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HomeMy WebLinkAboutTHOMAS HOUSE (4) - 2012!n EMERGENCY SOLUTIONS GRANT SUBRECIPIENT AGREEMENT BETWEEN THE CITY OF SANTA ANA AND THOMAS HOUSE TEMPORARY SHELTER A- 2012 -060 8/12 THIS AGREEMENT, is hereby made and entered into this 1 st day of July 2012, by and between the City of Santa Ana, a charter city and municipal corporation of the State of California, herein called the "CITY" and THOMAS HOUSE TEMPORARY SHELTER, a California nonprofit organization, herein called the "SUBRECIPIENT ". WITNESSETH Recitals: 1. The CITY is the recipient of Emergency Solutions Grant ( "ESG ") funds from the United States Department of Housing and Urban Development ( "HUD "), pursuant to subtitle B of title IV of the McKinney -Vento Homeless Assistance Act [42 U.S.C. 11371- 11378], for the rehabilitation or conversion of buildings for use as emergency shelter for the homeless, for the payment of certain expenses related to operating emergency shelters, for essential services (� related to emergency shelters and street outreach for the homeless, and for homelessness prevention and rapid re- housing assistance. 2. The CITY has approved the provision of federal funds under the ESG to be used in the operation of an emergency solutions program ( "program ") for the homeless or at -risk of homelessness of the City of Santa Ana as further described by Exhibit A, Scope of Work, attached hereto and by this reference incorporated herein. 3. The SUBRECIPIENT represents that it has the requisite qualifications, expertise, and experience in the provision of emergency solutions programs for the homeless or at -risk of homelessness and is willing to use said federal funds to operate said program. 4. The SUBRECIPIENT agrees to assist individuals and families that are homeless or at risk of homelessness in obtaining appropriate supportive services including, but not limited to: temporary and permanent housing, relocation and stabilization services, rapid re- housing assistance, medical and mental health treatment, counseling supervision, and other services essential for achieving independent living, as well as other federal, state, local and private assistance available for such individuals. 5. The SUBRECIPIENT has agreed to be reimbursed for the above services in an amount not to exceed $15,100 in grant funding. 6. This AGREEMENT is contingent upon the award of Emergency Solutions Grant funds from the United States Department of Housing and Urban Development. 7. The CITY and the SUBRECIPIENT have duly executed this AGREEMENT for the expenditure and utilization of said funds. NOW THEREFORE, it is agreed by and between the parties that the foregoing Recitals are a substantive part of this AGREEMENT and the following terms and conditions are approved and together with all exhibits and attachments hereto, shall constitute the entire AGREEMENT between the CITY and the SUBRECIPIENT: I. SCOPE OF PROGRAM A. General Administration The SUBRECIPIENT agrees to implement this activity as set forth in detail in Exhibit A, Scope of Work, which shall provide a description of each activity, including the services to be performed, the person or entity providing the service, the estimated number of recipients of the service, and the manner and means of the services. B. Levels of Accomplishment — Goals and Performance Measures The SUBRECIPIENT shall be responsible to accomplish the levels of performance as set forth in Exhibit A and report such measures quarterly to the CITY. If the SUBRECIPIENT estimates such goals will not be met, the SUBRECIPIENT is to contact the CITY, at which time the CITY will determine if any adjustments to the grant award is appropriate. C. Staffina The SUBRECIPIENT shall ensure adequate and appropriate staffing is allocated to each ESG activity. Nothing contained in this AGREEMENT is intended to, or shall be construed in any manner, as creating or establishing the relationship of employer /employee between the parties. II. AGREEMENT PERIOD This AGREEMENT shall take effect on July 1, 2012, and shall terminate on June 30, 2013, unless otherwise cancelled or modified according to the terms of this AGREEMENT. III. DISBURSEMENT AND FUNDS A. Amount and Expenditure End Date The CITY agrees to reimburse the SUBRECIPIENT a maximum amount not to exceed $15,100 from Emergency Solutions Grant (ESG) funds, as outlined in Exhibit B, Final Budget, and such funds shall be expended by the SUBRECIPIENT on or before June 30, 2013. B. Invoicing Procedures The SUBRECIPIENT shall submit quarterly invoices (on or before the 15''' day of October, January, April, and July) in a form prescribed by the CITY, detailing such expenses. Such schedule may be modified with the approval of the CITY. C. Payment Payment is subject to the receipt and approval of such invoices and quarterly activity reports, as hereinafter more fully set forth below under Reporting, with the final payment subject to the satisfaction of the condition precedent of submittal of complete invoicing and reporting information due on or before July 15 of the applicable funding year. The CITY shall pay such invoices within thirty (30) days after receipt thereof, provided the CITY is satisfied that such expenses have been incurred within the scope of this AGREEMENT and that the SUBRECIPIENT is in compliance with the terms and conditions of this AGREEMENT. The thirty day period will discontinue if the reimbursement request is determined to be incomplete and will restart the thirty day timeline once the remaining required elements have been submitted. Failure to provide any of the required documentation and reporting will cause the CITY to withhold all or a portion of a request for reimbursement until such documentation and reporting has been received and approved by the CITY. D. Use of Funds The SUBRECIPIENT agrees to use said funds pursuant to this AGREEMENT to pay for necessary and reasonable costs allowable under federal law and regulations to operate said program only. Said amounts shall include and will be limited to, street outreach, emergency shelter, homelessness prevention, rapid re- housing assistance, housing relocation and stabilization services, short-term and medium -term rental assistance, and Homeless Management Information Systems ( "HMIS ") data contribution as set forth in 24 CFR § 576.101 — § 576.107. Allowable program costs are detailed in the Budget, as set forth in Exhibit B, attached hereto and by this reference incorporated herein. The 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 the CITY is otherwise obligated to pay to the SUBRECIPIENT pursuant to the terms hereof The SUBRECIPIENT agrees that the homeless shelter /services under said program shall be available for the entire period during which said funds are provided. E. Condition of Funding_ (1) The CITY advises the SUBRECIPIENT that a significant change in entitlement funding may result in a change in the current process utilized by the CITY to determine funding allocations. The SUBRECIPIENT acknowledges that the obligation of the CITY is contingent upon the availability of Federal, State or Local government funds, which are appropriated or allocated for the payment of such an obligation. If funding levels are significantly affected by Federal budgeting or if funds are not allocated and available for the continuance of the function performed by the SUBRECIPIENT, this AGREEMENT may be terminated by the CITY at the end of the period for which funds are available. At the earliest opportunity, the CITY shall notify the SUBRECIPIENT of any service which may be affected by a shortage of funds. No penalty shall accrue to the CITY in the event this provision is exercised and the CITY shall not be liable for any damages as a result of termination under this provision of this AGREEMENT. Nothing herein shall be construed as obligating the CITY to expend funds in excess of appropriations authorized by law. (2) The SUBRECIPIENT shall allow representatives of the CITY or HUD to inspect facilities which are used in connection with the AGREEMENT or which implement programs funded under this AGREEMENT. F. Matching_ The SUBRECIPIENT is required to make matching contributions to supplement the ESG program in an amount that equals or exceeds the amount of ESG funds provided by HUD through the CITY. Such contributions shall be entirely consistent with the Matching Requirements as outlined by 24 CFR § 576.201. The anticipated source and amount of all matching funds contributed by the SUBRECIPIENT will be enumerated in Exhibit B, Final Budget. G. Program Income (1) Definition. Program income means, as provided by 24 CFR 84.24 or 24 CFR 85.25, gross income received by the SUBRECIPIENT directly generated by a grant supported activity, or earned only as a result of the grant agreement during the grant period. For purposes of ESG, program income will also include any amount of a security or utility deposit returned to the SUBRECIPIENT. (2) Use. The 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. (3) Counts toward Matching. Costs paid by program income may count toward meeting the matching requirements, provided the costs are eligible ESG costs that supplement the program. H. Separation of Accounts All funds received by the SUBRECIPIENT from the CITY pursuant to this AGREEMENT shall be maintained separate and apart from any other funds of the SUBRECIPIENT, or of any principal or member of the SUBRECIPIENT, in an account (the "Account ") at a federally insured banking or savings and loan institution with record keeping of such Accounts maintained pursuant to applicable legal requirements. The SUBRECIPIENT shall keep all records of the Account in a manner that is consistent with generally accepted accounting principles. No monies shall be withdrawn from the Account except for expenditures relating to essential services, homeless prevention, and/or operations costs, as authorized hereunder. All disbursements from the Account shall be for obligations incurred in the performance of this AGREEMENT and shall be supported by contracts, invoices, vouchers, and other data, as appropriate, evidencing the necessity of such expenditure. The CITY may withhold payment allocation requests if the SUBRECIPIENT fails to comply with the above requirements until such compliance is demonstrated. I. Expenditure of Funds Much like how HUD requires the CITY, pursuant to 24 CFR 576.203, to expend all of the grant funds for eligible activity costs within 24 months after the date that HUD signs the grant agreement with the CITY, it is a requirement for the SUBRECIPIENT to expend all of the grant funds for eligible activity costs within the aforementioned period. For the purposes of this paragraph, expenditure means either an actual cash disbursement for a direct charge for a good/service or an indirect cost, or the accrual of a direct charge for a good/service or an indirect cost. Failure to expend said funds within said timeframe can result in a reallocation of funds. J. Prohibited Use (1) Generally. The SUBRECIPIENT hereby certifies and agrees that it will not use funds provided through this AGREEMENT to pay for meals for persons other than those identified as homeless or at risk of homelessness. Said funds shall not be used for entertainment purposes or for gifts. The SUBRECIPIENT certifies that it will not use said funds for illegal or dishonest conduct, rather, fund use will remain in compliance with all applicable federal, state, and local laws, including applicable laws not outlined in this AGREEMENT. (2) Lobbying. The SUBRECIPIENT certifies and agrees 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. The 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. The SUBRECIPIENT shall submit said signed certification to the CITY prior to performing any of its obligations under this AGREEMENT and prior to any obligation arising on the part of the CITY to pay any sums to the SUBRECIPIENT under the terms and conditions of this AGREEMENT. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of 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 Exhibit C -1). IV. NOTICES The SUBRECIPIENT and the CITY agree that all notices required by this AGREEMENT shall be made in writing and delivered via mail (postage prepaid); commercial courier; personal delivery; or sent by facsimile or other electronic means (provided that receipt is confirmed). Any notice delivered or sent as aforesaid shall be effective on the date of delivery or sending. All notices and other written communications under this AGREEMENT shall be addressed to the individuals in the capacities indicated below, unless modified by subsequent written notice. Communication and details concerning the AGREEMENT shall be delivered to the office of, and directed to, the following representatives: 4 ky CITY: Francisco Hernandez Management Analyst City of Santa Ana Community Development Agency (M -25) 20 Civic Center Plaza P.O. Box 1988 Santa Ana, CA 92702 -1988 (714) 647 -5360 (714) 647 -6549 GENERAL CONDITIONS A. Coordination with Continuum of Care SUBRECIPIENT: Cyndee Albertson Executive Director THOMAS HOUSE TEMPORARY SHELTER P.O. Box 2737 Garden Grove, CA 92843 The SUBRECIPIENT must work with the Continuum of Care ( "CoC ") to ensure the screening, assessment, and referral of program participants are consistent with the CITY's written standards for providing ESG assistance as described in its consolidated plan. The SUBRECIPIENT must keep documentation evidencing the use of, and written intake procedures for, the centralized or coordinated assessment system(s) developed by the CoC in accordance with the requirements established by HUD. See 24 CFR 576.400. B. Evaluatoin of Program Participants Eligibility and Needs The SUBRECIPIENT must conduct evaluations and re- evaluations to determine the eligibility of each individual or family's eligibility for ESG assistance in accordance with 24 CFR 576.401. C. Terminating Assistance If a program participant violates program requirements, the SUBRECIPIENT may terminate the assistance in accordance with a formal process established by the SUBRECIPIET that recognizes the rights of individuals affected. See 24 CFR 576.402 D. Shelter and Housing Standards The SUBRECIPIENT certifies that shelters and housing supported by ESG funds and used by ESG beneficiaries will conform to 24 CFR 576.403. E. Homeless Involvement The 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. See 24 CFR 576.405(c) and 42 USC 11375(d). F. Independent Contractor. Nothing contained in this AGREEMENT is intended to, or shall be construed in any manner, as creating or establishing the relationship of employer /employee between the parties. The SUBRECIPIENT and its subcontractors shall at all times remain independent contractors with respect to the services to be performed under this AGREEMENT. The CITY shall be exempt from payment of any Unemployment Compensation, FICA, retirement, life and /or medical insurance and Workers' Compensation Insurance as the SUBRECIPIENT is an independent contractor. 5 G. Subcontracts. (1) Content Requirements. The SUBRECIPIENT will include all relevant provisions of this AGREEMENT in all subcontracts entered into as part of the activities undertaken in furtherance of this AGREEMENT and will take appropriate action pursuant to any subcontract upon a finding that the subcontractor is in violation of regulations issued by any federal agency. The SUBRECIPIENT will not subcontract with any entity where it has notice or knowledge that the latter has been found in violation of regulations under 24 CFR Part 135 (Economic Opportunities for Low- and Very Low- Income Persons) and will not allow any subcontract unless the entity has first provided it with a preliminary statement of ability to comply with the requirements of these regulations. (2) Submission to the CITY. The SUBRECIPIENT must submit all subcontracts and other agreements that relate to this AGREEMENT to the CITY. H. Licensina. The SUBRECIPIENT agrees to obtain and maintain all required licenses, registrations, accreditation, and inspections from all agencies governing its operations. The SUBRECIPIENT shall ensure that its staff and subcontractors shall also obtain and maintain all required licenses, registrations, accreditation and inspections from all agencies governing the SUBRECIPIENT"s operations hereunder. Such licensing requirements include obtaining a City business license, as applicable. I. Responsibilities Toward Employees The SUBRECIPIENT accepts full responsibility for payment of any and all unemployment compensation, insurance premiums, workers' compensation premiums, income tax withholdings, social security withholdings, and any and all other taxes or payroll withholdings required for all employees engaged in the performance of the work and activities authorized by the AGREEMENT. The SUBRECIPIENT accepts full responsibility for providing workers with proper safety equipment and taking any and all necessary precautions to guarantee the safety of workers or persons otherwise affected. J. Insurance and Bonding (1)Generally. The SUBRECIPIENT shall maintain liability and property insurance to cover actionable legal claims for liability or loss which are the result of injury to or death of any person, or damage to property (including property of Grantee) caused by the negligent acts or omissions, or negligent conduct of the SUBRECIPIENT, its employees, agents or subcontractors, to the extent permitted by law, in connection with the activities of this AGREEMENT. The SUBRECIPIENT shall comply with the bonding and insurance requirements of 24 CFR 84.31, 84.48, and 85.36. The SUBRECIPIENT shall undertake self - insurance, or shall obtain, at its sole cost, a policy or policies of commercial general liability insurance, or equivalent form. 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 programs maintained by the CITY; (3) contain standard separation of insureds provisions; and (4) give to the CITY prompt and timely notice of claim made or suit instituted arising out of the SUBRECIPIENT's operations hereunder. (2) Limits. The SUBRECIPIENT shall maintain, at all times, the following minimum levels of Insurance, and shall, without in any way altering its liability, obtain, pay for, and maintain insurance for the coverages and amounts of coverage not less than those set forth below: a. Workers' Compensation. Amount must comply with State and Federal Laws b. Comprehensive General Liability. $1,000,000 combined single limit of liability for bodily injuries, death, and property damage resulting from any one occurrence, including the following coverages: Premises and Operations; and ii. Broad Form Commercial General Liability Endorsement to include blanket contractual liability (specifically covering, but not limited to, the contractual obligations assumed by the SUBRECIPIENT); Personal Injury (with employment and contractual exclusions deleted); and Broad Form Property Damages coverages. C. The SUBRECIPIENT's self - insured retention or deductible per line of coverage shall not exceed $25,000 without the permission of the CITY. (3) Proof of Insurance. The SUBRECIPIENT shall furnish the CITY's Clerk of the Council with an insurance certificate 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 the CITY. The SUBRECIPIENT shall, prior to exercising any right under this AGREEMENT: a . furnish properly executed certificates of insurance and additional insured endorsement to the CITY which shall clearly evidence all coverages required above; b . provide that such insurance shall not be materially changed or terminated except on thirty (30) days prior written notice to the CITY; c . maintain such insurance for the period covered by this AGREEMENT; and d . replace such certificates for policies expiring prior to the expiration of this AGREEMENT. (4) Company Rating. All insurance coverage shall be written with a company having an A.M. Best Rating of "A" or better and financial size of VIII or larger. (5) Failure to Comply. In the event of any failure by the SUBRECIPIENT to comply with these provisions, the CITY may, on notice to the SUBRECIPIENT, suspend the program for cause until there is full compliance. K. Zonine. The 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 the SUBRECIPIENT fail to have the required land entitlement and/or permits, thus violating any local, state, or federal rules and regulations relating thereto, the SUBRECIPIENT shall immediately make good -faith efforts to gain compliance with local, state, or federal rules and regulations following written notification of said violation(s) from the CITY or other authorized citing agency. The SUBRECIPIENT shall notify the CITY immediately of any pending violations. Failure to notify the CITY of pending violations, or to remedy such known violation(s), shall result in termination of grant funding hereunder. The 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. L. Displacement and Relocation. The SUBRECIPIENT must assure that it has taken all reasonable steps to minimize displacement of persons. Relocation must be consistent with requirements as set forth in 24 CFR § 576.408. 7 M. Provisions Required by Law Deemed Inserted. Each and every provision of law and clause required by law to be inserted in this contract shall be deemed to be inserted herein and the AGREEMENT shall be read and enforced as though it were included herein, and if through mistake or otherwise any such provision is not inserted or correctly inserted, then upon the application of either party the contract shall forthwith be physically amended to make such insertion or correction. VL ASSURANCES AND CERTIFICATIONS A. Non- Profit Status The SUBRECIPIENT certifies that: (1) The 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 and in possession of required non- profit status under the United States Internal Revenue Code (for example, 26 USC § 501(c)(3). The 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 the SUBRECIPIENT has been fully authorized by all requisite actions on the part of the SUBRECIPIENT. (2) If the SUBRECIPIENT's non -profit status changes at anytime during this AGREEMENT, it will advise the CITY within 15 days. (3) If the SUBRECIPIENT is a private non - profit, it hereby agrees that the members of its Board of Directors will receive no compensation, directly or indirectly, other than reimbursement for expenses, from any funds generated from or because of the ESG program, for their services. (4) As a non - profit, the SUBRECIPIENT acknowledges that administration of its operation and services are subject to the requirements as established in 24 CFR Part 84. B. Adherence to Federal. State, and Local Laws and Regulations (1) General. The SUBRECIPIENT agrees to comply with all requirements of the ESG program and applicable cross - cutting Federal, State, and Local requirements. (2) Economic Opportunities for Low- and Very Low - income Persons. The SUBRECIPIENT shall ensure that employment and other economic opportunities generated by the Program shall, to the greatest extent feasible, be directed to low- and very low- income persons, particularly those who are recipients of government assistance for housing. Section 3 of the Housing and Urban Development Act of 1968, 12 U.S.C. 1701u, and regulations at 24 CFR part 135 apply, except that homeless individuals have priority over other Section 3 residents in accordance with § 576.405(c). (3) Civil Rights. The SUBRECIPIENT agrees to comply with Title VI of the Civil Rights Act of 1964, as amended, Title VIII of the Civil Rights Act of 1968, as amended, Section 109 of the Title I of the Housing and Community Development Act of 1974, Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, the Age Discrimination Act of 1975, and 41 CFR Chapter 60. (4) Nondiscrimination and Equal Employment Opportunity. During the performance of this contract, the SUBRECIPIENT agrees to not discriminate against any employee or applicant for employment based on race, color, creed, religion, sex, age, handicap, disability, ancestry, national origin, marital status, familial status, sexual orientation, or any other basis prohibited by applicable law. The SUBRECIPIENT shall take affirmative action to ensure that all applicants and employees are treated without regard to race, color, creed, religion, sex, age, handicap, disability, ancestry, national origin, marital status, familial status, and sexual orientation. The SUBRECIPIENT shall comply with all provisions of Executive Order 11246, Equal Employment Opportunity, as amended by Executive Orders 11375 and 12086. (5) Nondiscrimination and Equal Opportunity in Participation. The requirements in 24 CFR part 5, subpart A are applicable, including the nondiscrimination and equal opportunity requirements at 24 CFR 5.105(a). The SUBRECIPIENT shall not discriminate against any participant on the ground of race, color, creed, religion, sex, age, handicap, disability, ancestry, national origin, marital status, familiar status, sexual orientation, or any other basis prohibited by applicable law. The SUBRECIPIENT shall, through affirmative outreach, make known that use of the facilities, assistance, and services are available to all on a nondiscriminatory basis. The SUBRECIPIENT must take appropriate steps to ensure effective communication with persons with disabilities. (6) Americans with Disabilities Act. The SUBRECIPIENT agrees to comply with any federal regulations issued pursuant to compliance with the Americans with Disabilities Act which prohibits discrimination and ensures equal opportunity for persons with disabilities in employment, State and Local government services, and public accommodations. (7) Fair Housing. Under section 808(e)(5) of the Fair Housing Act, HUD has a statutory duty to affirmatively further fair housing. HUD requires the same of its funded sub - recipients. The SUBRECIPIENT will have a duty to affirmatively further fair housing opportunities for classes protected under the Fair Housing Act. C. Falsification of Information The SUBRECIPIENT represents and warrants that it has made no false statements to the CITY in the process of obtaining this award of the NSP Funds. D. Drug Free Workplace The SUBRECIPIENT represents and warrants that it has established the following drug -free workplace policy: (1) The unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace for any employee involved in a federally funded program. (2) As an employee working in conjunction with a federally funded program, the employees of the SUBRECIPIENT will be required to: a. Abide by the terms above in statement (1), and Notify the appropriate SUBRECIPIENT authorities and CITY officials of any criminal drug statute conviction for a violation occurring in the workplace. Such notification shall be made no later than five (5) days after 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 thirty (30) days of receiving such notice, appropriate personnel action will be taken against such employee, up to and including termination. (5) Each such employee shall be required to participate satisfactorily in a drug abuse assistance or 9 rehabilitation program approved for such purposes by a Federal, State or Local health, law enforcement, or other appropriate agency. E. Religious Organization The SUBRECIPIENT may not engage in inherently religious activities,, such as worship, religious instruction, or proselytization as part of said program or services. If the SUBRECIPIENT conducts such activities, the activities must be offered separately, in time or location, from said programs or services, and participation must be voluntary for the program participants. The SUBRECIPIENT shall not, in providing program assistance, discriminate against a program participant or prospective program participant on the basis of religion or religious belief. If the SUBRECIPIENT is a religious organization, it retains its independence from Federal, State, and Local governments, and may continue to carry out its mission, including the definition, practice, and expression of its religious beliefs, provided that the religious organization does not use direct ESG funds to support any inherently religious activities. The SUBRECIPIENT agrees that rehabilitation of structures by the religious organization in connection with said program must be in sound accord with the provisions under 24 CFR § 576.406. F. Additional Terms between the CITY and HUD The SUBRECIPIENT agrees further that it shall be bound by the standard terms and conditions used in the Grant Agreement between HUD and the CITY and such other rules, regulations, or requirements as HUD may reasonably impose in addition to the aforementioned assurances at or subsequent to the execution of this AGREEMENT by the parties hereto. G. OSHA Where employees are engaged in activities not covered under the Occupational Safety and Health Act of 1970, they shall not be required or permitted to work, be trained, or receive services in buildings or surroundings or under working conditions which are unsanitary, hazardous, or dangerous to the participants' health or safety. H. Hatch Act The SUBRECIPIENT agrees that no funds provided, nor personnel employed under this AGREEMENT, shall be in any way or to any extent engaged in the conduct of political activities in violation of the Hatch Act, 5 U.S.C. Section 1501 et seq. L 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. See 29 C.F.R. §5.6(a)(3). 10 VII. ADMINISTRATIVE REQUIREMENTS A. Generally The requirements of 24 CFR part 84 apply to the SUBRECIPIENT, except that 24 CFR 84.23 and 84.53 do not apply, and program income is to be used as the non - federal share under 24 CFR 84.24(b). These regulations include allowable costs and non - federal audit requirements. The following additional requirements and standards must be complied with: OMB Circular A -122 "Cost Principles for Non - Profit Organizations" or OMB Circular A -21 "Cost Principles for Educational Institutions ", as applicable; and, OMB Circular A -133, "Audits of States, Local Governments and Non -Profit Organizations ". B. Procurement (1) Compliance. The SUBRECIPIENT shall comply with current HUD and CITY policies concerning the procurement of equipment, goods, and services, and shall maintain inventory records of all non - expendable personal property as defined by such policy as may be procured with funds provided herein. The SUBRECIPIENT shall report to the CITY all program assets (unexpended program income, property, equipment, etc.), and upon the CITY'S request, such assets shall revert to the CITY upon termination of this AGREEMENT. (2) OMB Standards. Unless specified otherwise within this AGREEMENT, the SUBRECIPIENT shall procure all materials, property, or services in accordance with the requirements of 24 CFR 84.40 -48 or 24 CFR 85.36. (3) Use and Reversion of Assets. The use and disposition of equipment under this AGREEMENT shall be in compliance with the requirements of 24 CFR Part 84 or 85. C. Reporting Reporting requirements must conform to the policies and procedures as established by the CITY and 24 CFR § 576.500. The SUBRECIPIENT shall submit to the CITY, on or before the 15t' day of October, January, April, and July, as part of the Quarterly Report: (1) Payment Request. An original invoice and true copies of invoices, receipts, agreements, or other documentation supporting and evidencing how the ESG Funds have been expended during the applicable quarter. (2) Quarterly Activities and written cumulative (year -to -date) reports of activities, program accomplishments, new program information, and up -to -date program statistics on expenditures, caseload and activities. Failure to provide any of the required documentation and reporting will cause the CITY to withhold all or a portion of a request for reimbursement until such documentation and reporting has been received and approved by the CITY. (3) Matching. Quarterly certification of match, plus documentation of match source. (4) Any other such reports as the 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 the SUBRECIPIENT in the performance of its obligations under this AGREEMENT. D. Record Keeping Sufficient records must be established and maintained to enable the CITY and HUD to determine whether the ESG requirements are being met. Record keeping requirements must conform to the policies and procedures as established by the CITY. All accounting records, reports, all evidence pertaining to costs, expenses, and ESG Funds of the SUBRECIPIENT, and all documents related to this AGREEMENT shall 11 be maintained and kept available at the SUBRECIPIENT'S office or place of business for the duration of the AGREEMENT and thereafter for five (5) years post - completion of an audit in conformity with the ESG requirements, except as hereinafter provided relating to retention of any records or documentation existing, created, or maintained in compliance with Lead -based Paint regulations, which likely require longer retention as outlined below. 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 the 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 said records must be retained for the greater of the aforementioned duration or the periods specified in 24 CFR 576.500(y). All records relating to, or created or maintained in compliance with, the Lead -Based Paint regulations shall be retained and maintained by the SUBRECIPIENT indefinitely, including without limitation, all inspection report(s), disclosure statement(s), and clearance report(s). Copies made by microfilming, photocopying, or similar methods may be substituted for the original records. The CITY and HUD shall have the right to access all the SUBRECIPIENT records for as long as the records are retained by the SUBRECIPIENT. In the event the SUBRECIPIENT does not make the above - referenced documents available within the City of Santa Ana, California, the SUBRECIPIENT agrees to pay all necessary and reasonable expenses incurred by the CITY in conducting any audit at the location where said records and books of account are maintained. The SUBRECIPIENT agrees to meet requirements as set forth in 24 CFR § 576.500 E. Homeless Management Information Systems (HMIS) (1) Generally. The SUBRECIPIENT must ensure that data on all persons served and all activities assisted under ESG are entered into the applicable community -wide HMIS in the area in which those persons and activities are located, or with the express knowledge and written consent of the CITY, a comparable database, in accordance with HUD's standards on participation, data collection, and reporting under a local HMIS. (2) HMIS Agency Agreement. The SUBRECIPIENT shall have an agreement in place with the HMIS lead agency to participate in the regionally HMIS system. A copy of the SUBRECIPIENTS agreement with the HMIS lead agency shall be attached to this agreement as Exhibit D. In the case of Domestic Violence service providers or other agencies prohibited from entering data into HMIS, documentation from the HMIS lead agency certifying that the SUBRECIPIENT is using a comparable database shall be attached to this agreement as Exhibit D. (3) HMIS Interagency Data Sharing Agreement. The SUBRECIPIENT shall enter into an Interagency Data Sharing Agreement with the HMIS Lead Agency where the SUBRECIPIENT agrees to share HMIS data with other ESG funded agencies regarding clients that are served in ESG funded programs, unless prohibited by law. A copy of such agreement shall be attached as Exhibit E. F. Audit Report Requirements The SUBRECIPIENT agrees that if the SUBRECIPIENT receives Five Hundred Thousand Dollars ($500,000.00) or more in federal funds, the 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 in the Single Audit Act Amendments of 1996, OMB Circular A -133, and the OMB Circular Compliance Supplement and Government Auditing Standards. The SUBRECIPIENT shall provide the CITY with a copy of said audit by October 1 of the year following the program year in which this AGREEMENT is executed. Further, the SUBRECIPIENT shall comply and/or cause compliance with audit report(s) required by applicable provisions of the Lead -Based Paint Regulations as further detailed below. VIII. EVALUATION AND MONITORING A. Generally 12 The CITY will monitor the performance of the SUBRECIPIENT against goals and performance standards as required herein. The SUBRECIPIENT shall provide the CITY all necessary reporting information as required by the CITY in the administration and review of the Program. Substandard performance as determined by the CITY will constitute noncompliance with this AGREEMENT. If action to correct such substandard performance is not taken by the SUBRECIPIENT within a reasonable period of time after being notified by the CITY, contract suspension or termination procedures will be initiated. B . Access to Records The SUBRECIPIENT gives the CITY and HUD, including their authorized representative, access to and the right to examine all records, books, papers, items, emails, and documents, both physical and electronic, relating to the program. C. Audit The CITY shall have the right to audit and monitor any program income as a result of an ESG activity. Upon request by the CITY and for audit purposes, the SUBRECIPIENT further agrees to provide all files, records, and documents pertaining to related activities and clientele demographic data. IX. LIABILITY A. Generally Each party to this AGREEMENT acknowledges that it will be liable for its own negligent acts or negligent omissions by or through itself, its employees, agents, and subcontractors. Each party further agrees to defend itself and themselves, and to pay any judgments and costs arising out of such negligent acts or omissions, and nothing in this AGREEMENT shall impute or transfer any such liability from one to the other. In other words, the SUBRECIPIENT agrees to be fully responsible for its negligent acts or omissions, or any intentional tortuous acts which result in claims or suits against the CITY, and agrees to be liable for any damages proximately caused by said acts or omissions. Nothing herein shall be construed as consent by a State or CITY agency or subdivision to be sued by third parties in any matter arising out of any contract, and nothing herein is intended to serve as a waiver of sovereign immunity where sovereign immunity applies. B. CITY not Liable for Funds The SUBRECIPIENT further acknowledges that the source of the ESG Funds is a federal pass - through grant to the SUBRECIPIENT. The CITY shall have no obligation to advance or pay the SUBRECIPIENT with any funds other than the ESG Funds the CITY receives from HUD. C. Hold Harmless The SUBRECIPIENT shall defend, indemnify and save harmless the CITY, its officers, agents, employees, representatives, volunteers, and student externs 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 the CITY, and shall defend, indemnify and save harmless the CITY, its officers, agents, employees, representatives, volunteers, and student externs from and against any and all claims, demands, suits, actions or proceedings of any kind or nature, including, but not by way of limitation, workers compensation claims and attorney fees /expenses for litigation or settlement, resulting from or arising out of the negligent or wrongful acts, errors or omissions of the SUBRECIPIENT, its officers, directors, employees, agents, subcontractors, and suppliers arising out of the SUBRECIPIENT's performance of this AGREEMENT. X. ENVIRONMENTAL CONDITIONS A. Generally 13 ESG activities are subject to environmental review by HUD under the environmental regulations in 24 CFR 50. The SUBRECIPIENT, or any contractor of the SUBRECIPIENT, may not acquire, rehabilitate, convert, lease, repair, dispose of, demolish, or construct property for a project under this part, or commit or expend HUD or local funds for eligible activities under this part, until HUD has performed an environmental review under 24 CFR part 50 and the recipient has received HUD approval of the property. The SUBRECIPIENT agrees to comply with all applicable environmental requirements insofar as they apply to the performance of this AGREEMENT, including but not limited to the Clean Air Act, the Federal Water Pollution Control Act and the Flood Disaster Protection Act. If applicable, the SUBRECIPIENT also shall comply with the Historic Preservation requirements of National Historic Preservation Act of 1966. B. Lead -based paint remediation and disclosure The Lead -Based Paint Poisoning Prevention Act (42 U.S.C. 4821 - 4846), the Residential Lead -Based Paint Hazard Reduction Act of 1992 (42 U.S.C. 4851- 4856), and implementing regulations in 24 CFR part 35, subparts A, B, H, J, K, M, and R apply to all shelters assisted under ESG program and all housing occupied by program participants. C. Assignment of Responsibilities By this AGREEMENT, the SUBRECIPIENT will accept assignment from the CITY of all responsibilities set forth in Subpart K of 24 CFR 35. D. Compliance with Subpart K The purpose of Subpart K is to establish procedures to eliminate as far as practicable lead -based paint ( "LBP ") hazards in a residential property that receives Federal assistance under certain HUD programs for acquisition, leasing, support services, or operation. In connection with the grant funds under this AGREEMENT, the CITY requires that the SUBRECIPIENT comply and show evidence of compliance with all applicable subparts of 24 CFR 35, and especially, Subpart K. The SUBRECIPIENT shall conduct the following activities for the dwelling unit, common areas servicing the dwelling unit, and the exterior surfaces of the building in which the dwelling unit is located: (1) A visual assessment of all painted surfaces in order to identify deteriorated paint; (2) Paint stabilization of each deteriorated paint surface, and clearance, in accordance with §§ 35.1330(a) and (b), before occupancy of a vacant dwelling unit or, where a unit is occupied, immediately after receipt of Federal assistance; and (3) Ongoing lead -based paint maintenance activities into regular building operations, in accordance with § 35.1355(a), if the dwelling unit has a continuing, active financial relationship with a Federal housing assistance program, except that mortgage insurance or loan guarantees are not considered to constitute an active programmatic relationship for the purposes of this part. (4) And, notice to occupants in accordance with §§ 35.125(b)(1) and (c), describing the results of the clearance examination. E. Notification and Attachments The SUBRECIPIENT shall provide to all occupants of housing: (1) In accordance with Section 35.130 of the LBP Regs, the LBP hazard information pamphlet. The pamphlet shall be the EPA/HUD /Consumer Product Safety Commission lead hazard information pamphlet or an EPA - approved equivalent. 14 The current form and version of the pamphlet can be found at: http://www.santa-ana.org/cda/documents/ESGattachmenti-5.pdf as referenced on Attachment No. 1 to this AGREEMENT. (2) In accordance with 24 CFR 35, Subpart A, all available information and knowledge regarding the presence of LBP and LBP hazards prior leasing a housing unit. The current form and version of such notice is attached as Attachment No. 2 to this AGREEMENT. (3) And, in accordance with 24 CFR 35, Subpart A, notification 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. The current form and version of such notice is attached as Attachment No. 3 to this AGREEMENT. F. LBP Information Summary For purposes of information only and in no respect intended to be a representation or warranty of the provisions of the LBP Regulations, the CITY has caused to be prepared an information summary relating to the LBP Regulations and Application to dwelling units that may be occupied by recipients of services and/or funding from the SUBRECIPIENT under this AGREEMENT. Attachment No. 4 to this AGREEMENT, attached and hereby fully incorporated by this reference, is such information summary. The CITY staff will cooperate with and make themselves available to the SUBRECIPIENT to assist in implementation of compliance with the LBP REGS as to residential dwelling units to be assisted by the SUBRECIPIENT. The parties acknowledge and agree the CITY shall not be liable or responsible for the accuracy of such summary, and the SUBRECIPENT is directed to the LBP Regulations and implementing guidance published and provided by HUD relating to compliance with such LBP Regulations. G. Exemptions Section 35.115(a) provides exemptions from Subparts B through R. For example, lead -based paint requirements do not apply to housing assistance (such as for homeless persons) if the assistance lasts less than 100 days. XI. CONFLICTS OF INTEREST The SUBRECIPIENT shall comply with 24 CFR § 84.42 with respect to the use of program funds to procure services, equipment, supplies, or other property. With respect to all other decisions involving the use of program funds, the following restriction shall apply: No person who is an employee, agent, consultant, officer, or elected or appointed official of the SUBRECIPIENT and who exercises or has exercised any functions or responsibilities with respect to assisted activities, or who is in a position to participate in a decision making process or gain inside information with regard to such activities, may obtain a personal or financial interest or benefit from the activity, or have an interest in any contract, subcontract, or agreement with respect thereto, or the proceeds there under, either for himself or herself, or for those with who he or she has family or business ties, during his or her tenure or for one year thereafter. The SUBRECIPIENT agrees to abide by the ESG Program's Conflict of Interest provisions as expressly detailed in 24 CFR § 576.404 regarding Organizational Conflicts of Interest and Personal Conflicts of Interest. All contractors of the SUBRECIPIENT must comply with the same requirements that apply to the SUBRECIPIENT under this section. 15 XII. ASSIGNABILITY None of the duties of, or work to be performed by, the SUBRECIPIENT under this AGREEMENT shall be subcontracted or assigned to any agency, consultant, or person without the prior written consent of the CITY. The SUBRECIPIENT must submit all subcontracts and other agreements that relate to this AGREEMENT to the CITY. No subcontract or assignment shall terminate or alter the legal obligations of the SUBRECIPIENT pursuant to this AGREEMENT. XIII. EXCLUSIVITY OF AGREEMENT This AGREEMENT supersedes any and all other agreements, either oral or in writing, between the parties hereto with respect to the use of the CITY's ESG Funds by the SUBRECIPIENT and contains all the covenants and agreements between the parties with respect to such ESG Funds in any manner whatsoever. Each party to this AGREEMENT acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein, and that no other agreement or amendment hereto shall be effective unless executed in writing and signed by both the CITY and the SUBRECIPIENT. XIV. AMENDMENTS OR MODIFICATIONS The SUBRECIPIENT shall not obligate, encumber, spend, or otherwise utilize program funds for any activity or purpose not included or not in conformance with the budget as apportioned and as submitted to the CITY unless: (1) The SUBRECIPIENT has received explicit written approval from the CITY to undertake such actions, or (2) Budget changes may be made among approved program activities and among approved budget categories so long as the specific project activity has been approved, there is no change to the total grant amount, and the changes to the budget are documented. Any program modification request by the SUBRECIPIENT must be requested at least forty-five (45) days prior to the end of the term of this AGREEMENT. No modification to this AGREEMENT shall be binding by either party unless in writing and signed by both parties. In the event that the CITY approves any amendment to the funding allocation, the SUBRECIPIENT shall be notified in writing and such notification shall constitute an official amendment. The CITY may, at its discretion and upon provision of proper notice to the SUBRECIPIENT, amend this AGREEMENT to conform with changes in Federal, State, and/or the CITY laws, regulations, guidelines, directives, and objectives. Such amendments shall be incorporated by written amendment as a part of this AGREEMENT. XV. VIOLATION OF TERMS AND CONDITIONS A. Termination If, due to any cause, the SUBRECIPIENT fails to comply with the terms, conditions or requirements of this AGREEMENT, or any prior AGREEMENT whereby ESG funds were received by the SUBRECIPIENT, whether stated in a Federal statute or regulation, an assurance, a State plan or application, a notice of award, or elsewhere, the CITY may terminate or suspend this AGREEMENT in accordance with 24 CFR 85.43 and in accordance with 24 CFR 85.44 by giving written notice, and the CITY may request in writing that all or some of the grant funds be returned even if the SUBRECIPIENT has expended the funds. 16 If the SUBRECIPIENT reports inaccurately, or if on audit there is a disallowance of certain expenditures, the SUBRECIPIENT agrees to remedy the acts or omissions causing the disallowance and repay the CITY all amounts spent in violation thereof. If the SUBRECIPIENT engaged in fraudulent activity to obtain and/or justify expenditure of the ESG funds granted hereunder, the SUBRECIPIENT shall be required to reimburse the CITY of all such funds that were obtained and/or spent under fraudulent circumstances, and the CITY reserves the right to take other remedies that may be legally available. The SUBRECIPIENT agrees to return all funds as requested by the CITY under this section within thirty (30) days of receipt of the written request. Any objections regarding terminations or suspensions shall be made by the SUBRECIPIENT in writing and mailed to the CITY pursuant to the above NOTICES section. XVI. CLOSE -OUT The SUBRECIPIENT's obligation to the CITY shall not end until all close -out requirements are completed. Activities during this close -out period shall include, but are not limited to: making final payments; submitting final invoice(s), report(s), in accordance with this AGREEMENT, and documentation; disposing of program assets (including the return to the CITY of all unused materials and equipment); remitting any receivable accounts to the CITY and determining the custodianship of records. The SUBRECIPIENT shall be obligated to perform such duties as would normally extend beyond the term, including but not limited to obligations with respect to indemnification, audits, reporting, data retention/reporting, and accounting. XVII. VALIDITY AND SEVERABILITY The invalidity in whole or in part of any provision of this ARGREEMENT shall not void or affect the validity of any other provision of this AGREEMENT. Whenever possible, each provision of this AGREEMENT shall be interpreted in such manner as to be effective and valid under applicable law, but if any provision of this AGREEMENT is held to be prohibited by or invalid under applicable law, such provision shall be ineffective only to the extent of such prohibition or invalidity, without invalidating the remainder of such provisions of this AGREEMENT. XVIII. 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. None of the duties of, or work to be performed by, the SUBRECIPIENT under this AGREEMENT shall be subcontracted or assigned to any agency, consultant, or person without the prior written consent of the CITY. No subcontract or assignment shall terminate or alter the legal obligations of the SUBRECIPIENT pursuant to this AGREEMENT. XIX. WAIVER No delay or omission by the CITY hereto to exercise any right or power accruing upon any noncompliance or default by the SUBRECIPIENT with respect to any of the terms of this AGREEMENT shall impair any such right or power or be construed to be a waiver thereof. A waiver by either of the parties hereto of any of the covenants, conditions, or agreements to be performed by the other shall not be construed to be a waiver of any succeeding breach thereof or of any other covenant, condition, or agreement herein contained. XX. AGREEMENT DOCUMENT EXHIBITS AND ATTACHMENTS All of the attachments and exhibits attached to this agreement are deemed incorporated by reference. This document shall be executed in three (3) counterparts, each of which shall be deemed to be an original. 17 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 the CITY fully, including reasonable costs and attorney's fees, for any injuries or damages to the CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. IN WITNESS WHEREOF, the parties hereto have executed this AGREEMENT on the date and year first above written. ATTEST: (_ / j, VU,i ref' '9 MARIA D. HUIZAR d Clerk of the Council APPROVED AS TO FORM: SONIA CARVALHO City /Attorney/ �►-- By: LISA E. STORCK Assistant City Attorney DATED: CITY OF SANTA ANA a municipal corporation PAUL WALTERS City Manager SUBRECIPIENT: Name Cyndee Albertson Title: Executive Director Tax ID: 33- 0204757 18 City of Santa Ana Scope of Work Name of Organization Thomas House Temporary Shelter Name of Funded Program Thomas House Temporary Shelter Annual Accomplishment Goal I. Total number of unduplicated clients (Santa Ana and Non -Santa Ana Residents) anticipated to be served by the funded program, named above, during the 12 -month contract period. 7­1_5_01 Persons II. Number of unduplicated Santa Ana residents expected to be served by the funded program during the 12 -month contract period. 20 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 viewable space will print. Dverall, Thomas House programs are designed to: Provide a safe, stable living environment for homeless families working toward self- sufficiency; Help homeless families address the core issues that led to current crisis; Increase family resiliency and end generational homelessness and poverty for children; ' Help clients increase earning potential and employment levels; Help families learn budgeting, financial literacy and money management skills; ' Prevent families from returning to homelessness; and ' Give clients necessary tools and support to become and remain self - sufficient and productive citizens. intended outcome of the program is to transition as many families as possible from homelessness to )endent living. This is accomplished by supplying food shelter and life skill services, at no cost to the client. ,e families then become stable and contributing members of society. ro this end, Thomas House aims to see the following outcomes met in 2012/2013: 1. 90% of adult residents will attain an increased level of employment, as measured by case management ecords and exit interviews. ?. 90% of families will obtain permanent housing, as measured by case management records and exit nterviews. 3. 80% of families will continue to maintain employment, increase their earning potential, and remain self - ,ufficient, as measured by continued case management meetings. Schedule of Perrormance 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 5 Persons 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 $3,775.00 Quarter 2: October 1 - December 31 $3,775.00 Quarter 3: January 1 - March 31 $3,775.00 Quarter 4: April 1 -June 30 $3,775.00 $ 15,100.00 Total Grant Exhibit A Page 1 of 1 Final Budget Organization Name Thomas House Temporary Shelter Program Name Thomas House Temporary Shelter Expenditures Category Expenses Funded by Santa Ana Expenses Funded by Other Sources Individual donors & Events Total Program Budget Total Organizational Budget Essential Services $ 300,000 GG ESG $ 60,000 Anaheim ESG $ Food & Supplies $ 15,100 $ 50,900 $ 66,000 $ 66,000 $ 52,700 Total Funds for the Program $ 716,633 Shelter Operations Insurance $ - $ 58,500 $ 58,500 $ 58,500 Re airs & Maintenance $ 25,300 $ 25,300 $ 25,300 Personnel $ 289,430 $ 289,430 $ 289,430 Utilities $ 34,000 $ 34,000 $ 34,000 Other Program Ex p. $ 685,300 $ 685,300 $ 685,300 Other Fundraising Ex p. $ 37,850 $ 37,850 $ 37,850 Professional fees $ 70,500 $ 70,500 $ 70,500 Tax Expenses $ 25,000 $ 25,000 $ 25,000 Other G&A $ 18,524 $ 18,524 $ 18,524 Total $ 15,100 $ 1,295,304 $ 1,310,404 $ 1,310,404 LIST ALL OTHER PROGRAM FUNDS THAT HAVE BEEN SECURED (Total Funds for Program must equal Total Program Budget above) Source Amount Santa Ana $ 15,100 Individual donors & Events $ 165,000 Grants non government $ 300,000 GG ESG $ 60,000 Anaheim ESG $ 11,000 HUD Childcare $ 25,000 HUD Super Nofa $ 87,833 United Way $ 52,700 Total Funds for the Program $ 716,633 Exhibit B Page 1 of 1 Funded Personnel Name of Organization: Thomas House Temporary Shelter Name of Program Thomas House Temporary Shelter Examnle Position Title (only list funded positions) Budget Category Annual Salary Annual Benefits Total Compensation Funds Requested for this position Percent of time serving Santa Ana Maximum Amount of eligible Compensation Case Manager Case M mt $ 30,000 $ 2,000 $ 32,000 $ 6,000 40% $ 12,800.00 Outreach Worker En a ement $ 25,000 IS 2,000 $ 27,000 $ 5,400 20% $ 5,400.00 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - Total Amount Requested $ - $ - $ - Total Amount Re uested $ 11,400 PROGRAM STAFF Position Title (only list funded positions) Budget Category Annual Salary Annual Benefits Total Compensation Funds Requested for this position Percent of time serving Santa Ana Maximum Amount of eligible Compensation $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - Total Amount Requested $ - Total Amount Re uested $ - CONTRACTUAL/PROFESSIONAL SERVICES Type of Service (only list funded services) Budget Category Annual Contract Amount Total Compensation Funds Requested for this position Percent of time serving Santa Ana Maximum Amount of eligible Compensation $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - Total Amount Requested $ - Exhibit B -1 Page 1 of 1 Certification Regarding Lobbying Certification for Contracts, Grants, Loans, and Cooperative Agreements The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contact, grant, loan or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontract, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U. S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Grantee /Contactor Organization Program Title ("'� �, 9(co(la ame 4f Certifying Officer Signature Date EXHIBIT C Page 1 of 2 SUBRECIPIENT warrants the following: 1. SUBRECIPIENT will comply with Public Law 88 -352, Title VI of the Civil Rights Act of 1964 (42 U. S. C. section 2000 et seq.) and implementing regulation in 24 CFR Part 1. 2. No person in the United States shall on the ground of race, color, religion, national origin, or sex, be excluded from participation in, or be denied the benefits of, or be subjected to discrimination under any program or activity funded in whole or in part with community development funds made available pursuant to the ACT. 3. All laborers and mechanics, employed by contractors or subcontractors in the performance of construction work financed in whole or in part with community development funds shall be paid wages at rates not less than those prevailing on similar construction in the locality as determined in accordance with the Davis -Bacon Act, as amended, 40 U. S. C. Sections 276 a 1 -5, except for individuals who perform services for which they volunteered; do not receive compensation for such services; or are paid expenses, reasonable benefits, or a nominal fee for such services; and are not otherwise employed at any time in construction work. 4. SUBRECIPIENT will comply with all Federal statutes applicable to projects funded with community development funds, except that (a) SUBRECIPIENT does not assume CITY'S environmental responsibilities described at 24 CFR 570.604; and (b) SUBRECIPIENT does not assume CITY'S responsibility for initiating the review process under Executive Order 12372. EXHIBIT C Page 2 of 2 Attachments 1 -5 The current form and version of these documents can be found at: http: / /www.santa- ana.org /cda /documents /ESGattachmenti -5.pdf Los Angeles /Orange County Homeless Management Information System (HMIS) Collaborative HMIS Agency Agreement I. Purpose The Los Angeles/Orange County (LA/OC) Homeless Management Information System (HMIs) is a web - enabled database used by homeless service providers within the Los Angeles and Orange County region, to capture information about the persons they serve. The LA/OC HMIS Collaborative consist of four separate Continuum of Cares. The continuums are: Los Angeles Homeless Service Authority (LAHSA), Orange County Continuum of Care, the City of Glendale and the City of Pasadena. The LA/OC HMIS Collaborative's goal is to go beyond the HUD mandate of producing unduplicated counts of homeless persons. Our mission is to provide a comprehensive case management system to advance the provision of quality services for homeless persons, improve data collection, and promote more responsive policies to end homelessness in Los Angeles and Orange Counties. II. Audience and Agreement This Participating Agency Agreement permits The Agency and its participants to use the LA/OC HMIS and security services on their computers systems through an Internet connection. The LA/OC HMIS Collaborative and their assigned HMIS System Administrators are the primary coordinating Continuum of Cares (CoC) for the LA/OC HMIS. The Participating Agency is the "Agency" named in this agreement as Participants of the LA/OC HMIS. The HMIS "User" are the guardians entrusted with personal data to be entered and used in the LA/OC HMIS and the "Client" is the consumer of services. All agencies which have been granted access to the LA/OC HMI ws, S have agreed to abide by all la and the LA/OC HMIS Collaborative Policies and Procedures pertaining to client confidentiality, user conduct, security, and the ongoing functionality and stability of services and equipment used to support the LA/OC HMIS. The signature of the Executive Director of the Participating Agency indicates agreement with the terms set forth for an LA/OC HMIS account for the Agency. III. Confidentiality and Informed Consent The Agency agrees to abide by and uphold all privacy protection standards established by the LA/OC HMIS Collaborative as well as their respective agency's privacy procedures. The Agency will also uphold relevant Federal and California State confidentiality regulations and laws that protect client records, and the Agency will only release confidential client records with written consent by the client, or the client's guardian, unless otherwise provided for in the regulations or laws. Access to the LA/OC HMIS is granted to Thomas House Temporary Shelter based on the following premises: Oral Explanation: All clients will be provided an oral explanation stating their information will be entered into a computerized record keeping system. The Agency will provide an oral explanation of the LA/OC HMIS and the terms of consent. The agency is responsible for ensuring that this procedure takes place prior to every client interview. Written Explanation: Each client whose information is being shared with another participating agency must agree via the written Client consent/Information Release form. A client must be informed as to what information is being shared and with whom it is being shared. Information Release: The Agency agrees not to release client identifiable information to any other organization pursuant to federal and California State law without proper client consent. See attached Client Consent/Information Release Form and Regulations below. HMIS Agency Agreement Page 1 of S Revised 02101108 Regulations: The Agency will uphold all relevant Federal and California State confidentiality regulations to protect client records and privacy. In addition, the Agency will only release client records with written consent by the client, unless otherwise provided for in the regulations. Specifically, but not limited to, the following: A. The Agency will abide specifically by the federal confidentiality rules as contained in the Code of Federal Regulations (CFR) 42 Part 2 Confidentiality of Alcohol and Drug Abuse Patient Records, regarding disclosure of alcohol and/or drug abuse records. In general terms, the Federal regulation prohibits the disclosure of alcohol and/or drug abuse records unless disclosure is expressly permitted by written consent of the person to whom it pertains or as otherwise permitted by CFR 42 Part 2. A general authorization for the release of medical or other information . e Federal not sufficient for this purpose The Agency understands that th rules restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse patients. B. The Agency will abide specifically with the Health Insurance Portability and Accountability Act of 1996 and corresponding regulations passed by the U.S. Department of Health and Human Services. In general, the regulations provide consumers with new rights to control the release of medical information, including advance consent for most disclosures of health information, the right to see a copy of health records, the right to request a correction to health records, the right to obtain documentation of disclosures of information may be used or disclosed. The current regulation provides protection for paper, oral, and electronic information. C. The Agency will abide specifically with the California Government Code 11015.5 regarding Personal Information Collected on the Internet. In general, the Government Code ensures that any electronically collected personal information about clients cannot be shared with any third party without the client's written consent. Postings: Privacy and Mandatory Collection notices must be posted at the agency. A. The Agency must post Privacy and Mandatory Collection notices at each intake desk or comparable location. B. Privacy and Mandatory Collection notices must be made available in writing at the client's request. C. If the Agency maintains an agency website, of the agency's website. a link to the privacy notice must be on the homepage IV. Data use Data contained in the LA/OC HMIS will only be used to support the delivery of homeless services in the Los Angeles and Orange County region. Each User will affirm the principles of ethical data use and client confidentiality as noted below and contained in the LA/OC HMIS User Agreement. 1. The Agency will not solicit or input information from clients unless it is essential to provide services, or conduct evaluation or research. 2. The Agency understands that all client data will be maintained on a central server, which will contain all client information in an encrypted state. All client identifiable data is inaccessible to unauthorized users. 3. The Agency shall not be denied access to client data entered by the Agency. Agencies are bound by all restrictions placed upon the data by the client of any Participating Agency. The Agency shall diligently record in the LA/OC HMIS all restrictions requested. 4. The Agency shall not knowingly enter false or misleading data under any circumstances. 5. The Agency shall maintain appropriate documentation of client consent to participate in the LAIOC HMIS. 6. If a client withdraws consent for release of information, the Agency remains responsible to ensure that the client's information is unavailable to all other Agencies. HWSAgency Agreement Page 2 of S Revised 03101108 7. The Agency shall keep signed copies of the Client Consent/Information Release form for LA/OC HMIS for a period of seven years. 8. The Agency shall keep Interagency data sharing agreements and Client Consent/Information Release forms for all individual client data that is shared to non- custodial agencies where the internal policies of the Agency allows data sharing. V. Responsibilities The Agency is responsible for ensuring that its staff does not intentionally or unintentionally misuse the system. Such uses are but not limited to damage computing resources, obtain extra resources, take resources from another user, gain unauthorized access to resources, or otherwise make use of computing resources for which proper authorization has not been given. 1. The Agency will have an environment free of illegal or malicious acts and the Agency's users agree to never use the system to perform an illegal or malicious act. Any attempt to increase the level of access to which (s)he is authorized or any attempt to deprive other authorized users of resources or access to LA/OC HMIS shall be regarded as malicious and may be treated as an illegal act. 2. Any user who finds a possible security lapse on the system is obligated to report it to the HMIS System Administrator immediately. 3. The LA/OC HMIS Application, which has been granted, to each participating agency was purchased by the LA/OC HMIS Collaborative for each of its own continuums. The LA/OC HMIS application was paid for through the HUD grant. The maintenance, upgrades and license purchases are limited by the sanctions of the HUD grant. Any additional maintenance, upgrades and license purchases incurred after the grant fund limit, which is designated for HMIS services, becomes the sole responsibility of the Agency that has accepted possession and use of the software and services rendered for HMIS purposes and functionality. VI. System Usage Computer Equipment and Services are intended for LA/OC HMIS - related activities. Acceptable computer system use includes data intake, reports, research of client, client development and public service purposes. Prohibited Usage includes, but is not limited to, the following activities: fraudulent, threatening, harassing, or obscene messages and/or materials are to be avoided and not to be received, sent nor stored. Inappropriate mass mailing (spamming, flooding, bombing) are prohibited. Creation or intentional distribution of computer viruses, worms, or Trojan horses is prohibited Unauthorized access to or denial of service attacks on any computer system shall not be attempted. Abusers are subject to sanctions as outlined in Section XI. - Violations. Equipment if applicable: All of the computer equipment including, but not limited to, printers, scanners, laptops and monitors, which were purchased by your continuum of care for LA/OC HMIS purposes to all the participating agencies, are all under HUD grant funding. The maintenance and upgrades of these devices are limited by sanctions of the HUD grant. Any additional maintenance or upgrade costs incurred after the grant fund limit which is designated for LA/OC HMIS equipment becomes the sole responsibility of the Agency that has accepted possession and use of the equipment rendered for LA/OC HMIS purposes and functionality. Services if applicable: Which have been given to each participating agency are included but not limited to Anti -Virus Software and licenses, Firewall software and licenses, Windows software updates and High - Speed Internet Connections, are purchased by the LA/OC Collaborative for HMIS purposes and are all under HUD grant funding. The maintenance, upgrades and license purchases are limited by the sanctions of the HUD grant. Any additional maintenance, upgrades and license purchases incurred after the grant fund limit, which is designated for LA/OC HMIS services, becomes the sole responsibility of the Agency that has accepted possession and use of the software and services rendered for LA/OC HMIS purposes and functionality. HMIS Agency Agreement Page 3 of S Revised 02101108 VI1. Rights LA/OC HMIS data from agencies within each continuum resides in one central database. The Agency's data is separated by security for each continuum. Data sharing is currently limited to the data within the Agency's continuum. The LA/OC HMIS Collaborative reserves the right, at a later date, to expand data sharing to include collaborative wide data. The LA/OC HMIS Collaborative also reserves all rights, including termination of agreements, of the LA/OC HMIS application and the service resources that it owns and operates. These procedures shall not be construed as a waiver of any rights of the LA/OC HMIS Collaborative, nor shall they conflict with applicable acts of law. VIII. Privileges The LA/OC HMIS services and or equipment are a privilege and are assigned and managed by the HMIS System Administrator(s) or designee(s) of specific systems. The Agency is responsible for proper use of the system as outlined in Section VI. IX. Confidentiality Although technological and procedural securities have been reasonably exhausted by the LA/OC HMIS Collaborative to ensure client data confidentiality, this system is being used by a multitude of end users and is therefore subject to the diligence to which the Participating Agencies' staff protects client records. The protections that the LA/OC HMIS Collaborative put in place to protect client confidentiality include compliance with HUD Data and Technical Standards Final Notice, institution of a mandated HMIS training program for all HMIS users, consistent application of Policies and Procedures, and signed Agency End - User Agreements. X. Copyright The LA/OC HMIS is protected by copyright and is not to be copied, except as permitted by law or by contract with owner of the copyright. The number of copies and distribution of copies are to be managed by the HMIS Systems Administrator(s) of each CoC. Interference with measures used by copyright holders to protect copyrighted works is prohibited. Agency user's storing materials copyrighted by others on the systems or displaying the materials through web pages must comply with copyright laws and guidelines. Equipment if applicable: Computer software and data are protected by copyright and is not to be copied, except as permitted by law or by contract with the owner of the copyright. The number of copies and distribution of copies are to be managed by the HMIS Systems Administrator(s) of each CoC. Users of the computer systems agree to follow guidelines for use of copyrighted materials. XI. Violations An individual violating any of the guidelines outlined in this agreement will be reported immediately upon discovery. Such suspected violations will be confidentially reported to the HMIS System Administrator(s) of the CoC and or the designee of that agency. IWSAgency Agreement Page 4 of S Revised 02101108 XH. Agreement I have read the aforementioned Agency Agreement and waiver for use of technology of the LA/OC HMIS, Equipment and Services (Ifapplicable), and thoroughly understand that this technology is for LA/OC HMIS purposes only. j This Agreement is executed between the Agency and the Orange County Continuum of Care and upon execution the Agency will be given access to the HMIS. This agreement will be signed by the Executive Director at the Participating Agency. F cu ive Director's N Tnt) � a '' Contin um Representative s N e oe %� - - Exec five Director's , ignature Continuum Representative's Signa re _±r"T ry � —�. `,l• t'n,� Agency Name 7 rlt? tfC Continuum Mame (? I agl Date of Signature — / / '- Date of Signature HMIS Agency Agreement Page 5 of S Revised 02,'01108 J • OP ID DATE (MMIDD/YYYY) A-CORD CERTIFICATE OF LIABILITY INSURANCE THOMA -1 02/10/12 PRODUCER Huntington Pacific Ins. Agency 7901 Professional Circle Huntington Beach CA 92648 Phone: 714- 841 -6283 Fax:714- 842 -2538 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW INSURERS AFFORDING COVERAGE NAIC # INSURED Thomas House Temporary Shelter P.O. BOX 2737 Garden Grove CA 92842 -2737 INSURER A: Great American Insurance Co. POLICY NUMBER INSURER B: POLICY EXPIRATION DATE MMlDD/YY INSURER C: INSURER D: 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. iNbK LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYY POLICY EXPIRATION DATE MMlDD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X X COMMERCIAL GENERAL LIABILITY PAC5603738 10/03/11 10/03/12 PREMISES(Eaoccurence) $ 100,000 CLAIMS MADE 7 OCCUR MED I (Any one person) $ 5 , 000 PERSONAL & ADV INJURY $1,000,000 A PAC5603738 10/03/11 10/03/12 X Sexual Misconduct GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $1,000,000 X I POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY $ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ IF I (Per accident) GARAGE LIABILITY TO AUTO ONLY - EA ACCIDENT ANY AUTO j� AS I OTHER THAN EA ACC $ �4OVE+' F� AUTO ONLY: AGG $ EXCE BREL �+ EACH OCCURRENCE $ CUR CLAIMS MADE 11 'C —Is C S� ORv� G pttorn y AGGREGATE $ $ t C1ty ISIS to DEDUCTIBLE $ is RETENTION $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETORIPARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEB- OFFICER/MEMBER EXCLUDED? If yes, describe under - --- _ - - -- — --- -- SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS The City of Santa Ana; it's officers, employees,agents,volunteers,and representatives are named as additional insured in respects to the general liability.This insurance is Primary and noncontributory per endorsement CG 20 26 (07/04) . *10 Day Notice of Cancellation for non - payment of premium CERTIFICATE HOLDER CANCELLATION City of Santa Ana Community Development Agency Attn:Frank Hernandez 20 Civic Center Plaza Santa Ana CA 92702 ACORD 25 (2001108) CI TSAAA I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATI< DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ____AMENDED 0178469 GREAT AMERICAN 0 AnENTS QQFY ASSURANCE CO ­--72 Administrative offices Cin Walnut Ohio 4 CG 20 26 (E d . 07 / 04 1 GREATA' r Cincinnati, 69- 45202 tyra�Rl�%f�i�: Tel: t -813- 369 -5000 IN6U1;ANCP EBOUP P O I i c y: PAC5603738 -05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- DESIGNATED OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART - CH Name of Person or Organization: The City of Santa Ana,its officers, employees,agents,volunteers,and Representatives Community Development Agency 20 Civic Center Plaza Santa Ana, Ca 92702 PRIMARY INSURANCE: THIS INSURANCE IS PRIMARY AND ANY OTHER INSURANCE INTAINED BY SUCH ADDITIONAL INSUREDS IS NONCONTRIBUTING WITH THIS INSURANCE AS RESPECTS LEGAL LIABLITIES OR CLAIMS CAUSED BY, ARISING OUT OF OR RESULTING FROM THE ACTS OR OMISSIONS OF THE NAMED INSURED, OR OF OTHERS PERFORMED ON BEHALF OF THE NAMED INSURED. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. SECTION H - WHO IS AN INSURED is amended to include as an Additional Insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. in the performance of your ongoing operations, or B. in connection with your premises owned by or rented to you. A5 �0 APpgOVED ---- _ I ...........................:. K � istan� 0ty pltto pss � r Copyright, Insurance Services Office, Inc„ 1984 CG 20 26 07/04 (Page 7 of 1 ) ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company Great American Insurance Co. This endorsement modifies such insurance as is afforded by the provisions of Policy # PAC5603738 relating to the following: I . The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds ( "additional insureds ") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies: separately to each insured against :whom claim is made, or suit is brought except with:respectltothe:company's limits.of liability. The inclusion of any person or organization, as an .insured shall not. affect-any-right which such person or organization would have as a claimant ifnot so included. 4. With:respect to -the .additional insuredsthis insurance shall not he cancelled, or materially reduced in coverage;or limits except after thirty (30.) days written notice has been given to the City: of Santa Ana, 20,.Civic Center Plaza, :Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective 2/10/2012 this endorsement form as a part of Policy # PAQ,980738 Issued to Thomas House Temnorary Shelter Named Insured Countersigned by �� � uth orized Representati vovmi RGV£D A5 So tip-/ AYY K G � -�pR rn LISP t ,Sko 0 �S�stant G y U/ POLICYHOLDER COPY NE P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 10 -01 -2012 CITY OF SANTA ANA NE FRANK HERNANDEZ - DEVELOPMENT AGENCY M -25 20 CIVIC CENTER PLZ SANTA ANA CA 92701 -4058 GROUP: 000488 POLICY NUMBER: 0001566 -2012 CERTIFICATE ID: 10 CERTIFICATE EXPIRES: 10 -01 -2013 10 -01- 2012/10 -01 -2013 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10 -01 -2010 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER THOMAS HOUSE TEMPORARY SHELTER (NON- PROFIT ORG.) DBA: THOMAS HOUSE TEMPORARY SHELTER PO BOX 2737 GARDEN GROVE CA 92842 [RMM,CNj (REM-2012) PRINTED : 10 -02 -2012 POLICYHOLDER COPY NE P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 08 -03 -2012 CITY OF SANTA ANA NE FRANC HERNANDEZ - DEVELOPMENT AGENCY M -25 20 CIVIC CENTER PLZ SANTA ANA CA 92701 -4058 GROUP: 000488 POLICY NUMBER: 0001566 -2011 CERTIFICATE ID: 10 CERTIFICATE EXPIRES: 10 -01 -2012 10 -01- 2011/10 -01 -2012 THIS CERTIFICATE SUPERSEDES AND CORRECTS CERTIFICATE # 7 DATED 10 -01 -2011 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. e.- _11�4eZ14 -�� F� Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000;000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10 -01 -2010 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER THOMAS HOUSE TEMPORARY SHELTER (NON- PROFIT ORG.) DBA: THOMAS HOUSE TEMPORARY SHELTER PO BOX 2737 GARDEN GROVE CA 92842 [P1 K,NEI IREV.1 -20121 PRINTED : 08 -03 -2012