HomeMy WebLinkAboutVILLA CENTER, THECity of Santa A a
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AGREEMENT TERMINATION
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AGREEMENT BETWEEN THE CITY OF SANTA ANA
AND THE VILLA CENTER, INC.
FOR THE USE OF EMERGENCY SHELTER GRANT FUNDS
(With Provisions Relating to Compliance with Title X
and 24 CFR Part 35 Relating to Lead Based Paint)
THIS AGREEMENT, is hereby made and entered into this 1st day July, 2009, by and be-
tween the City of Santa Ana, a charter city and municipal corporation of the State of California
("CITY") and The Villa Center, Inc., a California nonprofit organization ("SUBRECIPIENT").
WITNESSETH
Recitals:
1. CITY is the recipient of Emergency Shelter Grant ("ESG") funds from the United
J' States Department of Housing and Urban Development ("HUD") pursuant to the Stewart B.
N McKinney Homeless Assistance Act: Emergency Shelter Grants Program 42 USC 11331 et seq.
U-
U2. CITY has approved the provision of federal funds under the ESG to be used in the op-
eration of an emergency shelter program for the homeless of the City of Santa Ana said pro-
gram") as further described by a Scope of Work and Schedule of Performance in Exhibit A, at-
tached hereto and by this reference incorporated herein.
3. SUBRECIPIENT represents that it has expertise and experience in the provision of
emergency shelter programs for the homeless and is willing to use said federal funds to operate
said program.
4. SUBRECIPIENT agrees to assist homeless individuals and families in obtaining:
appropriate supportive services including, but not limited to, temporary and permanent housing,
medical health treatment, mental health treatment, counseling supervision and other services es-
sential for achieving independent living, as well as other federal, state, local and private assis-
tance available for such individuals.
5. Title X of the 1992 Housing and Community Development Act (Title X) established
requirements relating to lead based paint ("LBP") in housing receiving federal assistance,
with particular requirements relating to (i) notification (including pamphlet distribution, disclo-
sure to purchasers and lessees, notice of lead hazard presumption or results of evaluation, and/or
lead hazard reduction), (ii) lead hazard evaluation (including visual assessment, paint testing,
and/or risk assessment), (iii) lead hazard reduction (including paint stabilization, interim con-
trols, standard treatments, or abatement depending on the requirements for housing activity type),
(iv) ongoing maintenance, if required, and (v) response to children with environmental interven-
tion blood lead levels, as required; and
6. On September 15, 1999 HUD adopted implementing regulations to Title X that became
effective September 15, 2000 as set forth in 24 CFR Part 35, et seq. ("LBP Regs."), which estab-
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lish specific rules regarding notification to owners and occupants about the existence of LBP ha-
zards, identification of LBP hazards, and control of LBP hazards; and
7. Residential structures built after January 1, 1978 are exempt from lead -based paint re-
quirements as the use of lead -based paint was banned for use in residences after this date by
Congress (24 CFR Part 35.115). Therefore, the Title X requirements set forth herein shall not be
applicable if the structures involved were built after January 1, 1978.
8. Subpart K - Acquisition, Leasing, Support Services, and Operation of the LBP Regs, sets
forth specific requirements relating to housing providers, such as SUBRECIPIENT, who admi-
nister local programs that provide supportive housing for special needs populations and are
funded by HUD Office of Community Planning and Development ("CPD") programs, including
ESG funds, as provided to SUBRECIPIENT under this Agreement; and
9. In connection with the grant of funds under this Agreement, CITY requires that
SUBRECIPIENT comply and show evidence of compliance with all applicable requirements of
Title X and the LBP Regs, in particular Subpart K relating to acquisition, leasing, support servic-
es, or operations, and Subpart J relating to rehabilitation, as and when applicable; and
10. In connection with the grant of funds under this Agreement, CITY requires that
SUBRECIPIENT comply and show evidence of compliance with all applicable requirements of
Title X and the LBP Regs, in particular Subpart M relating to tenant based rental assistance, as
and when applicable; and
11. Attached and hereby fully incorporated to this Agreement are the following notification
attachments: Attachment No. 1 entitled "Protect Your Family From Lead In Your Home",
EPA747-K-99-001, Attachment No. 2 entitled "Sample Disclosure Format for Target Housing
Sales, Disclosure of Information on Lead -Based Paint and Lead -Based Paint Hazards", and At-
tachment No. 3 entitled "Sample Summary Risk Assessment Notice Format"; provided however,
that such attachments are not intended to modify or limit SUBRECIPIENT' S obligation to fully
comply with all applicable provisions of Title X and the implementing regulations in the LBP
Regs; and
12. By this Agreement SUBRECIPIENT will accept assignment from the CITY of all respon
sibilities set forth in Subpart K of the LBP Regs; and
13. SUBRECIPIENT agrees that it will adhere to the performance measurements and out-
comes as indicated on Exhibit A-1 (Outcome Tracking). Failure to follow the measurements and
meet the stated outcomes may constitute breach of contract that could result in termination of this
Agreement or serve as reason for the City to recapture the grant funds awarded to
SUBRECIPIENT pursuant to this Agreement.
14. The CITY and SUBRECIPIENT have duly executed this Agreement for the expenditure
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of such funds; and
WHEREFORE, it is agreed by and between the parties, that the foregoing Recitals are a subs-
tantive part of this Agreement and the following terms and conditions are approved and together
with all exhibits and attachments hereto, shall constitute the entire Agreement between the CITY
and SUBRECIPIENT:
I. SUBRECIPIENTS'S OBLIGATIONS
A. Non -Profit Status - Representations and Warranties.
(1) SUBRECIPIENT acknowledges that its operations and the services it provides to
the community are subject to Subpart K, and, in some instance(s) Subpart J and/or Subpart M, of
the LBP Regs.
(2) SUBRECIPIENT acknowledges that its operations and the services it provides in-
clude: (a) acquisition, leasing, or ownership of residential property for the purpose of providing
affordable housing for persons with special needs, such as transitional housing, or (b) housing for
persons with special needs, such as the disabled, or (c) financial assistance to assist transitional
housing participants to move to permanent housing by paying for the first month's rent or securi-
ty deposit, or (d) tenant -based rental assistance to program participants who choose their own
housing units, and by provision of such services such housing is subject to the requirements of
the LBP Regs.
(3) Representations:
(a) Authority. SUBRECIPIENT is a duly organized and existing non-profit
corporation in good standing and authorized to do business under the laws of the State of
California. SUBRECIPIENT has full right, power and lawful authority to accept the funding
hereunder and to undertake all obligations as provided herein and the execution, performance and
delivery of this Agreement by SUBRECIPIENT has been fully authorized by all requisite actions
on the part of SUBRECIPIENT.
(b) Experience. SUBRECIPIENT is a qualified provider of the services to be
provided hereunder.
(c) Familiarity With Services Required. By executing this Agreement,
SUBRECIPIENT warrants that (i) it has thoroughly investigated and considered the services to
be performed and provided hereunder, (ii) it has carefully considered how the services should be
performed, and (iii) it fully understands the facilities, difficulties and restrictions attending per-
formance of the services under this Agreement, inclusive of compliance with the LBP REGS.
Should SUBRECIPIENT discover any latent or unknown conditions materially differing from
those inherent in the work or as represented by CITY, it shall immediately inform CITY of such
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fact and shall not proceed except at SUBRECIPIENT'S risk until written instructions are re-
ceived from CITY'S representative.
(d) No Conflict. To the best of SUBRECIPIENT'S knowledge,
SUBRECIPIENT'S execution, delivery and performance of its obligations under this Agreement
will not constitute a default or a breach under any contract, agreement or order to which
SUBRECIPIENT is a party or by which it is bound.
(e) No Bankruptcy. SUBRECIPIENT is not the subject of any current or threat-
ened bankruptcy proceeding.
(f) No Pending Legal Proceedings. SUBRECIPIENT is not the subject of a cur-
rent or threatened litigation that would or may materially affect SUBRECIPIENT'S performance
under this Agreement.
(g) Application Veracity. All provisions of and information provided in
SUBRECIPIENT'S application for funding submitted to CITY including any exhibits are true
and correct in all material respects.
(h) No Pending Investigation. SUBRECIPIENT is not aware that it is the
subject of any current or threatened criminal or civil action investigation by any public agency,
including without limitation a police agency or prosecuting authority, that would relate to affect
performance of the Agreement or provision of services hereunder.
(4) Compliance with Subpart K of LBP Regs. Subpart K — Acquisition, Leas-
ing, Support Services, or Operation
(a) SUBRECIPIENT acknowledges and agrees that it shall comply with and im-
plement the requirements set forth in Title X and the LBP Regs to eliminate, as far as practicable,
LBP hazards in all residential property that is under its ownership, possession, or control and/or
residential property occupied by persons or families that receive financial or other assistance
from SUBRECIPIENT.
(b) SUBRECIPIENT shall provide a notice to all residents/occupants of residen-
tial property that is under its ownership, possession, or control and/or residential property occu-
pied by persons or families that receive financial or other assistance from SUBRECIPIENT in
accordance with Section 35.125 of the LBP Regs.
(i) SUBRECIPIENT acknowledges that in connection therewith a
visual assessment is not considered an evaluation for purposes of the LBP
Regs.
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(c) Notification (24 CFR 35.130). SUBRECIPIENT shall provide the LBP ha-
zard information pamphlet in accordance with Section 35.130 of the LBP Regs to all occupants,
owners, and purchasers of housing.
(i) The pamphlet shall be the EPA/HUD/Consumer Product Safety
Commission lead hazard information pamphlet or an EPA -approved equivalent.
The current form and version of the pamphlet is attached as Attachment No. 1
to this Agreement.
(ii) SUBRECIPIENT shall cause to be disclosed to all purchasers
and lessees available information and knowledge regarding the presence of LBP
and LBP hazards prior to selling or leasing a housing unit in accordance with 24
CFR 35, Subpart A. The current form and version of such notice is attached as
Attachment No. 2 to this Agreement.
(iii) SUBRECIPIENT shall ensure that all occupants, owners, and
purchasers of housing be notified in writing of the results of the presumption of
LBP and/or LBP hazards, and results of any lead hazard evaluation, and any lead
hazard reduction work in accordance with 24 CFR 35, Subpart A. The current
form and version of such notice is attached as Attachment No. 3 to this Agree-
ment.
(d) Lead Hazard Evaluation (24 CFR 35.125). SUBRECIPIENT shall conduct
all activities described in Section 35.1015 relating to visual assessment, paint stabilization, risk
assessment, and maintenance with regard to all residential property that is under its ownership,
possession, or control and/or residential property occupied by persons or families that receive
financial or other assistance from SUBRECIPIENT, except for the exemptions described below
in section 4 (d)(1)(1).
(i) SUBRECIPIENT shall cause a visual assessment to identify de-
teriorated paint in all residential property that is under its ownership, possession, or control
and/or residential property occupied by persons or families that receive financial or other assis-
tance from SUBRECIPIENT.
(1)Section 35.115(a) provides exemptions from Subparts B
through R of the LBP Regs. including without limitation, (a) short term emergency assistance
lasting less than 100 days cumulatively is exempted from compliance with Subpart K as to such
short term rental assistance units, and (b) exemption for zero -bedroom units, including SRO
units, for which occupancy by a recipient of SUBRECIPIENT'S services is for less than 100
days, and (c) exemption for residential housing units constructed after January 1, 1978.
(ii) To the extent that the assistance provided by SUBRECIPIENT
to persons or households meets one or more of the exemptions set forth in the LBP Regs, then
compliance with the notification, evaluation, reduction, clearance and other requirements of the
LBP Regs is not required related to the subject housing unit due to such exemption.
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(iii) SUBRECIPIENT shall comply with the applicable provisions
of both Subpart K and Subpart M (Tenant Based Rental Assistance) of the LBP Regs. as to all
tenant -based long term housing assistance, i.e., assistance to persons/households residing in
housing units cumulatively for more than 100 days. If SUBRECIPIENT has knowledge that an
assisted family or household will occupy a dwelling unit for more than 100 days, the LBP Regs
require evidence of compliance prior to occupancy. Funding to be provided hereunder is condi-
tioned upon evidence of compliance.
(1) Subpart M applies to all dwelling units occupied to be
occupied by families or households that have one or more children of less than 6 years of age, as
well as the common areas servicing such dwelling units, and exterior painted surfaces associated
with such dwelling units or common areas. LBP compliance requirements relating to such dwel-
ling units includes, without limitation: notification, evaluation by visual assessment, paint stabi-
lization utilizing safe work practices, and clearance.
(2) CITY advises SUBRECIPIENT that in the event the
services provided hereunder include rental assistance payments, such as first and last month's
rent and/or security deposit, and the assisted tenant executes a lease for long term occupancy, in-
cluding occupancy in the same dwelling unit for more than 100 days, then the provisions of Sub-
part M (Tenant Based Rental Assistance), will apply (unless otherwise informed and directed by
HUD). In this regard, CITY advises SUBRECIPIENT that Subpart M requires HQS inspection
of each dwelling unit prior to occupancy and prior to compliance with applicable notification,
evaluation by visual assessment, reduction through paint stabilization utilizing safe work practic-
es, and clearance requirements of the LBP REGS.
(e) Lead Hazard Reduction Work. SUBRECIPIENT shall cause LBP hazard
reduction, such as paint stabilization, interim controls, standard treatments, or abatement of all
residential property that is under its ownership, possession, or control and/or residential property
occupied by persons or families that receive financial or other assistance from SUBRECIPIENT,
except as exempted as described in subsection 4(d)(i)(1) above.
(1) If paint stabilization occurs, SUBRECIPIENT shall cause paint stabi-
lization of each deteriorated surface and clearance of residential units pursuant to Section
35.1330(a) and (b) shall occur before occupancy of a vacant dwelling unit, or where a unit is
occupied, immediately after receipt of the ESG FUNDS hereunder.
(2) Safe Work Practices shall be used in all LBP hazard reduction work.
(3) Clearance shall be conducted to confirm that no LBP hazards remain
when LBP hazard reduction work is complete. Confirmation of clearance by written certification
of a qualified inspector is required on an annual basis in connection with submittal of the April
15 quarterly report.
(f) Ongoing Maintenance. SUBRECIPIENT shall incorporate ongoing LBP
maintenance activities into regular building operations in accordance with Section 35.1355(a) for
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all residential property that is under its ownership, possession, or control and/or residential prop-
erty occupied by persons or families that receive financial or other assistance from
SUBRECIPIENT, except as exempted as described in subsection 4(d)(1)(1) above.
(1) Ongoing maintenance includes confirmation of clearance which shall
be conducted to confirm that no LBP hazards remain when LBP hazard reduction work is com-
plete.
(2) Ongoing maintenance also includes confirmation of clearance by writ-
ten certification of a qualified inspector on an annual basis in connection with submittal of the
April 15 quarterly report.
(3) A part of such ongoing maintenance obligation includes notification of
the results of clearance confirmation and annual confirmation of clearance.
a. SUBRECIPIENT shall cause to be provided a notice to all oc-
cupants of all residential property that is under its ownership, possession, or control and/or resi-
dential property occupied by persons or families that receive financial or other assistance from
SUBRECIPIENT in accordance with Sections 35.125(b)(1) and (c), describing the results of the
clearance examination and the results of annual certification.
(g) Units Cleared Prior to Date of Agreement; Confirmation of Clearance.
In the event the requirements of the LBP REGS relating to lead hazard evaluation, lead hazard
reduction, and lead hazard clearance have been completed on the subject dwelling units prior to
the Date of Agreement, then the SUBRECIPIENT shall provide to the CITY with the April 15
quarterly report a certificate from a qualified inspector evidencing a recent inspection and con-
firmation of clearance of LBP and LBP hazards from the subject dwelling unit(s).
5. LBP Informational Summary. For purposes of information only and in no
respect intended to be a representation or warranty of the provisions of the LBP REGS, the CITY
has caused to be prepared an information summary relating to the LBP REGS and application to
dwelling units that may be occupied by recipients of services and/or funding from
SUBRECIPIENT under this Agreement. Attachment No. 4 to this Agreement, attached and he-
reby fully incorporated by this reference, is such information summary. CITY staff will coope-
rate with and make themselves available to SUBRECIPIENT to assist in implementation of
compliance with the LBP REGS as to residential dwelling units to be assisted by
SUBRECIPIENT. The parties acknowledge and agree the CITY is and shall not be liable or re-
sponsible for the accuracy of such summary, and the SUBRECIPENT is directed to the LBP
REGS and implementing guidance published and provided by HUD relating to compliance with
such LBP REGS.
B. Amount of Grant; Quarterly Disbursement and Match Funds. The amount
granted to SUBRECIPIENT is $11,000 ("BSG FUNDS"), and such funds shall be expended by
SUBRECIPIENT on or before June 30, 2010. The ESG FUNDS shall be disbursed by CITY to
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SUBRECIPIENT on a quarterly basis, subject to and upon receipt and approval of a complete
quarterly activity report, with the final payment subject to the satisfaction of the condition
precedent of submittal of complete reporting information due on or before July 15 of the applica-
ble funding year, as hereinafter more fully set forth. SUBRECIPIENT shall be obligated to per-
form such duties as would normally extend beyond the term, including but not limited to obliga-
tions with respect to indemnification, audits, reporting, data retention/reporting, and accounting.
In accordance with 42 USC 11375(a), SUBRECIPIENT agrees to match all federal funds
provided by CITY to SUBRECIPIENT with an equal amount of funds from sources other than
these or other ESG funds. SUBRECIPIENT cannot use ESG funds from other jurisdictions in
order to meet this match requirement. Match documentation showing new, previously unused
match dollars, must be provided with each quarterly report.
C. Use of Funds. SUBRECIPIENT agrees to use said funds pursuant to this
Agreement to pay for necessary and reasonable costs allowable under the federal law and regula-
tions to operate said program only. Said amounts shall include and will be limited to, essential
services, homeless prevention, and/or operations costs. Allowable program costs are detailed in
the Budget, as set forth in "Exhibit B," attached hereto and by this reference incorporated herein.
SUBRECIPIENT'S failure to perform as required may, in addition to other remedies set forth in
this Agreement, result in readjustment of the amount of funds CITY is otherwise obligated to pay to
SUBRECIPIENT pursuant to the terms hereof. SUBRECIPIENT agrees that the homeless shelter
and services under said program shall be made available for the entire period during which said
funds are provided.
D. Allowable Costs. SUBRECIPIENT agrees to complete said program on or before
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 essential services, homeless
prevention, and/or operations costs. Other allowable program costs are detailed in the Budget, as
set forth in "Exhibit B," attached hereto and by this reference incorporated herein.
SUBRECIPIENT shall use all income received from said funds only for the same purposes for
which said funds may be expended pursuant to the terms and conditions of this Agreement.
E. Licensing. SUBRECIPIENT agrees to obtain and maintain all required licenses,
registrations, accreditation and inspections from all agencies governing its operations.
SUBRECIPIENT shall ensure that its staff shall also obtain and maintain all required licenses,
registrations, accreditation and inspections from all agencies governing SUBRECIPIENT's
operations hereunder. Such licensing requirements include obtaining a City business license, as
applicable.
F. Zoning. SUBRECIPIENT agrees that any facility/property used in furtherance of
said program shall be specifically zoned and permitted for such use(s) and activity(ies). Should
SUBRECIPIENT fail to have the required land entitlement and/or permits, thus violating any local,
state or federal rules and regulations relating thereto, SUBRECIPIENT shall immediately make
good -faith efforts to gain compliance with local, state or federal rules and regulations following
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written notification of said violation(s) from the CITY or other authorized citing agency.
SUBRECIPIENT shall notify CITY immediately of any pending violations. Failure to notify CITY
of pending violations, or to remedy such known violation(s) shall result in termination of grant
funding hereunder. SUBRECIPIENT must make all corrections required to bring the
facility/property into compliance with the law within sixty (60) days of notification of the
violation(s); failure to gain compliance within such time shall result in termination of grant funding
hereunder.
G. Separation of Accounts. All funds received by SUBRECIPIENT from CITY
pursuant to this Agreement shall be maintained separate and apart from any other funds of
SUBRECIPIENT, or of any principal or member of SUBRECIPIENT, in an account in a federally
insured banking or savings and loan institution with record keeping of such accounts maintained
pursuant to applicable legal requirements. No monies shall be withdrawn from such account except
for expenditures relating to essential services, homeless prevention and/or operations costs, as
authorized hereunder.
H. Audit Report Requirements. SUBRECIPIENT agrees that if SUBRECIPIENT
receives Five Hundred Thousand Dollars ($500,000.00) or more in federal funds, SUBRECIPIENT
shall have an annual audit conducted by a certified public accountant in accordance with the
standards as set forth and published by the United States Office of Management and Budget.
SUBRECIPIENT shall provide CITY with a copy of said audit by October 1 of the year following
the program year in which this Agreement is executed. Further, SUBRECIPIENT shall comply
and/or cause compliance with audit report(s) required by applicable provisions of Title X and the
LBP Regs.
I. Record Keeping/Reporting. SUBRECIPIENT shall keep and maintain complete
and adequate records and reports to assist CITY in meeting and maintaining its record keeping
responsibilities under the ESG REGS, Title X, and the LBP Regs, including the following:
(1) Records
a. Documentation evidencing income level of persons and/or families par-
ticipating in or benefiting by the SUBRECIPIENT program.
b. Documentation of the number of persons and/or families participating in
or benefiting by the SUBRECIPIENT program.
c. Household information shall include number of persons, identification
of head of household, race/ethnicity, age of children, seniors, income
verification.
d. Documentation of homelessness pursuant to 42 U.S.C. 11374(a)(4)
and 24 CFR 576.21.
e. Documentation of all ESG FUNDS received from CITY.
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f. Documentation of expenses as identified in the Budget Proposal, in-
cluding evidence of incurring the expense, invoices for goods or services, copies of
any and all contracts or documentation pertaining to costs for subcontractors, plus
all other invoices for which ESG FUNDS were expended, and payment therefor.
g. Any such other related records as CITY shall reasonably require or as
required to be maintained pursuant to the ESG REGS.
h. Documentation evidencing compliance with all applicable provisions
of Title X and the LBP Regs, in particular Subpart K and, as applicable Subpart J
and/or Subpart M.
(i) Specific documentation, as required, evidencing com-
pliance with all applicable provisions of such LBP Regs in-
cluding: (i) notification, including distribution of the lead ha-
zard information pamphlet (Attachment No. 1), disclosure and
notices of hazard evaluation and reduction (Attachments No. 2
and 3); (ii) evaluation of lead hazard(s), including paint test-
ing and risk assessment; (iii) reduction of lead hazard(s), in-
cluding safe work practices and clearance, and confirmation
of clearance; and (iv) ongoing maintenance, as and if appli-
cable for multifamily properties.
(ii) In this regard SUBRECIPIENT shall track information on
all persons/households assisted and the housing units assisted
with the ESG FUNDS. Attachment No. 5 hereto is a sample
form for tracking persons/households and housing units as-
sisted with the ESG FUNDS. All categories of information set
forth in such tracking form shall be prepared and submitted to
the CITY with the April 15 quarterly report.
(iii) In the event that such information and reports are not com-
plete and reasonably satisfactory information submitted in order
for CITY staff to review and evaluate compliance with applica-
ble ESG REGS and LBP Regs, then the final quarterly dis-
bursement payment shall be withheld from the
SUBRECIPIENT.
(iv) Documentation of clearance confirmation as provided
herein.
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(2) Reports
(i) Payment Request. Concurrently with the submittal of each
quarterly report, on or before the 15th day of October, January,
April and July, SUBRECIPIENT shall submit both: an original
invoice and true copies of invoices, receipts, agreements or oth-
er documentation supporting and evidencing how the ESG
FUNDS have been expended during the applicable quarter.
(ii) Quarterly Activity Report: Including in such reports
evidence of compliance with all applicable provisions of Title X
and the LBP Regs, in particular Subpart K and, as applicable
Subpart J, as further described in subsection (d) hereinafter, and
Subpart M, if SUBRECIPIENT provides long term tenant -based
rental assistance. SUBRECIPIENT agrees to provide CITY with
written cumulative (year-to-date) reports of its activities on or
before the 15th day of October, January, April and July for the
period beginning July 1, and through and including the previous
three-month reporting period setting forth the activities, program
accomplishments, new program information and year-to-date
program statistics on expenditures, caseload and activities. When
appropriate, pictures should be included.
(iii) Quarterly certification of match, plus documentation of
match source.
(iv) Any such other reports as CITY (or HUD) shall reasonably
require and/or request, including but not limited to the following
information: monthly records of all ethnic and racial statistics of
persons and families benefited by SUBRECIPIENT in the per-
formance of its obligations under this Agreement, including, but
not limited to, the activities, program accomplishments, new pro-
gram information, match fund certification and current program
statistics on expenditures, caseload and activities. When appro-
priate, pictures/slides should be included.
(3) Recordkeeping of Ongoing Maintenance under the LBP Regs. If the services and
program activities provided by SUBRECIPIENT hereunder establish an ongoing relationship
with a property (such as long term tenant based rental assistance program [Subpart M] or transi-
tional or permanent housing operated or administered by the SUBRECIPIENT), then the
SUBRECIPIENT shall provide a report to the CITY evidencing that SUBRECIPIENT and/or the
property owner(s), as applicable, has performed ongoing maintenance of the subject property.
Ongoing maintenance shall include evidence of an annual clearance certification of the subject
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residential property conducted by a DHS certified technician to ensure that LBP hazard reduction
measures are maintained. All maintenance activities shall be conducted to ensure the threat of
LBP hazards is minimized.
(4) Recordkeeping_under the LBP Regs. The SUBRECIPIENT shall keep records of dis-
tribution of notifications, all visual assessment, evaluations, inspections, repairs, and any other
lead hazard evaluation, reduction, safe work practices, and clearance activities.
(a) The SUBRECIPIENT shall keep records evidencing distribution of all lead
hazard information pamphlet(s).
(b) The SUBRECIPIENT shall keep records evidencing each LBP evaluation re-
port, LBP hazard reduction documentations, (such as job specifications), and all clearance or ab-
atement report(s).
(c) The SUBRECIPIENT shall keep ongoing maintenance records and records of
relevant building operations for use during reevaluations of subject property for LBP and/or LBP
hazards.
1. Such records shall be maintained for not less than longer of
(A) four (4) years after the activities cease or (B) the period re-
quired by applicable program regulations. Under the ESG REGS
records shall be retained for not less than five (5) years after the ac-
tivities cease.
2. The SUBRECIPIENT shall provide a copy of any of the
above records to the CITY or to HUD upon request of either or
both.
(d) Tracking Report. If the SUBRECIPIENT has provided, or is providing, rental
assistance payments directed to a housing unit or housing units for more than 100 days, or it is
anticipated that during the last quarter of funding that such rental assistance payment will be for
more than 100 days, then the April 15 quarterly report shall contain information and evidence of
compliance with the requirements herein relating to tracking of housing units, cumulative days of
rental assistance, proper notifications to occupants and owners, HQS inspection, visual assess-
ment, work write-up, stabilization and clearance of LBP and LBP hazards, if any. The proposed
form of such tracking information is attached hereto as Attachment No. 5 and fully incorporated
by this reference. In the event such April 15 quarterly report does not fully satisfy the reporting
requirements set forth herein and in the LBP Regs, then the final installment payment of the
ESG FUNDS shall be withheld from disbursement to SUBRECIPIENT.
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
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regard to said program. CITY and the United States Government and/or their representatives shall
also schedule on -site monitoring at their discretion. Monitoring activities may also include, but are
not limited to, questioning employees and participants in said program and entering any premises or
any site in which any of the services or activities funded hereunder are conducted or in which any of
the records of SUBRECIPIENT are kept. Nothing herein shall be construed to require access to any
privileged or confidential information as set forth in federal or state law.
K. Location of Records/Required Length of Record Keeping. All accounting records,
reports, and evidence pertaining to all costs, expenses and the ESG FUNDS of SUBRECIPIENT
and all documents related to this Agreement shall be maintained and kept available at
SUBRECIPIENT' S office or place of business for the duration of the Agreement and thereafter
for five (5) years after completion of an audit in conformity with the ESG BEGS, except as
hereinafter provided relating to retention of any records or documentation existing, created, or
maintained in compliance with Title X or the LBP Regs. Records which relate to (a) complaints,
claims, administrative proceedings or litigation arising out of the performance of this Agreement,
or (b) costs and expenses of this Agreement to which CITY or any other governmental agency
takes exception, shall be retained beyond the five (5) years until complete resolution or
disposition of such appeals, litigation claims, or exceptions. All records relating to, or created or
maintained in compliance with, Title X and/or the LBP Regs shall be retained and maintained by
SUBRECIPIENT indefinitely, including without limitation, all inspection report(s), disclosure
statement(s), and clearance report(s). In the event SUBRECIPIENT does not make the above -
referenced documents available within the city of Santa Ana, California, SUBRECIPIENT agrees to
pay all necessary and reasonable expenses incurred by CITY in conducting any audit at the location
where said records and books of account are maintained.
L. Compliance with Law/Program Income. SUBRECIPIENT acknowledges that the
funds being provided by CITY for said program are received by CITY pursuant to applicable
ESG guidelines and that expenditures of these funds shall be in accordance with the ESG guide-
lines and all pertinent regulations issued by agencies of the federal government.
SUBRECIPIENT agrees to comply fully with all federal, state and local laws and court orders
applicable to its operation whether or not referred to in this Agreement, and all Program Re-
quirements. Program income received by SUBRECIPIENT shall be returned to CITY unless
otherwise provided for in this Agreement. SUBRECIPIENT agrees to comply fully with all fed-
eral, state and local laws and court orders applicable to its operation whether or not referred to in
this Agreement.
M. Standing. SUBRECIPIENT shall be in good standing, without suspension by the
California Secretary of State, Franchise Tax Board and Internal Revenue Service. Any change in
the corporate status or suspension of SUBRECIPIENT shall be reported immediately to CITY.
N. Confidentiality. Without prejudice to any other provisions of this Agreement,
SUBRECIMENT shall, where applicable, maintain the confidential nature of information pro-
vided to it concerning participants in accordance with the requirements of federal and state law.
SUBRECIPIENT certifies that it will develop and implement procedures to ensure the confiden-
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tiality of records pertaining to any individual provided family violence prevention or treatment
services under any project assisted under the Emergency Shelter Grants Program and that the ad-
dress or location of any family violence shelter project assisted under the Emergency Shelter
Grants Program will, except with written authorization of the person or persons responsible for
the operation of such shelter, not be made public (24 CFR 576.56). However, SUBRECIPIENT
shall submit to CITY and or HUD or its representatives, all records requested, including audit,
examinations, monitoring and verifications of reports submitted by SUBRECIPIENT, costs in-
curred and services rendered hereunder.
O. Independent Contractor. SUBRECIPIENT agrees that the performance of
obligations hereunder are rendered in its capacity as an independent contractor and that it is in no
way an agency of CITY.
P. Violation of Terms and Conditions. SUBRECIPIENT agrees that if
SUBRECIPIENT violates any of the terms and conditions of this Agreement or any prior
Agreement whereby ESG funds were received by SUBRECIPIENT, or if SUBRECIPIENT reports
inaccurately, or if on audit there is a disallowance of certain expenditures, SUBRECIPIENT agrees
to remedy the acts or omissions causing the disallowance and repay CITY all amounts spent in
violation thereof If SUBRECIPIENT engaged in fraudulent activity to obtain and/or justify
expenditure of the ESG funds granted hereunder, SUBRECIPIENT shall be required to reimburse
the CITY of all such funds that were obtained/spent under fraudulent circumstances.
Q. Equipment. SUBRECIPIENT agrees to maintain a record for each item of non -
expendable personal property acquired under the terms of this Agreement in accordance with 24
CFR 85.32. 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. Lobb3jn . SUBRECIPIENT certifies that it will comply with federal law (31
U.S.C. 1352) and regulations found at 24 CFR Part 87, which provide that no appropriated funds
may be expended by the recipient of a federal contract, grant, loan or cooperative agreement to pay
any person for influencing or attempting to influence an officer or employee of any agency,
Member of Congress, or an officer or employee of a Member of Congress in connection with
awarding of any federal contract, the making of any federal grant or loan, entering into any
cooperative agreement and the extension, renewal, amendment or modification of any federal
contract, grant, loan or cooperative agreement. SUBRECIPIENT shall sign a certification to that
effect in a form as set forth in "Exhibit C," attached hereto and by this reference incorporated
herein. SUBRECIPIENT shall submit said signed certification to CITY prior to performing any of
its obligations under this Agreement and prior to any obligation arising on the part of CITY to pay
any sums to SUBRECIPIENT under the terms and conditions of this Agreement.
14
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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-1).
T. Financial Interest. SUBRECIPIENT agrees that except for the use of ESG funds
to pay salaries and other related administrative or personnel costs, no persons who exercise or have
exercised any function with respect to ESG activities assisted under the terms of this Agreement, or
who are in a position to participate in a decision -making process or gain inside information with
regard to such activities, may obtain a financial interest or benefit from a ESG-assisted activity of
SUBRECIPIENT, either for themselves or those with whom they have family or business ties,
during their tenure or for one year thereafter. This prohibition applies to any person who is an
employee, agent, consultant, officer, or elected or appointed official of CITY, or of
any designated public agencies, or the SUBRECIPIENT.
U. Davis -Bacon Act. All laborers and mechanics employed by contractors or
subcontractors in the performance of construction work, including alterations and repairs, in excess
of $2,000.00, financed in whole or in part with federal funds shall be paid wages at rates not less
than those prevailing on similar construction in the locality as determined in accordance with the
Davis -Bacon Act, as amended, 40 U.S.C. sections 276a - 276a-5. Any such construction contract
shall include and comply with the required contract provisions and rules set forth in 29 C.F.R. §5.5.
Further, the payroll reports (along with the "Statement of Compliance") and basic records are
required to be maintained and submitted, or made available, pursuant to 29 C.F.R. §5.5(a)(3). No
payment, advance, grant, loan or guarantee of funds shall be approved by the federal agency unless
there is on file with the agency a certification by the contractor that the contractor and its
subcontractors have complied with the provisions of 29 C.F.R. §5.5. A breach of the contract
clauses in 29 C.F.R. §5.5 may be grounds for termination of the contract, and for debarment as a
contractor/subcontractor, as provided in 29 C.F.R. §5.12. Labor standards interviews/investigations
shall be made as necessary to assure compliance [29 C.F.R. §5.6(a)(3)].
V. Homeless Involvement. SUBRECIPIENT certifies that it will involve, to the
maximum extent practicable, homeless individuals and families in constructing, renovating,
maintaining, and operating facilities assisted under the ESG program, and in providing services for
occupants of these facilities [24 CFR 576.56(b); 42 USC 11375(d)].
W. Drug Free Workplace. SUBRECIPIENT certifies that it has established the fol-
lowing drug -free workplace policy:
1. The unlawful manufacture, distribution, dispensing, possession or use of a con-
trolled substance is prohibited in the workplace for any employee involved in a federally funded
program.
5/05
2. As an employee working in conjunction with a federally funded program, the em-
ployees of SUBRECIPIENT will be required to:
a) Abide by the terms above in statement 1.
b) Notify appropriate officials of SUBRECIPIENT and CITY officials of any
criminal drug statute conviction for a violation occurring in the workplace not later than five days
after such conviction.
3. The City and the United States Department of Housing and Urban Development
will be notified within ten days after receiving notice of any such violation.
4. Within 30 days of receiving such notice, appropriate personnel action will be tak-
en against such employee, up to and including termination.
5. Each such employee shall be required to participate satisfactorily in a drug abuse
assistance or rehabilitation program approved for such purposes by a federal, state or local health,
law enforcement, or other appropriate agency.
X. Expenditure of Funds: SUBRECIPIENT must spend all of its grant amount within 24
months of the grant award (24 CFR 576.35). Any funds not obligated within said timeframe
shall be reallocated.
II. CITY'S OBLIGATIONS
A. CITY shall pay to SUBRECIPIENT from funds received under the ESG when, if and
to the extent received from HUD, amounts expended by SUBRECIPIENT in carrying out said
program pursuant to this Agreement up to a maximum aggregate amount of levezl Cii Salad
Dollars ($1;1,000) in installments determined by CITY. Payments shall be made to
SUBRECIPIENT through the submission of quarterly invoices (on or before the 15th day of Oc-
tober, January, April and July) in a form prescribed by CITY, detailing such expenses. CITY shall
pay such invoices within thirty (30) days after receipt thereof, provided CITY is satisfied that
such expenses have been incurred within the scope of this Agreement and that SUBRECIPIENT
is in compliance with the terms and conditions of this Agreement.
Costs incurred prior to the effective date of this Agreement, accrued as of the first day of
July 1, for purposes identified herein will be allowable for reimbursement upon presentation of
evidence of and invoices for such expenditures.
B. Audit: CITY shall include an audit of the account maintained by SUBRECIPIENT in
CITY's annual audit of all funds pursuant to the Code of Federal Regulations and other applica-
ble federal laws and regulations.
C. Common Rule: Pursuant to CFR 85.40(a), the CITY manages the day-to-day operations
of each grant and subgrant supported activities. CITY staff has detailed knowledge of the grant
16
5/05
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 appli-
cable project.
E. Performance Monitoring: CITY shall monitor the performance of the
SUBRECIPIENT against goals and performance standards required herein. Substandard per-
formance as determined by the CITY will constitute non-compliance with this Agreement. If ac-
tion to correct such substandard performance is not taken by the SUBRECIPIENT within a rea-
sonable period of time after being notified by the CITY, contract suspension or termination pro-
cedures will be initiated.
III. NONDISCRIMINATION
SUBRECIPIENT agrees that no person on the ground of race, color, national origin, reli-
gion or sex will be excluded from participation in, be denied the benefits of, or be subjected to
discrimination under any program or activity funded in whole or in part with ESG funds.
IV. CONFLICT OF INTEREST
Pursuant to the conflict of interest requirements set forth in 24 CFR 576.57 and OMB Circu-
lars 1-102 and A-110, SUBRECIPIENT agrees that no officer, employee, agent or assignee of
CITY having direct or indirect control of any ESG monies granted to the CITY, inclusive of the
subject ESG FUNDS, shall serve as an officer of SUBRECIPIENT. Further, any conflict or poten-
tial conflict of interest of any officer of SUBRECIPIENT shall be fully disclosed in writing prior to
the execution of this Agreement and said writing shall be attached and deemed fully incorporated as
a part hereof. Notice shall be sent by SUBRECIPIENT to CITY regarding any changes or mod-
ifications to its board of directors and list of officers
V. SPECIAL CERTIFICATION FOR RELIGIOUS ENTITIES
In addition to, and not in substitution for, other provisions of this Agreement regarding
said program using federal funds, SUBRECIPIENT:
A. Represents that it is, or may be deemed to be, a religious or denominational institution
or organization or an organization operated for religious purposes that is supervised or controlled
by or in connection with a religious or denominational institution or organization;
B. Agrees that, in connection with said program:
1. It will not discriminate against any employee or applicant for employment on the
17
5105
basis of religion and will not limit employment or give preference in employment to persons on
the basis of religion;
2. It will not discriminate against any person applying for participation in said pro-
gram on the basis of religion and will not limit such participation or give preference to persons
on the basis of religion;
3. It will provide no religious instruction or counseling, conduct no religious worship
or services, engage in no religious proselytizing, and exert no other religious influence in said
program;
4. The funds received under this Agreement shall not be used to construct, rehabili-
tate, or restore any facility that is owned by SUBRECIPIENT and in which said program is to be
implemented; provided that, minor repairs may be made if such repairs (1) are directly related to
said program; (2) are located in a structure used exclusively for non -religious purposes and (3)
constitute in dollar terms only a minor portion of the federal fund expenditure for said program.
VI. CONDITIONS ON PROVISIONS OF DEVELOPMENT AND IMPLEMENTING
HOMELESS PREVENTION ACTIVITIES
In addition to, and not in substitution for, other provisions of this Agreement regarding
said program using federal funds, SUBRECIPIENT:
A. Represents that it is, or may be deemed to be, a Homeless Prevention Program [24
CFR 576.21(a)(4)] and will implement homeless prevention activities subject to the limitations
in 42 USC I I374(a)(4);
B. Agrees that, in connection with said program, if ESG funds are to be used to assist
families that have received eviction notices or notices of termination of utility services, the fol-
lowing conditions will be met:
1. The inability of the family to make the required payments must be the result of a
sudden reduction in income;
2. The assistance must be necessary to avoid eviction of the family or termination of
services to the family;
3. There must be a reasonable prospect that the family will be able to resume pay-
ments within a reasonable period of time; and
4. The assistance must not supplant funding for preexisting homeless prevention ac-
tivities from any other source.
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VII. PROHIBITION OF NEPOTISM
SUBRECIPIENT agrees not to hire or permit the hiring of any person to fill a position
funded through this Agreement if a member of that person's immediate family is employed in an
administrative capacity by SUBRECIPIENT. For the purposes of this section, the term "imme-
diate 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.
VIII. 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 CA 92702-1988
TO SUBRECIPIENT: Lorraine Martinez
The Villa Center, Inc.
910 N. French Street
Santa Ana, CA 92701
IX. ASSIGNABILITY
None of the duties of, or work to be performed by, SUBRECIPIENT under this Agree-
ment shall be subcontracted or assigned to any agency, consultant, or person without the prior
written consent of CITY. SUBRECIPIENT must submit all subcontracts and other agreements
that relate to this Agreement to CITY. No subcontract or assignment shall terminate or alter the
legal obligations of SUBRECIPIENT pursuant to this Agreement.
X. HOLD HARMLESS
SUBRECIPIENT shall defend, indemnify and save harmless CITY, its officers, agents,
employees, representatives and volunteers from and against any and all damages to property or
injuries to or death of any person or persons, including property and employees or agents of
CITY, and shall defend, indemnify and save harmless CITY, its officers, agents, employees, rep-
resentatives and volunteers from and against any and all claims, demands, suits, actions or pro-
ceedings of any kind or nature, including, but not by way of limitation, workers compensation
19
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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 SUBRECI-
PIENT's performance of this Agreement.
XI. TERMINATION
This Agreement may be terminated in accordance with Federal Register 24 CFR Part 576
as follows:
A. This Agreement may be terminated by CITY on thirty (30) days' written notice by ei-
ther party. In the event of such termination, SUBRECIPIENT shall only be entitled to reim-
bursement for approved expenses incurred to the effective date of termination.
B. This Agreement may be suspended or terminated by CITY upon five (5) days' written
notice for violation by SUBRECIPIENT of Federal, state and/or local laws governing the use of
Emergency Shelter Grant funds. Furthermore, the SUBRECIPIENT shall comply with the Con-
ditional Use permit requirements. For failure to comply with the aforementioned terms, suspen-
sion or termination shall result, and SUBRECIPIENT shall only be entitled to reimbursement for
approved expenses incurred up to the effective date of suspension or termination.
C. In the event SUBRECIPIENT defaults by failing to fulfill all or any of its obligations
hereunder, CITY may declare a default and termination of the Agreement by written notice to
SUBRECIPIENT, which default and termination shall be effective on a date stated in the notice
which is to be not less than ten (10) days after certified mailing or personal service of such no-
tice, unless such default is cured before the effective date of termination stated in such notice. If
terminated for cause, CITY shall be relieved of further liability or responsibility under this
Agreement, or as a result of the termination thereof, including the payment of money, except for
payment for approved expenses incurred for services satisfactorily and timely performed prior to
the mailing or service of the notice of termination, and except for reimbursement of (1) any pay-
ments made for services not subsequently performed in a timely and satisfactory manner, and (2)
costs incurred by CITY in obtaining substitute performance.
D. The grant of funds under this Agreement may be terminated for convenience.
E. The grant of funds under this Agreement may be terminated due to the non-
performance of SUBRECIPIENT and/or failure of SUBRECIPENT to perform the work de-
scribed 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 Section X.A through X.E, in-
clusive, SUBRECIPIENT agrees to immediately return to CITY, upon CITY's demand and prior
to any adjudication of SUBRECIPIENT's rights, any and all funds not used under this Agree-
ment.
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XII. LIMITATION OF FUNDS
The United States of America, through HUD, may, in the future, place programmatic or
fiscal limitations on the use of ESG funds which limitations are not presently anticipated. Ac-
cordingly, CITY reserves the right to revise this Agreement in order to take account of actions
affecting HUD program funding. In the event of funding reduction, CITY may, in its sole and
absolute discretion, reduce the budget of this Agreement as a whole or as to costs category, may
limit the rate of SUBRECIPIENT's authority to commit and spend funds, or may restrict SUB-
RECIPIENT's use of both its uncommitted and its unspent funds. Where HUD has directed or
requested CITY to implement a reduction in funding, in whole or as to a cost category, with re-
spect to funding for this Agreement, CITY's City Manager or delegate is authorized to act for
CITY in implementing and effecting such a reduction and in revising, modifying, or amending
the Agreement for such purposes. If such a reduction in funding occurs, SUBRECIPIENT shall
be allowed to de -scope accordingly. Where CITY has reasonable grounds to question SUBRE-
CIPIENT's fiscal accountability, financial soundness, or compliance with this Agreement, CITY
may suspend the operation of this Agreement for up to sixty (60) days upon five (5) days' written
notice to SUBRECIPIENT of its intention to so act pending an audit or other resolution of such
questions. In no event, however, shall any revisions made by CITY affect expenditures and le-
gally binding commitments made by SUBRECIPIENT before it received notice of such revision,
provided that such amounts have been committed in good faith and are otherwise allowable and
that such commitments are consistent with HUD cash withdrawal guidelines.
XIII. INSURANCE
A. SUBRECIPIENT shall furnish CITY's Clerk of the Council with an insurance certifi-
cate from its workers' compensation insurance carrier certifying that it carries such insurance and
that the policy shall not be canceled nor the coverage reduced except upon thirty (30) days prior
notice to CITY.
B. SUBRECIPIENT shall undertake self-insurance, or shall obtain, at its sole cost, a pol-
icy or policies of commercial general liability insurance, or equivalent form, with a combined
single limit of not less than $1 Million Dollars per occurrence.
Such insurance shall: (1) name the City of Santa Ana, its officers, agents, employees and
volunteers as additional insureds; (2) be primary with respect to insurance or self-insurance pro-
grams maintained by the CITY; (3) contain standard separation of insureds provisions; and (4)
give to CITY prompt and timely notice of claim made or suit instituted arising out of SUBRECI-
PIENT's operations hereunder.
SUBRECIPIENT shall: (i) prior to exercising any right under this Agreement, furnish
properly executed certificates of insurance and additional insured endorsement to the CITY
which shall clearly evidence all coverages required above; (ii) provide that such insurance shall
not be materially changed or terminated except on thirty (30) days prior written notice to the
21
5105
CITY; (iii) maintain such insurance for the period covered by this Agreement; and (d) replace
such certificates for policies expiring prior to the expiration of this Agreement.
XIV. EXCLUSIVITY AND AMENDMENT TO AGREEMENT
This Agreement supersedes any and all other agreements, either oral or in writing, be-
tween the parties hereto with respect to the use of CITY's ESG funds by SUBRECIPIENT and
contains all the covenants and agreements between the parties with respect to such employment
in any manner whatsoever. Each party to this Agreement acknowledges that no representations,
inducements, promises or Agreements, orally or otherwise, have been made by any party, or any-
one acting on behalf of any party, which are not embodied herein, and that no other agreement or
amendment hereto shall be effective unless executed in writing and signed by both CITY and
SUBRECIPIENT.
XV. LAWS GOVERNING THIS AGREEMENT
This Agreement shall be governed by and construed in accordance with the laws of the
State of California, and all applicable federal laws and regulations.
XVI. VALIDITY
The invalidity in whole or in part of any provision of this Agreement shall not void or af-
fect the validity of any other provision of this Agreement.
XVII. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature hereinbelow has the power,
authority and right to bind their respective parties to each of the terms of this Agreement, and shall
indemnify CITY fully, including reasonable costs and attorney's fees, for any injuries or damages to
CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn.
b. All Exhibits and Attachments referenced herein and attached hereto shall be incorporated
as if fully set forth in the body of this Agreement.
c. No delay or omission by either party hereto to exercise any right or power accruing
upon any noncompliance or default by the other party with respect to any of the terms of this
Agreement shall impair any such right or power or be construed to be a waiver thereof. A waiver
by either of the parties hereto of any of the covenants, conditions, or agreements to be performed
by the other shall not be construed to be a waiver of any succeeding breach thereof or of any oth-
er covenant, condition or agreement herein contained.
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the date
and year first above written.
ATTEST:
M ALY
Clerk of the Council
APPROVED AS TO FORM:
JOSEPH W.FLETCHER
City Attorney
By: LISA E. STORCK
Assistant City Attorney
DATED: q- 10 -
23
CITY OF SANTA ANA
a municipal corporation
DAVID N. RE
City Manager
SUBRECIPIENT:
Name:LO INE MARTIN
Title:Executive Director
Tax ID: 95-2312323
City of Santa Ana
Scope of Work
Name of Organization The Villa Center, Inc.
Name of Funded Program Emergency Shelter Program
Annual Accomplishment Goal
I. Total number of unduplicated clients (Santa Ana and Non -Santa Ana Residents) anticipated to be served by the
funded prociram, named above, during the 12-month contract period.
108 Persons
II. Number of unduplicated Santa Ana residents expected to be served by the funded program during the 12-month
contract Qeriod.
Persons
Program and Funding Description
III. Description of Work - In the space below, describe the program to be funded during the 12-month contract period.
What specific activities will be undertaken during the contract period. Please be concise in your response. Only the
viewame space wui print.
The Villa is a residential rehabilitation program for alcoholic and substance -abusing women that provides a
temporary, safe, supportive, and nurturing environment for women who are often homeless or at risk of
homelessness, where they can learn to live a life free of addiction and begin a lifelong path toward recovery and
self-sufficiency. Each resident is assigned a counselor/case manager who works with her to develop a short -
and long-term recovery plan that includes action steps, measurable goals, and a timeline, allowing both client
and staff to assess their achievement and note challenges to be addressed. Beginning with short-term goals
such as honoring curfews and participating in chores, the recovery plan moves the client, during the average
three-month stay with us, in the direction of longer -term achievements such as planning to return to school,
finding employment, and re-establishing relationships with family. Other services we provide include daily meals
prepared with the help of the residents, 12-Step and Big Book classes, speaker events and panel discussions
with former residents, counseling, physical and mental healthcare, in-house education and employment
referrals, and social and family services. Women who are addicted to drugs and alcohol, and who are homeless
or at risk of being homeless, have a unique set of needs and circumstances, which can include domestic
violence, mental illness, single parenthood and unplanned pregnancy. Many times these women have co-
occurring disorders and other needs. We respond to each client's individual needs, partnering with other
agencies such as the Huntington Beach Community Clinic, the Wise Place, and the Mariposa Women's Center
to provide healthcare, counseling, and other services. In some cases, we refer women to longer -term supportive
living services after leaving us, following up with them to make sure they have transitioned successfully.
Schedule of Performance
Estimate the number of unduplicated Santa Ana residents to be served by the funded program during the 12-month
contract period per quarter. (Enter number of new Santa Ana clients served each quarter. If they were served in
quarter 1 do not count them again in quarter 2
Quarter 1: July 1 - September 30 5Persons
Quarter 2: October 1 - December 31 5' Persons
Quarter 3: January 1 - March 31 5' Persons
Quarter 4: April 1 -June 30 5 Persons
20 Total unduplicated Santa Ana Residents to be served.
Schedule of Invoicing
Estimate the amount of grant funds to be requested during the 12-month contract period on a quarterly basis.
Quarter 1: July 1 - September 30 $ _3,000.00
Quarter 2: October 1 - December 31 $ 3,000.00
Quarter 3: January 1 - March 31 $ 3,000.00'
Quarter 4: April 1 -June 30 $ 2,00000
$ 11,000.00 Total Grant
Exhibit A
Page 1 of 1
City of Santa Ana
Performance Outcome Tracking
Activity/
Program
Outcome Tracking
Goal
HUD Outcome Tracking
HUD Goal
Transitional
Track homeless individuals
5% of homeless individuals
Number of persons assisted:
Accessibility for the
Housing
who participated in transitional
participating in transitional
-with new access to a service
purpose of creating
housing program that were
housing program will be
-with improved access to a service
Suitable Living
placed in permanent housing.
placed in permanent
-where activity was used to meet a
Environments
housing.
quality standard or measurably improved
quality, report the number that no longer
only have access to substandard service
Describe how you will gather the tracking information, noted above, for that activity.
The Villa is a residential rehabilitation program for alcoholic and substance -abusing women that provides
a temporary, safe, supportive, and nurturing environment for women who are often homeless or at risk of
homelessness, where they can learn to live a life free of addiction and begin a lifelong path toward
recovery and self-sufficiency. Each resident is assigned a counselor/case manager who works with her to
develop a short- and long-term recovery plan that includes action steps, measurable goals, and a timeline,
allowing both client and staff to assess their achievement and note challenges to be addressed. Beginning
with short-term goals such as honoring curfews and participating in chores, the recovery plan moves the
client, during the average three-month stay with us, in the direction of longer -term achievements such as
planning to return to school, finding employment, and re-establishing relationships with family. Other
services we provide include daily meals prepared with the help of the residents, 12-Step and Big Book
classes, speaker events and panel discussions with former residents, counseling, physical and mental
healthcare, in-house education and employment referrals, and social and family services. Women who
are addicted to drugs and alcohol, and who are homeless or at risk of being homeless, have a unique set
of needs and circumstances, which can include domestic violence, mental illness, single parenthood and
unplanned pregnancy. Many times these women have co-occurring disorders and other needs. We
respond to each client's individual needs, partnering with other agencies such as the Huntington Beach
Community Clinic, the Wise Place, and the Mariposa Women's Center to provide healthcare, counseling,
and other services. In some cases, we refer women to longer -term supportive living services after leaving
us, following up with them to make sure they have transitioned successfully.
Exhibit A-1
Page 1 of 1
Final Budget
Organization Name The Villa Center, Inc.
Program Name Emergency Shelter Program
txpenaltures
Category
Expenses Funded by
Santa Ana
Expenses Funded
by Other Sources
Total Program
Budget
Total Organizational
Administrative Staff
Salaries & Benefits
$
-
$
63,860
$
63,860
$
-Budget
63,860
Program Staff Salaries &
Benefits
$
-
$
278,615
$
278,615
$
278,615
Contractual/Professional
Services
$
-
$
41,200
$
41,200
$
41,200
Office Supplies
$
-
$
6,695
$
6,695
$
6,695
Rent
$
-
$
-
$
_
$
_
Communications
$
800
$
6,925
$
7,725
$
7,725
Utilities
$
2,300
$
14,180
$
16,480
$
16,480
Insurance
$
3,500
$
44,086
$
47,586
$
47,586
Other:List below
$
3,800
$
21,950
$
�w
25,750
$
25,750
1 Food
House
2 Supplies/Transportation
$
-
$
8,446
$
8,446
$
8,446
3 Program Supplies
$
-
$
7,210
$
7,210
$
7,210
4 Repairs/Maintenance
$
-
$
38,934
$
38,934
$
38,934
Interest, Tax, Prof. Dev.,
5 ADP Licensing
$
600
$
21,236
$
21,836
$
21,836
Total
$
11,000
$
553,337 1
$
564,337 1
$
564,337
LIST ALL OTHER PROGRAM FUNDS THAT HAVE BEEN SECURED
(Total Funds for Program must equal Total Program Budget above)
SOurcp Annni inf
Santa Ana
$
11,000
Contributions and Fundraising
$
86,437
State and County Grants
$
255,000
United Way & Foundation Grants
$
120,000
Resident Fees
$
65,000
Food Stamps
$
25,000
Interest Income
$
1,900
Total Funds for the Program
$
564,337
txnimt t3
Page 1 of 1
Funded Personnel
Name of Organization: The Villa Center, Inc.
Name of Program Emergency Shelter Program
ADMINISTRATIVE STAFF
Position Title
(only list funded positions)
Annual
Salary
Annual
Benefits
Total
Compensation
Funds
Requested for
this position
Percent of
time serving
Santa Ana
Maximum
Amount of
eligible
Compensation
No Funding Allowed Under ESG
$ -
$ -
Executive Director
$ 51,500
$ 12,360
$ 63,860
$ -
25%1
$ 15,965.00
$
$ -
$ -
$
$ -
$ -
$ -
$ -
$ -
$
Total Amount Requested
$ -
PROGRAM STAFF
Position Title
(only list funded positions)
Annual
Salary
Annual
Benefits
Total
Compensation
Funds
Requested for
this position
Percent of
time serving
Santa Ana
Maximum
Amount of
eligible
Com ensation
Senior House Director
$ 25,750
$ 6,180
$ 31,930
$ -
25%
$ 7,982.50
House Director
$ 20,600
1 $ 4,944
$ 25,544
$ -
25%
$ 6,386.00
House Director
$ 20,600
$ 4,944
$ 25,544
$ -
25%
$ 6,386.00
Office Coordinator
$ 25,750
$ 6,180
$ 31,930
$ -
25%
$ 7,982.50
$
$ -
$ -
$ -
$ -
$ -
Total Amount Requested-
$ -
CONTRACTUAL/PROFESSIONAL SERVICES
Type of Service
(only list funded services)
Annual Contract Amount
Total
Compensation
Funds
Requested for
this position
Percent of
time serving
Santa Ana
Maximum
Amount of
eligible
Compensation
Professional Consulting Services
$ 40,000
$ 40,000
$
25%
$ 10,000.00
$ -
$ -
Total Amount Requested
$ -
Exhibit B-1
Page 1 of 1
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Certification Regarding Lobbying
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with the awarding of any Federal
contract, the making of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any Federal contact, grant, loan or cooperative
agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with this Federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure
Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the
award documents for all subawards at all tiers (including subcontract, subgrants, and
contracts under grants, loans, and cooperative agreements) and that all subrecipients shall
certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed
when this transaction was made or entered into. Submission of this certification is a
prerequisite for making or entering into this transaction imposed by Section 1352, Title
31, U. S. Code. Any person who fails to file the required certification shall be subject to
a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
Grantee/Contactor Organization
b ml '/W
Name of Certifvin
r�111�z
Officer
EXHIBIT C
Page 1 of 2
Program Title
INN
Date
SUBRECIPIENT warrants the following:
1. SUBRECIPIENT will comply with Public Law 88-352, Title VI of the Civil Rights
Act of 1964 (42 U. S. C. section 2000 et seq.) and implementing regulation in 24 CFR
Part 1.
2. No person in the United States shall on the ground of race, color, religion, national
origin, or sex, be excluded from participation in, or be denied the benefits of, or be
subjected to discrimination under any program or activity funded in whole or in part with
community development funds made available pursuant to the ACT.
3. All laborers and mechanics, employed by contractors or subcontractors in the
performance of construction work financed in whole or in part with community
development funds shall be paid wages at rates not less than those prevailing on similar
construction in the locality as determined in accordance with the Davis -Bacon Act, as
amended, 40 U. S. C. Sections 276 a 1-5, except for individuals who perform services for
which they volunteered; do not receive compensation for such services; or are paid
expenses, reasonable benefits, or a nominal fee for such services; and are not otherwise
employed at any time in construction work.
4. SUBRECIPIENT will comply with all Federal statutes applicable to projects funded
with community development funds, except that (a) SUBRECIPIENT does not assume
CITY'S environmental responsibilities described at 24 CFR 570.604; and (b)
SUBRECIPIENT does not assume CITY'S responsibility for initiating the review process
under Executive Order 12372.
EXHIBIT C
Page 2 of 2
If you think your home
levels of lead:
Get your young children tested for lead, even if
they seem healthy.
Wash children's hands, bottles, pacifiers, and toys
often.
Make sure children eat healthy, low -fat foods.
Get your home checked for lead hazards.
Regularly clean floors, window sills, and other
surfaces.
Wipe soil off shoes before entering house.
Talk to your landlord about fixing surfaces with
peeling or chipping paint.
Take precautions to avoid exposure to lead dust
when remodeling or renovating (call 1-800-424-
LEAD for guidelines).
Don't use a belt -sander, propane torch, high
temperature heat gun, scraper, or sandpaper on
painted surfaces that may contain lead.
Don't try to remove lead -based paint yourself.
Protect
Your
Family
From
Lead In
Your
Home
United States
EPA Environmental
Protection Agency
United States
.Consumer Product
-� Safety Commission
a�MENi O.c
United States
Za * PG�
Department of Housing
and Urban Development
BuiltAre You Planning To Buy, Rent, or Renovate
a Home Before 1978?
IM Many houses and apartments built before 1978 have
paint that contains high levels of lead (called lead -
based paint). Lead from paint, chips, and dust can
pose serious health hazards if not taken care of properly.
®� OWNERS, BUYERS, and RENTERS are
encouraged to check for lead (see page 6)
before renting, buying or renovating pre-
1978 housing.
ederal law requires that individuals receive certain
information before renting, buying, or renovating
pre-1978 housing:
LANDLORDS have to disclose known infor-
mation on lead -based paint and lead -based
paint hazards before leases take effect.
Leases must include a disclosure about
lead -based paint.
SELLERS have to disclose known informa-
tion on lead -based paint and lead -based
paint hazards before selling a house. Sales
f
contracts must include a disclosure about
lead -based paint. Buyers have up to 10
days to check for lead.
RENOVATORS disturbing more than 2 square
feet of painted surfaces have to give you
this pamphlet before starting work.
Lead
From .
# Can Be
ProperlyManaged
FACT: Lead exposure can harm young
children and babies even before they
are born.
FACT: Even children who seem healthy can
have high levels of lead in their bodies.
FACT: People can get lead in their bodies by
breathing or swallowing lead dust, or by
eating soil or paint chips containing
lead.
FACT: People have many options for reducing
lead hazards. In most cases, lead -based
paint that is in good condition is not a
hazard.
FACT. Removing lead -based paint improperly
can increase the danger to your family.
If you think your home might have lead
hazards, read this pamphlet to learn some
simple steps to protect your family.
People can get lead in their body if they:
Childhood
lead
Breathe in lead dust (especially during
® .
renovations that disturb painted
poisoning
surfaces).
remains
Put their hands or other objects
major
covered with lead dust in their mouths.
vie e-
Eat paint chips or soil that contains
healthtal
lead.
problem
the U.S.
Lead is even more dangerous to children
under the age of 6:
At this age children's brains and nervous
systems are more sensitive to the dam-
aging effects of lead.
Even children
Children's growing bodies absorb more
who appear
lead.
healthy can
Babies and young children often put
have danger-
their hands and other objects in their
ous levels of
mouths. These objects can have lead
lead in their
dust on them.
1
Lead is also dangerous to women of
childbearing age:
Women with a high lead level in their
system prior to pregnancy would expose
a fetus to lead through the placenta
during fetal development.
Lead's Effects
It is important to know that even exposure
to low levels of lead can severely harm
children.
In children, lead can cause:
Nervous system and kidney damage.
Learning disabilities, attention deficit
disorder, and decreased intelligence.
Speech, language, and behavior
problems.
Poor muscle coordination.
Decreased muscle and bone growth.
Hearing damage.
While low -lead exposure is most
common, exposure to high levels of
lead can have devastating effects on
children, including seizures, uncon-
sciousness, and, in some cases, death.
Although children are especially
susceptible to lead exposure, lead
can be dangerous for adults too.
or Nerve Damage
Digestive
In adults, lead can cause: Problems
er
Increased chance of illness during Reproductive
pregnancy. Problems(Adults)
Harm to a fetus, including brain
damage or death.
Lead affects
Fertility problems (in men and women).
the body in
High blood pressure.
anyways.
Digestive problems.
Nerve disorders.
Memory and concentration problems.
Muscle and joint pain.
Hearing
10
In general,
Many homes built before 1978 have lead -
the older y
based paint. The federal government
banned lead -based paint from housing in
home, the
1978. Some states stopped its use even
re likely it
earlier. Lead can be found:
has lead-
In homes in the city, country, or suburbs.
based paint.
In apartments, single-family homes, and
both private and public housing.
Inside and outside of the house.
In soil around a home. (Soil can pick up
lead from exterior paint or other sources
such as past use of leaded gas in cars.)
Get your
To reduce your child's exposure to lead,
get your child checked, have your home
children and
tested (especially if your home has paint
home tested
in poor condition and was built before
if you think
1978), and fiat any hazards you may have.
youChildren's
r a
blood lead levels tend to increase
has high lev-
rapidly from 6 to 12 months of age, and
tend to peak at 18 to 24 months of age.
els of lead.
Consult your doctor for advice on testing
your children. A simple blood test can
detect high levels of lead. Blood tests are
usually recommended for:
Children at ages 1 and 2.
Children or other family members who
have been exposed to high levels of lead.
Children who should be tested under
your state or local health screening plan.
Your doctor can explain what the test results
mean and if more testing will be needed.
M
Identifying Lead Hazards
Lead -based paint is usually not a hazard if
it is in good condition, and it is not on an
Lead from
impact or friction surface, like a window. It
paintchips,
is defined by the federal government as
is h you
paint with lead levels greater than or equal
can and
to 1.0 milligram per square centimeter, or
,
more than 0.5% by weight.
lead dust,
Deteriorating lead -based paint (peeling,
which you
chipping, chalking, cracking or damaged)
always
is a hazard and needs immediate attention.
see,can
It may also be a hazard when found on sur-
be serious
faces that children can chew or that get a
hazards.
lot of wear -and -tear, such as:
Windows and window sills.
Doors and door frames.
Stairs, railings, banisters, and porches.
Lead dust can form when lead -based paint is scraped, sanded, or
heated. Dust also forms when painted surfaces bump or rub togeth-
er. Lead chips and dust can get on surfaces and objects that people
touch. Settled lead dust can re-enter the air when people vacuum,
sweep, or walk through it. The following two federal standards have
been set for lead hazards in dust:
40 micrograms per square foot (Ng/ft2) and higher for floors,
including carpeted floors.
250 µg/ft2 and higher for interior window sills.
Lead in soil can be a hazard when children play in bare soil or
when people bring soil into the house on their shoes. The following
two federal standards have been set for lead hazards in residential
soil:
400 parts per million (ppm) and higher in play areas of bare soil
1,200 ppm (average) and higher in bare soil in the remainder of
the yard.
The only way to find out if paint, dust and soil lead hazards exist is
to test for them. The next page describes the most common meth-
ods used.
5
Checking Your Home
You can get your home tested for lead in
Just knowing several different ways:
at a home A paint inspection tells you whether your
has lea - home has lead -based paint and where it
based paintis located. It won't tell you whether or not
may not tell your home currently has lead hazards.
you if there A risk assessment tells you if your home
is a hazard.currently has any lead hazards from lead
in paint, dust, or soil. It also tells you what
actions to take to address any hazards.
A combination risk assessment and
inspection tells you if your home has
any lead hazards and if your home has
any lead -based paint, and where the
lead -based paint is located.
Hire a trained and certified testing profes-
sional who will use a range of reliable
methods when testing your home.
i
Visual inspection of paint condition
and location.
A portable x-ray fluorescence (XRF)
machine.
Lab tests of i pa nt, dust, and soil
samples.
There are state and federal programs in
place to ensure that testing is done safely,
reliably, and effectively. Contact your state
or local agency (see bottom of page 1 1) for
more information, or call 1-800-424-LEAD
(5323) for a list of contacts in your area.
Home test kits for lead are available, but
may not always be accurate. Consumers
should not rely on these kits before doing
renovations or to assure safety.
I
If you suspect that your house has lead
hazards, you can take some immediate
steps to reduce your family's risk:
If you rent, notify your landlord of
peeling or chipping paint.
Clean up paint chips immediately.
Clean floors, window frames, window
sills, and other surfaces weekly. Use a
mop or sponge with warm water and a
general all-purpose cleaner or a cleaner
made specifically for lead. REMEMBER:
NEVER MIX AMMONIA AND BLEACH
PRODUCTS TOGETHER SINCE THEY
CAN FORM A DANGEROUS GAS.
Thoroughly rinse sponges and mop
heads after cleaning dirty or dusty
areas.
Wash children's hands often, especial-
ly before they eat and before nap time
and bed time.
Keep play areas clean. Wash bottles,
pacifiers, toys, and stuffed animals
regularly.
Keep children from chewing window
sills or other painted surfaces.
Clean or remove shoes before
entering your home to avoid
tracking in lead from soil.
Make sure children eat
nutritious, low -fat meals high
in iron and calcium, such as
spinach and dairy products.
Children with good diets absorb
less lead.
Reducing Lead Hazards In The Home
In addition to day-to-day cleaning and good
Removing
nutrition:
lead
You can temporarily reduce lead hazards
improperly
by taking actions such as repairing dam-
n increase
aged painted surfaces and planting grass
the hazard
to cover soil with high lead levels. These
your family
actions (called "interim controls") are not
by spreading
permanent solutions and will need ongo-
ing attention.
even more
lead dust
around the
remove
Always use a
is trained to
hazards safely.
To permanently remove lead hazards,
you should hire a certified lead "abate-
ment" contractor. Abatement (or perma-
nent hazard elimination) methods
include removing, sealing, or enclosing
lead -based paint with special materials.
Just painting over the hazard with regular
paint is not permanent removal.
Always hire a person with special training
for correcting lead problems —someone
who knows how to do this work safely and
has the proper equipment to clean up
thoroughly. Certified contractors will employ
qualified workers and follow strict safety
rules as set by their state or by the federal
government.
Once the work is completed, dust cleanup
activities must be repeated until testing
indicates that lead dust levels are below the
following:
40 micrograms per square foot (µg/ft2)
for floors, including carpeted floors;
250 Ng/ft2 for interior windows sills; and
400 /aglft2 for window troughs.
Call your state or local agency (see bottom
of page 1 1) for help in locating certified
professionals in your area and to see if
financial assistance is available.
Remodeling or RenovatingHome With
Lead -Based Paint
Take precautions before your contractor or
you begin remodeling or renovating any-
thing that disturbs painted surfaces (such
as scraping off paint or tearing out walls):
Have the area tested for lead -based
paint.
Do not use a belt -sander, propane
torch, high temperature heat gun, dry
scraper, or dry sandpaper to remove
lead -based paint. These actions create
large amounts of lead dust and fumes.
Lead dust can remain in your home
long after the work is done.
U
Temporarily move your family (espe-
cially children and pregnant women)
out of the apartment or house until
the work is done and the area is prop-
erly cleaned. If you can't move your
family, at least completely seal off the
work area.
rollow other safety measures to
reduce lead hazards. You can find out
about other safety measures by calling
1-800-424-LEAD. Ask for the brochure
"Reducing Lead Hazards When
Remodeling Your Home." This brochure
explains what to do before, during,
and after renovations.
If you have already completed renova-
tions or remodeling that could have
released lead -based paint or dust, get
your young children tested and follow
the steps outlined on page 7 of this
brochure.
9
?j Drinking water. Your home might have
plumbing with lead or lead solder. Call
your local health department or water
supplier to find out about testing
4 ppour Y
water. You cannot see, smell, or taste
lead, and boiling your water will not get
rid of lead. If you think your plumbing
might have lead in it:
and :; are the
most •
sources of lead,
other lead
sources also exist.
WE
• Use only cold water for drinking and
cooking.
• Run water for 15 to 30 seconds
before drinldng it, especially if you
have not used your water for a few
hours.
The job. If you work with lead, you
could bring it home on your hands or
clothes. Shower and change clothes
before coming home. Launder your work
clothes separately from the rest of your
family's clothes.
Old painted toys and furniture.
Food and liquids stored in lead crystal
or lead -glazed pottery or porcelain.
Lead smelters or other industries that
release lead into the air.
Hobbies that use lead, such as making
pottery or stained glass, or refinishing
furniture.
Folk remedies that contain lead, such as
"greta" and "azarcon" used to treat an
upset stomach.
The National Lead Information Center
Call 1-800-424-LEAD (424-5323) to learn
how to protect children from lead poisoning
and for other information on lead hazards.
To access lead information via the web, visit '.
www.epa.gov/lead and
www.hud.gov/offices/lead/.
EPA's Safe Drinking Water Hotline
Call 1-800-426-4791 for information about
lead in drinking water.
Consumer Product Safety
Commission (CPSC) Hotline
To request information on lead in
consumer products, or to report an
unsafe consumer product or a prod-
uct -related injury call 1-800-638-
2772, or visit CPSC's Web site at: 0
www.cpsc.gov.
Health and Environmental Agencies
Some cities, states, and tribes have
their own rules for lead -based paint
activities. Check with your local agency to
see which laws apply to you. Most agencies
can also provide information on finding a
lead abatement firm in your area, and on
possible sources of financial aid for reducing
lead hazards. Receive up-to-date address
and phone information for your local con-
tacts on the Internet at www.epa.gov/lead
or contact the National Lead Information
Center at 1-800-424-LEAD.
For the hearing impaired, call the Federal Information
Relay Service at 1-800-877-8339 to access any of
I the phone numbers in this brochure.
EPA e 91 ionalOffices
Your Regional EPA Office can provide further information regard-
ing regulations and lead protection programs.
EPA Regional Offices
Region 1 (Connecticut, Massachusetts,
Maine, New Hampshire, Rhode Island,
Vermont)
Regional Lead Contact
U.S. EPA Region 1
Suite 1 100 (CPT)
One Congress Street
Boston, MA 021 14-2023
1 (888) 372-7341
Region 2 (New Jersey, New York,
Puerto Rico, Virgin Islands)
Regional Lead Contact
U.S. EPA Region 2
2890 Woodbridge Avenue
Building 209, Mail Stop 225
Edison, NJ 08837-3679
(732) 321-6671
Region 3 (Delaware, Maryland,
Pennsylvania, Virginia, Washington DC,
West Virginia)
Regional Lead Contact
U.S. EPA Region 3 (3WC33)
1650 Arch Street
Philadelphia, PA 19103
(215) 814-5000
Region 4 (Alabama, Florida, Georgia,
Kentucky, Mississippi, North Carolina,
South Carolina, Tennessee)
Regional Lead Contact
U.S. EPA Region 4
61 Forsyth Street, SW
Atlanta, GA 30303
(404) 562-8998
Region 5 (Illinois, Indiana, Michigan,
Minnesota, Ohio, Wisconsin)
Regional Lead Contact
U.S. EPA Region 5 (DT-8J)
77 West Jackson Boulevard
Chicago, IL 60604-3666
(312) 886-6003
ON
Region 6 (Arkansas, Louisiana, New
Mexico, Oklahoma, Texas)
Regional Lead Contact
U.S. EPA Region 6
1445 Ross Avenue, 12th Floor
Dallas, TX 75202-2733
(214)665-7577
Region 7 (Iowa, Kansas, Missouri,
Nebraska)
Regional Lead Contact
U.S. EPA Region 7
(ARTD-RALI)
901 N. 5th Street
Kansas City, KS 66101
(913) 551-7020
Region 8 (Colorado, Montana, North
Dakota, South Dakota, Utah, Wyoming)
Regional Lead Contact
U.S. EPA Region 8
999 18th Street, Suite 500
Denver, CO 80202-2466
(303) 312-6021
Region 9 (Arizona, California, Hawaii,
Nevada)
Regional Lead Contact
U.S. Region 9
75 Hawthorne Street
San Francisco, CA 94105
(415) 947-4164
Region 10 (Alaska, Idaho, Oregon,
Washington)
Regional Lead Contact
U.S. EPA Region 10
Toxics Section WCM-128
1200 Sixth Avenue
Seattle, WA 98101-1 128
(206)553-1985
CPSC Re ional Offices
91
Your Regional CPSC Office can provide further information regard-
ing regulations and consumer product safety.
Eastern Regional Center Western Regional Center
Consumer Product Safety Commission Consumer Product Safety Commission
201 Varick Street, Room 903 1301 Clay Street, Suite 610-N
New York, NY 10014 Oakland, CA 94612
(212) 620-4120 (510) 637-4050
Central Regional Center
Consumer Product Safety Commission
230 South Dearborn Street, Room 2944
Chicago, IL 60604
(312) 353-8260
HUD Lead Office
Please contact HUD's Office of Healthy Homes and Lead Hazard
Control for information on lead regulations, outreach efforts, and
lead hazard control and research grant programs.
U.S. Department of Housing and Urban Development
Office of Healthy Homes and Lead Hazard Control
451 Seventh Street, SW, P-3206
Washington, DC 20410
(202) 755-1785
This document is in the public domain. It may be reproduced by an individual or
organization without permission. Information provided in this booklet is based
upon current scientific and technical understanding of the issues presented and
is reflective of the jurisdictional boundaries established by the statutes governing
the co-authoring agencies. Following the advice given will not necessarily pro-
vide complete protection in all situations or against all health hazards that can
be caused by lead exposure.
U.S. EPA Washington DC 20460 EPA747-K-99-001
U.S. CPSC Washington DC 20207 June 2003
U.S. HUD Washington DC 20410
M
Disclosure of Information on Lead -Based Paint and/or Lead -Based Paint Hazards
Lead Warning Statement
Housing built before 1978 may contain lead -based paint. Lead from paint, paint chips, and dust can pose
health hazards if not managed properly. Lead exposure is especially harmful to young children and pregnant
women. Before renting pre-1978 housing, lessors must disclose the presence of known lead -based paint and/or
lead -based paint hazards in the dwelling. Lessees must also receive a federally approved pamphlet on lead
poisoning prevention.
Lessor's Disclosure
(a) Presence of lead -based paint and/or lead -based paint hazards (check (i) or (ii) below):
(i) Known lead -based paint and/or lead -based paint hazards are present in the housing
(explain).
(ii) Lessor has no knowledge of lead -based paint and/or lead -based paint hazards in the
housing.
(b) Records and reports available to the lessor (check (i) or (ii) below):
(i) Lessor has provided the lessee with all available records and reports pertaining to
lead -based paint and/or lead -based paint hazards in the housing (list documents
below).
(ii) Lessor has no reports or records pertaining to lead -based paint and/or lead -based
paint hazards in the housing.
Lessee's Acknowledgment (initial)
(c) Lessee has received copies of all information listed above.
(d) Lessee has received the pamphlet Protect Your Family from Lead in Your Home.
Agent's Acknowledgment (initial)
(e) Agent has informed the lessor of the lessor's obligations under 42 U.S.C. 4852(d) and
is aware of his/her responsibility to ensure compliance.
Certification of Accuracy
The following parties have reviewed the information above and certify, to the best of their knowledge, that
the information they have provided is true and accurate.
Lessor Date Lessor Date
Lessee Date Lessee Date
Agent Date Agent Date
Disclosure of Information on Lead -Based Paint and/or Lead -Based Paint Hazards
Lead Warning Statement
Every purchaser of any interest in residential real property on which a residential dwelling was built prior to 1978 is
notified that such property may present exposure to lead from lead -based paint that may place young children at risk
of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage,
including learning disabilities, reduced intelligence quotient, behavioral problems, and impaired memory. Lead
poisoning also poses a particular risk to pregnant women. The seller of any interest in residential real property is
required to provide the buyer with any information on lead -based paint hazards from risk assessments or inspections
in the seller's possession and notify the buyer of any known lead -based paint hazards. A risk assessment or inspection
for possible lead -based paint hazards is recommended prior to purchase.
Seller's Disclosure
(a) Presence of lead -based paint and/or lead -based paint hazards (check (i) or (ii) below):
(i) Known lead -based paint and/or lead -based paint hazards are present in the housing
(explain).
(ii) Seller has no knowledge of lead -based paint and/or lead -based paint hazards in the housing.
(b) Records and reports available to the seller (check (i) or (ii) below):
(i) Seller has provided the purchaser with all available records and reports pertaining to lead -
based paint and/or lead -based paint hazards in the housing (list documents below).
(ii) Seller has no reports or records pertaining to lead -based paint and/or lead -based paint
hazards in the housing.
Purchaser's Acknowledgment (initial)
(c) Purchaser has received copies of all information listed above.
(d) Purchaser has received the pamphlet Protect Your Family from Lead in Your Home.
(e) Purchaser has (check (i) or (ii) below):
(i) received a 10-day opportunity (or mutually agreed upon period) to conduct a risk assess-
ment or inspection for the presence of lead -based paint and/or lead -based paint hazards; or
waived the opportunity to conduct a risk assessment or inspection for the presence of
lead -based paint and/or lead -based paint hazards.
Agent's Acknowledgment (initial)
(fl Agent has informed the seller of the seller's obligations under 42 U.S.C. 4852(d) and is
aware of his/her responsibility to ensure compliance.
Certification of Accuracy
The following parties have reviewed the information above and certify, to the best of their knowledge, that the
information they have provided is true and accurate.
Seller Date Seller Date
Purchaser Date Purchaser Date
Agent Date Agent Date
Appendix A --Sample Summary Inspection Notice Format
Note: The following appendix will not appear in the Code of
Federal Regulations
Summary Notice of Lead -Based Paint Inspection
Address/location of property or structure(s) this summary notice
applies to:
E----------------------------------------------------------------------
F
paint inspection description:
Date(s) of inspection: -----------------------------------------------
Summary of inspection results (check all that apply):
(a) No lead -based paint was found.
(b) Lead -based paint was found.
(c) A brief summary of the findings of the inspection is
provided below (required if lead -based paint found).
Summary of where lead -based paint was found. List at least the
housing unit numbers and common areas (for multifamily housing), and
building components (including type of room or space, and the
material underneath the paint):
----------------------------------------------------------------------
❑----------------------------------------------------------------------
n------------------------------------------------------------------
❑----------------------------------------------------------------------
E----------------------------------------------------------------------
c-----------------------------------------------------
-----------------
L-----------------------------------
E----------------------------------------------------------------------
❑----------------------------------------------------------------------
❑----------------------------------------------------------------------
❑----------------------------------------------------------------------
n----------------------------------------------------------------------
------------------------------------------------------------------------
E----------------------------------------------------------------------
Contact person for more information about the inspection:
Printed name:--------------------------------------------------------
Organization:--------------------------------------------------------
Street and city: -----------------------------------------------------
[[Page 5023111
State: ZIP: ------------------------------------------------------
Phone number: ( )-------------------------------------------------
Person who prepared this summary notice:
Printed name:--------------------------------------------------------
Signature:-----------------------------------------------------------
Attachment 3
Pagel of 5
Date:----------------------------------------------------------------
Organization:--------------------------------------------------------
Streetand city: -----------------------------------------------------
State: ZIP: --------------------------------------------------
Phone number: ( )-------------------------------------------------
Appendix B--Sample Summary Risk Assessment Notice Format
Note: This following appendix will not appear in the Code of
Federal Regulations
Summary Notice of Lead -Based Paint Risk Assessment
Address/location of property or structure(s) this summary notice
applies to:
----------------------------------------------------------------------
�----------------------------------------------------------------------
❑----------------------------------------------------------------------
Lead-based paint risk assessment description:
Date(s) of risk assessment: ------------------------------------------
Summary of risk assessment results (check all that apply):
(a) No lead -based paint hazards were found.
(b) Lead -based paint hazards were found.
(c) A brief summary of the findings of the risk assessment
is provided below (required if any lead -based paint hazards were
found) .
Summary of types and locations of lead -based paint hazards. List at
least the housing unit numbers and common areas (for multifamily
housing), bare soil locations, dust -lead locations, and/or building
components (including type of room or space, and the material
underneath the paint), and types of lead -based paint hazards found:
❑----------------------------------------------------------------------
C----------------------------------------------------------------------
C......................................................................
F----------------------------------------------------------------------
7----------------------------------------------------------------------
❑----------------------------------------------------------------------
n----------------------------------------------------------------------
F1----------------------------------------------------------------------
----------------------------------------------------------------------
❑----------------------------------------------------------------------
f-----------------------------------------------------------------------
C----------------------------------------------------------------------
Contact person for more information about the risk assessment:
Printed name:--------------------------------------------------------
n----------------------------------------------------------------------
Organization:--------------------------------------------------------
E----------------------------------------------------------------------
Street and city: -----------------------------------------------------
----------------------------------------------------------------------
State: ZIP: Phone number: ( )---------------------------
Attachment 3
Page 2 of 5
r] ----------------------------------------------------------------------
Person who prepared this summary notice:
Printedname: --------------------------------------------------------
C'----------------------------------------------------------------------
Signature:-----------------------------------------------------------
CDate: ----------------------------------------------------------------
-----------------------------------------------------------------------
Organization:--------------------------------------------------------
❑--------------------------------------------------
--------------------
Streetand city: -----------------------------------------------------
F]----------------------------------------------------------------------
State: ZIP: Phone number: ( )---------------------------
f-----------------------------------------------------------------------
Appendix C--Sample Summary Presumption Notice Format
Note: The following appendix will not appear in the Code of
Federal Regulations
Notice That Lead -Based Paint or Lead -Based Paint Hazards Are Presumed
to be Present
Address/location of property or structure(s) this notice of
presumption applies to:
----------------------------------------------------------------------
❑----------------------------------------------------------------------
❑--------------------------------------------------
--------------------
Type of presumption (check all that apply):
(a) Lead -based paint is presumed to be present.
(b) Lead -based paint hazard(s) is(are) presumed to be
present.
Summary of presumption. List at least the housing unit numbers and
common areas (for multifamily housing), bare soil locations, dust -
lead locations, and/or building components (including type of room
or space, and the material underneath the paint), and types of lead -
based paint hazards presumed to be present:
❑----------------------------------------------------------------------
E----------------------------------------------------------------------
C----------------------------------------------------------------------
C'----------------------------------------------------------------------
C----------------------------------------------------------------------
E----------------------------------------------------------------------
❑----------------------------------------------------------------------
----------------------------------------------------------------------
n----------------------------------------------------------------------
r----------------------------------------------------------------------
----------------------------------------------------------------------
n----------------------------------------------------------------------
E----------------------------------------------------------------------
❑----------------------------------------------------------------------
n------------------------------------------------------------------
❑----------------------------------------------------------------------
n----------------------------------------------------------------------
Contact person for more information about the presumption:
Attachment 3
Page 3 of 5
Printed name: --------------------------------------------------------
❑----------------------------------------------------------------------
Organization:--------------------------------------------------------
❑----------------------------------------------------------------------
Street and city: ---------------------------------------------
C----------------------------------------------------------------------
State: ZIP: Phone number: ( ) ---------------------------
----------------------------------------------------------------------
Person who prepared this notice of presumption:
Printed name: --------------------------------------------------------
❑----------------------------------------------------------------------
Signature:-----------------------------------------------------------
❑ Date: ----------------------------------------------------------------
❑----------------------------------------------------------------------
Organization:--------------------------------------------------------
❑----------------------------------------------------------------------
Street and city: -----------------------------------------------------
----------------------------------------------------------------------
State: ZIP: Phone number: ( )---------------------------
❑----------------------------------------------------------------------
Appendix D--Sample Hazard Reduction Completion Notice Format
Note: The following appendix will not appear in the Code of
Federal Regulations.
Summary Notice of Completion of Lead -Based Paint Hazard Reduction
Activity
Address/location of property or structure(s) this summary notice
applies to:
❑----------------------------------------------------------------------
❑----------------------------------------------------------------------
❑----------------------------------------------------------------------
Summary of the hazard reduction activity:
Start and completion date(s): ----------------------------------------
Activity locations and types. List at least the housing unit numbers
and common areas (for multifamily housing), bare soil locations,
dust -lead locations, and/or building components (including type of
room or space, and the material underneath the paint), and types of
hazard reduction activities performed at the locations listed:
❑----------------------------------------------------------------------
❑----------------------------------------------------------------------
❑----------------------------------------------------------------------
r----------------------------------------------------------------------
❑----------------------------------------------------------------------
❑----------------------------------------------------------------------
Date(s) of clearance testing and/or soil analyses:
Locations of building components with lead -based paint remaining in
the rooms, spaces or areas where activities were conducted:
❑----------------------------------------------------------------------
Attachment 3
Page 4 of 5
C'----------------------------------------------------------------------
❑----------------------------------------------------------------------
❑----------------------------------------------------------------------
Summary of results of clearance testing and soil analyses:
(a) No clearance testing was performed.
(b) Clearance testing showed clearance was achieved.
(c) Clearance testing showed clearance was not achieved.
Contact person for more information about the hazard reduction:
Printed name:--------------------------------------------------------
Organization:--------------------------------------------------------
Street and city: -----------------------------------------------------
State: ZIP: -----------------------------------------------------
Phone number: ( )-------------------------------------------------
Person who prepared this summary notice:
Printedname: --------------------------------------------------------
Signature:-----------------------------------------------------------
Date.----------------------------------------------------------------
Organization:--------------------------------------------------------
Street and city: -----------------------------------------------------
State: ZIP: -----------------------------------------------------
Phone number: ( )-------------------------------------------------
[FR Doc. 99-23016 Filed 9-14-99; 8:45 am]
BILLING CODE 4210-32-P
Attachment 3
Page 5 of 5
ATTACHMENT NO. 4
LBP INFORMATION SUMMARY
1. ZERO/0 BEDROOM < (LESS THAN) 100 DAYS IN UNIT; ASSISTANCE IN
HOMELESS SHELTER
• STATUS: EXEMPT TITLE X
2. ZERO/0 BEDROOM > (MORE THAN) 100 DAYS IN UNIT
• STATUS: OPEN ISSUE UNDER LBP REGS
ZERO/0 BEDROOM > (MORE THAN) 100 DAYS ASSISTANCE IN
HOMELESS SHELTER
• STATUS: OPEN ISSUE UNDER LBP REGS
• SEE SUBPART K
• CLEARANCE OF UNITS) WILL BE REQUIRED BY CITY FOR ALL HOUSING UNITS
(EVEN ZERO BEDROOM). FOR WHICH OCCUPANCY OCCURS BY ASSISTED
HOUSEHOLD FOR MORE THAN 100 DAYS, PENDING FURTHER
INTERPRETATION/GUIDANCE FROM HUD
3. ONE OR MORE (1+) BEDROOMS OCCUPANCY < 100 DAYS IN
RESIDENTIAL UNIT AND/OR OCCUPANCY IN HOMELESS SHELTER
• EXEMPT TITLE X
4. 1+ BEDROOMS > 100 DAYS IN RESIDENTIAL UNIT
• STATUS: SAME AS #2 ABOVE; CLEARANCE REQUIRED
• SEE SUBPART K
5. EMERGENCY RENTAL ASSISTANCE < 100 DAYS
• EXEMPT TITLE X
6. EMERGENCY RENTAL ASSISTANCE > TO HOUSEHOLD TO BE
OCCUPANCY IN RESIDENTIAL UNIT FOR MORE THAN 100 DAYS (SUCH AS
LONG TERM LEASE SIGNED AT TIME OF EMERGENCY ASSISTANCE)
Attachment 4
Pagel of 2
• CLEARANCE BEFORE ANY MONEY DISBURSED;
LBP COMPLIANCE: NOTIFICATION, EVALUATION, REDUCTION THROUGH
CLEARANCE REQUIRED BEFORE OCCUPANCY OF UNIT
• MAY BE CONSIDERED TENANT BASED RENTAL ASSISTANCE (TBRA); THUS
HQS INSPECTION AND SUBPART M MAY APPLY
• SEE SUBPARTS K AND M
• PENDING HUD GUIDANCE
7. TB RA < 100 DAYS
• EXEMPT TITLE X
8. TBRA > 100 DAYS OF HOME ASSISTANCE (SUCH AS WHEN TENANT
ENTERS INTO LONG TERM LEASE
• SEE SUBPART M
• CLEARANCE BEFORE ANY MONEY DISBURSED;
LBP COMPLIANCE: NOTIFICATION, EVALUATION, REDUCTION THROUGH
CLEARANCE REQUIRED BEFORE OCCUPANCY OF UNIT
• HQS INSPECTION REQUIRED BEFORE OCCUPANCY
• CLEARANCE BEFORE ANY MONEY DISBURSED
9. TBRA < 100 DAYS -TENANT ENTERS INTO LONG TERM LEASE, CITY
GIVES LESS THAN 100 DAYS OF ASSISTANCE.
• EXEMPT TITLE X
Attachment 4
Page 2 of 2
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Attachment 5
Page 1 of 1
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FROK :THEUJLLACENTER
FAX NO. :7145471249 Aug. 18 2009 01:59PM P1
ACQRD. CERTIFICATE OF LIABILITY INSURANCE 07114n" 09'
PRODUCER 800-73"904 THIS CERTIFICATE 85 MSUED AS A NATTER OF INFORMATION
SEARCY INSURANCE CENTER, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER -
IS CERTIFICATE
BAILOR
P. 0. BOX 471 ATERTHE OVERAGAFFORDED Y THE POLICIES BELOW.
VI$ALW, CA 93279-0471 INSURERS AFFORDING COVERAGE _ NAIC #
Wi9URE0 -" -� W4"SRA: PHILADELPHIA INDEMNIFY INS,
VILLA CENTER, INC. -THE WSURER0;
910 NORTH FRENCH STREET LNSURERC:
SANTA ANA, CA 92701 NMR D:
MSVRER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW NAVE 9EEN S$SUEO TO THE INSURED NAMED ABOVE FOR THE POLICY PERNlO INDICATED, NOTWITHSTANDING
ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI$ CERTIFICATI= MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDRIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REOUCED 9Y PAID CLAIM$-
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DESCRPMNOFOPERATWJNS/LOCATIONS/VEHICLESIEXCLIBAODMRYENOORSnMNTISPEGALPRONISIONS
CITY OF SANTA ANA, ITS OFFICERS, AGENT'S, EMPLOYEES AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED AS
RESPECTS THEIR INTEREST IN CONNECTION WITH THE NAMED INSURED.
CITY OF SANTA ANA - CDBG M-25
COMMUNITY DEVELOPMENT AGENCY
P O BOX 1988 M-25
SANTA ANA, CA 92702-1988
ONO=ANYOFTHE AHOMVwx7 Pow=aECANCeL=MEFORE711Eomm7m
DATE THEREOF, 711E ISSUING riffljMk WALL ogwAVOR TO MAW, 30 PATE w1a l l
NOTICE TO THE CERTIF"TE HOLDER NAMED TO THE LEFT, BUT FAILLM TO DO SO SHALL
WPOSE NO OBLIGATION OR LIAWLITY OF ANY KIND UPON THE antes k ITS AGMTS Ole
NTA9M. 10 DAY NOTICE FOR NONPAYMENT
AUTHORUtEPREPRESENTAMWE .At. Cl .
' ACORD CORPORATION l9n
POLICY NUMBER:
PHPK45MS
COMMERCIAL GENERAL UAEIUTY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -- DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Marne of Person or Organizadon:
City of Santa Ana, its officers, employees, agents and representatives are additional named insureds with re-
spect to liabilities arising out of the performances of the services of the Named Insured.
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the
Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or
rented to you.
With respects 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 insur-
ance carried by or for the benefit of the additionW insureds.
Subrogation is waived as regards the Additional Named Insured.
ZO
CG 20 26 1185 Copyright, Irmrance services office, inc., 1984
Page 1 of 1 C
2d Wd2020 600E zT .daS 6bElzbSbtiz: 'ON Xdd N31N33dlnIn3Hl: WONA
CERTHOLDER COPY
SP
�A QOhAPil�t$AT1pN P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807
INS 4RANCi
FUND CERTIFICATE OF WORKEW COMPIE:MSATION INSURANCE
ISSUE DATE: 08-18.2009 GROUP:
POLICY .NU 1701033-2008
CERTIFICATE Ilk 5
CERTIFICATE EXPIRES:07-01-2010
07-01-2008/07-01-2010
CITY OF SANTA ANA SP
COMKMUITY OMLOPMENT Ai1ENCY
PO BOX 1888
SAWA ANA CA 92702-1988
This is to certify that We have issued a valid Workers' Compensation insurar►ca policy in a form approved by the
California Insurance CoarnlsSioner to do employer named below for the policy period indicated
This policy is not subject to Cancellation by the Fund except upon 30 dW9 advance written notice to the employer.
We will also give you 30 drys advance notice Should to policy be Cancelled prior to its normal expiration,
Thfe, eertif;e*e Of insurance is not an insurance policy and does not ary"d, extend or after the Coverage afforded
the Policy listed herein. Not '
w�ltlr respect to which this cerUf rt�orre� 'to— or condition of any contract or other document
Issued or to which it may pertain, the insurance
afforded fry the policy described herein is subjectmay be to all the terns, exclusions, and conditions, of such policy.
ZZED R MSENTA PRESIDENT
EMPLOYERVS LIABILITY LIMIT INC=tNG DEFENSE COSTS. $1,000.000 PER OCGIIRRENQE.
ENDORSOWff 0200 ENTITLED CERTIFICATE HOLDERS' NOTICE ERFECTSVE 07-01-2003 :S
ATTACHED TO AND FORTIS A PART OF THIS POLICY.
EMPLOYER
THE VILLA CENTER INC SP
910 "J"C t ST
SANTA ANA CA 22701
(811;NEI
iasv.T-oai PRINTED : 08-18-2008
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