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HomeMy WebLinkAbout05638 - MIZELL SENIOR CENTER CDBG RECIPIENT RESTROOM CONSERVATION EFFICIENCIES DOCUMENT TRACKING Page:1 Report: One Document Detail October 14,2010 Condition: Document Number a5638, Document# Description Approval Date Expiration Date Closed Date A5638 CDBG 08-09 Restroom Conservation Efficiencies $15,000 04102/2008 company Name: Mizell Senior Center Wdress: Dean Lockwood,Exec.Director, 480 S Sunrise,Palm Springs,CA 92262 '.ontact: Mr.Lockwood Troup: COMMUNITY&ECONOMIC Contract Amt. Total Paid Balance )ervice: In File $15,000.00 $15,000.00 ,Ref: DALE COOK 760 323-8198 ns.Status: Certificate and Policies are OK Document Tracking Items: Due Completed Tracking Amount Amount Code Item Description Date Date Date Added Paid cab Insurance Compliance email sent 03/20/2009 JT Received Contract from Community Development 12118/2008 12/19/2008 JT To City Attorney for Review and Sign-off 12/23/2008 12/19/2008 JT to CM for signature 01/2012009 JT copy to dept.,in file 01/20/2009 kdh Res 22193 Item 1A 04/02/2008 $15,000,00 *** * END OF REPORT****** �10o+ , �. � � o �o n SUBRECIPIENT AGREEMENT THIS AGREEMENT (herein "Agreement"), is made and entered into this 11rh day of December, 2008, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and charter city, and the Mizell Senior Center of Palm Springs. , (herein "Provider"). WHEREAS, the City has entered into various funding agreements with the United States Department of Housing and Urban Development ("HUD"), which agreements provide funds ("CDBG Funds") to the City under the Federal Housing and Community Development Act of 1974 (42 U.S.C. Section 5301 et seg.), 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. 12 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 22, within ten (10) days following the termination of this Agreement, and at such other times as the Contract Officer shall request, Provider shall give the Contract Officer a written report describing the services provided during the period of time since the last report and accounting for the specific expenditures of contract funds hereunder, if applicable. At the times and in the manner required by law, the Provider shall provide to the City, the Department of Housing and Urban Development, the Comptroller General of the United States, any other individual or entity, and/or their duly authorized representatives, any and all reports and information required for compliance with the Act and the Regulations. 1.4 Financial Reporting. Any Provider receiving or due to receive or due to receiver $20,000.00 or more from the City during the 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 31"r of the current fiscal year. 017%, etrii. -d R7_,M.1T, 2.0 COMPENSATION. 2.1 Contract Sum. The City shall pay to the Provider on a reimbursable basis for its services a sum not to exceed FIFTEEN THOUSAND DOLLARS (a15.000.00) (the "Contract Sum") in accordance with the Budget attached hereto in Exhibit B and incorporated herein by this reference; and as herein provided. The budget cost categories set out in Exhibit B are general guidelines and if mutually agreed by both parties, may be amended administratively by no more than 10%, without the requirement of a formal amendment to this Agreement, but in no event shall such adjustments increase the Contract Sum. The Provider shall submit to the City 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 rol�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 Reoresentative 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: Dean Lockwood, Executive 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 Assignment. Provider shall not contract with any other entity to perform in whole or in part the services required hereunder without the express written approval of the City. Neither this Agreement nor any interest herein may be assigned or transferred, voluntarily or by operation of law, without the prior written approval of the City. 3.4 Independent Contractor. Neither the City nor any of its employees shall have any control over the manner, mode or means by which Provider, its agents or employees, perform the services required herein, except as otherwise set forth herein. Provider shall perform all services required herein as an independent contractor of City and shall remain at all times as to City a wholly independent contractor with only such obligations as are consistent with that role. Provider shall not at any time or in any manner represent that it or any of its agents or employees are agents or employees of City. 4.0 COMPLIANCE WITH FEDERAL. REGULATIONS. 4.1 The Provider shall maintain records of its operations and financial activities in accordance with the requirements of the Housing and Community Development Act and the regulations promulgated thereunder, which records shall be open to inspection and audit by the authorized representatives of the City, the Department of Housing and Urban Development and the Comptroller General during regular working hours. Said records shall be maintained for such time as - 2 - may be required by the regulations of the Housing and Community Development Act, but in no case for less than three 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 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 at41 CFR Chapter60; (e) Executive Order 11063, as amended by Executive Order 12259, and implementing regulations at 24 CFR Part 107; (f) Section 504 of the Rehabilitation Act of 1973 (P.L. 93-112). as amended, and implementing regulations; (g) The Age Discrimination Act of 1975 (P.L. 94-135, as amended, and implementing regulations; (h) The relocation requirements of Title II and the acquisition requirements of Title III of the Uniform Relocation Assistance and Real Properly Acquisition at 24 CFR Part 42; (i) The restrictions prohibiting use of funds for the benefit of a religious organization or activity as set forth in 24 CFR 570.200 0). (j) The labor standard requirements as set forth in 24 CFR Part 570, Subpart K and HUD regulations issued to implement and requirements; (k) The Program Income requirements as set forth in 24 C.F.R. 570.504(c) and 570.503(b)(8); (1) The Provider is to carry out each activity in compliance with all Federal laws and regulations described in 24 C.F.R. 570, Subpart K, except that the Provider does not assume the City's environmental responsibilities described at 24 C.F.R. 570.604; nor does the Provider assume the City's responsibility for initiating the review process under the provisions of 24 C.F.R. Part 52; (m) Executive Order 11988 relating to the evaluation of flood hazards and Executive Order 11288 relating to the prevention, control and abatement of water pollution; (n) The flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234), -3 - (o) The regulations, policies, guidelines and requirements of 24 CFR 570; the "Common Rule", 24 CFR Part 85 and subpart J; OMB Circular Nos. A-102, Revised, A-87, A-110 and A-122 as they relate to the acceptance and use of federal funds under the federally- assisted program; (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 sue.); (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 -4- foregoing and naming the City as an additional insured shall be delivered to and approved by the City prior to commencement of the services hereunder. The procuring of such insurance or the delivery of policies or certificates evidencing the same shall not be construed as a limitation of Provider's obligation to indemnify the City, its officers, or employees. The amount of insurance required hereunder shall be as required by the Contract Officer not exceeding 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. 6.2 Term. Unless earlier terminated in accordance with Section 6.3 of this Agreement, this Agreement shall continue in full force and effect until completion of the services, but not exceeding one (1)year from the date hereof. 6.3 Termination Prior to Expiration of Term. Either party may terminate this Agreement at any time, with or without cause, upon thirty (30) days' written notice to the other party. Upon receipt of the notice of termination the Provider shall immediately cease all services hereunder except as may be specifically approved by the Contract Officer. Provider shall be entitled to compensation for all services rendered prior to receipt of the notice of termination and City shall be entitled to reimbursement for any services which have been paid for but not rendered. 7.0 MISCELLANEOUS PROVISIONS 7.1 Notice. Any notice, demand, request, document, consent, approval, or communication either party desires or is required to give to the other party shall be in writing and either served personally or sent by prepaid, first-class mail to the address set forth below, or such other addresses as may from time to time be designated by mail. TO CITY: City of Palm Springs 3200 East Tahquitz Canyon Way Palm Springs, CA 92262-6959 Attn: City Manager - 5 - WITH COPY TO: City of Palm Springs 3200 East Tahquitz Canyon Way Palm Springs, CA 92262-6959 Attn: City Attorney TO PROVIDER: _Mizell Senior Center of Palm Springs 480 S Sunrise Way Palm Springs, CA 92262-7641 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 - CITY OF PALM SPRINGS - _ ATTEST: a municipal corporation I Clerk b f�T�O��b City Manager APPRJ�vE� ASS TO FdIRM: APPROVED BY CI iY COUNCIL VI&B 6 � '44— qIIr qt City Att�rney 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 Chief Financial Officer). Q Notarized Signature of Chairman of Board, Notarized Signature Secretary,Asst Secretary, President or any Vice Presidenk Treasurer,Asst Treasurer or Chief Financial Officer Name"._1 State of�,y�F I,I�� cz.�; 1 State county df?� ,� 155 County of nC'_4nUZ6i 55 On -2 before me, On 42 -/z' - ,Zooj before me, lyd✓r aC( dL',Zr C C'_,personally appeared f}r Q_L—�,personally appeared personally known _6 " A 1Z Y%. Jz5 yG H,c 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 subscribed to the to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/sho/they within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), executed the same in his/her/their authorized eapaeity(ies), and that by hisiher/their signature(s) on the instrument the and that by his/her/their signature(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($) acted,executed the instrument acted,executed the instrument. WITNESS my hand and OTJ ial seal. WITNESS my hand and d cial seal. Notary Signature:---A �_J_ �-� Notary Signature: � T 7 Notary Seal: Notary SOW: IAA M. RICE CoAtAt.N 1662454 III NOTARY PCSLIC•CALIFOANIA N FMOTCAORYMMPU SAN BERNARDINO CDONfl ,N f662454 f^ AIY�DYY.FSAAAN,�0,YO. BLIC•CALIFOANIANERNARDINO COONIY, AAA 8B 7B1O" Mlzell_$u1xeppggrmnL0stO8 _ 7_ CITY OF PALM SPRINGS EXHIBIT A Scope of Services Prolect/Activity Title: Proiect Number: Mizell Senior Center/ 0004 Restroom Conservation Efficiencies Name/Address of Provider Mizell Senior Center 480 S Sunrise Way Palm Springs, CA 92262-7641 O b I ectives/Activities The intent of this program is to provide programming and services for very-low income to moderate income seniors and frail elderly. .This will be accomplished, through the continuation of the facility renovations to facilitate client services areas and expand the ability to accommodate the rapidly increasing client base by making resource conservation improvements of the building's restroom fixtures by replacing with more efficient water saving ones. These upgrades will control operating expenses enabling those savings to be redirect to program and service operations. The Center also serves as one of the City's emergency shelters under the Fire Department's Emergency Preparedness Plan and Riverside County Summer Crisis Cooling Center. The Mizell Senior Center primarily covers the City of Palm Springs and the adjacent community of Cathedral City, serving 5,200 clients of which 4,940 are Palm Springs' residents. The Provider shall be responsible for the completion of the following objectives/activities in a manner acceptable and satisfactory to the City and consistent with the standards required as a condition of providing these CDBG funds. Objective 1: Assist the City by timely providing any additional information requested. TARGET DATE ACTIVITY#1 On-Going Make readily available any information relative to the successful implementation of the activity. Objective 2: Establish and maintain a programmatic and financial record keeping process. TARGET DATE ACTIVITY#1 On-Going Establish and maintain an efficient program process/procedure for proper record keeping. Set-up a filing system for CDBG files only. Document and maintain all records related to this program in a stable and secure location. Objective 3: Advertise, market and publicize the program_to_facilitate_positiv_e_prom_otion__for all parties (i.e., Provider, City, CDEG, etc 1. 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 qualify at least a total of 4,940 low and moderate-income Palm Springs residents. TARGET DATE ACTIVITY 91 On-Going Provide direct client programming for Palm Springs residents. Maintain records of names, addresses, demographics and service dates for all assistance. Objective 5: Maintain records for all CDBG activities related to this program. TARGET DATE ACTIVITY#1 On-Going Document and maintain all records related to this program, including those required, in accordance with HUD Regulations, in a stable and secure location. ACTIVITY#2 Monthly Submit Semi-Annual reports—referenced Exhibit E Objective 6: Manage/monitor program activities. TARGET DATE ACTIVITY#1 On-Going Perform monitoring activities necessary to ensure that the program is being conducted in compliance with the CDBG policies, federal regulations, and local statues, including Davis-Bacon Act, Copeland Act, and Non-discrimination/ EEO requirements. Objective 7: Upgrade and improve the building's restroom fixtures with more efficient low-flush toilets waterless urinals and motion sensing faucets as well as incorporate motion sensing and controlled delivery—paper towel dispensers for greater resource-efficiencies in accordance with an 'oxen competitive' procurement process as outlined in proposal. TARGET DATE ACTIVITY#1 On-Going Conduct program activities, as stipulated in the proposal and in consultation with the City. Objective 8; Provide an evaluation within fifteen 15 calendar days of the program completion or final reimbursement. TARGET DATE ACTIVITY#1 07/15/09 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 Project/Activity Title: Project Number: Mizell Senior Center/ 0004 Restroom Conservation Efficiencies Name/Address of Provider: Mizell Senior Center 480 S Sunrise Way Palm Springs, CA 92262-7641 BUDGETSUMMARY COST CATEGORY CDBG OTHER TOTAL SHARE SOURCES COST 1 Personnel $ - 0 - $ - 0 - $ - 0 - 2 Consultant/Contract Services $ - 0 - $ - 0 - $ - 0 - 3 Travel $ - 0 - $ - 0 - $ - 0 - 4 Space Rental $ - 0 - $ - 0 - $ - 0 - 5 Consumable Supplies $ - 0 - $500. $500. 6 Rental, Lease or Purchase of $ - 0 - $ - 0 - $ - 0 - Equipment 7 Insurance $ - 0 - $ 0 - $ - 0 - 8 Other $15,000. $1,000. $11,000. Material & Labor $ - 0 - $ - 0 - $ - 0 - $15,000. $1,500. $16,500. 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 Mizell's Building Repairs & Maintenance funds. The Subrecipient shall submit Request for Reimbursement in accordance with the aforementioned cost categories. Progress payments, approved by the Subrecipient and based upon the percentage of completion of the work with a 10% retention, shall be paid by the 30th 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 Project/Activity Title= Project Number Mizell Senior Center/ 0004 Restroom Conservation Efficiencies Name/Address of Provider. Mizell Senior Center 480 S Sunrise Way Palm Springs, CA 92262-7641 INSURANCE INVENTORY LIABILITY INSURANCE POLICY Name of Provider's Insurance Philadelphia Insurance Companies Effective Dates of Policy 10/15/08 to 10/15/09 Claims Made Policy / I Per Occurrence Policy / 1 Limits of Liability $3,000,000 General Aggregate Deductibles: Per Occurrence 1 000 000.00 Annual Aggregate $5,000,000.00 Additional Insured Endorsement (Certificate Holder) Q Yes 0 No Original Certificate of Insurance Attached ❑ Yes O No WORKER'S COMPENSATION POLICY Name of Provider's Insurance Company PBOA California Evr Effective Dates 03/01/08 to 03/01/09 Limits of Liability $1,000,000 Per Occurrence Underlying Coverage Limits Per Statute as set by State Law Original Certificate of Insurance Attached 13 Yes Q No ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID JC DATE(MMIDDNYYY) MIZEL-1 12/12/08 PRGDLDBR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO Curtis & Harris Insurance Sery ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CA License # OF30715 HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. sox 1585 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Palm Springs CA 92263 Phone: 760-778-8787 Fax:760-778-7676 INSURERS AFFORDING COVERAGE NAIL INSURED INS-I A Philadelphia Insv�ance [ompany 23850 INSURER B Mizell Senior Center INSUPFR- 480 S. Sunrise INSURER Palm Springs CA 92262 - -. -- - -- INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W RH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCR 0ED HEREIN IS SUBJECTTO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IF � POLICY NUMBER POLICY RFFBCT vE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE DA fB IMMIDOM41 BATE(MMMDNY) LIMITS GENERAL LIABILITY EACH OCCURRENCE 01000000 A X X COMMERCIALGENERALLIABILITY PHPK354613 10/14/08 10/14/09 `1M0ISE5 fEe axurenca) T100000 CLAIMS MADE OCCUR mED ExP(ARy one person) $5000 PERSONAL&ADV INJURY $ 3.000000 GENERAL AGGREGATE Z2000000 GEN L AG R EGATE LIMB APPLIES PER PRODUCTS-CC MPIOP AGc T1000000 POLICY PRO LUC =CT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 10DDDDD A X ANY ALTO PHPIC954613 10/14/08 10/14/09 (Ee a"'�°nI) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Par person) Ii IRED AUTOS BODILY Idont) t NON-OWNED AUTOb (Per exlbpnq A COMP & COLL PROPERTY DAMAGE $500 DED (Peraccloent) CAUSE LIABILITY ALI 10 ONLY-EA ACCIDENT $ ANY nUTO OTNER THAN HAACC $ AUTO ONLY AGG B EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE OCCUR CLAIMS MADE AGGREGATE �_. S DEDL IBLE RETENTION T T, WORKERS COMPENSATIONAND TORYI,IMA LER EMPLOYERS'LIABILITY ANY CERW MBER PARLUDEDxECUTIVE E L 6, CH ACCIDENT T 0"rFICER/MEMBER EXCLUDED? FI r)[SEASE-EAEIVPLOYEE T It yes describe under SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT C OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDEO BY ENDORSEMENT I SPECIAL PROVISIONS THE CITY OF PALM SPRINGS ITS OFFICIALS EMPLOYEES AND AGENTS ARE ADDITIONAL INSURED PER FORM CG2026. COVERp G$ Is PRIMARY AND NON CONTRIBUTORY. 10 DAY NOTICE OF CANCFLT4t TION FOR NON PAYMENT OF PREMIUM. REFERENCE CDBG#A5638/RESTROOM CONSERVATION. CERTIFICATE HOLDER CANCELLATION C ZTYOFP SHOULDANY OFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 90 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LER,BUT FAI W RE TO DO SO SHALL THE CITY OF PALM SPRINGS DALE COOK IMPOSE NO OBLIGATION ORLIABILITY OFANY KIND UPONTHE INSURER,ITS AGENTS OR P.O. SOX 2743 REPRESENTATIVES Palm Springs CA 92263 Au Es Tlv ACORD 25(2001108) 0 ACORD CORPORATION 1 POLICY NIr11I13ER PHPI054613 ('OALIIERCLLL GENERAL LUBILIT i' CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FULL1. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This etndorscnitut modiiics insurance provided under the follow ulg: C: ABIEIRCIAL GENERAL LI.-1]31LJTY COVER-IiGE PART SCHEOIU_E Name of Additional Insured Pcrson(s)or OrganizaLion(s) THE CITY OF PALM SPRINGS Information required to complete diis Schedule.if not shown above,will be shown In flit Declarations Section II-Who is -all Insured is amended to include as an additional insurcd tllc por,on(s)or oroganizatlon(%)shown nl flue Schedule,but only w ial respect to liability for"bodily uynrv'."property damage"or"personal and advertLv w, injury' caused, ili whole or in part bi •our act or onussions of dic acG or 11I1115tioils of those acing O11 your belialf. A Il the per'foritlancc Of Vlllir Ongoing operation': or D. In comiection with your premises ow need bi or rented to you. CG 20 26 07 04 (lOpvright ISO Prnhertles Inc 2004 Page I of 1 Paychex, �I}nrc�'y i F(1�[ 11211�81/Y21000y8Lp91:15�16;0(6rlP,rML+ PAGE 1��,�''Y33/003 Fax Scrvcr .. .ORn:_,:;ialG11, [F[J.if•1C'L.I�';.L171 L'F#.A.,i.I .I:::[iTl�7•U LII'tAJG_:.;�i AC "" %12178!08 PRODUCER THIS CERTIFICATE 1$ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PAYCHEX AGENCY INC. HOLDER. THIS CERTIFICATE DOES HOT AMEND,EXTEND OR 1175 JCHN 5TREEY ALTER THE VERA FFQ YTNEP LJCUES BELOW, WEST HENRIETTA,NY 145116 COMPANIES AFFORDING COVERAGE AAA PSOA California Evr j IH$0nEDMIZ - ... �..�.- -.-. .. .. wPAl+r S SUNRISE SENIOR CENTER Or PgLM SPRINGS 480 S WAY PA 5PRI _ PALM SPRINGS,CA 92262- cM�nrvr cove ES. TIIIS IS TO CER T IFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE IN$VRED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. CO rypE pFIN$URANCE POLICY NUMBBR POUCI EFFECTIVE POLICV EXPInATION y LIMITS LTA GATE(MMmolI ) DATE(MMINOIYY) GENERAL LIABILITY GENERALAGGREGATE F COMMEHCIAL GENERAL LIAEILITS �PRCDUCTS-OGIHPDP ACG S E::�LAIMS MADE E:::GCCUR I I P6H^UNAL E wV IN,IUFlY O ONMERS IsCoNTRACTORg PROr — EAGH OCCURRENCE _ � � •- �-• FIHG UAnwLlnny onu liq) "-"-" MED EAP V.nyono w.,) DMOBILE LIABILITY - ANY AUTO I COMBINED SINGLE LIM;l u ALL OWNED AUTOS O SCHEDULED AUTOS 6WlLY INaMFY ^HIRED AUTOS NON.OWNED AUTOS BODILY INJURY S "- �(Per xoltleml © PRCPEHTY UAL-AG6 $ I GARAGE LIABILITY OANYAVTD AUTO OIJLY B:ACqu.-- _ - CIHEHTRArvAUIOCXCLY I' -- •--." •-- --- EACH ACOIDENI 5 AOGREGATE— 1 �EI(CESS LIABILITY I S UMSRELLAFDRM icACH OCCURRENCE � AGGREGATE, S OTHER IHAIJ UMEHELLn FCHM WORKEIIS LOMPENSATIO.N AND LXJ 1'TAIu- •iTH• ({ EMP40YER5 LIABILITY 1° EL EACH ACCIDENT $ 1p0[I,OOD.OD THEPFWRlECW INCL I PMTNERi EXFCIIINE 81UOD07190 D3/DI/08 LI'3/Di/D9 EL 015Eh4E•POLICYLIdIr < I,DDD.DDD DD ecc..Rya. OEXCL CL OISEASE-FA GIAPLOy EE S 1,000,000.00 DTHER DESCRIPTION OFOPtAA1 KINSILOLATIONSIVENILLESISPELUL ITEMS i;IEFl!I7FICATE�Il4Lt)�t? : ..•::: [. ..:.: ...: :'_:...:- .:. [ -::`E' ANCEI'.G'A7ti]N ;. i ':�: : :. . : : .: ![.• ... SHOULD ANY OFTNE AOOVE DESCAWED POUDIES BE CANCELLED BEPOnE THE CITY OF PALM SPRINGS EXPIRATION DATE THFRECF,THE ISSUING COMPANY WILL ENDuAYDR TO MAIL CITY CLERKS 30 DAY$WRMF.HNOTICE-TOTHt CENYIFILATEHCLDEBNAMEDTOTHELEFT, PO BOX 2742 " PALM SPRINGS,CA S2263 BUT HAILURETOMAIL5UGH NOTICE$HALL IMPCSENOOBLIGATION On LIABILITY OF ANY KIND UPON YHE COMPANY.ITS AGENTS OR REPRESENTATIVES. A E)RIZED REPRESENTAPVE �a�oRtia oitPosnlTaR isss:.. CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement Proiect/Activity Title: Proiect Number: Mizell Senior Center/ 0004 Restroom Conservation Efficiencies Name/Address of Provider: Mizell Senior Center 480 S Sunrise Way Palm Springs, CA 92262-7641 BENEFICIARY QUALIFICATION STATEMENT This statement must be completed and signed by each person or head of household (legal guardian) receiving benefits form the described projecUactivity. 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—021131108) AREA MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD: INCOME(AMI) 1 2 3 4 5 6 7 8 LEVEL EXTREMELY LOIA INCOME S14,000 $16,000 S18,000 $20,000 S21,600 $23,200 $24,800 $26,400 0-30%of AMI _ VERY LOW INCOME $23.300 $26,650 $29.950 $33,300 $35,950 $38.650 S41,300 843950 31-50%of AMI LOW INCOME $37,300 S42,650 $47,950 $53,300 $57,550 S61,850 $66,100 $70,350 57-a0%of AMI MODERATE INCOME $52,100 $%500 S67,000 $74400 $80,400 $86300 $923070 598,200 81-720% 3. What race/ethnicity do you identify yourself as; please note that this self-identification is voluntary in accordance with equal opportunity laws? 0 White ❑ American Indian or Alaska Native AND White ❑ Black/African American 0 Asian AND White ❑ Asian ❑ Black/African American AND White ❑ American Indian or Alaskan Native ❑ American Indian/Alaska Native AND Black/African American ❑ Native Hawaiian or Other Pacific Islander ❑ Other: HISPANIC/LATINO ETHNICITY ❑ Yes 0 No If yes,check one' 0 Mexican/Chicano ❑ Puerto Rican ❑ Cuban ❑ Other: 4. Please check,ygs or no,if you are a female Head of Household? ❑ YES ❑ NO 5. Do you have a disability? ❑ YES ❑ NO If YES please describe: ACKNOWLEDGEMENT AND DISCLAIMER I CERTIFY UNDER PENALTY OF PERJURY THAT INCOME AND HOU$HOLO STATEMENTS MADE ON THIS FORM ARE TRUE, NAME: DATE: ADDRESS: PHONE NO: SIGNATURE: The informahon you provide on this form is confidential and is only utilized For Community Development Block Grant(CDBG)program purposes,a Federally-Funded program,governmental reporting purposes to monitor compliance CITY OF PALM SPRINGS EXHIBIT E Semi-Annual Program Progress Report Proiect/Activity Title: Pralect_N_umber; Mizell Senior Center/ 0004 Restroom Conservation Efficiencies Name/Address of Provider: Mizell Senior Center 480 S Sunrise Way Palm Springs, CA 92262-7641 PROGRAM PROGRESS REPORT Period: DIRECT BENEFIT REPORT ♦ Number of First-Time Program Beneficiaries Serviced: #of Households #of Persons 0-30% below 31-50% below: 51-80%below 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 Project/Activity Title: Project Number: Mizell Senior Center I 0004 Restroom Conservation Efficiencies Name/Address of Provider: Mizell Senior Center 480 S Sunrise Way Palm Springs, CA 92262-7641 BENEFICIARY QUALIFICATION STATEMENT A roved Current Prior Total Grant PP Description Grant Reimburseement Reimbursomant YTD eaianea Amount„ Period, Perlod(s) Reimbursement (Dvarl under) Materials & Labor $15,000. TOTAL $15,000. ���� 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. CITY OF PALM SPRINGS EXHIBIT G Employment Restrictions 1. Labor Standards The PROVIDER agrees to comply with the requirements of the Secretary of Labor in accordance with the Davis-Bacon Act as amended, the provisions of Contract Work Hours and Safety Standards Act, the Copeland "Anti-Kickback" Act (40 U.S.O. 275a-275a-5,40 USC 327 and 40 USC 275c)and all other applicable Federal, slate and local laws and regulations pertaining to labor standards insofar as those acts apply to the performance of this contract. The PROVIDER shall agree to submit documentation provide by the CITY which demonstrates compliance with hour and wage requirements of this part. The PROVIDER agrees that, all general contractors or subcontractors engaged under contracts in excess of$2,000.00 for construction, renovation or repair work financed in whole or in part with assistance provided under this contract shall comply with Federal requirements adopted by the CITY pertaining to such contracts and with the applicable requirements of the regulations of the Department of labor, under 29 CFR Parts 1, 3. 5 and 7 governing the payment of wages and ratio of apprentices and trainees to journeyworkers provided, that if wage rates higher than those required under the regulations are imposed by state and local law, nothing hereunder is intended to relieve the PROVIDER of its obligation, if any, to require payment of the higher wage. The PROVIDER shall cause or require to be inserted in full, in all such contracts subject to such regulations,provisions meeting the requirements of this paragraph. 2 "Section 3 Clause" a Compliance Compliance with the provisions of Section 3 the regulations set forth in 24 CFR 135, and all applicable rules and orders issued hereunder prior to the execution of this contract shall be a condition of the Federal financial assistance provided under this Contract and binding upon the CITY, the PROVIDER and any of the PROVIDER'S subrecipients and subcontractors Failure to fulfill these requirements shall subject the CITY, the PROVIDER and any of the PROVIDER'S subrecipients and subcontractors, their successors and assigns, to those sanctions specified by the Agreement through which Federal assistance is provided. The PROVIDER certifies and agrees that no contractual or other disability exists which would prevent compliance with these requirements The PROVIDER further agrees to comply with these "Section 3" requirements and to include the following language in all Subcontracts executed under this Agreement. "The work to be performed under this contract Is a project assisted under a program providing direct Federal financial assistance from HUD and is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U S.0 1701 Section 3 requires that to the greatest extent feasible opportunities for training and employment be given to low- and very low-income residents of the project area and contracts for work in connection with the project be awarded to business concerns that provide economic opportunities for low-and very low-income persons residing in the metropolitan area in which the project is located.' The PROVIDER further agrees to ensure that Opportunities for training and employment arising in connection with a housing rehabilitation (including reduction and abatement of lead-based paint hazards), housing construction, or other public construction project are given to low-and very low-income persons residing within the metropolitan area in which the CDBG- funded project is located;where feasible, priority should be given to low-and very low-income persons within the service area of the project or the neighborhood In which the project is located, and to low-and very low-income participants in other HUD programs; and award contracts for work undertaken in connection with a housing rehabilitation (including reduction and abatement of lead-based paint hazards), housing construction, or other public construction project are given to business concerns that provide economic opportunities for low- and very low-income persons residing within the metropolitan area in which the CDBG-funded project is located; where feasible, priority should be given to business concerns which provide economic opportunities to low-and very low-income residents within the service area or the neighborhood in which the protect is located,and to low-and very law-income participants in other HUD programs. The PROVIDER certifies and agrees that no contractual or other legal incapacity exists which would prevent compliance with these requirements. b. Notifications The PROVIDER agrees to send to each labor organization or representative of workers with which it has a collective bargaining agreement or other contract or understanding, if any, a notice advising said labor organization or worker's representative of its commitments under this Section 3 clause and shall post copies of the notice in conspicuous places available to employees and applicants for employment or training.