HomeMy WebLinkAboutTHOMAS HOUSE 6 - 2002
INSURANCE 1iQI ON FILE \.f
WORK MAY @T PROCEED
CLERK O~ COVNCIL 8/14/OIlS
DATE: 1'1-zBklZ AGREEMENT BETWEEN THE CITY OF SANTA ANA
t A ,1\ AND THOMAS HOUSE TEMPORARY SHELTER
C L L~ l"r 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 THOMAS HOUSE TEMPORARY SHELTER, a California nonprofit
organization ("SUBRECIPIENT"). INSURIl.NCE ON FILE
WORK MIl.Y PROCllD
.uNTIL INE~\~ ~QR~
CLERK OF COUNCIL. .:' /I-z..-
DATEt Yl..-)-1./
1. CITY is the recipient of Emergency Shelter Grant ("ESG") funds from the United
States Department of Housing and Urban Development ("HUD") pursuant to the Stewart B.
McKinney Homeless Assistance Act: Emergency Shelter Grants Program 42 USC 11331 et seq.
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A-2002-043-14
WITNESSETH
Recitals:
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 of the 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 CPR 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 1, 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
11. Attached and hereby fully incorporated to this Agreement are the following notification
attachments: Attachment No.1 entitled "Protect Your Family From Lead In Your Home",
EPA747-K-99-00I, 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 assigrunent from the CITY of all re-
sponsibilities set forth in Subpart K of the 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 SUB RECIPIENT.
(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.
(1) No Pending Legal Proceedings. SUBRECIPIENT is not the subject of a cur-
rent 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.
(4) Compliance with Subpart K of LBP Rees. Subpart K - Acquisition, Leas-
ing, Support Services, or Operation
(a) SUBRECIPIENT acknowledges and agrees that it shall 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 shall 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 shall be the EP AlHUD/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 shall cause to be disclosed to all purchasers
and lessees available information and knowledge regarding the presence of LBP
and LBP hazards prior to selling or leasing a housing unit in accordance with 24
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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 aU 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 aU residential property that is under its ownership,
possession, or control and/or residential property occupied by persons or families that receive
financial or other assistance from SUBRECIPIENT, except for the exemptions described below
in section 4 (d)(i)(1).
(i) SUBRECIPIENT shall cause a visual assessment to identify de-
teriorated paint in aU 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. 11 5(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 aU
tenant-based long term housing assistance, i.e., assistance to persons/households residing in
housing units cumulatively for more than 100 days. If SUBRECIPIENT has knowledge that an
assisted family or household will occupy a dwelling unit for more than 100 days, the LBP Regs
require evidence of compliance prior to occupancy. Funding to be provided hereunder is condi-
tioned upon evidence of compliance.
(1) Subpart M applies to all dwelling units occupied to be
occupied by families or households that have one or more children of less than 6 years of age, as
weU 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 dweU-
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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) rfpaint 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, inunediately 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) Oneoine 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.
(1) 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.l25(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 ofLBP and LBP hazards from the subject dwelling unit(s).
5. LBP Informational Summary. For purposes of information only and in no
respect intended to be a representation or warranty of the provisions of the LBP REGS, the CITY
has caused to be prepared an information summary relating to the LBP REGS and application to
dwelling units that 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 staff will 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 $ 25,000 ("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 final 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 of the amount of funds 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 complet said program on or before
June 30, 2002 and to use said funds to pay for necessary and reason Ie costs allowable under the
federal law and regulations to operate said program. Said amounts hall include essential services,
homeless prevention, and/or operations costs. Other allowable gram costs are detailed in the
Budget, as set forth in "Exhibit B," attached hereto and by . s reference incorporated herein.
SUBRECIPIENT shall use all income received from said ds only for the same purposes for
which said funds may be expended pursuant to the terms and nditions of this Agreement.
E. Licensing. SUBRECIPIENT agrees to ob . and maintain all required licenses,
registrations, accreditation and inspections from agencies governing its operations.
SUBRECIPIENT shall ensure that its staff shall also btain and maintain all required licenses,
registrations, accreditation and inspections from I agencies governing SUBRECIPIENT's
operations hereunder.
F. Zoning. SUBRECIPIENT agrees at any facility/property used in furtherance of
said program shall be specifically zoned and pitted for such use(s) and activity(ies). Should
SUBRECIPIENT fail to have the required land ntitlement and/or permits, thus violating any local,
state or federal rules and regulations relatin thereto, SUBRECIPIENT shall immediately make
good-faith efforts to gain compliance with cal, state or federal rules and regulations following
written notification of said violation(s) m the CITY or other authorized citing agency.
SUBRECIPIENT shall notify CITY imme iately of any pending violations. Failure to notify CITY
of pending violations, or to remedy suc known violation(s) shall result in termination of grant
funding hereunder. SUBRECIPIENT must make all corrections required to bring the
facility/property into compliance wi the law within sixty (60) days of notification of the
violation(s); failure to gain complianc within such time shall result in termination of grant funding
hereunder.
G. S aration of Ac unts. All funds received by SUBRECIPIENT from CITY
pursuant to this Agreement sh I be maintained separate and apart from any other funds of
SUBRECIPIENT, or of any pri cipal or member of SUBRECIPIENT,in an account in a federally
insured banking or savings an loan institution with record keeping of such accounts maintained
pursuant to applicable legal re irements. No monies shall be withdrawn from such account except
for expenditures relating to ssential services, homeless prevention and/or operations costs, as
authorized hereunder.
H. Audit Reoort 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 1 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 KeeoingfReoorting. 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:
(1) 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) 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 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 HOD) 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.
1. 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 HUD upon request of either or
both.
(d) Tracking Report. If the SUBRECIPIENT has provided, or is providing, rental
assistance payments directed to a housing unit or housing units for more than 100 days, or it is
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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 SUBREClPIENT.
J. Access to Records. CITY and the United State Government and/or their representatives
shall have access for purposes of monitoring, auditing, and examining SUBREClPIENT's activities
and performance, to books, documents and papers, and the right to examine records of
SUBREClPIENT'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 SUBREClPIENT 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 Keening. All accounting records,
reports, and evidence pertaining to all costs, expenses and the ESG FUNDS of SUBREClPIENT
and all documents related to this Agreement shall be maintained and kept available at
SUBREClPIENT'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
SUBREClPIENT indefinitely, including without limitation, all inspection report(s), disclosure
statement(s), and clearance report(s). In the event SUBREClPIENT does not make the above-
referenced documents available within the city of Santa Ana, California, SUBREClPIENT 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. Comoliance with Law. SUBREClPIENT 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. SUBREClPIENT 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. SUBREClPIENT agrees to
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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. Confidentialitv. 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. LobbYing. 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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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. SUBREClPIENT shall sign a certification to that
effect in a form as set forth in "Exhibit C," attached hereto and by this reference incorporated
herein. SUBREClPIENT 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 SUBREClPIENT 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-I).
T. Financial Interest. SUBREClPIENT 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
SUBREClPIENT, 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 SUBREClPIENT.
U. Davis-Bacon Act. All laborers and mechanics employed by contractors or
subcontractors in the performance of construction work, including alterations and repairs, in excess
of $2,000.00, financed in whole or in part with federal funds shall be paid wages at rates not less
than those prevailing on similar construction in the locality as determined in accordance with the
Davis-Bacon Act, as amended, 40 U.S.C. sections 276a - 276a-5. Any such construction contract
shall include and comply with the required contract provisions and rules set forth in 29 C.F.R. ~5.5.
Further, the payroll reports (along with the "Statement of Compliance") and basic records are
required to be maintained and submitted, or made available, pursuant to 29 C.F.R. ~5.5(a)(3). No
payment, advance, grant, loan or guarantee of funds shall be approved by the federal agency unless
there is on file with the agency a certification by the contractor that the contractor and its
subcontractors have complied with the provisions of 29 C.F.R. ~5.5. A breach of the contract
clauses in 29 C.F.R. ~5.5 may be grounds for termination of the contract, and for debarment as a
contractor/subcontractor, as provided in 29 C.F.R. 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 Workplace. 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 SUBRECIPIENT will be required to:
a) Abide by the terms above in statement I.
b) Notify appropriate officials of SUBRECIPIENT and CITY officials of any
criminal drug statute conviction for a violation occurring in the workplace not later than five days
after such conviction.
3. The City and the United State Department of Housing and Urban Development
will be notified within ten days after receiving notice of any such violation.
4. Within 30 days 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 TWENTY- FIVE
THOUSAND Dollars ($25,000) 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 ofthe 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-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.
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:
City of Santa Ana
Community Development Agency (M-25)
20 Civic Center Plaza
P.O. Box 1988
Santa Ana CA 92702-1988
TO SUBRECIPIENT:
THOMAS HOUSE TEMPORARY SHELTER
PO BOX 8693
FOUNTAIN VALLEY, CA 92728
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, indemnify 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 SUBRECIPIENT, 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 oftermination.
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, 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 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 of this 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 shall 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 shall
indemnify CITY fully, including reasonable costs and attorney's fees, for any injuries or damages to
CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn.
b. All Exhibits and Attachments referenced herein and attached hereto shall be incorporated
as if fully set forth in the body of this Agreement.
c. No delay or omission by either party hereto to exercise any right or power accruing
upon any noncompliance or default by the other party with respect to any of the terms of this
Agreement shall impair any such right or power or be construed to be a waiver thereof. A waiver
by either of the parties hereto of any of the covenants, conditions, or agreements to be performed
by the other shall not be construed to be a waiver of any succeeding breach thereof or of any
other covenant, condition or agreement herein contained.
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the date
and year first above written.
DATED:
ATTEST:
PATRICIAE. HEALY
Clerk of the Council
DATED: /) t/($,tv.Fi ;7 Sj 2ct/2
CITY OF SANTA ANA
a municipal corporation
APPROVED AS TO FORM:
dt{; ~ ~
r JOSEPH W. FLETCHER
City Attorney
SUBRECIPIENT:
THOMAS HOUSE TEMPORARY
SHELTER:
~ut ~~
SGNA
iJJ.t'Etr!hI1If/.I;Y~ Y-f, CLIf~U-
NAME & TITLE
22
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V. GOALS AND OBJECTIVESIIMPLEMENTATION STRATEGY
Goal: To graduate 30 families (120 individuals) into self sufficiency and transition them to
independent living in a permanent residence. Of this number 6 families (30 individuals) are
planned to be former Santa Ana residents.
Obiectives:
1. Supply food and shelter to 30 families during FY2002/03.
Task/Action:
(A) Have daily interface with other shelters, social service organizations, former clients
and our own local phons: hot line to determine clients with the most pressing needs.
(B) Interview prospective clients and generate a "get well" program with them.
(C) Provide accomodations for the clients (Esoivtated to be 18,00 bed-days for
FY2002/03).
(D) Provide the accomodations at a low cost benefit ratio.
2. Supply life skills services to all clients at the shelter by various organizations to aid in
providing self-sufficiency and the transition to independent living.
Task/Action: Life Skill Service Provided by
Individual & Family Counseling -Lutheran Social Services
Budgeting - In-house staff
Child Mentors -Bridge learning center
Parenting and Nutrition -Lutheran Social Services
Job Development & Computer course -In-House Staff
English as Second Language -Volunteers
Student Homework Assistance -Volunteers
Arts and Crafts -Fountain Valley High School
Medical and Welfare Assistance -Thomas House Staffguidamce
Drug Prevention -La Familia Counseling Center
Transportation Services -Thomas House
Clothing Assistance - Thomas House & Good Will
Well Baby Care .Public Health Nurses
Child Care -Licensed Day Care
Client Oureach Services -Thomas House
3. Prepare client for after shelter independent living.
Task/Action: (A) Have client save 80% of all earnings while at the shelter.
(B) Have client write weekly goals in conjunction with the case worker and
then track performance weekly with the case worker.
(C) Assist client in finding permanent housing.
(D) Conduct an exit interview when the client leaves the shelter.
(E}R.(lflder after-exit assistance to the clients when possible.
PI\I5~ 7A
EXffl8 1'/ A-
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Attachment 4
PROGRAM BUDGET PROPOSAL ...FY2002/03
1."./
( Organization Name: THOMAS HOUSE- TEMPORARY SHELTER
Program Name:
HOMELESS FAMILY SHELTER
SANTAANA ESG I OTHER SOURCES
REQUESTED/% OF TOTAL I
. Administrative Staff $ $
! expenses I
: Program Staff Salaries I
! & Benefits
;
f Supplies /Food
CATI:GORY
PROGRAM TOTAL
$
8,000
8,000
i
120,000
120,000
5,000/14.7%
..29,000
Rent/Lease/utili tiE s 15,000/14.3%
I Fund Raising
Professional Services
90,000
34,000
105,000
12,000
12,000
I
I
19,000
19,000
I Counselimg &
i Child C"r"'___
I Transportation
Insurance
-\
8,000
I
1 50,000
--1-----------
8,000
50,000
,
,
i
5,000/20.8% *1
19,000
24,000
other (Please Specify)
\1 Repair IMaintenar ce
& Furnishings
[OutreaCh servicesl
I !
Program SerV1ce
Miscellaneous
12,000
12,000
35,000
21,000
I 2,000
i
i$450,000
i 35,000
21,000
2,000
TOTAL .
$25 000/5.6%
$425 000
NOTE: All expenditures must be fuUy documented by receipts, time records, invoices,
canceled checks. inventory records or other appropriate documentation that fully and
completely discloses the amounts and nature of the expenditures_
* ~Iatching-'-'Pr'i>vided by volunteers
L
fjlffBfT g
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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:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with the awarding of any Federal
contract, the making of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any Federal contact, grant, loan or cooperative
agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with this Federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure
Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language ofthis certification be included 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.
11I1/11,1J IIrfv.JL .rbJl1;%'(/f~/'Jlh"'<L
Grantee/Contactor Organization
/!rJ u /-;~;J.r,,6#4/:tS.#~L:/f.i'
Program Itle
if f Ztfl Ilr ~'flj/v"
, ame of Certifying 0 licer
tl~-"'...J-,. ~ ;fv'-: ,( J'j2 M Z
Sign e Date
EXHffiIT C
Page 1 of2
-
'...I
SUBRECIPIENT warrants the following:
1. SUBRECIPIENT will comply with Public Law 88-352, Title VI of the Civil Rights
Act of 1964 (42 U. S. C. section 2000 et seq.) and implementing regulation in 24 CPR
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 wiII 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
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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 public burden disclosure.)
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
o a. contract Oa. 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 quarter ____
e. loan guarantee date of last report
f. ioan insurance
4. Name and Address of Reporting Entity: 5. If Reporting Entity In No.4 is a Subawardee. Enter Name
o Prime o Subawardee and Address of Prime:
Tier _____. Ifknown:
Conaresslonal District, If known: Conaressional 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:
$
10. a. Name and Address of Lobbying Entity b. Individuals Performing Services (inc/uding address if
(if individual, last name, first name, M/): different from No. 1 Oa)
(last name, first name, M/):
(aUach ContinuatiOll S_tls) SF-LLLA. ir necessarY)
11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply):
$ ----- o aclual o planned o 8. retainer
o b. one-time lee
12. Form of Payment (check all that apply): o c. commission
o a. cash o d. contingent lee
o b. in-kind; specify: nature ____ o e. deferred
value o f. 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:
(aUsch Continuation Sheet(s) SF-LLLA, i'necessary)
15. Continuation Sheet/s) SF.LLLA attached: DYe. nNo
16 Information requesl&d through this form II authorized by till. 31 U.S.C. Action Signature:
. 1352. This discklllUrB of lobbying acI/vKiaB II a material repr..ntaUon of fact
upon which n~llance was placed by the tier abovelllh.n this tran.action was made Print Name:
or entered Into. This dlsdl)lUrB Is required pursuant to 31 U.s.C. 1352. This
Informatloo will ba reported 10 the Congess IHImi-annualV and will be avallabte for Title:
pubic Inlpectlal. Any person who faU, 10 lie &he required d1sdoauN Ihal be
wbject to a ciVIl penally of not less that $10,000 and not mort than $100.000 for Telephone No.: Date:
aad1sudifal1lr..
. . c" . ...... . ... cc..c. . ... ..:.1 Authorized for Local Reproduction
Federal.lJseOnly:
.... . .. ..... .. . ... . .... . ... .. . . Standard Form LLL (Rev. 7-97)
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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 attempting to Influence an officer or employeeof any agency I a Member of Congress, an officer or employee of
Congress, or an employeeof a Memberof Congress In connection with a covered Federal action. Use the SF-LLlA Continuation Sheet for additionaiinfonnation 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 and/or has been secured to influence the outcome of a covered Federal aclion.
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 reclplenl.ldentify 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 conlract awards under grants.
5. If the organizatJonfiling the report in item 4 checks nSubawardee," then enter the full name, address, city, State and zip code of the prime Federal
recipient. Include Congressional District, If known.
6. Enter the nameof the Federal agency making the award or loan commitment. Include at least one organlzatlonallevel 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: the contract, grant, or loan award number: the application/proposal control number
assigned by the Federal agencyl.lnclude 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 awardlloan
commitment for the prime entity identified In item 4 or 5.
10. (8) 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 indlvidual(s) performing services, and Include full address if different from 10 (a). Enter Last Name, First Name, and
Middle Initial (Mil.
11. Enter the amountof compensation paid or reasonablyexpectedto be paid by the reporting entlty(ltem 4) to the lobbying entity (Item 10). Indicate whether
the payment has been made (actual) or wlll 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 approprlatebox(es). Check all boxes that apply. If paymentls made through an In-kind contribution, specify the nature and value of the in-klnd
payment.
13. Check the appropriate box(es}. Check all boxes that apply. If other, specify nature.
14. Provides specific and detailed description of the services that 'he lobbyist has performed. or wi. 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-LLLA Continuation Sheet(s) is attached.
16. The certifying official shall sign and date the form, print hlslher name, title, and telephone number.
According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of Informatlon unless It displays a valid OMB Control
Number. The valid OMS control number for this information collection is OMB No. 0346-0046. 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 regarc:llng 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 (0348-0046), Washington,
DC 20503.
.....
...,
AttA.C~1.
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Are You Planning To Buy, Rent, or Renovate
a Home Built Before 19781
Many houses and apartments built before 1978 have
paint that contains lead (called lead-based paint). Lead
from paint. chips, and dust can pose serious health
hazards if not taken care of properly.
federal law requires that individuals receive certain information
before renting, buying. or renovating pre-1978 housing:
.-~,
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1
"~"""""'1
~'~'.!.;
. ." . .;
'. ,.' ..,;J
~
LANDLORDS have to disclose known infor-
mation on lead-based paint and lead-based
paint hazards before leases take effect.
Leases must include a disclosure form
about lead-based paint.
SELLERS have to disclose known informa-
tion on lead-based paint and lead-based
paint hazards before selling a house. Sales
contracts must include a disclosure form
about lead-based paint. Buyers have up to
10 days to check for lead hazards.
RENOVATORS have to give you this
pamphlet before starting work. (After
June 1. 1999.)
IF YOU WANT MORE INFORMATION
on these requirements. call the
National Lead Information Clearinghouse
at 1-S00-424-LEAD.
This document is in the public domain. It may be reproduced by an individual or
organization without permission. Infamation provided in this booklet is based
upon current scientific and technical understanding of the issues presented and
is reflective ofthejurisdictional boundaries established by the statutes governing
the co-authoring agencies. Following the advice given wiil not necessarily pro-
vide complete protection in all situations or against an health hazards that can
be caused by lead exposure.
"
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IMPORTANT!
..
Lead From Paint, Dust, and
Soil Can Be Dangerous If Not
Managed Properly
FACT: Lead exposure can harm young
children and babies even before they
are born.
FACT: Even children who seem healthy can
have high levels of lead in their bodies.
FACT: People can get lead in their bodies by
breathing or swallowing lead dust, or by
eating soil or paint chips containing
lead.
FACT: People have many options for reducing
lead hazards. In most cases, lead-based
paint that is in good condition is not a
hazard.
FACT: Removing lead-based paint improperly
can increase the danger to your family.
If you think your home might have lead
hazards, read this pamphlet to learn some
simple steps to protect your family.
1
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Lead Gets in the Body in Many Ways
In the
United
States,
about
900,000
children ages
1 to 5 have a
blood-lead
level above
the level of
concern.
Even children
who appear
healthy can
have danger-
ous levels of
lead in their
bodies.
People can get lead in their body if they: '>
+ Put their hands or other objects
covered with lead dust in their mouths.
+ Eat paint chips or soil that contains
lead.
+. Breathe in lead dust (especially during
renovations that disturb painted
surfaces) .
Lead is even more dangerous to children
than adults because:
+ Babies and young children often put
their hands and other objects in their
mouths. These objects can have lead
dust on them.
+ Children's growing bodies absorb more
lead.
+ Children's brains and nervous systems
are more sensitive to the damaging
effects of lead.
2
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Lead's Effects
If not detected early. children with high
levels of lead in their bodies can suffer
from:
. Damage to the brain and
nervous system
. Behavior and learning .
problems (such as hyperactivity)
. Slowed growth
. Hearing problems
. Headaches
Lead is also harmful to adults. Adults
can suffer from:
. Difficulties during pregnancy
. Other reproductive problems (in both
men and women)
. High blood pressure
. Digestive problems
. Nerve disorders
. Memory and concentration problems
. Muscle and joint pain
-...I
..
""'n a, N."", tla""'ll"
Lead affects
the body in
many ways.
3
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Where Lead-Based Paint Is Found
In general,
the older your
home, the
more likely it
has lead-
based paint.
Many homes built before 1978 have lead- '"
based paint. The federal government
banned lead-based paint from housing in
1978. Some states stopped its use even
earlier. Lead can be found:
. In homes in the city, country, or suburbs.
. In apartments, single-family homes, and
both private and public housing.
. Inside and outside of the house.
. In soil around a home. (Soil can pick up
lead from exterior paint or other sources
such as past use of leaded gas in cars.)
Checking Your Family for Lead
Get your
children and
home tested
if you think
your home
has high lev-
els of lead.
4
To reduce your child's exposure to lead,
get your child checked, have your home
tested (especially if your home has paint
in poor condition and was built before
1978), and fix any hazards you may have.
Children's blood lead levels tend to increase
rapidly from 6 to 1 2 months of age, and
tend to peak at 1 8 to 24 months of age.
Consult your doctor for advice on testing
your children. A simple blood test can
detect high levels of lead. Blood tests are
usually recommended for:
. Children at ages 1 and 2.
. Children or other family members who
have been exposed to high levels of lead.
. Children who should be tested under
your state or local health screening plan.
Your doctor can explain what the test results
mean and if more testing will be needed.
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Where Lead Is Likely To Be a Hazard
lead-based paint that is in good condition
is usually not a hazard.
Peeling, chipping, chalking, or cracking
lead-based paint is a hazard and needs
immediate attention.
Lead-based paint may also be a hazard
when found on surfaces that children can
chew or that get a lot of wear -and-tear.
These areas include:
. Windows and window sills.
. Doors and door frames.
. Stairs, railings, and banisters.
. Porches and fences.
lead dust can form when lead-based paint
is dry scraped, dry sanded, or heated. Dust
also forms when painted surfaces
bump or rub together. Lead chips and
dust can get on surfaces and objects
that people touch. Settled lead dust
can re-enter the air when people vac-
uum, sweep, or walk through it.
lead in soilc an be a hazard when
children play in bare soil or when
people bring soil into the house on
their shoes. Call your state agency
(see page 11) to find out about test-
ing soil for lead.
Lead from
paint chips,
which you
can see, and
lead dust,
which you
can't always
see, can both
be serious
hazards.
5
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Checking Your Home for Lead Hazards
Just knowing
that a home
has lead-
based paint
may not tell
you if there
is a hazard.
6
..
You can get your home checked for lead haz-
ards in one of two ways, or both:
. A paint inspection tells you the lead
content of every different type of painted
surface in your home. It won't tell you
whether the paint is a hazard or how you
. should deal with it.
. A risk assessment tells you if there are
any sources of serious lead exposure
. .' (such as peeling paint and lead dust). It
also tells you what actions to take to
address these hazards.
Have qualified professionals do the work.
There are standards in place for certifying
lead-based paint professionals to ensure the
work is done safely, reliably, and effectively.
Contact your state lead poisoning prevention
program for more information. Call 1-800-
424-LEAD for a list of contacts in your area.
Trained professionals use a range of methods
when checking your home, including:
. Visual inspection of paint condition and
location.
. A portable x-ray fluorescence (XRF)
machine.
. Lab tests of paint samples.
. Surface dust tests.
Home test kits for lead are available, but
studies suggest that they are not always
accurate. Consumers should not rely on
these tests before doing renovations or to
assure safety.
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What You Can Do Now To Protect
Your Family
If you suspect that your house has lead
hazards, you can take some immediate
steps to reduce your family's risk:
. If you rent, notify your landlord of
peeling or chipping paint.
. Clean up paint chips immediately.
. Clean floors, window frames, window
sills, and other surfaces weekly. Use a
mop or sponge with warm water and a
general all-purpose cleaner or a cleaner
made specifically for lead. REMEMBER:
NEVER MIX AMMONIA AND BLEACH
PRODUCTS TOGETHER SINCE THEY
CAN FORM A DANGEROUS GAS.
. Thoroughly rinse sponges and mop
heads after cleaning dirty or dusty
areas.
. Wash children's hands often, especial-
ly before they eat and before nap time
and bed time.
. Keep play areas clean.W ash bottles.
pacifiers. toys. and stuffed animals
regularly.
. Keep children from chewing window
sills or other painted surfaces.
. Clean or remove shoes before
entering your home to avoid
tracking in lead from soil.
. Make sure children eat
nutritious, low-fat meals high
in iron and calcium, such as
spinach and dairy products.
Children with good diets absorb
less lead.
..
, ,
,~...: "",.,:,~,~",:"",..,,
7
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How To Significantly Reduce Lead Hazards
Removing
lead
improperly
can increase
the hazard to
your family
by spreading
even more
lead dust
around the
house.
Always use a
professional who
is trained to
remove lead
hazards safely.
8
In addition to day-to-day cleaning and good ...
nutrition:
. You can temporarily reduce lead hazards
by taking actions such as repairing dam-
aged painted surfaces and planting grass
to cover soil with high lead levels. These
. actions (called "interim controls") are not
permanent solutions and will need ongo-
ing attention.
. To permanently remove lead hazards.
you must hire a certified lead "abate-
ment" contractor. Abatement (or perma-
nent hazard elimination) methods
include removing. sealing. or enclosing
lead-based paint with special materials.
Just painting over the hazard with regular
paint is not enough.
Always hire a person with special training
for correcting lead problems-someone
who knows how to do this work safely and
has the proper equipment to clean up
thoroughly. Certified contractors will employ
qualified workers and follow strict safety
rules as set by their state or by the federal
government.
Call your state agency (see page 11) for
help with locating certified contractors in
your area and to see if financial assistance
is available.
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Remodeling or Renovating a Home With
lead-Based Paint
Take precautions before your contractor or
you begin remodeling or renovations that
disturb painted surfaces (such as scraping
off paint or tearing out walls);
. Have the area tested for lead-based
paint.
. Do not use a belt-sander, propane
torch, heat gun, dry scraper, or dry
sandpaper to remove lead-based
paint. These actions create large
amounts of lead dust and fumes. Lead
dust can remain in your home long
after the work is done.
. Temporarily move your family (espe-
cially children and pregnant women)
out of the apartment or house until
the work is done and the area is prop-
erly cleaned. If you can't move your
family, at least completely seal off the
work area.
. Follow other safety measures to
reduce lead hazards. You can find out
about other safety measures by calling
'-800-424-LEAD. Ask for the brochure
"Reducing Lead Hazards When
Remodeling Your Home." This brochure
explains what to do before, during,
and after renovations.
If you have already completed renova-
tions or remodeling that could have
released lead-based paint or dust, get
your young children tested and follow
the steps outlined on page 7 of this
brochure.
..
If not
conducted
properly,
certain types
of renova-
tions can
release lead
from paint
and dust into
the air.
9
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Other Sources of Lead
While paint, dust,
and soil are the
most common
lead hazards,
other lead
sources also exist.
10
. Drinking water. Your home might have
plumbing with lead or lead solder. Call
your local health department or water
supplier to find out about testing your
water. You cannot see, smell, or taste
. lead, and boiling your water will not get
rid of lead. If you think your plumbing
might have lead in it:
. Use only cold water for drinking and
cooking.
. Run water for 15 to 30 seconds
before drinking it. especially if you
have not used your water for a few
hours.
. The job. If you work with lead, you
could bring it home on your hands or
clothes. Shower and change clothes
before coming home. Launder your work
clothes separately from the rest of your
family's clothes.
. Old painted toys and furniture.
. Food and liquids stored in lead crystal
or lead-glazed pottery or porcelain.
. Lead smelters or other industries that
release lead into the air.
. Hobbies that use lead. such as making
pottery or stained glass, or refinishing
furniture.
. rolk remedies that contain lead, such as
"greta" and "azarcon" used to treat an
upset stomach.
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For More Information
."
The National Lead Infonnation Center
Call1-800-424-LEAO to learn how to protect
children from lead poisoning and for other
information on lead hazards. (Internet:
www.epa.gov/lead and www.hud.gov/lea).
For the hearing impaired, call the Federal
Information Relay Service at 1-800-877-
8339 and ask for the National Lead
Information Center at 1-800-424-LEAO.
EPA's Safe Drinking Water Hotline
Call 1-800-426-4791 for information about
lead in drinking water.
Consumer Product Safety
Commission Hotline
To request information on lead in
consumer products, or to report an
unsafe consumer product or a prod-
uct-related injury call 1-800-638-
2772. (Internet: www@cpsc.gov).
For the hearing impaired. call TOO 1-
800-638-8270.
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State Health and Environmental Agencies
Some cities and states have their own rules for lead-based
paint activities. Check with your state agency to see if state
or local laws apply to you. Most state agencies can also pro-
vide information on finding a lead abatement firm in your
area. and on possible sources of financial aid for reducing
lead hazards. Receive up-to-date address and phone infor-
mation for state and local contacts on the Internet at
www.epa.gov/lead or contact the National Lead Information
Center at 1-800-424-LEAO.
11
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EPA Regional Offices
~
Your Regional EPA Office can provide further information regard- ..
ing regulations and lead protection programs.
EPA Regional Offices
Region 1 (Connecticu~ Massachusetts.
Maine, New Hampshire. Rhode Island.
Vermont) ,
Regional Lead Contact
U.S, EPA Region'
Suite' 100 (CPl)
One Congress Street
Boston, MA 02114-202,3
, (888) 372-7341
Region 2 (New Jersey, New York.
Puerto Rico. Virgin Islands)
Regional Lead Contact
U.S. EPA Region 2
2890 lI\bodbridge Avenue
Building 209, Mail Stop 225
Edison. NJ 08837-3679
(732) 321-6671
Region 3 (Delaware. Washington DC.
Maryland. Pennsylvania. Virginia. West
Virginia) "
Regional Lead Contact
U.S. EPA Region 3 (3WC33)
'650 Arch Street
Philadelphia. PA 19103
(215) 814-5000
Region 4 (Alabama. Florida. Georgia.
Kentucky, Mississippi. North Carolina.
South Carolina. Tennessee)
Regional Lead Contact
U.S. EPA Region 4
61 Forsyth Stree~ SW
Atlanta. GA 30303
(404) 562-8998
Region 5 (Illinois. Indiana. Michigan,
Minnesota. Ohio, Wisconsin)
Regionai Lead Contact
U,S. EPA Region 5 (DT.8J)
77 West JacKson Boulevard
Chicago. IL 60604-3666
(312) 886-6003
12
Region 6 (Arkansas. Louisiana. New
Mexico. Oklahoma. Texas)
Regional Lead Contact
U.S. EPA Region 6
1445 Ross Avenue. 12th Floor
Dallas. TJ( 75202.2733
(214) 665-75n
Region 7 (Iowa. Kansas. Missouri,
Nebraska)
Regional Lead Contact
U.S. EPA Region 7
(ARTD-RAU)
901 N. 5th Street
Kansas City. KS 66101
(913) 551-7020
Region 8 (Colorado. Montana. North
Dakota. South Dakota. Utah, Wyoming)
Regional Lead Contact
U.S. EPA Region 8
999 18th Stree~ Suite 500
Denver. CO 80202-2466
(303) 312-6021
Region 9 (Arizona. California. Hawaii.
Nevada)
Regional Lead Contact
U.S. Region 9
75 Hawthorne Street
San Francisco, CA 94105
(415)744-1124
Region 10 (Idaho. Oregon. Washington,
AlaSka)
Regional Lead Contact
U.S. EPA Region 10
Toxics Section WCM-128
1200 Sixth Avenue
Seattle. WA 98101-1128
(206) 553-1985
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CPSC Regional Offices
Your Regional CPSC Office can provide further information regard- ..
ing regulations and consumer product safety.
Eastern Regional Center
6 World Trade Center
Vesey Street, Room 350
New York. NY 10048
(212) 466-1612
IJIA:lstem Regional Center
600 Harrison Street, Room 245
San Francisco, CA 94107
(415) 744-2966
Central Regional Center
230 South Dearborn Street
Room 2944
Chicago. IL 60604-1601
(312) 353-8260
HUD Lead Office
Please contact HUD's Office of Lead Hazard Control for informa-
tion on lead regulations, outreach efforts, and lead hazard control
and research grant programs.
u.S. Department of Housing and Urban Development
Office of Lead Hazard Control
451 Seventh Street. SW. P-3206
Washington, DC 20410
(202) 755-1785
13
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..,;-
Sample Disclosure Format for Target Housing Sales
Disclosure of Information on Lead-Based Paint and Lead-Based Paint Hazards
l.ead Warning Statement
Every purchaser of any interest in residential real property on which a residential dwelling was built prior to 1978
is notified that such property may present exposure to lead from lead-based paint that may place young children
at risk of developing lead poisoning. Lead poisoning in young children may produce pennanent neurological
damage, including leaming disabilities, reduced intelligence quotient, behavioral problems, and impaired memory.
Lead poisoning also poses a particular risk to pregnant WOmen. The seller of any interest in residential real property
is required to provide the buyer with any infonnation on lead-based paint hazards mJm risk assessments or
inspections in the sellers possession and notify the buyer of any known lead-basedpaint hazards. A risk
assessment or inspection for possible lead-based paint hazards is recommended poor to purchase.
Seller's Disclosure (initial)
_ (a) Presence of lead-based paint and/or lead-based paint hazards (check one below):
o Known lead-based paint and/o(lead-based paint hazards are present in the housing (explain).
o Seller has no knowledge oHead-based paint andlor lead-based paint hazards in the housing.
_ (b)
o
Records and reports available to the seller (check one below):
Seller has provided the purtlaser with all available records ancteports pertaining to lead-based paint
and/or lead-based paint hazards in the hOBing (list documents below).
o
Seller has no reports or re;ords pertaining to lead~ased pain1and/or lead-based paint hazards in the
housing.
Purchaser's Acknowledgment (initial)
(c) Purchaser has received copies of all information listed above.
_ (d) Purchaser has received the pamphlelProtect Your Family from Lead in Your Home.
_ (e) Purchaser has (check one below):
o Received a 10-day opportunity (or mutually agreed upon period) to conduct a risk assessmentro
inspection for the presence of lead-based paint and/or lead-based paint hazards; or
o Waived the opportunity to conduct a ri$k assessment or inspectioiDr the presence of lead-based paint
andlor lead-based paint hazards.
Agent's Acknowledgment (initial)
_ (f) Agent has informed the seller of the seller's obligations under 421$.C. 4852(d) and is aware of his/her
responsibility to ensure compliance.
Certification of Accuracy
The following parties have reviewed the information above and certify. to the best of their knowledge. thatElh
information prcwided by the signatory is true and accurate.
Date
Seller
Agent
Date
Seller
Date
gent
Date
Purchaser
Date
Purchaser
Date
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Sample Disclosure Format for Target Housing Rentals and Leases
Disclosure of Information on Lead-Based Paint and Lead-Based Paint Hazards
Lead Warning Statement
Housing built before 1978 may contain lead-based paint. Lead from paint, paint chips, and dust can
pose health hazards if not taken care of property. Lead exposure is especiall)l...jIarmful to young
children and pregnant women. Before renting pre-1978 housing, landlords must disclose the
presence of known lead-based paint and lead-based paint hazards in the dwelling. Tenants must
also receive a Federally approved pamphlet on lead poisoning prevention.
Lessor's Disclosure (initial)
~ (a) Presence of lead-based paint or lead-based paint hazards (check one below):
o Known lead-based paint and/or lead-based paint hazards are present in the housg,
(explain).
o
Lessor has no knowledge of lead-based paint and/or lead-based paint hazards inti'!
housing.
_(b)
o
Records and reports available to the lessor (check one below):
Lessor has provided the lessee with all aailable recordsa~d reports pertaining to lead-
based paint and/or lead-based paint haz~rds in the housing (list documents below).
o
Lessor has no reports or records pertaining to lead-based paint andlor lead-base
paint hazards in the housing. .
Lessee's Acknowledgment (initial)
(c) Lessee has received copies of all information listed above.
(d) Lessee has received the pamphletProtect Your Family from Lead in Your Home.
Agenfs Acknowledgment (initial)
(e) Agent has idonned the lessor of the lessor's obligations under 42 U.S.C. 4852(d) and
is aware of hislher responsibility to ensure compliance.
Certification of Accuracy
The following parties have reviewed the information above and certify, title best of their knowledge,
that the infonnation provided by the signatory is true and accurate.
klt""-~ 2. f'~ \ .{, L
Federal Regisler/Vol~,
, 178/Wednesday, September 15,....,.ef
des and Regulations 50231
e
Appendix B-Sample Summary Risk
Assessment Notice Format
Note: This following appendix will not
appear in the Code of Fedenll Regulations
Summai)' Notice of Lead-Based Pabtt Risk
Assessment
Addressl1ocatlon of propertY or structure(s)
this summaI)' notice applies to:
Lead-based pabtt risk assessment descripllon:
DateCs) of risk assessment:
Summai)' of risk assessment results (check
all that apply):
(a) _ No lead-based pabtt hazards were
found.
(b) _ Lead-based pabtt hazards were
found.
(c) _ A brief summary of the findings of
the risk assessment Is provided below
(required If any 1ead-based pabtt hazards
were found).
Summai)' of types and \ocatIOIIS of lead- .
.. based pabtt hazards. LIst at \eaSt the housing
.. unit numbers and common oieas (for
multlfaml\y housing). bare soil \ocatIons,
dust-lead locatIonS. andlor bul1d1ng
components (including type of room or
space, and the materta1 underneath the
paInt). and types of lead-based pabtt hazards
found:
Contact person for more Infonnadon about
the risk assessment:
Printed name:
OtganIzatIon:
Street and city:
State: _ ZIP: _ Phone number. L-J
Person who prepared this summary notice:
Printed name:
e
Signature:
Date:
Organization:
Screet and city:
State: _ ZIP: _ Phone number: L-J
Appendix C-Sample Summary
Presumption Notice Format
Note: The following appendix wl11 not
appear In the Code of Federal Regulations
Notice That Lead-Based Paint or Lead-Based
Pabtt Hazards Are Presumed to be Present
Addressl1ocation of property or structureCs)
this notice of presumption applies to:
Type of presumption (check all that apply):
(a) _ Lead-based pairlt is presumed to be
presenL .
(b) _ Lead-based paint hazardCs) is(are)
presumed to be presenL
Summary of presumption. LIst at least the
hOusing unit numbers and common areas (for
multlfaml\y housing). bare soli locations.
dust-lead locations. and/or building
components (Including type of room or
space. and the material underneath the
pabttl. and types of lead.based pabtt hazards
presumed to be present:
Contact person for more Information about
the presumption:
Printed name: .
OrganizatiOn:
Street and city:
State: _ZIP: _ Phone number: L-J
Person who prepared this notice of
presumption:
Printed name:
Signature:
Date:
'Organization:
A"lTAC~~ ~
Street and dty:
State: _ Z1F: _ Phone number: L-J
Appendix D-Sample Hazard
Reduction Completion Notice Format
Note: The following appendiX wlll not
appear In the Code of Federal Regulations.
Summary Notice of Completion of Lead-
Based Paint Haz,ard Reduction Activity
Addressl1ocatio1f&f propertY or structure(s)
this summary notice applies to:
Summary of the hazard reduction activity:
Start and completion date(s):
Activity locations and types. List at least the
housing unit numbers and common areas (for
multifamily housing). bare soU locations.
dust-lead locations. aneIIor buUdlng
components (includi,ng type of room or
space. and the matertal underneath the
paInt). and types of hazard reduction
actlvlties perfomted at the locations listed:
Date(s) of clearance testing and/or soil
analyses: _
Locations of bul\dIng components with lead-
based paint remaining In the rooms. spaces
or areas where aCtivities were conducted:
Summary of results of c:\eanll1Ce testing and
soli analyses:
(0) _ No c:\eanll1Ce testing was
perfomted.
(b) _ Clearance testing showed
cleanlnce was achIeVed.
(c) _ Clearance testing showed clearance
was not achieved.
Contact person for more Information about
the hazard reduction:
Printed name:
Organization:
Street and city:
State: _ ZIP:
Phone number: L-J
Person who prepared this summary notice:
PrInted name:
Signature:
Date:
Organization:
Street and city:
State: _ ZIP:
Phone number: L-J
IFR Doc. 99-23016 Flied 9--14-99: 8:45 aml
BIWNG. CODE 421D-32-P
""'
'wi
ATTACHMENT NO.4
LBP INFORMATION SUMMARY
1. ZEROIO BEDROOM < (LESS THAN) 100 DAYS IN UNIT; ASSISTANCE IN
HOMELESS SHELTER
. STATUS: EXEMPT TITLE X
2. ZERO/O BEDROOM> (MORE THAN) 100 DAYS IN UNIT
. STATUS: OPEN ISSUE UNDER LBP REGS
ZERO/O BEDROOM> (MORE THAN) 100 DAYS ASSISTANCE IN
HOMELESS SHELTER
. STATUS: OPEN ISSUE UNDER LBP REGS
. SEE SUBPART K
. CLEARANCE OF UNIT(S) WILL BE REQUIRED BY CITY FOR ALL HOUSING
UNITS (EVEN ZERO BEDROOM) FOR WHICH OCCUPANCY OCCURS BY
ASSISTED HOUSEHOLD FOR MORE THAN 100 DAYS, PENDING FURTHER
INTERPRETATION/GUIDANCE FROM HUD
3. ONE OR MORE (1+) BEDROOMS OCCUPANCY < 100 DAYS IN
RESIDENTIAL UNIT AND/OR OCCUPANCY IN HOMELESS SHELTER
. EXEMPT TITLE X
4. 1+ BEDROOMS> 100 DAYS IN RESIDENTIAL UNIT
. STATUS: SAME AS #2 ABOVE; CLEARANCE REQUIRED
. SEE SUBPART K
5. EMERGENCY RENTAL ASSISTANCE < 100 DAYS
. EXEMPT TITLE X
6. EMERGENCY RENTAL ASSISTANCE> TO HOUSEHOLD TO BE
OCCUPANCY IN RESIDENTIAL UNIT FOR MORE THAN 100 DAYS (SUCH AS
LONG TERM LEASE SIGNED AT TIME OF EMERGENCY ASSISTANCE)
Attachment No.4
LBP Information Summary
PagelOf2
7/1l101LS
'-"
'WI
. CLEARANCE BEFORE ANY MONEY DISBURSED;
LBP COMPLIANCE: NOTIFICATION, EVALUATION, REDUCTION THROUGH
CLEARANCE REQUIRED BEFORE OCCUPANCY OF UNIT
. MAY BE CONSIDERED TENANT BASED RENTAL ASSISTANCE (TBRA); THUS
HQS INSPECTION AND SUBPART M MAY APPLY
. SEE SUBPARTS K AND M
. PENDING HUD GUIDANCE
7. TBRA < 100 DAYS
. EXEMPT TITLE X
8. TBRA> 100 DAYS OF HOME ASSISTANCE (SUCH AS WHEN TENANT
ENTERS INTO LONG TERM LEASE
. SEE SUBPART M
. CLEARANCE BEFORE ANY MONEY DISBURSED;
LBP COMPLIANCE: NOTIFICATION, EVALUATION, REDUCTION THROUGH
CLEARANCE REQUIRED BEFORE OCCUPANCY OF UNIT
. HQS INSPECTION REQUIRED BEFORE OCCUPANCY
. CLEARANCE BEFORE ANY MONEY DISBURSED
9. TBRA < 100 DAYS - TENANT ENTERS INTO LONG TERM LEASE, CITY
GIVES LESS THAN 100 DAYS OF ASSISTANCE.
. EXEMPT TITLE X
[See HUD Interpretative Guidance: Online: Questions M4, K7, K4, for discussion]
Attachment No.4
LBP Information Summary
Page2of2
7/1I101LS
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'12/83/2002 21:20
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FAX~. : 714-647~9
Nov. 22:2002 01: 01PM P:3
ENDORSEMENT
"'POUCY NUMBER:
CP7781601
"'INSURED COMPANY NAME:
Thomas House ,Temporary Shelter
TH!lS ENDORSEMENT CHANGES TUE POLlCY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON or
ORGANIZATION
111is endorsement modifies insurance pl'Ovidad under the following:
COMMERCIAL GENE'RAL LlABIUTY COVERAGE PART
SCHEDULE
N~.cofPe~onQr~~o~
City of Santa Ana and its OMcers, Agents, Employcees and
Volunteers are named as additional insured as respects their
interest in connection with the named insured.
(If no entry appelU'S above. informati011 rlXl.uircd to complete this end~lmlcnt will be
5hown in the DeClarations as applicable to tbis endurllemcnt.)
WHO IS AN lNSVRED (Section m is lltllCDdcd to include as an insured the person or
organization shown in the Schlldule, but only with respect to liability arising out of your
operations or premises owned by or rented to you,
IT tS AGREED THAT ANY INSURANCE MAINTAINED BY THE CITY OF
SANTA ANA SHALL Al"l"L Y (1'1 EXCESS OF, AND NOT CONTJUBU1'J.? WtTII,
INSURANCE PROVIDED BY'l'HJS POLlCY.
Agellt'~Signature: ~ ~.~ #
-ae ·
~O l\.'P lie ...
t'~u\l
pt' ,
c,10?Cv-.
\.\s~ fC;\~ r>-\\O\"e~
(;G' 2010 II 85 ~SS\S\3\\\ r. j5)
(21 S)C $M'\PL~ _ AddidonD.lI.",r<<l wltlJ l'rlm.rylNon-C'.antribmins J,ongullAC Added ~D" .
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/ ", THIS CERTIFICATE~ AS' A MATIER OF INFORMATION
" ., ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
jtington Pac~f~c Ins. Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR
/672 Florida St. Ste. 302D ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW,
,iuntington Beach CA 92648 COMPANIES AFFORDING COVERAGE
COMPANY
A
Fulcrum Insurance Co
Robin Hatfield
_Phon~No 714-841-_G28L F?J(No
INSURED
--
COMPANY
B
Thomas House Temporary Shelter
Tim Foster
P.O. B9x 8693
Fountain Valley CA 92728
COVERAGES
THiS IS TO CERTIFY THAT THE POllCll.:S OF INSURANCE liSTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AGOVE FOR THE POLICY PERIOD
INDICATED. NOT\.liITHSTANOING ANY RF.QUIREME:NT, TERM OR CONDITION OF ANYCONTR4CT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTlFICAn:: MAY 81:0 ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREI~,j IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDI710NS OF SUCH POI.lCI(S LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
----.-..------,----1 POLICY EFFECTIVE POLICY EXPIRATIO~T---.
ET~ TWE OF INsurV,NCE POLICY NU,\1BER DATE (MMIDDfYY) DATE lMMIDDfYY) I
COI/,PANY
C
COMPA~~Y
D
"
LIMITS
GENf'RALlIAGllITY
A xl COMMERCIAL GENERAL LIABILITY CPJ.002551.-02
:~'TJ ClAIMS MADE ~ OCCUR
OWNER'S &. CONTRACTOR'S PROT
06/16/01
GENERAL AGGREGATE $1.,000, goo_
06/1.6/02 PRODUCTS-COMP/orAGG S Included
PERSONAL & ADV INJURY
EACH OCCURRENCE ~~ 0 0 / 0 Q.g_
FIRE DAMAGE (AflY Oile fire)
MEO EXP (Anyone per;;on)
AUTOM013ILE L1/,BllITY
',NY AUTO
ALL O'vVNED AUTOS
COME!INF.D SINGLE LIMIT S
SCHEDULED AUTOS
BQDIL Y INJURY
(Perpcf$on)
HI~ED AUTOS
NON-OWNED AUTOS
BOOIL Y INJURY
(Peracriderlt)
s
PROPERTY DAMAGE S
GAR"G~~ lIABILny
j :'" AUT~
AUTO ONLY - EA ACCIDENT S
OTHER THAN AUTO ONLY:
EXCESS LIAO:LIlY
EACH ACCIDENT S
AGGREGATE S
EAC! I OCCURRENCE
UMlmr:t U, FOH/,\
APPRO
D AS TO FORM
t,GGREGATE
WORKERS COMPEt,SATION AI,JD
EMPLOYEHS' LIABILITY
CRI I NE LEE SH W
Dep Ity City Attor ey
OTHEf{ THAN UMBRELLA FORM
THe: f'RorRIETO,U I INCL
PNHNERSIEXECUTIV[
OFI'ICERS ARE ~~~~. EXCL
r-__
UlSCr~lf'lION OF OPU{J\TIOlj$llOCATIONSNEHICLESISI-'EClfIL !l EMS
'The ci t:y of Santa Ana is named as addi tianal
endorsement.
EL OIS~AS[. POLICY LIMIT
s
EL DISEASE. EA EMPLOYEE S
insured as per att:ached
SHOULD ANY or THE AflOVE DESCHiOED POLlCIES BE CANCELLED SErORE Tilt:
EXPIRATION ot. TE TlIEf{Eor, THE: ISSUING COMPANY \';'i!.L ~~'-:'TO t..1A1~
30 DAYS V>'r\ITTFN.r-JOTIC[ TO 1 Hl: C[RTlfICA,.-eHOLOLfl. t~AM[D TO TIlE LEFl
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SANTANp.
City of Sant.a Ana,
Development Agency
P.O. Ben: 1988
Santa kna CA 92702-1,988
community
N-25
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98422538 P. 02
EXHIBIT B
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY POLICY
Insurance Company
Flllcrum Tnsurance ComDanv
This endorsement modifies such insurance as is afforded by the provisiollB of Poliry
# CPI002551-02 relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its
officers, employees, agents, volunteers and representatives are named as additional insureds
("lUlditional insureds") with regard to liability and defense of suits arising frOIl) the operations
and uses performed by or on behalf of the named insured.
2. Willi respect to claims arising out of the operations and uses performed by or on
behalf ofthe named insured, such insurance as is afforded by this policy is primary and is not
additional to or comnouting with any other insurance carried by or for the benefit of the
additional insureds.
3. This insurance applies separately to each insured against whom claim is made or
suit is brought except with respect to the company's limits ofliability. The inclusion of any
person or organization as an insured shall not affect any right which such person or organization
would have as a claimant if not so included.
4. With respect to the lUlditional insureds, this insurance shaH not bc cancelled, or
materially reduced in coverage or limits except after thirty (30) days writtcnnotice has been
givell to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701.
(Completion ofllie following, including countersignature, is required 10 make this endorsement.
effective.)
Effective ,JwlC' 16, 2001
Policy /I CPI002551 ~02
Issued to --'I11olIlaoUilll.ls",~rary Shelter
Named Insured
'--f5fJh~ 'A.1jO-tt-'-~L'Y-
Countersigned by Hobin L Hatfic,ld
Autborized Repr~';~lt~tive --~-~
, this endorsement fonu as a part of
AJ~!JJO{Y';D AS ;'O"FORM
<<<:~1J {',---,-~::::'..-~_13--
"-~.~CRISTINE LEE SHAW
Deputy City Attorney
10TAL P.02
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