HomeMy WebLinkAboutA8641 - BOYS AND GIRLS CLUB OF PALM SPRINGS: DISTANCE LEARNING PROGRAM COMMUNITY:DEVELOPMENT:BLOCK GRANT:(CDBG) PROGRAM :: • .
COVID=•.19 EMERGENCY RESPONSE •
SUBRECIPIENT AGREEMENT .
BETWEEN THE CITY OF PALM,SPRINGS
BOYS & GIRLS CLUB OF PALM SPRINGS .. . .
(Federal Grant No. [B-20-MW-06-0561])
THIS AGREEMENT herein"Agreement" is:made and entered into this 12TH:day:
. . -r of November, 2020, by and between the. CITY OF PALM. SPRINGS, (herein "City),Ha
municipal::corporation and: charter city, and the . BOYS.:& GIRLS CLUB OF PALM
:::SPRINGS; Federal Tax Number: [95-:1957907] (herein "Provider"):
WHEREAS, on March 27, 2020, the :President of the United State s:signed H.R.
748, known as.the Coronaviru s Aid, Relief; and Economic Security ("CARES") Act, ,
�.
. which provides:;an additional' $5 billion of Community Development Block Grant:;;
Coronavirus :("CDBG-CV")- funds to rapidly. prepare, prevent;: and respond: to the
coronavirus pandemic;:and
WHEREAS;-the City has. received CDBG-CV CARES Act, Public Law 116=136
from theUnited States Department of Housng.and Urban Development ("HOD");:end
WHEREAS; CARES Actprovides that the Cit may rant the.;CDBG-CV funds to
nonprofit :organizations::for certain. purposes allowed under the CARES :Act;: namely
according to HUD, the City "may use the funds for a range of eligible activities that ,
: ::.prevent and respond to the spread of infectious disease such as the:coronavirus"; and
WHEREAS, the Provider is a nonprofit organization that operates a program that is
:eligible for a grant of CDBG-CV funds and the City:desires to assist in the operation of the;
program by granting CDBG-CV Funds to the Provider to:.pay for all or a'portion of those • -
costs :incurred in operating the program permitted by the Act and the Regulations on
: terms and.conditions more particularly set forth herein; :.
. WHEREAS, according. to ...federal ..regulations (24.. CFR 570.503), before
disbursing any CDBG funds: to a subrecipient,:a written agreement shall be signed by •
the recipient and.subrecipient; and
NOW, THEREFORE, the parties hereto agree as follows:
1.0 SERVICES OF PROVIDER.
1.1 Scope of Services Activities funded with CDBG-CV funds must.
meet one of the Program's National Objectives (Title 24, Part 570, Sections 570.200(a)(2)
and (3);:570.208(a)-(d); and:.570:208). For purposes of this:Agreement, Provider agrees
to provide services meeting the National-:Objective of benefitting low and moderate-
, 'income area benefit, ;or low and: moderate income limited clientele.` Provider agrees to,
.
55575.18175\33228209.1
provide to City all of the services specified and detailed in Exhibit A. Provider represents
and warrants to City that it is able to provide, and will use funds granted by the City to
provide the services as represented herein. City provided funds shall be used only for
those purposes specified as contained in this Agreement.
1.2 Compliance with Law. All services rendered hereunder shall be
provided in accordance with all ordinances, resolutions, statutes, rules, and regulations of
the City and any Federal, State or local governmental agency of competent jurisdiction.
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1.3 Reports. No later than ten (10) days prior to any payment date
specified in Section 2.0, within ten (10) days following the termination of this Agreement,
and at such other times as the Contract Officer shall request, Provider shall give the
Contract Officer a written report describing the services provided during the period of time
since the last report and accounting for the specific expenditures of contract funds
hereunder, if applicable. At the times and in the manner required by law, the Provider
shall provide to the City, the Department. of Housing and Urban Development, the
Comptroller General of the United States, any other individual or entity, and/or their duly
authorized representatives, any and all reports and information required for compliance
with the Act and the Regulations. Provider shall, at minimum,, maintain the following
records and reports to assist the City in complying with its record keeping requirements.
a) Documentation (Exhibit B) of the income level, ethnicity, age of persons
and/or households participating in or benefiting from the Provider's.
program;
b) Documentation (Exhibit B) of the number of persons and/or households
participating in or benefiting from the Provider's program;
•
c) Documentation (Exhibit B) of the impact of the Coronavirus on the
assisted household and that no other financial resource is available to
provide assistance;
d) Documentation of all CDBG-CV funds received from the City;
e) Documentation of expenses as identified in the report and reimbursement
requests;
f) Documentation of how and when a determination was made as to the
eligibility status of persons assisted, including evidence that the persons
assisted are domiciled within the approved area of service, if any;
g) Documentation of compliance with any applicable Equal Employment
Opportunity guidelines and evidence of any actions undertaken by the
Provider to ensure equal employment opportunities to all persons; and
h) Any such other related records as the. City shall require or as are
necessary pursuant to 24 CFR 570.506.
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55575.18175\33228209.1 -2-
1.4 Financial Reporting. Any Provider receiving or due to receive
$20,000.00 or more from the City during the 2020 — 2021 Fiscal Year shall provide to
City a financial statement prepared by a recognized accounting firm approved by or
satisfactory to. City's Finance Director completed within the most recent twelve (12)
months showing the Provider's financial records to be kept in accordance with generally
accepted accounting standards. The report shall include a general ledger balance sheet
that identifies revenue sources and expenses in sufficient detail to demonstrate contract
compliance and be balanced to bank statements. Any organization receiving or due to
receive less than $20,000.00 in the current fiscal year from the City shall provide a copy
of the organization's most recent charitable trust report to the Attorney General, or other
financial information satisfactory to City's Finance Director. The financial information
provided for in this paragraph shall be furnished not later than January 31st of the current
fiscal year.
1.5 Records/Audit. Provider shall maintain separate accounting records
for the CDBG-CV funds provided by the City. The City, HUD, the Comptroller General of
the United States, or any of their duly authorized representatives shall have access to all
books, documents, papers and records maintained by Provider in connection with the
services for the purpose of audit, examination, excerpts and transcriptions. Unless
otherwise notified by the City, Provider shall retain all financial records, supporting
documents and statistical reports related to the project identified under this Agreement
until June 30, 2026. All records subject to an audit finding must be retained for five (5)
years from the date the finding is made or until the finding has been cleared by
appropriate officials and Provider has been. given official written notice. The. City shall
have the right to ensure that necessary corrective actions are made by the Provider for
any audit findings pertinent to Provider handling of funding attributable to the CDBG-CV
Program. In response to audit deficiencies or other findings of noncompliance with this
agreement, the City may impose additional conditions on the use of the CDBG-CV and/or
CDBG funds to ensure future compliance, or provide training and technical assistance as
needed to correct noncompliance.
1.6 Client Data and Other Sensitive Information. Provider is required to
maintain data demonstrating client eligibility for activities provided under this Agreement.
Such data may include, but not be limited to, client name, address, income level or other
basis for determining eligibility, and description of activities provided. Provider must
comply with 2 CFR §200.303 and take reasonable measures to safeguard protected
personally identifiable information, as defined in 2 CFR § 200.82, and other information
HUD or Provider designates as sensitive or Provider considers sensitive consistent with
applicable Federal, state, local, and tribal laws regarding privacy and obligations of
confidentiality. Protected personally identifiable information means an individual's first
name or first initial and last name in combination with any one or more of types of
information, including, but not limited to, social security number, passport number, credit
card numbers, clearances, bank numbers, biometrics, date and place of birth, mother's
maiden name, criminal, medical and financial records, educational transcripts. This does
not include personally identifiable information that is required by law to be disclosed.(2
CFR§ 200.82.)
55575.18175\33228209.1 -3-
2.0 COMPENSATION.
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2.1 Contract Sum. The City shall pay to the Provider on a reimbursable
basis for its services a sum not to exceed Twenty-two thousand three hundred and fifty two dollars&00/100
($ 22,352.00 ) (the "Contract Sum") in accordance with the Budget attached
hereto in Exhibit C and incorporated herein by this reference; and as herein provided. The
budget cost categories set out in Exhibit C are general guidelines and if mutually agreed
by both parties, may be amended administratively by no more than 10%, without the
requirement of a formal amendment to this Agreement, but in no event shall •such
adjustments increase the Contract Sum. The Provider shall submit to the City periodic
statements, in the form of Exhibit D, on reimbursable expenditures pursuant to the
attached Budget along with pertinent supporting'documentation. Payroll records, receipts
and paid invoices including an itemized statement of all costs are samples of appropriate
methods of reimbursement documentation. The City shall promptly review the monthly
expenditure statements and, upon approval, reimburse the Provider its authorized
operating costs.
• 2.2 Payroll Records. In cases where the Contract Sum will reimburse
payroll expenses as part of operations,the Provider will establish a system of maintaining
accurate payroll records which will track daily hours charged to the project by the
Provider's respective employees, as set forth in OMB Circular A-122 Attachment B.6. ..
2.3 Draw Downs. Failure by Provider to request reimbursement or
encumbrance of at least 25% of the total grant by the end of each fiscal-year quarter
(September 30, December 30, March 31, and June 30) shall result in the immediate •
forfeiture of 25% of the total grant.
3.0 COORDINATION OF WORK.
3.1 Representative of Provider. The following principals of Providers are
hereby designated as being the principals and representatives of Provider authorized to
act in its behalf with respect to the work specified herein and make all decisions on behalf
of Provider in connection therewith:
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3.2 Contract Officer. The Contract Officer shall be such person as may
be designated by the City Manager of City.
3.3 Prohibition Against Subcontracting or Assignment. Provider shall not
contract with any other entity to perform in whole or in part the services required
hereunder without the prior, express written approval of the City. Neither this Agreement,
nor any interest herein, including the right to any monies due hereunder, may be assigned.
or transferred, voluntarily or by operation of law, without the prior written approval of the
City.
55575.18175\33228209.1 =L�-
3.4 Independent Contractor. Neither the City nor any of its employees
shall have any control over the manner, mode or means by which Provider, its agents or
employees, perform the services required herein, except as otherwise set forth herein.
Provider shall perform all services,required herein as an independent contractor of City
and shall remain at all times as to City a wholly independent contractor with only such
obligations as are consistent with that role. Provider shall not at any time or in any
manner represent that it or any of its agents or employees are agents or employees of
City.
4.0- COMPLIANCE WITH FEDERAL REGULATIONS.
4.1 The Provider acknowledges that the funds being provided by the City
for the Project are distributed pursuant to the Coronavirus Aid, Relief, and Economic
Security Act ("CARES Act"), Public Law 116-136. The Provider agrees to comply with the
requirements of the CARES Act, Public Law 116-136, and any implementing regulations
and programmatic requirements. Further, the Provider agrees to comply with the
requirements of Title 24 of the Code of Federal Regulations, Part 570 (the U.S. Housing
and Urban Development regulations concerning Community Development Block Grants
(CDBG)) including subpart K of these regulations, except that (1) the Provider does not
assume the City's environmental responsibilities described in 24 CFR 570.604 and (2)the
Provider does not assume the City's responsibility for initiating the review process under
the provisions of 24 CFR Part 52. The Provider also agrees to comply with all other
applicable Federal, state and local laws, regulations, and policies governing the funds
provided under this Agreement including: financial standards according to OMB Circular
A-22 (non-profit), OMB Circular A-87 "Cost Principles for State and Local Governments,
OMB Circular A-133 "Audits of State and Local Government and Non-Profit
Organizations." The Provider further agrees to utilize funds available under this
Agreement to supplement rather than supplant funds otherwise available.
4.2 The Provider shall maintain records of its operations and financial
activities in accordance with the requirements of the Housing and Community
Development Act and the regulations promulgated thereunder, which records shall be
open to inspection and audit by the authorized representatives of the City, the
Department of Housing and Urban Development and the Comptroller General during
regular working hours. Said records shall be maintained for.such time as may be
required by the regulations of the Housing and Community Development Act, but in no
case for less than five years after the close of the program.
4.3 The Provider certifies it shall adhere to and comply with the following
as they may be applicable, and as may be amended from time to time:
(a) Submit to City through its Community and Economic
Development Department semi-annual reports on program
status (Exhibit E);
(b) Section 109 of the Housing and Community Development Act
of 1974, as amended and the regulations issued pursuant
thereto;
55575.18175\33228209.1 -5
(c) Section 3 of the Housing and Urban Development Act of
1968, as amended;
•
(d) Executive Order 11246, as amended by Executive Orders
11375 and 12086, and implementing regulations at 41 CFR
Chapter 60;
(e) Executive Order 11063, as amended by Executive Order
12259, and implementing regulations at 24 CFR Part 107;
(f) Section 504 of the Rehabilitation Act of 1973 (P.L. 93-112), as
amended, and implementing regulations;
(g) The Age Discrimination Act of 1975 (P.L. 94-135, as
amended, and implementing regulations;
(h) The relocation requirements of Title II and the acquisition
requirements of Title III of the Uniform Relocation Assistance
and Real Property Acquisition at 24 CFR Part 42;
(i) The restrictions prohibiting•use of funds for the benefit of a
religious organization or activity as set forth in 24 CFR
570.200 (j);
(j) The labor standard requirements as set forth in 24 CFR Part
570, Subpart K and HUD regulations issued to implement
and requirements;
(k) The Program Income requirements as set forth in 24 C.F.R.
570.504(c) and 570.503(b)(8), which are hereby
incorporated by reference;
(I) The Provider is to carry out each activity in compliance with
all Federal laws and regulations described in 24 C.F.R. 570,
Subpart K, except that the Provider does not assume the
City's environmental responsibilities described at 24 C.F.R.
570.604; nor does the Provider assume the City's
responsibility for initiating the review process under the
provisions of 24 C.F.R. Part 52;
. (m) Executive Order 11988 relating to the evaluation of flood
hazards and Executive Order 11288 relating to the
prevention, control and abatement of water pollution;
(n) The flood insurance purchase requirements of Section
102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-
234);
55575.18175\33228209.1 -6
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(o) The regulations, policies, guidelines and requirements of 24
CFR 570; the "Common Rule", 24 CFR Part 85 and subpart
J; OMB Super Circular 2 CFR 200 as they relate to the
acceptance and use of federal funds under the federally-
assisted program;
(p) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) and
implementing regulations issued at 24 CFR Part 1;
(q) Title VIII of the Civil Rights Act of 1968 (P.L. 90-284) as
amended;
•
(r) The lead-based paint requirements of 24 CFR Part 35
issued pursuant to the Lead-Based Paint Poisoning
Prevention Act (42 U.S.C. 4801 et seq.);
(s) Procure, use, manage and dispose of personal property in
accordance with 2 CFR 200.310 and 2 CFR 200.312
through 2 CFR 200.316;
(t) Reversion of asset. Upon the Expiration of the agreement,'
the Subrecipient shall transfer to the City any CDBG funds on
hand at the time of expiration and any accounts receivable
attributable to the use of CDBG funds. Additionally, any real
property under the Subrecipient's control that was acquired or
improved in whole or in part with CDBG funds (including
CDBG funds provided to the Subrecipient in the form of a
loan) in excess of$25,000 is either:
(i) Used to meet one of the national objectives in Section
570.208 (formerly Section 570.901) until five years
after expiration of the agreement, or for such longer
period of time as determined to.be appropriate by the
City; or
(ii) Not used in accordance with paragraph (t)(i) above, in
which event the Subrecipient shall pay to the City an
amount equal to the current market value of the
property less any portion of the value attributable to
expenditures of non-CDBG funds for the acquisition
of, or improvement to, the property. The payment is
program income to the City. (No payment is required
after the period of time specified in paragraph (t) of
• this section.)
(u) Conflict of Interest. The Provider is required to disclose to
the City in writing any potential conflict in accordance with 24
CFR Part 570.611; and
55575.18175\33228209.1 -7-
(v) Such other City, County, State, or Federal laws, rules, and
regulations, executive orders or similar requirements which
might be applicable.
(w) The federal uniform administrative requirements, as
described in § 570.502.
(x) Provider shall not carry out any of the activities under this
agreement in a manner that results in a prohibited
duplication of benefits as defined by the CARES Act.
Provider must comply with HUD's requirements for
duplication of benefits, imposed on the City, which are:
CDBG-CV grant funds may not be used to pay costs if
another source of financial assistance is available to pay
that cost.
(y) Provider hereby certifies to City that Provider will provide a
drug-free workplace, in accordance with federal law.
4.4 The City shall have the right to periodically monitor the program
operations of the Provider under this Agreement.
4.5 At the end of the program year, the City may require remittance of all
or part of any program income balances (including investments thereof) held by the
Provider (except those needed for immediate cash needs, cash balances of a revolving
loan fund, cash balances from a lump sum drawdown, or cash or investments held for
section 108 security needs).
4.6 Subrecipient shall be subject to audit requirements contained in the
Single Audit Act Amendment of 1996 (31 USE 7501 —7507) and revised OMB Circular A-
133. -Subrecipient shall be subject to random audits by City, HUD, and the Comptroller
General of the United States or any of their authorized representatives, at any time during
normal business hours, as often as deemed necessary to audit, examine, and make
excerpts or transcripts of all relevant data in its administration of the CDBG-CV Program
and federally funded activity. All CDBG-CV funded activity records and related
documents shall be made available as well as required financial records/data for the
Subrecipient. Failure of Subrecipient to comply with the above audit requirement will
constitute a violation of this Agreement and may result in the withholding of future
payments and/or reimbursement of funds paid. Subrecipient agrees to have an annual
'agency audit conducted in accordance OMB Circular A-133.
4.7 Subrecipent shall comply with City policy concerning the purchase of
equipment, fixed assets, and other similar items and shall maintain inventory records of
all non-expendable personal property as defined by such policy as may be procured with
funds provided herein. All program assets (unexpended program income, property
equipment, etc) shall revert to City upon termination of this Agreement. Unless specified
• otherwise within this Agreement, Subrecipient shall procure all materials, property, or
services in accordance with the requirements of 24 CFR 84.40-48.
55575.18175\33228209.1 -8-
4.8 Subrecipient certifies that they will not or have not used federal
appropriated funds to pay any persons or organization for influencing or attempting to
influence an officer .or employee of any agency, a member of Congress, or offier or
employee of Congress in connection with obtaining any Federal contract, grant, loan,
cooperative agreement, or any other award including the extension, continuation,
renewal, or modification of same. Subrecipient shall disclose any lobbying with non-
federal funds that takes place in conjunction with obtaining any federal award.
5.0 INSURANCE AND INDEMNIFICATION.
5.1 Insurance. The Provider shall procure and maintain, at its cost, and
submit concurrently with its execution of this Agreement, public liability and property
damage insurance against claims for injuries against persons or damages to property
resulting from Provider's acts or omissions arising out of or related to Provider's
performance under this Agreement. Provider shall also carry Workers' Compensation
Insurance in accordance with State Workers' Compensation laws. Such insurance shall
be kept in effect during the term of this Agreement and shall not be cancelable without
thirty (30) days' prior written notice of the proposed cancellation to City. A certificate
evidencing the foregoing and naming the City, its elected officials, officers, employees
and agents as additional insureds shall be delivered to and approved by the City's Risk
Manager prior to commencement of the services hereunder. The procuring of such
insurance or the delivery of policies or certificates evidencing the same shall not be
construed as a limitation of Provider's obligation to indemnify the City, its elected officials,
officers, employees or agents. The amount of insurance required hereunder shall be as
required by the Contract Officer not exceeding One Million Dollars ($1,000,000).
5.2 Indemnification. The Provider shall defend, indemnify and hold
harmless the City, its elected officials, officers, employees and agents, from and against
any and all actions, suits, proceedings, claims, demands, losses, costs, and expenses,
including legal costs and attorneys' fees, for injury to or death of person(s), for damage to
property (including property owned by the City) arising out of or related to Contractor's
performance under this Agreement, except for such loss as may be caused by City's own
negligence or that of its officers or employees.
6.0 CITY OFFICERS AND EMPLOYEES: NON-DISCRIMINATION,
TERMINATION, AND ENFORCEMENT.
6.1 Non-Liability of City Officers and Employees. No officer or
employee of City shall be personally liable to the Provider, or any successor-in-interest,
in the event of any default or breach by City or for any amount which may become due
to the Provider or its successor, or for breach of any obligation of the terms of this
Agreement.
6.2 Conflict of Interest. Provider acknowledges that no officer or
employee of the City has or shall have any direct or indirect financial interest in this
Agreement nor shall Provider enter into any agreement of any kind with any such officer
or employee during the term of this Agreement and for one year thereafter. Provider
warrants that Contractor has not paid or given, and will not pay or give, any third party
any money or other consideration in.exchange for obtaining this Agreement.
55575.18175\33228209.1 -9-
6.3 Covenant Against Discrimination. In connection with its
performance under this Agreement, Provider . shall not discriminate against any
employee or applicant for employment because of actual or perceived race, religion,
color, sex, age, marital status, ancestry, national origin (i.e., place of origin, immigration
status, cultural or linguistic characteristics, or ethnicity), sexual orientation,, gender
identity, gender expression, physical or mental disability, or medical condition (each a
"prohibited basis"). Provider shall ensure that applicants are employed, and that
employees are treated during their employment, without regard to any prohibited basis.
As a condition precedent to City's lawful capacity to enter this Agreement, and in
executing this Agreement, Provider certifies that its actions and omissions hereunder
shall not incorporate any discrimination arising from or related to any prohibited basis in
any Provider activity, including but not limited to the following: employment, upgrading,
demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates
of pay or other forms of compensation; and selection for training, including
apprenticeship; and further, that Provider is in full compliance with the provisions of
Palm Springs Municipal Code Section 7.09.040, including without limitation the
provision of benefits, relating to non-discrimination in city contracting.
6.4 Term. Unless earlier terminated in accordance with Section 6.5 of
this Agreement, this Agreement shall continue in full force and effect until completion of
•the services, but not exceeding one (1) year from the date hereof, unless extended by
mutual agreement based on HUD guidance or regulations.
6.5 'Termination Prior to Expiration of Term.
a. In accordance with 2 CFR 200.339, the City may suspend or
terminate, in whole or in part, this Agreement if Provider fails to
comply with any term of this Agreement or the terms and
conditions of the subaward;
b. In accordance with 2 CFR 200.339, the City may terminate this
Agreement with the consent of the Provider after both parties
have agreed. upon the termination conditions, including the
effective date and, in the case of a partial termination, the
portion to be terminated; and
c. The Provider may terminate this Agreement at any time, with or
without cause, upon thirty (30) days' notification setting forth the
reason(s) for such termination, the effective date and, in the
case of partial termination, the portion to be terminated. Upon
receipt of the notice of termination the Provider shall
immediately cease all services hereunder except as may be
specifically approved by the Contract Officer. However, if the
City determines in the case of partial termination that the
reduced or modified portion of the subaward will not accomplish
the purposes for which the subaward was made, the City may
• terminate the subaward in its entirety. Provider shall be entitled
to compensation for all services rendered prior to receipt of the
notice of termination and City shall be entitled to reimbursement
for any services which have been paid for but not rendered.
55575.18175\33228209.1 - 10-
7.0 MISCELLANEOUS PROVISIONS.
7.1 Notice. Any notice, demand, request, consent, approval, or
communication that either party desires, or is required to give to the other party or any
other person shall be in writing and either served personally or sent by pre-paid, first-
class mail to the address set forth below. Notice shall be deemed communicated
seventy-two (72) hours from the time of mailing if mailed as provided in this Section.
Either party may change its address by notifying the other party of the change of
address in writing.
TO CITY:
City of Palm Springs
3200 East Tahquitz Canyon Way
Palm Springs, CA 92262-6959
Attn: City Manager
WITH COPY TO: V
City of Palm Springs
3200 East Tahquitz Canyon Way
Palm Springs, CA 92262-6959
Attn: City Attorney
TO PROVIDER: V '
s ( s WV) c elm 5,y .onojS
1-kin suuoN(1 -e___
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7.2 Amendment. This Agreement may be amended at any time by the
mutual consent of the parties by an instrument in writing.
IN WITNESS WHEREOF, the parties have executed and entered into this Agreement
as of the date first written above.
[ End —Signatures on Next Page ]
55575.18175\33228209.1 - 11 -
•
•
CITY OF PALM SPRINGS
ATT T: munici al corporation
By: ►i✓ B
• Ci y Clerk City Manager cisN)
APPROVED AS TO FORM: APPROVED BY Cli?COUNCIL •
By: i, $21�/ ��+-- 9"c
Cit ttord .Vt
PROVIDER: Check one: _Individual _Partnership _Corporation
(Corporations require two notarized signatures: One signature/must-be fro u- the Chairman of
Board, President, or any Vice President. The second sig -te must b- • the Secretary,
- Assistant Secretary, Treasurer,Assistant Treasurer, or Chief ' ' -ncial I
By: By: . .�-
Notarized Signature of hairman of Board, 'moo i es Sig .t re Secretary,
President or any Vice President A-st Stec etary, Treas.rer, sst Treasurer or
Chief Financi: • icer
Name: sg.,y/A7`1 )Q6.7if Name:
Title: 15 0 Alto132 b
State of ) State of )
County of )ss County of )ss
A notary public or other officer completing this certificate A notary public or other-officer completing this certificate
verifies only the identity of the individual who signed the verifies only the identity of the individual who signed the
document to which this certificate is attached, and not document to which this certificate is attached, and not
the truthfulness,accuracy,or validity of that document. • the truthfulness,accuracy,or validity of that document.
State of CAtiiV04111% ) State of CAI t 14O✓Pt 1. K )
County of (L1 6IP )ss. County of(R tUWs )ss.
On i t I V`202a before me, On J I /1(o 12v before me,
11-VW1 f t40tMdy 9ueU6 ,personally appeared i~lovroet itt.SCAIckni J Iv �hlS4ersonally appeared
gLYAt l (1066 who' proved to ►n ETA-r Di rD who proved to me
me on the basis of satisfactory evidence to be the person() on the basis of satisfactory evidence to be the person(s)
whose name(A is/aFe subscribed to the within instrument and whose name*) is/are subscribed to the within instrument and
acknowledged to-me that he/sde/t ey executed the same in acknowledged to me that he/stie/they executed the same in
his/hed#beir authorized capacityfiea),and that by his/or/their his/hec/their authorized capacity(ies)^and that by his/her/their
signatures on the instrument the person(g, or the entity signature(sr)ron the instrument the person(s)7 or the entity upon
upon behalf of which the personna'j acted, executed the behalf of which the person(a)-acted,executed the instrument.
instrument.
I certify under PENALTY OF PERJURY under the laws of the
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and
State of California that the foregoing paragraph is true and correct. -
correct. •
WITNESS my hand and offi ial seal.
WITNESS my hand and official seal.
Notary Signature: Notary Signature:
Notary Seal: Notary Seal:
• FLORENCE M. NKINS
J.KELLY ' Notary Public-California
,,.•���, 1 Riverside County 5
Notary Public California
_ = Commission#2308169
Riverside County My Comm.Expires Nov 6,2023
i
L , Commission#2275231
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55575.18175\33228209.1 1 — 12-
= CITY OF. PALM SPRINGS
EXHIBIT A
Scope of Services
Project/Activity Title: - Project Number:
CDBG-CV Funding—Boys &Girls Club of Palm Springs
Name/Address of Provider:
Boys&Girls Club of Palm Springs
450 S Sunrise Way
Palm Springs, CA 92262
Obiectives/Activities
Provide a safe environment for youth to participate in Distance Learning pods.
The Provider shall be responsible for the completion of the following objectives/activities in a manner
acceptable and satisfactory to the City and consistent with the standards required as a condition of
providing these CDBG funds.
Objective 1: Assist the City by timely providing any additional information requested.
TARGET
DATE ACTIVITY#1
On-Going Make readily available any information relative to the successful implementation of the
activity.
Objective 2: Establish and maintain a programmatic and financial record keeping process.
TARGET
DATE ACTIVITY#1
On-Going Establish and maintain,an efficient program process/procedure for proper record
keeping. Set-up a filing system for CDBG files only. Document and maintain all records
related to this program in a stable and secure location.
Objective 3: Advertise, market and publicize the program to facilitate positive promotion for all parties
(i.e., Provider, City, CDBG, etc.).
TARGET
DATE ACTIVITY#1
On-Going Draft a promotional piece and submit to City for approval. Advertise in the Desert Sun.
Submit final publication to City.
Objective 4: Maintain records for all CDBG activities related to this program.
TARGET
DATE ACTIVITY#1
On-Going Document and maintain all records related to this program, including those required, in
accordance with HUD Regulations, in a stable and secure location.
ACTIVITY#2
On-Going Submit Semi-Annual reports — referenced Exhibit E within fifteen (15) calendar days of
the program mid-year, December 31st, and program completion, June 30th
Objective 5: Manage/monitor program activities.
TARGET
DATE ACTIVITY#1
On-Going Perform monitoring activities necessary to ensure that the program is being conducted in
compliance with the CDBG policies, federal regulations, and local statues, including
Davis-Bacon Act, Copeland Act, and Non-discrimination/EEO requirements.
Objective 6: Provide an evaluation within fifteen (15) calendar days of the program completion or final
reimbursement.
TARGET
DATE ACTIVITY#1
07/15/21, Provide an evaluation and final report on all programmatic and financial activities.
Provide Additional Objectives, Activities and Descriptions below:
Objective 7: Provide a place for Distance Learning for up to 30 youth.
TARGET
DATE ACTIVITY#1
On-going Operate 3 pods of up to 10 youth to help accommodate parents who are essential
workers and/or who do not have someone to help their child with distance learning at
home.
Add additional objectives as needed.
General Administration
Provide the management oversight and leadership to address specific operational tasks in meeting the
established performance levels, as well as perform supportive activities (i.e., clerical, monitoring, etc.)
The CEO (Margaret Keung) will ensure that the program is being run and the Director of Development
(Andrea Madrigal) will ensure that clerical administration is turning in, in a timely manner. The Director of
Operations (India Braemer) will ensure the Distance Learning Program is meeting the needs of the
students and that all employees and youth are following proper health and safety guidelines needed for
operating within a pandemic i.e. masks, sanitation, health check, etc..
CITY OFPALM SPRINGS
EXHIBIT B
Beneficiary Qualification Statement
Project/Activity Title: Project Number:
CDBG-CV Funding—Boys &Girls Club of Palm Springs
Name/Address of Provider:
Boys &Girls Club of Palm Springs
450 S Sunrise Way, Palm Springs, CA 92262
BENEFICIARY QUALIFICATION STATEMENT
This statement must be completed and signed by each person or head of household (legal guardian) receiving benefits form the
described project/activity. Please answer each of the following questions.
1. How many persons are in your household?
For this question a household is a group of related or unrelated persons occupying the same house with at least one member
being the head of the household. Renters,roomers,or borders cannot be included as household members.
2. Circle your combined gross annual income(Riverside-San Bernardino-Ontario,CA MSA—07/01/2020)
AREA MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD:
INCOME(AMI) 1 2 3 4 5 6 7 8
LEVEL-$75,300
EXTREMELY LOW
INCOME $15,850 $18,100 $21,720 $26,200 $30,680 $35,160 $39,640 $44,120
0-30%ofAMI
LOW
INCOME $26,400 $30,150 $33,900 $37,650 $40,700 $43,700 $46,700 $49,700
30-50%of AMI
MODERATE
INCOME $42,200 $48,200 $54,250 $60,250 $65,100 $69,900 $74,750 $79,550
50-80%of AM!
NON LOW&MOD
INCOME $42,201+ $48,201+ $54,251+ $60,251+ $65,101+ $69,901+ $74,751+ $79,551+
>80%
3. What race/ethnicity do you identify yourself as;please note that this self-identification is voluntary in accordance with
equal opportunity laws?
❑ White 0 American Indian or Alaska Native AND White
❑ Black/African American 0 Asian AND White
❑ Asian 0 Black/African American AND White
❑ American Indian or Alaskan Native 0 American Indian/Alaska Native AND Black/African American
❑ Native Hawaiian or Other Pacific Islander 0 Other:
HISPANIC/LATINO ETHNICITY 0 Yes 0 No If yes,check one: 0 Mexican/Chicano
❑ Puerto Rican
❑ Cuban
0 Other:
4. Are you female Head of Household? 0 YES ❑ NO
5. Do you have a disability? 0 YES 0 NO If YES,please describe:
6. Have you been impacted by the Coronavirus? 0 YES ❑ NO If YES,please describe:
ACKNOWLEDGEMENT AND DISCLAIMER
I CERTIFY UNDER PENALTY OF PERJURY THAT INCOME AND HOUSHOLD STATEMENTS MADE ON THIS FORM ARE TRUE.
NAME: DATE:
ADDRESS: PHONE NO:
SIGNATURE:
The information you provide on this form is confidential and is only utilized for Community Development Block Grant(CDBG) program purposes,a
Federally-funded program,governmental reporting purposes to monitor
CITY OF.PALM SPRINGS ._.
EXHIBIT C
Budget Summary
Project/Activity Title: Proiect Number:
CDBG-CV Funding—Boys&Girls Club of Palm Springs
Name/Address of Provider:
Boys & Girls Club of Palm Springs
450 S Sunrise Way
Palm Springs, CA 92262
in_- BUDGET SWMMARY ;
COST CATEGORY CDBG OTHER TOTAL
SHARE SOURCES COST
1 Personnel $ 22,352 $22,988 $45,340
2 Supplies for pods $2,610 $2,610
3 Utility Expenses for staying open 8 $11,700 $11700
hours &Janitorial Services
4
5
6
7
8
* If costs are to be shared by other sources of funding, including CDBG funds from other jurisdictions,
identify the source of funding,grantor/lending agency,and cost category information.
Progress payments, approved by the Subrecipient and based upon the percentage of completion of the work
with a 10% retention, shall be paid by the 30th day of each month, provided that the payment application has
been submitted to the City on or before the first working day of the month.
The Subrecipient shall receive reimbursements and/or its suppliers/vendors shall receive direct payments by
way of a two-party check, in accordance with the aforementioned cost categories and line items which are
subject to receipt of an acceptable requisition in the form of a monthly Request for Reimbursement.
The Subrecipient recognizes that the CDBG Funds are received from the HUD, and that the obligation of the
City to make payment to Subrecipient is contingent upon receipt of such funds from HUD. In the event that
said funds, or any part thereof, are, or become, unavailable, then the City may immediately terminate or
amend this Agreement.
Services are to be performed over a twelve month period of July 1, 2020 through June 30, 2021 with funds
allocated from 2020—21 Program Year.
CITY ;OF PALM SPRINGS
EXHIBIT D
Request for Reimbursement
Proiect/Activity Title: Protect Number:
CDBG-CV Funding—Boys&Girls Club of Palm Springs
Name/Address of Provider:
Boys&Girls Club of Palm Springs
450 S. Sunrise Way
Palm Springs, CA 92262
•
BENEFICIARY QUALIFICATION STATEMENT
Approved Z"^ Current; PfOr 1z F Toai
{ ,1" Des an}fnort G,Fant3:` �, R b eimursement Reimburse[rtent Baiankce �*
Ittx ,. ,� y s moi�nf t PenodtI, Penod(s)a Rer #ursement „pit dverlUnder�
/Personnel $22,352.00
f $22,352:00
TOTAL
I CERTIFY THAT, (a) the City of PALM SPRINGS, as grantee of the CDBG, has not previously been billed for the
costs covered by this invoice, (b) funds have not been received from the Federal Government or expended for such
costs under the terms of the Agreement or grant pursuant to FMC-74-4 & 24 CFR Part 58;(c) this agency is in full
compliance with all applicable provisions under the terms of the Contractor grant; and (d) this agency is in full
compliance with all applicable tax laws and hereby affix original signatures.
PREPARED BY: APPROVED BY:
Name, Title, Date Name, Title, Date
City of PALM SPRINGS Use Only
Audited by: Examined by: Approved by:
If necessary,additional sheet(s)must be attached detailing cost breakdowns, and verified by original signatures.
CITY OF PALM SPRINGS
EXHIBIT E
Semi-Annual Program Progress Report
Project/Activity Title: Project Number:
CDBG-CV Funding—Boys &Girls Club of Palm Springs
Name/Address of Provider:
Boys&Girls Club of Palm Springs
450 S Sunrise Way
Palm Springs, CA 92262
PROGRAM PROGRESS REPORT Period:
DIRECT BENEFIT REPORT
• Number of First-Time Program Beneficiaries Serviced:
#of Households #of Persons
<or=30%: 30-50%: 50-80%: >80%:
• Number of First-Time Female Headed Households:
• Counts by Race/Ethnicity:
White American Indian or Alaska Native AND White
Black/African American Asian AND White
Asian Black/African American AND White
American Indian or Alaskan Native American Indian/Alaska Native AND Black/African American
Native Hawaiian or Other Pacific Islander Other:
HISPANIC/LATINO ETHNICITY: Mexican/Chicano Puerto Rican
Cuban Other:
• Number of Disabled:
• Number of Homeless Persons Given Overnight Shelter:
ACCOMPLISHMENT NARRATIVE
LEVERAGING RESOURCES NARRATIVE
Signed Title Date