Loading...
HomeMy WebLinkAboutB&R BIRCHLER INVESTMENT CORP. DBA EDINGER 76-2016iNSil ANCF.ON FILE VV 64 MY PROCEED UNM lN$URANCE EXPIRES CLEIZK OF COUNCIL (LT ft 4 - 2016 ent � Agreement Na. 0- C.Q��lInC WorK l.[/l ON-THE-JOB TRAINING AGREEMENT CINDER THE WORKFORCE INVESTMENT ACT N-2016-011 THIS AGREEMENT is made and entered into this 26th day of January, 2016 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 B&R Birchler Investment Corp. DBA Edinger 76 (hereinafter "EMPLOYER"), WITNESSETH Recitals: A. CITY has been designated a Local Workforce Investment Area ("LWIA") pursuant to Section I16 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. 1.05-220, 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: I. Term. The effective term of this Agreement is for the period beginning January 26, 2016 and ending May 06, 2016. The term of this Agreement may be extended upon agreement of all parties and execution of an amendment of the term. 2. 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. 1 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. Fundin . CITY shall reimburse the EMPLOYER an amount not to exceed $2,016 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. 2 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. INVENTIONS, PATENTS AND COPYRIGHTS. A. Reporting Procedure. If any project produces patentable items, patent rights, processes, or inventions in the course of work wider 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 Linder 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 wider 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 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 or policies shall also contain a provision that no termination, cancellation or change of coverage or of insured or additional insured shall be effective until after thirty (30) days notice thereof has been given in writing to CITY. EMPLOYER shall give to CITY prompt and timely notice of claims made or suit instituted against said policy. EMPLOYER shall procure and maintain at its own costs and expense, any additional kinds and amounts of insurance which, in its own judgment, may be necessary for its proper protection. 11. Record Keening. 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, docrunents, 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, 11 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. Based on the size of Employer, 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 innnediately 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 fiords 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(3 1) 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: B&R Birchler Investment Corp. DBA Edinger 76 1502 E. Edinger Ave. Santa Ana, CA 92705 ATT: Adam Birchler G 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. Validi . 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: _VL a L4dt o. Maria D. Huizar Clerk of. the Council APPROVED AS TO FORM: Sonia R. Carvalho City Attorney By: Lisa Storck Assistant City Attorney RECOMMENDED FOR APPROVAL: 4ICeders Executive Directo Community Development Agency CITY OF SANTA ANA David Cavazos City Manager EMPLOYER: B&R Birchler Invest .ment Corp. DBA Edinger 76 Manager Tax ID#: 2514059 Exhibit A TRAINING PLAN I. GENERAL 1. Name of OJT Employer: B&R Birchler Investment Corp. DBA Endinger 76 2. Address of OJT Work -site: 1502 E. Edinger Ave. Santa Ana, CA 92705 3. Phone Number: 4. Training Supervisor: Adam Birchler 5. Name of OJT Trainee: Hector Martinez 6. Application Number of Trainee: #15368427 7. Grant/Program: OJT -201 8. Proportion of trainees/employees: (at time Agreement entered into) a. Total number of employer's regular employees C. Cumulative number of trainees currently in OJT II. OCCUPATION AND ON-THE-JOB TRAINING OUTLINE: 1. Occupation: Customer Service Representative 2. Length of Time in Business: 39 years 3. ONET Code: 43-4051.00 SVP Level: (4.0 to < 6.0) 4. Hourly Starting Wage: $ 10.50/hour Start Date: 01/26/2016 End Date: 05/06/2016 Hours 384 5. State and Federal Tax I.D.: State: 2514059 Federal 33-0991416 6. Basic Work Week Hours: 7. Outline of On -the -Job Training Plan and Method of Assessment: ELEMENTS OF TRAINING HOURS OF TRAINING Objective 1 172 Customer Service -Interact with customers to provide information in response to inquiries about products and gas station services and to handle and resolve complaints. Confer with customers by telephone or in person to provide information about products or gas station services. Greet Customers entering establishment. Check gasoline tank inventory. Checking product being delivered by vendors. Communicate with other associates and customers. Objective 2 172 Cashier -Receive payment by cash, check, credit cards or automatic debit. Use scanners, cash register and related equipment to process payment. Issue receipts, refunds, credits, or change due to customers. Assist customers by providing information and resolving their complaints. Count money and check if there is enough change. Record all transactions made. Will be trained to use cash register and software. Objective 3 40 Clean and Stock -Cleaning windows, floors, bathroom, emptying trash containers. Etc. Stocking shelves and coolers. Sweeping floors. Will be trained in light equipment maintenance (pumps, lighting, machinery, etc.) Maintain a safe and clean environment at all times. 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: S 5.25 (50% of $10.50) Training Hours: 384 Cost Per Trainee (Hourly Reimbursement X Training Hours) = $ 2,016 III. Person(s) authorized to sign payment invoices for PLOYER: Print Name Print Name Signature Signature Title Title Date 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. 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. 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 marriage 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 13 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. Employer Signature EXHIBIT B 01/07/2016 Date B&RBI-1 OP ID: J1 m CERTIFICATE OF LIABILITY INSURANCE aA12124115 I 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Wan ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the PRODUCER 949 - Roger Stone Insurance Agency 949- 5015 Birch Street Newport Beach, CA 92660 INSURED B&R Birchior Investment Corp. DBA: Edinger 76 1502 E. Edinger AVG. Santa Ana, CA 92705 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: _ _ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 10 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INT -- ADD -- POLWYE F I YEXP LTR TYPE OF INSURANCE POLICY NUMBER MM1061YYYY LMM1DDtYYYY LIMITS _ GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 A X COMMERCIAL GENERAL LIABILITY X CP6006626207 04116115 04116/16 OAWAJiES Ea 300,04 onoccsarrernm '$. CLAIMS -MADE OCCUR MED END(Anye person} J$ 5,00 PERSONAL &ADV INJURY $ .1,000,00 GENERAL AGGREGATE $ 2,000,000 GENLAGGREGATE LIMITAPPLIES PER, PRODUCTS - COMP/OP AGO $ 2,000,000 X POLICY PRO Loc Emp Ben. $ None AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Es accitlent $ 1,000000 _ , A ANY AUTO ACP3006628207 04/16/15 04/16/16 BODILY INJURY (Per Person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accitlent) $ AUTOS AUTOS NON -OWNED PROPERTY DAMAGE $ X HAEOAUT(1S X AUTOS Peraccident UMBRELLA UAa OCCUR EACH OCCURRENCE EXCESS LAID CLAIMS -MADE AGGREGATE $ DEO RETENTION$ S WORKERS COMPENSATION X WCSTATU- OTH- ANDEMPLOYERS'LWBILITYTORY B ANY PROPRIE]OWPARTNER/EXECUTIVE YIN GCN1520872 12131/14 12131115 E.L EACH ACCIDENT S EXCWDED4 N/A 1,000,000 OFFICERIMEMBFR (Mandatory in NH) EL.DISEASE -EAEMPLOYFF $-' 1,000,000 If mch'sa be under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ 1,000,000 A Property Section ACP3006826207 04/16/15 04/16/16 BUILDING 700,000 BPP 130,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aaach ACORD 101, Additional Remarks Schedule, If more spaco Is required) RE: All covered operations Certificate Holder is named Additional Insured as respects General Liability per endorsement to follow. CERTIFICATE HOLDER CANCELLATION ^� CITYSAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cit of Santa Ana City ACCORDANCE WITH THE POLICY PROVISIONS. Community Development Agency;{ O Economic Development Division AUTHORREserlrAnvE �Irr,111N'.\; �y 1000 E. Santa Ana Blvd. #200 Santa Ana, CA 92701 yo"" V� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and Io o are registered marks of ACORD Exhibit C 2U9INE990WNERS PB 60 03 0411 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — MUNICIPALITIES OR PUBLIC AGENCY —INSURED PROVIDING PROFESSIONAL SERVICES This endorsement modifies insurance provided under the following: PREMIER BUSINESSOWNERS LIABILITY COVERAGE FORM The following is added to Section II. WHO IS AN INSURED: The municipality and/or public agency designated in the Schedule of this endorsementis also an insured, but only with respectto liability for "bodily injury", "property damage" or "personal and advertising injury" caused ,in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf in connection with youroparations, other than the rendering of or the failure to render professional services, advice of instruction, subject to the following additional exclusion: This insurance, including any duty we have to defend "suits", does not apply to "bodily injury". "property damage" or "personal and advertising Injury" that arises out of, in whole or in part, or is a result of, in whole or in part, the active or primary negligence of the municipality and/or public agency designated in the Schedule of this endorsement, whether or not such negligence has been assumed by you in a contractor agreement. All terms and conditions of this policy apply unless modified by this endorsement. SCHEDULE Municipality and/or Public Agency: CITY OF SANTA ANA COMMUNITY DEVELOPMENT AGENCY ECONOMIC DEVELOPMENT DIVISION 1000 E SANTA ANA BLVD #1200 SANTA ANA CA 927013900 PB 60 03 0411 ACP SPR 3006625207 INSURED COPY Exhibit C Z'd ZOI, -Z99-17[Z 9L aebulp3 Page 1 of 1 ty�de 78 01527 V" J d79 ZI, 96 9 t uer ®Allied AMCO INSURANCE COMPANY Insurance a Nationwide Insuranc company CHANGE OF DECLARATIONS ENDORSEMENT - PLEASE READ CAREFULLY, POLICY NUMBER ACP BPR 3006525207 PREMIER BUSINESSOWNERS POLICY NAMED INSURED: B&R BIRCHLER INVESTMENT, CORP - DBA EDINGER 76 MAILING ADDRESS: 1502 E EDINGER AVE SANTA ANA, CA 92705.4908 AGENT NAME: ROGER STONE INSURANCE AGENCY 84 22292 NO CHARGE $ .00 AGENT ADDRESS: NEWPORT BEACH CA 92660 002 POLICY PERIOD: FROM 04.16.15 TO 04.16-16 12:D1 A.M. Standard Time EFFECTIVE DATE OF CHANGE: 12-24-15 12:61 A.M. Standard Time NOT A STATEMENT- YOUR BILLING WILL FOLLOW TOTAL PREMIUM 5 .00 LOCATION i BUILDING 3E3E1E3L3F3E3F31F3E3E3EifiOE3L1L7E NO. 001000 $ ,00 LOC/BLDG DESCRIBED PREMISES 01 01 1502 E EDINGER AVE SANTA ANA CA GAS STATION --BUILDING, PUMPS, AND CANOPY SIC CODE CHANGE NAICS CODE CHANGE 1E*ILS**3f3E3ELL3E3E*iE3t*Ilii**1E ADDITIONAL INSURED NO. 002000 $ .00 CITY OF SANTA ANA COMMUNITY DEVELOPMENT AGENCY ADDED NAME CITY OF SANTA ANA COMMUNITY DEVELOPMENT AGENCY ADDED OLD ADDRESS ECONOMIC DEVELOPMENT DIVISION ADDED ADDRESS 1000 E SANTA ANA BLVD #200 ADDED CITY SANTA ANA ADDED STATE CA ADDED ZIP CODE 927013900 ADDED FORM NUMBER PB6003 MUNICIPALITY CHANGE ***R*iliEi4MM**■R5*AIIiLiLR3E*iEMiLS ENDORSEMENT a�SM1Elr>E�r11AN�r*3�3rx*�11r1E*�tr�*11*11t1�* ADDED ENDORSEMENT FORM FORM PE6003 EDITION DATE 0411 A COPY OF THIS FORM IS ATTACHED in 0 ry DIRECT BILL LBAJ 16006 ENSURED COPY 937404493 o u, 78 04526 Exhibit C �vi�waA � �° ,'d LOl l L99 b6L 9Lae15UIP3 dt79 Zt 9t 9, Uhf '� ` '..401111[c6=i}al*7Etra <a 42p CERTIFICATE OF LIABILITY INSURANCE O01/001 2 01 6 Duo512015 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). PRODUCER Peck & Peck Insurance Brokers 1724 Laurel Street Suits 225 San Canes, GA Jerry Hermes CONTACT NAME: PHONE FAX" - twe Na. R.I. (aic, Rol: ADDRESS z RAM R AFFORDING COVERAGE 4 tNSURERA.COm West EACH OCCURRENCEPAMAar; INSURED Edinger 75 B&R Birchier Invstmnt Corp 1502 E. Edinger Santa Ana, CA 92705 INSURERG: INSURERC I -- INSURER J GENERAL AGGREGATE S _ INSURER E: S R P• S COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CQNDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INBR'�, 7ypE OF INSURANCE Stan 4 p LILY NUMBER IIADOL O Y P _ tJMn8 L NERAL LMSRJTY I ;. C__OMM£RCIAL GENERAL LABILITY CLAIM6 MADE F7 OCCUR �^ AUTHORIZED DRREPRESENTATIVE � (� C� EACH OCCURRENCEPAMAar; TV HE POEM ES tEnetas,9020 $ MED £XP { ass person) $ PERSONAL&ADVINJURY J GENERAL AGGREGATE S _ GEN'L AOGRWATE LIMIT APPLIES PER: POLI Y PRD• LOC PRODUCTS• COMPIOP AGO S S AUTOMOBILE LIABILITY ANY AUTO ALL OWNEDSCHEDULED AVTOS AUTOS NON -OWNED HIRED AUTOS AUTOS rl. EO�MBINED BINGLE LIMIT BODILY INJURY (Per perms) S BODILY INJURY (Per eccido,e) $ PROP TY DAMAGE8 NTI If UMBRELLA LAO OCCUR i EXCESSLAe CLNMSAWE EACH OCCURRENCE S AGGREGATE $ OED E RETENTION S WORXERB COMPENSATION AND EMPLOYERS' LIABILITY A ANYPROPRIETDRIPARTNEREXECUTIVE YIN OFFICERJMEMBER EXCLUDED? �(MerMalory In NHl III aa. tle6enbe wow DU! RIPT N OF OPERATIONS below NIA CVSN024900 12!7112015 12131(2018 X WCSTAT4M OTH- E.L EACH ACCIDENT $ 1,000,00 E.L.OISEASE•FA EMPLOYEE$ 1,000,00 EL OISEASE• POLICY LIMIT S 1,000,00 1I I DESCRIPTION OF OPERATIONS I LOCATIONS J VEHICLES (ARach ACORD 101, Addltlo uil Romema Schadulo, If mom space Is requNed) **Proof of Coverage only** CFRTIMCATF HDI. OF_R CANCELLATION BALNK-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN "'Proof of Insurance""" ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED DRREPRESENTATIVE � (� C� 01988.2010 ACORD CORPORATION, ACORD 26 (2010105) The ACORO name andXpcs,Treiragjatered marks of ACORD r All rights resor Z fit' BUSINESSOWN ERS PB 60 72 0711 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT TO OTHER INSURANCE CLAUSE FOR ADDITIONAL INSUREDS - PRIMARY AND NOW CONTRIBUTORY WHEN REQUIRED IN A WRITTEN I AGREEMENT OR CONTRACT WITH YOU This endorsement modifies insurance provided under the following: PREMIER BUSINESSOWNERS COMMON POLICY CONDITIONS Only with respectto any additional insured, in the COMMON POLICY CONDITIONS, form PB 00 09, under condition H, OTHER INSURANCE, paragraph 2.a. is replaced by the following: H. OTHER INSURANCE 2. Under any liability coverage provided by this policy, a. If for injury or loss we cover, there is other valid and collectible insurance available to any additional insured under another policy, our obligations are limited as follows: (1) Issued by another insurer, or if there is self insurance or similar risk retention that applies to a loss covered by this policy, then this insurance provided by us shall be excess over such other insurance, unless you have agreed in a written contract or written agreement signed prior to the loss that this insurance shall be primary: (a) Then this insurance is primary. If other insurance is also primary, we will share with all that other insurance as described In d. below; and (b) The coverage afforded by this insurance is non-contributory with the additional insured's own insurance. Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional insured to any other person or organization's policy.; or (2) Issued by us or any of our affiliate companies, that applies to a loss covered by this policy, then only the highest applicable Limit of Insurance shall apply to such loss. This condition does not apply to any policy issued by us that is designed to provide Excess or Umbrella liability insurance. All terms and conditions of this policy apply unless modified by this endorsement. PB 60 72 0711 ACP BPR 0000625207 Includes copyrighted material of Insurance Services Of ice, Inc., with its pormisslon. Pagel of 1 INSURED COPY 70 02765 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 - (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 Li (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: _01/07/2016 Employer Signature EXHIBIT D DIVISION OF EMPLOYMENT SERVICES PLACE OF PERFORMANCE FOR CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS Name: Adam Birchler Name of Contractor: B&R Birchler Investment Corp. DBA Edinger 76 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): 1502 E. Edinger Ave. Santa Ana, CA 92705 EXHIBIT D INSTRUCTIONS FOR CERTIFICATION 1. By signing and submitting this proposal, the prospective recipient of federal assistance fiords 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. 3. 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 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 Diose 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. 7. 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. 8. 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 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 DOL may pursue available remedies, including suspension and/or debarment. EXHIBIT E 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 01/07/2016 z�/ Signature Date EXHIBIT E