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HomeMy WebLinkAbout05822 - COURT APPOINTED SPECIAL ADVOCATES OF RIVERSIDE COUNTY INC (CASA) CDBG AGR Kathie Hart From: Dale Cook Sent: November 17, 2010 8:09 AM To: Kathie Hart Subject: RE: A5822 -CASA-Support Program for FY 09-10 Good morning —Yes, close-out. Thanks. — Dale DALE E. COOK,JR. Community Development Administrator City of Palm Springs 3200 E.Tahquitz Canyon Way Telephone: (760)323-8198 P.0. Box 2743 Fax. (760)322-8325 Palm Springs,CA 92263-2743 TDD: (760)864-9527 `\ www.palmspringsca.gov D..a...Le.:..C....o...ok.a�palmspringsca.gov.. Please consider the environment before printing this email FYI . . . the City's 2009 & 2010 Budget Reduction Plan has resulted in non-safety employee furlough day on every Friday. City Hall has extended hours of Sam to 6pm on Monday through Thursday. From: Kathie Hart Sent: Tuesday, November 16, 2010 5:54 PM To: Dale Cook Subject: A5822 - CASA- Support Program for FY 09-10 Ok to close this agreement? e441 e Kathie Hart, CMC Chief Deputy City Clerk City of Palm Springs 3200 E. Tahquitz Canyon Way Palm Springs,CA 92262 5'4� (760) 323-8206 1 A (760) 322-8332 L9 Kathie.Hart@PalmSpringsCA.gov Please note that City Hall is open S a.m.to 6 p.m.Monday through Thursday,and closed on Fridays at this time. 1 1 i�ail n SUBRECIPIENT AGREEMENT THIS AGREEMENT(herein"Agreement"), is made and entered into this day of 2009, by and between the CITY OF PALM SPRINGS, (herein"City),a municipal corporatio4anchnaC�rtlefr city, and the Court Appointed Special Advocates (CASA) 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 seg.), 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 A 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 S20,000.00 or more from the City during the 2009 —2010 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 organiization's most recent charitable trust report to the Attorney General, or other financial information satisfactory to City's Finance Director. The financial information provided far in this paragraph shall be furnished not later than January 31'�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 NINETEEN THOUSAND FOUR HUNDRED AND FORTY-SIX DOLLARS ($19,446.001 (the"Contract Sum") in accordance with the Budget attached hereto in Exhibit B and incorporated herein by this reference; and as herein provided.The budget cost categories set out in Exhibit B are general guidelines and if mutually agreed by both parties, may be amended administratively by no more than 10%, without the requirement of a formal amendment to this Agreement, but in no event shall such adjustments increase the Contract Sum. The Provider shall submit to the City monthly statements on reimbursable expenditures pursuant to the attached Budget along with per inept 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: Deborah Sutton, Executive Director 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- 42 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-monthly reports on program status; (b) Section 109 of the Housing and Community Development Ad 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 11 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); �) 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.E.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 CPR 570; the "Common Rule", 24 CER 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 VIII of the Civil Rights Act of 1968 (P.L. 90-284) as amended; (r) The lead-based paint requirements of 24 CFR Part 35 issued pursuant to the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et sea.); (s) 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 570208 (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 specked 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 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). -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 attomeys'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 Contractors 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 he designated by mail. TO CITY: City of Palm Springs 3200 East Tahquclz 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: CASA for Riverside County, Inc. PO Box 3008 Indio, CA 92202-3008 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 5B T; �l a municipal corporation ity Clerk, d`1lO Z/ Z b oq City Manager APPROVE 17 A/ TO FORM: (�li APPROVED BY CITY COUNCIL City Attorney a� I 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 Secretary, Treasurer, Assistant Treasurer, or ChiefA*r,ancial Officer). by: By: No rized Signature of Chairman of Board, Notarized Signature Secretary,Asst Secretary, President or any Vice President Treasurer,/A�sst Treasurer or Chief Financial)Officer Name: Name: (,c c e v-z, Title: d rz7o.�d_u�rz — C/57S7f /-L ,— ,'ee Cz, State of ,(�_r, j• State of��j I�"C��r�l wj• County of r� .�M ss�-f_ County of t�l�5i Ae,�s^s7 q On [ JST� .Cl-i� „before me, O�n/t't'CIA-r'S US1�-1G6 , 4CP 1 _before me, A X �kr-%42A7-,personally appeared j.r�W f-I A \J l C-66s ,personally appeared 01ho proved to ` a MCCAJ+le- Who proved to me on the basis of satisfactory evidence to be the person(! me on the basis of satisfactory evidence to be the persen(s) whose name(%is/ale subscribed to the within instrument and whose name(s)islam subscribed to the within instrument and acknowledged to me that Mla/she/tlley executed the same in acknowledged to me that he/shelthey executed the same in l4q/her,114ir authorized eapacity(ieQ,and [hat by tha/her/IAW hislherltheir authorized capaeity(ies), and that by his/her/their signature on the instrument the personN, or the entity signature(s) on the instrument the person(s), or the entity upon behalf of which the personN 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 ray hand and�othrial seal. WITNESS my hand and of Ci2l seal. Notary Signa7pr : Notary Signature: Notary Seal: Notary Seal: VWA T.VILLALOW CeMJOE ALAN KRAMER wary p6 IIt aukar e Commission:Y 1856877 MIN Ri PYYYC Coal* a z -r' Notary Public-California i Comm aNe CO[rMy Riverside County My Comm.Ex ires Jul 6,2013 r Da1eC/CnBG031 orCASA_suIxeoPngrmntAugo® -7- CITY OF PALM SPRINGS EXHIBIT A Scope of Services ProlectlActbvi Title: Project Number: Court Appointed Special Advocates(CASA)! 0008 Support Program Name/Address of Provider: Court Appointed Special Advocates (CASA)for Riverside County, Inc. PO Box 3008;44199 Monroe Street Indio, CA 92202-3008 Objectives/Activities The intent of this program is to recruit, train and supervise an additional twenty (20) new community volunteers to the total number of volunteers to fifty-four (54). These volunteers work with abused, neglected or abandoned children (birth to eighteen years old), who reside in foster or group homes and are dependents of the Juvenile Court System within the City_ This will be accomplished through well- trained community volunteers who will become Sworn Officers of the Juvenile Courts and the 'child's voice in court. One major benefit of this mentoring approach, unlike other court principals who often rotate cases, the CASA volunteer is a consistent figure in the proceedings, and provides continuity for a child. 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 (.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 quality at least a total of twenty (20) Palm Springs residents from very low income youth with new access to this service. TARGET DATE ACTIVITY#1 On-Going Twenty(20) Palm Springs residents will participate in CASA. 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 Dgcument 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 quarterly 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: Establish New and/or Exiianded Services for Seniors At-Risk Youth Severely Disabled Adults, and Special need Population. TARGET DATE ACTIVITY#1 On-Going Conduct program activities 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 07/15/09 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 ProieWActivity Title: Protect Number: Court Appointed Special Advocates(CASA)1 0008 Support Program Name/Address of Provider. Court Appointed Special Advocates(CASA)for Riverside County, Inc. PO Box 3008; 44199 Monroe Street Indio, CA 92202-3008 BUDGETSUMMARY COSTCATEGORY CDBG OTHER TOTAL SHARE SOURCES COST 1 Personnel-- $18,939_ $18,939. $37,878. Wages&Taxes 2 Consultant/Contract Services _ 0 - - 0- - 0 - 3 Travel - 0- $2,060. $2,060_ Mileage Reimbursement 4 Space Rental - 0 - - 0 - - 0 - 5 Consumable Supplies - 0 - $2,000. $2,000. Volunteer Training Material 6 Rental, Lease or Purchase of - 0 - - 0 - - 0 - E ui ment 7 Insurance - 0 - $4,000. $4,000. Liability 8 Other $507. $433. $940. Background Checks $19,446. $27,432. $46,878. TOTALS 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 Judicial Council of CA, United Way of the Desert, BetterWorld Together, Riverside County Transportation Committee, John Burton Foundation for Children Without Homes, Individual Fundraising,and Contributed Program Services, all totaling$27,432. 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 %of the total annual budget. Services are to be performed over the twelve-month period of this 2009— 10 Program Year—July 1, 2009 through June 30, 2010. CITY OF PALM SPRINGS EXHIBIT C Insurance Inventory Project/Activity Title: Protect Number. Court Appointed Special Advocates(CASA)/ 0008 Support Program Name/Address of Provider: Date: Court Appointed Special Advocates(CASA) for Riverside County, Inc. PO Box 3008;44199 Monroe Street Indio, CA 92202-3008 INSURANCEINVENTORY LIABILITY INSURANCE POLICY Name of Providers Insurance Company NIAC Effective Dates of Policy 05/20/09 to 05/02/10 Claims Made Policy_! !_ _ Per Occurrence Policy Limits of Liability 2M General Aggregate Deductibles: Per Occurrence Annual Aggregate Additional Insured Endorsement (Certificate Holder) a Yes ❑ No Original Certificate of Insurance Attached ❑Yes m No WORKER'S COMPENSATION POLICY Name of Provider's Insurance Company Travelers Casualty Insurance Company of America_ Effective Dates 11/01/08 to 11/01/09 Limits of Liability Underlying Coverage Limits Original Certificate of Insurance Attached 13 Yes M No ClienfiF:198 2CASAFOR ACORM CERTIFICATE OF LIABILITY INSURANCE 8/21120191rrrY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Desert Empire Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Services,Inc- LIC#DF09643 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 77-564 Country Club Drive Palm Desert,CA S2211 INSURERS AFFORDING COVERAGE NAIC wf - INSURED INSURERA NIAC 36684 CASA for Riverside County Inc INSURER P-Q'Box 3008 INSURER C Indio,CA 92202 INSURER INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICAT[D,NOTWITFISTANDING ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TI IIS CERTIFICATE MAY BE ISSUED OR MAY f ER7AIN THE INSLIRANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE T� POLICY NUMBER POLICY LFFLL fIVE POLITY EXPIRATION DATE M 0 IYY nATF MMIGDRY LIMITS A GENERAL LIABILITY 200904207NPO 05/02/09 05/02/10 B,CN OCCURRENCE $1.000.000 RENTED X COMMERCIAL GENERAL UAa1UTY DAMAGE TO n... "r 1500,000 nf[LAIMSMADE ❑X OCCUR MED UIP(Any one person) S10.000 X Add'I Insured End't CG201007104 PERSONAL d ADV INJURY S1.000.000 GErvERAL AGGREGATE s2,000,000 GEN L AGGREGAI E LIMIT APPLIES PER PRO DUCTS-COMP)OP AGG 52,000AOO X POLICY PRO- JECT LGC A AUTOMOBILE LIASI I.ITY 200904207NPO 05/02/09 05f02110 COM91NEO SINGLE LIMIT ANY AUTO (C.J.adenl) 51,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS IPorpors.n) 5 X HIRED AUTOS BODILY INJURY Ji NON•OWNED AUTOS (%r.,cdd l) PROP=RP(OAMAGE (Pei ..denU GARAGE UASRTfT AUTO ONLY-EA ACCIDENT 5 ANYAUTO OTHER THAN EA ACC 5 AUTO ONLY. AGG S EXCE551UM15RELLA LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE DEDUCTIBLE 5 RETENIION J WORKERS COMPENSATION AND WC STATU- OTH- C EMPLOVERS'LIABILITY EL EACH ACCIDENT S ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMSER EXCLWED7 EI 015EASB-4AEMPI,OYEE 3 Ifycu.d 6SIbuunder SPECIAI.PROVISIONS belew EL DISEASE-POLICY LIMIT S OTHER DE5CRIPTION OF OPERATIONS)LOCATIONS)YENICLES)EXCLUSIONS ADDED BY ENDORSEMENT I FPECIAL PROVISIONS ... y Additional Insured: The City of Palm Springs,i5 officers,officials,employees&volunteers are to be covered as additional insureds_ Coverage&)Tall be primary and non-contributory to any insurance maintained by the certificate holder. CERTIFICATE HOLDER CANCLLLATION 10 Days for Non-Payment 511OULD ANY OF m[i ABOVE DESCR16E0 POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Palm Springs OAI C THEREOF,TIIC ISSUING INSURER WILL ENOEAYOR TO MAIL Sr)_ DAYS WRITTEN _ - Attention: City Clerk N07ICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SG SHALL - P.O.Box 2743 IMPOSE NO OR!MATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR -. Palm Springs,CA 92263 REPRESENTATIVCS AUTHORRED REPRESENTATIVE ACDRD 25(2001108)1 of 2 #S1400131M133981 2PSAY 0 ACORD CORPORATION 1968 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ics)must be endorsed. A statement on this cortlfleate does not Confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,cerlain policies may require an endorsement. A statement on this certificaLe does not confer rights to the certificate holder in lieu of such endorsement(s) DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-5(2001108) 2 of 2 #S140013/M133g81 POLICY NUMBER- 2009-04207-NPO 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 anizatfon s : Locations Of Covered Operations CITY OF PALM SPRINGS ATTENTION: CITY CLERK P.O.Box 2743 Palm Springs,CA 922E3 Information ra cared to complete[his Schedule,if not shown above,will be shown in the Declarations. A. Section 11 — 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. All work, Including materials, parts or equip- I. Your acts or omissions;or men[ furnished in connection with such 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 behalt 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 engaged in performing operations for a princi- pal as a part of the same project. CG 20 10 07 04 ©ISO Properties, Inc.,2004 Page 1 of 1 71 ACO-EVFA~ _ pnTr(MMrnpl�vl'r] 4.mW�F kd(� �`ER�i'�6�'� A,IT'E OF �,�R.�M,e �OTY @ "SUR,:.l��kC � 1�/,7/:Dos rYlonuprP .` T[CIS CCRTIFICATL IF ISSUED A5 A MATT ER OF STrN QFUATIIIC M FAYc:HEri AGENIOY INC OKY AND CONFERS NO RlaG r:S WP0M THE CEFITIFICA T E 'ISO SAIMGHA5 DRIVE_ HOLDER. TH(S CERTIFICATE DOM NOT AMEND, E�FND OR 130 SAWG_R, S •,AG20 ALTER THE COVERA aE RFFORGED 6Y TWG POLfGIE5 LREL0171f. 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SF = 21.CD0.0001rL O -20111110J OERCRIF r19nI OF OPEFlnT1pNSrL00nTiCIP19r pF1{If1,Eg1 EJfCl_uSlOnl3 q➢dfa OV F.PID01ia•C+MF.M1T/SPF.CIhL RflOp1910p1g INTHF FVCNT OF NON-f-'AYMCNT C)F 15RE1gII,JM ON'`/T CN(IA)DAYS NQTICF OF CANCELLA T ION SHAD BE GIWFN rCERT'rIGATE HOLPF_R .`.`_�. �_ GACJ061-LATEOPV I 21HOl1411 ANY OF TI Ir AECVr Drs:Fliory POI,rCICq FE DANCP.I.LL@ 7EFORE THE E1;P13A'10n1 ➢ATE TRERrnr,TFIE IOBVINO INsugER 11LL T1ilrn1111 TO MAIL a0 lAYT IVRITTrN n1oTIf.E,-O THE rrgTlr:-0T[IIGLnrq iJnMCN'fo TPIE I EF,SLIT PAILURETO 110 SO 5"A',l. - IfuPOdr Pin OFUCIA7I0N OR LIAPoLITr OF APIV 1UND bPOFI 1'r2 CISURER,ITS AGERIrS OR WFIESWA-MOS nUTIIORRDD REPFE"EM1I�ATV- f r�! 1 ^nc,QF[C^xa( 0p'1/6r;i) .— —. rfSi ACS},RD COrgPORAoPOk+N 1919A CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement Proiect(Activit4 Title: Project_Number, Court Appointed Special Advocates(CASA)1 0008 Support Program Name/Address of Provider Date: Court Appointed Special Advocates(CASA) for Riverside County, Inc. PO Box 3008;44199 Monroe Street Indio, CA 92202-3008 BENEFICIARY QUALIFICATION STATEMENT This statement must be completed and Signed by each person or head of household (legal guardian) receiving benefits farm the described project/activity. Please answer each of the following questions. 1. Haw 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,momers,or borders cannot be included as household members- 2- Circle your combined gross annual income(Riversid"an Bernardino-Ontario,CA MSA—133110109) AREA MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD: INCOME(AMI) 1 2 3 4 5 6 7 3 LEVEL EXTREMELY LO INCOME $14,000 $16,000 $18,000 $20,000 $21,600 $23.200 S24,800 $26,400 0-30y of AMI VERY LOW INCOME S23130D $26,650 $29,950 $33,300 $35.950 $38,650 S411300 S43,950 31-50%of AMI LOW INCOME $37,300 $42,650 $47,950 $53,300 557,550 $61.850 $66,100 $70,350 51-80%of AMI MODERATE INCOME 554,200 $61,900 $69,650 $77,400 $83,600 $89,800 $96,000 $102.150 81-120Y 3. What racelethnieity do you identify yourself as;please note that this self-identification is voluntary in accordance with equal opportunity laws? ❑ White 0 American Indian or Alaska Native AND White ❑ Black/African American ❑ Asian AND White ❑ Asian ❑ SlaaklAfncan American AND White ❑ American Indian or Alaskan Native ❑ American IndianWaska Native AND Black/African American ❑ Native Hawaiian or Other Padfio Islander ❑ Other: HISPANIC/LATINOETHNICITY ❑ Yes 0 No If yes,check one: ❑ Mempir/Chicano 11 Puerto Rican ❑ Cuban 4 Other. 4_ Are you female Head of Household? ❑ YES ❑ NO S. Do you have a disability? ❑ YES 0 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 Federalty-funded program,governmental reporting purposes to monitor compliance CITY OF PALM SPRINGS EXHIBIT E Quarterly Program Progress Report Project/Activity Title: Proiect Number: Court Appointed Special Advocates(CASA)1 0008 Support Program Name/Address of Provider. Date: Court Appointed Special Advocates(CASA) for Riverside County, Inc. PO Box 3008;44199 Monroe Street Indio, CA 92202-3008 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 While Black/African American Asian AND White Asian BlacklAfrimn American AND White American Indian or Alaskan Native American Indian Alaska Native AND Black/African American Native Hawailan or Other Pacific Islander Other. HISPANICILATINO ETHNICITY: MexicanfChimno Puerto Rican Cuban Other. ♦ Number of Disabled: ACCOMPLISHMENT NARRATIVE LEVERAGING RESOURCES NARRATIVE Signed Title pate CITY OF PALM SPRINGS EXHIBIT F Request for Reimbursement P_roject/Activity Title: Proiect Number: Court Appointed Special Advocates (CASA)/ 0008 Support Program Name/Address of Provider. Date: Court Appointed Special Advocates(CASA) for Riverside County, Inc. PO Box 3008;44199 Monroe Street Indio, CA 92202-3008 Approved Current Prior Total Grant Description Grant Reimbursement Reimbursement YTD Balance Amount Period Periods) Reimbursement (over!Under) Personnel $18,939.00 Other 507.00 Background Checks TOTAL $19,446,00 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 byt Examined by! Approved by. If necessary, additional sheet(s)must be attached detailing cost breakdowns,and verified by original signatures.