HomeMy WebLinkAboutCAMBODIAN FAMILY 10Vr
AGREEMENT TERMINATION
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Please complete this form when the attached agreement is no longer in effect.
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City of Santa Ana
Revised 8 -7 -03 Clerk of the Council
INSURANCE ON Fitt
WORK MAY HUED
UMIt. INSURANCE. EXPIRES
CLERK OF COUNCIL
OAEE, AUG 0 9 2006 AGREEMENT BETWEEN THE CITY OF SANTA ANA AND
CD t4 Cad THE CAMBODIAN FAMILY FOR USE OF
COMMUNITY DEVELOPMENT BLOCK GRANT FUNDS
(tr. EIo�.ES�
A- 2006 - 092 -007
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This Agreement, is hereby made and entered into this 1 st day of July, 2006, by and between
the City of Santa Ana, a charter city and municipal corporation of the State of California ( "CITY ")
and The Cambodian Family, a California nonprofit corporation ( "SUBRECIPIENT ").
WITNESSETH
Recitals:
A. The CITY, as an entitlement recipient and grantee of the United States Department of
Housing and Urban Development ( "HUD ") Community Development Block Grant ( "CDBG ")
Program, desires to enter this Agreement with the SUBRECIPIENT for the expenditure of CDBG
funds in accordance with Title 24, Part 570 of Code of Federal Regulations 24 CFR 570.000, et seq.
( "CDBG REGS "); and
B. CITY has applied for and received CDBG funds from HUD pursuant to Title I of the
Housing and Community Development Act of 1974, Public Law 93 -383, as amended ( "ACT "); and
C. The SUBRECIPIENT is a private nonprofit agency that has been selected by the CITY
to receive CDBG funds and administer such financial assistance; and to provide the services
described in Exhibit A, in accordance with the schedule of performance included therein, hereinafter
referred to as "said program ". SUBRECIPIENT represents that it is qualified and willing to operate
said program and certifies that the activities carried out with funds provided under this Agreement
will meet one or more of the CDBG program's National Objectives (24 CFR Part 570.208).
D. SUBRECIPIENT agrees that it will adhere to the performance measurements and
outcomes as indicated on Exhibit B -1 (Outcome Tracking). Failure to follow the measurements
and meet the stated outcomes may constitute breach of contract that could result in termination
of this Agreement or serve as reason for the City to recapture the grant funds awarded to
SUBRECIPIENT pursuant to this Agreement.
E. The CITY and SUBRECIPIENT have duly executed this Agreement for the expenditure of
such funds; and
WHEREFORE, it is agreed by and between the parties that the foregoing Recitals are a
substantive part of this Agreement and the following terms and conditions are approved and
together with all exhibits and attachments hereto, shall constitute the entire Agreement between the
CITY and SUBRECIPIENT:
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I. SUBRECIPIENT'S OBLIGATIONS
A. Non -Profit Status - Representations and Warranties.
(a) Authority. SUBRECIPIENT is a duly organized and existing non - profit corporation
in good standing and authorized to do business under the laws of the State of California.
SUBRECIPIENT has full right, power and lawful authority to accept the funding hereunder and
to undertake all obligations as provided herein and the execution, performance and delivery of
this Agreement by SUBRECIPIENT has been fully authorized by all requisite actions on the part
of SUBRECIPIENT.
(b) Experience. SUBRECIPIENT is a qualified provider of the services to be provided
hereunder.
(c) Familiarity With Services Required. By executing this Agreement,
SUBRECIPIENT warrants that (i) it has thoroughly investigated and considered the services to
be performed and provided hereunder, (ii) it has carefully considered how the services should be
performed, and (iii) it fully understands the facilities, difficulties and restrictions attending
performance of the services under this Agreement.
(d) No Conflict. To the best of SUBRECIPIENT'S knowledge, SUBRECIPIENT'S
execution, delivery and performance of its obligations under this Agreement will not constitute a
default or a breach under any contract, agreement or order to which SUBRECIPIENT is a party
or by which it is bound.
(e) No Bankruptcy. SUBRECIPIENT is not the subject of any current or threatened
bankruptcy proceeding.
(f) No Pending Legal Proceedings. SUBRECIPIENT is not the subject of a current or
threatened litigation that would or may materially affect SUBRECIPIENT'S performance under
this Agreement.
(g) Application Veracity. All provisions of and information provided in
SUBRECIPIENT'S application for funding submitted to CITY including any exhibits are true
and correct in all material respects.
(h) No Pending Investigation. SUBRECIPIENT is not aware that it is the
subject of any current or threatened criminal or civil action investigation by any public agency,
including without limitation a police agency or prosecuting authority, that would relate to affect
performance of the Agreement or provision of services hereunder.
B. Amount of Grant and Quarterly Disbursement. The amount granted to
SUBRECIPIENT is $ 18,000( "CDBG FUNDS "), and such funds shall be expended by
SUBRECIPIENT on or before June 30, 2007. The CDBG FUNDS shall be disbursed by CITY
to SUBRECIPIENT on a quarterly basis (October, January, April and July) subject to and upon
receipt and approval of a complete quarterly activity report from SUBRECIPIENT, with the final
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payment subject to the satisfaction of the condition precedent of submittal of complete reporting
information due on or before July 15 of the applicable funding year, as hereinafter more fully set
forth. SUBRECIPIENT shall be obligated to perform such duties as would normally extend
beyond the term, including but not limited to obligations with respect to indemnification, audits,
reporting, data retention/reporting, and accounting.
C. Use of Funds. SUBRECIPIENT agrees to use all federal funds provided by CITY to
SUBRECIPIENT pursuant to this Agreement to operate said program, as set forth in "Exhibit A,"
attached hereto and by this reference incorporated herein. SUBRECIPIENT'S failure to perform as
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 hereunder.
D. Allowable Costs. SUBRECIPIENT agrees to complete said program on or before
June 30, 2007 and to use said funds to pay for necessary and reasonable costs allowable under the
federal law and regulations to operate said program. Said amounts shall include, but not be limited
to, wages, administrative costs, and employee benefits comparable to other similarly situated
employees. Other allowable program costs are detailed in the Budget, as set forth in "Exhibit B,"
attached hereto and by this reference incorporated herein. SUBRECIPIENT shall use all income
received from said funds only for the same purposes for which said funds may be expended
pursuant to the terms and conditions of this Agreement.
E. Licensing. SUBRECIPIENT agrees to obtain and maintain all required licenses,
registrations, accreditation and inspections from all agencies governing its operations.
SUBRECIPIENT shall ensure that its staff shall also obtain and maintain all required licenses,
registrations, accreditation and inspections from all agencies governing SUBRECIPIENT's
operations hereunder. Such licensing requirements include obtaining a City business license, as
applicable.
F. Zoning. SUBRECIPIENT agrees that any facility/property used in furtherance of
said program shall be specifically zoned and permitted for such use(s) and activity(ies). Should
SUBRECIPIENT fail to have the required land entitlement and/or permits, thus violating any local,
state or federal rules and regulations relating thereto, SUBRECIPIENT shall immediately make
good -faith efforts to gain compliance with local, state or federal rules and regulations following
written notification of said violation(s) from the CITY or other authorized citing agency.
SUBRECIPIENT shall notify CITY immediately of any pending violations. Failure to notify CITY
of pending violations, or to remedy such known violation(s) shall result in termination of grant
funding hereunder. SUBRECIPIENT must make all corrections required to bring the
facility/property into compliance with the law within sixty (60) days of notification of the
violation(s); failure to gain compliance within such time shall result in termination of grant funding
hereunder.
G. Separation of Accounts. All funds received by SUBRECIPIENT from CITY
pursuant to this Agreement shall be maintained in an account in a federally insured banking or
savings and loan institution with record keeping of such accounts maintained pursuant to applicable
OMB Circular A -110 requirements. SUBRECIPIENT is not required to maintain separate
depository accounts for CDBG FUNDS; provided however, the SUBRECIPIENT must be able to
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account for receipt, obligation and expenditure of CDBG FUNDS pursuant to applicable OMB
Circular A -I 10 requirements.
H. Audit Report Requirements. SUBRECIPIENT agrees that if SUBRECIPIENT
receives Three Hundred Thousand Dollars ($300,000.00) or more in federal funds,
SUBRECIPIENT shall have an annual audit conducted by a certified public accountant in
accordance with the standards as set forth and published by the United States Office of Management
and Budget. SUBRECIPIENT shall provide CITY with a copy of said audit by October 1 of the
year following the program year in which this Agreement is executed.
I. Record Keeping /Reporting. SUBRECIPIENT shall keep and maintain complete and
adequate records and reports to assist CITY in meeting and maintaining its record keeping
responsibilities under the CDBG REGS, including the following:
(1) Records
a. Documentation evidencing program income requirements in
conformity with 24 CFR 570.504(b((2)(i), (ii) and 24 CFR 570.503(b)(3) and 24
CFR 570.208(a)(2)(B) of the income level of persons and/or families participating
in or benefiting by the SUBRECIPIENT program.
b. Documentation of the number of persons and/or families participating
in or benefiting by the SUBRECIPIENT program.
c. Household information shall include number of persons, identification
of head of household, race /ethnicity, and income verification.
d. Documentation of all CDBG FUNDS received from CITY.
e. Documentation of expenses as identified in the Budget Proposal,
including evidence of incurring the expense, invoices for goods or services, copies
of any and all contracts or documentation pertaining to costs for subcontractors,
plus all other invoices for which CDBG FUNDS were expended, and any payments
therefor.
f. Any such other related records as CITY shall reasonably require or as
required to be maintained pursuant to the CDBG REGS.
(2) Reports
(i) Payment Request. Concurrently with the submittal of each
quarterly report, on or before the 15th day of October, January,
April and July, SUBRECIPIENT shall submit both: an original
invoice and true copies of invoices, receipts, agreements, copies
of any and all contracts or documentation pertaining to costs for
subcontractors or other documentation supporting and
evidencing how the CDBG FUNDS have been expended during
the applicable quarter.
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(ii) Quarterly Activity Report: SUBRECIPIENT agrees to keep monthly
records of all ethnic and racial statistics of persons and families benefited by
SUBRECIPIENT in the performance of its obligations under this Agreement,
including, but not limited to, the number of low and moderate income persons
and households assisted in accordance with federal income limits, the number
of female heads of households assisted, new program information and year -to-
date program statistics on expenditures, caseload and activities.
J. Access to Records. CITY and the United State Government and/or their representatives
shall have access for purposes of monitoring, auditing, and examining SUBRECIPIENT's activities
and performance, to books, documents and papers, and the right to examine records of
SUBRECIPIENT's subcontractors, bookkeepers and accountants, employees and participants in
regard to said program. CITY and the United States Government and/or their representatives shall
also schedule on -site monitoring at their discretion. Monitoring activities may also include, but are
not limited to, questioning employees and participants in said program and entering any premises or
any site in which any of the services or activities funded hereunder is conducted or in which any of
the records of SUBRECIPIENT are kept. Nothing herein shall be construed to require access to any
privileged or confidential information as set forth in federal or state law.
K. Location of Records/Required Length of Record Keening. All accounting records,
reports, and evidence pertaining to all costs, expenses and the CDBG FUNDS of
SUBRECIPIENT and all documents related to this Agreement shall be maintained and kept
available at SUBRECIPIENT' S office or place of business for the duration of the Agreement and
thereafter for five (5) years after completion of an audit in conformity with the CDBG REGS's.
Records which relate to (a) complaints, claims, administrative proceedings or litigation arising
out of the performance of this Agreement, or (b) costs and expenses of this Agreement to which
CITY or any other governmental agency takes exception, shall be retained beyond the five (5)
years until complete resolution or disposition of such appeals, litigation claims, or exceptions. In
the event SUBRECIPIENT does not make the above - referenced documents available within the city
of Santa Ana, California, SUBRECIPIENT agrees to pay all necessary and reasonable expenses
incurred by CITY in conducting any audit at the location where said records and books of account
are maintained.
L. Compliance with Law/Program Income. SUBRECIPIENT acknowledges that the funds
being provided by CITY for said program are received by CITY pursuant to the ACT as amended
and that expenditures of these funds shall be in accordance with the ACT and all pertinent
regulations issued by agencies of the federal government, including, but not limited to, all
regulations found at Title 24 of the Code of Federal Regulations. Program income received by
SUBRECIPIENT shall be returned to CITY unless otherwise provided for in this Agreement.
SUBRECIPIENT agrees to comply fully with all federal, state and local laws and court orders
applicable to its operation whether or not referred to in this Agreement.
M. Standine. 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.
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N. Confidentiality. Without prejudice to any other provisions of this Agreement,
SUBRECIPIENT shall, where applicable, maintain the confidential nature of information provided
to it concerning participants in accordance with the requirements of federal and state law. However,
SUBRECIPIENT shall submit to CITY and or HUD or its representatives, all records requested,
including audit, examinations, monitoring and verifications of reports submitted by
SUBRECIPIENT, costs incurred and services rendered hereunder.
O. Independent Contractor. SUBRECIPIENT agrees that the performance of
obligations hereunder is rendered in its capacity as an independent contractor and that it is in no way
an agency of CITY.
P. Violation of Terms and Conditions. SUBRECIPIENT agrees that if
SUBRECIPIENT violates any of the terms and conditions of this Agreement or any prior
Agreement whereby CDBG funds were received by SUBRECIPIENT, or if SUBRECIPIENT
reports inaccurately, or if on audit there is a disallowance of certain expenditures, SUBRECIPIENT
agrees to remedy the acts or omissions causing the disallowance and repay CITY all amounts spent
in violation thereof. If SUBRECIPIENT engaged in fraudulent activity to obtain and/or justify
expenditure of the CDBG funds granted hereunder, SUBRECIPIENT shall be required to reimburse
the CITY of all such funds that were obtained/spent under fraudulent circumstances.
Q. Ectuipme nt. 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. Lobbvine. SUBRECIPIENT certifies that it will comply with federal law (31
U.S.C. 1352) and regulations found at 24 CFR Part 87, which provide that no appropriated funds
may be expended by the recipient of a federal contract, grant, loan or cooperative agreement to pay
any person for influencing or attempting to influence an officer or employee of any agency,
Member of Congress, or an officer or employee of a Member of Congress in connection with
awarding of any federal contract, the making of any federal grant or loan, entering into any
cooperative agreement and the extension, renewal, amendment or modification of any federal
contract, grant, loan or cooperative agreement. SUBRECIPIENT shall sign a certification to that
effect in a form as set forth in "Exhibit C," attached hereto and by this reference incorporated herein.
SUBRECIPIENT shall submit said signed certification to CITY prior to performing any of its
obligations under this Agreement and prior to any obligation arising on the part of CITY to pay any
sums to SUBRECIPIENT under the terms and conditions of this Agreement.
If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of
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Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the
undersigned shall complete and submit a "Disclosure Form to Report Lobbying," in accordance
with its instructions (see C -1).
T. Financial Interest. SUBRECIPIENT agrees that except for the use of CDBG funds
to pay salaries and other related administrative or personnel costs, no persons who exercise or have
exercised any function with respect to CDBG activities assisted under the terms of this Agreement,
or who are in a position to participate in a decision - making process or gain inside information with
regard to such activities, may obtain a financial interest or benefit from a CDBG- assisted activity of
SUBRECIPIENT, either for themselves or those with whom they have family or business ties,
during their tenure or for one year thereafter. This prohibition applies to any person who is an
employee, agent, consultant, officer, or elected or appointed official of CITY, or of
any designated public agencies, or the SUBRECIPIENT.
U. Davis -Bacon Act. All laborers and mechanics employed by contractors or
subcontractors in the performance of construction work, including alterations and repairs, in excess
of $2,000.00, financed in whole or in part with federal funds shall be paid wages at rates not less
than those prevailing on similar construction in the locality as detemvned 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. §5.12. Labor standards interviews /investigations
shall be made as necessary to assure compliance [29 C.F.R. §5.6(a)(3)].
V. Drug Free Workplace. SUBRECIPIENT certifies that it has established the following
drug -free workplace policy:
1. The unlawful manufacture, distribution, dispensing, possession or use of a
controlled substance is prohibited in the workplace for any employee involved in a federally funded
program.
2. As an employee working in conjunction with a federally funded program, the
employees of SUBRECIPIENT will be required to:
a) Abide by the terms above in statement 1.
b) Notify appropriate officials of SUBRECIPIENT and CITY officials of
any criminal drug statute conviction for a violation occurring in the workplace not
later than five days after such conviction.
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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.
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.
Il. CITY'S OBLIGATIONS
A. Payment of Funds. Upon execution of this Agreement by SUBRECIPIENT, CITY shall
pay to SUBRECIPIENT from CDBG funds, when, if and to the extent received from HUD, for
CITY's 2006 -07 CDBG program year amounts expended by SUBRECIPIENT in carrying out said
program for fiscal year 2006 -07 pursuant to this Agreement up to a maximum aggregate payment
of Eighteen Thousand Dollars ($ 18,000) in installments determined by CITY. Payments shall be
made to SUBRECIPIENT through the submission of invoices on a quarterly basis (October, January,
April and July) in a form prescribed by CITY, detailing such expenses. CITY shall pay such
invoices within thirty (30) days after receipt thereof provided CITY is satisfied that such expenses
have been incurred and documented within the scope and provisions of this Agreement and that
SUBRECIPIENT is in compliance with the terms and conditions of this Agreement.
B. Audit of Account. CITY shall include an audit of the account maintained by
SUBRECIPIENT in CITY's annual audit of all CDBG FUNDS in accordance with Title 24 of
the Code of Federal Regulations and other applicable federal laws and regulations.
C. Common Rule: Pursuant to CFR 85.40(a), the CITY manages the day -to -day
operations of each grant and subgrant supported activities. CITY staff has detailed knowledge of the
grant program requirements and monitors grant and subgrant supported activities to assure
compliance with Federal requirements. Such monitoring covers each program, function and activity
and performance goals are reviewed periodically.
D. Environmental Review: In accordance with 24 CFR 58, the CITY is responsible for
undertaking environmental review and maintaining environmental review records for each
applicable project.
E. Performance Monitoring: CITY shall monitor the performance of the
SUBRECIPIENT against goals and performance standards required herein. Substandard
performance as determined by the CITY will constitute non - compliance with this Agreement. If
action to correct such substandard performance is not taken by the SUBRECIPIENT within a
reasonable period of time after being notified by the CITY, contract suspension or termination
procedures will be initiated.
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III.
SUBRECIPIENT agrees that no person on the ground of race, age, color, national origin,
religion or sex will be excluded from participation in, be denied the benefits of, or be subjected to
discrimination under any program or activity funded in whole or in part with CDBG funds.
IV. CONFLICT OF INTEREST
Pursuant to the conflict of interest requirements set forth in 24 CFR 576.57 and OMB
Circulars 1 -102 and A -I 10, SUBRECIPIENT agrees that no officer, employee, agent or assignee of
CITY having direct or indirect control of any CDBG monies granted to the CITY, inclusive of the
subject CDBG FUNDS, shall serve as an officer of SUBRECIPIENT. Further, any conflict or
potential conflict of interest of any officer of SUBRECIPIENT shall be fully disclosed in writing
prior to the execution of this Agreement and said writing shall be attached and deemed fully
incorporated as a part hereof. Notice shall be sent by SUBRECIPIENT to CITY regarding any
changes or modifications to its board of directors and list of officers.
V. SPECIAL CERTIFICATION FOR RELIGIOUS ENTITIES
If SUBRECIPIENT is a religious entity, SUBRECIPIENT hereby agrees that in connection
with the provision of the services SUBRECIPIENT shall provide with CDBG funds, in accordance
with 24 CFR 570.2000):
A. SUBRECIPIENT shall not discriminate against any employee or applicant for
employment on the basis of religion and shall not limit employment or give preference in
employment to persons on the basis of religion.
B. SUBRECIPIENT shall not discriminate against any person applying for the services
SUBRECIPIENT agrees to provide under the terms of this Agreement on the basis of religion and
shall not limit such services or give preference to applicants for such services on the basis of
religion.
C. SUBRECIPIENT shall NOT provide religious instruction or counseling, conduct
any religious worship or services, or engage in any religious proselytizing, or exert any religious
influence in the provision of the services in said program. The parties agree that this covenant is
intended to and shall be construed for the limited purpose of assuring compliance with respect to the
use of CITY funds by SUBRECIPIENT with applicable constitutional limitations respecting the
establishment of religion as set forth in the establishment clause under the First Amendment of the
United States Constitution and Article I, Section 4 of the California Constitution, and is not in any
manner intended to restrict other activities of SUBRECIPIENT.
D. Where the services to be provided under said program are rendered on property
owned by the primarily religious entity SUBRECIPIENT, CDBG funds may also be used for minor
repairs to such property which are directly related to the cost of rendering the services under said
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program, where the cost constitutes in dollar terms only an incidental portion of the CDBG
expenditure for rendering the services under said program.
VI. PROHIBITION OF NEPOTISM
SUBRECIPIENT agrees not to hire or permit the hiring of any person to fill a position
funded through this Agreement if a member of that person's immediate family is employed in an
administrative capacity by SUBRECIPIENT. For the purposes of this section, the term "immediate
family" means spouse, child, mother, father, brother, sister, brother -in -law, sister -in -law, father -in-
law, mother -in -law, son -in -law, daughter -in -law, aunt, uncle, niece, nephew, stepparent and
stepchild. The term "administrative capacity" means having selection, hiring, supervisor or
management responsibilities.
VII. NOTICES
Notices to the parties shall, unless otherwise requested in writing, be sent by U.S. Mail,
postage prepaid, and addressed as follows:
TO CITY: City of Santa Ana
Community Development Agency (M -25)
20 Civic Center Plaza
P.O. Box 1988
Santa Ana, California 92702 -1988
TO SUBRECIPIENT: Ritka Hirsch
Executive Director
The Cambodian Family
1111 E. Wakeham Avenue, Ste E
Santa Ana, CA 92705
VIII. ASSIGNABILITY
None of the duties of, or work to be performed by, SUBRECIPIENT under this Agreement
shall be subcontracted or assigned to any agency, consultant, or person without the prior written
consent of CITY. SUBRECIPIENT must submit all subcontracts and other agreements that relate
to this Agreement to CITY. No subcontract or assignment shall terminate or alter the legal
obligations of SUBRECIPIENT pursuant to this Agreement.
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IX. HOLD HARMLESS
SUBRECIPIENT shall indemnify, defend and save harmless CITY, its officers, employees,
agents, representatives and volunteers from and against any and all damages to or for loss of use of
property and for injuries to or death of any person or persons, including property and employees or
agents of CITY, and shall defend, indemnify and save harmless CITY, its officers, employees,
agents, representatives and volunteers from and against any and all claims, demands, suits, actions
or proceedings of any kind or nature, including, but not by way of limitation, workers compensation
claims and including attorney fees and reasonable expenses for litigation or settlement, resulting
from or arising out of the negligent or wrongful acts, errors or omissions of SUBRECIPIENT, its
officers, directors, employees, agents, subcontractors and suppliers arising out of
SUBRECIPIENT's performance of this Agreement.
X. INSURANCE
A. In accordance with the provisions of Section 3300 of the Labor Code, if
SUBRECIPIENT has any employees it is required to be insured against liability for worker's
compensation or to undertake self - insurance. Prior to commencing performance of this
Agreement, SUBRECIPIENT agrees to obtain and maintain employer's liability insurance with
limits not less than $1,000,000 per accident. If SUBRECIPIENT has no employees, nor
workers' compensation coverage, it must execute a Declaration available from the CITY, and
update as is necessary.
B. SUBRECIPIENT shall undertake self - insurance, or shall obtain, at its sole cost, a
policy or policies of commercial general liability insurance, or equivalent form, with a combined
single limit of not less than $1,000,000 per occurrence.
Such insurance shall: (1) name the City of Santa Ana, its officers, agents,
representatives, employees and volunteers as additional insured's; (2) be primary with respect to
insurance or self - insurance programs maintained by the CITY; (3) contain standard separation of
insured's provisions; and (4) give to CITY prompt and timely notice of claim made or suit
instituted arising out of SUBRECIPIENT's operations hereunder.
SUBRECIPIENT shall: (a) prior to exercising any right under this Agreement,
furnish properly executed certificates of insurance and additional insured endorsement to the
CITY which shall clearly evidence all coverages required above; (b) provide that such insurance
shall not be materially changed or terminated except on 30 days prior written notice to the CITY;
(c) maintain such insurance for the period covered by this Agreement; and (d) replace such
certificates for policies expiring prior to the expiration of this Agreement.
XI. REVERSION OF ASSETS
A. Upon the expiration of this Agreement, SUBRECIPIENT shall transfer to CITY any
CDBG funds on hand at the time of the expiration of this Agreement as well as any accounts
receivable attributable to the use of CDBG funds. [24 CFR 570.503(b)(8).]
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B. Any real property under SUBRECIPIENT's control that was acquired or improved
in whole or in part with CDBG funds in excess of $25,000.00 must either be:
1. Used, where CITY has given written approval, to meet one of the national
objectives stated in 24 CFR 570.208 until five (5) years after expiration of this Agreement, or for
such longer period of time as determined to be appropriate by CITY; or
2. If not used in accordance with subparagraph A above, SUBRECIPIENT
shall pay to CITY an amount equal to the current fair market value of the property less any portion
of the value attributable to the expenditure of non -CDBG funds for acquisition of, or improvement
to, the property. Such payment is program income to CITY.
C. Subject to the obligations set forth herein, title to equipment acquired under the
terms of this Agreement will vest upon acquisition in SUBRECIPIENT. When said equipment
which has been acquired in accordance with this Agreement and all applicable regulations is no
longer needed for said program, disposition of said equipment will be made as follows:
1. Items of equipment with a current per unit fair market value of less than
$5,000.00 may be retained, sold or otherwise disposed of with no further obligation to CITY.
2. Items of equipment with a current fair market per unit value of $5,000.00 or
more may be retained or sold and CITY shall have the right to an amount calculated by multiplying
the current market value or proceeds from the sale by CITY's share of federal funds used to acquire
the equipment, in accordance with 24 CFR 85.32(e)(2).
D. SUBRECIPIENT hereby agrees, upon the demand of CITY, to execute,
acknowledge and deliver, or cause any person or entity who may have any claim to rights hereunder
or under any document, instrument or agreement executed in furtherance of the services and
activities to be performed hereunder, to execute, acknowledge and deliver, to CITY assignment(s),
quit claim deed(s) or such other and further instruments, documents and agreements as may be
necessary, in the sole and absolute discretion of CITY, to vest in CITY all of SUBRECIPIENT's
right, title and interest (if any it may have) in and to CITY, CDBG or other federal, state and/or
local accounts or program funds or allocation of funds to which CITY is or may be entitled, either
for its own account or as fiduciary or trustee for others, which were obtained for the purpose of the
performance of this Agreement or any previous agreements relating to the same subject matter or
activities as this Agreement, together with any instruments, loans, grants or advances by
SUBRECIPIENT on behalf of CITY, in furtherance of the activities hereunder or thereof.
SUBRECIPIENT's obligations and responsibilities set forth in this paragraph "XI.
REVERSION OF ASSETS," and in paragraph "XII. TERMINATION" and other requirements
pertaining to program income shall not be affected by the termination of this Agreement and shall
survive the date of termination of this Agreement for such period of time as CITY and/or HUD
deems necessary for the responsibilities, duties and obligations to be performed and completed to
the satisfaction of CITY and HUD.
12
5/05
XIL TERMINATION
A. This Agreement may be terminated on thirty (30) days' written notice by either
party. In the event of such termination, SUBRECIPIENT shall only be entitled to reimbursement
for approved expenses incurred to the effective date of termination.
B. This Agreement may be suspended or terminated by CITY upon five (5) days'
written notice for violation by SUBRECIPIENT of Federal Laws governing the use of Community
Development Block Grant Funds. In the event of such suspension or termination, SUBRECIPIENT
shall only be entitled to reimbursement for approved expenses incurred up to the effective date of
suspension or termination.
C. Pursuant to 24 CFR 85.43, in the event SUBRECIPIENT defaults by failing to fulfill
all or any of its obligations hereunder, CITY may declare a default and termination of this
Agreement by written notice to SUBRECIPIENT, which default and termination shall be effective
on a date stated in the notice which is to be not less than ten (10) days after certified mailing or
personal service of such notice, unless such default is cured before the effective date of termination
stated in such notice. If terminated for cause, CITY shall be relieved of further liability or
responsibility under this Agreement, or as a result of the termination thereof, including the payment
of money, except for payment for approved expenses incurred for services satisfactorily and timely
performed prior to the mailing or service of the notice of termination, and except for reimbursement
of (1) any payments made for services not subsequently performed in a timely and satisfactory
manner, and (2) costs incurred by CITY in obtaining substitute performance.
D. The grant of funds under this Agreement may be terminated for convenience in
accordance with 24 CFR 85.44.
E. The grant of funds under this Agreement may be terminated due to the non-
performance of SUBRECIPIENT and/or failure of SUBRECIPENT to perform the work described
in Exhibits A and B or failure to meet the performance standards and program goals set forth
therein.
F. In the event this Agreement is terminated as set forth in subparagraphs XII.A.
through XILE., inclusive, SUBRECIPIENT agrees to immediately return to CITY upon CITY's
demand and prior to any adjudication of SUBRECIPIENT's rights, any and all funds not used, and
to comply with paragraph "XI. REVERSION OF ASSETS" of this Agreement.
XIH. LIMITATION OF FUNDS
The United States of America, through HUD, may in the future place programmatic or fiscal
limitations on the use of CDBG funds which limitations are not presently anticipated. Accordingly,
CITY reserves the right to revise this Agreement in order to take account of actions affecting HUD
program funding. In the event of funding reduction, CITY may, in its sole and absolute discretion,
13
5/05
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. If such a reduction in funding occurs, SUBRECIPIENT shall be permitted to de -scope
accordingly. Where CITY has reasonable grounds to question SUBRECIPIENT's fiscal
accountability, financial soundness, or compliance with this Agreement, CITY may suspend the
operation of this Agreement for up to sixty (60) days upon five (5) days written notice to
SUBRECIPIENT of its intention to so act, pending an audit or other resolution of such questions.
In no event, however, shall any revisions made by CITY affect expenditures and legally binding
commitments made by SUBRECIPIENT before it received notice of such revision, provided that
such amounts have been committed in good faith and are otherwise allowable and that such
commitments are consistent with HUD cash withdrawal guidelines.
XIV. EXCLUSIVITY AND AMENDMENT OF AGREEMENT
This Agreement supersedes any and all other agreements, either oral or in writing, between
the parties hereto with respect to the use of CITY's CDBG funds by SUBRECIPIENT and contains
all the covenants and agreements between the parties with respect to such employment in any
manner whatsoever. Each party to this Agreement acknowledges that no representations,
inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone
acting on behalf of any party, which are not embodied herein, and that no other agreement or
amendment hereto shall be effective unless executed in writing and signed by both CITY and
SUBRECIPIENT.
XV. LAWS GOVERNING THIS AGREEMENT
This Agreement shall be governed by and construed in accordance with the laws of the State
of California, and all applicable federal laws and regulations.
XVI. VALIDITY
The invalidity in whole or in part of any provision of this Agreement shall not void or affect
the validity of any other provision of this Agreement.
XVII. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature herein below has the power,
authority and right to bind their respective parties to each of the terms of this Agreement, and shall
14
5/05
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.
15
5/05
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the last date and
year written below.
ATTEST:
ATRICIA E. HEALY
Clerk of the Council
APPROVED AS TO FORM:
JOSEPH W.FLETCHER
City Attorney
By: LISA E. STORCK
Assistant City Attorney
DATE:
W
CITY OF SANTA ANA
DAVID N. REAM
City Manager
SUBRECIPIENT:
/ ti 1/
Name• Rifka Hirsch
Title: Executive Director
Tax ID: 95- 3854831
City of Santa Ana
Community Development Block Grant
Scope of Work
Name of Organization- The Cambodian Family
Name of Funded Program- The Cambodian Family Youth Program
Annual Accomplishment Goal
I. Total number of unduplicated clients (Santa Ana and Non -Santa Ana Residents) anticipated to be served by
the funded program, named above, during the 12 -month contract period.
100PERSONS
II. Number of only unduplicated Santa Ana residents to be served by the funded program, named above,
during the 12 -month contract period.
100PERSONS
Program and Funding Description
III. Description of Work — In the space below, describe the program to be funded during the 12 -month
contract period.
The Cambodian Family's Youth Program works with low - income Cambodian and Latino youths and their families in a
comprehensive way to create a shift from a paradigm of mere survival to a paradigm of achievement. Our work with youths is
designed ultimately to facilitate the transition from community poverty and reliance on welfare to community success and self -
reliance. To achieve these goals, our Youth Program includes both a youth strategy and a parent strategy. Our youth strategy is
organized around three Institutes: Academic, Leadership, and Career. Within the Academic Institute, we seek to ensure the
development of strong reading and writing skills, good academic performance, successful grade promotions, high school graduation,
and the opportunity to pursue higher education. Within the Leadership Institute, we seek to improve our young people's life skills,
character strengths and self - esteem. Within the Career Institute, we seek to help prepare our youth to make decisions about college
and careers.
We provide neighborhood youths a safe place to go after school, where our bilingual staffs tutor and mentor them, teach them
new skills, help them build dreams for the future, and support them in achieving their goals. We serve youths, ages 6 -20. Youths
activities take place after school, Tuesday through Friday, from 3 -6 PM, and on Saturday, from 9 -4 PM.
Our parent strategy aims to help parents develop skills to better provide for, supervise, nurture, and communicate with their
children. To achieve this objective, we hold monthly parent meetings to teach parents about the school system, and encourage them
to become actively involved in their children's education. We also facilitate their participation in school activities. .
IV. Activities funded by this grant — How will CDBG funds be used for the funded program? Narratively
describe the budget for the funded program illustrated in Exhibit B and B -1.
The CDBG funds will pay part of our Youth Coordinator Position. It will cove part of the salary and benefit of of this position. In
addition it will pay for office supplies, dancer supplies, and educational materials. A very small portion of it will pay for
mileage /travel.
Exhibit A
Page 1 of 2
Schedule of Performance
Estimate the number of only unduplicated Santa Ana residents to be served by the funded program during the
12 -month contract period per quarter. (How many new Santa Ana clients will be served each quarter.)
Quarter 1: Julyl — September 30 70 Persons
Quarter 2: Octoberl — December 31 10 Persons
Quarter 3: January 1 — March 31 10 Persons
Quarter 4: Apri l 1 — June 30 10 Persons
100 Total number of unduplicated Santa Ana residents to be
served. (Must equal the number for II above.)
Schedule of Invoicing
Estimate the amount of grant funds to be requested during the 12 -month contract period on a quarterly basis.
Quarter 1: Julyl — September 30 $4500
Quarter 2: Octoberl — December 31 $4
Quarter 3: January 1 — March 31 $4,500
Quarter 4: April 1 — June 30 $4,500
$18,OOOTotal Grant (Must equal the Total Program Budget
indicated on Exhibit B.)
Exhibit A
Page 2 of 2
CITY OF SANA ANA
Community Development Block Grant
Outcome Tracking
IMPORTANT: The City of Santa Ana is in the process of incorporating the new HUD Performance
Outcome Tracking guidelines, therefore this section is subject to change in order to be compliant with
HUD regulations. If the situation should occur that the current tracking system is not sufficient to meet
HUD regulations an amendment to this contract will be needed.
Instructions: From the list of activities below select the activity that best describes the purpose of the program that will be funded
in fiscal year 06 -07 by these grant funds. Two activities have multiple outcomes, therefore if "Senior Services" or "Youth Services" is
selected, please select the one outcome that best describes the purpose of the funded program. ONLY if none of the activities listed
adequately describe the funded program, please select that last activity "Low- and Moderate Income Services ".
Exhibit A -1
Page 1 of 4
Fulfillment
Tracking
HUD Objective to be fulfilled
HUD Outcome to be fulfiled
illustrated by
HUD Indicator
Suitable
Creating
Specific Outcome
Activity/Program
Outcome Tracking
Goal
Living
Decent
Economic
Availability/
Affordability
Sustainabili
Indicator #
Environment
Housing
g
Opportunitic
Accessibility
(Please see page 4
of 4 for desc J
nti -0rime Services
Track the reduction in
Reduce narrative time to
spouse time and the
in the City's
umber eremitical
-and Moderate -Income
❑
sppnhrnded as a result
ares by at least 3 minutes
resulting in the apprehension
f 1,500 tribunals that may
X
X
A
L
w
ther cape.
• ^5 -Year goal m bra
thieved by FY 09/10
Fair Housing Services
Provide fair housing service
1. Provide fair housing
and missing aalyaia of
unseling, education and
impediments n fair housing.
nfamement services to
❑
],OOO Sanm Ana households.
X
X
2
•'•5 -year goal m be
chievM by FY 09/10
. Actually assess actions to
limmett impediments to fan
sing.
X
X
2
L
Homelessness Prevention
track assisted individuals
50% of assisted individuals
no retained their homing in
and households win meant
utilities for at least 6 months
their housing car utilities for
❑
after assistance were
t least 6 months aRer
X
X
14
ravided.
assistance is provided.
mergency Shelter
Track individuals who
50% of
received support scrvwcs
N et were linked to ran, in
ndividuals lummeholds that
1 Ol
E]
re additional support
provided w emergency
re with emergency
shelter will trucanonm
V
!1
V
A
service appropriate
sing.
interim housing (i.e.,
maraltional housing).
13
Transitional Housing
Track homeless individuals
5 % of homeless individuals
who participated in
anoraling in trummmon
trentutial housing program
housing program will be
❑
that went placed in
laced in permanent housing.
X
X
wt housing.
suggestive Services
Track ndividuals who
0 oofindividuals/famnies
mosivedl support services
recowing, support s.,.a
that were biked to one or
will be lrdred
❑
are additionn support
ddtoul spp rt rvmore
X
2
service and/or appropriate
Nor approprata housing.
housing.
Exhibit A -1
Page 1 of 4
Exhibit A -1
Page 2 of 4
Fulfillment
illustrated by
Trackinit
HUD 0 jective to be fulfilled
HUD Outcomes to be fulfilled
HUD Indicator
Suitable
Creating
Specific Outcome
Activity/Program
Outcome Tracking
Goal
Living
Decent
Economic
Availability/
Affordability
Sustainabili
Indic for It
Environment
Boost. g
pportunitie
Acecssibili ty
(Please sec page 4
of 4 for desc J
nor Stains
I. Track assistedsemor
1.80% of assisted senior
citizens that remained
cimwinswairentain
❑
independent for at least 1
independent for a last 1
w
yeara sery iceswere,
na
year after services are
2
nvided.
provided.
. Track seniors receiving
.90% of seniors receiving
fenals that were linked m
chants will be linked to me
❑
the services sought
smites sought.
X
X
L
2
water- Occupied
umber ofowners assisted
hysical safety and comfort
rasing Rehabilitation
to rehabilitate their primary
will be improved for Low
sidence for the following
and Moderate income
income categories:
households by improving
❑
- Extremely Low Income
r mes to a level that meets
-very Low Income
exceeds HUD housing
l/J
- Moderate Income
totality standards.
Special Needs Categories
-Large Families
Frail Elderly Services
rack flail elderly
0% of flail elderly
individuals that were liNed
individuals will be linked in
❑
true services sought
the services sought.
A
X
v
A
isabled Services
Track dieablespereons
Support independent living
whomindepen dem living
for 90n, ofdisabled peons
rs
F_1
as supported by City funds.
ssistcdby City funds.
p
A
v
!1
toes fm Mentally 111
Track individuals assisted
100°/ of individuals assisted
with City resources that were
with City resouroes will be
❑
rovided an entry point into
provided an entry point into
e regional mental health
are system and linked test
the regional mental halm
none system and linked to at
L
least one additional mental
least one additional mental
Palm supportive service,
health supportive service.
ervmca far Substance
Track how many individuals
Provide entry into the
Addicted
with substance addiction in
ocgional recovery system for
ere provided an entry into
25 individuals with
me regional recovery system
substance addiction and link
❑
and linked to additional
them to additional services.
services.
X
V
!1
a goal to be
achieved
M1ieved by FY 09/10
ouch Services
1, Track mr rovementln
1. Foreducation -based
protest post-test scores,
ogram& improve pre -test
®
it -lest scores by 50%
is
!�
X
2
Track nunal
2. Provide opportunities for
F-1
individuals expoesd to the
xposure to the fine ass.
one arts.
X
X
2
3. Trackchildredyouch
T90-1. ofchilmcNyouth
❑
,seeking refertals that were
seeking referrals wilt M
linked to the services sought
inked to the services sought.
X
X
2
and Moderate-
rack program participants
90%, If program participants
come Services
t were linked w services
ill be li:zcd to aervicos
ought,
ought
X
X
2
❑
Exhibit A -1
Page 2 of 4
Description of Outcome Tracking System:
Please describe your organization's outcome tracking system that will enable you to fulfill the outcome selected above.
Measuring Youths Success: Upon enrollment, each youth are assessed. Youths then set quarterly goals for each of the three
institutes. Success in the Academic Institute is measured by youths meeting their goals for improved report card grades, for overall
GPA and for specific subject areas. Success in Leadership Institute is measured by the number of community service hours each youth
completes. Success in the Career Institute is measured by youths achieving personal goals in career exploration (attending
presentations by outside guest speakers, jobs fairs, applying to college and applying for scholarships, and working summer jobs). We
judge youths as successful if they meet their goals in at least two of the three institutes. At least 50 youths will achieve successful
measurable outcomes in our Youth Strategy activities.
Measuring Parent Success: Parents are considered successful if they participate in at least two- thirds of all monthly parent
meetings. At least 15 parents will achieve successful measurable outcomes in our Parent Strategy activities.
Exhibit A -1
Page 3 of 4
Specific Outcome Indicators
2) Public service activities
Number of persons assisted:
• with new access to a service
• with improved access to a service
• where activity was used to meet a quality standard or measurably improved quality, report the number
that no longer only have access to substandard service
9) Owner occupied units rehabilitated or improved
Total number of units:
Number occupied by elderly
Number of units brought from substandard to standard condition (HQS or local code)
Number qualified as Energy Star
Number of units brought into compliance with lead safe housing rule (24 CFR part 35)
Number of units made accessible for persons with disabilities
12) Number of homeless persons given overnight shelter
13) Number of beds created in overnight shelter or other emergency housing
14) Homelessness Prevention
Number of households that received emergency financial assistance to prevent
homelessness
Number of households that received emergency legal assistance to prevent
homelessness
Exhibit A -1
Page 4 of 4
Program Year 2006 -2007
Final Budget
Organization Name _ The Cambodian Family
Program Name The Cambodian Familv Youth Program
Expenditures
Category
Expenses Funded by
Santa Ana CDBG
Expenses Funded
by Other Sources
Federal Funding For Refugees
Total Program
Budget
Total Organizational
Budget
Administrative Staff
Salaries & Benefits
$
$
17,967
$
17,967
$
134,763
Program Staff Salaries &
Benefits
$ 17,250
$
132,872
$
150,122
$
481,627
Contractual /Professional
Services: List below
1 Audit
$
1,900
$
1,900
$
7,935
2 Consultant
1 $
$
26,209
3 Professional services
$
600
$
600
$
3,255
Office Supplies
$ 700
$
5,315
$
6,015
$
9,675
Rent
$
13,610
$
13,610
$
69,538
Communications
$
1,230
$
1,230
$
6,793
Utilities
$
2,370
$
2,370
$
12,128
Insurance
$
2,220
$
2,220
$
6,870
Other.List below
1 Advertising
:z
$
' -' °'
$
50
2 Staff Training
$
$
1,656
3 Conference Travel
$
$
2,000
4 Training Supplies
$
263
$
263
$
4,116
5 Direct Program Expenses
$
$
3,484
6 Equipment Rental /Maint.
$
960
$
960
$
4,905
Field Trip (Educations &
7 Incentive
$
1,500
$
1,500
$
2,750
Fund Raising /Development
8 Cost
$
$
1,605
9 Janitorial Maint. /Supplies
$
3,600
$
3,600
$
14,725
10 Licensing /Zoning Fees
$
$
1,162
11 Membership /Subscription
$
83
$
83
$
338
12 Mileage/-ravel
$ 50
$
1,834
$
1,884
$
7,942
13 Participant Materials
$
$
3,000
14 Postage
$
185
$
185
$
673
15 Printing
$
51
$
51
$
156
Total
$ 18,000
$
186,560
$
204,560
$
807,355
LIST ALL OTHER PROGRAM FUNDS THAT HAVE BEEN SECURED FOR 06 -07
(Total Funds for Program must equal Total Program Budget above)
Source Amount
Santa Ana CDBG
$
18,000
Federal Funding For Refugees
$
12,500
California Wellness Foundation
$
50,000
Orange Count United Way
$
17,000
Draper Family Fund /OCCF
$
25,000
FEZ - Youth Employment
$
57,060
Other Foundations/Corporations
$
25,000
Total Funds for Program
$
204,560
Exhibit 8
Page 1 of 1
2006 -2007 Funded Personnel
Name of Organization:
Name of Program
ADMINISTRATIVE STAFF
Position Title
Annual
Salary
Annual
Benefits
Total
Compensation
CDBG Funds
Requested for
this position
% of time
spent on
funded
program
Of this time
percent of
time serving
Santa Ana
% of Total
Compensation
Eligible
YOUTH COORDINATOR
$ 40,716
$ 10,179
$
$ 17,250
80%
42%
0%
$
0%
$
0%
$
0%
$ -
0%
$
0%
$
0%
$
0%
$
0%
Total Amount Requested!
$
Must equal amount indicated on Exhbit B
PROGRAM STAFF
Position Title
Annual
Salary
Annual
Benefits
Total
Compensation
CDBG Funds
Requested for
this position
% of time
spent on
funded
ro ram
Of this time
percent of
time serving
Santa Ana
% of Total
Compensation
Eligible
YOUTH COORDINATOR
$ 40,716
$ 10,179
$ 50,895
$ 17,250
80%
42%
34%
$
0%
$
0%
IS
0%
$ -
0%
$ -
0%
$ -
0%
$
0%
$
0%
Total Amount Re uested
$ 17,250
Must equal amount indicated on Exhbit B
CONTRACTUALIPROFESSIONAL SERVICES
Position Title
Annual
Contract
Amount
Annual
Benefits
Total
Compensation
CDBG Funds
Requested for
this position
% of time
spent on
funded
program
Of this time
percent of
time serving
Santa Ana
% of Total
Compensation
Eligible
$
0%
$
0%
$
0%
$
0%
$
0%
$
0%
$
0%
$
0%
$
0%
Total Amount Re uested
$
Must equal amount indicated on Exhbit B
** *Please note for personnel whose time is not directly traced to serving Santa Ana and instead a percentage is used please
confirm the percentage is accurate prior to requesting reimbursement.
Exhibit B -I
Page I of 1
Certification Regarding Lobbying
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with the awarding of any Federal
contract, the making of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any Federal contact, grant, loan or cooperative
agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with this Federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure
Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the
award documents for all subawards at all tiers (including subcontract, subgrants, and
contracts under grants, loans, and cooperative agreements) and that all subrecipients shall
certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed
when this transaction was made or entered into. Submission 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.
EXHIBIT C
Page I of 2
SUBRECIPIENT warrants the following:
1. SUBRECIPIENT will comply with Public Law 88 -352, Title VI of the Civil Rights
Act of 1964 (42 U. S. C. section 2000 et seq.) and implementing regulation in 24 CFR
Part 1.
2. No person in the United States shall on the ground of race, color, religion, national
origin, or sex, be excluded from participation in, or be denied the benefits of, or be
subjected to discrimination under any program or activity funded in whole or in part with
community development funds made available pursuant to the ACT.
3. All laborers and mechanics, employed by contractors or subcontractors in the
performance of construction work financed in whole or in part with community
development funds shall be paid wages at rates not less than those prevailing on similar
construction in the locality as determined in accordance with the Davis -Bacon Act, as
amended, 40 U. S. C. Sections 276 a 1 -5, except for individuals who perform services for
which they volunteered; do not receive compensation for such services; or are paid
expenses, reasonable benefits, or a nominal fee for such services; and are not otherwise
employed at any time in construction work.
4. SUBRECIPIENT will comply with all Federal statutes applicable to projects funded
with community development funds, except that (a) SUBRECIPIENT does not assume
CITY'S environmental responsibilities described at 24 CFR 570.604; and (b)
SUBRECIPIENT does not assume CITY'S responsibility for initiating the review process
under Executive Order 12372.
EXHIBIT C
Page 2 of 2
If
ACORD CERTIFIQ ! `SCE
. OF LIABILITY INSUR
Lake Insurance Agency
13891 Newport Ave., Suite 285
Lic #0747473
Tustin, CA 92780
1111 East Wakeham Avenue
Suite E
Santa Ana, CA 92705
INSURERS AFFORDING COVERAGE
DATE (n
02/03/2006
ATTER O NFORMATION
)N THE CERTIFICATE
)T AMEND, EXTEND OR
Y THE POLICIES BELOW.
NAIC #
Co.
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF MSURAIICE
POUCY IAILKER
DATE
DATE
LINTS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE O OCCUR
PHPK155246
03/09/2006
03/09/2007
EACHOCCURRENCE
s 1 000,
PREMISES Ea oavrarc
, 400,
MED EXP (MYane person)
$ 5,
PERSONAL BADVINJURY
$ 1,000,
GENERAL AGGREGATE
$ 3 000
GEN'POLICY ]JPERCT-APPLIESPER
POLICY � LOC
PTO TS- COMP/OPAGG
S 1 000
AUTOMOBILELMBILRY
ANY AUTO
ALL OWNED AUTOS
PHPKISS246
03/09/2006
03/09/2007
COMBINED SINGLE LIMB
(Ea aCdtlml)
S
1,000, ON
Per INJURY
(Pa
( pnsan)
=
A
SCHEDULED AUTOS
HIREDAVTOS
X
BODILY INJURY
(Per acident)
$
X
NO"WNEDAUrOS
X
SO Deductible
PROPERTY DAMAGE
(Per occident)
$
GARAGE LIABILITY
ANYAUTO
AUTO ONLY- EMACCIDEWr
$
OTHER THAN
AUTO ONLY:
S
S
EXC ESSAIMBRELLA LIABRRY
OCCUR ❑CLAIMS MADE
' , :. r _...
^AGGREGATE
EACH OCCURRS
f
DEDUCTIBLE
RETENTION S
L
(L
I '.: -✓:.��
:L Attor�.ey
S
$
$
WORKERS COMPENSATION AND
EMPLOYERS'LIABILRy
ANY PROPRIETORPARTNERIEXECInryE
OFFICERIMEMBER EXCLUDED?
TORY LIMR3 ER
E.L. EACH ACCIDENT
S
E.L. DISEASE- EA EMPLOYE
$
I describe under
SPECIAI. PROVISIONS below
OTHER
E.L DISEASE - POLICY LJMR
$
PHPKISS246 03 09
A use bMolestation / /2006 03/09/2007 $1,000,000 Each Claim
$1,000,000 Aggregate
DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY EEO-r EMEn /SPEOUIL PRWL910Ng $O Deductible
Except 10 days for non payment of premium. Employee Dishonesty $200,000/52,500 Ded.
rofessional Liability $1,000,000 Each Occ /53,000,000 Aggregate. City of Santa Ana
IS named additional insured per contract with named insured. Schedule of vehicles
nd drivers on file. "Non Profit organization"
r FDTCN�ATC un, nne
City of Santa Ana
Community Development Agency
CDBG -M -25
P.O. Box 1988
Santa Ana, CA 92702
ACORD 25 (2001108) FAX: (714)571 -1974
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL NX)OOOM MAIL
30? DAYS WRITTEN NOTICE TO THE CERTIRCATE HOLDER NAMED TO THE LEFT,
`�
IMPORTANT
If the certificate holier Is an ADDITIONAL INSURED, the policy(les) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in Neu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing Insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or after the coverage afforded by the policies listed thereon.
As,ista¢t City Atios' -- (;°
ACORD 26 (2001M)
POLICY NUMBER: PHPKISS246
COMMERCIAL GENERAL LIABILITY
CG 20 26 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modilles insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
CITY OF SANTA ANA, ITS OFFICERS, ITS
AGENTS & EMPLOYERS CDGB M -34
Section 11 — Who Is An Insured is amended to in-
dude as an additional Insured the person(s) or or-
ganization(s) shown in the Schedule, but only with
respect to liability for "bodily injury", "property dam-
age" or 'personal and advertising Injury" caused, in
whole or in part, by your acts or omissions or the acts
or omissions of those acting on your behafF:
A. In the performance of your ongoing operations; or
B. In connection with your premises owned by or
rented to you.
CG 20 26 07 04
will
0 ISO Properties, Inc., 2004
Page f of f
0
.l uv- Z(- Ztajl, lid;-10 1 Flt URMBUD 1 RN FAMILY 714 571 1974
STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807
COMPENSATION
1NSUPtANCE
FUND CERTIFICATE OF WORKERS COMPENSATION INSURANCE
ISSUE DATE: 00 -30 -2000 GROUP:
POLICY NUMBER 1000070 -2000
CERTIFCATE Ok 3
CERTIFICATE EXPIRES 00-30 -2007
00-30- 2000/00 -30 -2007
CITY OF SANTA ANA
PO sax less
SANTA ANA W 02702
Sc RECEIVED MAY Y 5 200,
This Is to certify that we have Issued a valid Workers' Competwation Insurance policy in a form approved by the
Ca1HOrnia Insurance Commissioner to the employer named below for the policy period indicated
This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer.
We will also give you 10 drys advance notice should this policy be cancelled prior to Its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policy listedherein Notwithstanding arty requirement, term or condition of arty contract or other document
with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy.
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
EMPLOYER
THE CAMBODIAN FAMILY SC
1111 E MAK9HAM AVE STE E
SANTA ANA CA 92700-
MEV.2 -05) if . ;i PRINTED : 05-17 -2000
P. 02/02
TOTAL P.02