HomeMy WebLinkAboutMONTELONE, SUE 1 - 2009INSURANCE ON FILE
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UNTIL INSURANCE EXPIRES
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CLERK OF COUNCIL
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AGREEMENT WITH
SUE MONTELONE
UNDER THE WORKFORCE INVESTMENT ACT
N-2009-108
THIS AGREEMENT, made and entered into this 1st day of July, 2009, by and between Sue
Montelone, hereinafter referred to as "CONSULTANT", and the City of Santa Ana, a charter city and
municipal corporation duly organized and existing under the Constitution and laws of the State of California,
hereinafter referred to as "CITY".
W-I-T-N-E-S-S-E-T-H
Recitals:
A. CITY has been designated a Local Workforce Investment Area (LWIA) under the
Workforce Investment Act of 1998, Public Law 105-220 ("the Act").
B. The State of California has created the LWIA to administer the Act programs operated
by the State of California pursuant to the Act.
C. As a LWIA, CITY is entitled to receive federal funds to establish programs to prepare
economically disadvantaged adults and youth for entry into the labor market and to provide job training to
those individuals who are economically disadvantaged or otherwise face serious barriers in obtaining
productive employment. One goal of California's Workforce Investment System is to provide individuals
with the opportunities to achieve career goals that will allow them to successfully compete in the labor
market and prepare them for higher education.
D. CONSULTANT is experienced in providing job preparedness and employability skills
instruction for clients at the Santa Ana WORK Center ("said program").
E. CONSULTANT is willing to operate said program pursuant to the Act and California
law
WHEREFORE, for and in consideration of the respective and mutual covenants and promises
hereinafter contained and made, and subject to all the terms and conditions hereof, the parties hereto do
hereby agree as follows:
1. TIME PERIOD OF AGREEMENT
This Agreement shall commence as of July 1, 2009 and all services to be performed pursuant to this
Agreement shall be completed on or before June 30, 2010. The term of this Agreement may be extended by
a writing executed by the Deputy City Manager for Development Services and the City Attorney.
2. INDEPENDENT CONTRACTOR
CONSULTANT agrees that CONSULTANT is an independent contractor and not an employee of
CITY and all of CONSULTANT'S personnel shall be employees of CONSULTANT and not employees of
the CITY. CONSULTANT shall pay all salaries and wages, employer's Social Security taxes,
unemployment insurance and wages, and similar taxes relating to employees and shall be responsible for all
applicable withholding taxes.
CONSULTANT shall not subcontract any of the services required hereunder without the prior written
approval of the CITY.
3. SCOPE OF SERVICES
For and in consideration of the hereinafter stated payment by CITY to CONSULTANT,
CONSULTANT agrees to perform, at its own cost and expense except for the compensation specified in this
Agreement, the services specified in the scope of work attached hereto and incorporated herein as Exhibit A
to this Agreement.
4. CONSULTANT OBLIGATIONS
A. CONSULTANT agrees to maintain such records and submit such reports, data and
information, on the form and containing such information, at such times as CITY may request or require
regarding the performance of CONSULTANT'S services or activities, costs or other data, including but not
limited to, participants' attendance, payroll records and job duty statements.
B. CITY, the State of California and the United States government and/or their
representatives shall have access for purposes of monitoring, auditing and examining of CONSULTANT'S
activities, performance, books, documents, papers, and records of CONSULTANT, subcontractors,
bookkeepers and accountants, and employees and participants related to this Agreement. Such agencies or
representatives shall also schedule on-site monitoring in their discretion. Monitoring activities may also
include, but are not limited to, questioning employees and participants and entering any premises or onto any
site in which any of the services or activities funded hereunder are conducted or in which any of the records
of CONSULTANT are kept. Nothing herein shall be construed to require access to any privileged or
confidential information as set forth in federal or state law.
In the event CONSULTANT does not make the above-referenced documents available within
the City of Santa Ana, California, CONSULTANT 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.
All accounting records and evidence pertaining to all costs of CONSULTANT and all
documents related to this Agreement shall be kept available at CONSULTANT'S office or place of business
for the duration of this Agreement and thereafter for three (3) years after completion of an audit. 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, the State of California or the
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United States Government take exception, shall be retained beyond the three (3) years until resolution of
disposition of such appeals, litigation, claims, or exceptions.
C. Without prejudice to any other section of this Agreement, CONSULTANT shall,
where applicable, maintain the confidential nature of information provided to it concerning participants in
accordance with the requirements of federal and state law. Notwithstanding the foregoing, CONSULTANT
agrees to submit to CITY, the State of California and/or the United States Government or their
representatives, all records requested for administrative purposes, including audits, examinations, monitoring
and verification of records submitted by CONSULTANT, costs incurred and services rendered hereunder.
D. CONSULTANT agrees to expend all funds in accordance with all applicable federal,
state and local laws and regulations. CONSULTANT also agrees to provide at CONSULTANT'S own
expense supplies and other costs of said PROGRAM.
E. CONSULTANT shall comply with the provisions of 48 CFR, Chapter 1, Parts 1-31.2,
for commercial organizations and all other applicable federal statutes and executive orders and their
implementing regulations.
F. CONSULTANT shall comply with the provisions of E.O. 12549 and 12689, requiring
compliance with the debarment and suspension requirements contained in 29 CFR Part 98.
G. CONSULTANT shall comply with the requirements of federal regulations found at 29
CFR 93 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. CONSULTANT shall sign a certification to that effect in a form as set forth
in "Exhibit B," attached hereto and by this reference incorporated herein. CONSULTANT 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 CONSULTANT under the terms and conditions of
this Agreement.
H. CONSULTANT agrees to provide a drug-free work place and to execute a
certification as set forth in "Exhibit C" attached hereto and incorporated herein by this reference.
I. CONSULTANT, in accordance with the Child Support Compliance Act, recognizes
and acknowledges the importance of child and family support obligations and shall fully comply with all
state and federal laws relating to child and family support enforcement, including, but not limited to:
disclosure of information and compliance with earnings assignment orders, as provided in Chapter 8
(commencing with Section 5200) of Part 5 of Division 9 of the state Family Code; and, to the best of its
knowledge is fully complying with the earnings assignment orders of all employees and is providing the
names of all new employees to the New Employee Registry maintained by the California Employment
Development Department (EDD).
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J. CONSULTANT agrees to comply with Title VI of the Civil Rights Act of 1964, and
provisions of WIA Section 188, as well as Equal Employment Opportunity provisions in Executive Order
("EO") 11246, as amended by EO 11375, and supplemented by the requirements of 41 CFR Part 60. Section
188 ensures nondiscrimination and equal opportunity for various categories of persons, including persons
with disabilities, who apply for and participate in programs and activities operated by recipients of WIA
assistance. EO 11246 specifically prohibits federal contractors and subcontractors and federally assisted
construction contractors, subcontractors or subgrantees that have contracts that exceed $10,000 from
discriminating in employment decisions on the basis of race, color, religion, sex, or national origin. All
covered contractors must take affirmative action to ensure that equal opportunity is provided in all aspects of
their employment.
5. APPLICABLE GUIDELINES
A. The parties hereto agree that CONSULTANT shall comply with all applicable federal
and state laws and regulations, including but not limited to the U.S. Department of Labor guidelines and
regulations, including amendments or revisions made during the terms of this Agreement. Said applicable
laws are hereby incorporated by reference and made as part of this Agreement as though fully set forth
herein.
B. CONSULTANT also assures and certifies that:
1. CONSULTANT shall comply with any and all federal laws limiting the
political activity of employees hired under this Agreement.
2. CONSULTANT shall provide the U.S. Department of Labor and the Controller
General, by and through any authorized representative, as well as the Santa Ana Local Workforce Investment
Area's Board, access to and the right to examine all records, books, papers or documents relating to the
accounting and use of funds under this Agreement for athree-year period from and after the effective date of
this Agreement.
3. No person with responsibilities in the operation of any program under the
Workforce Investment Act grant shall discriminate with respect to any program participant or any application
for participation in such program because of race, creed, color, national origin, sex, political affiliation or
beliefs.
4. CONSULTANT shall maintain appropriate standards for health and safety in
work and transportation situations.
5. CONSULTANT shall comply with general provisions, assurances, and
certifications attached hereto as "Exhibit D" and incorporated herein.
6. Any literature distributed by CONSULTANT for the purpose of apprising
businesses, participants, or the general public of its programs under this Agreement shall state that its
programs are supported by the City of Santa Ana and the Santa Ana Workforce Investment Board, and shall
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state that the program is an "equal opportunity employer/program" and that "auxiliary aids and services are
available upon request to individuals with disabilities."
7. CONSULTANT certifies that all property, finished or unfinished documents,
data, studies and reports prepared or purchased by the CONSULTANT under this Agreement, will be
disposed of in accordance with the direction of the CITY. In addition, any tools and/or equipment furnished
to the CONSULTANT by the CITY and/or purchased by the CONSULTANT with funds pursuant to this
Agreement, will be limited to use within the activities outlined in this agreement and will remain the property
of the United States Government and/or CITY. Upon termination of this Agreement, CONSULTANT will
immediately return such tools and/or equipment to the CITY or dispose of them in accordance with the
direction of the CITY.
8. CONSULTANT certifies that this Agreement does not provide
for the advancement or aid to any religious sect, church or creed, or sectarian purpose nor does it help to
support or sustain any school, college, university, hospital or other institution controlled by any religious
creed, church, or sectarian denomination, as specified by Article XVI, Section 5, of the Constitution of the
State of California, regarding separation of church and state.
9. If the grant hereunder exceeds $100,000, CONSULTANT shall be in
compliance with Section 306 of the Clean Air Act [(42 USC 1875(h)]; Section 508 of the Clean Water Act
(33 USC 1368); Executive Order 11738 and Environmental Protection Agency ("EPA") regulations (40 CFR
Part 15) as any may now exist or be hereafter amended. Under these laws and regulations, the
CONSULTANT assures that:
(a) No facility to be utilized in the performance of the proposed grant has been listed on the
EPA List of Violating Facilities;
(b) It will notify CITY prior to award of the receipt of any communication from the Director,
Office of Federal Activities, U.S. EPA, indicating that a facility to be utilized for the
grant is under consideration to be listed on the EPA List of Violating Facilities;
(c) It will notify the CITY and the EPA about any known violation of the above laws and
regulations.
10. CONSULTANT may copyright any work that is subject to copyright and was
developed, or for which ownership was purchased, under an award. The Federal awarding agency(ies)
reserve aroyalty-free, nonexclusive and irrevocable right to reproduce, publish, or otherwise use the work for
Federal purposes, and to authorize others to do so.
11. CONSULTANT is subject to applicable regulations governing patents and
inventions, including government-wide regulations issued by the Department of Commerce at 37 CFR part
401, "Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government
Grants, Contracts and Cooperative Agreements."
12. Based on the population eligible to be served, or likely to be directly affected
by the WIA program or activity, the services or information may need to be provided in a language other than
English in order to allow such population to be effectively informed about or able to participate in the
program or activity. Pursuant to 29 CFR 37.35, the CONSULTANT must take reasonable steps to provide
services and information in appropriate languages after considering the scope of the program or activity, and
the size and concentration of the population that needs services or information in a language other than
English.
6. COMPENSATION
CITY agrees to pay, and CONSULTANT agrees to accept for said services, total compensation in the
amount not to exceed Eight Thousand Dollars ($8,000.00). CONSULTANT will submit a detailed invoice
evidencing services performed. Final payment by the CITY shall be within 30 days following receipt of said
invoice, subject to CITY accounting procedures.
CONSULTANT acknowledges that approval of and funding for this Agreement is contingent upon
State approval, and funds received or obligated from the State of California to CITY. If such approval of
funds is not forthcoming, or is otherwise limited, CITY shall immediately notify CONSULTANT. Within
twenty (20) days of receipt of such notice, CONTRACTOR shall modify or cease operations as directed by
CITY and negotiate necessary modification to this Agreement and/or reimbursement of costs incurred
hereunder.
7. MISCELLANEOUS PROVISIONS
A. CONSULTANT covenants that it presently has no interest, and shall not have any interest,
direct or indirect, which would conflict in any manner with the performance of services required hereunder.
B. CONSULTANT certifies that it will not discriminate against any employee or applicant for
employment because of race, religious creed, color, national origin, ancestry, physical disability, mental
disability, medical condition, marital status, sex or age, in compliance with Title VII of the Civil Rights Act
of 1964 (P.L. 83-354) and Government Code 12900, et seq.
8. HOLD HARMLESS CLAUSE
CONSULTANT agrees to indemnify, defend and hold harmless CITY, its officers, agents,
employees, and volunteers from and against any and all loss or damage, and from any and all suits, actions
and claims filed or brought by any person or persons arising out acts or omissions of CONSULTANT or of
any approved subcontractor or of the officers, agents, employees of CONSULTANT or of its subcontractors
in the performance of this Agreement.
9. INSURANCE
CONSULTANT shall obtain and maintain for the entire term of this Agreement comprehensive
professional public liability insurance, in companies acceptable to the City, authorized to issue such
insurance in the State of California. Said insurance shall consist of the following:
a. Commercial General Liability Insurance. CONSULTANT agrees to obtain and keep in force
during the term of this Agreement a policy of commercial general liability insurance insuring the CITY and
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CONSULTANT against any liability for accident, injury or death arising out of or related to this Agreement.
Such insurance shall be in an amount not less than One Million Dollars ($1,000,000.00) for any injury to or
death of any person or persons in any single accident or occurrence. Said policy of commercial general
liability insurance shall be endorsed to provide to CITY at least thirty (30) days written notice prior to
cancellation.
b. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the
Labor Code, CONSULTANT, if CONSULTANT has any employees, is required to be insured against
liability for worker's compensation or to undertake self-insurance. CONSULTANT agrees to comply with
such provisions before commencing the performance of the work under this Agreement.
c. The following requirements apply to the insurance to be provided by CONSULTANT pursuant to
paragraph a., above:
1. A certificate of insurance, to be approved in form by the City Attorney, shall be furnished
to the City within 30 days of the execution of this Agreement.
2. Certificates and policies shall state that the policies shall not be canceled or reduced in
coverage or changed in any other material aspect without thirty (30) days prior written
notice to the City.
d. If CONSULTANT fails or refuses to produce or maintain the insurance required by this section or
fails or refuses to furnish the City with required proof that insurance has been procured and is in force and
paid for, the City shall have the right, at the City's election, to forthwith terminate this Agreement. Such
termination shall not affect CONSULTANT's right to be paid for its time and materials expended prior to
notification of termination.
10. TERMINATION
This Agreement may be terminated by either party at its sole discretion, upon thirty (30) days
prior written notice to the other party. Notice shall be deemed served on the date of mailing. However,
CONSULTANT may not terminate this Agreement if undue hardship will result to any participant.
11. DISPUTES
Except as otherwise provided in this Agreement, any dispute concerning any question arising
under this Agreement shall be decided by CITY. In such a case CITY shall reduce its decision to writing and
mail or otherwise furnish a copy thereof to CONSULTANT. The decision of the CITY shall be final and
conclusive unless within thirty (30) calendar days from the mailing or delivery of such copy, CITY receives
from CONSULTANT written request to appeal said decision.
Procedures governing the appeal shall be prescribed by CITY and/or the State of California in
accordance with the Act and all corresponding regulations and OMB circulars. Pending final disposition of
the appeal, CONSULTANT shall act in accordance with CITY's decision unless the dispute involves a
change order.
12. BREACH -SANCTIONS
If, through any cause, CONSULTANT violates any of the terms and conditions of this
Agreement, and/or prior agreements whereby grant funds were received by CONSULTANT pursuant to this
Agreement, or if CONSULTANT reports inaccurately or if any Audit Report makes disallowances,
CONSULTANT shall promptly remedy its acts or omissions and/or repay CITY all amounts due CITY as a
result of CONSULTANT's violation. For any such failures or violations, CITY shall also have the right at its
sole discretion to either: (1) discontinue program support until such time as CONSULTANT fulfills its
obligations or remedies all violations of this agreement or prior agreements; and/or (2) collect outstanding
amounts as determined by CITY due CITY by offsetting or debiting from current claims or invoices, if after
thirty (30) days' written notice CONSULTANT has failed to repay same or a repayment schedule has not
been made; and/or (3) terminate this Agreement by giving written notice to CONSULTANT of such
termination in accordance the notice provision contained below.
13. NOTICES
All notices, reports and correspondence between the parties hereto respecting this Agreement shall be
in writing and deposited in the United States Mail, postage prepaid, addressed as follows:
To CITY: Clerk of the Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. BOX 1988
Santa Ana, CA 92702-1988
Telefacsimile (714) 647-6956
With courtesy copy to:
Santa Ana Work Center
1000 E. Santa Ana Blvd., #200
Santa Ana, CA 92701
Telefacsimile (714) 565-2602
To CONSULTANT: Sue Montelone
19918 Paseo Lorenzo
Yorba Linda, CA 92886
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first
above written.
ATTEST:
Maria D. Huizar
Clerk of the Council
APPROVED AS TO FORM:
Joseph W. Fletcher
City Attorney
By: Lisa Storck
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
Cynthia J. Nelso
Deputy City Manager for Development
Services
CITY OF SANTA ANA
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David N. Ream
City Manager
CONSULTANT:
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Sue Montelone
Tax ID#/SS#: 565-66-7502
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EXHIBIT A
Sue Montelone
19918 Paseo Lorenzo, Yorba Linda, California 92886
Home:714-777-326` Ce11:714-290-8140 montelone_sue@yahoo.com
July 29, 2009
Ms. Lydia Morgan
Fiscal Specialist
Community Development Agency
Administrative Services
20 Civic Center Plaza, M-25
Santa Ana, CA 92701
Re: Santa Ana W/O/R/K Center 2009-10 Contract for Sue Montelone
Dear Lydia:
Since 2007, I have provided job search lab assistance or taught employability skills, resume
writing, and interviewing workshops at the Santa Ana W/O/R/K Center (SAWC). The City of
Santa Ana has paid me as a contractor to provide lab assistance or to teach workshops on days
that Santa Ana College School of Continuing Education is not in session.
To help meet the continuing need for lab assistance, resume writing, and interviewing
workshops, I would like to provide assistance and training from 9 a.m. to 1 p.m. on Mondays,
Tuesdays, and Thursdays, and 10 a.m. to 1 p.m. on Wednesdays from August 10, 2009 through
August 28, 2009, and additional days as needed prior to June 30, 2010, when Santa Ana College
School of Continuing Education is not in session. There are an estimated 45 hours at $60 per
hour in August 2009 and unknown additional hours through June 30, 2010.
Please mail the 2009-10 contract to me at my home address (see letterhead above). Thank you for
your consideration.
Sincerely,
~7~
Sue Montelone, Adjunct Instructor
Santa Ana College School of Continuing Education
cc: Carlos de la Riva, Interim Director, Santa Ana W/O/R/K Center
Exhibit B
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 an 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 contracts, the making of any Federal grant, the making
of any Federal loan, the entering into of any cooperative agreement, and the
extension, continuation, renewal, amendment or modification of any Federal
contract, 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 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 31 U.S.C. 1352.
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 that $100,000 for each such failure.
Grantee/Contractor Organization Program Title
~. ` ' ~ c~'~7~.~~5-`x' W I A
Name of Certifying Official Signature
Sue Montelone
Certification Regarding Drug-Free Workplace Requirements
The certification set out below is a material representation upon which reliance is placed
by the U.S. Department of Housing and Urban Development in awarding the grant. If it
is later determined that the contractor knowingly rendered a false certification, or
otherwise violates the requirements of the Drug-Free Workplace Act, the U.S.
Department of Housing and Urban Development, in addition to any other remedies
available to the Federal Government, may take action authorized under the Drug-Free
Workplace Act.
CERTIFICATION
A. The contractor certifies that it will provide adrug-free workplace by:
(a) Publishing a statement notifying employees that the unlawful manufacture,
distribution, dispensing, possession or use of a controlled substance is
prohibited in the contractor's workplace and specifying the actions that will
be taken against employees for violation of such prohibition;
(b) Establishing adrug-free awareness program to inform employees about -
(1) The dangers of drug abuse in the workplace;
(2) The contractor's policy of maintaining adrug-free workplace;
(3) Any available drug counseling, rehabilitation, and employee
assistance program; and
(4) The penalties that may be imposed upon employees for drug abuse
violations occurring iri the workplace;
(c) Making it a requirement that each employee who will be engaged in the
performance of the grant be given a copy of the statement required by
paragraph (a);
(d) Notifying the employee in the statement required by paragraph -(a) that,
as a condition of employment under the contract, the employee will -
(1) Abide by the terms of the statement; and
(2) Notify the employer of any criminal drug statute conviction for a
violation occurring in the workplace no later than five days after
such conviction.
Pg. 2
(e) Notifying the U.S. Department of Housing and Urban Development within
ten days after receiving notice under subparagraph (d)(2) from an
employee or otherwise receiving actual notice of such conviction;
(f) Taking one of the following actions, within 30 days of receiving notice
under subparagraph (d)(2), with respect to any employee who is so
convicted -
( 1) Taking appropriate personnel action against such an employee, up
to and including termination; or
(2) Requiring such employee 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;
(g) Making a good faith effort to continue to maintain adrug-free workplace
through implementation of paragraphs (a), (b), (c), (d), (e) and (f).
B. The contractor shall insert in the space provided on the attached "Place of
Performance" form the site(s) for the performance of work to be carried out with
the grant funds (including street address, city, county, state, and zip code) .the
contractor further certifies that, if it is subsequently determined that additional
sites will be used for the performance of work under the contract, it shall notify
the U.S. Department of Housing and Urban Development immediately upon the
decision to use such additional sites by submitting a revised "Place of
Performance" form.
Dated: `7~/'Z~~ y' ~~ i~J~°-~LL~%~~2-~.-
Program Operator
Sue Montelone
DIVISION OF EMPLOYMENT SERVICES
PLACE OF PERFORMANCE
Name:
FOR CERTIFICATION REGARDING DRUG-FREE
WORKPLACE REQUIREMENTS
Sue Montelone
Name of Contractor: Sue Montel on
Contractor Number:
Date:
July 1, 2009
The Contractor shall insert in the space provided below the site(s) expected to be used
for the performance of work under the contract covered by the certification:
Place of Performance (include street address, city, county, state, zip code for each site):
Santa Ana WORK Center
1000E Santa Ana Blvd #?~0
Santa Ana, CA 92701
Exhibit D
Subcontractor agrees that in addition to those agreements and obligations
specified in the contract boiler plate and scope of work, it will also adhere to and
obey the following provisions, assurances, and certifications.
ARTICLES
1) Subcontractor assures and certifies that it will not use any funds
appropriated under this agreement for religious activity or anti-religious
activity, or to promote or oppose any political candidate, parties, and/or
beliefs.
2) Subcontractor assures and certifies that any requested modification to this
agreement must be submitted in writing, explaining requested changes
and rationale. Subcontractor further assures that no modification will be
implemented without prior written approval from the Santa Ana WORK
Center.
3) Subcontractor agrees to cooperate with any monitoring, inspection, audit,
or investigations of activities related to this agreement as may be
scheduled and conducted by the Santa Ana WORK Center or the County
of Orange TANF Summer Youth Program.
4) Subcontractor agrees to acknowledge (given credit) the Santa Ana WORK
Center and the County of Orange as the source of funds in all oral
presentations, written document, publicity, and advertisements regarding
any activities that ensue from this agreement.
EVANSTON INSURANCE COMPANY
CERTIFICATE NO.: 2009-19
CERTIFICATE OF INSURANCE
EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS.
SPECIAL EVENT LIABILITY PROGRAM
PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED}
City of Santa Ana
Alliant Insurance Services, Inc. in conjunction with 20 Civic Center PIaza
Apex Insurance Services Santa Ana, CA 92701
P. O. Box 6450
Newport Beach, CA 92658
(949) 660-8135
License No: OC 36861
NAMED INSURED (EVENT HOLDER): EVENT INFORMATION:
Sue Montelone TYPE: Instructional Course (Resume Writing)
19918 Pasea Lorenzo DATE(S): June 8.2009 -December 31, 2009
Yorba Linda, CA 92886 LOCATION: Santa Ana WORK Center
*Liquor Liability Yes ^ No
**Li uor Liabili after 12 am ends before 2 am ^
This is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period
indicated. Notwithstanding any requirements, terms or conditions of any contract or other document with respect to which this
certificate maybe issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms,
exclusions and conditions of such policies. Limits shown may have been reduced by paid claims.
INSURANCE CARRIER: Evanston Insurance Company
MASTER POLICY NUMBER: 04SEP 1000001-5
MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2009 EXPIRATION: JANUARY 1, 2010
COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE
General Aggregate Limit $ 2,000,000
Products & Completed Operations 1,000,000
Persona] & Advertising Injury 1,000,000
Each Occurrence Limit 1,000,000
Fire Damage (Any One Fire) 50,000
Medical Payments (Any One Person) 5,000
Liquor Liability (If purchased} t,ooo,ooo
The limits of insurance apply separate]y to each event insured by this policy as if a separate policy of insurance has been issued for that event.
"Who is insured" is amended to include, as an insured, the person or organization shown in this schedule, but only with respect to liability arising out of the
ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: Any "occurrence" which takes place
after the event holder ceases to be a tenant in that premises.
OTHER ADDITIONAL INSUREDS
CANCELLATION: Should the above described policy to cancelled before the expiration date thereof, the issuing company will mai130 days written notice to the
certificate holder and additional insureds listed.
~~t!'
~~~~~
AUTHORIZED REPRESENTATNE:
DATE ISSUED: June 8. 2009 /~`y~-~~f__~!~~~,r„~
f? - 2C?C?G -1 O
EVANSTON INSURANCE COMPANY
CERTIFICATE NO.e 2010-056
CERTIFICATE OF INSURANCE 1? ?,?p?? ? ? ?.3
EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APP A `YI''bb FO NOMINEE EVENTS.
SPECIAL EVENT LIABILITY PROGRAM .._rA ANA
CITY G'i -_-
PRODUCER PUBLIC ENTITY AL'-1
Alliant Insurance Services, Inc. in conjunction with City of Santa Ana
Apex Insurance Services 20 Civic Center Plaza
P. O. Box 6450 Santa Ana, CA 92701
Newport Beach, CA 92658
License No: OC 36861
NAMED INSURED (EVENT HOLDER): EVENT INFORMATION:
Sue Montelone TYPE: Resume WorKshoa/Self Improvement
19918 Paseo Lorenzo DATE(S): September 15, 2010 -December 31.2010
Yorba Linda, CA 92886 LOCATION: WorK Center
*Liquor Liability Yes ? No
**Li uor Liabili after 12 am ends before 2 am
This is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period
indicated. Notwithstanding any requirements, terms or conditions 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. Limits shown may have been reduced by paid claims.
INSURANCE CARRIER: Evanston Insurance Company
MASTER POLICY NUMBER: lOSEP1000001
MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2010 EXPIRATION: JANUARY 1, 2011
COMMERCIAL GENERAL LIABILITY -OCCURRENCE FORM DEDUCTIBLE:NONE
General Aggregate Limit $ 2,000,000
Products 8c Completed Operations 1,000,000
Personal Rc Advertising Injury 1,000,000
Each Occurrence Limit 1,000,000
Fire Damage (Any,One Fire) 50,000
Medical Payments (Any One Person) 5,000
Liquor Liability (If purchased) 1,000,000
The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event.
"Who is insured" is amended to include, as an insured, the person or organization shown in this schedule, but only with respect to liability arising out of the
ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: Any "occurrence" which takes place
after the event holder ceases to be a tenant in that premises.
OTHER ADDITIONAL INSUREDS
CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the
certificate holder and additional insureds listed.
AUTHORIZED REPRESENTATIVE: ?? ? ???
DATE ISSUED: September 15, 2010 by Briza Morales _..?nAV£D ?'? ?®_?? M
Assistant City