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HomeMy WebLinkAbout05644 - JEWISH FAMILY SERVICE OF SAN DIEGO CDBG SUBRECIPIENT AGR DOCUMENT TRACKING Page:1 Report: one Document Detail August 11,2009 Condition: Document Numbera5644, Document# Description Approval Date Expiration Date Closed pate A5644 GDBG 08.09 Desed Horizon Services&Overnight Shelter $28,969 04/02/2008 Company Name: Jewish Family Services of San Diego Address: Group: COMMUNITY&ECONOMIC Contract Amt. Total Paid Balance Service: In File $26,969.00 $28,969 00 xRef: DALE COOK 760 323.8198 Ins.Status: Certificate and Policies are OK Document Tracking Items: Due Completed Tracking Amount Amount Code Item Description Date Date Date Added Paid Win Res 22194 Item 1A 0410212008 $28,969.00 kdh to CA for sig 04/28/2009 kdh to CM for sig 0511112009 05/04/2009 kdh per convo with Dale-DONE-ok to close 0811112009 ******END OF REPORT"""*"" ,mom SUBRECIPIENT AGREEMENT THIS AGREEMENT (herein "Agreement"), is made and entered into this 3`d day of April , 2009, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and charter city, and the Jewish Family Service of San Diego , (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 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, 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 Reportinq. Any Provider receiving or due to receive or due to receiver $20,000.00 or more from the City during the 2008 — 2009 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 315L 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-EIGHT THOUSAND NINE HUNDRED SIXTY-FOUR DOLLARS ($28.964.00) (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: Joel Craddock Senior Director 32 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 Assi nment. 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 three 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: (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; (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; (1) The restrictions prohibiting use of funds for the benefit of a religious organization or activity as set forth in 24 CFR 570200 0); 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.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 - 3- 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; (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 sew.); (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 Provider's -4- 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). 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 - 5 - 3200 East Tahquitz Canyon Way Palm Springs, CA 92262-6959 Attn: City Attorney TO PROVIDER: Jewish Family, Service of San Diego 8804 Balboa Ave San Diego, CA 92123-1506 72 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- Not o� hx�ceer: WJ thOLlt Th'9 ::5,4t'ess �Rrfttejt Authori7atioll Of The City Manager. CITY OF PALM SPRINGS ATTEST: a municipal corporation C�Clerk e)�/f I�Z4O City Manager APPR VE:D T o : APPROVED BY CITY COUNCIL By. �11h � [ hbA ity Atto ey PROVIDER: Check one: Individual ,Partnership _Corporation (Corporations require two notarized signatures: One signature roust be from the Chairman of Board, President, or any Vice President. The second signature must be from the Secretary, Assistant Secre a , Treasurer, Assistant Treasurer, or Chief Financial Offi/c9er). Notarized Signature of Chairman of Board, Notarized Signature Secretary,Asst Secretary, President or any Vice President Treasurer,Asst Treasurer or Chief Financial Officer Name: 51L]).F �XWu Jt Name;6WIAf,'UL-_45 A, K�RsicTT�� Title:Rm- [ t»tJ"r Title: e r_0 State of State of GR f 6, lL_ S'�County of iss County of S,: e5 r ^�t n St On before me, On / A o q r_L,t 1 �20- before me, personally appeared rr personally appeared personally known f�u]pt e e l a &PwS-(a�v�rJPJI personally known to me(or proved to me on the basis of satisfactory evidence) to me(or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscrbed to the to be the person(s) whose name(s) isfam subscribed to the within instrument and acknowledged to me that he/she/they within instrument and acknowledged to me that helshelthey executed the same in his/her/their authorized eapaeity(es), executed the same in hislhedtheir authorized capacity(ies), and that by hislhedtheir signatum(s) on the instrument the and that by his/her/their signatum(s) on the instrument the person(s), or the entity upon behalf of which the person(s) person(s), or the entity upon behalf of which the person(s) acted,executed the instrument, acted,executed the instrument. WITNESS my hand and official seal, WITNESS my hand and office all. Notary Signature: Notary Signature: Notary Seal: Notary Seal: n �, ETLEVA eEJKO h (J� Cow.t 1650326 rr NOTARY PIINLIC•CAlIFORNIA r SAN PIEGG CO�NT1' My cauN exr MnR.s 2oto "' JFS_Subredp4grmnL0C 6 -7- ACKNOWLEDGMENT" State of California ) County of San Diego ) On April 3, 2009, before me, Becky J. Neidhardt, a Notary Public, personally appeared Steven J. Levine, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. BECKY J. NEIDHARDT Comm.#M8302 (seal) N NOTARY POYIIC.UUF NMA N �, A , r sAn EV. Coue,r $CCI{y I�IClddt MY Cow,F,x!',MAY 21, ATTACHMENT TO SUBRECIPIENT AGREEMENT SD\675655 1 CITY OF PALM SPRINGS EXHIBIT A Scope of Services Project/Activity Title:_ Project Number: Jewish Family Service of San Diego/ 0010 Desert Horizon-SOS Transitional Housing Name/Address of Provider: Jewish Family Service of San Diego 8804 Balboa Ave 1733 N Palm Canyon Dr, Ste A San Diego, CA 92123-1506 Palm Springs, CA 92262-2957 Objectives/Activities The intent of this program is to assist homeless persons to obtain permanent housing, increase their functional independent living skills and secure employment. This will be accomplished through supplementing the funds required to match JFS Continuum of Care grant to provide housing and supportive services for fifty-one (51) 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 Cites 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 fifty-one (51) Palm Springs homeless residents with new access to services. 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: Provide emergency housing services, including motel vouchers to homeless individuals, as outlined in proposal. TARGET DATE ACTIVITY#1 On-Going Conduct program activities, 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 PraiecYActivity Title: Protect Number: Jewish Family Service of San Diego! 0010 Desert Horizon-SOS Transitional Housing Name/Address of Provider. Jewish Family Service of San Diego 8804 Balboa Ave 1733 N Palm Canyon Dr, Ste A San Diego, CA 92123-1506 Palm Springs, CA 92262-2957 'BUDGET SUMMARY ' COST CATEGORY CDBG OTHER TOTAL SHARE SOURCES COST 1 Personnel $28,964. - 0 - $28,964. 2 Consultant/Contract Services - 0 - - 0 - - 0 - 3 Travel - 0 - - 0 - - 0 - 4 Space Rental - 0 - $100,656. $100,656. 5 Consumable Supplies - 0 - - 0 - - 0 - 6 Rental, Lease or Purchase of - 0 - - 0 - - 0 - Equipment 7 Insurance 8 Other - 0 - - 0 - 0 - Telephone - 0 - $16,215. $16,215. Client HMIS $28,964. $116,871. $145,835. 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 primarily are fundraising activities conducted by Jewish Family Service of San Diego, totaling $20,000. EXHIBIT B—Budget Summary Page 2 of 2 Pages DETAIL BUDGET pESCRIPTION OF ACTIVITY/ CDBG OTMER TOTAL PAY ITEMS SHARE SOURCES COST Personnel - $21,723. - 0 _ $21,723. Salaries Benefits $7,241. - 0 _ Total $28,964. , _ 0 _ $28,964. The Subrecipient shall submit monthly reimbursement of Personnel Salaries/Benefits for Outreach Advocate at Palm Springs facility based on prorated salary and actual fringe benefits in accordance with the aforementioned cost categories. In no month shall the Subrecipient submit for reimbursement more than '% of the total annual budget. Payments, approved by the Subrecipient, 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. Services are to be performed over the twelve-month period of this 2008-09 Program Year—July 1, 2008 through June 30, 2009. CITY OF PALM SPRINGS EXHIBIT C Insurance Inventory Prolect/Activity Title: Project Number Jewish Family Service of San Diego/ 0010 Desert Horizon-SOS Transitional Housing Name/Address of Provider: Date: Jewish Family Service of San Diego 8804 Balboa Ave 1733 N Palm Canyon Dr, Ste A San Diego, CA 92123-1506 Palm Springs, CA 92262-2957 INSURANCE INVENTORY LIABILITY INSURANCE POLICY Name of Provider's Insurance Company Philadelphia Indemnity Effective Dates of Policy 07/01/08 through 07/01/09 Claims Made Policy ( / Per Occurrence Policy / / Limits of Liability General Aggregate $2,000,000 Deductibles: Per Occurrence Annual Aggregate Additional Insured Endorsement (Certificate Holder) GI Yes ❑ No Original Certificate of Insurance Attached ❑ Yes 0 No WORKER'S COMPENSATION POLICY Name of Provider's Insurance Company State Cam ensation Insurance Fund Effective Dates 07/01/08 through 07/01/09 Limits of Liability $1,000,000 Per Occurrence Underlying Coverage Limits Original Certificate of Insurance Attached 11 Yes IZ No 1 DATC IMMIDDNYI ACORD ''�i a :1:�1 ` rP L � �;#'��•f,,� ' ,.�1'1'''L �'F'�.�����`F'1'V � �� 12115/08 c ISSUED AS MATTER, 55 PRODUCER 619-238 1828 THIS CERTIFICATE IS S /- OF INFORMATION Alliant Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Lawrence A. Weltzen ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 701 B Street 6th Floor COMPANIES AFFORDING COVERAGE San Diego, CA 92101 COMPANY A Philadelphia Indemnity INSURED COMPANY Jewish Family Service B of San Diego COMPANY 8804 Balboa Avenue C: San Diego CA 92123 COMPANY D .. . pO,, afS.. i = ki4.ba .ae;:::" :yi<�Y;( .,,f'`fi'aSY�;+8a'%%%:yi,«.ii%aY"'nf»J•:: � ,,., o..:r :nn::::.:. �V P H. . J""..iida''•ri4'Ti"n%I:.aa ki ,"lf','," fr;,»ii,,(gi'bi'•1»':kk ,e:; '.:i;'« Y;M';s;:;;i ;';;«;;;; i» `.,°b..•» 'r',fm THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO INS •<, 'URED NAME❑ AeOVE..;. FORTHE POLICY PIER= INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM$, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE IMMIODNYI DATE IMM/DD1YY1 A GENERAL LIABILITY PHPK325003 7/01/08 7101/09 GENERAL AGGREGATE_ 2000000 X COMMERCIALGENERALLIAEILITY PRODUCTS-COMP/OP AGO 2000000 CLAIMS MADE F_x1 OOCUR PERSONAL y ADV INJURY S 1000000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE 1000000 FIRE DAMAGE(Any one Gee) 100000 MED EXP(AA,one person] $ 5000 A AUTOMOBILE UABILITY PHPK325003 7101103 7/01/09 COMBINED SINGLE LIMIT ANY AUTO 1000000 ALL OWNED AUTOS BODILY INJURY q X SCHEDULED AUTOS (Per person] X HIRED AUTOS BODILY INJURY 5 X NON•OWNGO AUTOS lPcr,cclecnd PROPERTY DAMAGE GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 6 ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT u AGGREGATE A EXCESS LIABILITY PHUB243302 7101/05 7/01109 EACH OCCURRENCE 0 5000000 UMBRELLA FORM AGGREGATE 5 S000000 X OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND WC SOnyTATU- OTH- EMPLOYERS UABILITY EL EACH ACCIDENT a THE PROPRIETOR/ INC[ EL DISEASE•POLICY LIMIT 5 PARTNERS/EXECUTIVE CFFICEAS ARE EXCL EL DISEASE•EA EMPLOYEE A OTHER PHPK325003 7/01108 7/01/09 PROFESSIONAL $1,000,000 EACH OCCURRENCE LIABILITY '10 DAYS NOTICE FOR NONPAYMENT DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIAL ITEMS RE. PROJECT 0010-JEWISH FAMILY SERVICE OF SAN OIEGO/DESERT HORIZON- SERVICES AND OVERNIGHT SHELTER. CERTIFICATE HOLDER IS ADDITIONAL INSURED PER CG2010. COVERAGE IS PRIMARY AND NON-CONTRIBUTORY- COMMERCIAL�AUTO DESIGNATED INSURED PER CA2048. D��'1F��A7�H>r1 M•6R=a9 • fi.f=e a Po ff 1fi a = f„GAMCEl,1,A,T�Qlkfs,» A, fi kL" 3 N »iffiia' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF PALM SPRINGS EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL r+IG6WWR—SO MAIL ATTN: CITY CLERK 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, P.O. BOX 2743 B'I'*'TA+ a neN-aR-elAa PALM SPRINGS, CA 92262 '° INFHIUPON E�"�' AUTIi RI REPRESENT TV •• H ..,.<..... , ya;,«<„iia�: iii, ,.,y q f,yY;SI"6< 5f9'. =AGORD,2$�,5 'J9 "'ltiGt?'E�p'CORPt?R.7:f"N`:T�'••... POLICY NUMBER PHPK325003 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL. INSURED - DINNERS, 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 Organization s : Locations Of Covered 0 orations THE CITY OF PALM SPRINGS, ITS OFFICERS, O n File with Company OFFICIALS, EMPLOYEES AND VOLUNTEERS APE TO BE COVERED AS ADDITIONAL INSUREDS. 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 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 7. All work, including materials, parts or equip- 1. Your acts or omissions; or ment 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 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) deslg- 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 FOR ANY CLALvIS RELATED TO THIS PROJECT, NAMED INSURED'S INSURANCE COVERAGE SHALL BE PRIMARY AND NON—CONTRIBUTORY TO ANY INSURANCE MAINTAINED BY THE CERTIFICATE HOLDER. CG 20 10 07 04 ©190 Properties, Inc., 2,004 Page 1 of 1 a POLICY NUMBER' PHPK325003 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modi- fied by this endorsement This endorsement identifies person(s) or organization(s)who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: 07/01/2008 Countersigned By: / Named Insured: v�� Jewish Family Service of Authorized Representative SCHEDULE Name of Person(s)or Organization(s): CITY OF PALM SPRINGS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured"for Liability Coverage, but only to the extent that person or organization qualifies as an 'insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. - CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 M BROKER COPY SD STATE P.O. BOX 420807, SAN PRANCISCO,CA 94142--0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 12-15-2008 GROUP: POLICY NUMBER: 18487GO-20DB CERTIFICATE ID: 13 CERTIFICATE EXPIRES:07-01-20De 07-01-2008/07-01-2009 CITY OF PALM SPRINGS SO ATTN: CITY CLERK PO 8OX 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 cancellaclon 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 hereln. 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 tho policy described herein is subject to all the terms, ,exclusions, and conditions, of such policy. tTMQRk1ZEDEPqRE/SENTATI%�SJC� PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT N2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07-01-2007 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. -�� ENDORSEMENT 92570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 200E-12-15 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF PALM SPRINGS EMPLOYER JEWISH FAMILY SERVICE OF SAN OIEGO SO 8804 BALBOA AVE SAN DIEGO CA 92123 [B17,SDj ifV.2-os) PRINTED 12-15-2009 CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement Project/Activity Title Project Number: Jewish Family Service of San Diego/ 0010 Desert Horizon-SOS Transitional Housing Name/Address of Provider: Date: Jewish Family Service of San Diego 8804 Balboa Ave 1733 N Palm Canyon Dr, Ste A San Diego, CA 92123-1506 Palm Springs, CA 92262-2957 BENEFICIARY QUALIFICATION STATEMENT This statement must be completed and signed by each person or head of household (legal guardian) receiving benefits form the described projectfactivity. 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—02113108) AREA MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD: INCOME(AMI) 1 2 3 4 5 6 7 8 LEVEL EXTREMELY LO INCOME $14,000 $16,000 S18,000 $20,000 $21.600 $23,200 $24800 S26,400 0.30%of AMI VERY LOW INCOME $23,300 S26 650 S29,950 $33,300 S35,950 $38,650 $41.300 $43.950 31.50%of AMI LOW INCOME $37,300 $42,650 $47,960 $53,300 $57550 S61,850 S66,100 $70,350 51-a0%of AMI MODERATE INCOME $52,100 $59,500 $67,000 $74,400 $80.400 $86,300 S92,300 S98,200 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 Q American Indian or Alaskan Native ❑ American Indian/Alaska Native AND Black/African American ❑ Native Hawaiian or Other Pacific Islander 0 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 HOUSHOLO STATEMENTS MADE ON THIS FORM ARE TRUE. NAME: DATE: ADDRESS: PHONE NO: SIGNATURE: The information you provide on this form is for Community Development Block Grant(CD8G)program purposes only and will be kept confidential. CITY OF PALM SPRINGS EXHIBIT E Program Progress Report Proiect/Activb Title: Project Number: Jewish Family Service of San Diego! 0010 Desert Horizon-SOS Transitional Housing Name/Address of Provider: Date: Jewish Family Service of San Diego 8804 Balboa Ave 1733 N Palm Canyon Dr, Ste A San Diego, CA 92123-1506 Palm Springs, CA 92262-2957 PROGRAM PROGRESS REPORT Period: DIRECT BENEFIT REPORT ♦ Number of First-Time Program Beneficiaries Serviced: #of Households #of Persons 0-30% below: 31-50°/a 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 BlacldAfriean American AND White American Indian or Alaskan Native American Indian/Alaska Native AND BladdAfrican American Native Hawaiian or Other Pacific Islander Other: HISPANICILATINO 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 Project/Activity Title: Proiect Number; Jewish Family Service of San Diego/ 0010 Desert Horizon-SOS Transitional Housing Name/Address of Provider: Date: Jewish Family Service of San Diego 8804 Balboa Ave 1733 N Palm Canyon Dr, Ste A San Diego, CA 92123-1506 Palm Springs, CA 92262-2957 ' 'Approved' Currant , Prior Total =,,an,, Description Grant, Reimbursement Relmbursament YTD Amount Period Periods) Reimbursement Salaries—Outreach Advocate $10,455. Benefits—Outreach Advocate $4,545. TOTAL 515,000. ���� 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.