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HomeMy WebLinkAbout05642 - SHELTER FROM THE STORM CDBG SUBRECIPIENT AGR Page 1 of 1 Kathie Hart From: Dale Cook Sent: April 21, 2010 3.48 PM To: Kathie Hart Cc: Jay Thompson Subject: RE: A5642-Shelter from the Storm - Domestic Violence Outreach &Advocacy FY 08-09 Hey Kathie—Thanks for the follow-up. Yes, the file can be closed. Thanks again. —Dale {\�N� r� D DALE E. COOK,JR. �r\� Community Development Administrator Telephone: (760)323.8198 Fax. (760)322.3325 Please consider the environment before printing this email lwr From: Kathie Hart Sent:Tuesday,April 20,2010 1:12 PM To: Dale Cook Cc:]ay Thompson Subject:A5642-Shelter from the Storm-Domestic Violence Outreach&Advocacy FY 08-09 pale: May we close this file? Please advise. Thx! Kathie Hart, CMC Chief deputy City Clerk City of Palm Springs 3200 E. Tahquitz Canyon Way Palm Springs, CA 92262 `T,R (760)323-8206 1 E6� (760) 322-8332 ® Kathie.Hart@PalmSpringsCA.gov Please note that City Hall is open 8 a.m. to 6 p.m.Monday through Thursday,and closed on Fridays at this time. 04/21/10 SUBRECIPIENT AGREEMENT THIS AGREEMENT (herein "Agreement"), is made and entered into this7—"'day of 2"y 2008, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and charter city, and the Shelter From The Storm. Inc. , (herein"Provider'). WHEREAS, the City has entered into various funding agreements with the United States Department of Housing and Urban Development ("HUD"), which agreements provide funds ("CDBG Funds") to the City under the Federal Housing and Community Development Act of 1974 (42 U.S.C. Section 5301 et sec.), as amended from time to time (the "Act"), and the regulations promulgated thereunder(24 C.F.R. Section 570 et semi. ("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 govemmental agency of competent jurisdiction. 1.3 Reports. No later than ten (10) days prior to any payment date specified in Section 2.2, within ten (10) days following the termination of this Agreement, and at such other times as the Contract Officer shall request, Provider shall give the Contract Officer a written report describing the services provided during the period of time since the last report and accounting for the specific expenditures of contract funds hereunder, if applicable. At the times and in the manner required by law, the Provider shall provide to the City, the Department of Housing and Urban Development, the Comptroller General of the United States, any other individual or entity, and/or their duly authorized representatives, any and all reports and information required for compliance with the Act and the Regulations. 1.4 Financial Reporting. Any Provider receiving or due to receive or due to receiver $20,000.00 or more from the City during the 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 Providers financial records to be kept in accordance with generally accepted accounting standards. The report shall include a general ledger balance sheet which identifies revenue sources and expenses in sufficient detail to demonstrate contract compliance and be balanced to bank statements. Any organization receiving or due to receive less than $20,000.00 in the current fiscal year from the City shall provide a copy of the organization's most recent charitable trust report to the Attorney General, or other financial information satisfactory to City's Finance Director. The financial information provided for in this paragraph shall be fumished not later than January 31'r of the current fiscal year. p R9IGI 7 jD AND/O ALL,`dR-EZr,,PENT 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 ($15.000.00) (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 Payroll Records, In cases where the contract sum will reimburse payroll expenses as part of operations, the Provider will establish a system of maintaining accurate payroll records which will track daily hours charged to the project by the Provider's respective employees, as set forth in OMB Circular A-122 Attachment B.6. 2.3 Draw Downs. Failure by Provider to request reimbursement or encumbrance of at least 25% of the total grant by the and 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 Re resentative 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: Lynn Moriarty, Executive Director 3.2 Contract Officer. The Contract Officer shall be such person as may be designated by the chief administrative officer of City. 3.3 Prohibition Aaainst 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. 4.2 The Provider certifies it shall adhere to and comply with the following as they may be applicable: (a) Submit to City through its Community and Economic Development Department monthly reports on program status; (b) Section 109 of the Housing and Community Development Act of 1974, as amended and the regulations issued pursuant thereto; (c) Section 3 of the Housing and Urban Development Act of 1968, as amended; (d) Executive Order 11246, as amended by Executive Orders 11375 and 12086, and implementing regulations at 41 CFR Chapter 60; (e) Executive Order 11063, as amended by Executive Order 12259, and implementing regulations at 24 CFR Part 107; (f) Section 504 of the Rehabilitation Act of 1973 (P.L. 93-112), as amended, and implementing regulations; (g) The Age Discrimination Act of 1975 (P.L. 94-135, as amended, and implementing regulations; (h) The relocation requirements of Title II and the acquisition requirements of Title III of the Uniform Relocation Assistance and Real Property Acquisition at 24 CFR Part 42; (i) The restrictions prohibiting use of funds for the benefit of a religious organization or activity as set forth in 24 CFR 570.200 a); (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 sea.); (s) Maintain property inventory system to numerically identify HUD purchased property and document its acquisition date as is set forth in OMB Circular A-110 Attachment N Property Management Standard 6d; and (t) Reversion of asset. Upon the Expiration of the agreement, the subrecipient shall transfer to the City any CDBG funds on hand at the time of expiration and any accounts receivable attributable to the use of CDBG funds. Additionally, any real property under the subrecipient's control that was acquired or improved in whole or in part with CDBG funds (including CDBG funds provided to the subrecipient in the form of a loan) in excess of$25,000 is either: (i) Used to meet one of the national objectives in Section 570.208 (formerly Section 570.901) until five years after expiration of the agreement, or for such longer period of time as determined to be appropriate by the City; or (ii) Not used in accordance with paragraph (s)(i) above, in which event the subrecipient shall pay to the City an amount equal to the current market value of the property less any portion of the value attributable to expenditures of non-CDBG funds for the acquisition of, or improvement to, the property. The payment is program income to the City. (No payment is required after the period of time specified in paragraph (s) of this section.) (u) Such other City, County, State, or Federal laws, rules, and regulations, executive orders or similar requirements which might be applicable. 4.3 The City shall have the right to periodically monitor the program operations of the Provider under this Agreement. 5.0 INSURANCE AND INDEMNIFICATION. 5.1 Insurance. The Provider shall procure and maintain, at its cost, and submit concurrently with its execution of this Agreement, public liability and property damage insurance against claims for injuries against persons or damages to property resulting from Provider's acts or omissions arising out of or related to Provider's performance under this Agreement. Provider shall also carry Workers' Compensation Insurance in accordance with State Workers'Compensation laws. Such insurance shall be kept in effect during the term of this Agreement and shall not be cancelable without thirty (30) days' prior written notice of the proposed cancellation to City. A certificate evidencing the -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 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 ($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, mental 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 Ter-n. 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 Tenn. Either party may terrninate 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: Shelter From The Storm, Inc. 73555 Alessandro Dr. Ste D Palm Desert. CA 92260-3635 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 ATT _ a municipal corporation By. r By: i Clerk l-�� 5Y 2�pa City Manager APPROVE_ S—TO FO APPROVED BY CITY COUNCIL vy City ttomey 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 Seorptary, Treasurer, Assistant Treasurer, or Chief Financial Officer). BY. jL P*/" Pj� By, Notariz�S gnature of Chairman of Board, -Ndfar Srgf a't rue Secretary,Asst Secretary, President or any Vice President Treasurer,Asst Treasurer or ChiefFinancial Officer Name: C ° arty ( ��� Name: �/�-�� _✓�� Title: YLi�'e� Title: (21, to of l(�1¢oQNlq - State of = coun ofZl IJER$I OE ASS Co ty of ASS On 0 .0�&E2 t 008 before..— On before me, 541 -ttH kof o A1e.S�w!-'-c( f"Ie personally appeared \ ,personally appeared TRW trJ C t&5� personally known \ personally known 70 me(or proved t0 0 on the basis of satisfactory evidence) to me(Or proved to meb the basis of satisfactory evidence) to 4e the person(5) so name(s) is(are subscribed to the to be the person(s) whose ame(s) is subscribed t0 the within Instrument and acknowledged to me that he/she/they within instrument and ackno edged to me that he/she/they executed the same in his r/their authonzed capacity(les), executed the same in hisRwr/thee uthonzed capacity(ies). and that by hislher/their slg ture(s) on the Instrument the and that by hisRrer/their signatura(s) the instrument the ' person(s), or the entity upon b If of which the person(s) person(s), or the entity upon behalf of whIcbth\on(s) acted,executed the Instrument. acted,executed the instrument. WITNESS my hand and official seal. � A WITNESS my hand and Official seal. n �7 Notary Notary --- Signature:, Qd to" t-7 D Signature: -/Zlk�L, Notary Seal: Notary Seal: SnVFrmStrrn_SubreclpAgmintSrvs_RO 0ct08 -7- CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California 1 County �o�ly t=•125 l be J} On L�dIERJ7� before me, a� 1 (9 n/ZEA)o, lVOY�e e l�r.lal¢e D. / Here In rt Name antl Tllle o IBe Cllicer personallyappeared „•„ Names)or Sunegs)— , who proved to me on the basis of satisfactory evidence to be the personlo whose nameQG) fs/Q-qKe subscribed to the within instrument and acknowledged to me that he/shc/they executed the same in his/hqr/tDdr authorized capacityx, and that by his/Y)er/Mir signatureo on the instrument the personf4, or the entity upon behalf of SHE LA MCIREH which the personX acted, executed the instrument- Commit; Ion # 1709366 6Notory9ulmpc Cdlltati ld Rivercido County I certify under PENALTY OF PERJURY under the laws _ - ecycar a r 7,xa of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature— ���� o K?J?o�D Place Notary scat Ah= Sign.turn of Notary Public OPTIONAL Though the information below 1s not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: 6tzLQ .C' J)i�A]T �Gt�c'cl))�1JT /� I Document Date:0P401 Q I-7, ,Z 0C")6 Number of Pages: .5f-0 _r- Signer(s) Other Than Named Above: 1� o _.LkL�tl riSsr > rRSli�€L. Capacfty(ies) Claimed by Signer(s) Signer's Name: �I�ln?tt.� ��LQra Signer's Name:-- ❑ Individual n' ElIndividual ,V Corporate Officer—Title(s): �)rCS_i(�,nn @F_c rwLTT' ❑Corporate Officer—Title(s): LJ Partner—❑ Limited ❑ General _ _ _ ❑ Partner—❑ Limited ❑ General ❑ Attorney in Fact ❑Attorney in Fact ❑ Trustee np or thump hrrr• ❑Trustee Top of thumb here ❑ Guardian or Conservator LJ Guardian or Conservator fl Other: LJ Other: S gner Is Representing: Signer Is Representing: d 4 (fcf �c try, C�BZGt�. n2007 Naflonal Notary Associatlon•9350 De Soto Ave PO eox 2A02•Ch rt,nrth(:A p131 i-pApQ•www NallonalNolaryorp Itemfi5907 Reorder.Call Toll-Free 1-800-578-6027 CALIFORNIA TALL-PURPOSE ACKNOWLEDGEMENT STATE OF CALIFORNI,{q�� (� )SS COUNTY OF `\ C—LV __S �^� f \^J Oil 0 G�u D C� �� � Q Qe hefnre me, a notary public is and for said state,personally appe:acd 7� if CY I G mar^ who proved to me on the basis of satisfai,tury evidence to be The persoa(,j whose .mle(s is/.iT subscribed to ton within instrument and acknowledged to me that he/sIumEltty oxel'umil the sane �in lus/h, it aiidlnnZcd Capamty(hL'9),and that by hisIh=Ltlatir shgnanirc�)on the inSLRll➢ctir die persua/1 or The eamy i upon hchalf of which the person( acted, oxuha[od[Ile insumnoa[. 7 I cetrify under PENALTY OF PERIT7RY under die laws of the State of California That du toregning paragraph is true and turret.[. WITNESS in hand and otticial seal. IRENE E. RING Signature _ - (Seal) '�� Comrnlsslon 1700678 .' Notory Publlc _Callfornla , p. Rlverslao County Myonal NOV2,2010 OPTIONAL Though the infnpvnatmn below l%not required by law it may prove valuable to persons relving on the document and could prevent froudulem removal and rearracivnen;of Aus form m another document. DESCRIPTION OF ATTACHED DOCUMENT Title or Type of Document: F IYN C cz —( Document Dale: — Number of Pages: Signer(b) o0icr than named above CAPACITY(IES) CLAIMED I3Y SIGNER(S) [ ] INDIVIDUAL [ ] TNDTVIDTTAT, Right Thuiubpiint Right Thumbprint [ ] CORPORATE OFFICER(S) ofJSt8ner [ ] CORPORATE OFFICER(S) of Signer TITLE(S) r op or MumbAcre TITLE(S) op ot thumh here [ ] PARTNER(S)- [ ] LIMITED, [ ] PARNER(S)-[ ],�MMITED [ ] GENERAL [,-] CENERAL i [ ] ATTORNEY-TN-FAC11' [ ] ATTaR<E•Y-IN-FACT [ ] TRUSTEE(s) % f --IRUSTEr(S) [ ] GUARDIAN OR CONSERVATOR [ ] GUARDIAN OR CONSERVATOR [ ] OTIIER [ ] OTT-TER F SIGNER IS REPRESENTING: i CITY OF PALM SPRINGS EXHIBIT A Scope of Services Prolect/Activit Title: Proiect Nu_m_ber: Shelter From The Strom ! 0008 Domestic Violence Outreach &Advocacy Name/Address of Provider: Shelter From The Storm, Inc. 73555 Alessandro, Ste. D Palm Desert, CA 92260-3635 Objectives/Activities The intent of this program is to provide domestic violence outreach and advocacy center, located in Palm Springs. This will be accomplished through the staffing of an Outreach and Advocacy Center facilitating a full range of'on-the-scene' crisis counseling, supportive services and emergency shelter for forty-five (45) residents. 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_, etc1 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 an approximately forty-five (4.5) 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 servic_es,_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 Proiect/Activity Title: Project Number: Shelter From The Strom/ 0008 Domestic Violence Outreach &Advocacy Name/Address of Provider: Shelter From The Storm, Inc. 73555 Alessandro, Ste. D Palm Desert, CA 92260-3635 �i;1�7ii"'.`1Nw'�Vl�ie"tt"*n'P$Y XV�2:i=.�'• oi"" i�<�i;,v •a�;�';%raB"UdGETAUMIIMARYa',W��.�l COST CATEGORY CDBG OTHER TOTAL SHARE SOURCES COST 1 Personnel $15,000. $8,188. $23,188. 2 Consultant/Contract Services $ $ $ 3 Travel $ $180. $180. 4 Space Rental $ $9,600. $9,600. 5 Consumable Supplies $ $500. $500. 6 Rental, Lease or Purchase of $ $2,160. $2,160. Equipment 7 Insurance $ $ $ 8 Other $ $960. $960. Telephone $ $1,000. $1,000. Client Education Material Ll $15,000. $22,588. $37,588. 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 Shelter From the Storm's auxiliary, Angels'Alliance and In-Kind Donation of office space, totaling $14,268. EXHIBIT B—Budget Summary Page 2 of 2 Pages DESCRIPTION OF ACTIVITY/ CDBG OTHER TOTAL PAY ITEMS SHARE SOURCES COST Personnel - $10,456- $4,545, $15,000- Salaries—Outreach Advocate Benefits—Outreach Advocate $4,545. $3,643. $8,188. Other Costs- -0- $14,400 $14,400. Operations &Overhead Expenses LIT-6—to "I.) A L580 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 1/4 of the total annual budget. Payments, approved by the Subrecipient, shall be paid by the 30'h 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 Proiect/Activity Title- Project Number: Shelter From The Strom ! 0008 Domestic Violence Outreach &Advocacy Name/Address of Provider: Date: Shelter From The Storm, Inc. 73555 Alessandro, Ste. D Palm Desert, CA 92260-3635 INSURANCE INVENTORY LIABILITY INSURANCE POLICY Name of Provider's Insurance Company Philadelphia Insurance Companies Effective Dates of Policy 07/01/08 through 07/01/09 Claims Made Policy ! I Per Occurrence Policy, /, ! Limits of Liability General Aggregate$2.000.000 Deductibles: Per Occurrence Annual Aggregate Additional Insured Endorsement (Certificate Holder) d Yes ❑ No Original Certificate of Insurance Attached ❑ Yes EI No WORKER'S COMPENSATION POLICY Name of Provider's Insurance Company State Compensation Insurance Fund Effective Dates 04/01/08 through 04/01/09 Limits of Liability $1,000,000 Per Occurrence Underlying Coverage Limits Original Certificate of Insurance Attached 11 Yes © No AGORA. CERTIFICATE OF LIABILITY INSURANCE SHELT-1 1 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO Cuxtis 6 Earris Insurance Sere ONLY AND CONFERS NO RIGHTS UPON THE:CERTIFICATE n& License B OP30715 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O. Box 1555 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Palm Springs CA 92263 Phone:760-779-8787 Fax:760-776-7676 INSURERS AFFORDING COVERAGE NAICN InauRED INSURERA nlil 02pb . invi .,n e� ��- wSORERB Shelter from the Storm INSURERC• 73-S55 A.l.esaandro ❑r. , Ste. ❑ INSURER❑ Palm Desert CAL 92260 I - �suacaE COVERAGES THE POLICIES CF INSURANCE LISTED OnCIFI v HAVE 6CEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANOING ANY REOUIRELIBHT TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUE[)OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES OESCRIBED HEREIN I$SUBJECT TO ALL THE TERMS,EXCLUSIONSAND CONDIT IONS OF SUCH PCIICES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS L'f11 NERD TYREOFIHSU RANCE POLICY NUiN3ER `---�pAYC NIHIM0191E bAi V/�INrp+ UNITS I ONNEM LIANUTY I "CH OCWRRENCC S I,0000d0 A X IC CAMNERCIALGENWLUA01LIIl' PHPFC125329 07/01/08 07/01/09 PRF�14E$ISx DeaCenml I100000 I� IT�'�DLAIM.S MADE �DCCukI I i MDO E%PlAny mr pePORI S5000 PERSONAL 6 AlVINAURY 3100 0000_ X CENSRALAGGREGATE IS2000000 GENT.ACGFEGATE LIMIT APPLIES PER.I I FRDDUCTS-CAMR)p AGG IXQQd000 )C PDUCY y ~J -OC 1 1000000 A LROAgSILE WIWMTT COMMED SINGLE UNIT AI AUTO I(E.e ffli 51dGDdQQ I— N.400NED AUTOS I I EOPLY INJURY-- — I SCHEQULEDAfITCS I YHPSC925329 I 07fp1/OB I d7f01/09 fP"i P"''0^I S A x MREDAUTOEOOCI4Y INJURY I $.NON6ATeEDALITCG fP[[amHeNl S n PROPERTY DAMACd S IPararnHyml OARAOIUAMUFY I AUTO ONLY-EA ACCIDENT s AM'AWRG :OTHEp THAN CA At'.(j b AUiOONLY AGG is ' IXCESSM40MLALIARILTN I I EACH=URRFNCE $2000000 A OCCUR I-:]CLAIW4 MADc F:Os 43443 07/01/08 07/01/139 I AGGRErrAjE 3 2000000 I = DEDUCIIRLE $ �xl RM"ON A10000 3 WORKERS CONIF01AVON AND �IiORYUMiTE PR � i EMRLOVERYLNW.ITY ANY PROPRIETORNARTNERRXOCIITIW I F LL&� ACCIIDE�NT 3 OFHCERMEMDER EXCLIIDEO? .E L D151 [ASF_EA EMPLOYELI S SIX EDIAL aETsar IP,L D*L-'.ASE-POLfLY UNIT 3 LPR0 PROVISIONS Ddw+ OTHER OESOIIETION DE OP ERATKINSI LOCATIONS IYSH18LU IEXCLUSEWS ADDED BY ENDORSEMENT,SPECIAL p ROVIMUMS VERIFICATION OF INSURANCE FOR TIM NAMED INSURED RE: CDBCG FONDING. THE CITY OF PALM SPRINGS, ITS OFFICIALS, EMPLOYEES AND AGENTS AM VOLUNTEERS ARE ADDITIONAL INSURED PER FORM CG 20 10 10 93. COWPAGE IS PRIMgRY AND NON CONTRIMVTORY TO ANY INSURANCE MAINTAINED BY THE CITY OF PALM SPRI17GS. 10 DAY NOTICE OF CANCELLATION FOR NONPAYMENT OF PREFILQM. CERTIFICATE HOLDER CANCELLATION ciTr❑Vp SHOULD ANY OF THE ANOW DEEMIURED AOUDIES BE CANCELLED BEFORE THE CKRIRAT1ON PATE THEREOF-TNt MSUING INSURER MLQjMP6M3P MML 30 DAY5 WRITTEN NGTICE TO THE CEITORCAT£HOLDER NAMED TO THE LEFT�ppT Rp[]q TJ( THE CITY OF PALM SPRTNGS DALE COOK 3200 E. TA9QUITZ CYN TTAY TD9alE6EplUlEiB PALM SPRINGS CA 92262 Au Ee nv ACORD 25 12001I05J ®ACORD CORPORATION 1 POLICY NUMBI>R: PI3PK325329 COMMERCIAL GENERAL LIABILITY INSURED: Shelter From The Storm CG 20 19 10 93 THIS ENDORSEMENT CHANGES TILE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED—OWNERS,LESSORS OR CONTRACTORS FORM(Bt This endorsement modifies insurance provided under the Following COMMERCIAL GFNERAL LIABILITY COVFKRAGE PART. SCHEDULE THE CITY OF PALM SPRINGS,ITS OFFICIALS,EMPLOYEES, AGENTS AND VOLUNTEERS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) WHO IS AN INSURED (Section II)is amended to include as an insured the person or Organization shown in the Schedule,but only with respect to liability arising out of your ongoing operations performed for that insured. Such insurance afforded by this policy for the benefit of the additional insured(s)shall be primary insurance bur nnly with respects any claim, loss, or liability arising out of the operations of the named insured, and any insurance maintained by the additional insureds) shall be non-contributing Your work is defined as work now being performed or to be performed by the named insured during the tern of Ibe policy CG 20 10 10 93 Copyright, Insurance Services Office, Inc., 1992 POLICYHOLDER COPY SK STATE P,O_ BOX 420807, SAN FRANCISCO,CA 94142-0807 COMPENSATION INS UFIANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 04-01-2008 GROUP: 000488 POLICY NUMBER: 0000092-2008 CERTIFICATE ID: 1 CERTIFICATE EXPIRES: 04-01-2009 04-01-20OW04-01-2009 CITY OF PALM SPRINGS SK CITY CLERKS OFFICE P 0 BOX 2743 PALM SPRINGS CA 922E3 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 Cancellation 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 herein. 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 the policy described herein Is subject to all the terms, exclusions, and conditions, of such policy. THORTED REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2005 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER SHELTER FROM THE STORM, INC. A NON-PROFIT, MUTUAL BENEFIT CORPORATION 7355S ALESSANDRO DR STE D PALM DESERT CA S2280 M0409 (REV.P-a5) PRINTED 03-18-2008 CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement Proiect/Activity Title: Project_Number: Shelter From The Strom / 0008 Domestic Violence Outreach &Advocacy Name/Address of Provider: Date: Shelter From The Storm, Inc. 73555 Alessandro, Ste. D Palm Desert, CA 92260-3635 BENEFICIARY QUALIFICATION STATEMENT This statement must be completed and signed by each person or head of household (legal guardian) receiving benefits farm the described projectlacbvity. Please answer each of the fallowing questions. 1- Haw many persons are in your household? For this question a household is a group of related or unrelated persons occupying the same house with at least one member being the head of the household, Renters,roomers,or borders cannot be Included as household members. 2. Circle your combined gross annual income(Riverside-San Bernardino-Ontario,CA MSA—03120/07) 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 $18,000 $20,000 $21.600 S23,200 S24,800 $26,400 0-30%of AMI VERY LOW INCOME $23,300 $26,650 $29,950 $33,300 $35,950 $38,650 $41,300 $43,950 31-50%of AMI LOW INCOME $37.300 $42,650 $47.950 $53,300 $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 $98,200 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 11 Black/Afncan American AND White ❑ Amenean Indian or Alaskan Native ❑ American Indian/Alaska Native AND BladdAfrican American ❑ Native Hawaiian or Other Pacific Islander ❑ Other: HISPANIC/LATINO ETHNICITY ❑ Yes ❑ NO If yes,check one: El Mexican/Chicano ❑ Puerto Rican ❑ Cuban ❑ Other. 4. Are you female Head of Household? ❑ 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 HOUSHOLO STATEMENTS MADE ON THIS FORM ARE TRUE. NAME: DATE: ADDRESS: PHONE NO: SIGNATURE: The information you provide an this form is for Community Development Block Grant(CDBG)program purposes only and will be kept confidendal. CITY OF PALM SPRINGS EXHIBIT E Program Progress Report Pro ect/Activit Title: Proiect Number: Shelter From The Strom ! 0008 Domestic Violence Outreach &Advocacy Name/Address of Provider: Date: Shelter From The Storm, Inc. 73555 Alessandro, Ste. D Palm Desert, CA 92260-3635 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 Proiect/Activity Title: Project Number: Shelter From The Strom / 0008 Domestic Violence Outreach &Advocacy Name/Address of Provider: Date: Shelter From The Storm, Inc. 73555 Alessandro, Ste. D Palm Desert, CA 92260-3635 9n7i dr .q'S�i,� �'i{s'`r^.,,q�� Frr"'xIM`,K.M�tr:�:�4:'ikca5ryi"fur"rrirt�.f�'.ci6:ni!;I,:iI?.1 g�° p5 �oi",p�:''i��,��y� '�'��;rrr�•u;�t�rr+��aK�' `>�vri�v�;rr���ra,<;'•. 'I�x�. r�gJl.w,i�t'%�gw,1'dl ;i�� �r;iS� �I��', �'; a�r��ttra;.§ al�n ,��°I v3wdrw_..t : 'q'1���,�la', ," l,�Ig1t,`%t "11�J,',":AmcunE^,P%rSAS :Y;�'i�t"f�iPerlougfn;4'r� V,�kn¢'`y�Pe'il�od(s nva7„4 ;FR2lmbursemenL'r'i rf.Uner�d 'GI Saran es—Outreach Advocate $10,455. Benefits—Outreach Advocate $4,545, 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.