HomeMy WebLinkAboutCALIFORNIA HISPANIC COMMISSION ON ALCOHOL & DRUG ABUSE 6
AGREEMENT TERMINA nON
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Revised 8-7-03
City of Santa Ana
Clerk of the Council
A-2006-092_006
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AGREEMENT BETWEEN THE CITY OF SANTA ANA AND
CALIFORNIA HISPANIC COMMISSION ON ALCOHOL & DRUG ABUSE FOR USE OF
COMMUNITY DEVELOPMENT BLOCK GRANT FUNDS
This Agreement, is hereby made and entered into this 1st 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 California Hispanic Commission on Alcohol & Drug Abuse, a California nonprofit corporation
("SUB RECIPIENT").
WIINE~~EIH
Recitals:
A. The CITY, as an entitlement recipient and grantee of the United States Department of
Housing and Urban Development ("HUO") Community Development Block Grant ("CDBG")
Program, desires to enter this Agreement with the SUB RECIPIENT 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". SUB RECIPIENT 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
SUB RECIPIENT pursuant to this Agreement.
E. The CITY and SUB RECIPIENT have duly executed this Agreement for the expenditure of
such funds; and
WHEREFORE, it is agreed by and between the parties that the foregoing Recitals are a
substantive part of this Agreement and the following terms and conditions are approved and
together with all exhibits and attachments hereto, shall constitute the entire Agreement between the
CITY and SUBRECIPIENT:
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I. SUBRECIPIENT'S OBLIGATIONS
A. Non-Profit Status - Reoresentations 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.
SUB RECIPIENT 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. SUB RECIPIENT is a qualified provider of the services to be provided
hereunder.
(c) Familiarity With Services Required. By executing this Agreement,
SUB RECIPIENT warrants that (i) it has thoroughly investigated and considered the services to
be performed and provided hereunder, (ii) it has carefully considered how the services should be
performed, and (iii) it fully understands the facilities, difficulties and restrictions attending
performance of the services under this Agreement.
(d) No Conflict. To the best of SUB RECIPIENT'S knowledge, SUBRECIPIENT'S
execution, delivery and performance of its obligations under this Agreement will not constitute a
default or a breach under any contract, agreement or order to which SUB RECIPIENT is a party
or by which it is bound.
(e) No Bankruptcy. SUB RECIPIENT is not the subject of any current or threatened
bankruptcy proceeding.
(1) No Pending Legal Proceedings. SUB RECIPIENT 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
SUB RECIPIENT'S application for funding submitted to CITY including any exhibits are true
and correct in all material respects.
(h) No Pending Investigation. SUBRECIPIENT is not aware that it is the
subject of any current or threatened criminal or civil action investigation by any public agency,
including without limitation a police agency or prosecuting authority, that would relate to affect
performance of the Agreement or provision of services hereunder.
B. Amount of Grant and Quarterlv Disbursement. The amount granted to
SUB RECIPIENT is $ 5,000("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 SUB RECIPIENT on a quarterly basis (October, January, April and July) subject to and upon
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receipt and approval of a complete quarterly activity report from SUBRECIPIENT, with the final
payment subject to the satisfaction of the condition precedent of submittal of complete reporting
information due on or before July 15 of the applicable funding year, as hereinafter more fully set
forth. SUBRECIPIENT shall be obligated to perform such duties as would normally extend
beyond the term, including but not limited to obligations with respect to indemnification, audits,
reporting, data retention/reporting, and accounting.
C. Use of Funds. SUBRECIPIENT agrees to use all federal funds provided by CITY to
SUBRECIPIENT pursuant to this Agreement to operate said program, as set forth in "Exhibit A,"
attached hereto and by this reference incorporated herein. SUB RECIPIENT'S failure to perform as
required may, in addition to other remedies set forth in this Agreement, result in readjustment of the
amount of funds CITY is otherwise obligated to pay to 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. SUB RECIPIENT shall use all income
received from said funds only for the same purposes for which said funds may be expended
pursuant to the terms and conditions of this Agreement.
E. Licensing. SUB RECIPIENT 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 SUB RECIPIENT's
operations hereunder. Such licensing requirements include obtaining a City business license, as
applicable.
F. Zoning. SUB RECIPIENT 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, SUB RECIPIENT 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 notiry CITY immediately of any pending violations. Failure to notiry 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
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depository accounts for CDBG FUNDS; provided however, the SUBRECIPIENT must be able to
account for receipt, obligation and expenditure of CDBG FUNDS pursuant to applicable OMB
Circular A-II 0 requirements.
H. Audit Report Requirements. SUBRECIPIENT agrees that if SUB RECIPIENT
receives Tbree Hundred Thousand Dollars ($300,000.00) or more in federal funds,
SUB RECIPIENT shall have an annual audit conducted by a certified public accountant in
accordance with the standards as set forth and published by the United States Office of Management
and Budget. SUBRECIPIENT shall provide CITY with a copy of said audit by October I of the
year following the program year in which this Agreement is executed.
1. Record KeepingfReporting. 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:
(I) 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 SUB RECIPIENT program.
c. Household information shall include number of persons, identification
of head of household, race/ethnicity, and income verification.
d. Documentation of all CDBG FUNDS received from CITY.
e. Documentation of expenses as identified in the Budget Proposal,
including evidence of incurring the expense, invoices for goods or services, copies
of any and all contracts or documentation pertaining to costs for subcontractors,
plus all other invoices for which CDBG FUNDS were expended, and any payments
therefor.
f. Any such other related records as CITY shall reasonably require or as
required to be maintained pursuant to the CDBG REGS.
(2) Reports
(i) Payment Request. Concurrently with the submittal of each
quarterly report, on or before the 15th day of October, January,
April and July, SUB RECIPIENT shall submit both: an original
invoice and true copies of invoices, receipts, agreements, copies
of any and all contracts or documentation pertaining to costs for
subcontractors or other documentation supporting and
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evidencing how the CDBG FUNDS have been expended during
the applicable quarter.
(ii) Quarterly Activity Report: SUBRECIPIENT agrees to keep monthly
records of all ethnic and racial statistics of persons and families benefited by
SUBRECIPIENT in the performance of its obligations under this Agreement,
including, but not limited to, the number of low and moderate income persons
and households assisted in accordance with federal income limits, the number
offemale 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 SUB RECIPIENT are kept. Nothing herein shall be construed to require access to any
privileged or confidential information as set forth in federal or state law.
K. Location of Records/Required Length of Record Keeoing. All accounting records,
reports, and evidence pertaining to all costs, expenses and the CDBG FUNDS of
SUB RECIPIENT 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 SUB RECIPIENT does not make the above-referenced documents available within the city
of Santa Ana, California, SUB RECIPIENT 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. Comoliance with LawlProgram Income. SUB RECIPIENT 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
SUB RECIPIENT shall be returned to CITY unless otherwise provided for in this Agreement.
SUB RECIPIENT agrees to comply fully with all federal, state and local laws and court orders
applicable to its operation whether or not referred to in this Agreement.
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M. Standing. SUBRECIPIENT shall be in good standing, without suspension by the
California Secretary of State, Franchise Tax Board and Internal Revenue Service. Any change in
the corporate status or suspension of SUBRECIPIENT shall be reported immediately to CITY.
N. Confidentiality. Without prejudice to any other provisions of this Agreement,
SUB RECIPIENT 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,
SUB RECIPIENT 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 ofthe CDBG funds granted hereunder, SUBRECIPIENT shall be required to reimburse
the CITY of all such funds that were obtained/spent under fraudulent circumstances.
Q. Equipment. SUBRECIPIENT agrees to maintain a record for each item of non-
expendable personal property acquired under the terms of this Agreement. Said record shall be
made available to CITY upon request. The term "non-expendable personal property" shall include
leased and purchased equipment.
R. Prohibited Use. SUBRECIPIENT hereby certifies and agrees that it will not use
funds provided through this Agreement to pay for entertainment, meals or gifts.
S. Lobbving. SUB RECIPIENT certifies that it will comply with federal law (3 I
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.
SUB RECIPIENT 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.
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If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the
undersigned shall complete and submit a "Disclosure Form to Report Lobbying," in accordance
with its instructions (see C-l).
T. Financial Interest. SUBRECIPIENT agrees that except for the use 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
SUB RECIPIENT, either for themselves or those with whom they have family or business ties,
during their tenure or for one year thereafter. This prohibition applies to any person who is an
employee, agent, consultant, officer, or elected or appointed official of CITY, or of
any designated public agencies, or the SUBRECIPIENT.
U. Davis-Bacon Act. All laborers and mechanics employed by contractors or
subcontractors in the performance of construction work, including alterations and repairs, in excess
of $2,000.00, financed in whole or in part with federal funds shall be paid wages at rates not less
than those prevailing on similar construction in the locality as determined in accordance with the
Davis-Bacon Act, as amended, 40 U.S.C. sections 276a - 276a-5. Any such construction contract
shall include and comply with the required contract provisions and rules set forth in 29 C.F.R. !l5.5.
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. !l5.5(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. !l5.5. A breach of the contract
clauses in 29 C.F.R. !l5.5 may be grounds for termination of the contract, and for debarment as a
contractor/subcontractor, as provided in 29 C.F.R. !l5.12. Labor standards interviews/investigations
shall be made as necessary to assure compliance [29 C.F.R. !l5.6(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 SUB RECIPIENT will be required to:
a) Abide by the terms above in statement 1.
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b) Notify appropriate officials of SUBRECIPIENT and CITY officials of
any criminal drug statute conviction for a violation occurring in the workplace not
later than five days after such conviction.
3. The CITY and the United State Department of Housing and Urban
Development will be notified within ten days after receiving notice of any such violation.
4. Within 30 days ofreceiving such notice, appropriate personnel action will be
taken against such employee, up to and including termination.
Each such employee shall be required to participate satisfactorily in a drug abuse
assistance or rehabilitation program approved for such purposes by a federal, state or local health,
law enforcement, or other appropriate agency.
II. CITY'S OBLIGATIONS
A. Pavment of Funds. Upon execution ofthis Agreement by SUB RECIPIENT, CITY shall
pay to SUBRECIPIENT from CDBG funds, when, if and to the extent received from HOD, for
CITY's 2006-07 CDBG program year amounts expended by SUB RECIPIENT in carrying out said
program for fiscal year 2006-07 pursuant to this Agreement up to a maximum aggregate payment
of Five Thousand Dollars ($ 5,000) in installments determined by CITY. Payments shall be made
to SUBRECIPIENT through the submission of invoices on a quarterly basis (October, January, April
and July) in a form prescribed by CITY, detailing such expenses. CITY shall pay such invoices
within thirty (30) days after receipt thereof provided CITY is satisfied that such expenses have been
incurred and documented within the scope and provisions of this Agreement and that
SUBRECIPIENT is in compliance with the terms and conditions of this Agreement.
B. Audit of Account. CITY shall include an audit of the account maintained by
SUBRECIPIENT in CITY's annual audit of all CDBG FUNDS in accordance with Title 24 of
the Code of Federal Regulations and other applicable federal laws and regulations.
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 ofthe
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 ofthe
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 SUB RECIPIENT within a
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reasonable period of time after being notified by the CITY, contract suspension or termination
procedures will be initiated.
III. NONDISCRIMINATION
SUB RECIPIENT 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-IIO, SUB RECIPIENT 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 SUB RECIPIENT to CITY regarding any
changes or modifications to its board of directors and list of officers.
V. SPECIAL CERTIFICATION FOR RELIGIOUS ENTITIES
If SUB RECIPIENT is a religious entity, SUB RECIPIENT hereby agrees that in connection
with the provision of the services SUBRECIPIENT shall provide with CDBG funds, in accordance
with 24 CFR 570.200(j):
A. SUBRECIPIENT shall not discriminate against any employee or applicant for
employment on the basis of religion and shall not limit employment or give preference in
employment to persons on the basis of religion.
B. SUBRECIPIENT shall not discriminate against any person applying for the services
SUB RECIPIENT agrees to provide under the terms of this Agreement on the basis of religion and
shall not limit such services or give preference to applicants for such services on the basis of
religion.
C. SUBRECIPIENT shall NOT provide religious instruction or counseling, conduct
any religious worship or services, or engage in any religious proselytizing, or exert any religious
influence in the provision of the services in said program. The parties agree that this covenant is
intended to and shall be construed for the limited purpose of assuring compliance with respect to the
use of CITY funds by SUB RECIPIENT 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.
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D. Where the services to be provided under said program are rendered on property
owned by the primarily religious entity SUB RECIPIENT, CDBG funds may also be used for minor
repairs to such property which are directly related to the cost of rendering the services under said
program, where the cost constitutes in dollar terms only an incidental portion of the CDBG
expenditure for rendering the services under said program.
VI. PROHIBITION OF NEPOTISM
SUBRECIPIENT agrees not to hire or permit the hiring of any person to fill a position
funded through this Agreement if a member of that person's immediate family is employed in an
administrative capacity by SUBRECIPIENT. For the purposes of this section, the term "immediate
family" means spouse, child, mother, father, brother, sister, brother-in-law, sister-in-law, father-in-
law, mother-in-law, son-in-law, daughter-in-law, aunt, uncle, niece, nephew, stepparent and
stepchild. The term "administrative capacity" means having selection, hiring, supervisor or
management responsibilities.
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:
Zamara V. John
Supervisor
CHCADA-La Familia
1905 N. College
Santa Ana, CA 92706
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
SUB RECIPIENT 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 SUB RECIPIENT 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 SUB RECIPIENT'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
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A. Upon the expiration ofthis Agreement, SUB RECIPIENT shall transfer to CITY any
CDBG funds on hand at the time of the expiration of this Agreement as well as any acconnts
receivable attributable to the use ofCDBG funds. [24 CFR 570.503(b)(8).]
B. Any real property nnder 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 oftime as determined to be appropriate by CITY; or
2. If not used in accordance with subparagraph A above, SUBRECIPIENT
shall pay to CITY an amonnt 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 nnder 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 nnit 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 nnit 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 herennder, 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 SUB RECIPIENT'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 herennder or thereof.
SUB RECIPIENT'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
12
5105
survive the date of termination of this Agreement for such period of time as CITY and/or HUD
deems necessary for the responsibilities, duties and obligations to be performed and completed to
the satisfaction of CITY and HUD.
XII. TERMINATION
A. This Agreement may be terminated on thirty (30) days' written notice by either
party. In the event of such termination, SUBRECIPIENT shall only be entitled to reimbursement
for approved expenses incurred to the effective date of termination.
B. This Agreement may be suspended or terminated by CITY upon five (5) days'
written notice for violation by SUBRECIPIENT of Federal Laws governing the use of Community
Development Block Grant Funds. In the event of such suspension or termination, SUBRECIPIENT
shall only be entitled to reimbursement for approved expenses incurred up to the effective date of
suspension or termination.
C. Pursuant to 24 CFR 85.43, in the event SUBRECIPIENT defaults by failing to fulfill
all or any of its obligations hereunder, CITY may declare a default and termination of this
Agreement by written notice to SUBRECIPIENT, which default and termination shall be effective
on a date stated in the notice which is to be not less than ten (10) days after certified mailing or
personal service of such notice, unless such default is cured before the effective date of termination
stated in such notice. If terminated for cause, CITY shall be relieved of further liability or
responsibility under this Agreement, or as a result of the termination thereof, including the payment
of money, except for payment for approved expenses incurred for services satisfactorily and timely
performed prior to the mailing or service of the notice of termination, and except for reimbursement
of (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 SUB RECIPIENT 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 XILA.
through XILE., inclusive, SUBRECIPIENT agrees to immediately return to CITY upon CITY's
demand and prior to any adjudication of SUB RECIPIENT's rights, any and all funds not used, and
to comply with paragraph "XL REVERSION OF ASSETS" of this Agreement.
XIII. LIMITATION OF FUNDS
13
5/05
The United States of America, through HUD, may in the future place programmatic or fiscal
limitations on the use ofCDBG funds which limitations are not presently anticipated. Accorclingly,
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 cliscretion,
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 SUB RECIPIENT's use of
both its uncommitted and its unspent funds. Where HUD has clirected or requested CITY to
implement a reduction in funding, in whole or as to a cost category, with respect to funcling 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, SUB RECIPIENT shall be permitted to de-scope
accorclingly. Where CITY has reasonable grounds to question SUB RECIPIENT's fiscal
accountability, fmancial 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
SUB RECIPIENT of its intention to so act, pending an auclit or other resolution of such questions.
In no event, however, shall any revisions made by CITY affect expenclitures and legally binding
commitments made by SUB RECIPIENT 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
marmer 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 ofthe State
of California, and all applicable federal laws and regulations.
XVI. VALIDITY
The invaliclity in whole or in part of any provision of this Agreement shall not void or affect
the valiclity of any other provision of this Agreement.
XVII. MISCELLANEOUS PROVISIONS
14
5/05
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
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.
/
A!!~ST:_) /
/ / ~.
/ ", ,
/ p, ....
. ? /
, "/~/~- \\
PATIUCIAE.HEALY 'v
Clerk of the Council
CITY OF SANTA ANA
~.
,d;..:J~ '~~~ '0.-
.... DAVID N. REAM I L
City Manager
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
c~.~ {.-:;gt~
By: LISA E. STORCK
Assistant City Attorney
SUBRECIPIENT:
DATE: /O/;-S!oC/.
I t
16
City of Santa Ana
Community Development Block Grant
Scope of Work
Name of Organization- CHCADAlLa Familia-Palomitas
Name of Funded Program- Palomitas
Annual Accomplishment Goal
I. Total number of un duplicated clients (Santa Ana and Non-Santa Ana Residents) anticipated to be served by
the funded program, named above, during the 12-month contract period.
12PERSONS
II. Number of only unduplicated Santa Ana residents to be served by the funded program, named above,
during the 12-month contract period.
12PERSONS
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 goal is to provide new innovative ways to empower Santa Ana Latino Communities and particularity to those in single
household at those exposed to domestic violence and child or subtance abuse, to emotionally oa dphysically cope with their varying
situations. Currently, many nofthese children and their sutodial and non-custodial parents have no idea how to lead normal
emotionally healthy lives. This program is designed tp give them these survival tools and concentrate on the children in order to
overcome the cycle of despair and violence.
La Familia will assist in providing the necessary survival tools to be able to function on families that are high rise of abuse-physical,
verbal, emotional, sexual, harmful to self or any family member. CHCADAlLa Families provides a safe, educational enviorment
with experienced and highly trained personnel.
The curriculum is a 10 weeks session encompasses cultural issues, child growth and development coping with abuse and neglect,
communication skills, anger management, discipline techniques, power and respect, parental identity, subtance abuse issues and
family dynamics.
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.
Funds will be used for Salaries and rent atrributed to the program.
Exhibit A
Page I of2
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 I: Julyl - September 30
Quarter 2: October! - December 31
Quarter 3: January I - March 31
Quarter 4: April I - June 30
~Persons
~Persons
~Persons
~Persons
----.lLTotal number of un duplicated Santa Ana residents to be
served. (Must equal the number for II above.)
Schedule ofInvoicing
Estimate the amount of grant funds to be requested during the 12-month contract period on a quarterly basis.
Quarter I: July I - September 30
Quarter 2: October I - December 31
Quarter 3: January I - March 31
Quarter 4: April I - June 30
$1250
$1250
$1250
$1250
$6857Total Grant (Must equal the Total Program Budget indicated
on Exhibit B.)
Exhibit A
Page 2 of2
CITY OF SANA ANA
Community Development Block Grant
Outcome Tracking
IMPORT ANT: 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".
Fulfillment
Tracking HUD Objective to be fulfilled HUD Outcome to be fulfilled illustrated by
HUD Indicator
Suitable Creating Specific Outcome
Activity/Program Outcome Tracking Goal Living Decent Economic Availability/ Affordability Sustainabili~ Indicator #
Housing Accessibility (Please see page 4
Environment Opportunitie of4fordesc.)
nti-CrimeSel"liices rack the reduction in Reduce response lime to
response time and the serious crimes inthe City's
number of criminal Low- and Moderate-Income
D pprehendedas are.ull. area by at least J minutes
re:iulting in the apprehension 2
ofl,SOOcriminals that may X X
otherwise escape.
.uS~yeargoaltobe
achieved by FY09!lO
Fair Housing Sel"liices Provide fair housing servi.e I. Provide fair housing
and ongoing analysis of oounseling,edu.ationand
impediments to fair housing. nforcementsel"liicesto
D 7,000 Santa Ana households. X X 2
...S-year goal to be
achievedbyFY09!1O
2. Annually assess ""tions to
eliminateimpedimentstofai X X 2
housing.
llomelessnessPrevention Tr""k assisted individuals =0 of assisted individuals
who retained their housing or households will retam
utilities for at least 6 months heir housing or utilities for 14
D after assistance was at least 6 rnonths all:er X X
rovided assistance is provided.
Emergen.yShelter Track individuals who SU%of
received support services individuals/householdsthat 12 or
that were linked to one or are provided wilhemergency
D more additional support helter will transition 10 X X
serviceandlorappropriate interim housing (i.e., 13
housing. ransitionalhousing).
ransilionalHousing rack homeless individuals S%ofhomelessindividuals
who participated in participating in transitional 2
transitional housing program housing program will be X X
0 that were pl""ed in pl""ed in permanent housing.
permanent housing.
SupportiveSel"liices Tra.k individuals who SO%ofindividuals1families
received support services receivingsupporlservices
tbatwere Iink.ed to one or ~ibelinkedtooneormore 2
D more additional support ,tionalsuPPorlservice X X
l"Iii.eandlorappropriate andIorapprupriatehousing.
oUSlng.
Exhibit A-I
Page I of 4
Fulfillment
illustrated by
Trackinl! Hun Obiective to be fulfilled Hun Outcomes to be fulfilled Hun Indicator
Suitable Creating Specific Outcome
Decent Availability/ Indicator #
Activity/Program Outcome Tracking Goal Living Housing Economic Accessibility AffordabiJity Sustainabilit) (Please see page 4
Environment Opportunitie of 4 for desc.)
eniorServices I. Track assiste<.l senior I. 80"/0 of assisted senior
'iti:rens that remaine<.l citizens will remain
0 independent for at least I independent for at least 1 X X 2
ear aller services were yearafier services are
rovided provided.
2. Track seniors receiving 2. 90% of seniors receiving
referrals that were linked to referrals will be linked to the
D the services sought. servicessoughl. X X 2
wner-O<;cupied NumherofoWllersassistell Physical safety and comfort
Housing Rehabilitation to rehabilitate lheir primary will be improved for Low
residence for the following and Moderate income
income categories: ouseholdsbyimproving
D -Extremely Low Income omes to a level lhal meets 9
-Very Low Income rexceedsHUDhousing X X
-Moderate Income ualitystandards.
SJl<"'ial Needs Categories
-Large Families
Frail Elderly Services racklrailelderly 0% of frail elderly
individuals that were linked individuals will be linked to 2
0 otheservicessought. heservicessougbt. X X
Disabled Services Track disables persons Support independent living
whose independent living for 90% of disabled persons 2
D was supported by City funds. assisted by City funds. X X
ervices for Mentally III Track inllividuals assisted 100% of individuals assisted
with City resources that were with City resources will be
[8J provided an entry point into provided an entry point into 2
lheregionalmentalhealth he regional mental health X X
care system and linked to at . resystem and linked to at
least one additional mental least One adtlitional mental
health supportive service. health supportive service.
ervicesforSubstance rack how many individuals Provide entry into the
ddicled wilh substance addiction in regional recovery system for
were provided an enrry into 25individualswilh
the regional recovery system substance addiction and link
D and linked to additional em to additional services. 2
services. X X
*n5_yeargoal to be
chievedbyFY09flO
outhServices I. Track improvement in 1. Foreducation-hased
pre-test,post-testscores. programs,improvepte-test 2
D post_test scores by 50"/0 X X
2. Track number of 2. Provide opporiunities for
0 individuals exposed to the xposuretothefinearts. X X 2
fine arts.
0 3. Trackchildrenfyouth 3,90%ofchildrenfyouth
seeking referrals thai were seeking referrals will be X X 2
linked to the services sought. linked to the services soughl.
Low_and Moderale- Trdck program participants 90"10 of program participants
Income Services that were linked to services will be linked to services 2
sought. ugh!. X X
0
Exhibit A-I
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.
Program perfonnance is measured by a avariety of methods. Internal audits are conducted to assess programmatic and fiscal areas such
as scheduling, client files, facility environment, etc. Based upon an assessment conducted by the staff a service plan will be created that
will specify the services to be received. counseling in the areas of Subtance Abuse, Anger Management, Child Development, Pareting,
and other areas will be provided. Case file intake data and exit client satisfaction data will be used to assess outcomes. Pre and Post test
will be conducted.
Exhibit A-I
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) N umber 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-I
Page 4 of 4
Organization Name
Program Name
Cate 0
Administrative Staff
Salaries & Benefits
Program Staff Salaries &
Benefits
Contractual/Professional
Services: List below
2
3
Office Su lies
Rent
Communications
Utilities
Insurance
Other:List below
FacmtY~Cleningand
MainfenanCe
2
3
4 Activities
5 Indlr'ectExpEinS&
Total
Exhibit B
Program Year 2006-2007
Final Budget
CALIFORNIA HISPANIC COMMtSSION ON ALCOHOL AND DRUG ABUSE, INC.
CDBG-PALOMITAS
Expenditures
Expenses Funded by Expenses Funded
Santa Ana CDBG b Other Sources
Total Program
Bud et
Total Organizational
Bud et
$
$
$
5,000 $
3,300 $
8,300 $
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 $ 5,000
LDVP-OC-Non Discretionarv Fund from $
Domestic Violence Proaram I
~
~
Total Funds for Program $ 8,300
Exhibit B
Page 1 of 1
2006-2007 Funded Personnel
Name of Organization:
Name of Program
CALIFORNIA HISPANIC COMMISSION ON ALCOHOL AND DRUG ABUSE, INC.
CDBG-PALOMITAS
ADMINISTRATIVE STAFF
Position Title Annual Annual Total CDBG Funds % of time Of this time % of Total
Salal)' Benefits Compensation Requested for spent on percent of Compensation
this position funded time serving Eligible
nrooram Santa Ana
I.~ - $ - $ - 0%
1$ - $ - $ - ,- I 0%
$ - 0%
$ - 0%
$ - 0%
$ - 0%
$ - -. ~ 0%
$ - 0%
$ - 0%
Total Amount Reauested $ -
Must equal amount indicated on Exhbit B
PROGRAM STAFF
Position Title Annual Annual Total CDBG Funds % of time Of this time % of lata 1
Salal)' Benefits Compensation Requested for spent on percent of Compensation
this position funded time serving Eligible
nroQ"ram Santa Ana
ProiectDirecto( $ 80 000 $ 24 920 $ 104 920 1$ 1049 10C ~ 1%
SUherVisorlCol.ltlselo( $ 40 000 $ 12460 $ 52 460 1$ ,----,m 5%
$ - 0%
$ - 0%
$ - 0%
$ - 0%
- $ - - - 0%
$ - 0%
$ - -- 0%
Total Amount Reauested $ 3,672
Must equal amount indicated on Exhbit B
CONTRACTUAL/PROFESSIONAL SERVICES
Position Title Annual Annual Total CDBG Funds % of time Of this time % of Total
Contract Benefits Compensation Requested for spent on percent of Compensation
Amount this position funded time serving Eligible
nrovram Santa Ana
$ - 0%
$ - 0%
$ - 0%
$ - ~ 0%
I $ - 0%
$ - - - 0%
$ - 0%
I $ - 0%
$ - 0%
Total Amount Reauested $ -
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-1
Page 1 of I
Exhibit B-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:
(I) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with the awarding of any Federal
contract, the making of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any Federal contact, grant, loan or cooperative
agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with this Federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure
Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be 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.
Calif. Hispanic Commision on Alcoholism in Drug Abuse
Grantee/Contactor Organization
CDBG-PALOMITAS
Program Title
JAMES Z. HERNANDEZ
Name of Certifying Officer
Ib;)<) 6lt
Dae
EXHIBIT C
Page I of2
SUBRECIPIENT warrants the following:
I. SUBRECIPIENT will comply with Public Law 88-352, Title VI of the Civil Rights
Act of 1964 (42 U. S. C. section 2000 et seq.) and implementing regulation in 24 CFR
Part I.
2. No person in the United States shall on the ground of race, color, religion, national
origin, or sex, be excluded from participation in, or be denied the benefits of, or be
subjected to discrimination under any program or activity funded in whole or in part with
community development funds made available pursuant to the ACT.
3. All laborers and mechanics, employed by contractors or subcontractors in the
performance of construction work financed in whole or in part with community
development funds shall be paid wages at rates not less than those prevailing on similar
construction in the locality as determined in accordance with the Davis-Bacon Act, as
amended, 40 U. S. C. Sections 276 a 1-5, except for individuals who perform services for
which they volunteered; do not receive compensation for such services; or are paid
expenses, reasonable benefits, or a nominal fee for such services; and are not otherwise
employed at any time in construction work.
4. SUB RECIPIENT will comply with all Federal statutes applicable to projects funded
with community development funds, except that (a) SUB RECIPIENT does not assume
CITY'S environmental responsibilities described at 24 CFR 570.604; and (b)
SUB RECIPIENT does not assume CITY'S responsibility for initiating the review process
under Executive Order 12372.
EXHIBIT C
Page 2 of2
.
.
o
ACORD~ CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
6/30/2006
PRODUCER (916) 784 9070 FAX (916) 784-0158 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
All-Cal Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
801 Riverside Ave. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 105
Roseville CA 95678 INSURERS AFFORDING COVERAGE NAIC.
INSURED INSURERA:.Nonprofits Ins Alliance
California Hispanic Commission On INSURERB,NORTH AMERICAN ELITE
Alcohol & Drug Abuse INSURER c:
2101 Capitol Ave INSURER 0:
Sacramento CA 958 16- INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VV1TH RESPECT TO WHICH ntlS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN.
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1$ SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ~~~~ PCMJ~REFFECTJVE poucl,FPlRAnON LIMITS
LTR TYPE OF INSURANCE POUCY NUMBER DATE MMlDDIYV) DATE MMlDDiYV)
~ERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL UABILlTY ~~~~J?E~~\ $ 50,000
A X I CLAIMS MADE ~ OCCUR 2005-03026 11/18/2005 11/18/2006 MED EXP (Any one oerson) $ 5,000
X IMPROPER SEXUAL COND PERSONAl & ADV INJURY $ 1,000,000
1,000,000/1,000,000 GENERAL AGGREGATE $ 2,000,000
-il'~AGG~n ~::~ nE~ PER: PRODUCTS - COMPIOP AGG $ 2,000,000
X POLICY JECT LOC PROFESSIONAL LIAB 1,000,000
~TOMOBlLE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
~ Am' AUTO (Eaaccident)
A X AlL OVVNED AUTOS 2005-03026 11/18/2005 11/18/2006 BODILY INJURY
t- (PerpersOl'l) $
SCHEDULED AUTOS
i HIRED AUTOS BODilY INJURY $
NON-QVllNED AUTOS {Per accident)
I-- PROPERTY DAMAGE $
(Peraccidenl)
r=iAGE UABILJTY AUTO ONLY - EA ACCIDENT $
Am' AUTO '. .,. OTHER THAN EA Ace $
., , '" . ," " "" AUTO ONL V: AGG $
,
EXCESSlUMBRELLA L1ABllJTY c.L; (1 EACH OCCURRENCE $
tJ OCCUR 0 CLAIMS MADE !-vJ ~_~. .~ $
-,.,. /...6. . AGGREGATE
-
Vc .Cd '0 $
. . '-''->-'j
R ~EDUCTlBLE ;: '~.jl,:;L '. , $
,-_.,t\-' ."\1;;-- "
RETENTION $ $
WORKERS COMPENSATION AND I WC~TATU., I 10lli.
TOR LIMITS ER
EMPLOYERS' UABILITY
AW( PROPRIETORJPARTNERJEXECUTIVE E.L EACH ACCIDENT $
OFFICERlMEMBER EXCLUDED? E.l. DISEASE. EA EMPLOYEE $
If yes, desabe under E.L DISEASE - POLICY LIMIT $
SPECIAl PROVISIONS below
B OTHER EMPLOYEE DI:SHONESTY CWB 000 2271 03 03026 11/18/2005 11/18/2006 LIMITS 100,000
FORGERY/ALTERATION OEDUCTIBLES 500
DESCRIPTION OF OPERATIONSJLOCA11ONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVIStONS
THE CITY OF SANTA ANA COMMUNITY DEVELOPMBNT AGENCY, ITS OFFICERS, AGENTS, OFFICIALS, EMPLOYEES AND VOLUNTEERS ARE
NAMED ADDITIONAL INSURED AS A FUNDING SOURCE. FORM CG 2026 APPLIES. *10 DAYS FOR NOTICE OF CANCELLATION FOR
NON-PAYMENT OF PREMIUM
CERTIFICATE HOLDER
THE CITY OF SANTA ANA
COMMUNITY DEVELOPMENT AGENCY
ATTN: FRANK HERNANDEZ
20 CIVIC CENTER PLAZA
SIXTH FLOOR
SANTA ANA, CA 92702
CANCELLATION
SHOULD AtfY OF TIlE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATtON DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN N011CE TO TIlE CER11F1CATE HOlDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHAll IMPOSE NO OBUGATION OR llABIUN OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPR
AUTIlORlZED REPRESENTATTV
ACORD 25 (2001/08)
INS025 (0108).06 AMS
e . .L LVMP Morlgag& Solutions, Inc. (800)327-0545
,
POLICY NUMBER: 2005-03026
COMMERCIAL GENERAL LIABILITY
CG 20 26 0704
ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSONS OR ORGANIZATION
This endorsements modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Named Of Additional Insured Person(s) Or Organization(s)
Any person or organization that you are required to add as an additional insured on this policy ~ under a written
contract or agreement currently in effect, or becoming effective during the term or this policy, and for which a
certificate of insurance naming such person or organization as additional insured has been issued, but only
respect to their liability arising out of their requirements for certain performance placed upon you, as a nonprofit
organization, in consideration for funding or financial contributions you receive from them. The additional insured
status wilJ not be afforded with respect to liability arising out of or related to your activities as a real estate
manager for that person or organization.
THE CITY OF SANTA ANA, ITS OFFICERS, AGENTS, OFFICIALS, EMPLOYEES AND
VOLUNTEERS.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II - Who Is An Insured is amended to included as an additional insured the person(s) or
organization(s) shown in the Schedule, but only with respect t liability for "bodily injury", "property
damage" 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 behalf:
A. In the performance of your ongoing operations; or
B. In connection with your premises owned by or rented to you.
v
CG 20 26 07 04
Copyright, Insurance Services Office, Inc., 1997
Page 1 oft
~.z6
o
ADDITIONAL INSURED ENDORSEMENT
Insurance Company l\ 11_("'", 1 Tnc:nr"nr" Aqpnry
This endorsement modifies such insurance as is afforded by the provisions of Polley
# ?nn<; n'1n?f; relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California
92702; its officers, employees, agents and volunteers are named as additional insureds
("additional insureds") with regard to liability and defense of suits arising from the
operations and uses performed by or on behalf of the named insured.
2. With respect to claims arising out of the operations and uses performed by
or on behalf of the named insured, such insurance as Is afforded by this policy is
primary and is not additional to or contributing with any other insurance carried by or for
the benefit of the 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 of liability. 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 additional insureds, this insurance shall not be
canceled, or materially reduced in coverage or limits except after thirty (30) days written
notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana,
California 92702.
(Completion of the following, including countersignature, is required to make this
endorsement effective.)
Effective
.Inn" JO. 7.00fi
, this endorsement form as a part of
Policy # ?nn<; 01nn
Issuedto (,,,lifnni,, Hi"p"nir rnmmi""ion On Drug & Alcohol Abuse
Named Insured
Countersigned by
~~
thorized Re~
~5b
ACORD," CERTIFICATE <... WORKERS' COMPENSATION _ JVERAGE I DATE (MMIOOIYY)
6/27/2006
THIS CERTlFICAlE IS ISSUED AS MATTER OF INFORMATION ONLY
PRODUCER AND CONFERS NO RIGHTS UPON THE CERTlFICA lE HOLDER.
Driver Alliant Insurance Services, Inc. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
The Transamerica Pyramid COVERAGE AFFORDED BY THE POLICIES BELOW.
. th
600 Montgomery Street, 9 Floor INSURERS AFFORDING COVERAGE
San Francisco, CA 94111
Phone: (415) 403-1400 Fax: (415) 402-0773
INSURED INSURER A: NonProfits' United Workers' Compensation Groutl
INSURER B: Insurance Corooration of Hannover
California Hispanic Conunission on Alcohol & Drug Abuse, Inc. INSURER c:
2101 Capito' Avenue INSURER 0:
Sacramento, CA 95816
INSURER E:
COVERAGES This Certificate is not intended to specify all eodorSemenlS. coverages, lenns, conditions and exclusions of the policies shOwn_
THE POliCIES OF INSURANCE LISTED BELOW HAVE BEEN lSSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER FOUCY POUCY LIMITS
LTR EFFE~E DDIY'Yl EXPIRATtoM
DATE MM/D DATE
GENERAL UABIUTY EACH OCCURRENCE S
COMMERClAl GENERAlllABIUIt FIRE DAMAGE (Any one lire) S
I CLAIMS MAnE I I OCCUR MED EXPENSE (hlyone ~ S
PERSONAL & ADV INJURY S
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-GOMPJOP AGG $
POLiCY I I ~:g; I IlOC
AUTOMOtULE LIABILITY COMBINED SINGLE LIMIT S
ANY AUTO (Ea accident) $
ALL OWNED AUTOS BQOIL Y INJURY S
SCHEDULED AUTOS (per person) S
HIRED AUTOS BOOIl Y INJURY S
NON-DWNED AUTOS (Perllcddent) $
PROPERTY DAMAGE S
(Perllccident) $
GARAGE UABIUTY ~- AUTO ONL Y-EA ACCIDENT $
I ANY AUTO -7 OTHER THAN I EA ACC $
AUTO DNL Y~
I I AGG S
EXCESS UAB'Ul'Y If EACH OCCURRENC $
OCCUR I I CLAIMS MAOE AGGREGATE $
$
DEDUCTIBLE S
RETENTION
WORKERS' COMPENSATION AND I WC STATU- I X I OTH-
EMPLOYERS UABIUTY TORY LIMITS ER
NPU. WCGOO-2006 2/1/2006 1/1/2007 E.L EACH ACCIDENT S 500,000
A
E.L. DISEASE - EA EMPLOYEE . 500,000
E.L DISEASE POLICY LIMIT , 500,000
OTHER
B Excess Worker's Compensation H35.Q402601 2/1/2006 1/1/2007 S25, 000,000 x S5oo,ooo
DESCRIPTION OF OPERATIONSIlOCATk)NS/VEHJCLES/EXClUSK>NS AODED BY ENOORSEMfNTISPECIAl.lPROVISlONS
Evidence of Coverage of Workers' Compensation
CERTIFICAlE HOLDER 1 ADOrOONA1.INSURfD; INSURER LETTER: CANCELLATION
SHOUlD MY OF THE ABOVE DESCRIBED POlICIES BE CANCELLED BEfORE THE EXPIRATKlN
NPU-CHCADA.(l1O DATE THEREOF. TltE tsSUING iNSURER WILL ENDEAVOR TO MAIl---12- DAYS WRITTEN NOTICE
City of Santa Ana - CDBO Palomitas
Community Development Agency TO THE CERTIFICATE HOlDER NAMED TO THE LEfT, aUT FAILURE TO 00 SO SHALL IMPOSE NO
20 Civic Center Plaza, 6th Floor OBLIGATION OR UABllITV OF />H'i KIND UPON THE INSURER, ITS AGEHTS OR
Santa Ana, CA 92702 REPRESEHTATIVES. 1--7 '^ J -...
A TIN: Frank Hernandez AUTI-lQR\ZED REPRESij "ATft~ft. ( .Y+
ACORD 25-S (7/97) -- @ACORD CORPORATION 1988
TO:ICSG\OOC\MASTERSICO':rt.ificat<: Qf Liabi\ity IfflUf'all1:.O': ACORD25-S.1
e-~.
cl"-E _ e. __ _- :n:n -nL,L_~ nL _I<~tlnntv~.c -.._ _,~.._ _ _
PpooucEp (8161 784-907D FAX: (9161784-0158 THIS CERTIFICATE Is IssVEU As A MA77ER DF INFORMATION
All-Cal Insurance Agency r T~~~ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
p.2~6 QQE "IJVb HOLDER. TRIS CERTIFICATE DOES NOT AMEND, EXTEND OR
801 Rlvereide Ave ~^ gOQb_~~ ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 105 G
Aosav i11e CA 95698 INSURERS AFFORDING COVERAOE NAIC p
INSURED INSURER w~CsRANITE STATE INSURANC£ _
CALIBOANIF. Hi SPANK CONFIISSION INSURERV GENERAL STAR INDENIIdITY CO i
ON ALCOHOL E DAUG ABUSE, INC. wsuREkc
2101 CAPTTOL AVENUE INSURERu
'~SACAAMENTO CA 95816 1NSUREkE
COVERAGES
fHt YULIGItt V` 1NSUNANCE LISTED BELOW HAVE BEEN INSUED TD THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
AEDUIREM'eIJT, TERM OR CONDITION O: ANY CONTRACTOR OTHER DOCUMENTWITH RESPECT TO WHICH 7M1$ CERYIPICATE MA1' $E ISSUED OR MAY PERTAIN.
THE INSURANCE AFFORDED 8Y THE PO~JOIE$ DESCRIBED HEREIN I$ $VBlEC7 TO ALL THE TERMS, E%ClU$IOPI$ AND CONDITIOINS OF SUCH POLICIES
AGGRE AT IMIT6 HOWN F N RFquf.FO RY PAID Cl AIMR
RY6R
Wt {{~~
D
E M
E
Y
P
P
1 N
TYPE OF INSURaHCE PDEIOY NUMBER AT
N
DDNY D
TE MMIDM LIMITS
A X GENERAL UaeIUTY 02Lx137375700D0 11/18/2006 11/18/2007 ~ ., p^ RRENCE s 1,000, OGO
X COMMERCIa~ GENEPAI LIABILITY
~ OAN~RGE TO RENTEp
PkFMISFr, Fa nrru~.mrn
S 200 , 000
I X I
CLAIMi MADE J OCCUR 1 MEb ta° M ane er5pl S 10, 000
la` PROFESSIONAL IIRH.
F-J + PFRRt~NA1 AA VINI RY $ 1,OOD, DOD
1, 000, 00013,9D0,900 GENENAL aGGkEGATE S 3, 0OO, ODO
fN'
AGGREGa7
'lNMi APP
IE
PER
i D
.
c
L ; PRppU: TS~COMPipn AGG ~ 3,000,000
I X POLIC FN~ I.O:' SEXUAL ABU3L/HOLEBT 1, D00, 000
A 'AUrbMDBILE LMDRm D2CA534b04900W 11/18/2D06 1 11 /18/2007 ODMBINFO SMlGLE LMIrt
+ I X ANY AI!TC ~ tEa acnamr, b 1,000,000
~ ALL OWNEtr A'J I(1 BpDrIY USJURY
SCNEDUIED AUTOg I IPE'PBfYON S
X MIRED AVTDg T~ T~
APPFtOV~DA Lf 7~~1
TO FOlU• } BODILY IPAILIRV
>
P S
X HDIA~OWN[D AUTOS CB btu0[011
PROPERTY DAMAGE
S
IP[r plGaC,lll
caRacEUAB/urr ASS1St811t Cl Attorney ~ Aur n r- accl NT s
J ~~~AN°qNU , CTH'ek THaN PAaff. 5
AUTO ONLY
AGG S
H EE6NMERELU LIA81{.ITY SXC 402973
'~E%~C 12/1/06 11/28/07 F r nfru pvl F 4, OOG,000
I
I ^ I DCCVR ~ C
AIM
A
L
3 M
DE
I- AGI' [: TF 5 4 , 000 , O00
S
UEWCIIHLE
o S
Y. RETINnbM ic,ooa .1 Zd s
' WpRRER6 DDMPPNSATIDN AND V I L f S Tt . p N.
EMPLOYERS' LIABILITY ~
(~ CA V l.v rT
ANY PRDPRIETDwPMTNEPJEAECUrreI (~
•`~U9I c:_[ACN ACUDErsr [
OFF]C£WMEMBER E%CLUDEU"~
Ilytt
oacnE[oNe, EL OISF.A$F. - FA EYPIOYEE S
.
. IAPF<JA' uk!1 Rm4u~
E-P 'Y IMIT
5
p OTRER EN.PLOYEE THEFT 02LX15737570D00 11/18/2D06 11/18/2007 LZHITB 100,000
FORGERY/ALTERATIONS
DEDV:TInt6E 1,000
DE6GRIPTION pF OPEMTION61lOCATIONENENICIEElE%CLUSIONg ADpEO BY ENOORSFMENT/BPECIAL PROVIgIONg
THE CTTY OF BANTA ANA, ITe Ob'FICTR8, AGERTB, OYTIOIALS, El1PLOYEEb, AND VOLVNT'CEAS ARE NAMED ADDFTIONAl iNBVRLTD AS A
I FUNDING SOURCE AEGARbING TNL OPEAATIONH OF THE INHUF$D UNDER TNi6 ALAERE~N?, FORM CG ?0 26 OT 04 APPLIES
I •IG DAY NpTICE OF CANCELLRTION FOR NON-PATn~FT OF PREISIUM
CFQTIFICG TC HAf nFV
gNOUlO ANY OP THE ABOVE DESCRIBED PbLIGEg BE CAHC
E
I
ED
I
e
Ef
OR
E THE
CITY OF SANTA ANA y
~
y
[
y y
y
~
y
E%PIRATION DATE THEREOF, THE ISSUING INSURER WILL 9M1LA[YATC,I{F\ M
AR
20 CIVIC CENTER PLAZA VV
YY
3O DAYS WRITTEN NDTIGF TO THE CERTIFICAtk HOLDER NAMED TO THE LEr•T
BycX
P.O. BOX 1988 ,
YKiXdfX~~'o"BYuKY~1Gi6~y~E,XL~o~41G1(iSuKeX
?E,1Cd6)L~Gi4dSiK3fJ6iCl4i€
SANTA ANA, CA 92702 ,
?6~ieYr+`6AtF~E>1SeE~1Ei(dla~.WYI (~~
AUTHOAILEO AEPAEHENTATIVF j ' r -
nwu+t. (smulVD) I ~ OACOR, D'~} RA~19S8
INS0251moe)ue AM$ (_E7n W'dleu nwwer FlnenaAl9emces I `VT ~ Pay,, ~,
V
e ~ e~ u r 19b YtlS:'I E.L.,-~ HL iiv~~nrow..c
ADDITIONAL INSURED ENDORSEMENT
EXHIBIT B
r ..-
~,
tnsuranceCOmpany f = ~Y(~p-~,1~"{~~, ,'~~~~U IY],,1aV~Ytf'0
This endorsement modifies such insurance as is afforded by the provis;ons of Policy
# 0"~:-~c 1~1='t~.~ ~1f; relating to the following
The City of Santa Anz, 20 Civic Center Plaza. Santa Ana, California
9702, its officers, employees, agents and volunteers are Hamad as additional insureds
i"additional insureds") vrittr regard to liability and defense of Suits arising from The
operations and uses performed by yr on behalf o<the named insured.
2. With reaped to claims arising out of the operations and uses performed by
or on behalf of the named insured, such insurance as +s afforded by this policy is
pnmery and ;s not additional to Or Contributing witn any other insurance carded by or for
the benefit of the additional Insureds.
3. This insurance applies Separately to each insured agains# whom cla;m is
made or Sult Is Drought except with respell to the company's limits of liability. The
inclusion of any pereon or organization as an insured shall Hat effect any right which
such person or organization would have as a claimant 'rf not so included.
4. With respect to the additional insureds, this insurance shall not be
canceled, or materially reduced in coverage or limits except after thirty (30) days written
notice has been given to the City of Santa Ana. 20 Civic Center Plaza, Santa Ana,
California 92702.
(Completion of the following, including countersignature, is required to make this
endorsement effective.)
Effective 11 1 r; f"""J ~- fi~ ~ ;~l X~~ , tnis endorsement form as a part of
Policy# C,~JLk1~'Iz-1~5]~(~'~
Issued to
tU~, M1
"~\J
Insured
Countersigned by ~~ t- ~ , ~,~,.<
utharized Representatives
t) ~;~-
REGEIti'FL 06-06-'t~~ 15'13 FR0;7- 714E357~:,[a TO- ALL-CAL INSpRANCE PC~02/t~(a0
CERTIFICATE OF WORKERS' COMPENSATION COVERAGE
ACORD DATEn,,M;DB'Yti
Ir. I~ ~x?uul~
THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY
PRODUCER AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
Allimll Ltsulan~c tins Iles Ins COVERAGE AFFORDED BY THE POLICIES BELOW
The Transamerica PYaamid
600 MuulgomerV~ Street, 9°i Floor INSURERS AFFORDING COVERAGE
San Francisco, CA 941 1 I
Phone. (411)403-1400 Fax:(4Uj402-0773
INSURERA Nunl'ro(its United 14'urkers Com znsation Grou
INSURED
INSURER B' SafCI'NallOnal IRSUfanCC'COID aI1Y
1nC.
Dnlllll$EIDn OD AICO1101 g DFUg A~USe
I '
anlc L
IOrllla FI IS
I
,
.
I
p
U INSURERC
~ I1 r I Cuprtol Avonuz
wsuRER ^
Sucranrentu, l'4 95ti I n
INSURER E.
COVERAGES Tnc CeOJ¢ale is nol mlentletl lu spenly all entlorsemenls. coverages, leans. contlieons antl exclusions of :ne pobc,es snpwa
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING
ANY REQUIRE MEN' TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THtS CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, E%CWSIONS AND CONDITIONS OF SUCH
POLICIES AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS
INSR TYPE OF INSURANCE POLICY NUMBER POLICY POLICY LIMITS
LTR EFFECTIVE EXPIRATION
GATE (MNJDDIYY) DATE IMMIDD11'YI
GENERAL LIABILITY EACH OCCURRENCE 5
CDhIh1ERGIAL GENERAL LIABILITY' FIRE DAMAGE (Any one fuel F
CLAIMS ldAOE OCCUR MED EXPENSE iAV O,a persml S
PERSONAL 8 ADV INJURY 5
GENERAL AGGREGATE F
GE N'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG R
PRO-
POLICV JECT tOC
AD TOMORILf: LIABILITI COMBINED SINGLE LIMIT
(Ea acc,tlent) E
ANV AUTO S
ALL CWNED AUTOS BODILY INJURY'
P
r
erson) S
SCHEDULED AUTOS p
e
I 8
HIRED AUTOS BODILY INJURY
IPer aocitlent) 5
NON~OSMED FUTOS S
PROPERTY DAMAGE S
' (Per acatlen0
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
ANT' AUTO OTHER THAN
AUTO ONLY EA ACC 5
AGG 5
E%CESS LIABILITY EACH OGGURRENC S
OCCUF O_AIMS MADE AGGREGATE 5
b
DED.IC TIdLE S
RcTENT10N
WORKERS'COMPENSATION AND WG STATU- ~' OTH-
EMPLOYERS LIABILITY TORY LIMITS ER
NPU-WCGOU-2007 111/07 111/118 Et-EACH ACCIDENT sj00,000
A EL DISEASE-EA EMPLOYEE S?UO,000
E L DISEASE POLICY LIMIT g jOU,000
OTHER
R Gxcess ll'orAer's Cumpensalion SF-1 F81 CA 111107 L/I108 $2j, WO,000 x $500,000 WC
$500,000 xs $SOQ000 EL
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIE%CLUSIONS ADDED DV ENDORSEMENT/SPECIAUPROVISIONS
Lvldence of \Nolkcrs' Compensation Coverage
CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE OESCRIBEO POLICIES 8E CANCELLED BEFORE THE E%PIRATION
DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL BO DAYS WRITEN NOTICE
NPULHCADA-OOd TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL IMPOSE NO
('I[y Ot Septa Ana OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
1FU' OTI:fOrCC I ^ ve5[mCni .AdmmlSlrallOB REPRESENTATIVES.
IOOO F. SaI1LIl AR8 BOUICPafd, SWLC ~20I) AUTHORIZED REPRES ATIVE
Santa Ana, CA 92701 ~~ T
ACORD 25S (7197) - v eA~.vni+ a.vnr ~rw, wn
TO •.CSO`J~UC,MA4ERSCCrt~! aie of Liabifry Iruwanee ACORD25-5 1