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HomeMy WebLinkAbout06510 - FAIR HOUSING COUNCIL OF RIVERSIDE COUNTY INC CDBG SUBRECIPIENT AGR FOR FAIR HOUSING SVCS SUBRECIPIENT AGREEMENT THIS AGREEMENT(herein"Agreement"), is made and entered into this3fdday of DCtem 2018, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and charter city, and the Fair Housing Council of Riverside County. Inc. , (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 at sec.), as amended from time to time (the "Act"), and the regulations promulgated thereunder(24 C.F.R. Section 570 at 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; 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 2018 — 2019 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 Citys Finance Director. The financial information provided for in this paragraph shall be furnished not later than January 31 sr of the current fiscal year. ORIGINAL BID ANDIOR AGREEMENT 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 THIRTY-NINE THOUSAND AND THREE HUNDRED FORTY- SEVEN DOLLARS ($39.347.00) (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: Board of Directors of the Fair Housing Council of Riverside County, Inc. 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. 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 -2- 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; (a) 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; (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 -3- 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 at seq.); (s) Procure, use, manage and dispose of personal property in accordance with 2 CFR 200.310 and 2 CFR 200.312 through 2 CFR 200.316; (t) Reversion of asset. Upon the Expiration of the agreement, the subrecipient shall transfer to the City any CDBG funds on hand at the time of expiration and any accounts receivable attributable to the use of CDBG funds. Additionally, any real property under the subrecipient's control that was acquired or improved in whole or in part with CDBG funds (including CDBG funds provided to the subrecipient in the form of a loan)in excess of$25,000 is either: (i) Used to meet one of the national objectives in Section 570.208 (formerly Section 570.901) until five years after expiration of the agreement, or for such longer period of time as determined to be appropriate by the City; or (ii) Not used in accordance with paragraph (t)(i) above, in which event the subrecipient shall pay to the City an amount equal to the current market value of the property less any portion of the value attributable to expenditures of non-CDBG funds for the acquisition of, or improvement to, the property. The payment is program income to the City. (No payment is required after the period of time specified in paragraph (t) of this section.) (u) Conflict of Interest. The Provider is required to disclose to the City in writing any potential conflict in accordance with 24 CFR Part 570.611; and (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. 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 Providers acts or omissions arising out of or related to Providers performance under this Agreement. Provider shall also cant'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 -4- 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. 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 -5- 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: Fair Housing Council of Riverside County, Inc. PO 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] -6 - CITY OF PALM SPRINGS ATTES :municipal corporation 12 rar gy. B � lerk City Manager APPROVED BY CITY COUNCIL APPROVED AS TO FORM: V11" ,Lwt a'R. -'n6 A6510 V B �ay'J9 ( City Attorney PROVIDER: Check one: _Individual _Partnership �rporation (Corporations require two notarized signatures: One signature must be from the Chairman of B d, President, or any Vice President. The second signature must be from the Secretary, Assi t Se ry, Trea istant Treasurer, or Chief Financial Off r). By: BY No ed Signature of al of Board, Notarized Signature ecretary,Asst Secretary, sident or any Vice President Treasurer,Asst Treasurer or Chief Financial Officer Name: Name: Title: :G zr�s: �� Title: State of ) State of i a ) County of S ss County of ss A notary public or other officer completing this certificate A notary public or other officer completing this certiVth verifies only the Identity of the Individual who signed fhe verifies only the identity of the individual who signedocument to which this certificate is attached, and not document to whlch this certificate is attached, anthe truthfulness,accuracy,or validity of that document. the truthfulness,accuracy,or validity of that docum Stale of ( a ) State of(:tAV(ilot A, ) County of E14n- _)as. County of —u f sI )ss. On 4��Y 'I•1' before me, On tV ( before me, Otom 1tUli personally appeared 'll11n--1 C J ersonally appeared 3t7ht� J\�� who proved to 1 d111� t�sf; who proved to me on the basis of satisfactory evidence to be the person(s) me on the b sis of satisfactory evidence to be the person(s) whose name(s)is/are subscribed to the within instrument and whose name(s)Were subscribed to the within instrument and acknowledged to me that he/she/they executed the same in acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their his/her/their 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 entlty 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 We and correct. correct. WITNESS my hand and official seal.- WITNESS my hand and official seat. Notary Signature: Notary Signature: Notary Seal: Notary Seal: MONK,Eopa MONICA LOPEZ Notary,Public California = Notary imllliC-CaO/omia San Bernardino County £ San Bernardino County _ Commi ion k 22aa ss 131 LOMM son N 22a6 111 I My Comm.EROira Jun t6.3032 My Comm.E.,i,.Jun 1a,102I Da1wQcDBG18-18FHC_sudediP4 utOCHB 7- CITY OF PALM SPRINGS EXHIBIT A Scope of Services Prolegt/Actiyity Title: Project Number: Fair Housing Council of Riverside/Fair Housing 0005 Senior Care Emergency Assistance Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 Objectives/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 Landlordfrenant 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 and eight hundred (1,800) 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 Draft a promotional piece and submit to City for approval. Advertise in the Desert Sun. Submit final publication to City. Objective 4: Enroll and income qualifies at least an approximately one thousand and eight hundred (1,800) 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 two thousand (2,000) 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 31", and program completion, June 301h . 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 600 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 07/15/19 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 10% Mina Baselyos Accounting Manager 10% Stephanie Davis Fair Housing Counselor 20% Kalaya Irby Fair Housing Counselor 15% Elizabeth Signorelli Fair Housing Counselor 15% CITY OF PALM SPRINGS EXHIBIT B Budget Summary Proiect/Activity Title: Project Number: Fair Housing Council of Riverside/Fair Housing 0005 Senior Care Emergency Assistance Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 BUDGET SUMMARY COST CATEGORY CDBG OTHER TOTAL SHARE SOURCES COST 1 3ersonnel Costs— $28,300. - 0 - $28,300. Wages, Benefits&Employers Taxes 2 Dffice Costs— $3,103. - 0 - $3,103. 3upplies, Equipment, Postage&Travel 3 3perational Costs— $6,444. - 0 - $6,746. ace Rental, Utilities&Maintenance 4 ConsultantlContract Services— $1,500. - 0 - $1,500. udit, PR,Technology&Insurance 5 6 7 8 TOTALS $39,347. - 0 - $39,347. 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, 2018 through June 30, 2019 with funds allocated from 2018—19 Program Year. CITY OF PALM SPRINGS EXHIBIT C Insurance Inventory Proiect/Activity Title: Project Number: Fair Housing Council of Riverside/ Fair Housing 0005 Senior Care Emergency Assistance Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 INSURANCE INVENTORY LIABILITY INSURANCE POLICY Name of Provider's Insurance Company Non-profits' Ins Alliance of CA Effective Dates of Policy 04/28/18 to 04/28/19 Claims Made Policy I I Per Occurrence Policy I I Limits of Liability $2M General Aggregate Deductibles: Per Occurrence Annual Aggregate Additional Insured Endorsement (Certificate Holder) Q Yes ❑ No Original Certificate of Insurance Attached ❑ Yes 0 No WORKER'S COMPENSATION POLICY Name of Provider's Insurance Company New York Marine and General Ins Co Effective Dates 07/01/18 to 07/01/19 Limits of Liability $1 M Per Occurrence Underlying Coverage Limits Original Certificate of Insurance Attached ❑ Yes 0 No A O® CERTIFICATE OF LIABILITY INSURANCE °ATE(MMDDIYYYY u/13/2018 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 ofthe 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 NAME, Cathy Negron The Empire Company j:' (909)476-0600 F*r 1909)476-06p1 N EY m Ne: 10201 Trademark St. , Suite D ass. cnegron@empire-co.com P.O. BOY 5400 I AFFORDING COVERAGE NAIC a Rancho Cucamonga CA 91729 INSURERA:Nonprofits Ins. Alliance of Ca E INSURERS:New York Marine and General Ins. CO. ng Council of Riverside County, Inc. INSURER C: 068 CA 92502-1068 INSURER F: COVERAGES CERTIFICATE NUMBER:16 19 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 NMICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE WSU RANCE 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 PAD CLAMS. ILTR TYPEOFINSURANCE POLICYNUAMER IMADC R POLICY LIMITS E COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIVSMALE %❑OCCUR PREMISES Ee occurrence $ 500,000 X PROFESSIONAL LLABILITY X 2018-04221-WO 4/28/2018 4/20/2010 MED EXP(Any one person) $ 20,000 PERSONAL&AIN INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPUES PER. GENERAL AGGREGATE $ 2,000,000 POLICY RRCL LOC PROWCTS-COHPIOPAGG $ 2,000,000 7C 0 OTHER FROG UP84GGREGATE $ 2,000,000 AUTOMOBILE LIABILITY a15 ocHent $ 1,000,000 A ANY AUTO BODILY INJURY(Per persm) 8 ALL OWNED SCHEDULED 2028-04221-MO 4/20/2018 4/28/2019 BODILY INAIRY(Per ecocent) $ AUTOS AUTOS X % NOHOWI PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per axiden[ UNBRELU LIIB OCCUR EACH OCCURRENCE $ E%CFSS LIAR CLAIM&MADE AGGREGATE $ DIED RETENTION 8 $ B WORKERS COMPENSATION g ANDEMPLOYERVLLABSITY STATUTE ER YIN ANY PRCPRIETCRPARTNERFJ(ECL)7VE =201800011319 7/01/2013 7/01/2019 EL.EACH ACCIDENT $ 1,000,000 OFPCERMEMBER E%CLUDEP+ NIA (MINdAory In Ml) Y EL.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRI PTION OF OPER ATI ONS bd EL.DISEASE-P000Y LIMIT S 1,000,000 A DIRECTORS G OFFICERS 2018-04221-M 4/28/2018 4/29/2019 UABI LI TY LI NrT $1,000,000 A EMPLOYEE DISHONESTY 2018-01 4/28/2018 4/20/2019 UNIT $200,000 DESCmPnMOFOPEMTONSILOCAYIONSIVEHICLES (ACORD909.Adeepne Re .SchWYN.mnb*a=t h9dam9mapa94bm"lmd) The City of Palm Springs, its officers, employees s agents are named as Additional Insured with respect to the General Liability per form (CC 20 26 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 cancell lies except 10 day notice for non-payment of premium. 0 Nod �v4� CERTIFICATE HOLDER CANCELLATION dale.cook@palmspririgs-ca.gov SHOULD ANY OF THE ABOVE DESCRIBED�OLEOANCEILLIM�B City o£ Palm Springs THE EXPBGTION DATE THEREOF,NOTICEIN Attn: City Clerk/Dale CookACCORDANCE WRN THE POLICY PRONSI \ P.O. Box 2743 Palm Springs, CA 92262 AUYHOa2ED REPRESENTATIVE athy Negcon/NEGRON �i, rylt9lfat. ®1988-2014 ACORD CORPORATION. All rights reserved ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(xwi) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA 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 named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2.00% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any Person or Organization as Required By Written Contract. Any Person or Organization as Required By Written Contract. All Operations of the Named Insured. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 2018-07-01 Policy No. Endorsement No.2 Insured WC201800017379 Fair Housing Council of Riverside County Inc. Insurance Company Countersigned By New York Marine and General Insurance Company/28746 D � 9 � uJRECT NO4 WC 040306 (Ed.(34-04) ®1998 by the Workers Compensation Insurance Rating Bureau of California.AN rights reserved. By--__ POLICY NUMBER: 2018-04221 COMMERCIAL GENERAL LIABILITY Named Insured: Fair Housing Council of Riverside County, Inc. CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(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. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II—Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds,the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury', "property damage" or"personal and advertising injury' If coverage provided to the additional insured is caused, in whole or in part, by your acts or required by a contract or agreement, the most we omissions or the acts or omissions of those acting will pay on behalf of the additional insured is the on your behalf: amount of insurance: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not Increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in The insured only applies to the extent permitted by Declarations. 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. M CG 20 26 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 ,M NONPROFITS POLICY NUMBER: 2018-04221 FORM: NIAC-E61 11 17 I INSURANCE NAMED INSURED: Fair Housing Council of Riverside County, Inc. ALLIANCE OF CALIFORNIA A Head for Insurance.A Heart far Nonprofits. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY p [ ((� 0 �� � ENDORSEMENT FOR PUBLIC ENTITIES NOV 14 REC'� This endorsement modifies insurance provided under the following: By _ COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: (Information required to complete this Schedule, it not shown above, will be shown in the Declarations.) A. Section 11—Who Is An Insured is amended to include any public entity as an additional insured for whom you are performing operations, who may be named in the schedule above, when you have agreed in a written contract or written agreement that such public entity be added as an additional insured(s) on your policy, 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 negligent acts or omissions; or 2. The negligent acts or omissions of those acting on your behalf; in the performance of your ongoing operations: No such public entity is an additional insured for liability arising out of the "products-completed operations hazard"or for liability arising out of the sole negligence of that pubic entity. B. With respect to the insurance afforded to these additional insured(s),the following additional exclusions apply. This insurance does not apply to"bodily injury"or"property damage"occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of"your work"out of which 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. The following is added to SECTION III—LIMITS OF INSURANCE: The limits of insurance applicable to the additional insured(s) are those specified in the written contract between you and the additional insured(s), or the limits available under this policy,whichever are less. These limits are part of and not in addition to the limits of insurance under this policy. NIAC-E61 11 17 Page 1 of 2 ,M NONPROFITS POLICY NUMBER: 2018-04221 FORM: NIAC-E61 11 17 ' INSURANCE NAMED INSURED: Fair Housing Council of Riverside County, Inc. ALLIANCE OF CALIFORNIA A Head for Insurance.A Heart for Nonprofits. D. A. With respect to the insurance provided to the additional insured(s), Condition 4.Other Insurance of SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance a. Primary Insurance This insurance is primary if you have agreed In a written contract or written agreement: (1) That this insurance be primary. If other insurance is also primary, we will share with all that other insurance as described in c. below, or (2) The coverage afforded by this insurance is primary and non-contributory with the additional insured(s)' own insurance. Paragraphs (1) and (2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below. b. Excess Insurance This insurance is excess over: 1. Any of the other insurance,whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for"your work"; (b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is insurance purchased by you to cover your liability as a tenant for"property damage'to premises temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos"or watercraft to the extent not subject to Exclusion g. of SECTION I—COVERAGE A—BODILY INJURY AND PROPERTY DAMAGE. (e) Any other insurance available to an additional insured(s) under this Endorsement covering liability for damages which are subject to this endorsement and for which the additional insured(s) has been added as an additional insured by that other insurance. (1) When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s) against any"suit" if any other insurer has a duty to defend the additional insured(s) against that"suit'. If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured(s)' rights against all those other insurers. (2) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any,that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self-insured amounts under all that other insurance. (3) We will share the remaining loss, if any,with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Methods of Sharing If all of the other insurance available to the additional insured(s) permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any other the other insurance available to the additional insured(s) does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of i of all insurers. NIAC-E61 11 17 NOV 14 age 2 of 2 By -I CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement Proiect/Activity Title: Prolect Number: Fair Housing Council of Riverside/Fair Housing 0005 Senior Care Emergency Assistance Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 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(RivemideSan Bemardino-Ontario,CA MSA—04101118) AREA MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD: INCOME(AMI) 1 2 3 4 5 6 7 8 LEVEL-$65,800 EXTREMELY LO INCOME $14,150 $16,460 $20,780 $25,100 $29,420 $33,740 $38,060 $42,380 0-30%ofAMI LOW INCOME $23,600 $27,000 $30,350 $33,700 $36,400 $39,100 $41,800 $44,500 30-50%ofAMl MODERATE INCOME $37.750 $43,150 $48,550 $53,900 $58,250 $62,550 $66,850 $71,150 50-80%olAMI NON LOW 8 MOD INCOME $37,751+ $43,151+ $48,551+ 53,901+ $58,251+ $62,551+ $66,851+ $71,151+ >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 ❑ BlacklAirican American ❑ Asian AND White ❑ Asian ❑ Black/African American AND While ❑ American Indian or Alaskan Native ❑ American IndianiAlaska Native AND Black/African American ❑ Native Hawaiian or Other Pacific Islander ❑ Other. HISPANICMTINO ETHNICITY ❑ Yes ❑ No If yes,check one:O McAcan/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 I CERTIFY UNDER PENALTY OF PERJURY THAT INCOME AND HOUSHOLD STATEMENTS MADE ON THIS FORM ARE TRUE. NAME: DATE: ADDRESS: PHONE NO: SIGNATURE: The information you provide on this form is confidential and is only utilized for Community Development Block Grant(CDBG)program purposes,a Federally4unded program,governmental reporting purposes to monitor compliance. CITY OF PALM SPRINGS EXHIBIT E Semi-Annual Program Progress Report Proiect/Activity Title: Project Number: Fair Housing Council of Riverside I Fair Housing 0005 Senior Care Emergency Assistance Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 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%: >BOW ♦ Number of First-Time Female Headed Households: ♦ Counts by Race/Ethnicity: White American Indian or Alaska Native AND White Black/African American Asian AND White_ Asian Black/African American AND While 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: ♦ Number of Disabled: ♦ Number of Homeless Persons Given Overnight Shelter: ACCOMPLISHMENT NARRATIVE LEVERAGING RESOURCES NARRATIVE Signed Title Date CITY OF PALM SPRINGS EXHIBIT F Request for Reimbursement Proiect/Activity Title: Project Number: Fair Housing Council of Riverside/Fair Housing 0005 Senior Care Emergency Assistance Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 BENEFICIARY QUALIFICATION STATEMENT Apprond 4tianrl! Prior Total enmt Dsaalptlen Grad Raddaaaamsol ltNmburmuld YiD "on" An nt Period parlod(xl rMn»M (earl UnMn Personnel Costs— $28,300. Wages,Benerits&Employers Taxes Office Costs— $3,103. Supplies,Equipment,Postage&Travel Operational Costs— $6.444. Space Rental,utilities&Maintenance Consultant/ContractServices— $1,500. Audit,PR,Technology&Insurance 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. AI CERTIFICATE OF LIABILITY INSURANCE DATE(MIN DDIYTTYI I`�' I1/13/2018 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 Cathy Negron NAME' The Empire Company PICHONENe : (909)476-0600 aaeuss-seal Ext A: Ne: 10201 Trademark St. , Suite D EI.NIL cnegron@empire-co.com ADDRESS: P.O. Box 5400 INSU2 AFFORDING COVERAGE NAICI Rancho Cucamonga CA 91729 INSURERA:Nonprofits Ins. Alliance of Ca INSURED INSURERB:Neal York Marine and General Ins. Co. Fair Rousing Council Of Riverside County, Inc. INSURER C: P.O. Box 1068 INSURER D: INSURER E'. Riverside CA 92502-1068 INSURER F'. COVERAGES CERTIFICATE NUMBER:18/19 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 MATH RESPECT TO WiICH 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. 01SR ADDL SOME POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER DIYYYY) fMMDIYYYn LIMITS X COMMERCIAL GENERAL UAOILITY EACH OCCURRB4CE $ 1,000,000 A CLA.Yltt�E X1 OCCUR PREM 0ce) $ 500,000 X PROFESSIONAL LIABILITY X 2 018-042 21-WO 4/28/2018 4/28/2019 hffD EAD(Any One Person) $ 20,000 / PERSONAL&ADV INJURY $ 1,000,000 GB4L AGGREGATE UPAT APPUES PER t/ GENERAL AGGREGATE $ 2,000,000 z POLICY 'EC'7 O LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER PROF UAS AGGREGATE $ 2,DDO,000 AUTOMOBILE LIABILITY $ 1,000,000 e account) A ANY AUTO BJCILY INJURY(Per person) $ ALL OYa4ED SCHEDULED 2018-a221-seo 4/28/2018 4/28/2019 BODILY INJURY(Per acaden) $ AUTOS ALTOS NONO'MJED z HIREDAUTOS z AUTOS Per sccldeTsm) $ $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESSLIA9 CLAIMSMADE AGGREGATE $ LEO I I RETENTION$ $ B WORNE0.S COMPEN011 $ I FISH AND EMFLOYERS'LIABI W A ER ANY PROPRIETOR,FART,IEREXE-CUTNE YIN =201800017379 7/01/2028 7/01/2919 EL.EACH AOCICE14T $ 1,000,000 OFFICERRAEMBER EXCLUDED'/ NIA Narel ory In hip Y / E.L.❑ISEASE.FAENPLOYEE $ 1,000,0DO If yes,describe under ✓ CESCRI PTION OF OPERATIONS belpv E.L.DISEASE-POLICY LIMIT $ 1,000,000 A DIRECTORS S OFFICERS 2018-04221-Do 4/21/2619 4/28/2019 UABIUTYUMIT $1,000,000 A EMPLOYEE DISHONESTY 2018-04221-PROP 4/28/201B 4/29/2039 OMIT $200,000 DESCRIPTION of OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101.AOdl04nal Remae4a Schedub,may be enmeshed Nmeu spore Ie re4elred) The City of Palm Springs, its officers, employees S agents are named as Additional Insured with respect to the General Liability per form (CC 20 26 04 13) attached as required by writ en contract. Waiver o Subro ton applies tD WC per forms attached. (WC 04 03 06 04-84) A30 day notice of cancel except 10 day notice for non-payment of premium. 0 ry7 V� N4 REC'O D CERTIFICATE HOLDER CANCELLATION dale.cook@palmsprings-ca.gov SHOULD ANY OF THE ABOVE DESCRIBED 1"JIM BE CANCELLED W2.o— City OP Palm Springs THE EXPIRATION DATE THEREOF,NOTICE WILL BE DEWERED IN Attn: City Clerk/Dale Cook ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 2743 Palm Springs, CA 92262 AUTHORIZED REPRESENTATIVE Cathy Negron/NEGRON .rIL?✓3"- ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025, ,o, WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA 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 named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2.00% of the California workers' compensation premium otherwrise due on such remuneration. Schedule Person or Organization Job Description Any Person or Organization as Required By Written Contract. Any Person or Organization as Required By Written Contract. All Operations of the Named Insured. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 2018-07-01 Policy No. Endorsement No.2 Insured WC201800017379 Fair Housing Council of Riverside County Inc. Insurance Company Countersigned By New York Marine and General Insurance Company/28746 WC 04 w os (/ N O V 1 4 REC'D i U 1 (Ed.04-84) IJ 91998 by the Workers'Compensation Insurance Rating Bureau of Califomia.AM rights reserved. BY--- POLICY NUMBER: 2018-04221 COMMERCIAL GENERAL LIABILITY Named Insured: Fair Housing Council of Riverside County, Inc. CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION F�� N This endorsement modifies insurance provided under the following: 4COMMERCIAL GENERAL LIABILITY COVERAGE PART — —� SCHEDULE By- Name Of Additional Insured Person(s)Or Organization(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. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II—Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional Insured the person(s) or additional insureds,the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for"bodily injury', "property damage" or "personal and advertising injury' If coverage provided to the additional insured is caused, in whole or in part, by your acts or required by a contract or agreement, the most we omissions or the acts or omissions of those acting will pay on behalf of the additional Insured is the on your behalf: amount of insurance: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in the insured only applies to the extent permitted by Declarations. 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. CG 20 26 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 ,M NONPROFITS POLICY NUMBER: 2018-04221 FORM: NIAC-E61 11 17 ' INSURANCE NAMED INSURED: Fair Housing Council of Riverside County, Inc. ALLIANCE OF CALIFORN IA A Head for Insurance.A Heart for Nonprofits. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY EI� N [ 1pENDORSEMENT FOR PUBLIC ENTITIES V 1 � RECD This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART --- SCHEDULE Name of Person or Organization: (Information required to complete this Schedule, if not shown above,will be shown in the Declarations.) A. Section II—Who Is An Insured is amended to include any public entity as an additional insured for whom you are performing operations, who may be named in the schedule above, when you have agreed in a written contract or written agreement that such public entity be added as an additional insured(s) on your policy, 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 negligent acts or omissions; or 2. The negligent acts or omissions of those acting on your behalf; in the performance of your ongoing operations: No such public entity is an additional insured for liability arising out of the "products-completed operations hazard"or for liability arising out of the sole negligence of that pubic entity. B. With respect to the insurance afforded to these additional insured(s),the following additional exclusions apply. This insurance does not apply to"bodily injury' or"property damage"occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of"your work"out of which 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. The following is added to SECTION III—LIMITS OF INSURANCE: The limits of insurance applicable to the additional insured(s) are those specified in the written contract between you and the additional insured(s), or the limits available under this policy, whichever are less. These limits are part of and not in addition to the limits of insurance under this policy. NIAC-E61 11 17 Page 1 of 2 NONPROFITS POLICY NUMBER: 2018-04221 FORM: NIAC-E61 11 17 INSURANCE NAMED INSURED: Fall Housing Council of Riverside County, Inc. ALLIANCE OF CALIFORNIA A Head for insurance.A Heart far Nonprofits. D. A. With respect to the insurance provided to the additional insured(s), Condition 4.Other Insurance of SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreement: (1) That this insurance be primary. It other insurance is also primary, we will share with all that other insurance as described in c. below; or (2) The coverage afforded bythis insurance is primary and non-contributory with the additional insured(s)' own insurance. Paragraphs (1) and (2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below. b. Excess Insurance This insurance is excess over: 1. Any of the other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for"your work"; (b) That is tire, lightning, or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is insurance purchased by you to cover your liability as a tenant for"property damage"to premises temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos"or watercraft to the extent not subject to Exclusion g. of SECTION I—COVERAGE A—BODILY INJURY AND PROPERTY DAMAGE. (a) Any other insurance available to an additional insured(s) under this Endorsement covering liability for damages which are subject to this endorsement and for which the additional insured(s) has been added as an additional insured by that other insurance. (1) When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s) against any"suit" it any other insurer has a duty to defend the additional insured(s) against that"suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured(s)' rights against all those other insurers. (2) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self-insured amounts under all that other insurance. (3) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Methods of Sharing If all of the other insurance available to the additional insured(s) permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any other the other insurance available to the additional insured(s) does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. AIL � [� L V M � NIAC-E61 11 17 NOV 14 REC'D Page 2 of 2 8y SUBRECIPIENT AGREEMENT qh,n THIS AGREEMENT (herein "Agreement'), is made and entered into this 5-day of f , by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation nd charter city, and the Fair Housing Council of Riverside County. Inc. , (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 sec.), as amended from time to time (the "Act"), and the regulations promulgated thereunder(24 C.F.R. Section 570 et sea. ("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 2017 — 2018 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 31 sc of the current fiscal year. ORIGINAL BID AND/OR AGREEMENT 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 THOUSAND, TWO HUNDRED AND SIX DOLLARS ($40,206.00) (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: Board of Directors of the Fair Housing Council of Riverside County, Inc. 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. 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 - 2 - 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); (j) The labor standard requirements as set forth in 24 CFR Part 570, Subpart K and HUD regulations issued to implement and requirements; (k) The Program Income requirements as set forth in 24 C.F.R. 570.504(c) and 570.503(b)(8); (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 - 3 - 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 VI II of the Civil Rights Act of 1968 (P.L. 90-284) as amended; (r) The lead-based paint requirements of 24 CFR Part 35 issued pursuant to the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.); (s) Procure, use, manage and dispose of personal property in accordance with 2 CFR 200.310 and 2 CFR 200.312 through 2 CFR 200.316; (t) Reversion of asset. Upon the Expiration of the agreement, the subrecipient shall transfer to the City any CDBG funds on hand at the time of expiration and any accounts receivable attributable to the use of CDBG funds. Additionally, any real property under the subrecipient's control that was acquired or improved in whole or in part with CDBG funds (including CDBG funds provided to the subrecipient in the form of a loan) in excess of$25,000 is either: (i) Used to meet one of the national objectives in Section 570.208 (formerly Section 570.901) until five years after expiration of the agreement, or for such longer period of time as determined to be appropriate by the City; or (ii) Not used in accordance with paragraph (t)(i) above, in which event the subrecipient shall pay to the City an amount equal to the current market value of the property less any portion of the value attributable to expenditures of non-CDBG funds for the acquisition of, or improvement to, the property. The payment is program income to the City. (No payment is required after the period of time specified in paragraph (t) of this section.) (u) Conflict of Interest. The Provider is required to disclose to the City in writing any potential conflict in accordance with 24 CFR Part 570.611; and (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. 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 -4- 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 DISCRIMINATION, TERMINATION, AND ENFORCEMENT. 6.1 Covenant Against Discrimination. In connection with its performance under this Agreement, Contractor 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 Contractor 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 Contractor 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. 6.2 Term. Unless earlier terminated in accordance with Section 6.3 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. 6.3 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 - 5 - 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, document, consent, approval, or communication either parry desires or is required to give to the other party shall be in writing and either served personally or sent by prepaid, first-class mail to the address set forth below, or such other addresses as may from time to time be designated by mail. 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: Fair Housing Council of Riverside County, Inc. PO 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] - 6- CITY OF PALM SPRINGS ATTE i al corporation By: By: i Clerk City Manager APP ED S TO O APPROVED BY CITY COUNCIL City Attorney / PROVIDER: Check one: _Individual _Partnership Y 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, Assistant Secretary, Treasurer, Assistant Treasurer, or Chief Fina r). By: By:�� �Oarized Signature of Chairman of Board, Notarized Signature Secretary,Asst Secretary, President orany Vice President Treasurer,Asst Treasurer or Chief Financial Officer Name: JA%-eel/"l `� �7Y1 Name: �1,12A 12 ccSP J S _ Title: 6L'Y��' tr Title: i �� / 7 � �� , i�I�l �!A rLd' C1/ State of 4thr: RN/A) State of ) County of r r ss County of ss A notary public or other officer completing this certificate A notary public or other officer completing this certificate verifies only the identity of the individual who signed the verifies only the identity of the individual who signed the document to which this certificate is attached, and not document to which this certificate is attached, and not the truthfulness,accuracy,or validity of that document. the truthfulness,accuracy,or validity of that document. State of till IA- ) State of 6u/omir/1 ) County of )ss. County,�r � of fQj�ly�y��� E!)�ss. ✓� Qn 14 before me, On_ 0 "1et7%- G 71 20) / before me, �b sonally appeared 9f!Ot QQAs/n ally appeared J r+n(�C-f Jti!l9ny C�I�t'�'N who proved to /%l iI Dj who proved to me on the basis of Bali factory evidence to be the person K me on the basis orsatisfacfory evidence to be the person(s) whose name is/ate subscribed to the within instrument and whose name(s)Ware subscribed to the within instrument and acknowled ed to -I me that�e/sheAhcy executed the same in acknowledged to me that he/she/they executed the same in hie/herltbeirauthorized capacityDasj;and that byhis/herAhetr' his/her/their authorized capacity(ies), and that by his/her/their signaturefFy on the instrument the person>ror the entity signature(s) on the instrument the person(s), or the entity upon behalf of which the person 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: Note LA A ROY tary Seal: Netery Pu LAYIfAN Riverside County i NoWY '.CoGiftnis Commission 0 216MI It RIverCommission ids miry f01 M Comm.Expires Nov 24.2020 IN Comm.Es ires Nov 2e,2020 &iCC ecn-rev c r -7- CITY OF PALM SPRINGS EXHIBIT A Scope of Services Proiect/Activity Title: Project Number: Fair Housing Council of Riverside/Fair Housing 0003 Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 Ob iectives/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 and eight hundred (1,800) 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 Draft a promotional piece and submit to City for approval. Advertise in the Desert Sun. Submit final publication to City. Objective 4: Enroll and income qualifies at least an approximately one thousand and eight hundred (1,800) 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 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 31st, and program completion, June 301n 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 600 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 07/15/18 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 10% Mina Baselyos Accounting Manager 5% Stephanie Davis Fair Housing Counselor 10% Selvio Martinez Fair Housing Counselor 5% Marian McClanahan Fair Housing Counselor 10% Elizabeth Signorelli Fair Housing Counselor 10% Sara Teliez Fair Housing Counselor 10% CITY OF PALM SPRINGS EXHIBIT B Budget Summary Proiect/Activity Title: Project Number: Fair Housing Council of Riverside/Fair Housing 0003 Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 COST CATEGORY CDBG OTHER TOTAL SHARE SOURCES COST 1 Personnel Costs— $29,419. - 0 - $29,419. Wages, Benefits&Employers Taxes 2 Office Costs— $2,718. - 0 - $2,718. —supplies, Equipment, Postage&Travel 3 Operational Costs— $6,746. - 0 - $6,746. —Space Rental, Utilities&Maintenance 4Consultant/Contract Services— $1,323. - 0 - $1,323. Audit, PR, Technology&Insurance 5 6 7 8 TOTALS ;;,$40,206. - 0- $4,0 206 .. w 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$9,510. 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, 2017 through June 30, 2018 with funds allocated from 2017—18 Program Year. CITY OF PALM SPRINGS EXHIBIT C Insurance Inventory Proiect/Activity Title: Proiect Number: Fair Housing Council of Riverside/Fair Housing 0003 Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 INSURANCE INVENTORY LIABILITY INSURANCE POLICY Name of Provider's Insurance Company Non-profits' Ins Alliance Effective Dates of Policy 04/28/17 to 04/28/18 Claims Made Policy / / Per Occurrence Policv / / Limits of Liability $2M General Aggregate Deductibles: Per Occurrence Annual Aggregate Additional Insured Endorsement (Certificate Holder) Q Yes ❑ No Original Certificate of Insurance Attached ❑ Yes Q No WORKER'S COMPENSATION POLICY Name of Provider's Insurance Company State Compensation Insurance Fund Effective Dates 07/01/17 to 07/01/18 Limits of Liability $1 M Per Occurrence Underlying Coverage Limits Original Certificate of Insurance Attached ❑ Yes RI No TE �� CERTIFICATE OF LIABILITY INSURANCE DAl/(3/aDlem 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 CONTANAME: Cathy Negron The Empire Company PHONE (909)476-0600 FAX (909)476-0601 C N Ex : AIC No) 10201 Trademark St., Suite D E-MAILss:cnegron@empire-co.com ADDRE P.O. Box 5400 INSURERS AFFORDING COVERAGE NAIC If Rancho Cucamonga CA 91729 INSURER A:Non rofits Ins. Alliance of Ca INSURED INSURER B Fair Housing Council of Riverside County, Inc. INSURERc: P.O. Box 1068 INSURERD: INSURER E Riverside CA 92502-1068 INSURERF: COVERAGES CERTIFICATE NUMBER:17/18 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYV MMIDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 _15—AM-AGE TO RENTED A CLAIMS-MADE L^_ OCCUR PREMISES Ea occurrence $ 500,000 X Professio_n_al Liability X ' 2 017-04221-NPO 4/28/2017 4/28/2018 MED EXP(Any one person) $ 20,000 PERSONAL B ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO LOC PRODUCTS AGG $ 2,000,000 �_ JECT _ OTHER: Social Service Prof Liability $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 _ Ea accident _ A ANY AUTO BODILY INJURY(Per person) $ AUTOS OS AUT S SCHEDULED AU 2017-04221-NPO 4/28/2017 4/28/2018 BODILY INJURY(Per accident) $ O _ X HIREDAUTOS X NON-OWNED PROPERTYDAMAGE $ AUTOS Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR Ld CLAIMS-MADE AGGREGATE $ DIED I I RETENTION$ $ WORKERS COMPENSATION PER TH- AND EMPLOYERS'LIABILITY YIN STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE O E.L.EACH ACCIDENT $ FFICERIMEMSER EXCLUDED? 1:1N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under �, DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Directors and Officers 12017-04221-DO 4/28/2017 4/28/2018 Liability Limit $1,000,000 A Employee Dishonesty ! 2017-04221-PROP 4/28/2017 4/28/2018 Limit $200,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Palm Springs, its officers, employees & agents are named as Additional Insured with respect to the General Liability per form CG20100413 attached as required by written contract. *30 day notice of cancellation applies except 10 day notice for non-payment of premium. CERTIFICATE HOLDER /r CANCELLATION dale.cook spriags'ca.g SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Palm Springs sf THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: City Clerk/Dale Cook ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 2743 Palm Springs, CA 92262 AUTHORIZED REPRESENTATIVE �-athy Negron/NEGRON ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logb'are registered marks of ACORD INS025(201401) POLICY NUMBER: 2017-04221 COMMERCIAL GENERAL LIABILITY Named Insured: Fair Housing Council of Riverside County, Inc. CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anizatlon s Locations Of Covered Operations Any person or organization that you are required to All insured premises and operations. 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. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II—Who Is An Insured is amended to 2. If coverage provided to the additional insured include as an additional insured the person(s)or is required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured with respect to liability for"bodily injury", "property will not be broader than that which you are damage" or"personal and advertising injury" required by the contract or agreement to caused, in whole or in part, by: provide for such additional insured. 1. Your acts or omissions; or B. With respect to the insurance afforded to these 2. The acts or omissions of those acting on your additional insureds,the following additional behalf; exclusions apply: in the performance of your ongoing operations for This insurance does not apply to"bodily injury'or the additional insured(s)at the location(s) "property damage"occurring after: designated above. 1. All work, including materials, parts or However: equipment furnished in connection with such 1. The insurance afforded to such additional work, on the project(other than service, insured only applies to the extent permitted maintenance or repairs)to be performed by by law; and or on behalf of the additional insured(s)at the location of the covered operations has been completed; or CG 20 10 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 2 2. That portion of"your work" out of which the 2. Available under the applicable Limits of injury or damage arises has been put to its Insurance shown in the Declarations; intended use by any person or organization whichever is less. other than another contractor or subcontractor engaged in performing operations for a This endorsement shall not increase the principal as a part of the same project. applicable Limits of Insurance shown in the C. With respect to the insurance afforded to these Declarations. additional insureds,the following is added to Section III—Limits Of Insurance: 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 CG 20 10 04 13 ©Insurance Services Office, Inc., 2012 Page 2 of 2 NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head for Insurance.A Heart for Nonprofits. POLICY NUMBER: 2017-04221 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II—WHO IS AN INSURED is amended to include any public entity as an additional insured for whom you are performing operations when you and such person or organization have agreed in a written contract or written agreement that such public entity be added as an additional insured(s) on your policy, 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 negligent acts or omissions;or 2. The negligent acts or omissions of those acting on your behalf; in the performance of your ongoing operations. No such public entity is an additional insured for liability arising out of the"products-completed operations hazard"or for liability arising out of the sole negligence of that public entity. B. With respect to the insurance afforded to these additional insured(s),the following additional exclusions apply. This insurance does not apply to"bodily injury" or"property damage"occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project(other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of"your work'out of which 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. The following is added to SECTION III—LIMITS OF INSURANCE: The limits of insurance applicable to the additional insured(s)are those specified in the written contract between you and the additional insured(s), or the limits available under this policy, whichever are less. These limits are part of and not in addition to the limits of insurance under this policy- D. With respect to the insurance provided to the additional insured(s), Condition 4.Other Insurance of SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreement: NIAC-E61 1215 Page 1 of 2 (1) That this insurance be primary. If other insurance is also primary,we will share with all that other insurance as described in c. below;or (2) The coverage afforded by this insurance is primary and non-contributory with the additional insured(s)'own insurance. Paragraphs (1) and(2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below. b. Excess Insurance This insurance is excess over: 1. Any of the other insurance,whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is insurance purchased by you to cover your liability as a tenant for"property damage"to premises temporarily occupied by you with permission of the owner;or (d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION I—COVERAGE A—BODILY INJURY AND PROPERTY DAMAGE. (e) That is any other insurance available to an additional insured(s) under this Endorsement covering liability for damages arising out of the premises or operations, or products- completed operations,for which the additional insured(s) has been added as an additional insured by that other insurance. (1) When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s) against any"suit" if any other insurer has a duty to defend the additional insured(s) against that"suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured(s)'rights against all those other insurers. (2) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self-insured amounts under all that other insurance. (3) We will share the remaining loss, if arty, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Methods of Sharing If all of the other insurance available to the additional insured(s) permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains,whichever comes first. If any other the other insurance available to the additional insured(s) does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. NIAC-E61 12 15 Page 2 of 2 CERTHOLDER COPY SIP STATE P.O. BOX 8192, PLEASANTON, CA 94588FUN s w CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-03-2018 GROUP: �J POLICY NUMBER: 1344748-2017 CERTIFICATE ID: 208 CERTIFICATE EXPIRES: 07-01-2018 07-01-2017/07-01-2018 THIS CERTIFICATE SUPERSEDES AND CORRECTS CERTIFICATE # 189 DATED 07-01-2017 CITY OF PALM SPRINGS SIR PO BOX 2743 PALM SPRINGS CA 82253-2743 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative��/ President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2016-07-01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF PALM SPRINGS ENDORSEMENT #2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07-01-1995 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2018-01-03 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF PALM SPRINGS EMPLOYER THE FAIR HOUSING COUNCIL OF RIVERSIDE COUNTY INC. (A NON-PROFIT CORP. ) PO BOX 1068 RIVERSIDE CA 92502 [SAZ,CSj IREV.7-2014) PRINTED : 01-03-2018 /; ry WAIVER OF SUBROGATION NOTICE Enclosed is your copy of a certificate of insurance on which the certificate holder required a waiver of subrogation: 1 . Please be advised that a waiver of subrogation requires that a 3% surcharge will be applied by State Fund ONLY to the premium assessed on the payroll of your employees earned while engaged in work for that certificate holder who requested the waiver. (Note: if you have no employee payroll on that job, then there is no charge.) 2. To apply the 3% surcharge, you must also agree to maintain accurately segregated payroll records for employees engaged in work on job/s for the certificate holder who has the waiver. The payroll records are subject to verification by an auditor. Example: Payroll for job : $5 , 000 . 00 Sample Rate : 13 . 30% Regular Premium equals : $ 665 . 00 Surcharge : 3 . 0006 Additional Waiver charge : $ 19 . 95 Total premium equals $ 684 . 95 (665 . 00 + 19 . 95 ) CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement Proiect/Activity Title: Project Number: Fair Housing Council of Riverside/Fair Housing 0003 Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 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 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 1104101117) AREA MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD: INCOME AMI LEVEL-$63,200 1 2 3 4 5 6 7 8 EXTREMELYLO INCOME $13,550 $16,240 $20,420 $24,600 $28,780 $32,960 $37,140 $41,320 0 30%ofAMI LOW INCOME $22,600 $25,800 $29,050 $32,250 $34,850 $37,450 $40,000 $42,600 30-50%ofAW MODERATE INCOME $36,150 $41,300 $46,450 $51,600 $55,750 $69,900 $64,000 $68,150 50-80%ofAMl NON LOW&MOD INCOME $36,151 $41,301 $46,451 $51,601 $55,751 $59,901 $64,001 $68,151 >80% 3. What racelethnicity 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 I CERTIFY UNDER PENALTY OF PERJURY THAT INCOME AND HOUSHOLD STATEMENTS MADE ON THIS FORM ARE TRUE. NAME: DATE: ADDRESS: PHONE NO: SIGNATURE: The information you provide on this form is confidential and is only utilized for Community Development Block Grant(CDBG)program purposes, a Federally-funded program,governmental reporting purposes to monitor compliance. CITY OF PALM SPRINGS EXHIBIT E Semi-Annual Program Progress Report Proiect/Activity Title: Project Number: Fair Housing Council of Riverside/Fair Housing 0003 Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 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 White _ Black/African American Asian AND White_ Asian Black/African American AND White_ American Indian or Alaskan Native American Indian/Alaska Native AND Black/African American _ Native Hawaiian or Other Pacific Islander _Other: _ HISPANIC/LATINO ETHNICITY: Mexican/Chicano Puerto Rican _ Cuban Other: ♦ Number of Disabled: ACCOMPLISHMENT NARRATIVE LEVERAGING RESOURCES NARRATIVE Signed Title Date CITY OF PALM SPRINGS EXHIBIT F Request for Reimbursement Proiect/Activity Title: Project Number: Fair Housing Council of Riverside/Fair Housing 0003 Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 BENEFICIARY QUALIFICATION STATEMENT Personnel Costs— $29,419. Wages,Benefits&Employers Taxes Office Costs— $2,718. Supplies,Equipment,Postage&Travel Operational Costs— $6,746. Space Rental,Utilities&Maintenance Consultant/ContractServices— $1,323. Audit,PR,Technology&Insurance $40,206. 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. SUBRECIPIENT AGREEMENT THIS AGREEMENT(herein"Agreement"), is made and entered into this(1 day of AV., JS- Ol1 , by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and charter city,and the Fair Housing Council of Riverside County, Inc. , (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 at sec.), 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 2016 — 2017 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 31 st of the current fiscal year. ORIGINAL BID AND/OR AGREEMENT 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 THIRTY THOUSAND DOLLARS 30 000.00) (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: Board of Directors of the Fair Housing Council of Riverside County, Inc. 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. 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. -2- 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); (j) The labor standard requirements as set forth in 24 CFR Part 570, Subpart K and HUD regulations issued to implement and requirements; (k) The Program Income requirements as set forth in 24 C.F.R. 570.504(c)and 570.503(b)(8); (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; -3- (p) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) and implementing regulations issued at 24 CFR Part 1; (q) Title VIII of the Civil Rights Act of 1968 (P.L. 90-284)as amended; (r) The lead-based paint requirements of 24 CFR Part 35 issued pursuant to the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.); (s) Procure, use, manage and dispose of personal property in accordance with 2 CFR 200.310 and 2 CFR 200.312 through 2 CFR 200.316; (t) Reversion of asset. Upon the Expiration of the agreement, the subrecipient shall transfer to the City any CDBG funds on hand at the time of expiration and any accounts receivable attributable to the use of CDBG funds. Additionally, any real property under the subrecipient's control that was acquired or improved in whole or in part with CDBG funds (including CDBG funds provided to the subrecipient in the form of a loan)in excess of$25,000 is either: (i) Used to meet one of the national objectives in Section 570.208 (formerly Section 570.901) until five years after expiration of the agreement, or for such longer period of time as determined to be appropriate by the City; or (ii) Not used in accordance with paragraph (t)(i) above, in which event the subrecipient shall pay to the City an amount equal to the current market value of the property less any portion of the value attributable to expenditures of non-CDBG funds for the acquisition of, or improvement to, the property. The payment is program income to the City. (No payment is required after the period of time specified in paragraph (t) of this section.) (u) Conflict of Interest. The Provider is required to disclose to the City in writing any potential conflict in accordance with 24 CFR Part 570.611; and (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. 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 Providers 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 Providers obligation -4 - 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 aftomeys'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 DISCRIMINATION,TERMINATION, AND ENFORCEMENT. 6.1 Covenant Against Discrimination. Provider covenants that, by and for itself, its heirs, executors, assigns, and all persons claiming under or through them that there shall be no discrimination against or segregation of any person or group of persons on account of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, pregnancy, marital status, age, sex, sexual orientation, gender identity, or any other basis Protected Characteristic by applicable federal, state or local law in the performance of this Agreement. Provider shall take affirmative action to insure that applicants are employed and that employees are treated during employment without regard to their race, color, creed, religion, sex, sexual orientation, gender identity, marital status, physical or mental disability, national origin, ancestry or any other basis Protected Characteristic by applicable federal,state or local law. 6.2 Term. Unless earlier terminated in accordance with Section 6.3 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. 6.3 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, document, consent, approval, or communication either party desires or is required to give to the other party shall be in writing and either served personally or sent by prepaid, first-class mail to the address set forth below, or such other addresses as may from time to time be designated by mail. -5- 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: Fair Housing Council of Riverside County, Inc. PO 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] -6- CITY OF PALM SPRINGS ATTEST: V1 a municipal corporation By: t'�ZJ By: City Clerk �ity Manager APPR S TOE RM. APP�® COUNCIL By City Attorney 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, Assistant ecretary, Treasurer, Assistant Treasurer, or Chief Financia er). By: � i�2c/� U� By: tarized Signature of Chairman of Board, Notarized Signature Secretary,Asst Secretary, President or any Vice President Treasurer,Asst Treasurer or Chief Financial Officer Name: 1 /Ve �' �2L �i/r/ Name: 1�GfJ��olf��/y /�/�� ' Title: �_�e W Title: State of State of ) County of s C� County of ss A notary public or other officer completing this certificate A notary public or other officer completing this certificate verifies only the identity of the individual who signed the verifies only the identity of the individual who signed the document to which this certificate is attached, and not document to which this certificate is attached, and not the truthfulness,accuracy,or validity of that document. the truthfulness,accuracy,or validity of that document. State of A %.k State of WQ�— ) County of lUt&k it a L )SS. County of (t1uC: x9,(, )ss. On Zj ill I\-I before me, On � ('I 0 I l before me, )-{ A\ & ( personally appeared t U 4A personally appeared �ttkC--f- f�--j 111t who proved to Wt \li N who proved to me on the basis of satisfactory evidence to be the personv me on the 2''s of sati actory evidence to be the persorK whose nameA is/are subscribed to the within instrument and whose name(;)islet su scribed to the within instrument and acknowledged to me that fre/shePohey executed the same in acknowledged to me that heWuLUIMily executed the same in ItielhherAUir authorized capacity(iml, and that by fits/her/their hislheNlhetr authorized capacity0eig),and that by his/ltrrRwr signaturaJo on the instrument the person(sy, or the entity signatureA on the instrument the personor or the entity upon behalf of which the person acted, executed the upon behalf of which the persor44 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. ® t>M Cow MIUry WYfi W C e• MYarY U11 NIDA 1101 IIMUMM CIM1 Metul MMc•C+Wa�1+ CS MM"I ttNIN IIIwrNM C/Wr Mv CMM,916W On ZI;M Da6CICp9G16-1]FHC_Sudetlp4JmR.Nov16 7 CITY OF PALM SPRINGS EXHIBIT A Scope of Services Proiect/Activity Title: Project Number: Fair Housing Council of Riverside/Fair Housing 0006 Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 Obiectives/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 and eight hundred (1,800) 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 41 On-Going Establish and maintain an efficient program process/procedure for proper record keeping. Set-up a filing system for CDBG files only. Document and maintain all records related to this program in a stable and secure location. Objective 3: Advertise, market and publicize the program to facilitate positive promotion for all parties (i.e., Provider. City, CDBG, etc.). TARGET DATE ACTIVITY#1 On-Going Draft a promotional piece and submit to City for approval. Advertise in the Desert Sun. Submit final publication to City. Objective 4: Enroll and income qualifies at least an approximately one thousand and eight hundred (1,800) 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 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 31 St, and program completion, June 30tn 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 600 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 07/15/17 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 2% Richard Lemire Project Administrator 2% Pamela Binion Accountant/Administrative 4% Francia Lugo Fair Housing Counselor 28% Stephanie Davis Fair Housing Counselor 28% Juanita Kodera Fair Housing Counselor 4% Craig Oliver Fair Housing Counselor 2% Sara Tellez Fair Housing Counselor 2% CITY OF PALM SPRINGS EXHIBIT B Budget Summary Proiect/Activity Title: Project Number: Fair Housing Council of Riverside/Fair Housing 0006 Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 COST CATEGORY CDBG OTHER TOTAL SHARE SOURCES COST 1 Personnel Costs— $23,780. -0 - $23,780. Wages,Benefits&Employers Taxes 2 Dffice Costs- $1,416. -0 - $1,416. Supplies, Equipment, Postage&Travel 3 Dperational Costs- $3,603. -0 - $3,603. ace Rental, Utilities&Maintenance 4 onsultant/Contract Services - $1,201. -0 - $1,201. udit, PR,Technology&Insurance 5 6 7 8 TOTALS .0. 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 JFSD's through other local governmental grants,all totaling$20,000. 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. CITY OF PALM SPRINGS EXHIBIT C Insurance Inventory Proiect/Activity Title: Project Number: Fair Housing Council of Riverside/ Fair Housing 0006 Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 INSURANCE INVENTORY LIABILITY INSURANCE POLICY Name of Provider's Insurance Company Non-profits' Ins Alliance Effective Dates of Policy 04/28/17 to 04/28/18 Claims Made Policy / I Per Occurrence Policy / I Limits of Liability $2M General Aaareaate Deductibles: Per Occurrence Annual Aggregate Additional Insured Endorsement (Certificate Holder) El Yes ❑ No Original Certificate of Insurance Attached ❑ Yes 21 No WORKER'S COMPENSATION POLICY Name of Provider's Insurance Company State Compensation Insurance Fund Effective Dates 07/01/17 to 07/01/18 Limits of Liability $1 M Per Occurrence Underlying Coverage Limits Original Certificate of Insurance Attached ❑ Yes 21 No A�® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 4/24/2017 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 CathyNE ron NAME: g The Empire Company PHONE (909)476-0600 AX No;(909)476-0601 10201 Trademark St., Suite D ADDRIESS;cnegron@empire-co.com P.O. BOX 5400 INSURERS AFFORDING COVERAGE NAIC9 Rancho Cucamonga CA 91729 INSURER A Non rofits Ins. Alliance of Ca INSURED INSURER B: Fair Housing Council of Riverside County, Inc. INSURERC: P.O. Box 1068 INSURER D: INSURER E: Riverside CA 92502-1068 INSURER F: COVERAGES CERTIFICATE NUMBER:17/18 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN SR F INSURANCE ADDLSUBR POLICY EFF POLICY EXP LTR TYPE O I SD WVD POLICY NUMBER MMIDD MMIDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 500,000 A CLAIMS-MADE X OCCUR PREMISES Eaoccurrence $ X 2017-04221-NPO 4/28/2017 4/28/2018 MED EXP(Any one person) $ 20,000 PERSONAL B ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO - BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED AUTOS AUTOS 2017-04221-NPO 9/28/2017 4/28/2018 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS Par accident $ UMBRELLA UAB Ld OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETE 1$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICEMMEMBER EXCLUDED? NIA. (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY DMIT $ A Directors and Officers 2 017-0 4 221-DO 4/28/2017 4/28/2018 Liability Limit $1,000,000 A Employee Dishonesty 2017-04221-PROP 4/28/2017 4/28/2018 Limit $200,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) The City of Palm Springs, its officers, employees & agents are named as Additional Insured with respect to the General Liability per form attached. CERTIFICATE HOLDER CANCELLATION dale.cook@palmsprings-ca.g SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Palm Springs THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: City Clerk/Dale Cook ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 2743 Palm Springs, CA 92262 AUTHORIZED REPRESENTATIVE (� Cathy Negron/NEGRON 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(Pn14nr) N nprofits'Insurance Alliance of California A"_MII W4U...A MEAei MR WW MS THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II—WHO IS AN INSURED is amended to include any public entity as an additional insured for whom you are performing operations when you and such person or organization have agreed in a written contract or written agreement that such public entity be added as an additional insured(s)on your policy, but only with respect to liability for"bodily injury", "property damage" or"personal and advertising injury" arising out of, in whole or in part, by: 1. Your negligent acts or omissions; or 2. The negligent acts or omissions of those acting on your behalf; in the performance of your ongoing operations. No such public entity is an additional insured for liability arising out of the "products-completed operations hazard"or for liability arising out of the sole negligence of that public entity. B. With respect to the insurance afforded to these additional insured(s), the following additional exclusions apply. This insurance does not apply to"bodily injury"or"property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project(other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the location of the covered operations has been completed; or 2. That portion of"your work' out of which injury or damage arises has been put to its intended u.se 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. The following is added to SECTION III—LIMITS OF INSURANCE: The limits of insurance applicable to the additional insured(s) are those specified in the written contract between you and the additional insured(s), or the limits available under this policy, whichever are less. These limits are part of and not in addition to the limits of insurance under this policy. D. With respect to the insurance provided to the additional insured(s), Condition 4. Other Insurance of SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreement: NIAC=E61 02 13 (1) That this insurance be primary. If other insurance is also primary, we will share with all that other insurance as described in c. below; or (2) The coverage afforded by this insurance is primary and non-contributory with the additional insured(s)' own insurance. Paragraphs (1) and (2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below. b. Excess Insurance This insurance is excess over: 1. Any of the other Insurance,whether primary,excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is insurance purchased by you to cover your liability as a tenant for "property damage"to premises temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE. (e) That is any other insurance available to an additional insured(s) under this Endorsement covering liability for damages arising out of the premises or operations, or products- completed operations, for which the additional insured(s) has been added as an additional insured by that other insurance. (1) When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s) against any"suit" if any other insurer has a duty to defend the additional insured(s) against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured(s)' rights against all those other insurers. (2) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any,that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self-insured amounts under all that other insurance. (3) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Methods of Sharing If all of the other insurance available to the additional insured(s) permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any other the other insurance available 10 the additional insured(s)does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. NIAC-E61 02 13 POLICYHOLDER COPY 591 SP STATECcMPrNSATION P.O. BOX 8192, PLEASANTON, CA 94588 FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 07-01-2017 GROUP: POLICY NUMBER: 1344748-2017 CERTIFICATE ID: 189 CERTIFICATE EXPIRES: 07-01-2018 07-01-2017/07-01-2018 CITY OF PALM SPRINGS SP DEPT OF BUILDING & SAFETY PO BOX 2743 PALM SPRINGS CA 92283-2743 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 80 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2016-07-01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF PALM SPRINGS ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07-01-1895 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER THE FAIR HOUSING COUNCIL OF RIVERSIDE COUNTY INC. (A NON-PROFIT CORP. ) PO BOX 1068 RIVERSIDE CA 92502 M0410 (REV.7-2014) PRINTED : OB-16-2017 CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement Proiect/Activity Title: Project Number: Fair Housing Council of Riverside/ Fair Housing 0006 Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 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 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-03/28116) AREA MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD: INCOME(AMI) 1 2 3 4 5 6 7 8 LEVEL-$61,400 EXTREMELY LOA INCOME $13,450 $16,020 $20.1600 $24,300 $28,440 $32,580 $36,730 $40,890 0 30%of AMI LOW INCOME $22,400 $25,600 $28,800 $31,950 $34,550 $37,100 $39,650 $42,200 30-50%of AMI MODERATE INCOME $35,800 $40,900 $46,000 $51,100 $55,200 $59,300 $63,400 $67,500 50-80%of AMI NON LOW&MOD INCOME $35,801 $40,901 $46,001 $51,101 $55,201 $59,301 $63,401 $67,501 >80% 3. What race/ethnicity do you identify yourself as;please note that this seHrdentlficatlon 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 I CERTIFY UNDER PENALTY OF PERJURY THAT INCOME AND HOUSHOLD STATEMENTS MADE ON THIS FORM ARE TRUE. NAME: DATE: ADDRESS: PHONE NO: SIGNATURE: The information you provide on this form is confidential and is only utilized for Community Development Block Grant(CDBG)program purposes, a Federally-funded program,governmental reporting purposes to monitor compliance. CITY OF PALM SPRINGS EXHIBIT E Semi-Annual Program Progress Report Proiect/Activity Title: Protect Number: Fair Housing Council of Riverside/Fair Housing 0006 Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 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 White Black/African American Asian AND White Asian Black/African American AND White American Indian or Alaskan Native American Indian/Alaska Native AND Black/African American Native Hawaiian or Other Pacific Islander Other: HISPANIC/LATINO ETHNICITY: Mexican/Chicano Puerto Rican Cuban Other. ♦ Number of Disabled: ACCOMPLISHMENT NARRATIVE LEVERAGING RESOURCES NARRATIVE Signed Title Date CITY OF PALM SPRINGS EXHIBIT F Request for Reimbursement Proiect/Activi!y Title: Project Number: Fair Housing Council of Riverside/ Fair Housing 0006 Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 BENEFICIARY QUALIFICATION STATEMENT Personnel Costs— $23,780. Wages,Benefits&Employers Taxes Office Costs— $1,416. Supplies,Equipment,Postage&Travel Operational Costs— $3,603. Space Rental,utilities&Maintenance Consultant/ContractServices— $1,201. Audit,PR,Technology&Insurance 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. SUBRECIPIENT AGREEMENT THIS AGREEMENT (herein "Agreement"), is made and entered into this eday of November, 2015, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and charter city, and the Fair Housing Council of Riverside County, Inc. , (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 sec.), as amended from time to time (the "Act"), and the regulations promulgated thereunder(24 C.F.R. Section 570 et sec. ("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 or due to receive $20,000.00 or more from the City during the 2015 —2016 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 31 st of the current fiscal year. ORIGINAL BID ANDIOR AGREEMENT 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 THIRTY THOUSAND DOLLARS ($30.000.00) (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 specked herein and make all decisions in connection therewith: Board of Directors of the Fair Housing Council of Riverside County Inc 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. 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. - 2 - 4.2 The Provider certifies it shall adhere to and comply with the following as they may be applicable: (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); (j) The labor standard requirements as set forth in 24 CFR Part 570, Subpart K and HUD regulations issued to implement and requirements; (k) The Program Income requirements as set forth in 24 C.F.R. 570.504(c) and 570.503(b)(8); (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 Circular Nos. A-102, Revised, A-87, A-110 and A-122 as they relate to the acceptance and use of federal funds under the federally- assisted program; - 3 - (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 Vill 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 etseec.); (s) Maintain property inventory system to numerically identify HUD purchased property and document its acquisition date as is set forth in OMB Circular A-110 Attachment N Property Management Standard 6d; and (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) 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. 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). -4 - 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 DISCRIMINATION,TERMINATION,AND ENFORCEMENT. 6.1 Covenant Against Discrimination. Provider covenants that, by and for itself, its heirs, executors, assigns, and all persons claiming under or through them that there shall be no discrimination against or segregation of any person or group of persons on account of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, pregnancy, marital status, age, sex, sexual orientation, or any other basis Protected Characteristic by applicable federal, state or local law in the performance of this Agreement. Provider shall take affirmative action to insure that applicants are employed and that employees are treated during employment without regard to their race, color, creed, religion, sex, marital status, physical or mental disability, national origin, ancestry or any other basis Protected Characteristic by applicable federal, state or local law. 6.2 Term. Unless earlier terminated in accordance with Section 6.3 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. 6.3 Termination Prior to Expiration of Term. Either party may terminate this Agreement at any time, with or without cause, upon thirty (30) days' written notice to the other party. 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. 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, document, consent, approval, or communication either party desires or is required to give to the other party shall be in writing and either served personally or sent by prepaid, first-class mail to the address set forth below, or such other addresses as may from time to time be designated by mail. 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: Fair Housing Council of Riverside County, Inc. P.O. Box 1068 Riverside, CA 92502-1068 - 5 - 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] - 6- CITY OF PALM SPRINGS ATTEST: a unicipal corporatio By y; 4�16ity Clerk �_ /City Manager APPRT: Check TO FORM: APPROVED BY CITY COUNCIL, By: Q�) a3��� 4I^�✓�17 Ci PROVI 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, Assistant tSSecretary, Treasurer, Assistant Treasurer, or Chief Financial O ' ). By ti oG [ti L L/ By; No rized Signature of Chairman of Board, Notarized Signatu a Secretary, Asst Secretary, President or any Vice Prudent Treasurer Ass�Tre r Chief Fina9pa G1, l Officer Name: �J Ll(��t (S E/1/ Name: Title: . ce�S; dee f Title: A notary public or other officer completing this certificate A notary public or other officer completing this certificate verifies only the identity of the individual who signed the verifies only the identity of the individual who signed the document to which this certificate is attached, and not document to which this certificate is attached, and not the truthfulness,accuracy,or validity of that document. the truthfulness,accuracy,or validity of that document. State of (jKl YVAMIA- ) State of zaT' rj di County of IC64Et✓,O E )as. county of ILl&AE n7 S ss. On 1qW,-,A%6-C7t I y 201 S before me, On No✓e 1r3'6 1 Lp 2-01 j before me, IfIF Naw )Orsonally appeared 4f'k1gnAlW Wnr /V �/a�q[l4 personally appeared , )PnL�GT /t'I�`l 67rL.*i(,nl who proved to 49'9 rMP4/ 441-Z- '� who proved to me on the basis of sati factory evidence to be the person>K me on the basis of satisfactory evidence to be the person ar whose name�ubscribe to the within instrument and whose namejs)6A�subscribed to the within instrument and acknowledged to me that hee key executed the same in acknowledged to me tha&WWAKey executed the same in authorized capacityQea); and that by er li arnHe,r authorized capacity(iW, and that byBsl$cutkalt' - sigIrralur9keron the instrument the persoq(a)'or a entity signaturS(sron the instrument the persory(s,y; or the entity upon behalf of which the person(;) acted, executed the upon behalf of which the person 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: LAWANDA ROY R LAWANDARO COMM.#1995828 & COMM.#1995828 NOTARY PUBLIC•CALIFORNIA Ib NOTARY PUBLIC-CALIFORNIA RIVERSIDE COUNTY GO RIVERSIDE COUNTY Mr Comm.E)*es Nov.24,2016 My Comm.Esplres Nok 21,2018 0.ecmoecsl6Emsgcnci suw*Agnntails CITY OF PALM SPRINGS EXHIBIT A Scope of Services Proiect/Activity Title: Project Number: Fair Housing Council of Riverside/ Fair Housing 0004 Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 Obi a ctives/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 for 623 Palm Springs residents 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 for 2 Palm Springs residents such as enforcement (i.e., compliant intake, investigation, resolution options) which totals six and hundred twenty-five (625) 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 Draft a promotional piece and submit to City for approval. Advertise in the Desert Sun. Submit final publication to City. Objective 4: Enroll and income qualifies at least an approximately six hundred and twenty-six (625) Palm Springs residents in accordance with Exhibit D for new access to services. TARGET DATE ACTIVITY#1 On-Going Provide fair housing services to 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 Monthly Submit semi-annual reports—referenced Exhibit E within fifteen (15)calendar days of the program mid-year, December 31", and program completion, June 30'h. 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 600 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 07/15/16 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 can not 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 2% To Be Hired Deputy Director 2% Pamela Binion Administrative Assistant 4% Juanita Kodera Fair Housing Counselor 28% Stephanie Davis Fair Housing Counselor 28% Craig Oliver Fair Housing Counselor 2% Sara Tellez Fair Housing Counselor 2% CITY OF PALM SPRINGS EXHIBIT B Budget Summary Proiect/ActiyitV Title: Project Number: Fair Housing Council of Riverside/Fair Housing 0004 Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 BUDGET=SUMMARY s =. COST CDBG OTHER TOTAL CATEGORY SHARE SOURCES COST 1 Personnel Costs — $23,742. - 0 - $23,742. Wages, Benefits&Employers Taxes 2 Dffice Costs — $1,575. - 0 - $1,575. 5upplies, Equipment, Posta e&Travel 3 Dperational Costs — $3,705. - 0 - $3,705. ace Rental, Utilities&Maintenance 4Consultant/Contract Services— $978. - 0 - $978. udit, PR, Technology& Insurance 5 6 7 8 OTALS $30,000. - 0 - $30,000. 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. The Subrecipient shall submit monthly reimbursement based on prorated and actual costs in accordance with the aforementioned cost categories and pay items. In no month shall the Subrecipient submit for reimbursement more than Y<of the total annual budget. 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 the twelve-month period of this 2015— 16 Program Year- July 1, 2015 through June 30, 2016. CITY OF PALM SPRINGS EXHIBIT C Insurance Inventory Proiect/Activity Title: Project Number: Fair Housing Council of Riverside/ Fair Housing 0004 Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068: 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 INSURANCE INVENTORY LIABILITY INSURANCE POLICY Name of Provider's Insurance Company Non-Profits Insurance Alliance Effective Dates of Policy 04/28/15 to 04/28/16 Claims Made Policy ! / Per Occurrence Policy / / Limits of Liability $2,000,000 aggregate/$1,000,000 er occurrence Deductibles: Per Occurrence none Annual Aggregate Additional Insured Endorsement (Certificate Holder) 0 Yes ❑ No Original Certificate of Insurance Attached ❑ Yes 0 No WORKER'S COMPENSATION POLICY Name of Provider's Insurance Company State Compensation Insurance Fund Effective Dates 07/01/15 to 07/01/16 Limits of Liability $1 000,000 per occurrence Underlying Coverage Limits n/a Original Certificate of Insurance Attached 71 Yes Q No DATE(MMIDDIYYYY) A CERTIFICATE OF LIABILITY INSURANCE 4/23/2015 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcyles) must be endorsed. If SUBROGATION 15 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 endorsements . PRODUCER IMNEACT Cathy Negron The Empire Company PHONE E (909)476-0600 1 q/C No: (909)476-0601 10201 Trademark St. , Suite D 'MAIL .cnegron@empire-co.corn P.O. BOX 5400 INSURI AFFORDING COVERAGE NAICS Rancho Cucamonga CA 91729 INSURERANOn rofits Ins. Alliance of Ca INSURED INSURERB.North American Elite Ins. Co. Fair Housing Council of Riverside County, Inc, 1NSURERC: P.Q. BOX 1068 INSURERD: INSURER E Riverside CA 9250 2-106 8 INSURER F: COVERAGES CERTIFICATE NUMBER:15/16 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER MMMOYEFF MM1D�Y TR LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL AlL PREMISES Ea ocarrenca $ 500,000 A CLAIMS-MADE aOCCUR X 015-04221-NPD /28/2015 /28/2016 MED EXP(Any One person) $ 20,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEML AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO $ 2,000,000 X POLICY JEC LOC $ AUTOMOBILE LIABILITY Ea amideM IMI 1 000 000 A MY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 015-04221-NPO /28/2015 /28/2016 BODILY INJURY(Per eocclent) $ AUTOS AUTOS X HIRED AUTOS X AUTOSED PPereccRiOenIAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-,ADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION NC STATU- OTH- ANDEMPLOYERTUABILITV TORV I IT YIN ANY PROPRIETORIEXCLUDRlF.XECUTIVE❑ NIA EL EACH ACCIDENT $ OFFICERory In REXCLWED? (Mandatory in NH} E.L.DISE4SE-EA EMPLOYE $ Ilro,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Directors and Officers 015-04221-DO /28/2015 /28/2026 UsWity Limit $1,000,000 B Employee Dishonesty 0000560-13 4/28/2015 A/28/2016 Unit $200,000 DESCR PE ON OF 0PERATIONSI LOCATIONS I VEHICLES (Affich ACORD 101,Additional Remarks Schedule,if more spece is required) The City of Palm Springs, its officers, employees & agents are named as Additional Tnstu-ed with respect to the General Liability per form CG 20 26 07 04 attached. CERTIFICATE HOLDER CANCELLATION dale.cook@palmsprings-ca.q SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Palm Springs ACCORDANCE WITH THE POLICY PROVISIONS. Attn: City Clerk/Dale Cook P.O. BOX 2743 AUTHORIZED REPRESENTATIVE Palm Springs, CA 92262 Cathy Negron/NEGRON ACORD 25(2010105) ©1988.2010 ACORD CORPORATION. All rights reserved. INS02512oiao5)0i The ACORD name and logo are registered marks of ACORD Nonprofits'Insurance Alliance of California A IUD lOI IIAUGNCF ..A IfM110R IpNJiS THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II —WHO IS AN INSURED is amended to include any public entity as an additional insured for whom you are performing operations when you and such person or organization have agreed in a written contract or written agreement that such public entity be added as an additional insured(s) on your policy, but only with respect to liability for "bodily injun/', "property damage" or "personal and advertising injury" arising out of, in whole or in part, by: 1. Your negligent acts or omissions; or 2. The negligent acts or omissions of those acting on your behalf; in the performance of your ongoing operations. No such public entity is an additional insured for liability arising out of the "products-completed operations hazard" or for liability arising out of the sole negligence of that public entity. B. With respect to the insurance afforded to these additional insured(s), the following additional exclusions apply. This insurance does not apply to"bodily injury" or"property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work. on the project (other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the location of the covered operations has been completed; or 2. That portion of"your work' out of which 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. The following is added to SECTION III—LIMITS OF INSURANCE: The limits of insurance applicable to the additional insured(s) are those specified in the written contract between you and the additional insured(s), or the limits available under this policy, whichever are less. These limits are part of and not in addition to the limits of insurance under this policy. D. With respect to the insurance provided to the additional insured(s), Condition 4. Other Insurance of SECTION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreement: NIAC-E61 02 13 (1) That this insurance be primary. If other insurance is also primary, we will share with all that other insurance as described in c. below; or (2) The coverage afforded by this insurance is primary and non-contributory with the additional insured(s)' own insurance. Paragraphs (1) and (2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below. b. Excesslnsurance This insurance is excess over: 1. Any of the other insurance,whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work", (b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is insurance purchased by you to cover your liability as a tenant for "property damage"to premises temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE. (e) That is any other insurance available to an additional insured(s) under this Endorsement covering liability for damages arising out of the premises or operations, or products- completed operations, for which the additional insured(s) has been added as an additional insured by that other insurance. (1) When this Insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s)against any"suit" if any other insurer has a duty to defend the additional insured(s) against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured(s)' rights against all those other insurers. (2) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance;and (b) The total of all deductible and self-insured amounts under all that other insurance. (3) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Methods of Sharing If all of the other insurance available to the additional insured(s) permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any other the other insurance available to the additional insured(s)does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. NIAC-E61 02 13 Nonprafits'Insurance Alliance of California �w�ororutwvx.,.•rwnrdxuerams THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION Thus endorsement modifies insurance provided Linder the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization- 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 terra of this policy,in consideration of food contributions or client referrals you receive from them (If no entry appears above,information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED(Section II) is amended to include as an insured the person or organization shown in the Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. NI .C-E25(1198) CERTHOLDER COPY SK STATE P.O. BOX 8192, PLEASANTON, CA 94588 FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 11-18-2015 GROUP: POLICY NUMBER: 1344748-2015 CERTIFICATE ID: 189 CERTIFICATE EXPIRES: 07-01-2015 07-01-2015/07-01-2016 THIS CERTIFICATE SUPERSEDES AND CORRECTS CERTIFICATE N 180 DATED 07-02-2015 CITY OF PALM SPRINGS SK DEPT OF BUILDING 8 SAFETY PO BOX 2743 PALM SPRINGS CA 92283-2743 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded b_y the policy �described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT N0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2015-07-02 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF PALM SPRINGS ENDORSEMENT N2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07-01-1995 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER THE FAIR HOUSING COUNCIL OF RIVERSIDE COUNTY INC. (A NON-PROFIT CORP. ) PO BOX 1088 RIVERSIDE CA 92502 PRM,CS] (REV.7-2014) PRINTED : 11-18-2015 ENDORSEMENT AGREEMENT ADDITIONAL INSURED EMPLOYER 1344748-15 STATE RENEWAL SK 2-67-15-23 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE JULY 2, 2015 AT 12 . 01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME THE FAIR HOUSING COUNCIL OF RIVERSIDE COUNTY INC. 613 PO BOX 1068 RIVERSIDE, CA 92502 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING. IT IS AGREED THAT CITY OF PALM SPRINGS IS HEREBY NAMED AS AN ADDITIONAL INSURED EMPLOYER ON THIS POLICY BUT ONLY AS RESPECTS EMPLOYEES WHOSE NAMES APPEAR ON THE PAYROLL RECORDS OF THE FAIR HOUSING COUNCIL OF (HEREIN CALLED THE PRIMARY INSURED) WHILE THOSE EMPLOYEES ARE ENGAGED IN WORK UNDER THE SIMULTANEOUS DIRECTION AND CONTROL OF THE PRIMARY INSURED AND THE ADDITIONAL INSURED EMPLOYER. IT IS FURTHER AGREED THAT THE PAYMENT OF THE FULL PREMIUM DUE AND PAYABLE UNDER THIS POLICY SHALL REMAIN THE SOLE RESPONSIBILITY OF THE PRIMARY INSURED. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT S/AN�FRANCISCO: JULY 6, 2015 0015 y/ AUTHORIZED REPRESENT IVE PRFSIDFNT AM] CFn CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement Proiect/Activity Title: Project Number: Fair Housing Council of Riverside/ Fair Housing 0004 Name/Address of Provider: Date: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 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, roamers,or borders cannot be included as household members. 2. Circle your combined gross annual income(Riverside-San Bernardino-Ontario,CA MSA-03106115) AREA MEDIAN NUMBER Or PERSONS IN YOUR HOUSEHOLD: INCOME(AMI) 1 2 3 4 5 6 7 8 LEVEL-$60,500 EXTREMELY LO INCOME $13,100 $15,930 $20,090 $24,250 $28,410 $32,570 $36,730 $40,890 0 30%of AMI LOW INCOME $21,750 $24,850 $27,950 $31,050 $33,550 $36,050 $38,550 $41,000 30-50%of AMI MODERATE INCOME $34,800 $39,800 $44,750 $49,700 $53,700 $57,700 $61,650 $65,650 50-80%of AMI NON LOW&MOD INCOME $34,801 $39,801 $44,750 $49,701 $53,701 $57,701 $61,651 $65,651 >80% 3. What racefethnicity 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 I CERTIFY UNDER PENALTY OF PERJURY THAT INCOME AND HOUSHOLD STATEMENTS MADE ON THIS FORM ARE TRUE. NAME: DATE: ADDRESS: PHONE NO: SIGNATURE: The information you provide on this form is confidential and is only utilized for Community Development Block Grant(CDBG) program purposes.a Federally-funded program,governmental reporting purposes to monitor compliance. CITY OF PALM SPRINGS EXHIBIT E Semi-Annual Program Progress Report Proiect/Activity Title: Proiect Number: Fair Housing Council of Riverside/ Fair Housing 0004 Name/Address of Provider: Date: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 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 White Black/African American Asian AND White Asian Black/African American AND White American Indian or Alaskan Native American Indian/Alaska Native AND Black/African American Native Hawaiian or Other Pacific Islander Other: HISPANIC/LATINO ETHNICITY: Mexican/Chicano Puerto Rican Cuban Other: • Number of Disabled: ACCOMPLISHMENT NARRATIVE LEVERAGING RESOURCES NARRATIVE Signed Title Date ^ CITY OF PALM SPRINGS EXHIBIT F Request for Reimbursement Proqect/Activity Title: Proiect Number: Fair Housing Council of Riverside/ Fair Housing 0004 Name/Address of Provider: Date: Fair Housing Council of Riverside County, Inc. PO Box 1O08; 3833 Mission Inn Avenue 055N Palm Canyon Dr, Ste 201 Riverside, CA 92502'1060 Palm Springs, CA 92202'5512 Pr en ion [Re 40 Unde Vages,Benefits&Employers axes 3upplies,Equipment, Postage& .ravel 3pace Rental,Utilities& Maintenance Services— O,udit,PR,Technology& nsurance TRTAL 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 xomtodvv: 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 repair work 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 journeyworkers; 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 CDBG- funded 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 concems 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. SUBRECIPIENT AGREEMENT THIS AGREEMENT (herein "Agreement"), is made and entered into this q-A day of October , 2014, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and charter city, and the Fair Housing Council of Riverside County, Inc. , (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 sec.), as amended from time to time (the "Act"), and the regulations promulgated thereunder(24 C.F.R. Section 570 et sec. ("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, and to conduct all programs specified therein in a manner to reflect credit upon the City and Provider. 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. 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 2.2, 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 or due to receiver $20,000.00 or more from the City during the 2014 — 2015 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 31 s'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, FIVE HUNDRED and FORTY-FIVE DOLLARS ($15,545.00) (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 monthly statements 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 Providers 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: Board of Directors of the Fair Housing Council of Riverside County Inc. P.O. Box 1068 3933 Mission Inn Avenue Riverside, CA 92502-1068 3.2 Contract Officer. The Contract Officer shall be such person as may be designated by the chief administrative officer 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. 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. -2 - 4.2 The Provider certifies it shall adhere to and comply with the following as they may be applicable: (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; (1) The restrictions prohibiting use of funds for the benefit of a religious organization or activity as set forth in 24 CFR 570.200 0); (j) The labor standard requirements as set forth in 24 CFR Part 570, Subpart K and HUD regulations issued to implement and requirements; (k) The Program Income requirements as set forth in 24 C.F.R. 570.504(c) and 570.503(b)(8), (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 Circ ular Nos. A-102, Revised, A-87, A-110 and A-122 as they relate - 3 - to the acceptance and use of federal funds under the federally- assisted program; (p) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) and implementing regulations issued at 24 CFR Part 1; (q) Title VIII of the Civil Rights Act of 1968 (P.L. 90-284) as amended; (r) The lead-based paint requirements of 24 CFR Part 35 issued pursuant to the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.); (s) Maintain property inventory system to numerically identify HUD purchased property and document its acquisition date as is set forth in OMB Circular A-110 Attachment N Property Management Standard 6d, and (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 subrecipienfs 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 (s)(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 (s) of this section.) (u) 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. 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 - 4 - to indemnify the City, its officers, or employees. The amount of insurance required hereunder shall be as required by the Contract Officer not exceeding Five Hundred Thousand Dollars($500,000). 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 DISCRIMINATION, TERMINATION, AND ENFORCEMENT. 6.1 Covenant Against Discrimination. Provider covenants that, by and for itself, its heirs, executors, assigns, and all persons claiming under or through them that there shall be no discrimination against or segregation of any person or group of persons on account of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, pregnancy, marital status, age, sex, sexual orientation, or any other basis Protected Characteristic by applicable federal, state or local law in the performance of this Agreement. Provider shall take affirmative action to insure that applicants are employed and that employees are treated during employment without regard to their race, color, creed, religion, sex, marital status, physical or mental disability, national origin, ancestry or any other basis Protected Characteristic by applicable federal, state or local law. 62 Term. Unless earlier terminated in accordance with Section 6.3 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. 6.3 Termination Prior to Expiration of Term. Either party may terminate this Agreement at any time, with or without cause, upon thirty (30) days' written notice to the other party. 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. 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, document, consent, approval, or communication either party desires or is required to give to the other party shall be in writing and either served personally or sent by prepaid, first-class mail to the address set forth below, or such other addresses as may from time to time be designated by mail. 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 - 5 - TO PROVIDER, Fair Housing 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 ] -6 - CITY OF PALM SPRINGS ATTEST: a municipal corporation v y Clerk City Manager APPROVED AS TO FORM: By. City Attorneyh 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, Assistant S cretary, Treasurer, Assistant Treasurer, or Chief Financial O er). By: 1(/G By: No rized Signature of Chairman of Board, Notarized Signature Secretary, Asst Secretary, President or any Vice President "/ Treasurer,Asrst1 Treasurer �Iorr }Chief Financial Officer r Name: � rTj6✓FCt� on. �IQ�I�ry Name: DW(6��f/pC�"'/N�l//* �IG� Title:_ Cf ./ I Resf e-y f Title: // � h+ ✓��cG+�� Stale of (_... wudf State of Cf W'VMvtfrt rf County of -ss County of (O� =SS `r On before me, On__—,�__�FQmJ yi_ q7 ZO1 T before me, personally appeared IJTWrI'PfliF �CD�I �'{ti71A/Ptl611(iersonally appeared �) -n� ._lam who proved to �e16/Pf/TM L M '2t '(c who proved to me on the basis of s tisfactory evidence to be the personal Me on the basis of satisfactory evidence to be the persorpe whose nameWislem'subscribed to the within instrument and whose namy,K isAwe subscribed to the within instrument and acknowledged to me that he/she/they executed the same in acknowledged to me that hek.4a4ey executed the same in lvs/her1their authorized capacily(es), and that by his/her/tIbwr hisAiwMN it authorized capacityjlae), and that by hisA 40FA40ir signature,( Yon the instrument the person- or the entity signature„W on the instrument the perso%pJ, or the entity upon behalf of which the perso� acted, executed the upon behalf of which the person ailed, 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: BtOZ'►Z'xoPl vailm9'onooO WY 'Z4 3n LAWANDA ROY tlINliOintlO-on �EN10N 9Z89881#'WW00 COMM•#1995828 NOTARY PUBLIC-Chl1PoRN IA AON VQNVM` 1 LV RIMSmEcouNry My Carlin.�Nov.24,2111f I WANDA ROY FMsngCnd_SubredpAgrmd OU14 COMM.#1995828 NOTARY PUBLIC•CALIFORNIA RIVMSIDE COUNTY - 7 - My Canm.E>Igm Nov.N,201! CITY OF PALM SPRINGS EXHIBIT A Scope of Services Pro4ect/Actiyity Title: Project Number: Fair Housing Council of Riverside/Fair Housing 0004 Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 O b 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 for 950 Palm Springs residents 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 for 50 Palm Springs residents 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 Draft a promotional piece and submit to City for approval. Advertise in the Desert Sun. Submit final publication to City. Objective 4: Enroll and income qualifies at least an approximately one thousand (1,000) Palm Springs residents with new access to this service. TARGET DATE ACTIVITY#1 On-Going Provide fair housing services to 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 Monthly Submit semi-annual reports—referenced Exhibit E. 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 600 clients and offer two workshops for property owners, managers, Realtors and lenders to improve availability/accessibility, as stipulated in the proposal. Objective 8: Provide an evaluation within fifteen (15) calendar days of the program completion or final reimbursement. TARGET DATE ACTIVITY#1 07/15/13 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 can not 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 2% To Be Hired Programs Administrator 2% Pamela Binion Administrative Assistant 13% Stephanie Davis Fair Housing Counselor 28% Hermes Ayala Fair Housing Counselor 48% Juanita Kodera Fair Housing Counselor 6% Craig Oliver Fair Housing Counselor 8% Sara Tellez Fair Housing Counselor 5% CITY OF PALM SPRINGS EXHIBIT B Budget Summary ProiecUActivity Title: Proiect Number: Fair Housing Council of Riverside/ Fair Housing 0004 Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 BUDGETSUMMARY COST CDBG OTHER TOTAL CATEGORY SHARE SOURCES COST 1 PersonnelCosts— $12,303. $19,353. $31.656. Wages, Benefits& Employers Taxes 2 Office Costs — $1,321. $2,079. $3,400. —Supplies, Equipment, Posta e&Travel 3 OperationalCosts— $1,066. $1,678. $2,744. Space Rental, Utilities&Maintenance 4 ConsultantlContractServices— $855. $1,345. $2,200. udit, PR, Technology&Insurance 5 6 7 8 OTALS $15,545. $24,455. $40,000. 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. The Subrecipient shall submit monthly reimbursement based on prorated and actual costs in accordance with the aforementioned cost categories and pay items. In no month shall the Subrecipient submit for reimbursement more than Y. of the total annual budget. The reimbursement shall be split between the Housing Successor Agency and CDBG's General Administration with the respective allocation of$24,455 (61.14%)and $15,545(38.86%), totaling $40,000. 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 the twelve-month period of this 2014— 15 Program Year- July 1, 2014 through June 30, 2015. CITY OF PALM SPRINGS EXHIBIT C Insurance Inventory Proiect/Activity Title: Project Number: Fair Housing Council of Riverside/Fair Housing 0004 Name/Address of Provider: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 INSURANCE INVENTORY LIABILITY INSURANCE POLICY Name of Provider's Insurance Company Non-Profits Insurance Alliance Effective Dates of Policy 04/28/14 to 04/28/15 Claims Made Policy / ! Per Occurrence Policy I I Limits of Liability $2,000,000 aggregate/$1.000,000 per occurrence Deductibles: Per Occurrence none Annual Aggregate Additional Insured Endorsement (Certificate Holder) a Yes ❑ No Original Certificate of Insurance Attached ❑ Yes 0 No WORKER'S COMPENSATION POLICY Name of Provider's Insurance Company State Compensation Insurance Fund Effective Dates 07/01/14 to 07/01/15 Limits of Liability $1,000,000 per occurrence Underlying Coverage Limits n/a Original Certificate of Insurance Attached ❑ Yes 10 No acoRo� CERTIFICATE OF LIABILITY INSURANCE DA21/2014 9/21/2014 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 CONTCONTACT Cathy Negron The Empire Company PHONE _ (909)476-0600 1AIC.NoI: (909)476-0601 10201 Trademark St. , Suite D ADDRESS cnegron@empire-co.com P.G. BOX 5400 INSURERS AFFORDING COVERAGE NAIL# Rancho Cucamonga CA 91729 NSURERA Nonprofits Ins. Alliance of Ca INSURED INSURER 8: _ Fair Housing Council of Riverside County, Inc. INSURER C: P.O. BOX 1068 INSURER D INSURER E' Riverside CA 92502-1068 INSURERF' COVERAGES CERTIFICATE NUMBER:14/15 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 INDICATFO. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 70 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MSq TYPE Of INSURANCE A POLICY EFF POLICY EXP ' N R WVD POLICY NUMBER MMIODIYWY MMIDDM I LIMITS GENERAL LIABILITY EACH occuRRENr,F_ s 1,000,000 X COMMLRQAL GENERAL LIABIIIN )OAMA E- R@ TE PREMISES F rrep)Cel-- S 500/0001 u /28/2014 /28/2015 A CL/aM5-MADE MED EXP(Any one person) S 20,000 PFRSONAL 6 ADV INJURY S 1,000,000 GENE HAL AGGREGATE 5 2,000,000 GCNL AGGHFL9ATF I IMIT APPJESPER PH07UCTG�GOMP/pP AGG 5 2,00O,OOD X I POLICY FRO_ L JC 5 AUTOMOBILE LIABILITY CCMBIIRED 51NGLE LIMIT aecdr n 1,000,000 A ANY AVID BODILY INJL;RY(Per onrsnn) S AL OWNCD �� SC'HE:n =D 014-04221-CPO '21,2014 4,28,2015 BOs".Y.,I RY P-,aca Ode-; Au SGS AL4 as NON-GINNED X HIRED AUTOS X PROPERTY DAMAGE AI:Tos jeer acmoenr 5 __ S UMBRELLA LIAR oAIcr w (I�EACH occcaeENCE s EXCESS HAD CLMS-MACE AGC� q DEC REfFNT,ONs U WORKERS COMPENSATION m.'C STAT,J OTH- AND EMPLOYERS'LIABILITY YIN -_14RY L.MIT R A.y PROFRIF'ORPARTNEWEXECUTIVE ❑ EL FACH A(I CIOENT $ Dr f,CE R'ME MSFR E XC'UOE D' NIA (Mandatory in NH) II yes.des ci be u.Cer E L CIS ASE EA EMPLOYE 5 DESCRIPTION OF OLE RATONS h,b. E.L DISEASE POI ICY LIMIT S A Directors & Officers 014-04221-00 4/28/2014 4/28/2015 L'so04VIU ,. $1,000,000 B Employee Dishonesty W60000560-12 /28/2014 4/28/2015 L„, $200,000 DESCRIPTION OF OPERATIONS)LOCATIONS)VEHICLES (Attach ACORD tat Additional Remarks Schedule it more space is required) The City of Palm Springs, its officers, employees & agents are named as Additional Insured with respect to the General Liability per form CG 20 26 07 04 attached. CERTIFICATE HOLDER CANCELLATION dale.cook@palmsprings-ca.g SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of palm Springs ACCORDANCE WITH THE POLICY PROVISIONS Attn: City Clerk/Dale Cook P.O. Box 2743 AUTHORIZED REPRESENTATIVE Palm Springs, CA 92262 Cathy Negron/NEGRON ACORD 25(2010105) C 1988-2010ACORD CORPORATION. All rights reserved. THe At-non..„„e lnnn ..,ewe.f Arnan POLICY NUMBER COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s : Locations Of Covered Operations Any person or organization that you are required to All insured premises and operations 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. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section tl — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" ..property damage" occurring after. caused, in whole or in part, by: 1. Your acts or omissions. or 1. All work, including materials, parts equip- ment furnished in connection with such h work, 2. The acts or omissions of those acting on your on the project (other than service, maintenance behalf, or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desig- covered operations has been completed. or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ POLICYHOLDER COPY SK P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 07-01-2014 GROUP: POLICY NUMBER: 1344748-2014 CERTIFICATE 10: 142 CERTIFICATE EXPIRES: 07-01-2015 07-01-2014/07-01-2015 CITY OF PALM SPRINGS SK DEPT OF BUILDING & SAFETY PO BOX 2743 PALM SPRINGS CA 92263-2743 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 3O days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT H0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2013-07-01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF PALM SPRINGS ENDORSEMENT M2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07-01-1995 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER THE FAIR HOUSING COUNCIL OF RIVERSIDE COUNTY INC. (A NON-PROFIT CORP. ) PO BOX 1068 RIVERSIDE CA 92502 M0409 (REV.1-2012i PRINTED : 06-17-2014 CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement Prolect/ACtiyitV Title: Project Number: Fair Housing Council of Riverside/ Fair Housing 0004 Name/Address of Provider: Date: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 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 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-12/18113) AREA MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD: INCOME(AMI) 1 2 3 4 5 6 7 8 LEVEL EXTREMELYLO INCOME $12,750 $15,730 $19,790 $23,850 $27,910 $31,970 $36,030 $40,090 0-30%of AM! VERY LOW INCOME $21,250 $24,300 $27,350 $30,350 $32,800 $35,250 $37,650 $40,100 31-50%of AMI LOW INCOME $34,000 $38,850 $43,700 $48.550 $52,450 $56,350 $60,250 $64,100 51-80%of AMI MODERATE INCOME $50,990 $58,270 $65,560 $72,840 S78,670 $84,500 $90,320 $96,150 81-120% 3. What racelethnlclty 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/Afncan 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 ❑ 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 I CERTIFY UNDER PENALTY OF PERJURY THAT INCOME AND HOUSHOLD STATEMENTS MADE ON THIS FORM ARE TRUE. NAME: DATE: ADDRESS: PHONE NO: SIGNATURE: The information you provide on this form is confidential and is only utilized for Community Development Block Grant(COBG)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: Project Number: Fair Housing Council of Riverside/Fair Housing 0004 Name/Address of Provider: Date: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 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 0-30% below: 31-50%below: 51-80%below: 120%below: ♦ Number of First-Time Female Headed Households: ♦ Counts by Race/Ethnicity: White American Indian or Alaska Native AND White Black/African American Asian AND White Asian Black/African American AND White American Indian or Alaskan Native American Indian/Alaska Native AND Black/African American Native Hawaiian or Other Pacific Islander Other: HISPANIC/LATINO ETHNICITY: Mexican/Chicano Puerto Rican Cuban Other: ♦ Number of Disabled: ACCOMPLISHMENT NARRATIVE LEVERAGING RESOURCES NARRATIVE Signed Title Date CITY OF PALM SPRINGS EXHIBIT F Request for Reimbursement Proiect/Activity Title: Project Number: Fair Housing Council of Riverside/Fair Housing 0004 Name/Address of Provider: Date: Fair Housing Council of Riverside County, Inc. PO Box 1068; 3933 Mission Inn Avenue 655 N Palm Canyon Dr, Ste 201 Riverside, CA 92502-1068 Palm Springs, CA 92262-5512 Approved Current Prior Total Grant Descrlptlon Groh Reimbursement Reimbursement YTD Balance Amount Period Period(s) Reimbursement (Over/Under) ersonnelCosts— $12,314. ages,Benefits&Employers axes ffice Costs— $856. upplies, Equipment,Postage& ravel perationalCosts— $117. pace Rental,Utilities& aintenance onsultant/Contract $456. Services— udit, PR,Technology& nsurance TOTAL IL:=[ E::=E== 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 tennis 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 repair work 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 journeyworkers; 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 CDBG- funded 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.