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A9237 - FAIR HOUSING COUNCIL OF RIVERSIDE COUNTY (CDBG FY 2022-2023)
CONTRACT ABSTRACT Contra Company Name: Company Contact: Summary of Services: Contract Price: Funding Source: Contract Term: FAIR HOUSING COUNCIL OF RIVERSIDE COUNTY ROSE MAYES, EXECUTIVE DIRECTOR CDBG — FAIR HOUSING SERVICES $48,000 COMMUNITY DEVELOPMENT BLOCK GRANT July 1, 2022 to June 30, 2023 (FY 2022-2023) Contract Approvals City Council Approval Date: Agenda Item No./ Resolution Number: Agreement No: A g23-7 Contract Administration Lead Department: Contract Administrator: May 12, 2022 Item 2D I Resolution No. 25006 Community & Economic Development Jay Virata, Director Contract Compliance Exhibits: YES Signatures: YES Insurance: YES Bonds: N/A Contract prepared by: JAY VIRATA Submitted on: 09/27/2022 By: Annie Rodriguez Housing Program Assistant COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM SUBRECIPIENT AGREEMENT BETWEEN THE CITY OF PALM SPRINGS AND FAIR HOUSING COUNCIL OF RIVERSIDE COUNTY, INC. (Federal Grant No. [B-22-MC-06-05611) THIS AGREEMENT (herein "Agreement"), is made and entered into this 1st day of JULY, 2022, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal A corporation and charter city, and the FAIR HOUSING COUNCIL OF RIVERSIDE COUNTY, INC., Federal Tax Number: [33-05338091 (herein "Provider"). WHEREAS, the City has entered into various funding agreements with the United States Department of Housing and Urban Development ("HUD"), which agreements provide funds ("CDBG Funds") to the City under the Federal Housing and Community Development Act of 1974 (42 U.S.C. Section 5301 et seq.), as amended from time to time (the "Act"), and the regulations promulgated thereunder (24 C.F.R. Section 570 et seq. ("Regulations"); and WHEREAS, the Act provides that the City may grant the CDBG Funds to nonprofit organizations for certain purposes allowed under the Act; and WHEREAS, the Provider is a nonprofit organization which operates a program which is eligible for a grant of CDBG Funds and the City desires to assist in the operation of the program by granting CDBG 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; and WHEREAS, the Provider is a nonprofit organization that operates a program that is eligible for a grant of CDBG Funds and the City desires to assist in the operation of the program by granting CDBG 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; and 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; NOW, THEREFORE, the parties hereto agree as follows: 1.0 SERVICES OF PROVIDER. 1.1 Scope of Services. Activities funded with CDBG 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 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. 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 of all CDBG Funds received from the City; (d) Documentation of expenses as identified in the report and reimbursement requests; (e) 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; (f) 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 (g) Any such other related records as the City shall require or as are necessary pursuant to 24 CFR 570.506. -2- 1.4 Financial Reporting. Any Provider receiving or due to receive $20,000.00 or more from the City during the 2022 — 2023 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 315t of the current fiscal year. 1.5 Records/Audit. Provider shall maintain separate accounting records for the CDBG 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, 2027. 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 Funds 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 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.) -3- 2.0 COMPENSATION. 2.1 Contract Sum. The City shall pay to the Provider on a reimbursable basis for its services a sum not to exceed FORTY-EIGHT THOUSAND DOLLARS ($48,000) (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: Rose Mayes, Executive Director 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. 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. -4- 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 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; (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; -5- (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 Q); Q) 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; (1) 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); (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; IMI (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 propelrty 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 (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. 7- (x) 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 Program and federally funded activity. All CDBG Fund fundedactivity 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. 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 -8- 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. 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. 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 -10- Palm Springs, CA 92262-6959 Attn: City Manager WITH COPY TO: City of Palm Springs 3200 East Tahquitz Canyon Way Palm Springs, CA 92262-6959 Attn: City Attorney TO PROVIDER:. Fair Housinq Council of Riverside County, Inc. P.O. Box 1068 Riverside, CA 92502-1068 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 ] - 11 - CITY OF PALM SPRINGS ATTEST: /� a municipal corporation 11 By: �L/F / AI t/ By: X k.a (^ C-- — City Clerk ?,-%Ac i .,City Manager APPROVED AS TO FORM: All OI®NCayso Nak City torney PROVIDER: Check one: _ Individual _ Partnership _ Corporation (Corporations require two notarized signatures: One signature must be from the Chairman of Board, President, or any Vice President. The second signature must be from the Secretary, Assista Secr , Treasurer, Assistant Treasurer, or Chief Financial Officer). By: By: Notarized ature of Chairman of Board, Notarized Signature Secretary, President or any Vice President Asst Secretary, Treasurer, Asst Treasurer or Chief Financial Officer Name: �,oaary Name: 4 i[k S K9 Title: G-'j T, State of County of F\Td\-ss< a ) ss A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of 6q-L *AAi sin ) County of jetj-f n yep!j�= )as O''n,.,,IIg''4w�z7 before me, GAX fg-NilfY A"- �hky IVIA personally appeared who proved to e on the basis of atis actory evi ence to be the person(s) whose name(s) is/are subscribed to the within Instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Notary ■ iii weary'v D"'-Cal to. fa Pivenm. CwMtyVAMMM IE cemm,,,.w a 2176606 w [emm. Eamres eev 16. 10L ■ Title: State of ) County of ss A notary public or other officer completing this certificate vedfies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of atf-AXN th LI County of "j am LI ss. of On ` )i9Z12VZ2-- n before me, �A21.114n0)g AVAY A.rrt_J16g Uc, personally appeared %Ei//Y,q- who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(les), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. IAWAMOA WY wury P.blk - CtlNanIs ll a fde Ceumy Canmbsim a 7336602 Ow Camn. Cipher M P. 101 CITY OF PALM SPRINGS Council of Riverside / Fair Housing EXHIBIT A ope of Services Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068 190 W. Amado Road Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 Ob i ectives/Activities The intent of this program is to provide a full menu of fair housing services for Palm Springs residents that promotes fair housing rights and obligations as defined and articulated in the Federal Fair Housing Act and the California State Law Enactments under the Rumford & Unruh Civil Rights Acts which affirmatively furthers fair housing. This will be accomplished through the staffing of a Palm Springs' office facilitating three components, as it relates to Landlord/Tenant services such as education (i.e., outreach, public awareness, individualized counseling) and training / technical assistance (i.e., pro -active workshops preventing complaints and violations); and Anti -Discrimination such as enforcement (i.e., compliant intake, investigation, resolution options) which totals one thousand (1,000) Palm Springs low/moderate income residents. 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 Provider agrees to promote, market and publicize the program by Advertisement in the Desert Sun and/or using Alternative Method(s) of Advertisement including, but not limited to, outreach through flyers, public service announcements, networking with local agencies (i.e. email blast to other local agencies that may share the same client type), scheduling of open houses and other means to inform the low- and moderate -income community of the availability of services. If Provider utilizes an Alternative Method(s) of Advertisement, it shall retain records in sufficient detail, to the satisfaction of the City, of the Alternative Method(s) of Advertisement utilized to promote the program to Parties. If provider chooses to advertise in the Desert Sun, a draft promotional piece shall be submitted to City for Approval. Submit final publication to City. Objective 4: Enroll and income qualifies at least an approximately one thousand (1,000) low/moderate income Palm Springs residents in accordance with Exhibit D for new access to services. TARGET DATE ACTIVITY #1 On -Going Provide fair housing services to one thousand (1,000) City-wide clients. Maintain records of names, addresses, demographics and service dates for all assistance. Objective 5: 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 3151, and program completion, June Wh. Objective 6: 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 7: Provide fair housing services. including Fair Housing Practice and Landlord/Tenant workshops, as outlined in proposal. TARGET DATE ACTIVITY #1 On -Going Conduct program activities for 750 clients and offer two workshops for property owners, managers, Realtors and lenders to improve availability/accessibility, as stipulated in this Agreement. Objective 8: Provide an evaluation within fifteen (15) calendar days of the program completion or final reimbursement. TARGET DATE ACTIVITY #1 07/15/23 Provide an evaluation and final report on all programmatic and financial activities. 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.) Personnel Summary Provider agrees to assign the following individuals to perform the services set forth herein which cannot be altered without the prior written approval of the Contract Officer. The City shall have the unrestricted right to order the removal of any personnel assigned by providing written notice to the Provider. Name: Title: % of Time: Rose Mayes Executive Director 6% Mina Baselyos Accounting Manager 6% Stephanie Davis Fair Housing Counselor 5% Juanita Kodera Fair Housing Counselor 7% Margarita McKissick Fair Housing Counselor 10% D'Antoinette Robertson Fair Housing Counselor 6% Deanna Heredia Fair Housing Counselor 5% CITY OF PALM SPRINGS EXHIBIT B Beneficiary Qualification Statement Proiect/Activity Title: Project Number:3 Fair Housing Council of Riverside / Fair Housing Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068 190 W. Amado Road Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 BENEFICIARY QUALIFICATION STATEMENT This statement must be completed and signed by each person or head of household (legal guardian) receiving benefits form the described projectlactivity. 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 — 0710112022) AREA MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD: INCOME (AMI) 1 2 3 4 5 6 7 8 LEVEL -$87400 EXTREMELY LO INCOME $18,500 $21,150 $23,800 $27,750 $32,470 $37,190 $41,910 $46,630 0 - 30% ofAMI LOW INCOME $30.800 $35,200 $39,600 $44,000 $47,560 $51,050 $54,600 $58,100 30 - 50% ofAMI MODERATE INCOME $49,300 $56,350 $63,400 $70,400 $76,050 $81,700 $87,300 $92,950 50 - 80% ofAMI NON LOW & MOD INCOME $49,301+ $56,351+ $63,401+ $70,401+ $76,051+ $81,701+ $87,301+ $92,951+ > 60% 3. What race/ethnicity do you identify yourself as; please note that this self -Identification is voluntary In accordance with equal opportunity laws? ❑ White ❑ American Indian or Alaska Native AND White ❑ Black/African American ❑ Asian AND White ❑ Asian ❑ Black/African Amedcan 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 ❑ Yes ❑ No If yes, check one: ❑ MexicamChicano ❑ Puerto Rican ❑ Cuban ❑ Other: 4. Are you female Head of Household? ❑ YES ❑ NO 5. Do you have a disability? ❑ YES ❑ NO If YES, please describe: ACKNOWLEDGEMENT AND DISCLAIMER 1 CERTIFY UNDER PENALTY OF PERJURY THAT INCOME AND HOUSHOLD STATEMENTS MADE ON THIS FORM ARE TRUE. DATE: ADDRESS: PHONE 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 compliance. CITY OF PALM SPRINGS EXHIBIT C Budget Summary Proiect/Activity Title: Project Number:3 Fair Housing Council of Riverside / Fair Housing Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068 190 W. Amado Road Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 BUDGET SUMMARY COST CATEGORY CDBG SHARE OTHER SOURCES TOTAL COST 1 Personnel Costs — Wages, Benefits & Employers Taxes $34,500 - 0 - $34,500 2 Office Costs — Supplies, Equipment, Postage & Travel $2,388 - 0 - $2,388 3 Operational Costs — [Space Rental, Utilities & Maintenance $9,912 - 0 - $9,912 4Consultant/Contract Services — udit, PR, Technology & Insurance $1,200 - 0 - $1,200 5 6 7 8 TOTALS $48,000 - 0 - $48,000 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. Other funding sources include fundraising activities conducted by FHC's through donations/gifts of $4,245. The Subrecipient shall submit Request for Reimbursements in accordance with the aforementioned cost categories and line items. 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, 2022 through June 30, 2023 with funds allocated from 2022-2023 Program Year. CITY OF PALM SPRINGS EXHIBIT D Request for Reimbursement Proiect/Activity Title: Project Number:3 Fair Housing Council of Riverside / Fair Housing Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068 190 W. Amado Road Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 BENEFICIARY QUALIFICATION STATEMENT Approved Current Prior Total .Grant Description Grant Reimbursement Reimbursement YTD Balance Amount Period Period(s) Reimbursement (Over/Und personnel Costs — Wages, Benefits & Employers Taxes )ffice Costs — Costs — Ublities & Maintenance PR, Technology & Insurance TOTAL 1 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: Name, Title, Date Audited APPROVED BY: Name, Title, Date City of PALM SPRINGS Use Only 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 ProiecttActivity Title: Project Number:3 Fair Housing Council of Riverside / Fair Housing Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068 190 W. Amado Road Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 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 While 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 Cuban • Number of Disabled: Puerto Rican Other: ACCOMPLISHMENT NARRATIVE LEVERAGING RESOURCES NARRATIVE Signed Title Date ACOR ® CERTIFICATE OF LIABILITY INSURANCE DATE28/ODI'l22 4/28/2022 TH�RTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER The Empire Company RT�E�jj,,�TT�TTT[E�TT�� ��-"L+Id1VrL Archibald Avenue ACT CONTCT NANT ME: Cathy NegroR PHONE (909) 476-0600ftCOVE�GENAIC E-MAIL cnegron@empire-co.co9050 ADDRESS:P.O. UNSURE S AFFORDING eRancho Box 5400 JUL 1S INSURERA:Non rofits Ins. AllINSURED Cucamonga CA 91729 202 �� p the City C1 INSURER 8: Preferred EID 10 Br9 Fair Housing Council Of Riverside COunDfrl Af ; URERC: INSURER D: P.O. Box 1068 INSURER E INSURER F: - --cIncln\I A1114ADCD- Riverside CA 92502-1068 L/UVt:KAULb IiCRI1r1Y,111. I umu��. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWII HSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. INSRLS A TYPE OF INSURANCE % COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR X SOCIAL SERVICE PROFESSIONAL ADDL X POLICY NUMBER 2022-04221-NPO POLICY EFF MMIDDIYYYY 4/28/2022 POLICY UP MMIDDyYYYY 4/28/2023 LIMITS EACH OCCURRENCE S 1,000,000 MA RENTE PREMISES Ea occurrence S 500,000 MED EXP(An one person) E 20,000 PERSONAL SADV INJURY $ ,000,000 $2 000 000 AGGREGATE GENERAL AGGREGATE 2 S ,000, 000 GEN'L AGGREGATE LIMIT APPLIES PER X POLICY1:1 PRO- JEGT ❑ LOC PRODUCTS -COMROP AGG $ 2,000,000 Uquor Landry S 1,000,000 OTHER' AUTOMOBILE LIABILITY D SIN L LIMIT ntNJURY S 1,000,000 (Per pem r) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIREDAUTOS % AUTOSS 2022-04221-WO 4/28/2022 4/28/20NJURY (Per acsden0 $ Y DAMAGENON-0WNED ent V $ UMBRELLA LIAB OCCUN CURRENCE $ EXCESS LIAB CLAIMS -MADE ATE $ S OEO RETENTIONS WORRERSCOMPENSATION PER OTH- % STATUTE R EL. EACH ACCIDENT S 1 000,000 ANDEMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNERIUIIUTIVE EL. DISEASE -EA EMPLOYEE S 1 000,000 B OFFICERIMEMBER EXCLUDED9 ❑ (Mandatory in NH) NIA SVN1T1530-1 7/1/2023 Y/1/2022 II yes. deacroa under OESCRIPTION OF OPERATIONS OOlow E.L. DISEASE - POLICY LIMIT S 1,000,000 A A DIRECTORS S OFFICERS LIABILITY EMPLOYEE DISHONESTY 2022-04221-DO 2022-04221-PROP 4/28/2022 4/28/2022 4/28/2023 4/28/2023 ANNUALAGG/OCCURRENCE $2M/$1M LIMIT $200, 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddAional Remarks Schedule, may l atuctwd if more space is required) The City of Palm Springs, its officers, employees 6 agents are named as Additional Insured with respect to the General Liability per form(CG 20 10 04 13)(CG 20 37 04 13)attached as required by written contract. Waiver of Subrogation applies to WC per forms attached.(WC 04 03 06 04-84) -30 day notice of cancellation applies except 10 day notice for non-payment of premium. CERTIFICATE HOLDER CANCELLATION dale.cook@palmsprings-ca.gov SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Palm Springs THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: City Clerk/Dale Cook P.O. BOX 2743 AUTHORIZED REPRESENTATIVE Palm Springs, CA 92262 Cathy Negron/NEGRON © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) Preferred Emplo�er_s I N a-U H A N c B C O M P A N Y WC Ss 0700 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT— BLANKET We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization for which you perform work under a written contract that requires you to obtain this agreement from us. The premium charge for this endorsement shall be 3% of the Worker's Compensation premium, subject to a minimum charge of $500.00 This endorsement changes the policy to which it is attached effective on the dale issued unless otherwise slated. (The Information below is required only when this endorsement is Issued subsequent to preparation of the policy.) Endorsement Effective 07/01/21 Policy No. SUN171530-1 Endorsement No Insured FAIR HOUSING COUNCIL OF RIVERSIDE COUNTY. INC. ( NON-PROFIT ) Insurance Company PREFERRED EMPLOYERS INSURANCE COMPANY Countersigned By POLICY NUMBER: 2022-04221 COMMERCIAL GENERAL LIABILITY Named Insured: Fair Housing Council of Riverside County, Inc. CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization that you are required to add as an additional insured on this policy, under a All insured premises and operations. written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 12 19 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 2022-04221 COMMERCIAL GENERAL LIABILITY Named Insured: Fair Housing Council of Riverside County, Inc. CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Orcianization(s) Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Location(s) Of Covered Operations All insured premises and operations. I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 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(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 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 CG 20 10 12 19 ©insurance Services Office, Inc., 2012 Page 1 of 2 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 for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 12 19 © Insurance Services Office, Inc., 2012 Page 2 of 2 A 923-7 ACOCERTIFICATE OF LIABILITY INSURANCE DALE0 6//3/3/2023RH 023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Cathy Neg,on PHONE (909)476-0600 FAX No, Is491414-44d3 The Empire Company 9050 Archibald Avenue E-MAIL ADDREcnegron@empire-co.com SS: INSU S AFFORDING COVERAGE NAIC 8 P.O. Box 5400 INSURERA: Nonprofits Ins. Alliance of Ca Rancho Cucamonga CA 91729 INSURED INSURERS: Preferred Employers Ins. Co. 10900 INSURER C: Fair Housing Council of Riverside County, Inc. INSURER D: P.O. BOX 106E INSURER E: INSURER F: Riverside CA 92502-1068 COVERAGES CERTIFICATE NUMBER:23/24 UPDATED MASTER 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. INSR LTR TYPE OF INSURANCE AWL 8U POLICYNUMBER POLICY EFF M POLICY EXP M UMns X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CIAIMS�MADE � OCCUR AMANTA PREMI GE TOREwe S 500,000 X MED EXP(Any one pwaon) S 20,000 SOCLAL SERVICE PROF£SS101IDL X 2023-04221-NM 4/28/2023 4/26/2024 §2,000,000 AGGREGATE PERSONAL &ADV INJURY $ 1,000,000 GENIAGGREGATE LIMIT APPUES PER GENERALAGGREGATE S 2,000,000 X POLICY ❑ JECT LOC PRODUCTS - COMPIOPAGG S 2,000,000 LNNO, Wbily S 1,000,000 OAR., AUTOMOBILE LIABILITY COMBINED nt SINGLEUNIT S 1,000,000 BODILY INJURY (Pon person) S ANYAUTO A ALL OWNED SCHEWLED AUTOS AUTOS 2023-04221-NM 4/28/2023 4/28/2024 BODILY INJURY (Pon uoden0 S X NONOVMED X PROPERTY DAMAGE Pwa dent S HIRED AUTOS AUTOS S X UMSRELIALIAB IX OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE 5 A EXCESS LIAB CVUMS# DE DED RETENTION S $ 2023-04221-IAm 4/20/2023 4/26/2024 WORKERS COMPENSATION XI PER OTH- ANDEMPLOYERS'UAMUTY YIN EL EACH ACCIDENT $ 1,000,000 ANY PROPRIETORIPARTNERIEXECUTNE OFFILERIMEMBER EXCLUDED' ❑ NIA B (Mmdatory In NH) y SUN171530-3 7/1/2023 7/1/2024 EL DISEASE -EA EMPLOYEE S 1 000 000 If yesdownhe under DESCRIPTION OF OPERATIONS OeIav E.L. DISEASE - POLICY UMIT S 11000,000 A DIRECTORS S OFFICERS LIABILITY 2023-04221-M 4/28/2023 4/28/2024 ANNAGGREGATIVOCCURRENCE $2M/$IM A EMPLOYEE DISHONESTY 2023-04221-PROP 4/28/2023 4/28/2024 LIMIT $200,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Addilional Remo Ma SchMuk. may In a0achad N mow spew Is wAulwd) The City of Palm Springs, its officers, employees 6 agents are named as Additional Insured with respect to the General Liability per form(CG 20 10 12 19) 6 (CG 20 37 12 19) attached as required by written contract. Waiver of Subrogation applies to workers Compensation per form attached INC 99 07 00). e30 day notice of cancellation applies except 10 day notice for non-payment of premium. City of Palm Springs Attn: City Clerk/Dale Cook P.O. Box 2743 Palm Springs, CA 92262 RECEIVED JUN 2 p 2023 City Hall Reception Desk I.NNI.CLLNI IVIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Negron/NEGRON i ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401)