qualified inspector is required on an annual basis in connection with submittal of the April
15 quarterly report.
(f) Onl!:Oinl! Maintenance. SUBRECIPIENT shall incorporate ongoing LBP
maintenance activities into regular building operations in accordance with Section 35.1355(a) for
all residential property that is under its ownership, possession, or control and/or residential prop-
erty occupied by persons or families that receive financial or other assistance from
SUBRECIPIENT, except as exempted as described in subsection 4(d)(i)(I) above.
(J) Ongoing maintenance includes confirmation of clearance which shall
be conducted to confirm that no LBP hazards remain when LBP hazard reduction work is com-
plete.
(2) Ongoing maintenance also includes confirmation of clearance by writ-
ten certification of a qualified inspector on an annual basis in connection with submittal of the
April 15 quarterly report.
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(3) A part of such ongoing maintenance obligation includes notification of
the results of clearance confirmation and annual confirmation of clearance.
a. SUBRECIPIENT shall cause to be provided a notice to all oc-
cupants of all residential property that is under its ownership, possession, or control and/or resi-
dential property occupied by persons or families that receive financial or other assistance from
SUBRECIPIENT in accordance with Sections 35.125(b)(I) and (c), describing the results of the
clearance examination and the results of annual certification.
(g) Units Cleared Prior to Date of Al!reement: Confirmation of Clearance.
In the event the requirements of the LBP REGS relating to lead hazard evaluation, lead hazard
reduction, and lead hazard clearance have been completed on the subject dwelling units prior to
the Date of Agreement, then the SUBRECIPIENT shall provide to the CITY with the April 15
quarterly report a certificate from a qualified inspector evidencing a recent inspection and con-
firmation of clearance of LBP and LBP hazards from the subject dwelling unites).
5. LBP Informational Summary. For purposes of information only and in no
respect intended to be a representation or warranty of the provisions of the LBP REGS, the CITY
has caused to be prepared an information summary relating to the LBP REGS and application to
dwelling units that may be occupied by recipients of services and/or funding from
SUBRECIPIENT under this Agreement. Attachment No. 4 to this Agreement, attached and
hereby fully incorporated by this reference, is such information summary. CITY staffwill coop-
erate with and make themselves available to SUBRECIPIENT to assist in implementation of
compliance with the LBP REGS as to residential dwelling units to be assisted by
SUBRECIPIENT. The parties acknowledge and agree the CITY is and shall not be liable or re-
sponsible for the accuracy of such summary, and the SUBRECIPENT is directed to the LBP
REGS and implementing guidance published and provided by HUD relating to compliance with
such LBP REGS.
B. Amount of Grant and Quarterlv Disbursement. The amount granted to
SUBRECIPIENT is $ 32,000 ("ESG FUNDS"), and such funds shall be expended by
SUBRECIPIENT on or before June 30, 2003. The ESG FUNDS shall be disbursed by CITY to
SUBRECIPIENT on a quarterly basis, subject to and upon receipt and approval of a complete
quarterly activity report, with the fmal payment subject to the satisfaction of the condition prece-
dent 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. Fur-
ther, SUBRECIPIENT agrees to match all federal funds provided by CITY to SUBRECIPIENT
with an equal amount of funds from sources other than these or other ESG funds.
C. Use of Funds. SUBRECIPIENT agrees to use said funds pursuant to this
Agreement to pay for necessary and reasonable costs allowable under the federal law and regula-
tions to operate said program only. Said amounts shall include and will be limited to, essential
services, homeless prevention, and/or operations costs. Allowable program costs are detailed in
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the Budget, as set forth in "Exhibit B," attached hereto and by this reference incorporated herein.
SUBRECIPIENT'S failure to perform as required may, in addition to other remedies set forth in
this Agreement, result in readjustment ofthe amount offunds CITY is otherwise obligated to pay to
SUBRECIPIENT pursuant to the terms hereof. SUBRECIPIENT agrees that the homeless shelter
and services under said program shall be made available for the entire period during which said
funds are provided.
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 essential services,
homeless prevention, and/or operations costs. 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 inunediately 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 inunediately of any pending violations. Failure to notifY CITY
of pending violations, or to remedy such known violation(s) shall result in termination of grant
funding hereunder. SUBRECIPIENT must make all corrections required to bring the
facility/property into compliance with the law within sixty (60) days of notification of the
violation(s); failure to gain compliance within such time shall result in termination of grant funding
hereunder.
G. Separation of Accounts. All funds received by SUBRECIPIENT from CITY
pursuant to this Agreement shall be maintained separate and apart from any other funds of
SUBRECIPIENT, or of any principal or member of SUBRECIPIENT,in an account in a federally
insured banking or savings and loan institution with record keeping of such accounts maintained
pursuant to applicable legal requirements. No monies shall be withdrawn from such account except
for expenditures relating to essential services, homeless prevention and/or operations costs, as
authorized hereunder.
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
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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. Further,
SUBRECIPIENT shall comply and/or cause compliance with audit report(s) required by applicable
provisions of Title X and the LBP Regs.
1. Record Keeoing,IReoorting. SUBRECIPIENT shall keep and maintain complete
and adequate records and reports to assist CITY in meeting and maintaining its record keeping
responsibilities under the ESG REGS, Title X, and the LBP Regs, including the following:
(I) Records
a. Documentation evidencing income level of persons and/or families par-
ticipating 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, age of children, seniors, income verification.
d. Documentation of all ESG FUNDS received from CITY.
e. Documentation of expenses as identified in the Budget Proposal, in-
cluding 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 ESG FUNDS were expended, and payment therefor.
f. Any such other related records as CITY shall reasonably require or as
required to be maintained pursuant to the ESG REGS.
g. Documentation evidencing compliance with all applicable provisions of
Title X and the LBP Regs, in particular Subpart K and, as applicable Subpart J
and/or Subpart M.
(i) Specific documentation, as required, evidencing compli-
ance with all applicable provisions of such LBP Regs includ-
ing: (i) notification, including distribution of the lead hazard
information pamphlet (Attachment No.1), disclosure and no-
tices of hazard evaluation and reduction (Attachments No. 2
and 3); (ii) evaluation of lead hazard(s), including paint test-
ing and risk assessment; (iii) reduction of lead hazard(s), in-
cluding safe work practices and clearance, and confirmation
of clearance; and (iv) ongoing maintenance, as and if appli-
cable for multifamily properties.
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(ii) In this regard SUBRECIPIENT shall track information on
all persons/households assisted and the housing units assisted
with the ESG FUNDS. Attachment No.5 hereto is a sample
form for tracking persons/households and housing units as-
sisted with the ESG FUNDS. All categories of information set
forth in such tracking form shall be prepared and submitted to
the CITY with the April 15 quarterly report.
(iii) In the event that such information and reports are not com-
plete and reasonably satisfactory information submitted in order
for CITY staff to review and evaluate compliance with applica-
ble ESG REGS and LBP Regs., then the final quarterly dis-
bursement payment shall be withheld from the
SUBRECIPIENT.
(iv) Documentation of clearance confirmation as provided
herein.
(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, SUBRECIPIENT shall submit both: an original
invoice and true copies of invoices, receipts, agreements or
other documentation supporting and evidencing how the ESG
FUNDS have been expended during the applicable quarter.
(ii) Quarterly Activity Report: Including in such reports
evidence of compliance with all applicable provisions of Title X
and the LBP Regs, in particular Subpart K and, as applicable
Subpart J, as further described in subsection (d) hereinafter, and
Subpart M, if SUBRECIPIENT provides long term tenant-based
rental assistance. SUBRECIPIENT agrees to provide CITY with
written cumulative (year-to-date) reports of its activities on or
before the 15th day of October, January, April and July for the
period beginning July 1, 2002 and through and including the
previous three-month reporting period setting forth the activities,
program accomplishments, new program information and year-to-
date program statistics on expenditures, caseload and activities.
When appropriate, pictures should be included.
(iii) Any such other reports as CITY (or HUD) shall reasonably
require and/or request, including but not limited to the following
information: monthly records of all ethnic and racial statistics of
persons and families benefited by SUBRECIPIENT in the per-
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formance of its obligations under this Agreement, including, but
not limited to, the activities, program accomplishments, new pro-
gram information, match fund certification and current program
statistics on expenditures, caseload and activities. When appro-
priate, pictures/slides should be included.
(3) Recordkeeoing of Ongoing Maintenance under the LBP Regs. If the services and
program activities provided by SUBRECIPIENT hereunder establish an ongoing relationship
with a property (such as long term tenant based rental assistance program [Subpart M] or transi-
tional or permanent housing operated or administered by the SUBRECIPIENT), then the
SUBRECIPIENT shall provide a report to the CITY evidencing that SUBRECIPIENT and/or the
property owner(s), as applicable, has performed ongoing maintenance of the subject property.
Ongoing maintenance shall include evidence of an annual clearance certification of the subject
residential property conducted by a DHS certified technician to ensure that LBP hazard reduction
measures are maintained. All maintenance activities shall be conducted to ensure the threat of
LBP hazards is minimized.
(4) Recordkeeoing under the LBP Regs. The SUBRECIPIENT shall keep records of dis-
tribution of notifications, all visual assessment, evaluations, inspections, repairs, and any other
lead hazard evaluation, reduction, safe work practices, and clearance activities.
(a) The SUBRECIPIENT shall keep records evidencing distribution of all lead
hazard information pamphlet(s).
(b) The SUBRECIPIENT shall keep records evidencing each LBP evaluation re-
port, LBP hazard reduction documentations, (such as job specifications), and all clearance or
abatement report(s).
(c) The SUBRECIPIENT shall keep ongoing maintenance records and records of
relevant building operations for use during reevaluations of subject property for LBP and/or LBP
hazards.
I. Such records shall be maintained for not less than longer of
(A) three (3) years after the activities cease or (B) the period re-
quired by applicable program regulations. Under the ESG REGS
records shall be retained for not less than four (4) years after the
activities cease.
2. The SUBRECIPIENT shall provide a copy of any of the
above records to the CITY or to BUD upon request of either or
both.
(d) Tracking Report. If the SUBRECIPIENT has provided, or is providing, rental
assistance payments directed to a housing unit or housing units for more than 100 days, or it is
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anticipated that during the last quarter of funding that such rental assistance payment will be for
more than 100 days, then the April 15 quarterly report shall contain information and evidence of
compliance with the requirements herein relating to tracking of housing units, cumulative days of
rental assistance, proper notifications to occupants and owners, HQS inspection, visual assess-
ment, work write-up, stabilization and clearance of LBP and LBP hazards, if any. The proposed
form of such tracking information is attached hereto as Attachment No.5 and fully incorporated
by this reference. In the event such April 15 quarterly report does not fully satisfy the reporting
requirements set forth herein and in the LBP Regs, then the final installment payment of the
ESG FUNDS shall be withheld from disbursement to SUBRECIPIENT.
J. Access to Records. CITY and the United State Government and/or their representatives
shall have access for purposes of monitoring, auditing, and examining SUBRECIPIENT's activities
and performance, to books, documents and papers, and the right to examine records of
SUBRECIPIENT's subcontractors, bookkeepers and accountants, employees and participants in
regard to said program. CITY and the United States Government and/or their representatives shall
also schedule on-site monitoring at their discretion. Monitoring activities may also include, but are
not limited to, questioning employees and participants in said program and entering any premises or
any site in which any of the services or activities funded hereunder are conducted or in which any of
the records of 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 RecordslRequired Length of Record Keeping. All accounting records,
reports, and evidence pertaining to all costs, expenses and the ESG 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 four (4) years after completion of an audit in conformity with the ESG REGS, except as
hereinafter provided relating to retention of any records or documentation existing, created, or
maintained in compliance with Title X or the LBP Regs. Records which relate to (a) complaints,
claims, administrative proceedings or litigation arising out of the performance of this Agreement,
or (b) costs and expenses of this Agreement to which CITY or any other governmental agency
takes exception, shall be retained beyond the four (4) years until complete resolution or
disposition of such appeals, litigation claims, or exceptions. All records relating to, or created or
maintained in compliance with, Title X and/or the LBP Regs shall be retained and maintained by
SUBRECIPIENT indefinitely, including without limitation, all inspection report(s), disclosure
statement(s), and clearance report(s). In the event SUBRECIPIENT does not make the above-
referenced documents available within the city of Santa Ana, California, SUBRECIPIENT agrees to
pay all necessary and reasonable expenses incurred by CITY in conducting any audit at the location
where said records and books of account are maintained.
1. Compliance with Law. SUBRECIPIENT acknowledges that the funds being pro-
vided by CITY for said program are received by CITY pursuant to applicable ESG guidelines and
that expenditures of these funds shall be in accordance with the ESG guidelines and all pertinent
regulations issued by agencies of the federal government. 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, and all Program Requirements. SUBRECIPIENT agrees to
12
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comply fully with all federal, state and local laws and court orders applicable to its operation
whether or not referred to in this Agreement.
M. Standing. SUBRECIPIENT shall be in good standing, without suspension by the
California Secretary of State, Franchise Tax Board and Internal Revenue Service. Any change in
the corporate status or suspension of SUBRECIPIENT shall be reported immediately to CITY.
N. Confidentiality. Without prejudice to any other provisions of this Agreement,
SUBRECIPIENT shall, where applicable, maintain the confidential nature of information pro-
vided to it concerning participants in accordance with the requirements of federal and state law.
SUBRECIPIENT certifies that it will develop and implement procedures to ensure the confiden-
tiality of records pertaining to any individual provided family violence prevention or treatment
services under any project assisted under the Emergency Shelter Grants Program and that the ad-
dress or location of any family violence shelter project assisted under the Emergency Shelter
Grants Program will, except with written authorization of the person or persons responsible for
the operation of such shelter, not be made public. 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 ser-
vices rendered hereunder.
o. Indeoendent 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 ESG funds were received by SUBRECIPIENT, or if SUBRECIPIENT reports
inaccurately, or if on audit there is a disallowance of certain expenditures, SUBRECIPIENT agrees
to remedy the acts or omissions causing the disallowance and repay CITY all amounts spent in
violation thereof. If SUBRECIPIENT engaged in fraudulent activity to obtain and/or justify
expenditure of the ESG funds granted hereunder, SUBRECIPIENT shall be required to reimburse
the CITY of all such funds that were obtained/spent under fraudulent circumstances.
Q. Equipment. SUBRECIPIENT agrees to maintain a record for each item of non-
expendable personal property acquired under the terms of this Agreement. Said record shall be
made available to CITY upon request. The term "non-expendable personal property" shall include
leased and purchased equipment.
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,
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8114/01 IS
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 ofESG funds
to pay salaries and other related administrative or personnel costs, no persons who exercise or have
exercised any function with respect to ESG activities assisted under the terms of this Agreement, or
who are in a position to participate in a decision-making process or gain inside information with
regard to such activities, may obtain a financial interest or benefit from a ESG-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 D.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. 95.5.
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. 95.5(a)(3). No
payment, advance, grant, loan or gnarantee 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.F.R. 95.5. A breach of the contract
clauses in 29 C.F.R. 95.5 may be grounds for termination of the contract, and for debarment as a
contractor/subcontractor, as provided in 29 C.F.R. 95.12. Labor standards interviews/investigations
shall be made as necessary to assure compliance [29 C.F.R. 95.6(a)(3)].
V. Homeless Involvement. SUBRECIPIENT certifies that it will involve, to the
maximum extent practicable, homeless individuals and families in constructing, renovating,
maintaining, and operating facilities assisted under the ESG program, and in providing services for
occupants of these facilities.
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W. Drug Free Workt>lace. SUBRECIPIENT certifies that it has established the fol-
lowing drug-free workplace policy:
1. The unlawful manufacture, distribution, dispensing, possession or use of a con-
trolled 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 em-
ployees 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 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 of receiving such notice, appropriate personnel action will be
taken against such employee, up to and including termination.
5. 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. CITY shall pay to SUBRECIPIENT from funds received under the ESG when, if and
to the extent received from HUD, amounts expended by SUBRECIPIENT in carrying out said
program pursuant to this Agreement up to a maximum aggregate amount of THIRTY-TWO
THOUSAND Dollars ($32,000) in installments determined by CITY. Payments shall be made to
SUBRECIPIENT through the submission of quarterly invoices (on or before the 15th day of Oc-
tober, 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 within the scope of this Agreement and that SUBRECIPIENT
is in compliance with the terms and conditions ofthis Agreement.
Costs incurred prior to the effective date of this Agreement, accrued as of the first day of
July 2002, for purposes identified herein will be allowable for reimbursement upon presentation
of evidence of and invoices for such expenditures.
B. CITY shall include an audit of the account maintained by SUBRECIPIENT in CITY's
annual audit of all funds pursuant to the Code of Federal Regulations and other applicable federal
laws and regulations.
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III. NONDISCRIMINATION
SUBRECIPIENT agrees that no person on the ground of race, color, national origin, re-
ligion 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 ESG funds.
IV. CONFLICT OF INTEREST
SUBRECIPIENT agrees that no officer, employee, agent or assignee of CITY having direct or
indirect control of any ESG monies granted to the CITY, inclusive of the subject ESG FUNDS,
shall serve as an officer of SUBRECIPIENT. Further, any conflict or potential conflict of interest
of any officer of SUBRECIPIENT shall be fully disclosed in writing prior to the execution of this
Agreement and said writing shall be attached and deemed fully incorporated as a part hereof. Notice
shall be sent by SUBRECIPIENT to CITY regarding any changes or modifications to its board of
directors and list of officers.
V. SPECIAL CERTIFICATION FOR RELIGIOUS ENTITIES
In addition to, and not in substitution for, other provisions of this Agreement regarding
said program using federal funds, SUBRECIPIENT:
A. Represents that it is, or may be deemed to be, a religious or denominational institution
or organization or an organization operated for religious purposes that is supervised or controlled
by or in connection with a religious or denominational institution or organization;
B. Agrees that, in connection with said program:
1. It will not discriminate against any employee or applicant for employment on the
basis of religion and will not limit employment or give preference in employment to persons on
the basis of religion;
2. It will not discriminate against any person applying for participation in said pro-
gram on the basis of religion and will not limit such participation or give preference to persons
on the basis of religion;
3. It will provide no religious instruction or counseling, conduct no religious worship
or services, engage in no religious proselytizing, and exert no other religious influence in said
program;
4. The funds received under this Agreement shall not be used to construct, rehabili-
tate, or restore any facility that is owned by SUBRECIPIENT and in which said program is to be
implemented; provided that, minor repairs may be made if such repairs (1) are directly related to
said program; (2) are located in a structure used exclusively for non-religious purposes and (3)
constitute in dollar terms only a minor portion of the federal fund expenditure for said program.
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VI. CONDITIONS ON PROVISIONS OF DEVELOPMENT AND IMPLEMENTING
HOMELESS PREVENTION ACTIVITIES
In addition to, and not in substitution for, other provisions of this Agreement regarding
said program using federal funds, SUBRECIPIENT:
A. Represents that it is, or may be deemed to be, a Homeless Prevention Program;
B. Agrees that, in connection with said program, if ESG funds are to be used to assist
families that have received eviction notices or notices of termination of utility services, the fol-
lowing conditions will be met:
1. The inability of the family to make the required payments must be the result of a
sudden reduction in income;
2. The assistance must be necessary to avoid eviction of the family or termination of
services to the family;
3. There must be a reasonable prospect that the family will be able to resume pay-
ments within a reasonable period of time; and
4. The assistance must not supplant funding for preexisting homeless prevention ac-
tivities from any other source.
VII. 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 "immedi-
ate family" means spouse, child, mother, father, brother, sister, brother-in-law, sister-in-law, fa-
ther-in-Iaw, 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.
VIII. NOTICES
Notices to the parties shall, unless otherwise requested in writing, be sent by U.S. Mail,
postage prepaid, and addressed as follows:
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TO CITY:
8/14/0lLS
City of Santa Ana
Community Development Agency (M-25)
20 Civic Center Plaza
P.O. Box 1988
Santa Ana CA 92702-1988
TO SUBRECIPIENT:
MERCY HOUSE SHELTER SUPPORT
P.O. BOX 1905
SANTA ANA, CA 92702
IX. ASSIGNABILITY
None of the duties of, or work to be performed by, SUBRECIPIENT under this Agree-
ment 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.
X. HOLD HARMLESS
SUBRECIPIENT shall defend, indenmify and save harmless CITY, its officers, agents,
employees, representatives and volunteers from and against any and all damages to property or
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, agents, employees, rep-
resentatives and volunteers from and against any and all claims, demands, suits, actions or pro-
ceedings 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 SUB RECIPIENT, its
officers, directors, employees, agents, subcontractors and suppliers arising out of SUBRECIPI-
ENT's performance of this Agreement.
XI. TERMINATION
This Agreement may be terminated in accordance with Federal Register 24 CFR Part 576
as follows:
A. This Agreement may be terminated by CITY on thirty (30) days' written notice by ei-
ther party. In the event of such termination, SUBRECIPIENT shall only be entitled to reim-
bursement 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, state and/or local laws governing the use of
Emergency Shelter Grant funds. Furthermore, the SUBRECIPIENT shall comply with the Con-
ditional Use permit requirements. For failure to comply with the aforementioned terms, suspen-
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sion or termination shall result, and SUBRECIPIENT shall only be entitled to reimbursement for
approved expenses incurred up to the effective date of suspension or termination.
C. In the event SUBRECIPIENT defaults by failing to fulfill all or any of its obligations
hereunder, CITY may declare a default and termination of the 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 no-
tice, unless such default is cured before the effective date of termination stated in such notice. If
terminated for cause, CITY shall be relieved of further liability or responsibility under this
Agreement, or as a result of the termination thereof, including the payment of money, except for
payment for approved expenses incurred for services satisfactorily and timely performed prior to
the mailing or service of the notice of termination, and except for reimbursement of (I) any pay-
ments 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.
E. In the event this Agreement is terminated as set forth in Section X.A through X.D, in-
clusive, 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 under this Agree-
ment.
XII. LIMITATION OF FUNDS
The United States of America, through HUD, may, in the future, place programmatic or
fiscal limitations on the use of ESG funds which limitations are not presently anticipated. Ac-
cordingly, 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 SUBRE-
CIPIENT's fiscal accountability, [mancial 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 le-
gally 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.
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XIII. INSURANCE
A. SUBRECIPIENT shall furnish CITY's Clerk of the Council with an insurance certifi-
cate from its workers' compensation insurance carrier certifYing that it carries such insurance and
that the policy shall not be canceled nor the coverage reduced except upon thirty (30) days prior
notice to CITY.
B. SUBRECIPIENT shall obtain, at its sole cost, a policy or policies of commercial gen-
eralliability insurance, or equivalent form, with a combined single limit of not less than
$1 Million Dollars per occurrence.
Such insurance shall: (1) name the City of Santa Ana, its officers, agents, employees and
volunteers as additional insureds; (2) be primary with respect to insurance or self-insurance pro-
grams 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 SUBRE-
CIPIENT's operations hereunder.
SUBRECIPIENT shall: (i) 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; (ii) provide that such insurance shall
not be materially changed or terminated except on thirty (30) days prior written notice to the
CITY; (iii) maintain such insurance for the period covered by this Agreement; and (d) replace
such certificates for policies expiring prior to the expiration ofthis Agreement.
XIV. EXCLUSIVITY AND AMENDMENT TO AGREEMENT
This Agreement supersedes any and all other agreements, either oral or in writing, be-
tween the parties hereto with respect to the use of CITY's ESG 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 any-
one 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.
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XVI. VALIDITY
The invalidity in whole or in part of any provision of this Agreement shaH not void or af-
fect the validity of any other provision of this Agreement.
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 shaH
indemnify CITY fuHy, 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. AH Exhibits and Attacbrnents referenced herein and attached hereto shaH 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 shaH impair any such right or power or be construed to be a waiver thereof. A waiver
by either of the parties hereto of any of the covenants, conditions, or agreements to be performed
by the other shaH not be construed to be a waiver of any succeeding breach thereof or of any
other covenant, condition or agreement herein contained.
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the date
and year first above written.
DATED:
CITY OF SANTA ANA
a municipal corporation
(1 /;
/ ~. uC2~
DAVID N. REAM
City Manager
----
ATTEST:
APPROVED AS TO FORM:
~: --d~
PATRICIA E. HEALY
Clerk of the Council
61f-,' '- ;:;k~.
cr10SEPH W. FLETCHER
City Attorney
SUBRECIPIENT:
MERCY HOUSE:
DATED:
\--'22. G~
~--
S NATURE
\ II Y~~11.eS I f.;x~Clriill(-
NAME TITL D\ (-<: C:-\'Ot
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V.
GOALS AND OBJECTIVES/
IMPLEMENTATION STRATEGY
In the space below, please list the primary goals and objectives for your program. Provide
projected numbers of Santa Ana residents to be served, and the kinds of services they would
receive if your program is funded. Also describe the specific actions arid tasks that would be
performed on a day-to-day basis to achieve these goals.
Objective:
o
Provide comprehensive case management services
Task/Action:
. Complete an assessment on each client
. Develop an individual program plan based on client needs
. Hold weekly case management meetings
. Evaluate case management services upon client exit
provide on-site life skills classes
Task/Action:
. Conduct focus groups to determine topics of interest
. Recruit professionals to facilitate life skills classes
. Schedule life skills classes monthly at each program
. Evaluate speakers/classes to determine effectiveness
Objective:
o
Goal 2: To increase job skills and promote emplovabilitv bv providing iob development services
Objective: Identify clients in need of job development services
o Task/Action:
. Case manager to assess clients for need
. Case manager to refer appropriate clients to job developer
Objective: Identify action plan for job development clients
o Task/Action:
'Career and Job Developer (CJD) to assess each client
. CJD to complete a vocational case plan on each client
. CJD provides job development services as outlined on vocational case plan
Objective: Offer job development workshops
o Task/Action:
. CJD to identify workshop topics
. CJD to develop and facilitate workshops
. Evaluate workshops t~determine effectiveness
Goal 3: To increase permanent housina resources available to clients
Objective: establish an in-house housing committee
o Task/Action:
. recruit members for committee
. develop committee guidelines
Objective: to provide alternative housing options to clients
o Task/Action:
. attend community meetings that address housing issues
. assist ciients with applying for subsidized housing programs
. research shared housing programs in Orange County
. create a housing resource guide for resident and staff use
FOR.. II 0
s~~ ~i~
9
EXK IBIT A-
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Projected Program Budget for Joseph House and Regina House
Fiscal Year 2002 - 2003
Amount for
Annual this %ESG ESG Other
Salaries Salary FTE program for program Amount Sources
Executive Director $71,500 50% $35,750 0% $0 $35,750
Administrative Director $66,000 40% $26,400 0% $0 $26,400
Program Director $47,000 30% $14,100 . '.0% $0 $14,100
Deputy Admin Director $46,125 40% $18,450 0% $0 $18,450
Administrative Assistant $25,000 10% $2,500 0% $0 $2,500
Bookkeeper $29,167 0% $0 0% $0 $0
SHP Grant Manager $42,070 0% $0 0% $0 $0
_ Case Mjlr - JosePl11Regina House $29,400 100% $29,400 51% $15,000 $14,400
Case Mgr - Joseph House/MHC $24,292 50% $12,146 0% $0 $12,146
Job & Career Developer $31 ,593 100% $31,593 0% $0 $31,593
MHC 1 Volunteer Coordinator $31,000 50% $15,500 16% $5,000 $10,500
Resident Mgr - Regina House $11,340 100% $11,340 0% $0 $11,340
Resident Mgr - Joseph House $15,439 100% $15,439 0% $0 $15,439
Subtotal $212,618 9% $20,000 $192,618
%ESG ESG Other
Joseph & Regina House expenses Expenses for program Amount Sources
Payroll Taxes $19,352 0% $0 $19,352
Workers Compensation $12,901 0% $0 $12,901
Health Insurance $10,926 0% $0 $10,926
Program Supplies $25,021 0% $0 $25,021
Program Services $5,040 0% $0 $5,040
Local Expenses $1,995 0% $0 $1,995
Professional Fees $4,200 0% $0 $4,200
Insurance $6,932 0% $0 $6,932
Office Expenses $7,132 0% $0 $7,132
Rent & Utilities $28,864 42% $12,000 $16,864
MaintlRepair $27,574 0% $0 $27,574
Capital Imprvmts $19,250 0% $0 $19,250
Property Taxes $630 0% $0 $630
Subtotal $169,817 7% $12,000 $157,817
Total ~ $382,435 8% $32,000 $350,435
fXf{(!Sff IS
5/14/2002
\w'
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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 incluued in the
award documents for all subawards at all tiers (including subcontract, sub grants, 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.
1-
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Program . e
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EXHIBIT C
Page 1 of2
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SUBRECIPIENT warrants the following:
1. SUBRECIPIENT will comply with Public Law 88-352, Title VI of the Civil Rights
Act of 1964 (42 U. S. C. section 2000 et seq.) and implementing regulation in 24 CFR
Part 1.
2. .No person in the United States shall on the ground of race, color,. religion, national
origin, or sex, be excluded from participation in, or be denied the benefits of, or be
subjected to discrimination under any program or activity funded in whole or in part with
community development funds made available pursuant to the ACT.
3. All laborers and mechanics, employed by contractors or subcontractors in the
performance of construction work financed in whole or in part with community
development funds shall be paid wages at rates not less than those prevailing on similar
construction in the locality as determined in accordance with the Davis-Bacon Act, as
amended, 40 U. S. C. Sections 276 a 1-5, except for individuals who perform services for
which they volunteered; do not receive compensation for such services; or are paid
expenses, reasonable benefits, or a nominal fee for such services; and are not otherwise
employed at any time in construction work.
4. SUBRECIPIENT will comply with all Federal statutes applicable to projects funded
with community development funds, except that (a) 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.
~
EXHffiIT C
Page 2 of2
"" '-'
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
Approved by OMS
0348.0046
(See reverse for pubiic burden disclosure.)
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
D a. contract D a. 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
DPrime D Sub awardee and Address of Prime:
Tier __, if known:
Congressional District, if known: Congressional District, if known:
6. Federal Department/Agency: 7. Federal Program Name/Description:
CFDA Number, if applicab/e: ______
8. Federal Action Number, if known: 9. Award Amount, if known:
$
10. a. Name and Address of Lobbying Entity b. Individuals Performing Services (including address if
(if individual, last name, first name, M/): different from No. 1 Oa)
(last name, first name, M/l:
(attach Continuation Sheet(s) SF-LLLA, if necessary)
11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply):
$ D actual D planned o a. retainer
D b. one-Ume fee
12. Form of Payment (check all that apply): o c. commission
D a. cash o d. contingent fee
D b. in~kind; specify: nature I. D e. deferred
value ------ Of. other; specify:
.
14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s),
employee(s), or Member(s) contacted, for Payment Indicated in Item 11:
(attach Continuation Sheel(s) SF.LLLA, if necessary)
15. Continuation Sheet(s) SF.LLLA attached: DYes DNo
16 Information requested through this form is authorized by tilla 31 U.S.C. section Signature:
. 1352. This disdosure of lobbying activilies Is 8 material IlIprellll!lntalion of fad:
upon which reliance was placed by 1119 tier above when this transaction was made Print Name:
or enlerEld into. This disdosure is required pursuant to 31 U.S.C. 1352. This
informa1ia'l will be reported to the Congess seml-annualy ancl will be available for Title:
pubic InspectiCJl. Any person who fails to file the requhtd dlsdosul9 shall be
subject to a dvil penalty of not less thet $10.000 and not more than $100,000 for Telephone No.: Date:
eactl such failure.
Federal Use Only: -- ....... ...... .1 Authorized for local Reproduction
..... ..... -....< < Standard Form LLL (Rev. 7-97)
""
'wi
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity. whether subawardee or prime Federal recipient. at the initiation or receipt of a covered Federal
action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreementto make
payment to any lobbying entity for influencing or aUemptingto Influence an officer Of employeeof any agency, a Member of Congress. an officer or employeeof
Congress. or an employeeof a Memberof Congress in connection with 8 covered Federal action. Use the SF-LlLA ContinualionSheet for additional information if
the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance
published by the Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is andlor has been secured to influence the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
. ..
3. Identify the appropriate classification of this report. If this is a followup report caused by a material change to the information previously reported, enter
the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal
action.
4. Enter the full name, address, city, State and zip code of the reporting entity . Include Congressional District, if known. Check the appropriateclassification
of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee
of the prime is the 1 st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.
5. If the organization filing the report in item 4 checks "Subawardee,"then enter the full name, address, city, State and zip code of the prime Federal
recipient. Include Congressional District, if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizationallevel below agency name, if known. For
example, Department of Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance
(CFDA) number for grants. cooperative agreements, loans, and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number;
Invitation for Bid (IFB) number; grant announcement number; Ihe contract, grant, or loan award number; the application/proposal control number
assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-o01."
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan
commitment for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, State and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influence the covered
Federal action.
(b) Enter the full names of the individual(s) perfonning services, and include full address if different from 10 (a). Enter Last Name, First Name, and
Middle Initial (MI).
11. Enter the amount of compensationpaid or reasonablyexpectedto be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether
the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative
amount of payment made or planned to be made.
#
12. Check the approprialebox(es).Check all boxesthatapply.lf paymentis made through an in-kind contribution, specify the nature and value of the in-kind
payment.
13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature.
14. Providea specific and detailed description of the services that the lobbyist has performed, or will be expected to perform, and the date(s) of any services
rendered. Include all preparatory and related activity, not just time spent In actual contact with Federal officials. Identify the Federal official(s) or
employee(s) contacted or the officer(s), employee(s), or Member(s) of Congress that were contacted.
15. Check whether or not a SF-l.LLA Continuation Sheet(s) is attached.
16. The certifying official shall sign and date the form, print hislher name, title, and telephone number.
According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB Control
Number. The valid OM6 control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is
estimated to average 30 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the Office of Managementand Budget, Paperwork. Reduction Project (0348..(l046), Washington,
DC 20503.
A CORD_
CERTIFICf TE OF LIABILITY INsunANCeeRgi~lDH OA~.:;'(;'40~
THIS CERTIFICATE SUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P~OOt."CER
Huntiagton Pacific Ins. Agency
18672 Florida St. Ste. 302D
Huntington Beach CA 92648
Phone:714-B41-6283
INSURERS AFFORDING COVERAGE
INSURED
Mercy House Transitional
Living Center ETAL
P.O. Box 1905
Santa Ana CA 92702
I
\.uvr:i-<AGES
INSURER A:
INSURER B;
INSURER c:
INSURER 0:
INSURER E:
Great American Insurance Co.
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ~~o CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID ClAIMS.
l~f~1 TYPE OF INSURANCE POLICY NUMBER DATEUMMIOOfYYl OATE"MM/DDrvYl LIMITS
~"- EACH OCCURRENCE $1,000,000
A X COMMERCIAL GENERAL LIABIUTY PAC6536218 05/02/03 05/02/04 FIRE DAMAGE (Anyone fire) $200,000
CLAIMS MADE 0 OCCUR MEO EXP (Anyone person) $10,000
PERSONAL & ADV INJURY , 1,000,000
~L AGGREGATE LIMIT APPL;S-PER I , I ';f~c.:RAL AGGRE~.... I c: li;',V~C/GG;l
PRODUCTS. COMP/OP AGG $1,000,000
,[=tPRO. n
X POLICY JEeT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
r-- (Eaaccident)
ANY AUTO
f- ALL OWNED AUTOS
BODILY INJURY .
r--- (Per person)
SCHEDULED AUTOS
A ex HIRED AUTOS PAC6536218 05/02/03 05/02/04 BODilY INJURY $
r--- (Per accident)
~ NON-DWNED AUTOS
- PROPERTY DAMAGE .
(Per accident)
GARAGE LIABILITY AUTO ONL Y ~ EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
APPROVED AS Tu l-v -\..10. AUTO ONLY: AGG .
EXCESS LIABILITY J>>. ",/,., EACH OCCURRENCE .
:=J OCCUR D CLAIMS MADE AGGREGATE $
.d::::.
LauVI She. oj' lJrnt $
=1,0EOUCTIBLE poputy City At .
RETENTION $ .
I WORKERS COMPENSATION AND I jTORYLlMrisl I"ER.
EMPLOYfRS' LIASILITY E.L. EACH ACCIDENT $
( t::.i... DISEASE. E,., ..;"r-:':':":::j W
,
I I 1E.-l~ISEASE. POLlZy LIMIT I $
IOTHER
I
DESCRIPTION OF OPERATIONSILOCATIONSNEHIClES/EXClUSIONS ADDEO BY ENDORSEMENT/SPECIAL PROVISIONS
hOith respec ts to the additional insureds, this insurance shall not be
cancelled or materially reduced in coverage or limits except after (30) days
written notice has been given to the City of Santa Ana.
'::.7: t:;r,. C' :::0.. ~--t: ~-'9 :~; 0 I:j::i
CERTIFICATE HOLDER
I y I ADDITIONAL INSURED; INSURER LETTER:
SANTANA
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPlRATIO~<
DATE THEREOF, THE ISSUING INSURER Will ~""'ijB MAll ..3..L OAYS WRITTEN
NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT, ~ '41~~ VJ R J.. r1-'
~~n}J..~'I"'l'O'fT'n"'rorfiftt<I#s#
City of Santa Ana, Community
Development Agency M-25
Att: John Maloney
P.O. Box 1988
Santa Ana CA 92702-1988
I
ACORD 25.S (7/97)
AUTHORIZED REPRESENT~~E
Don Heberden Ji}(frV
~
@ACORD CORPORATION 1988
O~_./"....~__
. -'-:-:-.:e"-'\t~'---
,
"'"
......;
I
IMPORTANT
If tI1e certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s}.
If SUBROGATiON IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s}.
DISCL.II.IMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer{s), authorized representative or producer, and the certificate holder, nor does it
...... affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25.S (7/97)
t"t(U'/ .
t-HX NU. ; (1.'1-04 (-0;)4';:1
oc:: J.:; .:::.t:.Jt::J.::. .,i...l..J.t:..If'"OI.. j..J
j" .
'-'
~
ADDITIONAL INSURED ENDORSEMENT
FOR COMM.ERCIAL UENERAL LIABILITY POLICY
Tnl<umnce Company
Great American Insurance Company
This endorsement modifies such insurance as is afforded by the provisions of Policy
# PAC6536218 relating to the following: '.
1. The City of Santa Ana, 20 Civic CenterPla7..a, Santa Ana, California 92701; its
officers, employees, agents, volunteers and representatives are named as additional insureds
("additional insureds") with regard to liability and defense of suits arising from tne operations
and uses performed by or on behalf(]fthe named insured.
2. With respect to claims arising out of the operations and u.~es perfo~d by or on
behalf of the named insured, such insurance llS is afforded by this policy is primary nnd is not
additional to or contributing with any other insuranec carried by or for the benefit of the
additional insureds.
3. This insurance applies separately to each insured against whom claim is made or
sui~ is brought except with rcspect to the company's limits of liability. The inclusion of any
person or organization as an insured shall not affect any right which sllch person or orguni7..ation
would have as a claimant if not so includcd. .
4. With respect to the additional insureds, this insurance shall not 00 cancelled, or
materially reduced in coverage or limits except after thirty (30) days written notice has been
given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701.
(Completion of the rollowing, including countersignature, is required to make this endorsement
effective.)
Effective
Policy #
Issued to
May 3, 2003 , tbis endorsement form as a part of
PAC6536218
Mprr,y H()lI<;" Transitional Livinq Center ETAL
Named Insured
Countersigned by
7j~'~
Authorized Represen ative
Robin Hatfield - Broker
APPROVED AS
i2..~y" .
, . ~ ~
~il:' fie
~.1Ura Sheedy 7~
) t~ll!v c'- . /
. ~ ..ty A[!ornr.v
TO FORM
---~
>dE'a. 'T': ..,' .P.:l"C:::A'tE""'O:"F"':::L' <:t"A> :S...:,.[.:>:I:r...:y....::IKlS.. 'j:>io:AN' >'C' "'E"'::: >':':::':::':>': ... DATErMIIJ1lOIYY}
:.:>.::.:.:...,:. :,:::::.....:!:y,:.:.}.::>.:::: :'::::.., .':,:,:.<:.::.:>.!,,:..YQb.:>.::.:...:.:.:~~:i. ...... 05/03/02
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 POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
NOY-eS-2aS2 83:20 PM
-c,=, House
'-'
ACORD.
PRODUCER
HUT.~ington Pacific Ins. Agency
~8672 Florida St. Ste. 302D
Huntington Beach CA 9~'4B
Robin Hatfield
Phone No. 714-841-6283
INSuneo
F", No. 714-842-2538
A ~2M2-IM'-2'"
14 -~l. -"C/~ -~q
Mercy Bouse Transitional
Living Center E'I'AL A--'24n-1J1{3-1J~
P.O. Box 1905
Santa Ana CA 92702
71~ "36 7901
....J
COMPANY
A Great American Insurance Co.
COMPANV
B
COMPANY
C
COMPA.N'l'
D
~Wr~~~~~iZT ';~~oLl6ES OF INSU;"N~~ L1ST~~.ELO~ ~~ ~~~~D;D .;~~ ~~D~~~ ~~6vE FO~~E ;.olley PERIOD'
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUI.lENT WITH RESPECT TO 'M-t10l THIS
CERTIFICATE MA.Y Be ISSUeo OR MAY PERTotJN, THE INSURANCE AFFORDED BY THE POLICIES CESCRIllEO HEREIN IS SUBJECT TO All THE TERMS,
EXClUSIONS ANO CONDITIONS OF SUCH POl.ICIE.S. l.IMlT8 SHOWN MAY HAVE e!!eN REDUCED BY PAID ClAIMS.
co
LTR
TYPE OF INSURANCE:
POLICY NUMeeR
GENERAl llAalLnY
t-=
A X COMMERCIAl. GENeRAL LIABIlITY
:::;: I CLAlMS""" [!] OCCUR
Olh'NER'S & CONTRACTOR'S PROT
-
PAC65362J.B
!.,:,:"OMOBILE LIABJlJTY
ANY AUTO
- ....LL OWNeD AUTOS
- SCHEDULEO AUTOS
A X HIRED ALn'OS
~ NON-O'o\INED AUTOS
.-0
f-
PAC6S362J.B
~MGE LIABILITY
r-- ANY AUTO
-
EXCESS LIABILITY
I UMBRelLA FORM
I OTHEA THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS'LlABllITY
POLICY G'fECTrve: POLICY EXPIRA rlCN
DATE(Mf.IJODiYV) DATE(MfNCOfr'Y}
05/02/02
GENERAl AGGREGATE
PRODUCTS. COMPJOP AGO
PERSONAL & AOV IHJURY
EACH OCCURRENCE
FIRE OMIAGE (Any one nr~)
NED EXP (My one pl!I"sonJ
05/02/03
COMBINED SINGLE lIMIT
05/02/02
BODn..VINJURY
(P<<"""",)
05/02/03 eoOJLYJNJURY
(Per.cddenl]
PROPERTY OAMAGE
AUTO ONLY. EA ACCIDENT
OTHEA.1'HA.N AUTO ONLY:
EACH ACCIO!NT
AGGR.fGA TE
EACH OCCURRfNCE
AGGREGATE
P.82
LIMITS
52,000,000
.J.,OOO,OOO
11,000,000
.s 1,. 000, 000
. 200,000
'J.O,OOO
. J., 000, 000
.
.
.
~
S
.
.
>\PPROVJ:;J) AS TO r{J!<
Ih ./
)f';'/A'A /J "f4 I A
Lliura Sheedy /
Deputy City Attorne.
.
.
1~~~I.YiR I IO~'~
EL EACH ACCmENT 5
a. OJSEASE - POLICY LIMIT S
EL DISEASe. EA EMPLOYEE $
THE PRQPFUETORI
PARTNER~XECUT~
OFFICERS ARe:
OTHER
nlNeL
NEXCl
DESCRIPTION OF OPERATIOHSflOCATJONSNEHlClES'SPEClAllTEMS
With respects to the additional insureds, this insurance shall not be cancelled or materially
reduced in coverage or limits except after (3D) days written notice has ~ given to the
City of Santa ana.
CERTIF:r(;ATEi;OI:DEfl::::>,:,........ ... ...... ..... .... .........: :<:::,:C1\,'lI:;~Lli\:T!Dt-I,:::::.:::'",:::::::":"",, ...
City of Santa Ana,~nitY
Development Agency, -25
Att: John Maloney
P.O. Box 1.988
Santa Ana CA 92702-J.988
SHOULD /4Nf OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BefORE THE
t:XPJRATION DATE THEREOf, THE ISSUING COMPANY WILl_~-WJL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOlDER NAMEO TO THE LEFT.
...."~,,.O<<T__....,~!""<~t1t~~
m7'3.'",,::::;''Y' .
!>N. . .
AUTHORIZED REPRESENTATIVE
SANTANA
!icPRQ :~S;$l'$l<:
...~>:.......
Robin Hatfie1d
.:,.: ..:::':::A<:(:j"p:q9~QRh!10N ,1:9~8.
NOV-21-20a2 04:11 PM M~rc~ Hou~e
714 836 79al
P.12t3
11/20/2B02 22:5&
--r<t.n,
7l4~538
<I
FRX tn 17104-647-6549
'-' PAGE 02/02
Sep, 1:1 20B2 111111A'1 1"3
ADDI'I10NAL tNStJ'ARn RNDOIlSBMENl'
FORCOMMF.RCIAT. OITNHRAL tTABlLITVPOLICY
Jn~11TIIIl"" Cornpatl,y Great Amel:.i.can Insurancl: Con\:>aIlY
This tndot1il!ml:nt modilies such iniurlncc as iI Afforded by the 1ll'OvisiOllS of :~clicy
1/ .J'.AC6~:l6218 rel~ 10 the fbllawine;:
I, The Oly of Sama ^'" 20 Civic Centa' PI""", 5.1)18 AIIIl, catlfl/lnla 92701; ill
officers, IlrXlpluyeea, aaentI. voJwlN:s IIIICl roplesentlltiv;s Il'Il named as addillllnallllSlnCl8
("&ddlll.olla1lmun:ds") 1lli1h regard to llablllty IIld dcf'cD8c or suits Il'!aIDa from the operations
and UllIlS p.o.!\" I 'led by (11' on belwlf of the nllllHld IIllIUI'lld.
2. Wnb I'CIpCet to cIaima wIns Ollt of the opcraIiODS and llItIl ""*!,,,wc:d by or on
behalf of the .08IlIIId mlllnd, _h in~co 1& is Ilffonled by lbls polley ill primary Md Is not
additional to or comrlbuUng with &lIY Olber iMItaocc caniaI by or tor the beneflt of the
IIddiUan&llllBureds.
3. 'fhj, IllS1II'IOco applies sepuatel)'to each I.a.nred ~(IP;"qt whom (~a~ I. made or
I1IIt Is btou&ht except w111t rcspa to thc compan)"s limit! of lfability. The Inchl.IOA or~
PIlliOn or Otphi...tiDll as III inaun:d shall nCllatrcct any rlsJrt which ~ pcmm or OI'JPUll:ra!lon
wou14 havo as .. CllIinl8ut if not .0 Illcllldw,
4. With ~ ID the additimuillllllllNds, this illS1ltllllCe sbaU not \)<l Cll1lcolIed, Ol'
ma1cl'i.llr reduced in COVI:llIgc or Jimi1I tlXllOpt I1Icr thlrt)' (30) days written ntltlee bJIs beea
gMu to the City afBmta Ana, 20 Civic Center PIll%&, s.uu. Ana, Calilbmta 92101-
(Com,pleLioll of th, following. including ClOUlIlarSipture, iM required to make tb.ls cnclo1'scmt.nt
BffiK:tive.)
El!'tc1ive
Policy #
Issued to
MaV 3. 2002 .1hI. cndor8cmcltt form as~. part or
p1.C6536218
""'''7 H""'''. Trans:itional Livinq Center ETA!. __
Named IIlSIlI'Cd
CO\lllll::rlignodby '4,~^~~
utl'lOTf:!Ald ~c live
Robin Hatfield - Broker
APPROVED AS TO FORM
AJt~~~
LaIl1ra Sheedy
f)('!l1Jty City Attorney
~J;;~~~~::~:~'"tSAN FRANCiSCO,CA 9:~4"'1':.'O."1:0'~8fo."-7':"-~~;{:~~i.~~,!:>~.f~~~:~:j:,~;~i~~~;~11~~i~
". : COMPENSATION '\~~,_ _ ," >1 .,: - . - - - i ...- - - '-;^~'~~<';~' .;; . . -,". . ,-';~;!;:~~.;<~~.',~,:</'.-t
. '" " , '
INS U 1'\ II< N C'E " .,' > ,. J I
FUN ,0 CERTIFICATE QF! WOkKERifpQMPENSATlO~ \IN~URANCE
l..~,/' r " .... '" "j
,
ISSUEDA TE,
10-01-02
POLICY NUMBER 1209902 - 02
CERTIFICATE EXPIRES, 10-01-03
CITY OF SANTA ANA
COMMUN ITY' DEVELOPMENT AGENCY M-25
POBOX 1988 ATTN JOHN'~ALONEY
SANTA ANA CA 92702
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 30 days' advance written notice to the employer.
We will also give you__ 30 days' advarlce notice should this policy be cancelled prior to its normal -expiration.
., ,'-" -' "
This cer.tific;:ate:~off-tnsllrAanc:eis "ot~n insurance policy and does not amend, extend or alter__tlle.,coverageafforded
by the P9Iicie~-' li$ted herei(L~, Nqtwithstandirl."g any r.e,quirer:n.i!nt. term, or condition ~f any contract ,or' other d.pcumenL
with resp-~ct}o.which this c'ertificate of irisuraqce,_,may. pe '-i~sued or may pertain" the Insurance afforded~by' the)
policies described herein is subject to all the t(lrms, exclusions and conditions of such policies.
-:" , ~
,,' ;..
.,,-f ,.'
~ ./1> /7c !/i/ .
""::_V?'~
" PRESIDENT .. .
,.',..
EMPLOXE~'~ LIABILITY LIMIT INCLUDING DEFENSE COSTS: $l~QOO;OOO.OO P~Rlbcqu~RENCE.
,v, _~, ^ ~ -;. '.. .'1:
'ENDORSEMENT"'2065 'ENTI~'rL.~DCERTIFIC.ATE HOLDERS' NOTICE EFFECTIVE '10/01/02 IS 'ATi/l.giEDTO AND
FORMS A PART 'OF THIS poqCY.' , "'" \; ..' ~
. '~,',- ,.'
\
APPROVED AS
'~LV~
}:a raSheedy
Do:rl:l} C:t~!A:ttorney
10 FORNI
EMPLOYER
LEGAL NAME
.-:"
;:
MERCY. HOUSE TRANSITIONAL
CENTERS ;
PO BOX 1905 . ..... '
SANTA ANA CA'92702
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S'TATE
COMPENSA1'"iON
INSURANCE
FUND
P.O. BOX ~07, SAN FRANCISCO,CA 94101-0$07
CERTIFICATE OF, WORKERS'COMPENSA T10N1NSURANCE
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ISSUE DATE: 10-01-02
POLICY NUMBER: 1209902 - 02
CERTIFICATE EXPJRES:l0-0 1-03
C.I TY OF SANTA ANA
COMMUNITY'OEVEUOPMENLAGENCY M-25
POBOX 1988, :ATTN eJOHN'MALONEY
SANTA ANA CA '9270~ .
This is to certify that we have issued a valid Workers' Compensation insurance polic{'in a -forni"approvedby^the
California Insurance Commissioner to the employer named below for the policy perioq_indicated.
This policy is not subject to cancellation by the Fund except upon 30 days' advance written~o_tjce t~.__theemployer.
We will also give you: 39 d.a'ysi-a9va~ee notice should this pOlicy be cancelled prjortojts,:norniaf~xpiration.
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This certificate,'bf)insur~nce_ is ,,' not, an insurance policy and does not Jme~d/ eXlend or-alter__ tt1f3,co"erag~:afforded
bX the pQlicies li,$te.d her~in.<,_~qt~ithstand~~g any_requirl!I'I'J~~t, term, or corydit!o,ry' q1 ;any contra,c,tor'ptherdoculT!enL,
with resp~ct to Which thiS certificate of_ Insural')ce :.mayl?e-~I~sued or may pertam,:,the Insurance ',afforded:by the "",,~
policies de~crjbed herein 'S subject to tdl the t,rrrjs,excl~sj~ns and conditi~,ns ,of such policies.
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EN60.~SEMEm.#20llSENTiTLED CERTIFICATE HOLDERS'
fORMS A PART Of THIS POLICY. " '.
EMPLOYER'S LIABIL~TY LIMIT INCLUOING DEFENSE CDSTS:
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$1,ood;o~.oo PERjoCCURRENCE.
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NOTICE EFFECTIVE '10/01/02 IS ATTACHED TO AND
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Al'yROVED AS TO FORM
Li~Lu~
IJeputy City Attorney'
EMPLOYER
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, LEGAL NAME
MERCY f-ItiUSE TRANSITIONAL LIVING
CENTERS
PO BOX 1905
SANTA ANA CA 92702
MERCY HOUSE. TRANSITIONAL, LIVING CENTERS
(A NON-PROFIT 'ORG,) (' ' :
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THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND selF 10265 (REV 201)
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