HomeMy WebLinkAboutANAHEIM CHAMBER OF COMMERCE FOUNDATION - 2010 1
City of Santa Ana ca-ecD
Clerk of the Council
AGREEMENT TERMINATION FORM
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Please complete this form when the attacheL°Tai ement a%nc~all"O
amendments (if any) are no longer in effect f
CITY OF S -NTA ANA
Return form to the Clerk of the Council OfficeQL6aK OF cOUNC1L
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Signature: ~AL A -L,
Date: OR16 1 to
Revised 04-12-10
1 INSURANCE ON FILE
WORK MAY PROCEED N-2010-062
UNTIL I SURA CE EXPIRES
I CLEW OFC UNCIL ~ ,
DATE:JUL 3 0 201/zl
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AGREEMENT WITH
ANAHEIM CHAMBER OF COMMERCE FOUNDATION
~ UNDER THE WORKFORCE INVESTMENT ACT
J
THIS AGREEMENT, made and entered into this c day ofdu4a/2010, by and between the
Anaheim Chamber of Commerce Foundation, a 501(c)(3) non-profit corporation, hereinafter referred to as
"CONSULTANT", and the City of Santa Ana, a charter city and municipal corporation duly organized and
existing under the Constitution and laws of the State of California, hereinafter referred to as "CITY".
W-I-T-N-E-S-S-E-T-H
Recitals:
A. CITY has been designated a Local Workforce Investment Area (LWIA) under the
Workforce Investment Act of 1998, Public Law 105-220 ("the Act").
B. The State of California has created the LWIA to administer the Act programs operated
by the State of California pursuant to the Act.
C. As a LWIA, CITY is entitled to receive federal funds to establish programs to prepare
economically disadvantaged adults and youth for entry into the labor market and to provide job training to
those individuals who are economically disadvantaged or otherwise face serious barriers in obtaining
productive employment. One goal of California's Workforce Investment System is to provide individuals
with the opportunities to achieve career goals that will allow them to successfully compete in the labor
market and prepare them for higher education.
D. CONSULTANT is experienced in providing a Regional Job Fair co-sponsored by the
three Workforce Investment Boards (Anaheim, Santa Ana and Orange County) ("said program").
E. CONSULTANT is willing to operate said program pursuant to the Act and California
law.
WHEREFORE, for and in consideration of the respective and mutual covenants and promises
hereinafter contained and made, and subject to all the terms and conditions hereof, the parties hereto do
hereby agree as follows:
1. TIME PERIOD OF AGREEMENT
This Agreement shall commence as of, 1c1Se l 2010 and all services to be performed pursuant
to this Agreement shall be completed on or before June 30, 2010, as the Program is a one-day event. The
term of this Agreement may be extended by a writing executed by the Deputy City Manager for Development
Services and the City Attorney.
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2. INDEPENDENT CONTRACTOR
CONSULTANT agrees that CONSULTANT is an independent contractor and not an employee of
CITY and all of CONSULTANT'S personnel shall be employees of CONSULTANT and not employees of
the CITY. CONSULTANT shall pay all salaries and wages, employer's Social Security taxes,
unemployment insurance and wages, and similar taxes relating to employees and shall be responsible for all
applicable withholding taxes.
CONSULTANT shall not subcontract any of the services required hereunder without the prior written
approval of the CITY.
3. SCOPE OF SERVICES
For and in consideration of the hereinafter stated payment by CITY to CONSULTANT,
CONSULTANT agrees to perform, at its own cost and expense except for the compensation specified in this
Agreement, the services specified in the scope of work attached hereto and incorporated herein as Exhibit A
to this Agreement.
4. CONSULTANT OBLIGATIONS
A. CONSULTANT agrees to maintain such records and submit such reports, data and
information, on the form and containing such information, at such times as CITY may request or require
regarding the performance of CONSULTANT'S services or activities, costs or other data, including but not
limited to, participants' attendance, payroll records and job duty statements.
B. CITY, the State of California and the United States government and/or their
representatives shall have access for purposes of monitoring, auditing and examining of CONSULTANT'S
activities, performance, books, documents, papers, and records of CONSULTANT, subcontractors,
bookkeepers and accountants, and employees and participants related to this Agreement. Such agencies or
representatives shall also schedule on-site monitoring in their discretion. Monitoring activities may also
include, but are not limited to, questioning employees and participants and entering any premises or onto any
site in which any of the services or activities funded hereunder are conducted or in which any of the records
of CONSULTANT are kept. Nothing herein shall be construed to require access to any privileged or
confidential information as set forth in federal or state law.
In the event CONSULTANT does not make the above-referenced documents available within
the City of Santa Ana, California, CONSULTANT agrees to pay all necessary and reasonable expenses
incurred by CITY in conducting any audit at the location where said records and books of account are
maintained.
All accounting records and evidence pertaining to all costs of CONSULTANT and all
documents related to this Agreement shall be kept available at CONSULTANT'S office or place of business
for the duration of this Agreement and thereafter for three (3) years after completion of an audit. Records
which relate to (a) complaints, claims, administrative proceedings or litigation arising out of the performance
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of this Agreement, or (b) costs and expenses of this Agreement to which CITY, the State of California or the
United States Government take exception, shall be retained beyond the three (3) years until resolution of
disposition of such appeals, litigation, claims, or exceptions.
C. Without prejudice to any other section of this Agreement, CONSULTANT shall,
where applicable, maintain the confidential nature of information provided to it concerning participants in
accordance with the requirements of federal and state law. Notwithstanding the foregoing, CONSULTANT
agrees to submit to CITY, the State of California and/or the United States Government or their
representatives, all records requested for administrative purposes, including audits, examinations, monitoring
and verification of records submitted by CONSULTANT, costs incurred and services rendered hereunder.
D. CONSULTANT agrees to expend all funds in accordance with all applicable federal,
state and local laws and regulations. CONSULTANT also agrees to provide at CONSULTANT'S own
expense supplies and other costs of said PROGRAM.
E. CONSULTANT shall comply with the provisions of 48 CFR, Chapter 1, Parts 1-31.2,
for commercial organizations and all other applicable federal statutes and executive orders and their
implementing regulations.
F. CONSULTANT shall comply with the provisions of E.O. 12549 and 12689, requiring
compliance with the debarment and suspension requirements contained in 29 CFR Part 98.
G. CONSULTANT shall comply with the requirements of federal regulations found at 29
CFR 93 which provide that no appropriated funds may be expended by the recipient of a federal contract,
grant, loan or cooperative agreement to pay any person for influencing or attempting to influence an officer
or employee of any agency, member of Congress or an officer or employee of a member of Congress in
connection with awarding of any federal contract, the making of any federal grant or loan, entering into any
cooperative agreement and the extension, renewal, amendment or modification of any federal contract, grant,
loan or cooperative agreement. CONSULTANT shall sign a certification to that effect in a form as set forth
in "Exhibit B," attached hereto and by this reference incorporated herein. CONSULTANT shall submit said
signed certification to CITY prior to performing any of its obligations under this Agreement and prior to any
obligation arising on the part of CITY to pay any sums to CONSULTANT under the terms and conditions of
this Agreement.
H. CONSULTANT agrees to provide a drug-free work place and to execute a
certification as set forth in "Exhibit C" attached hereto and incorporated herein by this reference.
1. CONSULTANT, in accordance with the Child Support Compliance Act, recognizes
and acknowledges the importance of child and family support obligations and shall fully comply with all
state and federal laws relating to child and family support enforcement, including, but not limited to:
disclosure of information and compliance with earnings assignment orders, as provided in Chapter 8
(commencing with Section 5200) of Part 5 of Division 9 of the state Family Code; and, to the best of its
knowledge is fully complying with the earnings assignment orders of all employees and is providing the
names of all new employees to the New Employee Registry maintained by the California Employment
Development Department (EDD).
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J. CONSULTANT agrees to comply with Title VI of the Civil Rights Act of 1964, and
provisions of WIA Section 188, as well as Equal Employment Opportunity provisions in Executive Order
("EO") 11246, as amended by EO 11375, and supplemented by the requirements of 41 CFR Part 60. Section
188 ensures nondiscrimination and equal opportunity for various categories of persons, including persons
with disabilities, who apply for and participate in programs and activities operated by recipients of WIA
assistance. EO 11246 specifically prohibits federal contractors and subcontractors and federally assisted
construction contractors, subcontractors or subgrantees that have contracts that exceed $10,000 from
discriminating in employment decisions on the basis of race, color, religion, sex, or national origin. All
covered contractors must take affirmative action to ensure that equal opportunity is provided in all aspects of
their employment.
5. APPLICABLE GUIDELINES
A. The parties hereto agree that CONSULTANT shall comply with all applicable federal
and state laws and regulations, including but not limited to the U.S. Department of Labor guidelines and
regulations, including amendments or revisions made during the terms of this Agreement. Said applicable
laws are hereby incorporated by reference and made as part of this Agreement as though fully set forth
herein.
B. CONSULTANT also assures and certifies that:
1. CONSULTANT shall comply with any and all federal laws limiting the
political activity of employees hired under this Agreement.
2. CONSULTANT shall provide the U.S. Department of Labor and the Controller
General, by and through any authorized representative, as well as the Santa Ana Local Workforce Investment
Area's Board, access to and the right to examine all records, books, papers or documents relating to the
accounting and use of funds under this Agreement for a three-year period from and after the effective date of
this Agreement.
3. No person with responsibilities in the operation of any program under the
Workforce Investment Act grant shall discriminate with respect to any program participant or any application
for participation in such program because of race, creed, color, national origin, sex, political affiliation or
beliefs.
4. CONSULTANT shall maintain appropriate standards for health and safety in
work and transportation situations.
5. CONSULTANT shall comply with general provisions, assurances, and
certifications attached hereto as "Exhibit D" and incorporated herein.
6. Any literature distributed by CONSULTANT for the purpose of apprising
businesses, participants, or the general public of its programs under this Agreement shall state that its
programs are supported by the City of Santa Ana and the Santa Ana Workforce Investment Board, and shall
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state that the program is an "equal opportunity employer/program" and that "auxiliary aids and services are
available upon request to individuals with disabilities."
7. CONSULTANT certifies that all property, finished or unfinished documents,
data, studies and reports prepared or purchased by the CONSULTANT under this Agreement, will be
disposed of in accordance with the direction of the CITY. In addition, any tools and/or equipment furnished
to the CONSULTANT by the CITY and/or purchased by the CONSULTANT with funds pursuant to this
Agreement, will be limited to use within the activities outlined in this agreement and will remain the property
of the United States Government and/or CITY. Upon termination of this Agreement, CONSULTANT will
immediately return such tools and/or equipment to the CITY or dispose of them in accordance with the
direction of the CITY.
8. CONSULTANT certifies that this Agreement does not provide
for the advancement or aid to any religious sect, church or creed, or sectarian purpose nor does it help to
support or sustain any school, college, university, hospital or other institution controlled by any religious
creed, church, or sectarian denomination, as specified by Article XVI, Section 5, of the Constitution of the
State of California, regarding separation of church and state.
9. If the grant hereunder exceeds $100,000, CONSULTANT shall be in
compliance with Section 306 of the Clean Air Act [(42 USC 1875(h)]; Section 508 of the Clean Water Act
(33 USC 1368); Executive Order 11738 and Environmental Protection Agency ("EPA") regulations (40 CFR
Part 15) as any may now exist or be hereafter amended. Under these laws and regulations, the
CONSULTANT assures that:
(a) No facility to be utilized in the performance of the proposed grant has been listed on the
EPA List of Violating Facilities;
(b) It will notify CITY prior to award of the receipt of any communication from the Director,
Office of Federal Activities, U.S. EPA, indicating that a facility to be utilized for the
grant is under consideration to be listed on the EPA List of Violating Facilities;
(c) It will notify the CITY and the EPA about any known violation of the above laws and
regulations.
10. CONSULTANT may copyright any work that is subject to copyright and was
developed, or for which ownership was purchased, under an award. The Federal awarding agency(ies)
reserve a royalty-free, nonexclusive and irrevocable right to reproduce, publish, or otherwise use the work for
Federal purposes, and to authorize others to do so.
11. CONSULTANT is subject to applicable regulations governing patents and
inventions, including government-wide regulations issued by the Department of Commerce at 37 CFR part
401, "Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government
Grants, Contracts and Cooperative Agreements."
12. Based on the population eligible to be served, or likely to be directly affected
by the WIA program or activity, the services or information may need to be provided in a language other than
English in order to allow such population to be effectively informed about or able to participate in the
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program or activity. Pursuant to 29 CFR 37.35, the CONSULTANT must take reasonable steps to provide
services and information in appropriate languages after considering the scope of the program or activity, and
the size and concentration of the population that needs services or information in a language other than
English.
6. COMPENSATION
CITY agrees to pay, and CONSULTANT agrees to accept for said services, total compensation in the
amount not to exceed Fifteen Thousand Dollars ($15,000.00). CONSULTANT will submit a detailed
invoice evidencing services performed. Final payment by the CITY shall be within 30 days following receipt
of said invoice, subject to CITY accounting procedures.
CONSULTANT acknowledges that approval of and funding for this Agreement is contingent upon
State approval, and funds received or obligated from the State of California to CITY. If such approval of
funds is not forthcoming, or is otherwise limited, CITY shall immediately notify CONSULTANT. Within
twenty (20) days of receipt of such notice, CONTRACTOR shall modify or cease operations as directed by
CITY and negotiate necessary modification to this Agreement and/or reimbursement of costs incurred
hereunder.
7. MISCELLANEOUS PROVISIONS
A. CONSULTANT covenants that it presently has no interest, and shall not have any interest,
direct or indirect, which would conflict in any manner with the performance of services required hereunder.
B. CONSULTANT certifies that it will not discriminate against any employee or applicant for
employment because of race, religious creed, color, national origin, ancestry, physical disability, mental
disability, medical condition, marital status, sex or age, in compliance with Title VII of the Civil Rights Act
of 1964 (P.L. 83-354) and Government Code 12900, et seq.
8. HOLD HARMLESS CLAUSE
CONSULTANT agrees to indemnify, defend and hold harmless CITY, its officers, agents,
employees, and volunteers from and against any and all loss or damage, and from any and all suits, actions
and claims filed or brought by any person or persons arising out acts or omissions of CONSULTANT or of
any approved subcontractor or of the officers, agents, employees of CONSULTANT or of its subcontractors
in the performance of this Agreement.
9. INSURANCE
CONSULTANT shall obtain and maintain for the entire term of this Agreement comprehensive
professional public liability insurance, in companies acceptable to the City, authorized to issue such
insurance in the State of California. Said insurance shall consist of the following:
a. Commercial General Liability Insurance. CONSULTANT agrees to obtain and keep in force
during the term of this Agreement a policy of commercial general liability insurance insuring the CITY and
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CONSULTANT against any liability for accident, injury or death arising out of or related to this Agreement.
Such insurance shall be in an amount not less than One Million Dollars ($1,000,000.00) for any injury to or
death of any person or persons in any single accident or occurrence. Said policy of professional liability
insurance shall be endorsed to provide to CITY at least thirty (30) days written notice prior to cancellation.
b. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the
Labor Code, CONSULTANT, if CONSULTANT has any employees, is required to be insured against
liability for worker's compensation or to undertake self-insurance. CONSULTANT agrees to comply with
such provisions before commencing the performance of the work under this Agreement.
c. The following requirements apply to the insurance to be provided by CONSULTANT pursuant to
paragraph a., above:
1. A certificate of insurance, to be approved in form by the City Attorney, shall be furnished
to the City within 30 days of the execution of this Agreement.
2. Certificates and policies shall state that the policies shall not be canceled or reduced in
coverage or changed in any other material aspect without thirty (30) days prior written
notice to the City.
d. If CONSULTANT fails or refuses to produce or maintain the insurance required by this section or
fails or refuses to furnish the City with required proof that insurance has been procured and is in force and
paid for, the City shall have the right, at the City's election, to forthwith terminate this Agreement. Such
termination shall not affect CONSULTANT's right to be paid for its time and materials expended prior to
notification of termination.
10. TERMINATION
This Agreement may be terminated by either party at its sole discretion, upon thirty (30) days
written notice to the other party. Notice shall be deemed served on the date of mailing. However,
CONSULTANT may not terminate this Agreement if undue hardship will result to any participant.
11. DISPUTES
Except as otherwise provided in this Agreement, any dispute concerning any question arising
under this Agreement shall be decided by CITY. In such a case CITY shall reduce its decision to writing and
mail or otherwise furnish a copy thereof to CONSULTANT. The decision of the CITY shall be final and
conclusive unless within thirty (30) calendar days from the mailing or delivery of such copy, CITY receives
from CONSULTANT written request to appeal said decision.
Procedures governing the appeal shall be prescribed by CITY and/or the State of California in
accordance with the Act and all corresponding regulations and OMB circulars. Pending final disposition of
the appeal, CONSULTANT shall act in accordance with CITY's decision unless the dispute involves a
change order.
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12. BREACH - SANCTIONS
If, through any cause, CONSULTANT violates any of the terms and conditions of this
Agreement, and/or prior agreements whereby grant funds were received by CONSULTANT pursuant to this
Agreement, or if CONSULTANT reports inaccurately or if any Audit Report makes disallowances,
CONSULTANT shall promptly remedy its acts or omissions and/or repay CITY all amounts due CITY as a
result of CONSULTANT's violation. For any such failures or violations, CITY shall also have the right at its
sole discretion to either: (1) discontinue program support until such time as CONSULTANT fulfills its
obligations or remedies all violations of this agreement or prior agreements; and/or (2) collect outstanding
amounts as determined by CITY due CITY by offsetting or debiting from current claims or invoices, if after
thirty (30) days' written notice CONSULTANT has failed to repay same or a repayment schedule has not
been made; and/or (3) terminate this Agreement by giving written notice to CONSULTANT of such
termination in accordance the notice provision contained below.
13. NOTICES
All notices, reports and correspondence between the parties hereto respecting this Agreement shall be
in writing and deposited in the United States Mail, postage prepaid, addressed as follows:
To CITY: Clerk of the Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Telefacsimile (714) 647-6956
With courtesy copy to:
Santa Ana Work Center
1000 E. Santa Ana Blvd., #200
Santa Ana, CA 92701
Telefacsimile (714) 565-2602
To CONSULTANT: Anaheim Chamber of Commerce Foundation
201 E. Center Street
Anaheim, CA 92805
Attn: Todd Ament, President/CEO
Telephone: (714) 758-0222 Ext. 213
Telefacsimile: (714) 758-0468
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first
above written.
ATTEST: CITY OF SANTA ANA
Maria D. Huizar David N. Ream
Clerk of the Council City Manager
APPROVED AS TO FORM: CONSULTANT:
Joseph W. Fletcher
City Attorney
-ZK -
By: Lisa Storck An eim Chamber of Commerce Foundation
Assistant City Attorney By: Todd Ament, President/CEO
Tax ID#/SS#:
Fed !D#aG-a;"6o79~o'
RECOMMENDED FOR APPROVAL:
2.
Cynthia J. Nels n
Deputy City Manager for Development
Services
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L Anaheim Chamber Foundation Fed ID No: 26-0560796 Invoice
201 E. Center Street
rswmM
Anaheim, CA 92805 Date Invoice #
5/28/2010 19
Phone No: 714-758-0222
Bill To
City of Santa Ana/Santa Ana WIB
Linda Summers, Economic Dev Mgr
Comm Dev Agency/Econ Dev Div
20 Civic Center Plaza (M-25)
Santa Ana, CA 92701
P.O. Number Terms
Quantity Item Code Description Rate Amount
Job Fair Job Fair Partnership 15,000.00 15,000.00
Please Remit Payment To:
Anaheim Chamber Foundation
201 E. Center St.
Anaheim, CA 92805
Total $15,000.00
Exhibit A
DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046
(See reverse for public burden disclosure.)
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
? a. contract ? a. bid/offer/application ? a. initial filing
b. grant b. initial award b. material change
c. cooperative agreement c. post-award For Material Change Only:
d. loan year quarter
e. loan guarantee date of last report
f. loan insurance
4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is a Subawardee, Enter Name and Address
? Prime ? Subawardee of Prime:
Tier , if known:
Congressional District, if known: Congressional District, if known:
6. Federal Department/Agency: 7. Federal Program Name/Description:
CFDA Number, if applicable:
8. Federal Action Number, if known: 9. Award Amount, if known:
10. a. Name and Address of Lobbying b. Individuals Performing Services ( including address
Entity if different from No. 10a)
( if individual, last name, first name, MI): (last name, first name, MI):
(attach Continuation Sheet(s) SF-LLLA, if necessary)
11. Amount of Payment ( check all that apply): 13. Type of Payment ( check all that apply):
$ ? actual ? planned ? a. retainer
? b. one-time fee
?
12. Form of Payment ( check all that apply): c, commission
? a. cash ? d. contingent fee
? e. deferred
? b. in-kind; specify: nature ? f. other; specify:
value
14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including
officer(s), employee(s), or Member(s) contacted, for Payment Indicated in Item 11:
attach Continuation Sheets SF-LLLA, if necessary)
15. Continuation Sheet(s) SF-LLLA attached: ? Yes ? No
16. Signature:
Information requested through this form is authorized by title 31 Print me/
U.S.C. section1352. This disclosure of lobbying activities is a Title:
material representation of fact upon which reliance was placed Tele n Date: 0
by the tier above when this transaction was made or entered 714Y- 03Zx --J
into. This disclosure is required pursuant to 31 U.S.C. 1352. This
information will be reported to the Congress semi-annually and
will be available for public inspection. Any person who fails to file r
the required disclosure shall be subject to a civil penalty of not / L
r^ ou klzjl
less that $10,000 and not more than $100,000 for each such A/0
failure. J
Authorized for Local Reproduction
Federal Use Onl : Standard Form LLL Rev. 7-97
EXHIBIT B
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether sub-awardee or prime Federal recipient, at the initiation or receipt of a covered
Federal action, or a material change to a previous fling, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or
agreement to make payment to any lobbying entity 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 a covered Federal action. Use the SF-LLLA
Continuation Sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material
change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal
action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a follow up report caused by a material change to the information previously reported,
enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this
covered Federal action
4, Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate
classification of the reporting entity that designates if it is, or expects to be, a prime or sub-award recipient. Identify the tier of the sub-awardee, e.g.,
the first sub-awardee of the prime is the 1st tier. Sub-awards include but are not limited to subcontracts, sub-grants and contract awards under
grants.
5. If the organization filing the report in item 4 checks "Sub-awardee," then enter the full name, address, city, State and zip code of the prime Federal
recipient. Include Congressional District, if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name, if
known. For example, Department of Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic
Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP)
number; Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control
number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the
award/loan commitment for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, State and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influence the
covered Federal action.
b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name, First Name, and
Middle Initial (MI).
11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate
whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the
cumulative amount of payment made or planned to be made.
12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the
in-kind payment.
13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature.
14. Provide a specific and detailed description of the services that the lobbyist has performed, or will be expected to perform, and the date(s) of any
services rendered. Include all preparatory and related activity, not just time spent in actual contact with Federal officials. Identify the Federal
official(s) or employee(s) contacted or the officer(s), employee(s), or Member(s) of Congress that were contacted.
15. Check whether or not a SF-LLLA Continuation Sheet(s) is attached.
16. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a
valid OMB Control Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this
collection of information is estimated to average 30 minutes per response, including time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the
burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management
and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503.
EXHIBIT B
Certification Regarding Drug-Free Workplace Requirements
The certification set out below is a material representation upon which reliance is placed
by the U.S. Department of Housing and Urban Development in awarding the grant. If it
is later determined that the contractor knowingly rendered a false certification, or
otherwise violates the requirements of the Drug-Free Workplace Act, the U.S.
Department of Housing and Urban Development, in addition to any other remedies
available to the Federal Government, may take action authorized under the Drug-Free
Workplace Act.
CERTIFICATION
A. The contractor certifies that it will provide a drug-free workplace by:
(a) Publishing a statement notifying employees that the unlawful manufacture,
distribution, dispensing, possession or use of a controlled substance is
prohibited in the contractor's workplace and specifying the actions that will
be taken against employees for violation of such prohibition;
(b) Establishing a drug-free awareness program to inform employees about -
(1) The dangers of drug abuse in the workplace;
(2) The contractor's policy of maintaining a drug-free workplace;
(3) Any available drug counseling, rehabilitation, and employee
assistance program; and
(4) The penalties that may be imposed upon employees for drug abuse
violations occurring in the workplace;
(c) Making it a requirement that each employee who will be engaged in the
performance of the grant be given a copy of the statement required by
paragraph (a);
(d) Notifying the employee in the statement required by paragraph -(a) that,
as a condition of employment under the contract, the employee will -
(1) Abide by the terms of the statement; and
(2) Notify the employer of any criminal drug statute conviction for a
violation occurring in the workplace no later than five days after
such conviction.
EXHIBIT C
Pg. 2
(e) Notifying the U.S. Department of Housing and Urban Development within
ten days after receiving notice under subparagraph (d)(2) from an
employee or otherwise receiving actual notice of such conviction;
(f) Taking one of the following actions, within 30 days of receiving notice
under subparagraph (d)(2), with respect to any employee who is so
convicted -
( 1) Taking appropriate personnel action against such an employee, up
to and including termination; or
(2) Requiring such employee to participate satisfactorily in a drug
abuse assistance or rehabilitation program approved for such
purposes by a Federal, State, or local health, law enforcement, or
other appropriate agency;
(g) Making a good faith effort to continue to maintain a drug-free workplace
through implementation of paragraphs (a), (b), (c), (d), (e) and (f).
B. The contractor shall insert in the space provided on the attached "Place of
Performance" form the site(s) for the performance of work to be carried out with
the grant funds (including street address, city, county, state, and zip code) the
contractor further certifies that, if it is subsequently determined that additional
sites will be used for the performance of work under the contract, it shall notify
the U.S. Department of Housing and Urban Development immediately upon the
decision to use such additional sites by submitting a revised "Place of
Performance" form.
Dated:ju P1O d6 l a 49r)Z
. Program Oper or
EXHIBIT C
DIVISION OF EMPLOYMENT SERVICES
PLACE OF PERFORMANCE
FOR CERTIFICATION REGARDING DRUG-FREE
WORKPLACE REQUIREMENTS
Name: 40e Name of Contractor: no4 d L. "4e!: d7C&&'V0% Q,
Contractor Number:
Date:L~~l
The Contractor shall insert in the space provided below the site(s) expected to be used
for the performance of work under the contract covered by the certification:
Place of Performance (include street address, city, county, state, zip code for each site):
r-,g 04 C. EXHIBIT C
ASSURANCES
Subcontractor agrees that in addition to those agreements and obligations specified in
the contract boilerplate and scope of work, it will also adhere to and obey the following
provisions, assurances, and certifications.
ARTICLES
1. Subcontractor assures and certifies that it will not use any funds appropriated
under this agreement for religious activity or anti-religious activity, or to promote
or oppose any political candidate, parties, and/or beliefs
2. Subcontractor assures and certifies that any requested modification to this
agreement must be submitted in writing, explaining requested changes and
rationale. Subcontractor further assures that no modification will be implemented
without prior written approval from the Santa Ana WORK Center
3. Subcontractor agrees to cooperate with any monitoring inspection audit or
investigations of activities related to this agreement as may be scheduled and
conducted by the Santa Ana WORK Center
4. Subcontractor agrees to acknowledge (give credit to) the Santa Ana WORK
Center in all oral presentations, written document publicity, and advertisements
regarding any activities that ensue from this agreement.
Exhibit D
CLM DATE
ACORD,N CERTIFICATE OF LIABILITY INSURANCE UDBB 07-22-2010
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
PROFESSIONAL INS ASSOC INC/PHS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
141078 P:(866)467-8730 F:(877) 905-0457 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO BOX 33015
SAN ANTONIO TX 78265 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Hartford Casualty Ins Cc
INSURER B:
ANAHEIM CHAMBER OF COMMERCE INSURER C:
100 S. ANAHEIM BLVD. STE 300 INSURER D:
ANAHEIM CA 92805 INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
4TR O F MM D Y DATE MM V LIMITS
GENERAL LIABILITY EACH OCCURRENCE s2,000,000
A COMMERCIAL GENERAL LIABILITY 57 SBA D02666 03/11/10 03/11/11 FIRE DAMAGE (Any one fire) s300,000
CLAIMS MADE I OCCUR MED EXP (Any one person) $10 000
X General Liab PERSONAL & ADV INJURY s2,000,000
GENERAL AGGREGATE 44, 000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGO s4 000,000
POLICY PRO X LOC
AUTOMOBILELIABILITY
A ANY AUTO 57 SBA D02666 03/11/10 03/11/11 COMBINED SINGLE LIMIT 2, 000,000
IEa accitlent)
ALL OWNED AUTOS
BODILY INJURY s
SCHEDULED AUTOS IPer person
X HIRED AUTOS
BODILY INJURY 5
X NON-OWNED AUTOS IPer eccidenq
PROPERTY DAMAGE s
IPer acciaenD
GARAGEL/AB/LLTY AUTO ONLY -
F EA ACCIDENT 5
ANY AUTO 1/'~
yV OTHER THAN EA ACC s
AUTO ONLY AGO 9
Tow
EXCESS LIABILITY
EACH OCCURRENCE $
OCCUR L:1 CLAIMS MADE AGGREGATE 9
$
E G Rotor 6y $
DEDUCTIBLE A
(1t
RETENTION 9 PjS,st $
TWO CRYUNIT-~
OTH-
WORKERS COMP£NSAT/ON AND
I FR
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT $
E. L. DISEASE - EA EMPLOYEE 5
E.L. DISEASE - POLICY LIMIT 5
OTHER
DESCRIPTION OF OPERAT/ONU OCATKWN EHICLES/£XCLUYONS ADDED BY ENOORSEMENT/SPECIAL PROVISIONS
Those usual to the Insured's Operations. Coverage is primary and
non-contributory per Business Liability Coverage Form SS0008. See cover page
for additional wording.
CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER CANCELLATION
City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Y EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
Community Development Agency 30 DAYS WRITTEN NOTICE (10 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE
Economic Development Division HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO
PO BOX 198 8 OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
SANTA ANA, CA 92702 qU HORIZ £PRES£MA1/VE
57 Q
ACORD 25-S (7/97) C ACORD CORPORATION 1986
QUICK REFERENCE
BUSINESS LIABILITY COVERAGE FORM
READ YOUR POLICY CAREFULLY
BUSINESS LIABILITY COVERAGE FORM Beginning on Page
A. COVERAGES 1
Business Liability 1
Medical Expenses 2
Coverage Extension - Supplementary Payments 2
B. EXCLUSIONS 3
C. WHO IS AN INSURED 10
D. LIABILITY AND MEDICAL EXPENSES
LIMITS OF INSURANCE 14
E. LIABILITY AND MEDICAL EXPENSES GENERAL CONDITIONS 15
1. Bankruptcy 15
2. Duties In The Event Of Occurrence, Offense, Claim Or Suit 15
3. Financial Responsibility Laws 16
4. Legal Action Against Us 16
5. Separation Of Insureds 16
6. Representations 16
7. Other Insurance 16
8. Transfer Of Rights Of Recovery Against Others To Us 17
F. -OPTIONAL ADDITIONAL INSURED COVERAGES 18
Additional Insureds 18
G. LIABILITY AND MEDICAL EXPENSES DEFINITIONS 20
APPRQVE7/D/ its TO FORM
LISA E, STORCK
Assistant city Attorney
Form SS 00 08 04 05
BUSINESS LIABILITY COVERAGE FORM
If more than one limit of insurance under this (1) Immediately send us copies of any
policy and any endorsements attached thereto demands, notices, summonses or
applies to any claim or "suit", the most we will pay legal papers received in connection
under this policy and the endorsements is the with the claim or "suit";
single highest limit of liability of all coverages (2) Authorize us to obtain records and
applicable to such claim or "suit". However, this other information;
paragraph does not apply to the Medical Expenses
limit set forth in Paragraph 3. above. (3) Cooperate with us in the investigation,
settlement of the claim or defense
The Limits of Insurance of this Coverage Part apply against the "suit" and
separately to each consecutive annual period and to (4) Assist us, upon our request, in the
any remaining period of less than 12 months, starting
with the beginning of the policy period shown in the enforcement of any right against any
person or organization that may be
Declarations, unless the policy period is extended liable to the insured because of injury
after issuance for an additional period of less than 12 or damage to which this insurance
months. In that case, the additional period will be may also apply.
deemed part of the last preceding period for purposes
of determining the Limits of Insurance. d. Obligations At The Insured's Own Cost
E. LIABILITY AND MEDICAL EXPENSES No insured will, except at that insured's own
GENERAL CONDITIONS cost, voluntarily make a payment, assume
any obligation, or incur any expense, other
1. Bankruptcy than for first aid, without our consent.
Bankruptcy or insolvency of the insured or of e. Additional Insured's Other Insurance
the insured's estate will not relieve us of our If we cover a claim or "suit" under this
obligations under this Coverage Part. Coverage Part that may also be covered
2. Duties In The Event Of Occurrence, by other insurance available to an
Offense, Claim Or Suit additional insured, such additional insured
a. Notice Of Occurrence Or Offense must submit such claim or "suit" to the
other insurer for defense and indemnity.
You or any additional insured must see to
it that we are notified as soon as However, this provision does not apply to
practicable of an "occurrence" or an the extent that you have agreed in a
offense which may result in a claim. To written contract, written agreement or
the extent possible, notice should include: permit that this insurance is primary and
non-contributory with the additional
(1) How, when and where the "occurrence" insured's own insurance.
or offense took place; f. Knowledge Of An Occurrence, Offense,
(2) The names and addresses of any Claim Or Suit
injured persons and witnesses; and
Paragraphs a. and b. apply to you or to
(3) The nature and location of any injury any additional insured only when such
or damage arising out of the .,occurrence", offense, claim or "suit" is
,.occurrence" or offense. known to:
b. Notice Of Claim (1) You or any additional insured that is
If a claim is made or "suit" is brought an individual;
against any insured, you or any additional
insured must: (2) Any partner, if you or an additional
insured is a partnership;
(1) Immediately record the specifics of the (3) Any manager, if you or an additional
claim or "suit" and the date received; insured is a limited liability company;
and
(2) Notify us as soon as practicable. (4) Any "executive officer" or insurance
manager, if you or an additional
You or any additional insured must see to insured is a corporation;
it that we receive a written notice of the (TOM* trustee, if you or an additional
claim or "suit" as soon as practicable. Q
~p insured is a trust; or
c Insured And Cooperation Of Theg ~flj/Uy (6) acted or appointed official, if you
You and any other involved insured must: V s. SZO~ko ,)Mbdiv siontlor public entity. apolitical
Ct'ry F
~stsfa~t
Form SS 00 08 04 05 Page 15 of 24
PROFESSIONAL INS ASSOC INC/PHS
PO BOX 33015
SAN ANTONIO TX, 78265
City of Santa Ana
Community Development Agency
Economic Development Division
PO BOX 1988
SANTA ANA, CA 92702
Additional Certholder Text
The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, CA 92702; its officers,
employees, agents and volunteers are named as additional insured with regard to
liability and defense of suits arising from the operations and uses performed by or
on behalf of the named insured per business liability coverage form SS0008.
ACORD 25-S (7/97)