HomeMy WebLinkAboutORANGE COAST INTERFAITH 4 - 2002
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INSURANCE liOl: ON FILE
WORK MAY fiOT PROCEED
CLERK OF COllfC'J.;
DATE: V:H .-0 XGREEMENT BETWEEN THE CITY OF SANTA ANA AND
ORANGE COAST INTERFAITH SHELTER FOR USE OF
COMMUNITY DEVELOPMENT BLOCK GRANT FUNDS
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This Agreement, made and entered into this' S ~ day of _14- -p \<. \ L , 2LXJ 2 ,
by and between the City of Santa Ana, a charter city and municipal corporation of the State of
California ("CITY") and ORANGE COAST INTERFAITH SHELTER, a California nonprofit
corporation ("SUBRECIPIENT") INSURANCE ON FILE
, WORK MAY PROCEED
UNTlL..INS_URANP~PIREh '":>
WIINg~~.!HH \ \....../. --U ~
CLERK OF COUNCIL .
DATE: \\ -2-\-O'L
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
Recitals:
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," hereinafter referred to as "said program" and SUBRECIPIENT represents
that it is qualified and willing to operate said program.
D. The CITY and SUBRECIPIENT have duly executed this Agreement for the expenditure of
such funds; and
WHEREFORE, it is agreed by and between the parties, that the foregoing Recitals are a
substantive part of this Agreement and the following terms and conditions are approved and
together with all exhibits and attachments hereto, shall constitute the entire Agreement between the
CITY and SUBRECIPIENT:
I. SUBRECIPIENT'S OBLIGATIONS
A. Non-Profit Status - Representations and Warranties.
(a) Authority. SUBRECIPIENT is a duly organized and existing non-profit corporation
in good standing and authorized to do business under the laws of the State of California.
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,
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 ofthe services under this Agreement.
(d) No Conflict. To the best of SUBRECIPIENT'S knowledge, SUBRECIPIENT'S
execution, delivery and performance of its obligations under this Agreement will not constitute a
default or a breach under any contract, agreement or order to which SUBRECIPIENT is a party
or by which it is bound.
(e) No Bankruptcy. SUBRECIPIENT is not the subject of any current or threatened
bankruptcy proceeding.
(I) No Pending Legal Proceedings. SUBRECIPIENT is not the subject of a current or
threatened litigation that would or may materially affect SUBRECIPIENT'S performance under
this Agreement.
(g) Application Veracity. All proVISIOns of and information provided in
SUBRECIPIENT'S application for funding submitted to CITY including any exhibits are true
and correct in all material respects.
(h) No Pending Investigation. SUBRECIPIENT is not aware that it is the
subject of any current or threatened criminal or civil action investigation by any public agency,
including without limitation a police agency or prosecuting authority, that would relate to affect
performance of the Agreement or provision of services hereunder.
B. Amount of Grant and Quarterlv Disbursement. The amount granted to
SUBRECIPIENT is $ 5,000 ("CDBG FUNDS"), and such funds shall be expended by
SUBRECIPIENT within a time period not exceeding twelve (12) consecutive months following
the date of this Agreement. The CDBG FUNDS shall be disbursed by CITY to
SUBRECIPIENT on a quarterly basis (October, January, April and July) subject to and upon
receipt and approval of a complete SUBRECIPIENT'S quarterly activity report, with the final
payment subject to the satisfaction of the condition precedent of submittal of complete reporting
information due on or before July 15 of the applicable funding year, as hereinafter more fully set
forth. SUBRECIPIENT shall be obligated to perform such duties as would normally extend
beyond the term, including but not limited to obligations with respect to indemnification, audits,
reporting, data retention/reporting, and accounting.
C. Use of Funds. SUBRECIPIENT agrees to use all federal funds provided by CITY to
SUBRECIPIENT pursuant to this Agreement to operate said program, as set forth in "Exhibit A,"
attached hereto and by this reference incorporated herein. SUBRECIPIENT'S failure to perform as
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required may, in addition to other remedies set forth in this Agreement, result in readjustment ofthe
amount of funds CITY is otherwise obligated to pay to SUBRECIPIENT under Paragraph II hereof.
D. Allowable Costs. SUBRECIPIENT agrees to complete said program on or before
June 30, 2003 and to use said funds to pay for necessary and reasonable costs allowable under the
federal law and regulations to operate said program. Said amounts shall include, but not be limited
to, wages, administrative costs, and employee benefits comparable to other similarly situated
employees. Other allowable program costs are detailed in the Budget, as set forth in "Exhibit B,"
attached hereto and by this reference incorporated herein. SUBRECIPIENT shall use all income
received from said funds only for the same purposes for which said funds may be expended
pursuant to the terms and conditions of this Agreement.
E. Licensing. SUBRECIPIENT agrees to obtain and maintain all required licenses,
registrations, accreditation and inspections from all agencies governing its operations.
SUBRECIPIENT shall ensure that its staff shall also obtain and maintain all required licenses,
registrations, accreditation and inspections from all agencies governing SUBRECIPIENT's
operations hereunder.
F. Zoning. SUBRECIPIENT agrees that any facility/property used in furtherance of
said program shall be specifically zoned and permitted for such use(s) and activity(ies). Should
SUBRECIPIENT fail to have the required land entitlement and/or permits, thus violating any local,
state or federal rules and regulations relating thereto, SUBRECIPIENT shall immediately make
good-faith efforts to gain compliance with local, state or federal rules and regulations following
written notification of said violation( s) from the CITY or other authorized citing agency.
SUBRECIPIENT shall notify CITY immediately of any pending violations. Failure to notify CITY
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-II 0 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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I. Record Keeoing/Reoorting. 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 III
conformity with 24 CFR 570.504(b((2)(i), (ii) and 24 CFR 570.503(b)(3) and 24
CFR 570.208(a)(2)(B) of the income level of persons and/or families participating
in or benefiting by the SUBRECIPIENT program.
b. Documentation of the number of persons and/or families participating
in or benefiting by the SUBRECIPIENT program.
c. Household information shall include number of persons, identification
of head of household, race/ethnicity, and income verification.
d. Documentation of all CDBG FUNDS received from CITY.
e. Documentation of expenses as identified in the Budget Proposal,
including evidence of incurring the expense, invoices for goods or services, copies
of any and 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.
1. Reoorts
(i) Payment Request. Concurrently with the submittal of each
quarterly report, on or before the 15th day of October, January,
April and July, SUBRECIPIENT shall submit both: an original
invoice and true copies of invoices, receipts, agreements or
other documentation supporting and evidencing how the CDBG
FUNDS have been expended during the applicable quarter.
(ii) Quarterly Activity Report: SUBRECIPIENT agrees to keep monthly
records of all ethnic and racial statistics of persons and families benefited by
SUBRECIPIENT in the performance of its obligations under this Agreement,
including, but not limited to, the number of low and moderate income persons
and households assisted in accordance with federal income limits, the number
of female heads of households assisted, new program information and year-to-
date program statistics on expenditures, caseload and activities..
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J. Access to Records. CITY and the United State Government and/or their representatives
shall have access for purposes of monitoring, auditing, and examining SUBRECIPJENT's activities
and performance, to books, documents and papers, and the right to examine records of
SUBRECIPJENT's subcontractors, bookkeepers and accountants, employees and participants in
regard to said program. CITY and the United States Government and/or their representatives shall
also schedule on-site monitoring at their discretion. Monitoring activities may also include, but are
not limited to, questioning employees and participants in said program and entering any premises or
any site in which any of the services or activities funded hereunder are conducted or in which any of
the records of SUBRECIPIENT are kept. Nothing herein shall be 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 govermnental agency takes exception, shall be retained beyond the five (5)
years until complete resolution or disposition of such appeals, litigation claims, or exceptions. In
the event SUBRECIPIENT does not make the above-referenced documents available within the city
of Santa Ana, California, SUBRECIPIENT agrees to pay all necessary and reasonable expenses
incurred by CITY in conducting any audit at the location where said records and books of account
are maintained.
L. Compliance with LawlProgram Income. SUBRECIPIENT acknowledges that the funds
being provided by CITY for said program are received by CITY pursuant to the ACT as amended
and that expenditures of these funds shall be in accordance with the ACT and all pertinent
regulations issued by agencies of the federal govermnent, including, but not limited to, all
regulations found at Title 24 of the Code of Federal Regulations. Program income received by
SUBRECIPIENT shall be returned to CITY unless otherwise provided for in this Agreement.
SUBRECIPIENT agrees to comply fully with all federal, state and local laws and court orders
applicable to its operation whether or not referred to in this Agreement.
M. Standing. SUBRECIPIENT shall be in good standing, without suspension by the
California Secretary of State, Franchise Tax Board and Internal Revenue Service. Any change in
the corporate status or suspension of SUBRECIPIENT shall be reported immediately to CITY.
N. Confidentiality. Without prejudice to any other provisions of this Agreement,
SUBRECIPIENT shall, where applicable, maintain the confidential nature of information provided
to it concerning participants in accordance with the requirements of federal and state law. However,
SUBRECIPIENT shall submit to CITY and or HUD or its representatives, all records requested,
including audit, examinations, monitoring and verifications of reports submitted by
SUBRECIPIENT, costs incurred and services rendered hereunder.
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O. Independent Contractor. SUBRECIPIENT agrees that the performance of
obligations hereunder are rendered in its capacity as an independent contractor and that it is in no
way an agency of CITY.
P. Violation of Terms and Conditions. SUBRECIPIENT agrees that if
SUBRECIPIENT violates any of the terms and conditions of this Agreement or any prior
Agreement whereby CDBG funds were received by SUBRECIPIENT, or if SUBRECIPIENT
reports inaccurately, or if on audit there is a disallowance of certain expenditures, SUBRECIPIENT
agrees to remedy the acts or omissions causing the disallowance or repay CITY all amounts spent in
violation thereof.. If SUBRECIPIENT engaged in fraudulent activity to obtain and/or justify
expenditure ofthe CDBG funds granted hereunder, SUBRECIPIENT shall be required to reimburse
the CITY of all such funds that were obtained/spent under fraudulent circumstances.
Q. Equipment. SUBRECIPIENT agrees to maintain a record for each item of non-
expendable personal property acquired under the terms of this Agreement. Said record shall be
made available to CITY upon request. The term "non-expendable personal property" shall include
leased and purchased equipment.
R. Prohibited Use. SUBRECIPIENT hereby certifies and agrees that it will not use
funds provided through this Agreement to pay for entertairunent, meals or gifts.
S. Lobbving. SUBRECIPIENT certifies that it will comply with federal law (31
U.S.c. 1352) and regulations found at 24 CFR Part 87, which provide that no appropriated funds
may be expended by the recipient of a federal contract, grant, loan or cooperative agreement to pay
any person for influencing or attempting to influence an officer or employee of any agency,
Member of Congress, or an officer or employee of a Member of Congress in connection with
awarding of any federal contract, the making of any federal grant or loan, entering into any
cooperative agreement and the extension, renewal, amendment or modification of any federal
contract, grant, loan or cooperative agreement. SUBRECIPIENT shall sign a certification to that
effect in a form as set forth in "Exhibit C," attached hereto and by this reference incorporated herein.
SUBRECIPIENT shall submit said signed certification to CITY prior to performing any of its
obligations under this Agreement and prior to any obligation arising on the part of CITY to pay any
sums to SUBRECIPIENT under the terms and conditions of this Agreement.
If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the
undersigned shall complete and submit a "Disclosure Form to Report Lobbying," in accordance
with its instructions (see C-1).
T. Financial Interest. SUBRECIPIENT agrees that except for the use ofCDBG funds
to pay salaries and other related administrative or personnel costs, no persons who exercise or have
exercised any function with respect to CDBG activities assisted under the terms of this Agreement,
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or who are in a position to participate in a decision-making process or gain inside information with
regard to such activities, may obtain a financial interest or benefit from a CDBG-assisted activity of
SUBRECIPIENT, either for themselves or those with whom they have family or business ties,
during their tenure or for one year thereafter. This prohibition applies to any person who is an
employee, agent, consultant, officer, or elected or appointed official of CITY, or of
any designated public agencies, or the SUBRECIPIENT.
U. Davis-Bacon Act. All laborers and mechanics employed by contractors or
subcontractors in the performance of construction work, including alterations and repairs, in excess
of $2,000.00, financed in whole or in part with federal funds shall be paid wages at rates not less
than those prevailing on similar construction in the locality as determined in accordance with the
Davis-Bacon Act, as amended, 40 U.S.C. sections 276a - 276a-5. Any such construction contract
shall include and comply with the required contract provisions and rules set forth in 29 C.F.R. 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 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.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. Drug Free Workolace. SUBRECIPIENT certifies that it has established the following
drug-free workplace policy:
1. The unlawful manufacture, distribution, dispensing, possession or use of a
controlled substance is prohibited in the workplace for any employee involved in a federally funded
pro gram.
2. As an employee working in conjunction with a federally funded program, the
employees of SUBRECIPIENT will be required to:
a) Abide by the terms above in statement 1.
b) Notify appropriate officials of SUBRECIPIENT and CITY officials of
any criminal drug statute conviction for a violation occurring in the workplace not
later than five days after such conviction.
3. The United State Department of Housing and Urban Development will be
notified within ten days after receiving notice of any such violation.
4. Within 30 days of receiving such notice, appropriate personnel action will be
taken against such employee, up to and including termination.
Each such employee shall be required to participate satisfactorily in a drug abuse
assistance or rehabilitation program approved for such purposes by a federal, state or local health,
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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 2002-2003 CDBG program year amounts expended by SUBRECIPIENT in carrying out
said program for fiscal year 2002-2003 pursuant to this Agreement up to a maximum aggregate
payment of FNE THOUSAND Dollars ($ 5,000) in installments determined by CITY. Payments
shall be made to SUBRECIPIENT through the submission of invoices on a quarterly basis (October,
January, April and July) in a form prescribed by CITY, detailing such expenses. CITY shall pay
such invoices within thirty (30) days after receipt thereof provided CITY is satisfied that such
expenses have been incurred and documented within the scope and provisions of this Agreement
and that SUBRECIPIENT is in compliance with the terms and conditions of this Agreement.
B. Audit of Account. CITY shall include an audit of the account maintained by
SUBRECIPIENT in CITY's annual audit of all CDBG FUNDS in accordance with Title 24 of
the Code of Federal Regulations and other applicable federal laws and regulations.
III. NONDISCRIMINATION
SUBRECIPIENT agrees that no person on the ground of race, age, color, national origin,
religion or sex will be excluded from participation in, be denied the benefits of, or be subjected to
discrimination under any program or activity funded in whole or in part with CDBG funds.
IV. CONFLICT OF INTEREST
SUBRECIPIENT agrees that no officer, employee, agent or assignee of CITY having direct
or indirect control of any CDBG monies granted to the CITY, inclusive of the subject CDBG
FUNDS, shall serve as an officer of SUB RECIPIENT. Further, any conflict or potential conflict of
interest of any officer of SUBRECIPIENT shall be fully disclosed in writing prior to the execution
of this Agreement and said writing shall be attached and deemed fully incorporated as a part hereof.
Notice shall be sent by SUBRECIPIENT to CITY regarding any changes or modifications to its list
of officers.
V. SPECIAL CERTIFICATION FOR RELIGIOUS ENTITIES
If SUBRECIPIENT is a religious entity, SUBRECIPIENT hereby agrees that in connection
with the provision 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.
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B. SUBRECIPIENT shall not discriminate against any person applying for the services
SUBRECIPIENT agrees to provide under the terms of this Agreement on the basis of religion and
shall not limit such services or give preference to applicants for such services on the basis of
religion.
C. SUBRECIPIENT shall NOT provide religious instruction or counseling, conduct
any religious worship or services, or engage in any religious proselytizing, or exert any religious
influence in the provision of the services in said program. The parties agree that this covenant is
intended to and shall be construed for the limited purpose of assuring compliance with respect to the
use of CITY funds by SUBRECIPIENT with applicable constitutional limitations respecting the
establishment of religion as set forth in the establishment clause under the First Amendment of the
United States Constitution and Article I, Section 4 of the California Constitution, and is not in any
manner intended to restrict other activities of SUBRECIPIENT.
D. Where the services to be provided under said program are rendered on property
owned by the primarily religious entity SUBRECIPIENT, CDBO 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 COBO
expenditure for rendering the services under said program.
VI. PROHIBITION OF NEPOTISM.
SUBRECIPIENT agrees not to hire or permit the hiring of any person to fill a position
funded through this Agreement if a member of that person's immediate family is employed in an
administrative capacity by SUBRECIPIENT. For the purposes of this section, the term "immediate
family" means spouse, child, mother, father, brother, sister, brother-in-law, sister-in-law, father-in-
law, mother-in-law, son-in-law, daughter-in-law, aunt, uncle, niece, nephew, stepparent and
stepchild. The term "administrative capacity" means having selection, hiring, supervisor or
management responsibilities.
VII. NOTICES
Notices to the parties shall, unless otherwise requested in writing, be sent by U.S. Mail,
postage prepaid, and addressed as follows:
TO CITY:
City of Santa Ana
Community Development Agency (M-25)
20 Civic Center Plaza
P.O. Box 1988
Santa Ana, California 92702-1988
TO SUBRECIPIENT:
OC Interfaith Shelter
1963 Wallace Avenue
Costa Mesa, CA 92627
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VIII. ASSIGNABILITY
None of the duties of, or work to be performed by, SUBRECIPIENT under this Agreement
shall be subcontracted or assigned to any agency, consultant, or person without the prior written
consent of CITY. SUBRECIPIENT must submit all subcontracts and other agreements that relate
to this Agreement to CITY. No subcontract or assignment shall terminate or alter the legal
obligations of 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
Agreement, SUBRECIPIENT agrees to obtain and maintain employer's liability insurance with
limits not less than $1,000,000 per accident. If SUBRECIPIENT has no employees, nor
workers' compensation coverage, it must execute a Declaration available from the CITY, and
update as is necessary.
B. SUBRECIPIENT shall obtain, at its sole cost, a policy or policies of commercial
general liability insurance, or equivalent form, with a combined single limit of not less than
$1,000,000 per occurrence.
Such insurance shall: (1) name the City of Santa Ana, its officers, agents,
representatives, employees and volunteers as additional insureds; (2) be primary with respect to
insurance or self-insurance programs maintained by the CITY; (3) contain standard separation of
insureds provisions; and (4) give to CITY prompt and timely notice of claim made or suit
instituted arising out of SUB RECIPIENT's operations hereunder.
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SUBRECIPIENT shall: (a) prior to exercising any right under this Agreement,
furnish properly executed certificates of insurance and additional insured endorsement to the
CITY which shall clearly evidence all coverages required above; (b) provide that such insurance
shall not be materially changed or terminated except on 30 days prior written notice to the CITY;
(c) maintain such insurance for the period covered by this Agreement; and (d) replace such
certificates for policies expiring prior to the expiration ofthis Agreement.
XI. REVERSION OF ASSETS
A. Upon the expiration ofthis Agreement, SUBRECIPIENT shall transfer to CITY any
CDBG funds on hand at the time of the expiration of this Agreement as well as any accounts
receivable attributable to the use ofCDBG funds. [24 CFR 570.503(b)(8).]
B. Any real property under SUBRECIPIENT's control that was acquired or improved
in whole or in part with CDBG funds in excess of$25,000.00 must either be:
1. Used, where CITY has given written approval, to meet one of the national
objectives stated in 24 CFR 570.208 until five (5) years after expiration of this Agreement, or for
such longer period of time as determined to be appropriate by CITY; or
2. If not used in accordance with subparagraph A above, SUBRECIPIENT
shall pay to CITY an amount equal to the current fair market value of the property less any portion
of the value attributable to the expenditure ofnon-CDBG funds for acquisition of, or improvement
to, the property. Such payment is program income to CITY.
C. Subject to the obligations set forth herein, title to equipment acquired under the
terms of this Agreement will vest upon acquisition in SUBRECIPIENT. When said equipment
which has been acquired in accordance with this Agreement and all applicable regulations is no
longer needed for said program, disposition of said equipment will be made as follows:
1. Items of equipment with a current per unit fair 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 assigrunent(s),
quit claim deed(s) or such other and further instruments, documents and agreements as may be
necessary, in the sole and absolute discretion of CITY, to vest in CITY all of SUBRECIPIENT's
right, title and interest (if any it may have) in and to CITY, CDBG or other federal, state and/or
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local accounts or program funds or allocation of funds to which CITY is or may be entitled, either
for its own account or as fiduciary or trustee for others, which were obtained for the purpose of the
performance of this Agreement or any previous agreements relating to the same subject matter or
activities as this Agreement, together with any instruments, loans, grants or advances by
SUBRECIPIENT on behalf of CITY, in furtherance of the activities hereunder or thereof.
SUBRECIPIENT's obligations and responsibilities set forth in this paragraph "XI.
REVERSION OF ASSETS," and in paragraph "XII. TERMINATION" and other requirements
pertaining to program income shall not be affected by the termination of this Agreement and shall
survive the date of termination of this Agreement for such period of time as CITY and/or HUD
deems necessary for the responsibilities, duties and obligations to be performed and completed to
the satisfaction of CITY and HUD.
XII. TERMINATION
A. This Agreement may be terminated on thirty (30) days' written notice by either
party. In the event of such termination, SUBRECIPIENT shall only be entitled to reimbursement
for approved expenses incurred to the effective date of termination.
B. This Agreement may be suspended or terminated by CITY upon five (5) days'
written notice for violation by SUBRECIPIENT of Federal Laws governing the use of Community
Development Block Grant Funds. In the event of such suspension or termination, SUBRECIPIENT
shall only be entitled to reimbursement for approved expenses incurred up to the effective date of
suspension or termination.
C. Pursuant to 24 CFR 85.43, in the event SUBRECIPIENT defaults by failing to fulfill
all or any of its obligations hereunder, CITY may declare a default and termination of this
Agreement by written notice to SUBRECIPIENT, which default and termination shall be effective
on a date stated in the notice which is to be not less than ten (10) days after certified mailing or
personal service of such notice, unless such default is cured before the effective date of 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 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.
12
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070102
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 fimds 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 fimding. In the event of fimding 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 fimds, or may restrict SUBRECIPIENT's use of
both its uncommitted and its unspent fimds. Where HUD has directed or requested CITY to
implement a reduction in fimding, 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 fimds by SUBRECIPIENT and contains
all the covenants and agreements between the parties with respect to such employment in any
manner whatsoever. Each party to this Agreement acknowledges that no representations,
inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone
acting on behalf of any party, which are not embodied herein, and that no other agreement or
amendment hereto shall be effective unless executed in writing and signed by both CITY and
SUBRECIPIENT.
XV. LAWS GOVERNING THIS AGREEMENT
This Agreement shall be governed by and construed in accordance with the laws of the State
of California, and all applicable federal laws and regulations.
XVI. VALIDITY
The invalidity in whole or in part of any provision of this Agreement shall not void or affect
the validity of any other provision of this Agreement.
13
v
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070102
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 ofthis Agreement, and shall
indemnify CITY fully, including reasonable costs and attomey'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 iffully set forth in the body of this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the last date and
year written below.
DATED:
\o-H~V
CITY~. A.
/ /2;'
t2.
DAVID N. REAM
City Manager
ATTEST:
APPROVED AS TO FORM:
c;;;;a
PATRICIA E. HEALY
Clerk of the Council
/ff~~ ~
J9-. JOSEPH W. FLETCHER
City Attorney
SUBRECIPIENT:
DATE: Y/f/!Jd.,
ttPk- .~
Name: 7U'-<Ui d4Y'Ii.::.
Title: ;;:;eGC. cOl;t!c-eft''l...
Tax ID: 16 - J:t/:5~ 9/
14
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"""
GOALS AND OBJECTIVES!
IMPLEMENTATION STRATEGY
VI.
In the space below, please list the primary goals and objectives for your program. Provide
projected numbers of Santa Ana residents to be ser.ed, and the kinds of services they would
receive if your program is funded. Also describe the specific actions and tasks that \\Quid be
performed on a day-to-day basis to achieve these goals. " ." ~
See Appendix A for examples.
GOALS:
. To provide shelter and program services for up to 120 low-income, ethnically diverse families, couples
and single women per night in both programs, with 60-65 individuals within the Transitional Program,
. Provide 19,000 bed nights to 25 families annually in the Transitional Program,
. Provide 30,000 meals annually in the Transitional Program,
. Of the above mentioned numbers, 20 of the residents will be from Santa Ana,
Objectives:
(1) Accept up to 18 homeless families at a time, including annual total of 20 Santa Ana
residents, in the Transitional Program.
Task/Action:
(a) Make contact with service organizations within Orange County to ensure they are
acquainted with the services ofOCIS.
(b) Accept referrals and phone calls for beds available daily for Emergency Program.
(c) Interview families in the Emergency Program for entrance into the Transitional
Program.
(2) Provide for basic needs of food, shelter and clothing.
Task/Action:
(a) Maintain supplies needed by both emergency and transitional clients,
(b) Ask various organizations in the community to have drives for needed items
throughout the year.
(c) Maintain an inventory of school supplies, uniforms, and back packs for children
when they enroll in school.
(3) Provide case management services to homeless families.
Task/Action:
(a) Emergency Program Advocate interview clients and complete pre-intake for the
Transitional Program, then Family Advisor interview potential families for
Transitional Program and complete intake process.
(b) Discuss potential families at Case Management meetings with all staff and
determine potential for successful completion of program.
(c) Develop case plan with families as they enter OCIS Transitional Program and
weekly while participating in the program. Review goals weekly wuh families
and other staff. 7 of 10
(d) Refer families to appropriate agencies for assistance, as appropriate.
CIIf! 13 I r d
--""IO'I'\'~"'~->r"'~'" _,
""'"
"-tI
A B C D E F
1 VIII. 3.
2
3 ORANGE COAST INTERFAITH SHELTER
4 I
5 FISCAL YEAR 2002-3 BUDGET
6
7 Description of Santa Ana % FUNDED Other
8 Expenditures Total CDBG BY CDBG
9
10 Salaries/Benefits
11 Other Staff $ 244,280.00 $ . $ 244.280.00
12 Family Advisors $ 60,095.00 $ 5,000.00 9% $ 55,095.00
13 Other Staff Expenses $ 70,894.00 $ 70.894.00
14 $ 375,269.00 $ 5,000.00 $ 370,269.00
15 ODe rating expenses
16 House expenses $ 51,100.00 $ 51,100.00
17 Client expenses $ 99,865.00 $ 99,865.00
18 Office expenses $ 111,230.00 $ 111,230.00
19 Insurance $ 17,400.00 $ 17,400.00
20 Total Operating Exp $ 279,595.00 $ 279,595.00
21
22 Total $ 654,864.00 $ 5,000.00 $ 624,864.00
23
24 Revenues:
25 Santa Ana ESG $ 20,000.00
26 Other Cities & County $ 79,050.00
27 FEMA $ 20,000.00
28 Church donations $ 18,600.00
29 SuoerNOFA $ 38,500.00
30 Fund Raising $ 130,000.00
31 AdoDt.a.Unit $ 100,000.00
32 Donations $ 271,900.00
33 Total FY Revenue $ 678,050.00
34
(NIlE /1 .D
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"""
Certification Regarding Lobbying
-
Certification for Contracts. Grants. Loans. and Coooerative 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 b~half of the
undersigned, to any person for influencing or attempting to influence an" officer or
employee of any agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with the awarding of any Federal
contract, the making of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any Federal contact, grant, loan or cooperative
agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with this Federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure
Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the
award documents for all subawards at all tiers (including subcontract, subgrants, and
contracts under grants, loans, and cooperative agreements) and that all subrecipients shall
certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed
when this transaction was made or entered into. Submission of this certification is a
prerequisite for making or entering into this transaction imposed by Section 1352, Title
31, U. S. Code. Any person who fails to file the required certification shall be subject to
a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
t)R~6-{!c;/Iif J/!"?6Pr-A!r7--d 5'1I6c;.T~
Grantee/Contactor Organization
,I ~>+iPv-9'L
Program Title
,5' H6er:' ,5~/i 5
Name of Certifying Officer
,~~~
Signature
7%fd.;l
Dae
EXHIBIT C
Page 1 of2
'-"
'...I
SUBRECIPIENT warrants the following:
i. 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. ~o,person in the United States shall on the ground of race, color, religion, I}ational
origin, or sex, be excluded from participation in, or be denied the behelfis 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)
SUB RECIPIENT does not assume CITY'S responsibility for initiating the review process
under Executive Order 12372.
EXHIBIT C
Page 2 of2
+::_._~-,",:~ ,'~-.....:~.~
'-'
Disclosure of Lobbying Activities
"".~~;~~~;::;~:!:X~}~??fT~~~~;r@{~-~~~!:?:;~
Approved by OMB 0348-0046
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
(See reverse side for Instructions and Public Reporting burden statement)
1. Type of Federal Action 2. Status of Federal Action 3. Report Type
o 8. contract o a. bid/offer/application o a. initial filing
b. grant b. initial award b. material change
c. cooperative agreement c. post-award For Material Change Only
d. loan year (yyyy) ___ quarter ___
e. loan guarantee
f. loan insurance date of last report (mmJddlyyyy)_____
4. Name and Address'of Reporting Entity 5. If Reporting Entity In No.4 Is Subawardee. enter Name and Address
DPrime D Subawardee Toer , if known: of Prime
Congressional District, if known Congressional 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, if known
$
10a. Name and Address of Lobbying Registrant b. Individuals Pelforming Services (including address if different from No. 10a.)
(if individual. last name, first name. MI) (last name, first name, MI)
(attach continuation sheet(s) If necessary)
11.
Amount of Payment (check all that apply)
$ actual
13. Type of Payment (check alllhat apply)
D a. retainer
o b. one-lime fee
o c. commission
o d. contingent fee
o e. deferred
D f. other (specify)
Brief Description of Services Performed or to be Performed and Oate{s) of Service, including officer(s), employee(s), or Member(s) contacted,
for Payment Indicated in Item 11
planned
12. Form of Payment (check all that apply)
D a. cash
D b. in-kind; specify: nature
value
14.
(attach contlnuation sheet(s) if necessary)
15. Continuation sheets attached DYes D No
16. Information requested through this form is authorized by Sec.319,
Pub. L. 101-121. 103 Stat. 750, as amended by sec. 10; Pub. L. 104-
65. Stat. 700 (31 U.S.C. 1352). This disclosure of lobbying activities
is a material representation of fact upon which reliance was placed
by the above when this transaction was made or entered into. This
disclosure is required pursuant to 31 U.S.C. 1352. This information
will be reported to the Congress semiannually and will be available
for public inspection. Any person who fails to file the required
disclosure shall be subject to a civil penalty of not less than $10,000
and not more than $100.000 for each such failure.
Signature
Print Name
Title
Telephone No.
Date (mmldd/yyyy)
Federal Use Only:
Authorized for Local Reproduction
Standard Fonn-LLL (7/97)
\.;
c'::':'('~~C~~~~.~~~~,~~'~;~~?r:~~::r~'0"?$
""'"
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 agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee
of any agency. a Member of Congress. an officer or employee of Congress, or any employee of a Member of Congress in connection with
a covered Federal action. 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-andJot'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 informa-
tion 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 fuil name, address, city, state and zip code of the
reporting entity. Include Congressional District, if known.
Check the appropriate classification of the reporting entity
that designates if it is, or expects to be, a prime or subaward
recipient. Identify the tier of the subawardee, e.g., the first
subawardee ofthe prime is the 1st 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 Congres-
sional District, if known.
6. Enter the name of the Federal agency making the award or
loan commitment. Include at least one organizational level
below agency name, if known. For example, Department of
Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the cov-
ered 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 eppropriate Federal Identifying number avail-
able for the Federal action identified in item 1 (e.g., Request
for Proposal (RFP) number; Invitation for Bid (IFB) number;
grant announcement number; the contract, grant, or loan
award number; the application proposal control number as-
signed by the Federal agency). Include prefixes, e.g., -RFP-
DE-90-001."
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
registrant under the t.obbying Disclosure Act of 1995 engaged
by the reporting entity identified in item 4 to influence the
covered Federal action.
(b) Enter the full names of the indlvidual(s) performing ser-
vices, and include full address if different from 10 (a). Enter
Last Name, First Name, and Middle Initial (MI).
11. Enter the amount of compensation paid or reasonably ex-
pected to be paid by the reporting entity (Item 4) to the
lobbying entity (item 10). Indicate whether the payment has
been made (actual) or will be made (planned). Check ail
boxes that apply. If this is a material change report, enter the
cumulative amount of payment made or planned to be made.
12. Check the appropriate box (as). Check ail boxes that apply.
If payment is made through an in-kind contribu1ion, specify the
nature and value of the in-kind payment.
13. Check the appropriate box (es). Check ail boxes that apply.
If other, specify nature.
14. Provide specific and detailed description of the services that
the lobbist has performed, or will be expected to perform, and
the date(s) of any services rendered. Include all preparatory
and related activity, not just the time spent in actual contact
with Federal officiais. Identify the Federal offlcial(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 continuation sheet(s) are attached.
16. The certifying officiai shall sign and date the form, print his/her
name, title, and telephone number.
Public Reporting Burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Please do not
return your completed form to the Office of Management and Budget; send it to the address provided by the sponsoring agency.
Send comments regarding the burden estimate or any other aspect of this collection of information, Including suggestions for reducing this burden, to the
Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503.
Authorized for Local Reproduction
Standard Form-LLL (7/97)
;--- CERTIFICA'fE OF LIABILITY INSURANCE
ACgRDm I DATE
01/29/2003
PROOUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
A11-Ca1 Insurance Agency (916)784-9070 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
420 Folsom Road, Suite Ilc ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Rosevil1e 95678- INSURERS AFFORDING COVERAGE
CA
INSURED INSURER A' Nonnrofi ts Ins Alliance Of CA
ORANGE COAST INTERFAITH SHELTER INSURER 8:
1963 WALLACE AVENUE INSURER C
INSURER 0:
COSTA MESA CA 92627- INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANOING 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 DESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID ClAIMS.
II~TS: TYPE OF INSURANCE POUCV NUMSER ~i~~~'b~E POo.kW~~N UMITS
X Q ENERAL LIABILITY 1 1 1 1 EACH OCCURRENCE . 1,000,000
X COMMERCIAL GENERAL lIASI UTY AAE DAMAGE (An one firel . 50,000
I CLAJMS MADE [!] OCCUR 2003-02187 01/17/2003 01/17/2004 MED E.XP (Anyone person) . 5,000
X PROFESSIONAL LIAR. PERSONAL & AnV INJURY . 1,000,000
X IMPROPER SEXUAL CONn 1 1 1 1 GENERAL AGGREGATE . 2,000,000
GEN'L AGG~nE UMIT nES PEA: PRODUCTS - COMP/OP AGO . 2,000,000
Xl PRO- 1 1 1 1 1,000,000
X POLICY JEer lOC IMPROPER SIXUAL COND
X ~l1TOMOBILE LIABIUlY 1 1 1 1 COMBINEO SINGLE LIMIT
~ ANY AUTO (Ea accident) . 1,000,000
ALL OWNED AUTOS 2003-02187 01117/2003 01117/2004 BODILY INJURY
t-
SCHEDULED AUTOS (perpersonj .
- 1 1 1 1
~ HIRED AUTOS BODILY INJURY
..!.. NON-O'MIIED AUTOS (peraccidenl) .
1 1 1 1 PROPERTY DAMAGE
(per accident} .
RAAOE LIABIlITY AUTO ONLY - EA/lCCIDENT .
ANY AUTO 1 1 1 1 OTHER THAN EA/lCC S
AUTO ONLY: AGG $
EXCESS LIABILITY 1 1 1 1 EACH OCCURRENCE .
~]'OCCUR D CLAlMSMADE AGGREGATE .
.
R ~EDUCTIBLE 1 1 1 1 .
RETENTION S APPROVED AS TO Fe Ri\l .
WORKERS COMPENSATION AND flU 1 1 1 1 I T~~~ L~Jflfs I 10TH-
EMPLOYEAS' LIABILITY ER
II b'eW E.L EACH ACCIDENT .
r~illlra Sheedy ! - --r-I 1 1 E.L DISEASE- EAEMPLOYEE S
E.L DISEASE. POLICY LIMIT $
r\, ., r.:. . ."
... '"
OTHER
1 1 1 1
DESCRIPTION OF OPERA TION$1.OCA TJONSlVEHICLES,'EXCLUSIONS ADDED BY ENDQ RSEMENT.'SPEClAl PROVISIONS
THE CITY OF SARTA AHA, ITS OFFICIALS, OFFICERS, AGENTS, EMPLOYEES, AND VOLUNTEERS ARE HAMED AS ADDITIONAL IHSURED AS A
FUHDING SOURCE REGARDING THE ACTIVITIES OF ~HE IHSURED PER THE ATTACHED ENDORSEMENT.
CERTIFICATE HOLDER I X I ADOrrlONAL INSURED: INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WilL ~)(){X<< MAIL
30 DAYS WRrrTEN NOTICE TO THE CERTIFICATE HOLDEA NAMED TO THE LEFT, KCtP<>
CITY OF SANTA ANA ~ll~~llllll(liI/:llll<llC)(_llK~~lIJtllE
20 CIVIC CENTER PL.I M-25 1I~
P.O. BOX 1988 AUTHORlZ~ tRESEN"f:..IVE ""'-J/~
SANTA ANA CA 92701- _ A,
ACORD 25-S fl /97) ELECTRONIC LASER FOAMS, 1~)327-0545 \/1 / ~ ACORD CORPORATION 1988
'ftn.--INS025S (9910).01 yo. Page 1 of2
.
*POLICY NUMBER:
'-'
~OQ?:'- (")d-.\~-'
'-'
ENDORSEMENT
.
*INSURED COMPANY NAME: l.\.0\'" 9fl\~ l-\S 1"'!'. fu1i...cv, c.e. c,t (o..l ~f.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON or ORGANIZATION
This endorsement modifies ins~ce provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
City of Santa Ana and its Officers, Agents, Employees and Volunteers are
named as additional insured as respects their interest in connection with the
named insured.
(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 person or organization shown in the
Schedule, but only with respect to liability arising out of your operations or premises owned by or rented to you.
IT IS AGREED THAT ANY INSURANCE MAINTAINED BY THE CITY OF SANTA ANA SHALL
APPLY IN EXCESS OF, AND NOT CONTRIBUTE WITH, INSURANCE PROVIDED BY THIS
POLICY.
Agent's Signatur~ (r/.
CO 2010 11 85
(218)C SAMPLE - Additional Insured with PrimarylNon-Contributing Language Added
, L. , .; -~ ~__:.--"'.,,, j -..1 r OR1\1
-Y() t~cl"
"~~~--;-~---'-
;V:~ur~: :)l,i".'~'l:Y
:;':f-'Uy' C;lY _-\Lror~lc);
NOV-08-2002 10:43
FROM-ALL CAL I\."
CERTIFICATE OF LlA:
9167840158
7-028
P002l003
F-741
ACORD..
ULlTY INSURA'lfCE
I DATE
10/30/2002
THIS CERnFICATI! IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERnFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
.ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
~) :9
INSURERS AffORDING COVERAGE
f'flOOUCSll
All-Cal Zneu~anoe Agency/916
420 ~olsom Road, Suite Ic
ATTN: BEVERLY
784-9070
:Ro....,.i...l1.
011
INSURED ./ \
0lU\I:iIGI: COAlI'l.' ZN'l.'BRI'AZ'l.'II' SIIBL'l.'D ,./J 'J,<
1963 WALLACE AVENUE /1Y
t
_ 0;"70-
COSTA MESA
COVERAGES
CA 92627-
IN:!lJRER",Nonl:>~ofit.... In... AlliAne.!! Of CA
IN:!lJRER" I!'IDI!lLI'l'Y & Dl!lpOSI'l.' COMPlIm
INSURER c:
INSUAF.R 0:
INSURER E:
THE POUCIES OF INSURANCE umo IlfLOW HAVE BEEN ISSUED TO THI "
NSUReD NAM!!D A80VE fOR THe POllCY peRIOD INOIICA TED. NOT\MTliSTANDING ANY
"~QI.lIrt:~=NT11llRM Of!: CONClTlON Of ANY CONTRACTOR OTHI!R [)O{ I M!:NTV\lTTl1 Re8P~Tro \lVHrC1-l THIS ceRTljSJCAR; MAY BE ISSUED OR MAY PERTAIN,
THE INSURANCE AFFORDED BY THE POUCIr;s oeSCRIBiO HEREIN I: SUElJECT TO AU. THE reAMs, EXCLUSICNS AND CONDITIONS OF SUCH POliCIES.
AGGREGATE LIMITS SHC!I/N MAY HAVE BEEN RfOUCEO BY PAlOCI-AlMS.
'~ TYPE OF INSURANCE POLICY NUM8SR ~o,~.EFl'9W' l'OI.lor~RI\~ LIMITS
TS MfMlCW !)AYE M,og,y
A gENERAL LJABlUTY / / / / i.<CH oeOVRReNOE ~ 1,000,000
~
X CO~ERCIAl GENEML llABIUfv RR~D.4MAGE (Ivt'fcnofira> $ 50,000
I CLAIMS MAOe [i] OCCUR 2002-02187 01/17/2002 01/n/2003 MED EXP (My I:lI1tI ~l'&Dn) . 5,000
X PlK>PIISSlCll.U. ~l~_ PERSOOAL & NJV INJURY . 1,000,000
r!. lNPROPl<ll- SEXUAL COIl. / / / / GeN~ AGGRElJAiE $ 2,000,000
Iil" AGGilWMIT niSPER; PAooocre:. COMPIOP AGe:: . 2,000,000
XF'Ol.ICY ~ = / / / / D6'ROPJ:R SKXtmL CQlf. 1,000,000
A --!.UTCM06ILE L1A61UTY I I / / COWllNED SING", UMrT
- I<NYIV.ffO (l!!aaecider'll) . 1,000,000
X ALl. ow.EC> AUTOS 2002-02187 01/17/2002 Olln/2003 BOOIL Y INJUf!tV
SOhCDuLeo AUTos (Perpl!lr:lQ'1) .
~ HIRID AUTOS / / / / eoolLY INJurtv
I-
r!. NON-OWN5a:l .A.vrOS (Per~eml ,
I- / / / / PROPERTY DAMAGE
(PerilOOidtnt) .
~"'G~LIAIllLrrv AUTO ONI,. 'f - EA ACOD5NT .
ANYAl.JTO / / / / OTHE:R THAN EA ACe iii
ALITa ONLY' AGO S
~SSLlA.BllITY / / / / eACH OCCURRENCE S
OCQ,lR 0 CVJMS MAll!' AGGREGATE S
S
~ ~BLE A p~~ pD !'~ TO FO~M / / / / .
Ri'TeNTION t .
WORKERS CCMPENSATJON AND ,...-" It. r--- / / / / I TORY MtrS I ~-
f!:MPl.OYE!RS LJABluTY
CRI mNE LEE 'j' 'M.J E,t.. EACH ACCloeNT .
DeputY. City AtMney / I / / e.L DiSEAsE. CA EMPLOYEe $
e.L. DISEASE - F'OUCY LIMIT S
OTltER
B EMPLOYEE 01 BHOlIESTY CCP0045041-02 01/17/2002 01/17/2003 ........ 20,000
FOlIGERY /ALTERAT1ON tlIWO'1'l:IlU 500
OE$Cjll;If'TlotI CFOPERATgNSlLOCATJON5IYiliICt..E$/EXCLI,ISIONSAODIiiP 5lV I!NDOFc .. :MI!HT/SP8CIAL PROVISJONS
THE CI'lY Of' SAN'l'A UA., I'l'S OFFICJ:ALS1 onrelt1UJ, AGJmT. I DtPLOftBlS, AHD V01.UK"1'DRS ARB VAMRO As AOD:l:l':rONAt. INstJItBn AS A
.rotmING 800RCE REGAJIDlNG 'l'HZ AC"I':IVITIE$ oF !"a& :J:N'SCDtBJ, UtmBR 'l'B%S ADRIBMJDf"J
..
CERTifiCATE HOLDER I XIADDlTlOIlAI.IN$UI>"": IIISlJI"!I"-&TT&R, . CANCELLAnON
.-
SHOUl.D ANV OF THE ABOVE' DESCRIBED POLICIES BE CANCELLED BErOftE THE
~TION DATE THEREOF, THE' rsBUlNG INSURER WILL W~xti' MAIL
!2- DAVS W'UTTEN NOTIC;I!! TO 11't& C;IIiIiliTlI"tCATI!! I1DI-DJR NAMoIlD TO THI! 1-liFT. WttllO
CJ:Tlr OF SJlN'l'A A1>TA/W 0 II K CI!:NTE!I ~)/~~lll(~:GI~~lIl4E
1000 B.SJlN'l'A ANA BLVD ~--
CON'l.'!lAC'rS AUTH"~O. -;LAT","
SJlN'rA ANA CA 92703- ue y. 'It! ~->
"
ACORD 2S-S (7187)
ft",.INSlI25S(001D).01
ELI!CTRONIC L. : :R PORMS, I
I!> ACORD CORPORATION 1988
Pl3981of:2
"-
-...I
EXHIBIT B
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILlTY POLICY
Insurance Company J.//)YJ Prh-U+:S 1:)75. BII/cy,(:J2 01 La h?'C
Thi3 endorsement modifies such insUtance as is afforded by the provisions of Policy
# 2OCYz.. -C)7 1 ~7 relating to the following:
I. The City of Santa Ana, 20 Civic Center Flaza, Santa Ana, California 92701; its
officers, employees, agents, volunteers and repre3entatives are named as additional insureds
("additional insureds") with regard to liability and defense of suits arising from the operations
and use~ performed by or on behalf of the named insured.
2. With respect to claims arising out of the operations and uses performed by or on
bel1/i.l( ?~4e named insured, such insurance as is afforded by this policy is primary and is not
additi<>nal to or conllibuting with any other insurance Carried by or fOT the benefit of the
additiQQal insureds.
3 This insurance applies separately to each insured against whom claim is made or
suit i~ broUght except with respect to the company's limits of liability. The inclusion of any
pcr.;o'a.ctr organization as an insured shall not affect any right whicb such person or organization
would have as a claimant if not so included.
4. With respect to the additional insureds, this insurance shall not be cancelled, OT
materially reduced in coverage or limits e"ctpt after thirty (30) days wrinen notice has been
given to the Clerk of the CounCil, City of Santa Ana, 20 Civic Center Plaza, Santa Ana,
California 9270 I.
(Compl~tion of the following, including countersignature, is required to make this endorsement
effective. )
Effective ! 0 I ~ LJ I ;>W , this endorsement fonn as a part of
Policy # Zt'l/Y7 - 0"2 1 <;>(( ,
Issued to or<arye (t7JQ.s-t ;:r.-n-fer+4rtnShR/~
Named Insured
~~igned by
A,.:rl~. "AS ~1i)
{' .- -:-:~:':-i~
n,[l~\Y cAY Attor~
ck ~~-J
~thonzed Repre em .
q