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HomeMy WebLinkAboutA5639 - CDBG FUNDS FOR NONPROFIT ORGANIZATION GRANTS SUBRECIPIENT AGREEMENT THIS AGREEMENT(herein "Agreement"), is made and entered into thisol Y day of Qz:V1 2019, by and between the CITY OF PALM SPRINGS, (herein"City), a municipal corporation and charter city, and the Stroke Recovery Center/Neuro Vitality Center , (hereinf"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 seg. ("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; NOW, THEREFORE, the parties hereto agree as follows: 1:0 SERVICES OF PROVIDER. 1.1 Scope of Services. Provider agrees to provide to City all of the services specified and detailed in its application for funding and 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 represented in the Provider's application for funding. City provided funds shall be used only for those purposes specified in such application and 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. 1.4 Financial Reporting. Any Provider receiving or due to receive $20,000.00 or more from the City during the 2019 — 2020 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 which 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 315r of the current fiscal year. 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 FIFTEEN THOUSAND AND SIXTY-SEVEN DOLLARS ($15.067.001 (the "Contract Sum") in accordance with the Budget attached hereto in Exhibit B and incorporated herein by this reference; and as herein provided. The budget cost categories set out in Exhibit B 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 F, on reimbursable expenditures pursuant to the attached Budget along with pertinent supporting 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 in connection therewith: Beverly Greer. Chief Executive Officer 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 express written approval of the City. Neither this Agreement nor any interest herein 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. 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. -2- 4.1 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. 4.2 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; (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; (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 0); 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); (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; -3- (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; (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 sea.); (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 (v) Such other City, County, State, or Federal laws, rules, and regulations, executive orders or similar requirements which might be applicable. 4.3 The City shall have the right to periodically monitor the program operations of the Provider under this Agreement. 5.0 INSURANCE AND INDEMNIFICATION. -4- 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 as an additional insured shall be delivered to and approved by the City 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 officers, or employees. 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 officers and employees, 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. -5- 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. 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 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: -6- Stroke Recovery Center/Neuro Vitality Center 2800 East Alelo Road Palm Springs, CA 92262-6253 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 CITY OF PALM SPRINGS ATTES mrz ' I corppration By: By: City Clerk City Manager APPROVED AS TO FORM: APPROVED BY CITY COUNCIL City Attorney PROVIDER: Check one: _Individual _Partnership Zcorporation (Corporations require two notarized signatures: One signature must be from the Chairman of Board, Presidient, or any Vice President. The second signature must be from the Secretary, Assistant (--�SeCret r rer Assist nt Treasurer, or Chief FinancialAOfflir). I/ By: Notarized Signature of h irrm n of Boar , Notarized Sign ure Secretary,Asst Secretary, ]� 'I e or any Vice rest e t Treasurer,Asst Treasurer or Chief Financial Officer Name: / � O✓�&lJ- Name: An'C-0ce-y Title: Title: State of ) State of ) , County of )as County of )ss A notary public or other officer completing this i icate A notary public or other officer completing this certificate verifies only the identity of the indi iduaned the verifies only the identity of the individual who si e document to which this ce�te is attached,and not document to which this certlfi s attached,and not the truthfulness,accuracy,or validity of that document. the truthfulnessZaccuracy,or at document State of County )ss. State - t] L�kotO[n�E� Notai 7 con Mycor CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1050 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 California County of RIVERSIDE On 10/24/2019 before me, D.G.DRISKILL �z a notary public personally appeared ROZEgT- I-1, C9,EEP — v�e who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) j99are subscribed to the within instrument and acknowledged to me that lie/they executed the same in his#e:/their authorized capacity(ies), and that by tamer/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 of cial seal. D.G.DRISKILL Notary Public-California Riverside County Commission N 2200325 My Comm.Explres Jul 2,2021 Signature (Seal) DRISKILL iblic-California ;ide County a sion a 2200325 Expires Jul 2,2021 County of tf- Ess. On before me, On before me, personally appeared ,personally appeared who proved to who proved to me on the basis of satisfactory evidence to be the person(s) me on the basis of satisfactory evidence to be the person(s) whose name(s)is/are subscribed to the within instrument and whose name(s)is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in acknowledged to me that helshe/they executed the same in hislher/their authorized capacity(ies),and that by his/her/their hisfheritheir authorized capacity(ies),and that by his/her/their signature(s) on the instrument the person(s), or the entity signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the upon behalf of which the person(s) 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 official seal. WITNESS my hand and official seal. Notary Signature: Notary Signature: Notary Seal: Notary Seal: AnnieR/CDBG1&2WSb Re very_NVC Subre pAWrt SE 19 CITY OF PALM SPRINGS EXHIBIT A Scope of Services Proiect/Activity Title: Project Number: Stroke Recovery Center/Neuro Vitality Center 0005 Protective Shade Structure Name/Address of Provider: Stroke Recovery Center/Neuro Vitality Center 2800 East Alejo Road Palm Springs, CA 92262 Objectives/Activities The intent of this program is to provide the most comprehensive direct client services and advocacy to help individuals and their families living with stroke and related chronic neurological conditions through community-centered care, rehabilitation services, behavioral health support, wellness education, nutrition and research. This will be accomplished through the facility upgrades to provide expansion and access to essential services to enhance quality of life and well-being of patients served. The upgrades will be a purchase and installation of an outdoor shade structure in conjunction with the new campus layout that allows for expansion of their disabled neurological patient rehabilitation programs and group support networks. The Stroke Recover Center / Neuro Vitality Center covers the City of Palm Springs, and the adjacent four communities of Cathedral City, Desert Hot Springs, Rancho Mirage, and Palm Desert serving 350 clients West Valley of which 100 are Palm Springs 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 Draft a promotional piece and submit to City for approval. Advertise in the Desert Sun's daily general circulation. Submit final publication to City. Objective 4: Enroll and income qualify at least a total of one hundred (100) extremely low income to moderate-income Palm Springs residents in accordance with Exhibit D for improved access to the facility. TARGET DATE ACTIVITY#1 On-Going Provide direct client services and advocacy to help 350 Valley-wide residents living with neurological conditions manage their chronic disease. 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 31st, and program completion, June 301" 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: Make improvements through Architectural & Enaineering Services (A&E) and associated installation costs to install an outdoor shade structure that will be a usable area to expand the disabled neurological patient rehabilitation programs and group support networks. DATE ACTIVITY#1 On-Going Conduct activities to improve availability/accessibility in accordance with an 'open competitive' procurement process as stipulated in this Agreement and in consultation with the City. Objective 8: Provide an evaluation within fifteen (15) calendar days of the program completion or final reimbursement. TARGET DATE ACTIVITY#1 07/15/20 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.) CITY OF PALM SPRINGS EXHIBIT B Budget Summary Proiect/Activity Title. Project Number: Stroke Recovery Center/Neuro Vitality Center 0005 Protective Shade Structure Name/Address of Provider: Stroke Recovery Center/Neuro Vitality Center 2800 East Alejo Road Palm Springs, CA 92262 BUDGET SUMMAR COST CATEGORY CDBG OTHER TOTAL SHARE SOURCES COST 1 Personnel -0- -0- -0- 2 Consultant/Contract Services -0- -0- -0- 3 Travel -0- -0- -0- 4 Space Rental -0- -0- -0- 5 Consumable Supplies -0- -0- -0- 6 Rental, Lease or Purchase of -0- -0- -0- Equipment 7 Insurance -0- -0 - -0- 8 Other— $15,067. -0 - $15,067. Construction/Rehabilitation Landscaping, Irrigation Control, -0- $33,780 $33,780. Side Walks and Demolition Costs TOTALS $15,067. $33,780. $48,847. ` 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 may include Stroke Recovery Foundation contribution of$33,780. 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 30'h 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, 2019 through June 30, 2020 with funds allocated from 2019-20 Program Year. CITY OF PALM SPRINGS EXHIBIT C Insurance Inventory Proiect/Activity Title. Proiect Number: 0005 Stroke Recovery Center/Neuro Vitality Center Protective Shade Structure Name/Address of Provider: Stroke Recovery Center/Neuro Vitality Center 2800 East Alejo Road Palm Springs, CA 92262 INSURANCE INVENTORY LIABILITY INSURANCE POLICY Name of �/v�/O/LaPi�s 1 +SccfisfwC� Provider's AG c/,wer_ v P c-A Insurance Company / / Per Occurrence Policy / / $3,000,000 Effective Dates of Policy Claims Made Policy Limits of Liability 2/&Qv".1az Deductibles: Per Occurrence 6 Wa/ 0-0-V Annual Aggregate A-VV`2 Var a Additional Insured Endorsement (Certificate Holder) El Yes ❑ No Original Certificate of Insurance Attached ❑ Yes Q No WORKER'S COMPENSATION POLICY Name of Providers Insurance Company �TlITE Ga.+tP rNSLe. +twe-E Effective Al ^+4 PAC A Dates Limits of Liability $2M Per Occurrence Underlying Coverage Limits Original Certificate of Insurance Attached ❑ Yes El No CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement Proiect/Activity Title: Project Number: Stroke Recovery Center/Neuro Vitality Center 0005 Protective Shade Structure Name/Address of Provider: Stroke Recovery Center/Neuro Vitality Center 2800 East Alejo Road 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—06128/19) AREA MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD: INCOME(AMI) 1 2 3 4 5 6 7 8 LEVEL-$65,800 EXTREMELY LOW INCOME $15,100 $17,250 $21,330 $25,750 $30,170 $34,590 $39,010 $43,430 0-30%ofAMI LOW INCOME $25,150 $28,750 $32,350 $35,900 $38,800 $41,650 $44,550, $47,400 30-50%ofAMI MODERATE INCOME $40.250 $46.000 $51,750 $57,450 $62,050 $66,650 $71,250 $75,850 50-80%ofAMI NON LOW&MOD INCOME $40,250+ $461000+ $51,750+ $57,450+ $62,050+ $66,650+ $71,250+ $75,850+ >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 ❑ 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❑ Yes❑ No If yes,check one:❑ Mexican/Chicano ❑ 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. NAME: DATE: PHONE NO: ADDRESS: 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 compliance. CITY OF PALM SPRINGS EXHIBIT E Semi-Annual Program Progress Report Proiect/Activity Title: Proiect Number: Stroke Recovery Center/Neuro Vitality Center 0005 Protective Shade Structure Name/Address of Provider: Stroke Recovery Center/Neuro Vitality Center 2800 East Alejo Road Palm Springs, CA 92262 PROGRAM PROGRESS REPORT Period: DIRECT BENEFIT REPORT D Number of First-Time Program Beneficiaries Serviced: #of Households #of Persons <or=30%: 30-50%: 50-80%: >80%: 0 Number of First-Time Female Headed Households: 0 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. HISPANICILATINO ETHNICITY: Mexican/Chicano Puerto Rican Cuban Other: 0 Number of Disabled: 0 Number of Homeless Persons Given Overnight Shelter: ACCOMPLISHMENT NARRATIVE LEVERAGING RESOURCES NARRATIVE Signed Title Date CITY OF PALM SPRINGS EXHIBIT F Request for Reimbursement Project/Activity Title: Project Number: Stroke Recovery Center/Neuro Vitality Center 0005 Protective Shade Structure Name/Address of Provider: Stroke Recovery Center/Neuro Vitality Center 2800 East Alejo Road Palm Springs, CA 92262 BENEFICIARY QUALIFICATION STATEMENT Approved Current Prior Total Grant Description Grant Reimbursement Relmbbrsemerit YTD Balance Amount .Period Periods) Reimbursement_ (Over/Under) Other— Construction/Rehabilitation $15,067 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 G Employment Restrictions 1. Labor Standards The PROVIDER agrees to comply with the requirements of the Secretary of Labor in accordance with the Davis-Bacon Act as amended,the provisions of Contract Work Hours and Safety Standards Act,the Copeland"Anti-Kickback"Act(40 U.S.C.276a- 276a-5;40 USC 327 and 40 USC 276c)and all other applicable Federal,state and local laws and regulations pertaining to labor standards insofar as those acts apply to the performance of this contract. The PROVIDER shall agree to submit documentation provide by the CITY which demonstrates compliance with hour and wage requirements of this part. The PROVIDER agrees that, all general contractors or subcontractors engaged under contracts in excess of$2,000.00 for construction,renovation or repairwork financed in whole or in part with assistance provided under this contract,shall comply with Federal requirements adopted by the CITY pertaining to such contracts and with the applicable requirements of the regulations of the Department of labor, under 29 CFR Parts 1, 3, 5 and 7 governing the payment of wages and ratio of apprentices and trainees to joumeyworkers;provided,that if wage rates higher than those required under the regulations are imposed by state and local law,nothing hereunder is intended to relieve the PROVIDER of its obligation,if any,to require payment of the higher wage. The PROVIDER shall cause or require to be inserted in full,in all such contracts subject to such regulations, provisions meeting the requirements of this paragraph. 2. "Section 3 Clause" a. Compliance Compliance with the provisions of Section 3,the regulations set forth in 24 CFR 135, and all applicable rules and orders issued hereunder prior to the execution of this contract, shall be a condition of the Federal financial assistance provided under this Contract and binding upon the CITY, the PROVIDER and any of the PROVIDER'S subrecipients and subcontractors. Failure to fulfill these requirements shall subject the CITY, the PROVIDER and any of the PROVIDER'S subrecipients and subcontractors, their successors and assigns, to those sanctions specified by the Agreement through which Federal assistance is provided. The PROVIDER certifies and agrees that no contractual or other disability exists which would prevent compliance with these requirements. The PROVIDER further agrees to comply with these 'Section 3" requirements and to include the following language in all subcontracts executed under this Agreement: "The work to be performed under this contract is a project assisted under a program providing direct Federal financial assistance from HUD and is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968,as amended,12 U.S.0 1701.Section 3 requires that to the greatest extent feasible opportunities for training and employment be given to low-and very low-income residents of the project area and contracts for work in connection with the project be awarded to business concerns that provide economic opportunities for low-and very low-income persons residing in the metropolitan area in which the project is located." The PROVIDER further agrees to ensure that opportunities for training and employment arising in connection with a housing rehabilitation(including reduction and abatement of lead-based paint hazards),housing construction,or other public construction project are given to low-and very low-income persons residing within the metropolitan area in which the CDBGfunded project is located;where feasible,priority should be given to low-and very low-income persons within the service area of the project or the neighborhood in which the project is located, and to low-and very low-income participants in other HUD programs;and award contracts for work undertaken in connection with a housing rehabilitation(including reduction and abatement of lead-based paint hazards), housing construction, or other public construction project are given to business concerns that provide economic opportunities for low-and very low-income persons residing within the metropolitan area in which the CDBG-funded project is located;where feasible, priority should be given to business concerns which provide economic opportunities to low-and very low-income residents within the service area or the neighborhood in which the project is located,and to low-and very low-income participants in other HUD programs. The PROVIDER certifies and agrees that no contractual or other legal incapacity exists which would prevent compliance with these requirements. b. Notifications The PROVIDER agrees to send to each labor organization or representative of workers with which it has a collective bargaining agreement or other contract or understanding, if any, a notice advising said labor organization or worker's representative of its commitments under this Section 3 clause and shall post copies of the notice in conspicuous places available to employees and applicants for employment or training.