HomeMy WebLinkAboutACCURATE PERFORMANCE MACHINING INC. 3 - 2014ON -THE -JOB TRAINING AGREEMENT
UNDER THE WORKFORCE INVESTMENT ACT
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THIS AGREEMENT is made and entered into this 28" day of October, 2014 between
the City of Santa Ana, a charter city and municipal corporation duly organized and existing
tinder the Constitution and laws of the State of California (hereinafter "CITY ") and Accurate
Performance machining, Inc. (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 111 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 WIA and applicable
federal, state 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:
Term. The effective term of this Agreement is for the period beginning November 3"
2014, and ending March 27Th, 2015. The term of this Agreement may be extended upon
agreement of all parties and execution of an amendment of the term.
Scope of Work. The EMPLOYER shall employ and train one employee (hereinafter
"Trainee ") in the occupation and in accordance with the OJT Training Outline set forth in
Exhibit A, attached hereto and incorporated herein by this reference.
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 $3,470.00 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.
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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, subgr<antee 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 Keeping. 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,
CAI
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, terms 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 (30) 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. 0.
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/I_ 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 patties 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:
Accurate Performance Machining Inc,
2255 South Grand Avenue
Santa Ana, CA 92705
(714) 434 -781
Attention: Bob Fischer
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 attachments 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:
Maria D. -Hu iw
Clerk of the Council
APPROVED AS TO FORM:
Sonia R. Carvalho
City Attorney
By: Lisa Storck
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
Kelly Reenders
Executive Direc or,
Community Development Agency
CITY OF SANTA ANA
David Cavazos
City Manager
Z��4 4e(:
Bob Fischer
President
STATE TAX I.D. # 423 -1934
FEDERAL TAX I.D. # 33- 0709645
SA Business License # 171691
Agreement # Exhibit A
TRAINING PLAN
I. GENERAL
1. Name of OJT Employer:
Accurate Performance Machining, Inc.
2. Address of OJT Work -site:
2255 S. Grand Ave., Santa Ana, CA 92705
3. Phone Number:
(714) 434 -7811
4. Training Supervisor:
Bob Fischer
5. Name of OJT Trainee:
Emmanuel Maravilla
6. Application Number of Trainee: 3252269
7. Grant /Program:
201
8. Proportion of trainees /employees: (at time Agreement entered into)
a. Total number of employer's regular employees 22
C. Cumulative number of trainees currently in OJT 1
II. OCCUPATION AND ON -THE -JOB TRAINING OUTLINE:
1. Occupation: Debur Operator
2. Length of Time in Business: 18
3. ONET Code: 514033.00 SVP Level: 4.0 to < 6.0
4. Hourly Starting Wage: $10.00 per hour
Start Date: 11/03/2014 End Date: 03/27/2015
Hours 694
5. State and Federal Tax I.D.: State: 423 -1934
Federal 33-0709645
6. Basic Work Week Hours: 40
7. Outline of On- the -Job Training Plan and Method of Assessment:
1
ELEMENTS OF TRAINING
HOURS OF TRAINING
1. Orientation to company policies and procedure to include safety,
properly reporting incidents and accidents
34 hrs.
Communicating with Supervisors, or Peers,— Providing information to
supervisors, co- workers, by telephone, in written form, e -mail, or in
person.
Measurement Method: Q & A, task observation and inspection. Goal is to achieve rate of proficiency
within rirst Month and a hah'of training,
2. Blue Prints
60 hrs.
Thought to read, examine blueprints, drawings or samples to determine
size, tolerances, type of materials, finish and additional requirements
for acceptable parts
Measurement Method: Q & A, task observation and inspection. Goal is to achieve rate of proficiency
within subsequent three and a half months.
3. Tools and applications
Learn proper debur tools and applications. Safety use of equipment
200 hrs.
such as Hand Grinders, Polishing Wheels, Air Gun, Knowledge of
machines and tools, including their designs, uses, repair, and
maintenance.
Measurement Method: Q & A task observation and inspection. Goal is to achieve rate of proficiency
within subsequent three and a half months.
4. Proper debur Techniques — Secondary Operations
400 hrs.
Inspection of linear dimensions, angles, diameters, depth, finish,
thread, run -out, flatness, parallelism and true position.
Will be trained in numerous techniques involved with deburring a
finished part.
Assembly work shall be included as well.
Assist in warehouse operation to include but not limited to Shipping
and Handling procedures, Inventory Control and overall warehouse
organization and sanitation
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 OJT participant acquired the skill? Q &A, observation,
product review /inspection, etc.
PROFICIENT MODERATE MARGINAL
II. COST COMPUTATION
Hourly Reimbursement: $5.00 per hour (50% of $10.00 per hour)
Training Hours: 694
Cost Per Trainee (Hourly Reimbursement X Training Hours) _ $ 3470.00
III. Person(s) authorized to sign payment in ices for EMPLOYER:
,;v�� �s 014 ` °�Z�/4-
Print Name Sig ature Title Date
CL4-5u-� 'C'k� r; �Sl� (w na,-- 10 Iasi l
Print Name T Signature Title t Date
ASSURANCES
A. The EMPLOYER assures that:
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.
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.
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 imder 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.
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.
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.
a
Employer Signature ate
EXHIBIT B
�ecoRd� CERTIFICATE OF LIABILITY INSURANCE
`...�'"
F oATEIMM/DD(YYYY)
1 1012712014
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 pollcy(les) 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 endorsement(s).
PaooucER EX2CUiIVB Team Insurance services, LLC
An Affiliate of United Agencies, Inc.
23421 S. Pointe Drive Ste. 190
Laguna Hills, CA 926�a3
CONTACT
Executive Team Insurance Services, LLC
PHONE -- FAX- -
A C Nn Ext. 626- 214.70az -_�1n c Nor
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ADORES�S;. _�L! -_ -. „_
INBURERLe.LAPFOR0INO COVERAGE
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6/15/2015
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INSURER A: Nova CasualLomp_any__
INSURED
Accurate Performance Machining Inc.
2086 S. Grand Avenue
INSURER e_
--
INSURER G
.$ -- _5,000
INSURER
$ 1,000,000
Santa Ana CA 92705
INSURER E:
—_—
PRODUCTS - COMP /OP AGO
INSURER F;
_
S
COVERAGES CERTIFICATE NUMBER: 22113531 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 18SUED 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, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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TYPE OF INSURANCE
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COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
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6/15/2015
EACH OCCURRENCE
$ 11000,000
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$ 300,000
,RREMjS,ES
MEDEXP(Any one person
.$ -- _5,000
PERSONAL &ADV INJURY
$ 1,000,000
GC_N'L AGGREGATE LIMIT APPLIES PER:
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OTHER:
GENERAL AGGREGATE
_
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PRODUCTS - COMP /OP AGO
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ALL OWNED 101-O SCHEDULED
AUTO§ AUTOS
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HIRED AUTOS AUTOS
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WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR /PARTNERIEXECUTIVE
OFFGER/NIEMBER EXCLUDED? ❑NIA
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DESCRIPTION OF OPERATIONS below
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DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 1N, Addelonai Remarks Schedule, may ba atleched if more apace is required)
The City of Santa Ana, its officers, employees, agents, and representatives are named as additional insureds in res ects lo,the genera liab' it
policy only per the attached forms.
iILe
City of Santa Ana
Santa Ana Work Center
20 Civic Center Plaza
Santa Ana CA 92701
ACORD 25 (2014101)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
The ACORD name and logo are registered marks of ACORD
CEAT NO- 22113531 Na tbor[ne DumaCol 10/21/2014 1,53,02 PM (PVr) Pago 3 of 6
EXHIBIT C
rights reRPYVP.rI.
M50CL0010119 -3
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COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
GENERAL LIABILITY EXTRA ENDORSEMENT
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
1. EXTENDED PROPERTY DAMAGE
It Is agreed that SECTION I — COVERAGE A., paragraph 2. Exclusions a. Expected or Intended is deleted
and replaced by the following:
a. Extended Property Damage
"Bodily Injury' or °Property Damage" expected or Intended from the standpoint of the insured. This
exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable farce
to protect persons or property.
It is agreed that SECTION 1 — COVERAGE A. paragraph 2. Exclusion j.(2) is deleted and replaced by the
following:
(2) Premises you sell, give away, or abandon, if the `property damage" arises out of any part of those
premises, and occurred from hazards that were known by you or should have reasonably been known
by you, at the time the property was transferred or abandoned.
3. NON OWNED WATERCRAFT
It is agreed that SECTION I — COVERAGE A. paragraph 2. Exclusion 9.(2) Is deleted and replaced by the
following:
(2) A watercraft you do not own that is:
(a) Less than 52 feet long; and
(b) Not being used to cant' persons or property for a charge;
This provision applies to any person, who with your consent, either uses or is responsible for the use of
a watercraft.
This insurance is excess over any other valid and collectible Insurance available to the insured whether
primary, excess, or contingent.
4. DAMAGE TO PREMISES RENTED TO YOU
a. It is agreed that SECTION I — COVERAGE A. the last paragraph of 2. Exclusions is deleted and
replaced by the following:
Exclusions c, through n. does not apply to:
(1) damage by fire, lightning, explosion, smoke or leaks from automatic fire protective systems; and
(2) damage caused by a resident;
to premises while rented to you or temporarily occupied by you with the permission of the owner,
b, it Is agreed that paragraph S.of SECTION Ht — LIMITS OF INSURANCE is deleted and replaced by the
following:
S. Subject to S. above, the Damage to Premises Rented To You Limit is the most we will pay under
COVERAGE A for damages because of "property damage%
a. resulting from fire, lightning, explosion, smoke or leaks from automatic fire protective systems, or
any combination thereof; and
b, caused by a resident;
to premises, rented to you or temporarily occupied by you with the permission of the owner.
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COMMERCIAL GENERAL LIABILITY
It is agreed that SECTION 11- WHO IS AN INSURED is amended to include the following:
Any corporation organized under the laws of the United States of America (including any state thereof, its
territories or possessions, or Canada (including any province thereof) will qualify as a Named Insured if there
is no similar insurance available to that organization, provided that one or more Named Insureds shown in
the Declarations has, at the inception of the policy period, an ownership interest in such organization of more
than 50 %.
S. KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT
The notification requirements of paragraphs 2.a. and 2.b. of SECTION IV - COMMERCIAL GENERAL
LIABILITY CONDITIONS apply only when the "occurrance% offense, claim, or °suit" is known to:
a. You, if you are an individual;
b. A partner or member if you are a partnership or joint venture;
c. An officer or director if you are an entity other than a partnership, joint venture or limited liability
company;
d. A member or manager if you are a limited liability company; or
a. An insurance manager, risk manager or other "employee" you designate prior to loss to give notice to us,
Knowledge of an °occurrence," offense, claim, or "suit° by your agent, servant or °employee shall not in and
of itself constitute knowledge to you unless an individual described in items 1. - 5. of this provision G. has
actual knowledge.
7. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS OR PRIOR OCCURRENCES
The following is added to Condition B. Representations of SECTION iV - COMMERCIAL GENERAL
LIABILITY CONDITIONS:
Failure to disclose all hazards or prior "occurrences" or offenses existing as of the inception date of this
Coverage Part shall not prejudice the coverage afforded under this Coverage Part, provided such failure to
disclose all hazards or prior "occurrences° or offenses is unintentional.
8. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US
Condition 8. Transfer of Rights of Recovery Against Others To Us of SECTION IV — COMMERCIAL
GENERAL LIABILITY CONDITIONS is amended by adding the following:
We waive any right of recovery we may have against any person or organization when such waiver is required
by a written contract that you have agreed to prior to loss.
9. ADDITIONAL INSUREDS
a. LESSOR OF LEASED EQUIPMENT
SECTION 11 - WHO I$ AN INSURED is amended to include as an additional insured any person or
organization from whom you [ease equipment when you and such person or organization have
agreed in writing in a contract or agreement that such person or organization be added as an
additional insured on your policy. Such person or organization is an insured only with respect to their
liability for 'bodily Injury", "property damage" o€ "personal and advertising Injury" caused, in whole or
In part, by your maintenance, operation or use of equipment leased to you by such person or
organization. A person's or organization's status as an additional insured under this endorsement
ends when their contract or agreement with you for such leased equipment ends.
it. With respect to the insurance afforded these additional insureds, this insurance does not apply to
any "occurrence" which takes place after the equipment lease expires.
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b. MANAGERS OR LESSORS OF PREMISES
COMMERCIAL GENERAL LIABILITY
I. SECTION 11 - WHO IS AN INSURED is amended to Include as an additional insured any person or
organization from whom you lease premises when you and such person or organization have
agreed in writing In a contract or agreement that such person or organization be added as an
additional Insured on your policy. Such person or organization is an insured only with respect to
liability arising out of your ownership, maintenance or use of that part of the premises leased to you
subject to the following additional exclusions:
It, With respect to the Insurance afforded these additional insureds, the following additional exclusions
apply:
This Insurance does not apply to:
(1) Any "occurrence" which takes place after you cease to be a tenant In that premises.
(2) Structural alterations, new construction or demolition operations performed by or on behalf of
such person or organization.
c. VENDORS
I. SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or
organization (referred to below as vendor) with whom you and such person or organization have
agreed In writing In a contract or agreement that such person or organization be added as an
additional insured on your policy, but only with respect to "bodily Injury" or "property damage" arising
out of "your products" which are distributed or sold in the regular course of the vendor's business,
subject to the following additional exclusions:
ii. The insurance afforded the vendor does not apply to:
(1) 08ocilly injury" or "property damage" for which the vendor is obligated to pay damages by reason
of the assumption of liability in a contract or agreement. This exclusion does not apply to liability
for damages that the vendor would have in the absence of the contract or agreement;
(2) Any express warranty unauthorized by you,
(3) Any physical or chemical change in the product made intentionally by the vendor;
(4) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or
the substitution of parts under instructions from the manufacturer, and then repackaged In the
original container,
(6) Any failure to make such Inspections, adjustments, tests or servicing as the vendor has agreed
to make or normally undertakes to make in the usual course of business, in connection with the
distribution or sale of the products;
(6) Demonstration, installation, servicing or repair operations, except such operations performed at
the vendor's premises in connection with the sale of the product;
(T) Products which, after distribution or sale by you, have been labeled or relabeled or used as a
container, part or Ingredient of any otherthing or substance by or for the vendor; or.
(6) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own
acts or omissions or those of its employees or anyone else acting on its behalf. However, this
exclusion does not apply to:
(a) The exceptions contained in Sub- paragraphs 4.or 6.; or
(b) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or
normally undertakes to make in the usual course of business, in connection with the
distribution or sale of the products.
iii. This insurance does not apply to any insured person or organization, from whom you have acquired
such products, or any Ingredient, part or container, entering into, accompanying or containing such
products.
t
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d. OWNERS, LESSEES OR CONTRACTORS
COMMERCIAL GENERAL LIABILITY
SECTION II — WHO IS AN INSURED is amended to include as an additional insured any person or
organization for whom you are performing operations when you and such person or organization
have agreed in writing in a contract or agreement that such person or organization be added as an
additional insured on your policy. Such person or organization is an additional Insured only with
respect to liability for "bodily injury", "property damage" or °personal and advertising injury" caused,
In whole or in part", by:
(1) Your acts or omissions; or
(2) The acts or omissions of those acting on your behalf;
in the performance of your ongoing operations for the additional insured.
A person's or organization's status as an insured under this endorsement ends when your
operations for that Insured are completed.
IL With respect to the insurance afforded these additional Insureds, the following additional exclusion
applies:
This insurance does not apply to:
(1) "Bodily injury", "property damage" or "personal and advertising injury" arising out of the
rendering of, or the failure to render, any professional architectural, engineering or surveying
services, including:
(a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions,
reports, surveys, field orders, change orders or drawings and specifications; and
(b) Supervisory, Inspection, architectural or engineering activities.
(2) Bodily injury" or "property damage" occurring after:
(a) All work, including materials, parts or equipment furnished In connection with such work, on
the project (other than service, maintenance or repairs) to be performed by or on behalf of
the additional insured(s) at the location of the covered operations has been completed; or
(b) That portion of "your work" out of which the injury or damage arises has been put to its
intended use by any person or organization other than another contractor or subcontractor
engaged in performing operations for a principal as a part of the same project.
e. ADDITIONAL INSUREDS —BY CONTRACT, AGREEMENT OR PERMIT
SECTION II —WHO IS AN INSURED is amended to Include as an additional insured:
(1) Any person or organization is an insured with whom you are required to add as an additional
insured to this policy by a written contract, written agreement, or permit that is:
(a) currently in effect or becoming effective during the term of this policy; and
(b) executed prior to the "bodily injury", "property damage ", "personal and advertising Injury".
(2) This insurance provided to the additional insured by this endorsement applies as follows:
(a) That person or organization is only an additional insured with respect to liability caused by
your negligent acts or omissions at or from:
(1) Premises you own, rent, lease or occupy, or
(2) Your ongoing operations performed for the additional insured at the job indicated by
written contract or written agreement.
(b) The limits of insurance applicable to the additional insured are those specified in the written
contract or written agreement or in the Declarations of this policy whichever is less. These
limits of insurance are inclusive of and not in addition to the limits of insurance shown in the
Declarations.
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COMMERCIAL GENERAL LIABILITY
(3) With respect to the Insurance afforded these additional insureds, the following additional exclusions
apply:
(a) This Insurance does not apply to "bodily injury" or "property damage" occurring after.
(1) all work, including materials, parts or equipment furnished in connection with such
work, on the project (other than service, maintenance or repairs) to be performed by
or on behalf of the additional Insured(s) at the site of the covered operations has been
completed; or
(2) that portion of "your work" out of which the Injury or damage arises has been put to its
intended use by any person or organization other than another contractor or
subcontractor engaged In performing operations on or at the same project.
(b) This insurance does not apply to "bodily injury", "property damage ", "personal and
advertising injury" caused by the rendering of or failure to render any professional services.
(4) Regardless of whether other insurance Is available to an additional Insured on a primary basis,
this insurance will be primary and noncontributory if a written contract between you and the
additional insured specifically requires that this insurance be primary,
10. EXTENDED DEFINITION OF "BODILY INJURY"
The definition of 'bodily Injury" in SECTION V — DEFINITIONS paragraph 3. is replaced by the following:
"Bodily Injury" means bodily injury, sickness or disease sustained by a person, including mental anguish or
death resulting from any of these at any time.
11. EXTENDED DEFINITION OF "PERSONAL AND ADVERTISING INJURY"
The definition of 'personal and advertising injury" in SECTION V — DEFINITIONS paragraph 14, is amended
to Include the additional offense of abuse of process.
v
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Certification Regarding Drug -Free Workplace Requirements
The certification set out below is a material representation upon which reliance is
placed by the U.S. Department of Housing and Urban Development in awarding the
grant. If it is later determined that the contractor knowingly rendered a false
certification, or otherwise violates the requirements of the Drug -Free Workplace
Act, the U.S. Department of Housing and Urban Development, in addition to any
other remedies available to the Federal Government, may take action authorized
under the Drug -Free Workplace Act.
CERTIFICATION
A. The contractor certifies that it will provide a drug -free workplace by:
(a) Publishing a statement notifying employees that the unlawful
manufacture, distribution, dispensing, possession or use of a
controlled substance is prohibited in the contractor's workplace and
specifying the actions that will be taken against employees for
violation of such prohibition;
(b) Establishing a drug -free awareness program to inform employees
about —
(1) The dangers of drug abuse in the workplace;
(2) The contractor's policy of maintaining a drug -free workplace;
(3) Any available drug counseling, rehabilitation, and employee
assistance program; and
(4) The penalties that may be imposed upon employees for drug
abuse violations occurring in the workplace;
(c) Making it a requirement that each employee who will be engaged in
the performance of the grant be given a copy of the statement
required by paragraph (a);
(d) Notifying the employee in the statement required by paragraph -(a)
that, as a condition of employment under the contract, the employee
will -
(1) Abide by the terms of the statement; and
(2) Notify the employer of any criminal drug statute conviction for
a violation occurring in the workplace no later than five days
after such conviction.
EXHIBIT D
M
(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:
Employer Signature
EXHIBIT D
DIVISION OF EMPLOYMENT SERVICES
PLACE OF PERFORMANCE
FOR CERTIFICATION REGARDING DRUG -FREE WORKPLACE
REQUIREMENTS
Name: Accurate Performance Machining, Inc.
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):
Accurate Performance Machining, Inc.
2255 S. Grand Ave.
Santa Ana, CA 92705
EXHIBIT D
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
0a
Signature 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 leams that its certification was erroneous when submitted or has become erroneous
by reason of changed circumstances.
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.
5. 'the prospective recipient of federal assistance funds agrees by submitting this proposal that, should
the proposed covered transaction be entered into, it shall not knowingly 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.
6. 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 Programs.
& 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.
9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a
covered transaction luiowingly 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 DOL may pursue available
remedies, including suspension and/or debarment.
EXHIBIT E