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HomeMy WebLinkAboutAMERIPACIFIC INDUSTRIAL CORPORATION-2014INSURANCE ON FILE WORK MAY PROCetO UNTIL INSURANCE EXPIRES —,5--IS CLERK OF OOUNCq�I „ 4 DATE -.-3 \% I Agreement No. Q : GD q'A�/WorKeeh%� - CZ, r o(e &GZ�vitx, ON- THE -JOB TRAINING AGREEMENT UNDER THE WORKFORCE INVESTMENT ACT N- 2014 -089 THIS AGREEMENT is made and entered into this 7"' day of May, 2014 between the City of Santa Ana, a charter city and municipal corporation duly organized and existing under the Constitution and laws of the State of California (hereinafter "CITY ") and AmeriPacific Industrial Corporation (hereinafter "EMPLOYER "). WITNESSETH Recitals: A CITY has been designated a Local Workforce Investment Area ( "LWIA ") pursuant to Section 116 of the Workforce Investment Act ( "WIA "), P.L. 105 -220, 29 USC Section 2801, to receive federal funds to promote effective delivery of job training services to local area residents. B. The State of California has created the California Workforce Investment Board pursuant to Section III of the Workforce Investment Act, P.L. 105 -220, 29 USC 2821 to administer the WIA programs operated by the State of California. C. As a LWIA, CITY is entitled to receive federal funds to establish programs to prepare eligible unskilled youth, adults and dislocated workers for entry into the labor market, and to provide job training to those individuals who face serious barriers in obtaining productive employment ( "said Program "). D. EMPLOYER is able and willing to train eligible unskilled applicants for entry into the labor market and is willing to operate said program pursuant to the WLA and applicable federal, suite and local laws. WHEREFORE, for and in consideration of the respective and mutual covenants and promises hereinafter contained and made, and subject to all the terms and conditions hereof, the parties hereto do hereby agree as follows: 1. Term. The effective term of this Agreement is for the period beginning May 1.9, 2014, and ending August 29, 2014. The term of this Agreement may be extended upon agreement of all parties and execution of an amendment of the term. 2. Scope-of Worls. The EMPLOYER shall employ and train one employee (hereinafter "Trainee ") in the occupation and in accordance with the OJT' raining Outline set forth in Exhibit A, attached hereto and incorporated herein by this reference. 11 Said Trainee shall be referred by the City of Santa Ana W /O /R/K Center. Training must significantly raise the Trainee from his /her prior position in both level of skill and salary by the end of the training period. 3. Funding. CITY shall reimburse the EMPLOYER an amount not to exceed $5197.50 in accordance with the Cost Computation included in Exhibit A. EMPLOYER shall bill the CITY monthly on an invoice provided by CITY for actual and reasonable cost for providing the services described in this Agreement. Reimbursement of EMPLOYER under this Agreement shall be limited to the costs incurred during the basic work week, excluding overtime and any paid holidays or sick leave. 4. Subcontracting Prohibited. The EMPLOYER shall not subcontract or assign the OJT Training. Any attempt by the EMPLOYER to delegate or assign OJT training duties under this Agreement shall void, and permit CITY to immediately terminate, this Agreement. 5. Employer Obligations. During the training, the EMPLOYER shall ensure that the Trainee: a. is on the EMPLOYER's payroll, not paid as a contracted employee /independent contractor; and, b. receives the same benefits as EMPLOYER's other employees performing similar work; and, C. is paid the salary as indicated in Exhibit A with appropriate payroll taxes withheld and reported; and, d. is provided Worker's Compensation Insurance coverage, pursuant to state law; and, e. is provided by EMPLOYER with safety instructions and equipment necessary for reasonable protection against injury and damage. CONTRACTOR shall maintain appropriate standards for health and safety in work and training situations. Where special clothing or equipment is provided to the EMPLOYER's regular employees, EMPLOYER shall provide the same type of clothing or equipment to the Trainee performing similar work. 6. Employment of Trainee. The EMPLOYER shall employ the Trainee as a regular member of EMPLOYER's work force. If EMPLOYER wants to continue to employ the Trainee upon the successful completion of the training period under this Agreement, said employment shall be subject to the same conditions of employment applied to EMPLOYER's other regular employees, including termination for unsatisfactory performance. K 7. Patent Copyrights and Rights in Data. The EMPLOYER will disclose to the CITY any invention, written product, computer program developed or data assembled as a result of performance of work under this Agreement within seventy four (74) days of invention, development or assembly. The CITY, State of California, and U.S. Department of Labor will have the right to patent any invention and copyright any written product or computer program or data generated by EMPLOYER. Upon written request, EMPLOYER will transfer all pertinent information, specifications and right, title and interest to the designated agency. 8. INVENTIONS, PATENTS AND COPYRIGHTS. A. Reporting Procedure. If any project produces patentable items, patent rights, processes, or inventions in the course of work under a U.S. Department of Labor (DOL) grant or agreement, the CONTRACTOR shall report the fact promptly and fully to the CITY. The CITY shall report the fact to the Grant Officer, at the DOL. Unless there is a prior agreement between the CITY and the DOL and its representative on these matters, the DOL shall determine whether to seek protection on the invention or discovery. The DOL and its representative shall determine how the rights in the invention or discovery, including rights under any patent issued thereon, will be allocated and administered in order to protect the public interest consistent with the "Governmental Patent Policy" (President's Memorandum for Heads of Executive Departments and Agencies, August 23, 1971, and Statement of Government Patent Policy). B. Copyright Policy. 1. Unless otherwise provided in the terms of the grant or agreement, when copyright -able material is developed in the course of or under a DOL Grant or agreement, the author and the CITY which developed the work is free to copyright material or to permit others to do so. The EMPLOYER and the Workforce Investment Board (WIB) shall have a royalty - free, nonexclusive and irrevocable license to reproduce, publish, use and to authorize others to use all copyrighted material. 2. The DOL reserves a royalty -free, nonexclusive, and irrevocable license to reproduce, publish or otherwise use, and to authorize others to use, for Federal Government purposes: (a) The copyright in any work developed under any grant, sub - grant, or contract under a grant or subgrant; (b) Any right of copyright to which a grantee, subgrantee or a EMPLOYER purchases ownership with grant support; and (c) EMPLOYER shall comply with the requirements of 29 CFR Part 97.34, C. Rights to Data. The DOL and the CITY shall have unlimited rights to any data first procured or delivered under this Agreement. 9. Hold Harmless. The EMPLOYER shall indemnify, defend and hold harmless CITY, and its officers, agents and employees, from and against any and all damages to property or injuries to or death of any person or persons, including property and employees or agents of CITY, and shall indemnify, defend and hold harmless CITY, and its officers, agents and employees, from any and all claims, demands, suits, actions or proceedings of any kind or nature, including, but not limited to, workers' compensation claims, resulting 3 from or arising out of the negligent acts, errors or omissions of EMPLOYER, its employees, agents or subcontractors. 10. Insurance. The EMPLOYER shall obtain at its sole cost and file with the City of Santa Ana — Santa Ana W /O /R/K Center, upon execution of this Agreement, and maintain for the period covered by this Agreement, a policy or policies of commercial general liability insurance or a certificate of such insurance, satisfactory to the City Attorney of CITY, naming CITY, and its officers, agents and employees, as insured or additional insured (see attached Additional Insured Endorsement, Exhibit C), which provides coverage not less than that provided in the form of a comprehensive general liability insurance policy against liability for any and all claims and suits for damages or injuries to persons or property resulting from or arising out of operations of EMPLOYER, and its officers, agents, or employees. Said policy or policies of insurance shall provide coverage for both bodily injury and property damage in no less than One Million Dollars ($1,000,000). Said policy of comprehensive public liability insurance shall be endorsed to provide to CITY and to the State of California, Employment Development Department, at least thirty (30) days written notice prior to cancellation; name CITY, its officers, agents, employees, and volunteers, and the State of California, its officers, employees, and volunteers as additional insured; and state that such coverage is primary to any other coverage or self- insurance of the State of California and CITY. Governmental entities may substitute a certificate of self- insurance. 11. Record Keeaint . CITY, the State of California and the United States government and /or their representatives shall have access for purposes of monitoring, auditing and examining of EMPLOYER'S activities, performance, books, documents, papers, and records of EMPLOYER'S subcontractors, bookkeepers and accountants, and employees and participants related to this Agreement. Such agencies or representatives shall also schedule on -site monitoring in their discretion. Monitoring activities may also include, but are not limited to, questioning employees and participants and entering any premises or onto any site in which any of the services or activities funded hereunder are conducted or in which any of the records of EMPLOYER are kept. Nothing herein shall be construed to require access to any privileged or confidential information as set forth in federal or state law. In the event EMPLOYER does not make the above - referenced documents available within the City of Santa Ana, California, EMPLOYER agrees to pay all necessary and reasonable expenses incurred by CITY in conducting any audit at the location where said records and books of account are maintained. All accounting records and evidence pertaining to all costs of EMPLOYER and all documents related to this Agreement shall be kept available at the location where EMPLOYER conducted the program, as well as in the County of Orange, for the duration of this Agreement and thereafter for three (3) years after completion of an audit. Records which relate to (a) complaints, claims, administrative proceedings or litigation arising out of the performance of this Agreement, or (b) costs and expenses of this Agreement to which CITY, the State of California or the United States Government take exception, 21 shall be retained beyond the three (3) years until resolution of disposition of such appeals, litigation, claims, or exceptions. 12. Government Funding. This Agreement is valid and enforceable only if sufficient funds are made available to the State by the United States Government for the same Fiscal Year as for this Program. In addition, this Agreement is subject to any additional restrictions, limitations, or conditions enacted by Congress or any statute enacted by Congress which may affect the provision, tenors or funding of this Agreement in any manner. 13. Payment Cap. City's OJT payments to EMPLOYER shall not exceed a maximum of fifty percent (50 %) of the wages paid by EMPLOYER during the training period specified in Exhibit A. 14. Amendment of Agreement. No alteration or variation of the terms of this Agreement shall be valid and /or binding unless made in writing and signed by both parties. There are no oral understandings or agreements between the parties. 15. Breach/Sanctions. If, through any cause, EMPLOYER violates any of the terms and conditions of this Agreement, or if EMPLOYER reports inaccurately or if any Audit Report makes disallowances, EMPLOYER shall promptly remedy its acts or omissions and /or repay CITY all amounts due CITY as a result of EMPLOYER's violation. For any such failures or violations, CITY shall also have the right at its sole discretion to either: (1) discontinue program support until such time as EMPLOYER fulfills its obligations or remedies all violations of this agreement or prior agreements; and /or (2) collect outstanding amounts as determined by CITY due CITY by offsetting or debiting from current claims or invoices, if after thirty (3 0) days' written notice EMPLOYER has failed to repay same or a repayment schedule has not been made; and /or (3) terminate this Agreement by giving written notice to EMPLOYER of such termination in accordance the notice provision in Paragraph XVIII herein below. 16. Termination. Either party may terminate this Agreement upon thirty (30) days prior written notice to the other party. However, the CITY may immediately terminate this Agreement at such time as funds are not made available to CITY through the United States Department of Labor or the State of California Employment Development Department for the purpose of carrying out this Agreement. 17. Independent Contractor. The EMPLOYER, and any agents and employees of the EMPLOYER, in the performance of this Agreement, shall act in an independent capacity as independent contractors and not as officers, employees, or agents of the CITY, This Agreement is not intended nor shall it be construed to create an employer - employee relationship between EMPLOYER and CITY, nor a joint venture relationship. The EMPLOYER shall not subcontract in the name of the CITY. 18. Equal Employment Opportunities. The EMPLOYER warrants that it will comply with Title VI of the Civil Rights Act of 1964, and the requirements relating to equal employment opportunities set forth in Executive Order No. 11246, as amended by E.O. 5 11375 and supplemented by the requirements of 41 CFR Part 60. EMPLOYER will also comply with all applicable federal and state laws and regulations, and particularly those assurances and certifications set forth in Exhibit B attached hereto and by this reference incorporated herein. 19. Prohibitions. The EMPLOYER shall not use any of the training funds provided under this Agreement for political or sectarian activities. 20. Grievance Procedure, The EMPLOYER shall continue to operate, or shall establish and maintain a grievance or complaint handling procedure relevant to the terms and conditions of employment and the EMPLOYER's activities and programs, which shall meet at a minimum the requirements set forth in Section 101(31) of the Act and 663.700- 710 and regulations promulgated by the State or Federal Government. Employers that do not have a grievance or complaint handling procedure shall use the procedures prescribed by the CITY. 21, Guidelines. The CITY shall make the WIA applicable federal regulations and policy guidelines available to EMPLOYER at CITY — W /O /R/K Center, 1000 E. Santa Ana Blvd., Suite 200, Santa Ana, California 92701. The CITY shall also inform the EMPLOYER of changes in the WIA regulations or policy guidelines if such changes affect the operation of this Agreement. 22. Drug Free Workplace. The EMPLOYER agrees to provide a drug -free work place and to execute a certification as set forth in Exhibit D attached hereto and incorporated herein by this reference. 23. Notices. All notices, reports and correspondence between the parties hereto respecting this Agreement shall be in writing and deposited in the United States mail, postage prepaid, addressed as follows: CITY: City of Santa Ana— Santa Ana WORK Center 1000 E. Santa Ana Blvd., Suite 200 Santa Ana, CA 92701 Attention: WORK Center Director EMPLOYER: AmeriPacific Industrial Corporation 1509 E. McFadden Ave Santa Ana, CA 92705 ATT: James Wang 9 24. Debarment. To protect the public interest and ensure the integrity of Federal programs, CITY may only conduct business with responsible persons and may not make any award or permit any award to any party which is debarred or suspended or is otherwise excluded from or ineligible for participation in Federal assistance programs under Executive Order 12549, "Debarment and Suspension ". See also 29 CRF Parts 97.35 and 98.510. EMPLOYER must review and sign Exhibit E "Debarment ", which is attached hereto and incorporated herein by this reference. 24. Merger. This Agreement, together with the attaclunents hereto, expresses the total understanding of the parties. There are no oral understandings of the parties or terms and conditions other than as stated herein. 25. Validity. The invalidity in whole or in part of any provision of this Agreement shall not void or affect the validity of any other provision of this Agreement. 26. Miscellaneous Provisions. a. Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify CITY fully, including reasonable costs and attorney's fees, for any injuries or damages to CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: -7K �0' Maria D. Huizar Clerk of the Council APPROVED AS TO FORM: Sonia R. Carvalho City Attorney CITY OF SANTA ANA David Cavazos City Manager EMPLOYER: dl By: Lisa Storck Jam s Wang Assistant City Attorney President STATE TAX I.D. # 031 - 3202 -4 FEDERAL TAX I.D. # 20- 8151106 SA Business License # 325618 RECOMMENDED FOR APPROVAL: Agreement # Exhibit A TRAINING PLAN I. GENERAL 1. Name of OJT Employer: AmeriPacific hrdustrial Corporation 2. Address of OJT Work -site: 1509 E. McFadden Ave, Santa Ana, CA 92705 3. Phone Number: (714) 648 -0888 4, Training Supervisor: Natalia Castano /.Tames Wang 5. Name of OJT Trainee: Carlos Garcia Jr. 6. Application Number of Trainee: 7. Grant/Program: 201 8. Proportion of trainees /employees: (at time Agreement entered into) a. Total number of employer's regular employees 12 C. Cumulative number of trainees currently in OJT { II. OCCUPATION AND ON- THE -JOB TRAINING OUTLINE: 1. Occupation: Accounting Assistant /operations Assistant 2. Length of Time in 'Business: Seven years+ 3. ONET Code: 43- 3031.00 SVP Level: (4.0 to <6.0) 4. Hourly Starting Wage: Start Date: 5/19/2014 End Date: 8/29/2014 Hours 693 5. State and Federal Tax LD.: State: 031 - 3202 -4 Federal 20- 8151106 6. Basic Work Week Hours: 7. Outline of On- the -Job Training Plan and Method of Assessment: ELEMENTS OF TRAINING HOURS OF TRAINING 1. Will be trained to support our sales team across the United States and Logistics Operations. 240 a. Lean logistics, booking freight companies and cost analyzing to save to most on cost. b. Learn to send our material samples and literature support to the sales representatives through UPS, Fed Ex, USPS, etc... c. Learn to maintain appropriate records and reports on Google Does, QuickBooks, internal documentation to provide feedback on sales statistics and inventory levels. d. Learn international shipping, ocean freight forwarding and inland freight methods, cost and communication needed to fulfill overseas shipments. e. Learn to maintain the equipment cache in an appropriate state of readiness for immediate deployment. f. Packaging, transporting, distributing, and the maintenance of the task force equipment cache during mission assignments. Measurement Method: Q & A, task observation and inspection. Goal is to achieve rate of proficiency within first Month and a half of training, 2. Will be trained on QuickBooks. a. Learn how to enter purchase orders accordingly to each customer 160 terms and create sales confirmations accurately. b. Learn how to invoice customers according to the terms, promotional discounts. Measurement Method. Q & A, task observation and inspection. Goal is to achieve rate ofproficiency within subsequent three and a hat 'months. 3. Will be trained on products offered. a. Learn the different products offered by our company. Get familiar 250 with all of our customers and vendors and understand type of business relationship and terms of business. b. Learn to inquiry on new vendors for possible business growth. C. Learn to cross sale /up sale products to customers inquiring on information. d. Learn how to advertise online like Amazon, E -bay, etc. e. Learn how to do sales calls. Measurement Method: Q & A task observation and inspection. Goal is to achieve rate of proficiency within subsequent three and a half months. 4. Communications Will learn terminology and adhere to legal regulations at a Federal level, State 43 Level or County to City level Learn how to place order with various vendors to keep the operations moving forward Measurement Method. Q & A task observation and inspection Goal is to achieve rate of proficiency within subsequent three and a half months. RATING LEVELS: Measurement method: how will it be determined if OJ "T participant acquired the skill? Q &A, observation, product review /inspection, eta PROFICIENT MODERATE MARGINAL II, COST COMPUTATION Hourly Reimbursement: $7.50 (50% of $15.00) Training Hours: 693 Cost Per Trainee (Hourly Reimbursement X Training Hours) _ $ 5197.50 III. Person(s) authorized to sign payment invoices for EMPLOYER; James Wang Print Name Si,i3fture Print Name Signature Title Title 6.S' -14 -1� Date Date A. The EMPLOYER assures that: 1. It will comply with the requirements of the Workforce Investment Act (WIA), the California Unemployment Insurance Code, as amended, and the regulations and policies promulgated thereunder. 2. No OJT participant displaces a regular employee nor shall an OJT participant fill a position of a person who has been laid off from the same or similar position. 3. No current employees are receiving unemployment insurance benefits as a result of layoffs or work reductions. 4. No person in the United States shall on the grounds of race, color, sex, religion, national origin, age, disability, sexual orientation, or marital status be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the applicant receives federal financial assistance and will immediately take any measure necessary to effectuate this Agreement. 5. It will comply with provisions of the Hatch Act, if applicable, which limits the political activities of employees. 6. Individuals receiving training on the job shall be compensated by the EMPLOYER at such rate, including periodic increases, as may be deemed reasonable under regulations prescribed by the Secretary of Labor, but in no event at a rate less than that specified in Section 6 (a) (1) of the Fair Labor Standards Act of 1938 or, if higher, under the applicable State or local minimum wage law. 7. Services and activities provided under this Agreement will be administered by or under the supervision of the EMPLOYER. 8. No relative by blood, adoption or marriages of the EMPLOYER may be trained under this Agreement. 9. Appropriate standards for health and safety in work and training situations will be maintained. 10. Conditions of employment or training are appropriate and reasonable with regard to the type of work, the geographical region, and the proficiency of the trainee. 11. Training will not be for any occupation which requires less than six weeks of training according to the Specific Vocational Preparation Table (SVP Code). 12. Training will, to the maximum extent practicable, be consistent with every individual's fullest capabilities and lead to employment possibilities. 13. The program will, to the maximum extent feasible, contribute to the occupational development or upward mobility of individual participants. 14. Training will be in accordance with the training plan, which plan incorporates documentation that must be completed by EMPLOYER before end of contract. EXHIBIT B 15. *Dot and * *SVP code books will be used to determine length of OJT period. The training time may not be longer than the SVP Code allows; however, contractors are encouraged to negotiate shorter training periods whenever applicable. 16. OJT trainees shall not number more than 40% of the EMPLOYERS work force. 17. All EMPLOYER training payments (reimbursements) must be exclusive of any and all EMPLOYER fringe benefits, paid holidays, paid sick days and overtime compensation. 18. The participating EMPLOYER must keep an accurate and up -to -date time sheet for the OJT trainee. 19. Payroll records, time and attendance records and job duties retained on file by the participating EMPLOYER for each OJT trainee are subject to review. 11111ployer Sign ture Date EXHIBIT B CERTIFICATE OF LIABILITY INSURANCE KCAL INSURANCE AGENCY 2048 S. HACIENDA BLVD. HACIENDA HEIGHTS, CA 91745 AMERIPACIFIC INDUSTRIAL CORP. 1509 E. MC FADDEN AVE. SANTA ANA CA 92705 COVERAGES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR INSURERS AFFORDING COVERAGE u: 0211412014 NAIC A THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYPERIOD MDICAI'ED. NOTWITHSTANDING ANY REOUIREMCNT. 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 1'0 AI.L THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR', LM 10D't INSR TYPECr INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIOORY POLICY EXPIRATION 2 MA4OOMY LIMITS GENERAL I-Ri TV VBA28797400 02105114 02105115 EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS FIX OCCUR ,TMNOE TO FifNTEO PREMI.pFS Ea onaymm�el S 100,000 MED. EXII (Any nne person) $ 5,000 A X oaldnddN: 6500per Clam PERSONAL &NOV INJURY j 1,000,009 GENERAL AGGREGATE 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY 7 'U'T' LOG PRODUCTS - COMPIOP AGO S EXCLUDED AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (E.."'J"ne S ALL OWNED AUTOS BODILY INJURY SCHEDULED AU 108 (PorpernclV S HIRED AIJ HDS BODILY @MURY NON-OWNED AUTOS (Pereccd "t) PROPERTY DAMAGE (Par uccltlyn0 T GARAGE LIABILITY ANY AUTO LC•.— YC�' AD ONLY - EA ACCIDENT S OTIIER THAN EA ACC 5 AUTO ONLY AGO S EXCESS I UMBRELLA LIABILIT Y YY A y' { EACH OCCURRENCE S OCCUR ❑ CLAIMS MADE W{ psis { {Drn ant CAY �, AGGREGATE S S DEDUCTIBLE RETENTION S S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY =V1" iT'�TU m'Hen TORY OMITS E.L. EAEASE -EDEM E.L.DSEAS "c EA EMPLOYEE 5 LIAMIRIEXCLUDE/EXECUTIVE ❑ OWIOERIM in NH) EXCLUDED? (MvnYabry In NH) it voe, art ayjm r SPECIAL PROVISIONS ra cyv PL DISEASE-POLICY LIMIT Is OTHER DESCRIPTION OF OPE RATIO NSILOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS The City of Santa Ana, Its officers, employees, agents, and representative are named as additional insured in respect for general liability as per written contract per CG2010 attached. Importer & Wholesaler of geotextile engineered fabrics use for waterproofing roof uneriayment and house wrap. No Installation, Premises Location: 1509 E Me Fadden Ave., Santa Ana, CA 92705 CERTIFICATE HOLDER CANCELLATION The City of Santa Ana 20 Civic Center Plaza M-16 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BF:FORETHE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. Santa Ana, CA 92701 Attention: AUTHORIZED REPRESENTATIVE {�y ACORD 25 (2009/01) Certificate # 19760 ©1988.2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Exhibit C POLICY NUMBER, VBA287874 00 COMMERCIAL GENERAL LIABILITY CG 20 10 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE HEAD IT CAREFULLY, ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS AND REPRESENTATIVES 20 CIVIC CENTER PLAZA M -16 SANTA ANA, CA 92701 (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II — Who Is An Insured is amended to (1) All work, including materials, parts or include as an insured the person or organization equipment furnished in connection with shown in the Schedule, but only with respect to such work, on the project (other than liability arising out of your ongoing operations per- service, maintenance or repairs) to be formed for that insured, performed by or on behalf of the add!- B. With respect to the insurance afforded to these tioral insured(s) at the site of the cov- additional insureds, the following exclusion Is ered operations has been completed; added, or 2. Exclusions (2) That portion of "your work' out of which the injury or damage arises has been This insurance does not apply to "bodily inju- put to its intended use by any person or ry" or "property damage" occurring after: organization other than another con- tractor or subcontractor engaged in performing operations for a principal as a part of the same project. Appitu V w R8 iY Ii 111111 ST_ LISA ASSISta�li L � CG 20 10 10 01 0 ISO Properties, Inc., 2000 Page 1 of 1 Exhibit C 1J ADDITIONAL INSURED ENDORSEMENT Insurance Company This endorsement modifies such insurance as Is afforded by the provisions of Policy ## v/5A 9X�V -H -100 relating to the following; 1, The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92702; its officers, employees, agents and volunteers are named as additional insureds ( "additional Insureds ") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other Insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included, A. With respect to the additional insureds, this insurance shall not be canceled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92702. (Completion of the following, including countersignature, is required to make this endorsement effective.) (Effective ��I � �� d 9 { this endorsement form as a part of Policy# Issued to Ame- 6p=u4c "Wv -t�etI Co,-P,' Ak Pron (. mSeve --,,qe ¢ gal+fi Named Insureds' Aft& Countersigned by it zed Representative �pp'I;C7V "EU tita 'rte & v'n1"a Exhibit C Icn -- rnrtCKK µssls" `l CERTIFICATE OF LIABILITY INSURANCE ov24/2o14 MM 50' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsor s PROeUDER AME! Redge Bendhelm Conzone Insurance Agency 2323 N, Tustin Ave. PR NE 714.203 -6032 i• Nnl, 888.209.2860 all _ A Owes; Redge.dcanzona@farmersagencycom Santa Ana, CA 92705 INSURER 8 AFRORDINO COVERAGE - NL,AIC R INSURERA: Mid - Century Insurance Company 12998 S INSURED INSURER a; Anneripaclflc Industrial Corp, INSURER C: 1509 E Mofadden Ave INSURER O: Santa Ana, Ca 92705 INSURER E: PERSONAL &ADV INJURY INSURER F: COVERAGES CERTIFICATE NUMBER: 1 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OP 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 SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMpS. IN R TYPE Op INSURANCE 00L POLICY NUMBER POLICY 0 LPt MMLd�Y EVY LIMITS Redge Bendheim GENERAL LIABILITY EACH OCCURRENCE S DAMAGE 10 RENTED -PREMSES EB Occurrence $ COMMERCIAL GENERAL LLASILIN CLAII ❑ OCCUR EXP Aryaoepemon $ PERSONAL &ADV INJURY g GENERAL AGGREGATE $ GEN'LAOORBGATELIMITAPPUESPER: POUCY PERO LOG PRODUCTS- COMPIOP AGG $Y- 8 AUTOMOBILE LIABILITY _10_1 �EDa11 01ELIIIFT � SODILYINJURY(Pdrporson) § ANY AUTO ALLOWNED SCHEDULED AUTOS I I AUTOS NON -OWNED WIRED AUTOS AUTOS 1 BODILY INJURY (Per Fmddene § PROPERTY ¢t a4ddeM) UMBRELLAUAB OCCUR EACH OCCURRENCE___ $ AGGREGATE $ EXOE85LIAB CLAIMS MADE DEO I RETENTIONS § Y WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOWPARTNEWEXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) 11 no, dw0be Under OESCRIPTIONOFOPERATIOPSbelow NIA AOg4fi•93.8200 01/24/2014 01/2412015 x WC STATU- OTRry. . E.LEACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYER -- F.L. DISEASE � POLICY LIMIT S 11000,000 -- S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLS5 (ARacc ACORD 101, Atldillanal R¢markc SahadNC, if mom spot¢ Ip rcqulrod) Operations carried out by the WYerod Workor(a) are as follows: w9� tl v�.0 100% Clerical Clans Code 8810 AV tD City Attorney CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010105) 01888 -2010 ACORD CORPORATION. All rights rosewed. The ACORD name and logo are registered marks of ACORD Exhibit C SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ALI HORIZED REPRESENTATIVE Redge Bendheim ACORD 25 (2010105) 01888 -2010 ACORD CORPORATION. All rights rosewed. The ACORD name and logo are registered marks of ACORD Exhibit C Certification Regarding Drug -Free Workplace Requirements The certification set out below is a material representation upon which reliance is placed by the U.S. Department of Housing and Urban Development in awarding the grant. If it is later determined that the contractor knowingly rendered a false certification, or otherwise violates the requirements of the Drug -Free Workplace Act, the U.S. Department of Housing and Urban Development, in addition to any other remedies available to the Federal Government, may take action authorized under the Drug -Free Workplace Act. CERTIFICATION A. The contractor certifies that it will provide a drug -free workplace by: (a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the contractor's workplace and specifying the actions that will be taken against employees for violation of such prohibition; (b) Establishing a drug -free awareness program to inform employees about — (1) The dangers of drug abuse in the workplace; (2) The contractor's policy of maintaining a drug -free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance program; and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; (c) Making it a requirement that each employee who will be engaged in the performance of the grant be given a copy of the statement required by paragraph (a); (d) Notifying the employee in the statement required by paragraph -(a) that, as a condition of employment under the contract, the employee will - Pg. 2 (1) Abide by the terms of the statement; and (2) Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction. IWi.H 311ii17 (e) Notifying the U.S. Department of Housing and Urban Development within ten days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction; (f) Taking one of the following actions, within 30 days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted - ( 1) Taking appropriate personnel action against such an employee, up to and including termination; or (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; (g) Making a good faith effort to continue to maintain a drug -free workplace through implementation of paragraphs (a), (b), (c), (d), (e) and (f). B. The contractor shall insert in the space provided on the attached "Place of Performance" form the site(s) for the performance of work to be carried out with the grant funds (including street address, city, county, state, and zip code) .the contractor further certifies that, if it is subsequently determined that additional sites will be used for the performance of work under the contract, it shall notify the U.S. Department of Housing and Urban Development immediately upon the decision to use such additional sites by submitting a revised "Place of Performance" form. Dated: - I`h Emplo er Signature EXHIBIT D DIVISION OF EMPLOYMENT SERVICES PLACE OF PERFORMANCE FOR CERTIFICATION REGARDING DRUG -FREE WORKPLACE REQUIREMENTS Name: AmeriPacific Industrial Corp Name of Contractor: Contractor Number: Date: The Contractor shall insert in the space provided below the site(s) expected to be used for the performance of work under the contract covered by the certification: Place of Performance (include street address, city, county, state, zip code for each site): AmeriPacific Industrial Corp 1509 E, McFadden Ave Santa Ana, CA 92705 5NTI IT .TWO Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 29 CFR Part 98, Section 98.510, Participants' responsibilities. The regulations were published as Part VII of the May 26,1988 Federal Register (pages 19160 - 19211). (BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS FOR CERTIFICATION - Attached) (1) The prospective recipient of federal assistance funds certifies, by submission of this proposal, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency. (2) Where the prospective recipient of federal assistance funds is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Name and Title of Authorized Representative Signab- re 5/7/14 Date EXHIBIT E INSTRUCTIONS FOR CERTIFICATION By signing and submitting this proposal, the prospective recipient of federal assistance funds is providing the certification as set out below. 2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective recipient of federal assistance funds knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the Department of Labor (DOL) may pursue available remedies, including suspension and/or debarment. The prospective recipient of federal assistance funds shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective recipient of federal assistance funds learns that its certification was erroneous when submitted or has become erroneous by reason of changed circnrnstances. 4. The terms 'covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," "person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. The prospective recipient of federal assistance funds agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not lnowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the DOL. The prospective recipient of federal assistance funds further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and voluntary exclusion - Lower Tier Covered Transactions," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to check the List of Parties Excluded from Procurement or Non - Procurement Pro grams. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the DOE may pursue available remedies, including suspension and/or debarment. EXHIBIT E