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HomeMy WebLinkAbout06339 - MIZELL SENIOR CENTER OF PALM SPRINGS CDBG SUBRECIPIENT AGR .�....� (hr Ddo ok � clogs, FCC I�d6�.� 3 .s Is SUBRECIPIENT AGREEMENT THIS AGREEMENT (herein "Agreement"), is made and entered into this_may of August , 2013, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and charter city, and the Mizell Senior Center of Palm Springs , (herein"Provider"). WHEREAS, the City has entered into various funding agreements with the United States Department of Housing and Urban Development ("HUD"), which agreements provide funds ("CDBG Funds") to the City under the Federal Housing and Community Development Act of 1974 (42 U.S.C. Section 5301 et seq.), as amended from time to time (the "Act"), and the regulations promulgated thereunder(24 C.F.R. Section 570 et 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, 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 Comoliance 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 2013 — 2014 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 Providers 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 316t 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 TWENTY-FOUR THOUSAND FIVE HUNDRED AND TWENTY-EIGHT DOLLARS ( 24 528.00) (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 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: Jack Newby. Director of Development 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 three 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 monthly 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); 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 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 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 sea.); (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 (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 Providers 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 affirmafive 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: Mizell Senior Center of Palm Springs 480 S Sunrise Way Palm Springs, CA 92262-7641 -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 municipal corporation ity Clerk Qj/9 20/ 3 City Manager APPROV D O F RM: APPROVED BY CITY COUNCIL By: �ha� �av•y P-e3'fi City Attor ey PROVIDER: ' Check one: _Individual _Partnership .X 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, Tr easurer, As ant Treasurer, or Chief F' ncial OffcOffcer). B By: Notarized Signature of Chairman of Board, Notarized Signature Secretary, Asst Secretary, President or any Vice President Treasurer,Asst Treasurer or Chief Financial Officer Name:: l{t\f U^t ic-(< Name: �Y21�/ Title: V�- �� ��+P, Title: //pp / 'cdn� State -•�/..h2 State of County of --,(; =ss County of �iGf 2 On 9 7-013 before me, .41(14Z-o before me, rsonally appeared 5NUA.A Vb D I.' 1, rsonally appeared G . who proved to L• W S who proved to me on the basis of satisfactory evidence to be the person(ct me on the basis of satisfactory evidence to be the person(s) whose nameO6 is/are subscdb d to the within instrument and whose name(( is/ere subs bed to the within instrument and acknowledge to me that sh y executed the sa In knowledged to me ffi he hexffey executed t same in his/her/their authorized capacl ), and that by a heir (emirs erkkeic authorized cap city(iM,, and that by is eFAheir signature($) on the instrument the person(s�, or t o entity gnature(yf on the instrument the person(s), c e entity upon behalf of which the person(s) acted, executed the upon behalf of which the persons) 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 Stale of California that the foregoing paragraph is true and correct. correct. WITNESS my hand and official seal. WITNESS my hand and official seal. Notary Signatu e. Notary Signa r Notary Seal: Notary Seal: SHARON M. DOTY Commission # 1861750 Notary Public-California z Riverside County �- SHARON M. DOTY My Comm.Expires Sep 16,2013� - Commission# 1861150 i •iu0- Notary Public-California = Riverside County My Comm.Ex Tres Se DaleC/C DBG 13-14M1 izell_SubrecipAg,mntAug 13 -7 - CITY OF PALM SPRINGS EXHIBIT A Scope of Services Proiect/Activity Title: Project Number: Mizell Senior Center/ 0003 Energy-Efficiency Upgrades Name/Address of Provider: Mizell Senior Center 480 S Sunrise Way Palm Springs, CA 92262-7641 Ob iectives/Act ivitie s The intent of this program is to provide programming and services for extremely-low income to moderate income seniors and frail elderly. This will be accomplished through the continuation of the facility renovations to facilitate client services areas and expand the ability to accommodate the rapidly increasing client base by making energy conservation improvements of the building's roof system to cool roof relative materials which will reduce energy costs. These upgrades will control operating expenses enabling those savings to be redirect to program and service operations as well as allow more donated funds to go directly to programs and services. The Center also serves as one of the City's emergency shelters under the Fire Department's Emergency Preparedness Plan and Riverside County Summer Crisis Cooling Center. The Mizell Senior Center primarily covers the City of Palm Springs and the adjacent community of Cathedral City, serving 5,200 clients of which 4,680 are Palm Springs'residents. The Provider shall be responsible for the completion of the following objectives/activities in a manner acceptable and satisfactory to the City and consistent with the standards required as a condition of providing these CDBG funds. Objective 1: Assist the City by timely providing any additional information requested. TARGET DATE ACTIVITY#1 On-Going Make readily available any information relative to the successful implementation of the activity. Objective 2: Establish and maintain a programmatic and financial record keeping process. TARGET DATE ACTIVITY#1 On-Going Establish and maintain an efficient program process/procedure for proper record keeping. Set-up a filing system for CDBG files only. Document and maintain all records related to this program in a stable and secure location. Objective 3: Advertise, market and publicize the program to facilitate positive promotion for all parties (i.e., Provider. City. CDBG. etc.). TARGET DATE ACTIVITY#1 On-Going Draft a promotional piece and submit to City for approval. Advertise in the Desert Sun. Submit final publication to City. Objective 4: Enroll and income aualifv at least a total of 4,680 extremely-low to moderate-income Palm Springs residents. TARGET DATE ACTIVITY#1 On-Going Provide direct client programming for Palm Springs residents. 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: Upgrade and improve the building's roof bulbs in accordance with an 'open competitive' Procurement process as outlined in proposal. TARGET DATE ACTIVITY#1 On-Going Conduct program activities, as stipulated in the proposal and in consultation with the City. Objective 8: Provide an evaluation within fifteen (15) calendar days of the program completion or final reimbursement. TARGET DATE ACTIVITY#1 07/15/13 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.) CITY OF PALM SPRINGS EXHIBIT B Budget Summary Proiect/Activity Title: Project Number: Mizell Senior Center/ 0003 Energy-Efficiency Upgrades NarnelAdClreSs Or rovi er: Mizell Senior Center 480 S Sunrise Way Palm Springs, CA 92262-7641 BUDGET SUMMARY COST CATEGORY CDBG OTHER TOTAL SHARE SOURCES COST 1 Personnel $ - 0 - $ - 0 - $ - 0 - 2 Consultant/Contract Services $ - 0 - $ - 0 - $ - 0 - 3 Travel $ - 0 - $ - 0 - $ - 0 - 4 Space Rental $ - 0 - $ - 0 - $ - 0 - 5 Consumable Supplies $ - 0 - $ - 0 - $ - 0 - 6 Rental, Lease or Purchase of $ - 0 - $ - 0 - $ - 0 - E ui ment 7 Insurance $ - 0 - $ - 0 - $ - 0 - 8 Other $21,328. $ - 0 - $21,328. Material & Labor $3,200. $1,300. $4,500. Project Management TOTALS 1 $24,528. 1 $1,300. $25,828. "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 primarily are Mizell's general donations and specific solicitations. The Subrecipient shall submit Request for Reimbursement in accordance with the aforementioned cost categories. Progress payments, approved by the Subrecipient and based upon the percentage of completion of the work with a 10% retention, shall be paid by the 301"day of each month, provided that the payment application has been submitted to the City on or before the first working day of the month. The Subrecipient shall receive reimbursements and/or its suppliers/vendors shall receive direct payments by way of a two-party check, in accordance with the aforementioned cost categories and line items which are subject to receipt of an acceptable requisition in the form of a monthly Request for Reimbursement. The Subrecipient recognizes that the CDBG Funds are received from the HUD, and that the obligation of the City to make payment to Subrecipient is contingent upon receipt of such funds from HUD. In the event that said funds,or any part thereof, are,or become, unavailable,then the City may immediately terminate or amend this Agreement. Services are to be performed over the twelve-month period of this 2013-14 Program Year—July 1, 2013 through June 30, 2014. CITY OF PALM SPRINGS EXHIBIT C Insurance Inventory Proiect/Activity Title: Proiect Number: Mizell Senior Center/ 0003 Energy-Efficiency Upgrades Name/Address of Provider: Mizell Senior Center 480 S Sunrise Way Palm Springs, CA 92262-7641 INSURANCE INVENTORY LIABILITY INSURANCE POLICY Name of Provider's Insurance Non Profits Insurance Alliance Effective Dates of Policy 10/14/12 to 10/14/13 Claims Made Policy I I Per Occurrence Policy ! / Limits of Liability $2,000,000 General Apgregate Deductibles: Per Occurrence $1,000,000.00 Annual Aggregate Additional Insured Endorsement (Certificate Holder) 0 Yes ❑ No Original Certificate of Insurance Attached ❑ Yes 21 No WORKER'S COMPENSATION POLICY Name of Provider's Insurance Company Amtrust Effective Dates 01/31/13 to 01/31/14 Limits of Liability $1 M Per Occurrence Underlying Coverage Limits Per Statute as set by State Law Original Certificate of Insurance Attached 0 Yes 2 No aco CERTIFICATE OF LIABILITY INSURANCE /T3 /2013 II CERTIFICATE 0/2013 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 endomement(s). PRODUCER CONTACT let Community Insurance Services 1st Community Insurance Services PHONE (760)325-7400 NX No;(T60)325-'1509 United Valley Ins Services pOORIESS:service@cisps.com P. 0. BOX 2408 INSURERIS1 AFFORDING COVERAGE NAIC9 Palm Springs CA 92263 INSURERANon Profits Insurance Alliance NIAC INSURED INSURER B: Mizell Senior Center of Palm Springs INSURERC: 460 South Sunrise Way INSURER D: INSURER E: Palm Springs CA 92262 INSURER F: COVERAGES CERTIFICATE NUMBER2013 Cert 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 UBR POLICY EFF POLICY EXP TR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY IMM/DDIY)r`fY1 LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 TF X COMMERCIAL GENERAL LIABILITY DAMAGE PREMISES�a occurrence) $ 500,000 A CLAIMS MADE ❑X OCCUR X 012-06856 10/14/2012 0/14/2013 MED EXP(Any one person) $ 20,000 PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X POLICY PRO- LOC 8 AUTOMOBILE LIABILITY COMBINED IT SINGLE LIM E 1,000,000 A X ANY AUTO BODILY INJURY(Per person) $ ALL OVVNED SCHEDULED 012-06856 10/14/201210/14/2013 BODILY INJURY Per accident $ AUTOS AUTOS ( I HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Medical a meets $ 5 000 X UMBRELLA DAB OCCUR EACH OCCURRENCE $ 11000,000 A EXCESS DAB CLAIMS-MADE AGGREGATE S 11000,000 DED X RETENTION$ 10,00 012-06856-U 0/14/2012 0/14/2013 S WORKERS COMPENSATION VJC STATU- OTH- AND EMPLOYERS'LIABILITY YIN T ANY PROPRIETORIPARTNEREXECUTIVE E.L.EACH ACCIDENT $ OFFICERMEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ U yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I S DESCRIPTION OF OPERATIONS)LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Those usual to the insured's operations. Certificate holder is named as additional insured per attached form CG 2026 07 04, subject to all the policy provisions and only if indicated by "Xn above. Additional insured status applies only to the extent that the work is performed under a written agreement/contract. The policy provisions govern in all situations. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Palm Springs ACCORDANCE WITH THE POLICY PROVISIONS. Office of the City Clerk ATTN: Kathie Hart, CMC AUTHORIZED REPRESENTATIVE PO Box 2743 Palm Springs, CA 92263 ��_✓ 2 ��> Stephen Baker/STEVE ACORD 25(2010105) ©1988-2010 ACORD CORPORATION, All rights reserved. INS02B on,nnF%nl The err)Pn.,an,..nnH M ernen 7ZJCY NUMBER- 2012-06856 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 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 FART SCHEDULE Name Of Additional Insured Persons 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. The City of Palm Springs information required to complete this Schedule,it not shown above,will be shown in the Declarations. Section It — Who Is An Insured is amended to in- clude as an additional insured the person(s)or organi- zations) shown in the Schedule, but only with respect to liability for "bodily injury", 'property damage' or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations;or B. in connection with your premises owned by or rented to you. CG 20 26 07 04 C ISO Properties. Inc.,2004 Page 1 of 1 ❑ MIZESEN-01 SJOHNSON ACORO' DATE IN MIDDmYY) s� CERTIFICATE OF LIABILITY INSURANCE 5/29/2013 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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER CONTACT AP Into go Insurance Group,LLC / '.� ,J NAME: g p, �� fl ? Z j PHONE 800 274.4632 FAX Suite North Road Y `' / A o Eat) ( ) Sudbury,0 �� EMAIL -- Sudbury,MA 01776 / � 1,. -.�' �� Aooaess: INSURER(Sl AFFORDING COVERAGE NAIC a INSURER A:Amtrust 135125 INSURED INSURER B. Mizell Senior Center of Palm Springs(a Corp) INSURER C: 480 S Sunrise Way INSURER O: Palm Springs,CA 92262 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 rypE OF INSURANCE S P LI YEFF POLICY EXP LTR POLICY NUMBER MMAJDfIYYY MM,DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea ocmeence $ CLAIMS-MADE OCCUR MED EXP_(Ar,one person) 3 _ PERSONAL&AOV INJURY $ J _ GENERAL AGGREGATE 3 GEN'L AGGREGATE LIMIT APPLIES PER: i PRODUCTS-COMPIOP AGG 5 _ POLICY PRO- LOC ! 3 AUTOMOBILE LIABILITY MBINEnINGLE LIMIT Ea $ ANY AUTO BODILY INJURY(Per person) 5 I ALLOWNED SCHEDULED BODILY INJURY(Per scoderd) S AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTYDAMAGE S AUTOS Per acdden f UMBRELLA LIAR _ OCCUR EACH OCCURRENCE $ EXCESSLIAa CW MSMADE AGGREGATE S LED I I RETENTIONS Is ANOREMPLOYERS'LIABI X RE8S COMPENSATIONSTLI AIT- ER A ZANYPROPRIETORIPARTNEWEXECUTIVEYIN SWC1016499 1/3112013 113112014 E.L.EACHACCIDENT S 1,000,00 OFFICERIMEMBER EXCLUDED? MIA i IMandatory In NNl E.L.DISEASE-EA EMPLOYE $ 1,000,00 "gas des"ibe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,DOD,OB DESCRIPTION OF OPERATIONSI LOCATIONSI VEHICLES (ARech ACORD 101,Additional RemerMs Schedule,a more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Palm Springs THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 3200 East Tahquitz Canyon Way ACCORDANCE WITH THE POLICY PROVISIONS. Palm Springs,CA 92262 AUTHORIZED REPRESENTATIVE 01988-2010 ACORD CORPORATION. All rightsres;rJed. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement ProiecUActivity Title: Project Number: Mizell Senior Center! 0003 Energy-Efficiency Upgrades Name/Address of Provider: Mizell Senior Center 480 S Sunrise Way Palm Springs, CA 92262-7641 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 induced as household members. 2. Circle your combined gross annual income(Riverside-San Bernardino-Ontario,CA MSA—12111112) AREA MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD: INCOME(AMI) 1 2 3 4 5 6 7 a LEVEL EXTREMELY LO INCOME $13,400 $15,300 $17,200 $19,100 $20,650 $22,200 $23,700 $25,250 0-30%ofAMI VERY LOW INCOME $22,300 $26,500 $28,700 $31,850 $34,400 $36,950 $39,500 $42,050 31-50%of AMI LOW INCOME $35,700 $40,800 $45,900 $50,950 $55,050 $59,150 $63,200 $67,300 51-80%ofAMl MODERATE INCOME $62,650 t$60,150 $67,650 $75,150 t$781200T$87,200 $93,200 $99,2 00 81-120% 3. What race/ethnicity do you identify yourself as;please note that this self-identification is voluntary in accordance with equal opportunity laws? ❑ White ❑ American Indian or Alaska Native AND White ❑ Black/African American ❑ Asian AND White ❑ Asian ❑ Black/African American AND White ❑ American Indian or Alaskan Native ❑ American Indian/Alaska Native AND Black/African American ❑ Native Hawaiian or Other Pacific Islander ❑ Other: HISPANIC/LATINO ETHNICITY ❑ Yes ❑ No If yes,check one: O Mexican/Chicano ❑ Puerto Rican ❑ Cuban ❑ Other: 4. Please check,for no if you are a 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(CDSG)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: Mizell Senior Center/ 0003 Energy -Efficiency Upgrades Name/Address of Provider: Mizell Senior Center 480 S Sunrise Way Palm Springs, CA 92262-7641 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: 81-120%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: Mizell Senior Center/ 0003 Energy -Efficiency Upgrades Name/Address of Provider: Mizell Senior Center 480 S Sunrise Way Palm Springs, CA 92262-7641 BENEFICIARY QUALIFICATION STATEMENT Approved Current Prior Total Grant Description Grant Reimbursement Reimbursement YTO Balance Amount Pedod Pedod(s) Reimbursement (over/Under) Materials & Labor $21,328. Project Management $3,200. TOTAL $24,528. 1 CERTIFY THAT, (a)the City of PALM SPRINGS, as grantee of the CDBG, has not previously been billed for the costs covered by this invoice, (b)funds have not been received from the Federal Government or expended for such costs under the terms of the Agreement or grant pursuant to FMC-74-4 & 24 CFR Part 58;(c) this agency is in full compliance with all applicable provisions under the terms of the Contractor grant; and (d) this agency is in full compliance with all applicable tax laws and hereby affix original signatures. PREPARED BY: 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 Wth assistance provided under this contract, shall comply with Federal requirements adopted by the CITY pertaining to such contracts and with the applicable requirements of the regulations of the Department of labor, under 29 CFR Parts 1, 3, 5 and 7 governing the payment of wages and ratio of apprentices and trainees to joumeyworkers; provided, that if wage rates higher than those required under the regulations are imposed by state and local law, nothing hereunder is intended to relieve the PROVIDER of its obligation, if any, to require payment of the higher wage. The PROVIDER shall cause or require to be inserted in full,in all such contracts subject to such regulations, provisions meeting the requirements of this paragraph. 2. "Section 3 Clause" a. Compliance Compliance with the provisions of Section 3, the regulations set forth in 24 CFR 135, and all applicable rules and orders issued hereunder prior to the execution of this contract,shall be a condition of the Federal financial assistance provided under this Contract and binding upon the CITY, the PROVIDER and any of the PROVIDER'S subrecipients and subcontractors. Failure to fulfill these requirements shall subject the CITY,the PROVIDER and any of the PROVIDER'S subrecipients and subcontractors, their successors and assigns, to those sanctions specified by the Agreement through which Federal assistance is provided. The PROVIDER certifies and agrees that no contractual or other disability exists which would prevent compliance with these requirements. The PROVIDER further agrees to comply with these "Section X 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 concems 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 concems 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 workers 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.