HomeMy WebLinkAbout05636 - FAMILY YMCA OF THE DESERT CDBG SUBRECIPIENT AGR DOCUMENT TRACKING
Page:1
Report: One Document Detail October 14,2010
Condition: Document Numbera5636,
Document# Description Approval Date Expiration Date Closed Date
A5636 Public Facilities Improvements CDBG FY 2008.09 04/02/2008
,ompany Name: Family YMCA of the Desert
address: Terri Bona,Director of Fund Development, 43-930 San Pablo,Palm Desert,CA 92260
:ontact: Ms.Bona
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
kdh to CM for sig distrib to Dale C IN FILE 12/15/2008 12108/2009
kdh Res 22193 Item 1A 04/02/2008 $15,000.00
*** **ENDOFREPORT******
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SUBRECIPIENT AGREEMENT
THIS AGREEMENT (herein "Agreement"), is made and entered into this day of December,
2008, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and
charter city, and the Family YMCA of the Desert , (herein 'Provider').
WHEREAS, the City has entered into various funding agreements with the United States
Department of Housing and Urban Development ("HUD"), which agreements provide funds ("CDBG
Funds") to the City under the Federal Housing and Community Development Act of 1974 (42 U.S.C.
Section 5301 at sec.), as amended from time to time (the "Act"), and the regulations promulgated
thereunder(24 C.F.R. Section 570 et seq. ("Regulations"); and
WHEREAS, the Act provides that the City may grant the CDBG Funds to nonprofit
organizations for certain purposes allowed under the Act; and
WHEREAS, the Provider is a nonprofit organization which operates a program which is eligible
for a grant of CDBG funds and the City desires to assist in the operation of the program by granting
CDBG Funds to the Provider to pay for all or a portion of those costs incurred in operating the program
permitted by the Act and the Regulations on terms and conditions more particularly set forth herein;
NOW, THEREFORE, the parties hereto agree as follows,
1.0 SERVICES OF PROVIDER.
1.1 Scope of Services. Provider agrees to provide to City all of the services
specified and detailed in its application for funding and Exhibit A, and to conduct all programs specified
therein in a manner to reflect credit upon the City and Provider. Provider represents and warrants to
City that it is able to provide, and will use funds granted by the City to provide the services represented
in the 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 competentjurisdiction.
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 furnished not later than January 31 si of the current fiscal year. /�
Pam '
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.
22 Payroll Records. In cases where the contract sum will reimburse payroll
expenses as part of operations, the Provider will establish a system of maintaining accurate payroll
records which will track daily hours charged to the project by the Provider's respective employees, as
set forth in OMB Circular A-122 Attachment B.6.
2.3 Draw Downs. Failure by Provider to request reimbursement or encumbrance
of at least 25% of the total grant by the end of each fiscal year quarter (September 30, December 30,
March 31, and June 30) shall result in the immediate forfeiture of 25% of the total grant.
3.0 COORDINATION OF WORK.
3.1 Representative of Provider. The following principals of Providers are hereby
designated as being the principals and representatives of Provider authorized to act in its behalf with
respect to the work specified herein and make all decisions in connection therewith:
Terri Bona. Director of Fund Development
Alison Elsner, Associate Executive Director
Rob Ballew, Chief Executive Officer _
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
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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.
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 semi-annual 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 570200 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 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),
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(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 CDBC funds on hand at the
time of expiration and any accounts receivable attributable to the use
of CDBG funds. Additionally, any real property under the
subrecipient's control that was acquired or improved in whole or in part
with CDBG funds (including CDBG funds provided to the subrecipient
in the form of a loan) in excess of$25,000 is either.
(i) Used to meet one of the national objectives in Section
570208 (formerly Section 570.901) until five years after
expiration of the agreement, or for such longer period of time
as determined to be appropriate by the City; or
(ii) Not used in accordance with paragraph (s)(i) above, in which
event the subrecipient shall pay to the City an amount equal
to the current market value of the property less any portion of
the value attributable to expenditures of non-CDBG funds for
the acquisition of, or improvement to, the property. The
payment is program income to the City. (No payment is
required after the period of time 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
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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
($500,000).
5.2 Indemnification. The Provider shall defend, indemnify and hold harmless the
City, its officers and employees, from and against any and all actions, suits, proceedings, claims,
demands, losses, costs, and expenses, including legal costs and attorneys' fees, for injury to or death
of person($), 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 parry desires or is required to give to the other parry 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
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WITH COPY TO-
City of Palm Springs
3200 East Tahquitz Canyon Way
Palm Springs, CA 92262-6959
Attn, City Attorney
TO PROVIDER.
Family YMCA of the Desert
43-930 San Pablo
Palm Desert, CA 92260-9312
7.2 Amendment. This Agreement may be amended at any time by the mutual
consent of the parties by an instrument in writing.
IN WITNESS WHEREOF, the parties have executed and entered into this Agreement as of the date
first written above.
[ End—Signatures on Next Page]
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CITY OF PALM SPRINGS
FyClerk
a municipal corporation
r
/2'/ City Manager
APPROVED S—6FORM• APPROVED BY CITY COUNCIL
v 1 _
City Att may
PROVIDE Check one: —individual —Partnership =Corporation
(Corporations require two notarized signatures: One signature must be from the Chairman of
Board, President, or an Vice President. The secon signature must be from the Secretary,
Assistant Secret reas�rer, Assistant Treasurer, or C i 'f Financial Offlcer).
By: l/ rxi � By:Ac4 I
Notarized Signature of Chairman of Board, a Notarized Signature Secretary,Asst Secrete ,
President or any Vice President Treasurer Asst Treasurer or Chief Financial Officer
Name: Xl�-h G nF /C Name: ��e g, A
Title: C((yy(7ig, r Title:
State of ;�1� State of
County of N iVe.f S i A Jss County 11of a ye t,Sd( ss
On
11 UbUQb'\\yapp aa, -aoo7 + before me, On 1V C'+Uf�6'4L��C rr�S� �.{.,L,Y� before me,
I(L a\LYti V. ICr� wli cpersonally appeared �PQLI_ ut��c, 1�,��l�.P yS�'p��lnff,eelsonally appeared
rLLti't TCL F'Y-' personally known �('F����/ P �I CU_J ezj personally(mown
to me(or proved to me on the basis of satisfactory evidence) to me(or proved to me on the basil factory evidence)
to be the person(%whose name(5A is/are subscribed to the to be the pemon('4 whose name(s is/are-subscribed to the
within instrument and acknowledged to me that ho/shaidh y within instrument and acknowledged to me that he/she/tl ey
executed the same in his/heO*eir authorized capacity(i executed the same in hislharA4ar-authorized capacity(-},
and that by his/kerkheir signature(U on the instrument the and that by his/hei;#elr s gnture(F¢an the instrument the
porson(�O, or the entity upon behalf of which the porson(W porsonM or the entity upon behalf of which the person(te
acted,executed the instrument. acted,executed the instrument.
WITNESS my hand and official seal. WITNESS my hand and official seal.
Notary Signature:V�e ,p, 0'LL^6-- Notary Signature:C,�
Notary Seal: 1J Notary Seal:
DEIANNA D.MYERS DEtANN►,D.MYERS'..
CommisYonM 15426M ------ - commillowY 1542600
=CeuWY �r Pubic-Callill
Nlrankle court
MYGanNrw *l Comm. Jun25 2
YMCA_SulbrecipAgmmLOCOII
—
PALM SPRINGS ' .
EXHIBIT A
Scope of Services
ProiectlActiyity Title: Project Number:
Family YMCA of the Desert
Public Facility Improvements 0002
Name/Address of Provider:
Family YMCA of the Desert
43-930 San Pablo Avenue 3601 E Mesquite Ave
Palm Desert, CA 92260 Palm Springs, CA 92263-9530
O b i e c tiveslActiy i t i es
The intent of this program is to provide after-school programs for at-risk children of low and moderate
income households. This will continue the YMCA's renovation efforts to the facility by replacing the
facility's exterior doors with new metal gym doors and install ADA compliant power-assisted door closures
for the existing main front entrance doors. The YMCA also serves as one of the City's emergency
shelters under the Fire Department's Emergency Preparedness Plan and houses one of the Fire
Departments Disaster Medical Assistance Packages on their premise. Palm Springs'YMCA serves 2,660
residents on the westem portion of Coachella Valley of which 1,141 will be low to moderate-income Palm
Springs'residents.
The Provider shall be responsible for the completion of the following objectives/activities in a manner
acceptable and satisfaclory 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 finsnciai 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
(Le., Provider, City. CDBG, etc.).
TARGET
DATE ACTIVITY#1
On-Going Draft a promotional piece and submit to City for approval. Advertise in the Desert Sun.
Submit final publication to City.
Objective 4: Enroll and income qualify at least a total of one thousand one hundred and forty-one
(1,141)_low and moderate-income Palm Springs residents with improved access to the
facility.
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 orooram.
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
On-Going Submit Semi-Annual reports—referenced Exhibit E.
Objective 6: Manage/monitor orogram activities.
TARGET
DATE ACTIVITY#1
On-Going Perform monitoring activities necessary to ensure that the program is being conducted in j
compliance with the CDBG policies, federal regulations, and local statues, including
Davis-Bacon Act, Copeland Act, and Non-discrimination/EEO requirements.
Objective 7: Upgrade the roofing system on the lower roof section of the gym and replace the gym's
seven evaporative coolers.
TARGET
DATE ACTIVITY#1
On-Going Conduct program activities to improve availability/accessibility in accordance with an
open competitive' procurement process as stipulated in the proposal and in consultation
with the City.
Objective 3: Provide an evaluation within fifteen 15 calendar days of the program completion or final
reimbursement.
TARGET
DATE ACTIVITY#1
07/15/08 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.)
C.1TY;:DF'
DAL ' .
EXHIBIT B
Budget Summary
Project/Activity Title: Pro•ec�t Number:
Family YMCA of the Desert
Public Facility Improvements 0002
Name/Address of Provider.
Family YMCA of the Desert
43-930 San Pablo Avenue 3601 E Mesquite Ave
Palm desert, CA 92260 Palm Springs, CA 92283-9530
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 - _ - 0 - - 0 -
6 Rental, Lease or Purchase of - 0 - - 0 - - 0 -
Equipment
7 Insurance - 0 - - 0 - - 0 -
8 Other $15,000. - 0 - $15,000.
� Job_Contract& Continge�
,lLail+in,ua? e:pCii="i?i:_ :=,� ii:iri:Fc—:'._-'_": ,
,:c:�:a„:-r.,al.rbb..,....__Si41ux-m:'.::-, r�me._..,cr_t i l(.:,w.:•^$,..�,.. _ � vlc- c �i1' 4I,u=--:c
, i .dx1.i_4_.:gaa;a'1.,.V_.. ,: _Ficlk_?.�_'tt:l„m c' ____:-,:::, a$lu>, ��.�a:.,:�:-_:_:_:._.ai lW vu+'i..r:L,..., - �..a;:'f!i,i'�:i iii__ si5-:il;=lk„�..1ia•F6:= _m ue... r ... .n.,
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.
Progress payments, approved by the Subrecipient and based upon the percentage of completed
work, as outlined in the respective Professional Service Agreement and the Construction
Agreement with a 10% retention, shall be paid by the 301h 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-
The Subrecipient shall receive reimbursements and/or its suppliers/vendors shall receive direct
payments by way of a two-party check, in accordance with the aforementioned cost categories and
line items which are subject to receipt of an acceptable requisition in the form of a monthly Request
for Reimbursement.
Services are to be performed over a twelve month period of July 1, 2008 through June 30, 2009
with funds allocated from 2008--09 Program Year.
G -0 , PALM SPRIN,
EXHIBIT C
Insurance Inventory
FromecVActivity Title- Project Number,
Family YMCA of the Desert
Public Facility Improvements 0002
Name/Address of Provider.
Family YMCA of the Desert
43-930 San Pablo Avenue 3601 E Mesquite Ave
Palm Desert, CA 92260 Palm Springs, CA 92263-9530
INSURANCE INVENTORY
LIABILITY INSURANCE POLICY
Name of Provider's Insurance Philadelphia Indemnity
Effective Dates of Policy 01/01108 to 07/01/09
Claims Made Policy / I Per Occurrence Polic 1 X I
Limits of Liability_ $2M General Aggregate
Deductibles-
Per Occurrence
Annual Aggregate
Additional Insured Endorsement (Certificate Holder) Z Yes ❑ No
Original Certificate of Insurance Attached 0 Yes Z No
WORKER'S COMPENSATION POLICY
Name of Providers Insurance Company Tower Select Insurance Company
Effective Dates 06101/08 to 06/01/09
Limits of Liability $1 M Each Accident
Underlying Coverage Limits
Original Certificate of Insurance Attached 0 Yes [a No
xyDDn
ACOW. CERTIFICATE OF LIABILITY INSURANCE
PROPUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Desert Empire Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Services,Inc. L1C#OF09643 HOLDER.THIS CERTIFICATE DOES NOTAMEND,EXTEND OR
ALTERTHE COVERAGE AFFORDED eYTHE POLICIES BELOW.
77-SO4 Country Club Drive
Palm Desert,CA 92211 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA: Philadelphia Indemnity 18058
Family YMCA of the Desert INSURER D. Tower Select Insurance Company
43-930 San Pablo Ave.
rvsuRERc.
Palm Desert,CA 92260 IrvsuRERD:
INSURERE:
COVERAGES
THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY RrcUIREMENT,TERM OR CONDITION OF AM'CONTRACT OR OTHER DOCUMENT WITH RESPECTTO wHICFI THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
[ POLICY EFFECTIVE-CTIVE POLICY EXPIRATION LIMIT:
LTR SR TYPECFINSURANCE POLICYNVMBER
A PM!UL LIADIUTY PHPK283340 01/01/08 07/01709 aCHOCCURRENCE S1000000
X I COMMERCIAL GENERAL LIABILITY pR AGE TO RENTED $SD DDD
CIAIMS MADE aOCCUR MEDESP(Anyanepemob) $5000
PERSONAL B ADV INJURY S11000.000
CENEP ACCREGATE 321000.000
CENIACCRECATE LIMITAPPLIES PER PRODUCTS-COMP/DP AGO 52000000
POLICY , O,T LOC
A AUTOMOBILE LIABILITY PHPK283340 01/01/OB 07/01/09 COMBINED SINGLE LIMIT
X ANY AUTO (Eaacod") 51,000,000
ALL OWNED AUTOS BODILY INJURY
SCHEDULEDAUTOS (Por PPron) $
X HIRED AUTOS &DOILY INJURY
X NON-OWNED AUTOS (Per aecdenp 5
PROPERTY DAMAGE S
(Per scodenp
GARAGE UABILRY AUTO ONLY-EAACCIDENT E
ANY AUTO OTHERTHAN EA ACC 3
AUTO ONLY: ABC S
A EYCESnJUMBkELI-A LIABILITY PHUB103512 01/01/0S 07/01/09 EACH OCCURRENCE 510000D0
X1 OCCUR 7 CLAIMS MADE AGGREGATE 51006000
S
PEPUcTIULE
RETENTION S S
fH
B WORKERS COMPENSATION AND TSIWP7081379900 06/01103 06/01/09 X WRY)TMIY Tq FR'
EMPLOYERS'LIASILITY
ANY PROPRIETOR/PARTNERIEXECJTIVE E.L.EACH ACCIDENT 31,900 ODO
OFFICEB/MEMeER EXCLUDED? FI DISEASE-EA EMPLOYEE1$1,000,000
ByE d PROEuPder
GPECIAL PROVISIDNG below EJ—DLSE4sE-PCIJCV LIMIT 31,606,999
A OTHER PHPK2S3340 01109/08 07/01/09 1,000,000/1,000,000
Sexual/Phys Abuse
-DESCRIPTION OF OPERATIONS I LOCATIONS(VEHIcL S;I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS it ll _jrl�•^"•^^�^^-`- ^- �L-,•_.I; j�
`10 Day notice of cancellation for non-payment of premium.City of Palm Springs, its II'L'ij �y
officers anellor employees are included as additional insured per attached endorsement on
job described as Palm Springs YMCA Kitchen Remodel at 3601 E.Mesquite,Palm Springs,CA l
92264 per attached. City of Palm Springs is funding this project. "i�i L`: r'
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORe THE EXPIRATION
City of Palm Springs••Attn: PATETHEREDF.T4lOISSUWGINSURERWILLENDEAVORTOMML ,_= DAYswRrTEN
Dale Cook NOTICE TO THE CERTIFICATE HOLDER NAMED TOTHE LEFT,BUT FAILURE TO DO SO SHALL
Box 2743 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR
Palm Springs,CA 92263 REPRESENTATIVES.
AUTHOMMD REPRESENTATIVE
ACORD 25(2001/08)1 of 3 #S120116/M118919 2RCOT 0 ACORD CORPORATION 1986
POLICY NUMBER: PEPK283340 COMMERCIAL GENERAL LIABILITY
CG 20 26 07 04
THIS ENDORSEMENT CHANCES THE POLICY, PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
P _80NOR ORGANIZATION EM"
This endorsement modifies insurance provided under the foflolmlng;
COMMERCIAL GENERAL LIAS I LITY COVERAGE PART
SCHEDULE
Nume.Of Additional'Insured Personsj_Qv Qygani7atlon(o
&jauke# as. reqaSxed.by written: ccnytwac=L aba eifective' &=Ing the PC'UaY Period
as stated dn, the �licy decla-rafibns.
Information rouized.to oQrnplete lbiq Schedule,.if not shown a4Qvq,will be shown li=i the Declaraftons.
sp�ionl 11,—Who t� An, Itys'dr
T.i ed is: amended to in-
� .ad�lejo)IAHnE�red the person(sj a organt-
zkpn(a,j,.SfioWa in t6e',Rdhedufe; but OpTy wifh respect
ta'JlijAj� kir rbodif , Injury'", "`property damage" or
�lpar-,6ni ilsfng .lajury" caused, In whole.or
ircpalt, 4y yob Tdcts bromisslahs or'& acts,or 6mils-
sldi%etf uos acflrlq oh your beihalf,
A, or
In. roriri.0 don with your premises cifted by or
ranfed you.
JUL 1 1 2008 ij �fl
1E
00',20 28 07 04 0 ISO ProperJes, Inc.,2004 Pager l.of 1
�ITY 'O
F ,I I:, M SPRINGS
EXHIBIT 1)
Beneficiary Qualification Statement
ProiecYActivity Title, Proiect Number,
Family YMCA of the Desert
Energy-Efficiency Improvements 0002
Name/Address of P ovider.
Family YMCA of the Desert
43-930 San Pablo Avenue 3601 E Mesquite Ave
Palm Desert, CA 92260 Palm Springs, CA 92263-9530
BENEFICIARY QUALIFICATION STATEMENT
This statement must be completed and signed by each person or head of household(legal guardian) receiving benefits form the
desorlbedproject/activlty, Please answer each of the following questlons-
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 boAveers cannot be included as household members.
2. Circle your combined gross annual income(Riverside-San Bernardino,CA—02113108)
AREA MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD:
INCOME(AMI) 1 2 3 4 5 6 7 $
LEVEL
EXTREMELY LO
INCOME S14,000 $16,000 $18,000 $20,000 $21600 $23,200 S24,800 $26,400
0-30%ofAMI
VERY LOW
INCOME $23,300 $26.660 $29.950 533.300 $35,950 $38,650 $41,300 $43.950
31-50%ofAM1
LOW INCOME $37,300 $42650 $47,250 $53,300 $57,550 $61,850 566,100 S70350
51-80%of AMI
MODERATE
INCOME $52,100 I$59,500 $67,000t$74400 1 $80,400 $86.300 592,300 S98,200
81
3. What race/ethnicity do you Identify yourself as:please note that this self-identification is voluntary in accordance with
equal opportunity laws?
❑ White Q American Indian or Alaska Native AND White
❑ BlacWAfrican American ❑ Asian AND White
❑ Asian ❑ Black/African American AND White
❑ American Indian or Alaskan Native ❑ American Indian/Alaska Native AND BIack/African American
❑ Native Hawaiian or Other Pacific Islander 13 Other.
HISPANIC/LATINO ETHNICITY ❑ Yes ❑ No If yes,i cheek one:El Mexican/Chicano
0 Puerto Rican
❑ Cuban
❑ Other.
4. Please check,yes or_no if you are a female Head of Household? 0 YES 0 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 HOUSHOLD STATEMENTS MADE ON THIS FORM ARE TRUE.
NAME: DATE;
ADDRESS: PHONE NO:
SIGNATURE: `
The infonnatlon you provide on this form Is confltlentlai and is only ubliked for Community Development Elpck Grant(COBG)program purposes a
Federally-funded program,governmental reporting purposes to monllar compliance.
EXHIBIT E
Semi-Annual Program Progress Report
PrDieCt/ActiyitV Title' Project Number:
Family YMCA of the Desert
Public Facility Improvements 0002
Name/Address of Provider:
Family YMCA of the Desert
43-930 San Pablo Avenue 3601 E Mesquite Ave
Palm Desert, CA 92260 Palm Springs, CA 92263-2530
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 Femalc Headed Households:
Counts by RaceVEthnlcity:
White — American Indian or Alaska Native AND White
elack/Afriodn American Asian AND While_
Asian _ BlacklAfpcan American AND White
American Indian or Alaskan Native American IndiardAlaska Native AND glacW/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
:,. 1CITY;Q .PQL-N(15PRINGS:
EXHIBIT F
Request for Relmbursement
Project/ActivftVTCtCe7 Proiect Number:
Family YMCA of the Desert
Public Facility Improvements 0002
Name/Address of Provider
Family YMCA of the Desert
43-930 San Pablo Avenue 36D1 E Mesquite Ave
Palm Desert, CA 92260 Palm Springs, CA 92263-9530
BENEFICIARY QUALIFICATION STATEMENT
—�20
� '•H��t�4'. =1.'�riI}� 0_:r'k�ti„'!�. ,pr+e .o- .: _.�.r , o'r,��,l.g?i�l j6?���1�d�A_�7ui:'aL"=;��k��ir�`il�1;�N, 0..�" _
--- I-- ;"-( rtl�lnae I
Other $15,D00-
Job contract&Contm enc
EMO—
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 terns 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.
c,1y;9 ''PALM;I,`.
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.0
276a-276a-5;40 USG 327 and 40 USC 276c)and all other applicable Federal, state and local laws and regulations pertaining
to labor Standards insofar as those acts apply to the performances of this oontraoL 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
I I
regulallons,provisions meeting the requirements of this paragraph.
2. "Secfion 3 Clause"
a. Compliance
Compliance with the provisions of Section 3,the regulations set forth in 24 CFR 135,and all applicable rules and oAveers
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 subrecipicrits 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
1968r 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[he 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 ether public
construction project are given to low-and very law-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 protect is located, and to low-and very low-income participants in other HUD
programs; and award eontraefs for work undertaken in connection with a housing rehabilitation (including reduction and
abatement of lead-based paint hazard), 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 project
is located,and to low-and very low-income participants in other HUD programs.
i
I
The PROVIDER certifies and agrees that no contractual or other legal incapacity exists which would prevent compliance with
these requirements.
b. Notifications
I
The PROVIDER agrees to send to each labor organization or representative of workers with which it has a collective
I
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.
i