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HomeMy WebLinkAbout05645 - CASA OF RIVERSIDE COUNTY CDBG AGR DOCUMENT TRACKING Page:1 Report: One Document Detail October 14,2010 Condition: Document Number a5645, Document# Description Approval Date Expiration Date Closed Date A5645 Support Program for FY 2008-09 $16,000 04102/2008 company Name: CASA for Riverside County kddress: Marc Haupert Intrim Executive Director, P 0 Box 3008,Indio,CA 92202 ,ontact: Mr.Haupert 3roup: COMMUNITY&ECONOMIC Contract Amt. Total Paid Balance Service: In File $16,000.00 $16,000.00 cRef: DALE COOK 760 323-8198 ns.Status: A policy has Expired Document Tracking Items: Due Completed Tracking Amount Amount Code Item Description Date Date Date Added Paid cab to Jay for sig 02/06/2009 cab dupl orig to Dale Cook,In File 02/0612009 kdh Res 22193 Item 1A 04102/2008 $16,000.00 kdh to CA for sig 01/2712009 kdh to CM for sig 02/02/2009 ******END OF REPORT****** X�o uVL t SUBRECIPIENT AGREEMENT THIS AGREEMENT(herein"Agreement"), is made and entered into this-1�day of 2008, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and charter city, and the Court Appointed Special Advocates (CASA) of Riverside County Inc. , (herein i "Provider"). WHEREAS, the City has entered into various funding agreements with the United States i 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. y Section 5301 et seg.), as amended from time to time (the "Act"), and the regulations promulgated t thereunder(24 C.F.R.Section 570 gt seq.("Regulations");and i 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 i 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 Providers 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 fallowing 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 1. 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 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 organizations most recent charitable trust report to the Attorney General,or other financial information satisfactory to Ctty's Finance Director_ The financial information provided for in this = paragraph shall be furnished not later than January 3V of the current fiscal year. s � 3 i 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 SIXTEEN THOUSAND DOLLARS 16 000.00) (the "Contract j 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 0 this AgreemeM 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 Pa IIRecords. 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 13.6. 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. i 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 Suiion Executive Director @r rya s. do nh � . 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 -2- I i G 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. 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; v (b) Section 109 of the Housing and Community Development Act of 1974, j as amended and the regulations issued pursuant thereto; k i r (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; ' F (e) Executive Order 11063, as amended by Execufive Order 12259, and implementing regulations at 24 CFR Part 107; (f) Section 504 of the Rehabilitation Act of 1973 (P.L. 93-112), as amended,and implementing regulations; (g) The Age Discrimination Act of 1975 (P.L. 94-135, as amended, and implementing regulations; (h) The relocation requirements of Title II and the acquisition requirements of Title III of the Uniform Relocation Assistance and Real Property Acquisition at 24 CFR Part 42; (i) The restrictions prohibiting use of funds for the benefit of a religious organization or activity as set forth in 24 CFR 570.200 0); Q) The labor standard requirements as set forth in 24 CFR Part 570, Subpart K and HUD regulations issued to implement and requirements; (k) The Program Income requirements as Set forth in 24 G.F.R. 570.504(c)and 570.503(b)(8); (1) The Provider is to cant' 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); -3- i i (o) The regulations, policies, guidelines and requirements of 24 CFR 1 570; 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; F i (p) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) and j implementing regulations issued at 24 CFR Part 1; I i (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 etM.); (s) Maintain property inventory system to numerically identify HUD purchased property and document its acquisition date as is set forth f 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 t 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 i 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 cast, 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 ads or omissions arising out of or related to Providers performance under this Agreement Provider shall also carry Workers'Compensation Insurance in accordance with State Workers'Compensation laws. Such insurance shall be kept in effect during the term of this Agreement and shall not be cancelable without thirty (30) days' prior written notice of the proposed cancellation to City. A certificate evidencing the -4- I f foregoing and naming the City as an additional insured shall be delivered to and approved by the City I ! prior to commencement of the services hereunder. The procuring of such insurance or the delivery of 6 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 Five Hundred Thousand Dollars i ($500,000). j i 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 casts 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 g negligence or that of its officers or employees. I 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 I 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. r TO CITY: n City of Palm Springs 3200 East Tahquitz Canyon Way Palm Springs,CA 92262-6959 Attn, City Manager -5- f. V WITH COPY TO: F City of Palm Springs 3200 East TahquitzCanyon Way Palm Springs,CA 92262-6959 Attn: City Attomey i ,TO PROVIDER- CASA for Riverside County. Ina 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 insbument in writing. i IN WITNESS WHEREOF,the parties have executed and entered into this Agreement as of the date. first written above- End—Signatures on Next Page] �i -6- is " — CITY OF PALM SPRINGS [[ I ATT a municipal corporation i By: B __ OZ�d to/700 City Manager E. I Clerk i I AyPPRO E TO F nPlJP�Ra v�) SaY tGVT.Y CO1hC�l}, B : 9 City Attorney 5l�15 I i PROVIDER: Check one: —Individual —Partnership —Corporation t (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 Secreta ,Treasurer,AssjstantTreasurer,or Chief Financial Officer). By . o rized Signahare of C mian o Board, Notarii d Signature secretary,Ass,Secretary, President or any Vice President Treasury,Asst Treasurer or Chief Financial Officer ame: �ifl I ! Name: 2 J_ i(v" / rj,5;,1 oA �y Title:?Cx5; L4$ CR514 Zd L^ ,°aid 4ta:t� C Title: KC USAV i C` 100 fc4 Le't� PPP . State of C4 Stan of `-"to(ml I��b� } countyoF `rrlrr"L�ss p ' counryoF �V(N5Y(x"Z �55 .—J- - -•� - 0A before me, O\n before me, personally appeared \ personally appeared personally known �, pamonally known to me(or phqved to me on the basis of satisfactory evidence) o me for prmr\od to me on the basis of satisfactory evidence) to be the pe (s)whose name(s)islare subscribed to the to be the perse 5)whose names)islam subscribed to the within instnrmen nd arhnowledged to me that helshelthey within instnrment d acknowledgo I m me that he/shelthey executed the same " his/herltheir author>zed rapaciKies), exeaited the same r hisAredtheir authorized capacity(ies). and thaC by hislher/th - signatune(s) on the instrument the and that by hislher/Ihei igRalurc(s) on the instrument the porson(s), or the entity on behalf of wifich the person(s) person(s), or the entity up behalf of which the persons) (; acted,executed the insbum acted,executed the inswmen .I WITNESS my hand and official s wITNESS my hand and official sea- Nctary Notary Signature: Signature: - Notary Sea(: Notary Seal: r CASA_SubrecipAgnnnCoctp6 -7_ _ �i CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California n County of n On BUJ before me, 4v G� �?.ti c � / ! ��J d I Lb-, o c ' (Here insert name and Wile of the officer) personally appeared D Lc S A who proved to me on the basis of satisfactory evidence to be the person(o whose name(O is/a(e subscribed to the within instrument and acknowledged to me that he/she/they executed the same in hisTier/thefr authorized capacity(i s), and that by hisUr/tlteir signature(s) on the instrument the person(S), or the entity upon behalf of which the persona) 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. ] - w; LETICIA sANCOVAL ,� i COMM *1745173 7 N !?� Nolary Public-Csidgnla L_ Wl" SS my hand and Icial seal. 1° LOS ANOELES COUNTY My Comm,EYp May 14.2011 Y � �ii (Notary Seal) 6�Signature ofNr([ary Public ADDITIONAL OPTIONAL INI+ORMATION INSTRUCTIONS FOR COMPLETING THIS FORM Any ae/mom4dgmenl cumpleled in California tire, cuntain vc,bragc exaetln+ as Ili DE CRIPTTON OF THE ATTACHED DOCUMENT ,ppvvr5 above in the notary secmnn oe a acparate ocknmviedgment forni inner be properly compleled and arrachud to that document the only excelmon a if a doCLenenl i5 io be rucurdud outside of'Cohfnrvia In M'01,rnamnccs any alternative (I ite or description ofallached document) oclu,mrlurlgnlent herbage at may be prrnled on such a document so long a,, the ncr-bragc does not require Elie noiu,y to do something that is dlepal for a nnmry in California (r e certifying the authurrred capacity of the s/gnerJ pluaau chuck tb. (]'rclu o e"cripnon of attached document continued) document carefidlvfor pi open notarial rvordmgand attach this form ifregeured, Number of Paa Document Date State and County ullormalion must be the State and County where the document aignei(s)polsonally appedred before the notary public far acknowledgment. • Dale of notdnzatmn must be the dam that the signer(a)personally appeared which must also be the saint date the acknowledgment is completed (Ad ytlonal information) • The notary public must print ]its or her name as It appears within his or hei i commission Iollowed by a comma and then your into(notary public) • Print the name(s) 01 IIoCLiMUM aigner(s) who personally appear a[ the lime of notarization CAPACITY CLAIMED 13V THE SIGNER • Indicate the coned mngular or plural forms by crossing off incorrect forms(i e ❑ Individual(s) He/shclNtet,-is lure)or circling the correct fonts Failure to Correctly indicate this information may lead to rejection OI d=lmenl recording ❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible Impression nhust not cover text or Imes. If seal impression snhudres,le-seal if a (Talc) sett icient ai as pennna,otherwise complete a dd4ercni acknowledgment form ❑ Partner(s) • Signaitre of the notary public must match the signature on file with the office of the County clerk ❑ Attorney-in-Fact Additional information is not required but could help to ensure this ❑ Trusiee(s) acknowledgment e,not misused or attached to a different document ❑ Other Indicate title or type of attached document,number of pages and date Indicate the capacity claimed by the signet If the claimed capacity is a corporate officer,indicate the title(I u.CEO,CFO,secretary) • Securely attach this document to the signed document 2008 Version CAPA v12 10 07 800.873�9865 w v NofuryClasses cum CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT SLate of California County of I OnCl j,V d I /r)-CO before me, L/,o� 1 ��N"o (1-Icrc mgn name and title of the officer) personally appeared i I who proved to 1ne on the basis of satisfactory evidence to be the persorL(q whose name(siks/are subscribed to the within instrument and acknowledged to me that Ip'e/she/tllrSy executed the same in )�is/her/tlleir authorized capacity(ie9), and that by Vis/her/their signature(S) on the instrument the personO, or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. LETICIA SANE)OVAL r / COMM.91745173 m // .c Notary Pubic-Ullanla N TNFrSS my hand and'oftici I scab LCSANGELEscourm A. %Caren.Erlr Mt/14 y1111 (Notary Seal) Sigignott�at-No[ery Public I ADDITIONAL OPTIONAL INFORMATION l INSTRUCTIONS POP COMPLETTNO THT$FORM any a1ln7u1v1UdK1?enl completed fit Cal forma meet contain nerbmge exactly us DESCRIPTION OF TI-IE.ATTACHED DOCUf�4l1'.NT appears abm,c it, the notary section in a aepurury achy*owledgmenf form must be ' proper•lr completed and attached to that docunnnit The only exception 1$ If a document rx tv be r'vtv,dod ounfde ofCollfarma In.such instances any alternative ('tide ordescriptlon ofaL ocumenl) acWlmvled,Grneut ierheage as may be printed on such a document so long ae the �erbyage does nor require the notary to do something that u r11cgul for a norary In Callfurnul (r o cc I trfyrng the mphorred capacity of the ugner) Please chuck the document car of W13 for proper note,lal Iva,ding and utlach[Ilia fora 1 J required (Title or description Drattachcd document continued) l • Slate and County information must be the State and County where the document Number pt Pad 5 Document DfllC mgner(a)personally appeared before the notary public foracknowledgmenl . • Date of nulaneallon must be the dale that the signer(s)personally appeared which must also be the same date the acknowledgment is eoinpleted l (Additional information) • the notary pubhc must piml his or her name as it appears within his or her commission followed by a comma Lind then your title(notary public) Punt the names) of document 5igner(s) who personally appear at the time of notai Nation CAPACITY CLAIMED BY THE STONER • Indicate the correct singular or plural forms by crossing on Incorrect forms(I e IIelslteltHe't is/are)or circling the correct forms 1,adure to correctly indicate this ❑ Individual (s"") f_I information may lead to rejection o doctilnem recording D Corporate Officer • I-lie notary seal ImpresslUn must be clear and photographically reproduclIblC Impression must not cover text or Imes If SCdl Impresglan slnudgce, re-seal if II (T¢Ic) sufficient area permits,otherwise complete a different acl.nowledgincnl form ICI ❑ Partnel'(s) • S1gnnrure of the notary public must match the signature on file with the office 01 ! the county dude 1 ElAttornle m`Paot Additional information is not requiled but could help to ensure this ❑ Trustecc(5) acknowledgment is not nmsuscd or attached to a dllfetent document Indicare title or type of attached document,number of pages and dare ❑ Other i +• Indicate the capaelty Claimed by The signer If the claimed capacity is a corporate officer,indicate the title(I e CEO,CFO,Secretary) • Securely anaeh this document to the signed document 2008 Version CAPA v12 10 07 800-873-9NC5 www NolaryClasses coin CITY OF PALM SPRINGS EXHIBIT A Scope of Services Project/Activity Title: Project Number Court Appointed Special Advocates (CASA)l 0011 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 O bj ectiyeslActiy iti es 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 thirty-four (34) 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 fallowing objectiveslactivities 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 Al 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 qualify at least a total of twent 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 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 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 Expanded Services ,for Seniors. At-Risk Youth Severely Disabled Adults and Special need Population. TARGET DATE ACTIVITY Al On-Going Conduct program activities to improve availability/accessibility, as stipulated in the proposal. Objective S: 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 (Le., clerical, monitoring, etc.) CITY OF PALM SPRINGS EXHIBIT B Budget Summary Pro_Lect(Activity Title: Project Number Court Appointed Special Advocates (CASA)/ 0011 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 BUDGET SUMMARY COST CATEGORY CDBG OTHER TOTAL SHARE SOURCES COST 1 Personnel -- $16,000. $284,000. $300,000. Wages & Taxes 2 Consultant/Contract Services - 0 - - 0 - - 0 - Pa roll Processing 3 Travel - 0 - $15,000. $15,000. Milea a Reimbursement 4 Space Rental - 0 - - 0 - - 0 - 5 Consumable Supplies - 0 - $12,000. $12,000. Volunteer Train in Material 6 Rental, Lease or Purchase of _ - 0 - - 0 - - 0 - Equipment 7 Insurance - 0 - $15,000. $15,000. Liability _ 8 Other - 0 $6,000. $6,000. Background Checks $16,000. $332,000. $348,000. 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 $461,000. 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 2008 — 09 Program Year— July 1, 2008 through June 30, 2009. CITY OF PALM SPRINGS EXHIBIT C Insurance Inventory Prolect/ArtIVItV Title Project Number:, Court Appointed Special Advocates (CASA) / 0011 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 INSURANCE INVENTORY LIABILITY INSURANCE POLICY Name of Provider's Insurance Company NIAC Effective Dates of Policy 05/20/08 to 05/02/09 Claims Made Policy / / Per Occurrence Policy I I Limits of Liability_ $2M General Aggregate Deductibles: Per Occurrence Annual Aggregate Additional Insured Endorsement (Certificate Holder) Ef Yes ❑ No Original Certificate of Insurance Attached ❑ Yes 0 No WORKER'S COMPENSATION POLICY Name of Provider's Insurance Company Travelers Casualty Insurance CompanV of America Effective Dates 11/01/08 to 11/01/09 Limits of Liability Underlying Coverage Limits Original Certificate of Insurance Attached 13 Yes 21 No Clienttl:5..a =—ASAFOR ACORD. CERTIFICATE OF LIABILITY INSURANCE ;;rz112008 Y rRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Desert Empire Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Services,Inc. LIG S 0FOSW HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFPOROED BY THE POLICIES BELOW. 77�64 Country Club Drive i Palm Deceit,CA 92211 INSURERS AFFORDING COVERAGE NAIC Y NSURFD D�uREKA NIAC CASA for Riverside County[no INSURER a P.O.Box 3608 Indio,CA 92202 NSURERC INSURER D: IrsuRat E: COVERAGES 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 WTD1 RESPECT TO WIVCH TI[IS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURAIJOE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS S=ECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE 95EN REDUCED BY PAID CLAIMS. LTR s TrPEOFINSDi4WCE POLICY NDMaER P^L1cr EPPEf.TLYE POACYWI�TON WRa A GENSAL��' 200804207NPO MOMS 05102J09 am WrURRENCE s1606060 X CCMMPRCW.GEN9+N.CNBILrrT =,AKTED 1100006 CWISMADE OCCUR penm)DIIURY s1 000 0D0 GATE s 000 000 GFNLAeOREOATE LPFIY mPAGG s2000000 X Palo ..c� Lac A AVICNIOBILE U,uIILTIY 2003D4207NP0 05/02/03 05102I09 couemEo swsLEUMrr ANYAUTQ (E,acrJeenl) s1,000,OQ6 ALL OWNED AUTOS BODILY INJURY SCHEOUL AUTOS (Pwp ony 5 X HFEDAVTOE ROOILYUiryRY X NONOWNEOALITOS (Fe,re[idenO 5 PROPE TYDMIAGE S GARAGE LUDILnY AUTO ONLY-a ACGDENT i ANYAUTO EAACC s AUTO ONLY; AGG S A IxcEssussTRELU LIABILITY 200E04207UMS-NP0 DSI0210B 0510709 EACH C=IUt2JCE s1000000 X OCCUR �CLN"s wDe AGGR,"WTE f1000000 r DEDUCTIBLE s X RETENTION A 10000 S WVRILFRS CONPENSAnON AMJ =SrATU- OTi- EMPLOYERS LIAWI ANY PROM EMPARTNERE%ECURVE ELaCIVACCIWNT s O rERMEM8EREXCLIIDmT EL DISEASE-EA ENPLOYEL• S VICNTef,de PROender E DISEASE-POLICYLIMIT 5 &, &&mtIONS hclyu A OTHER Directors b 200904207130-NPO 05/02108 05/02109 $1,000,000. Officers Liabilit DESCPoPdON GF OPERAnONS I LOCATIONS I WMCLCS I MCLUSIOHS ADDED BY OIbyI^pq:tlT/S GCM PRONSIONS '10 Day Notice Of Cancellation applies for Non Payment of Premium Forms CG2010 07104 attached;CG2037 97104 attached. Waiver of Subrogation applies-endorsement to follow. (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION SHOULD ANYOFTHE ABOVE DUCRIBEO POLICIES DE CANCELLED BEFORE THE FXPDUnoN City of Palm Springs DATETiEREOF,THE 195UING INWR9RWI1-L RKXM6dxx MAIL 30• DAYS wRI M Attu: City Clerk NOTICE TO THE CERTJRr ENO m RAYED TO THE LEFT,�(>[7y1MiBCW0000GOtl8i% P.O.Box 2743 AIMKx Palm Springs,CA 92253 =ENrAnvc ACORD 2S(280110E)1 Df 3 #S12W021d119148 2pSAy 0 ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. A statement on this Certificate does rot mnfer rights to the cetilimte holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsemer4. A statement on this certificate does riot Confer rights to the ceRificate holder in lieu of such endorsernett(s). DISCLAIMER The Certificate of Insurance on the reverse side of this farm does not constitute a contract between the issuing insuref(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 ZS-5(20011011) 2 of 3 #S1261021M11R148 U,5RINN L;S q W .......... 71PE. M*,Pj, The insurance shall be primary with respect to the insured shown in the schedule above,Or if excess,shall stand in an unbroken chain of coverage excess of the named insured's scheduled underlying pdmary coverage- In either event,any other insurance maintained by the insured scheduled above shall be in excess of this insurance and shall not be called upon to contnbula with it :,�421P["f-4 AMS 75.3(2001108) 3 00 SS12W20119148 TIUS ENDORSEMENT CHANGES TIIE POLICY.PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER RIGHTS TO RECOVERY AGAINST OTHERS This endorsement modifies insurance provided under the following: COMMERCIAL GF,NERAL LIABILITY COVERAGE PART OWNERS&CONTRACTORS PROTECTIVE LABILITY COVERAGE PART We waive any right of recovery we tray have against the person or organization shown in the schedule below because of payments we make for iujuty or damage arising out of"yaw wok"done under a contract with that person or organbat on,The waiver applies only to the person or organization shown in the scbwulc SCHEDULE. NAME OF PERSON OR ORGANIZATION: City of Palm Springs NIAC-E26(7199) POUCY NUMBER: 200S0 207NpC 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(&) Qr Q anization s: Locations Of Covered Operations City of Palm Springs Attn: City Clerk P.O.Box 2743 Palm Springs,CA 92263 Information re ired to complete this Schedule,if not shown above,will be shown in the Declarations_ A. Section II — Who Is An Insured is amended to R. 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 applyr with respect to liability for"bodily injury', "property This insurance does not apply to "bodily injury"or damage" or "personal and advertising injury" ..property damage"occurring after. caused,in whole or in part,by 1. Your acts or omissions;or I. All work, including materials, parts or equip- ment fumished 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) 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 11107 04 0 ISO Properties, Inc.,2004 Page 1 of 1 O POLICY NUMBER: 200804207NPO COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -- COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LABILITY COVERAGE PART SCHEDULE Name OfAddltlonal Insured Person(s) Or O anlzation s: Location And Description Of Completed O eraUons City of Palm Springs Aun: City Clerk P.O-BOX 2743 Palm Springs,CA 92263 Infarmatton required to complete this Schedule.If not shown above,will be shown In the Declarations. 5ectlon 11 — Who Is An Insured is amended to include as an additional insured the person(s) or organtzation(s)shown in the Schedule, but only with respect to liability for"bodily injury"or"property dam- age' caused, In whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". Can add words from example B here if required CG 20 37 07 04 ©ISO Properties, Inc.,2004 Page 1 of 1 171 12/17/2809 11:47 9517741978 JOHN W VINEYARD PAGE 02/03 RightFax N1-2 12/17/2008 10:34:24 AM PAGE 2/003 Fax Server aco C�, CERTIFICATE OF LIABILITY INSURANCE 12MV20008 .RPDuaR HIS CERTIFICATE ISSUEPASAMATTEROFINFORMATION PAYOHE%AGENCY IVE HOLDER. THIS CERTIFICATE DOES NOT AMEND CERTIFICATE R 150 SA ST5' ' DRIVE THE COVERAGE F p C ES O ROCHESTER,NY 14620 ALTER (877)362.6785 SV998 70A INSURERS AFFORDING COVERAGE NAIC# INMM INSURERATRAVELERSCASUALTYINSURANC�c PMIY DFMAEPICA CASA FOR RIVERSIDE COUNTY INC 44188 MONROE STREET v RER B STE,D INSURER C. INDIO,CA 4201 INSURER D. INSURER E COVERAGES THE PGu0IE5 OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ApOVE FOR THE,POLICY PSMOD INDICATED,NOTWITHSTANDING ANY RFQ111REMENT.TERM OR CCNDIYION OF ANY CONTRACT OR 01NF,R DOCUMENT WITH RESPECT TO WHICH THIS CERTIEICAT@ MAY CE I55UgD oR MAY PERTAIN.THE INSURANCP AFFORDED BY THE POLICIES DESCRIBEY/HERE%Y I8 5MEL.T To ALL THP TERMS,EXCLUSIONS AND CONDITIONS OF SLICH POLICIES AOOREGATg LIMITS SHOWN MAY HAVE BEEN REDUCHD my PAID CLAIMS INRA ADDI ROUCYEFFECTYE POIJCYEBPIRATDN ILL TTPEOFINBURANCE POILCY NUMBER A OOry A LINTS 20ICRAL=wry COMMERCIAL GENERAL LIAe41TY :OAMNIF,IO HFN IFD C-I•AIM' MAIIF ©LVX:LIR PREb113E31Ce cec, 5 _ men P%R An on $ P OPN LAOGR=GATF LMI-APPLIES PER ��CTS=LOUP/GP AG_G_ S POLICY d OTRD- F-jLQl AUTOMONLe MANU Y EUMENED 51WLE LIMIT ANYAUT.0 ALL OWNED AIRO5 BODILY I W UW AcHFINII FOAuTOE IPer P..nnl $ NIREO Au7CS , L✓v ILTIN'ly� ; NON-0WNEAUTOS IPliefelae�nMAOI' �. OARASELIADIUTY L •EA ACCIDENT nNYALITa OTHFRTW EA ACC 8 AIITOONLY AGG E%CC:NMBRELLA LIA914RY rA0H0QqlJRFENC s OCCUR MCLAIM6 MADE AOGR SATI DCDUCTISLC IF RETz"T BGL $ $ A WGRKERB COMPENSATION AND UB-0314T280-08 11/01/2008 11/01/2009 X r;v' Iu vII•I 6MPLC$RTWCLA�ztL�TqyTT��[ryE EL EACHAG:IDENT 1000 DGD /OJFFICEAR.IPEMaENIEIL•`W DGG"%ECVTVE :I IP�,dyMn1Y�NHWIB � BLeraEnss•wEmRLarEE 10tltl000 •L P15wBE-POLICY LINT S1000.000 aTmF DENCORRONOF OPERA Doc I WCATIDN3 I VEHICLES 16XVLI lum ADDED BY WOURS WWI PPWAL PMOMnIONO IN THE EVENT OF NON-PAYMENT OF PREMIUM,ONLY TEN(10)DAYS NOTICE OF CANCELLATION SHALL BE GIVEN. CERTIFICATE HOLDER CANCELLATION SHOULD ANY CF THE A ROVE DCCRIGED PW=5 RE cANC moEq THE W1 NATION CITY OF PALM SPRINGS PATE THEREOF,THE ISSUING INSURER"LL LTIGEAYOR TO MAIL•,�CAYY WTTTIN ATTN CITY 43 CLERK TO PO BOX NW10 THE CERiM TE HOLDER NAMEDTOTHE V ,RLIT PAR SO SHALL TO DO SHALL PALM SPRINGS,CA9226a IMPOS4 NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS ARENT$OR REPNEDIXIA'11V4➢ AUTHORD:ED REPRE WATVE ACORD 26(2001/08) CORD CORPORATION Iwo 12/17/2008 11:47 9517742970 JOHN W VINEYARD PAGE 03/03 R1ghtFax N1-2 12/17/2008 10;34;24 AM PAGE 31003 Fax Server IMPORTANT If the certificate holder is an A001TIONAL IN5WR6D,the policy(ies) must be endorsed. A statement on this certlflvate does not confer rights to the ccrtlfiaato holder in lieu of such endarsementfs). 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 endarsement(s). DISCLAIMER The Cenificate of Insurance on the reverse side of this form does hot constitute rt 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, i i ACORD 25(2001108) CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement Project/Activity Title: Project Number: Court Appointed Special Advocates (CASA) ! 0011 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 form the described project/activity Please answer each of the following questions. 1. How many persons are in your household? For this question a household is a group of related or unrelated persons occupying the Same house with at least one member being the head of the household. Renters, roomers, or borders cannot be included as household members. 2. Circle your combined gross annual income(Riverside-San Bernardino-Ontario,CA MSA m 021131108) AREA MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD: INCOME(AMI) 1 2 3 4 5 6 7 8 LEVEL EXTREMELY LO INCOME $14,000 S16,000 518,000 $20,000 $21.600 $23,200 $24,800 526,400 0-30%of AMI VERY LOW INCOME S23,300 $26,560 $29,950 $33,200 $35,950 S38,650 $41,300 543,950 31-50%of AMI LOWINCOME $37,300 S42,650 S47,950 $53300 $57,550 $61,850 $66,100 $70,350 51-80%of AMI MODERATE INCOME $52.100 $59,500 $67,000 $74,400 $80,400 $86,300 $92.300 $96.200 B1-120% 3. What race/ethnicity do you identify yourself as;please note that this self-identification is voluntary in accordance with equal opportunity laws? White _ 0 American Indian or Alaska Native AND White ❑ Black/African American 0 Asian AND White ❑ Asian ❑ Black/African American AND White ❑ American Indian or Alaskan Native ❑ American Indi2n1Al2s1k2 Native AND Black/African American ❑ Native Hawaiian or Other Pacific Islander ❑ Other: HISPANIC/LATINO ETHNICITY ❑ Yes ❑ No If yes,check one ❑ Meximn/Chicano ❑ Puerto Rican ❑ Cuban ❑ Other: 4. Arc you female Head of Household? Q YES ❑ NO S. Do you have a disability? ❑ YES ❑ NO If YES,please describe: ACKNOWLEDGEMENT AND DISCLAIMER I CERTIFY UNDER PENALTY OF PERJURY THAT INCOME AND H0U$H0LD 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 Dovolopment Block Grant(COaG) program purposes, a Federally-funded program,governmental reporting purposes to monitor compliance - CITY OF PALM SPRINGS EXHIBIT E Quarterly Program Progress Report Pro ect/A Project Number: Court Appointed Special Advocates (CASA)/ 0011 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 #F of Persons 0.30%below 31-50%below- 51-80%below 120% below ♦ Number of First-Time Female Headed Households: ♦ Counts by Race/Ethnicity: White American Indian or Alaska Native AND White Black/African American Asian AND White Asian Black/African American AND White American Indian or Alaskan Native American Indian/Alaska Native AND Black/African American Native Hawaiian or Other Pacific Islander Other HISPANIC/LATINO ETHNICITY: Mexican/Chicano Puerto Rican Cuban Other ♦ Number of Disabled. ACCOMPLISHMENT NARRATIVE LEVERAGING RESOURCES NARRATIVE Signed Title Date CITY OF PALM SPRINGS EXHIBIT F Request for Reimbursement Proiect/Activity Title: Project Number Court Appointed Special Advocates (CASA)1 0011 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 beseriptlon 7Grant Reimbursement Reimbursement YTO Balance Amount Period Period(s) Reimbursement (Over]Under) Personnel $16,000.00 TOTAL 1 CERTIFY THAT, (a) the City of PALM SPRINGS, as grantee of the Ct78G, 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.