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HomeMy WebLinkAbout05263 - STROKE ACTIVITY CENTER CDBG RECIPIENT FOR ENERGY CONSERVATION IMPROVEMENTS SUBRECIPIENT AGREEMENT THIS AGREEMENT (herein "Agreement"), is made and entered into this 1 day of July 200 61 by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation—and' charter city, and the Stroke Recovery Center, (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 seq.), as amended from time to time (the "Act), and the regulations promulgated thereunder(24 C.F.R. Section 570 et M. ("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 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 2006—2007 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 n of the current fiscal year. (Gq 7'] .f E :.? ' 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 FIFTY THOUSAND DOLLARS ($50.000.00) (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 Providers respective employees, as set forth in OMB Circular A-122 Attachment B.6. 2.3 Draw Downs. Failure by Provider to request reimbursement or encumbrance of at least 25% of the total grant by the end of each fiscal year quarter(September 30, December 30, March 31, and June 30) shall result in the immediate forfeiture of 25%of the total grant_ 3.0 COORDINATION OF WORK. 3.1 Representative of Provider. The following principals of Providers are hereby designated as being the principals and representatives of Provider authorized to act in its behalf with respect to the work specified herein and make all decisions in connection therewith: Beverly Greer, Administrator 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 Assi nment. Provider shall not contract with any other entity to perform in whole or in part the services required hereunder without the express written approval of the City_ Neither this Agreement nor any interest herein may be assigned or transferred, voluntarily or by operation of law,without the prior written approval of the City. 3.4 Independent Contractor. Neither the City nor any of its employees shall have any control over the manner, mode or means by which Provider, its agents or employees, perform the services required herein, except as otherwise set forth herein. Provider shall perform all services required herein as an independent contractor of City and shall remain at all times as to City a wholly independent contractor with only such obligations as are consistent with that role. Provider shall not at any time or in any manner represent that it or any of its agents or employees are agents or employees of City. 4.0 COMPLIANCE WITH FEDERAL REGULATIONS. 4.1 The Provider shall maintain records of its operations and financial activities in accordance with the requirements of the Housing and Community Development Act and the regulations promulgated thereunder, which records shall be open to inspection and audit by the authorized representatives of the City, the Department of Housing and Urban Development and the Comptroller General during regular working hours. Said records shall be maintained for such time as 1) 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 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 570.200 0); Q) The labor standard requirements as set forth in 24 CFR Part 570, Subpart K and HUD regulations issued to implement and requirements; (k) The Program Income requirements as set forth in 24 C.F.R. 570.504(c) and 570.503(b)(8); (1) The Provider is to carry out each activity in compliance with all Federal laws and regulations described in 24 C.F.R. 570, Subpart K, except that the Provider does not assume the City's environmental responsibilities described at 24 C.F.R. 570.604; nor does the Provider assume the City's responsibility for initiating the review process under the provisions of 24 C.F.R. Part 52; (m) Executive Order 11988 relating to the evaluation of flood hazards and Executive Order 11288 relating to the prevention, control and abatement of water pollution; (n) The flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234); (o) The regulations, policies, guidelines and requirements of 24 CFR 570; the "Common Rule", 24 CFR Part 85 and subpart J; OMB 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 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 A 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). 52 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 attomeys'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 parry 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 S WITH COPY TO: City of Palm Springs 3200 East Tahquitx Canyon Way Palm Springs, CA 92262-6959 Attn: City Attorney TO PROVIDER: Stroke Recovery Center 2Rnn F. plo_igad Palm q=ririg5 CA 322.6� 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] F CITY OF PALM SPRINGS ATTEST: a municipal corporation By: City Clerk City Manager APPROVE1O%�S TO FARM: By: ,GJ J APPROVED BY D1TY City Attorney PROVIDER: Check one: Individual _Partnership _Corporation Y`yJ (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, ,---A7Mii-a&,Secretary,_Trqasurer, Assistant Treasurer, or Chief Financial Officer). By: By, �P Notarized Sig ature IIf Ch I nan Board, Notarized Sign�ure 55Sdcretary,Asst Secretary, Presid or anyU� reside Treasurer,Asst Treasurer or Chief Financial Officer Name: d j �—� t�s Name: G'2 d'o-2- Title: G� U f�QS it3r� Titre: ✓ASS/s:. �� State of 644F01pi A = State of CMi k foyrub. County of t! 6C5lhE Ss County of f-I V( Ir 1Cl! -ss On 6/2 -07 before me, On �D Z�-��1,,! Fy,, before me, Q 7L/$L/C personally appeared M7 i�Ud f P �i A rN 0 1 L(LL?sa^ally appeared ?004y personally known "v e'r I I (,,c oar pefsena"nown to me(or proved to me on the basis of satisfactory evidence) tome(or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) istare subscribed to the to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/shefthey within instrument and acknowledged to me that he/she/they executed the same in hislher/their authorized capacity(ies), executed the same in hisfher/their authorized capacity(ies), and that by hislherRheir slgnature(s) on the instrument the and that by histher/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(s) acted,executed the instrument. acted,executed the instrument. WITNESS .myyhhand an/d Oftial seal. WITNESS my and and o Val seal. Notary Notairy Sign ure: /•rl. / �/ _ _ Signatures Notary Seal: Notary Seal: M. NORTON Commission #F 1736893 tf 1( ACU Notary Public -California commti1K0#r 1652573 Riverside County Notary public -CoMornla MyCamm.eVkmApr 5,2011 Rhrerskte County WCo .Expires Mar 19,2010 StrukeRemveryCn7__SuhreripAgnni-ADA_ROUulce 7 CITY OF PALM SPRINGS EXHIBIT A Scope of Services Proiect/Activity.Titles Project Number Stroke Recovery Center/ 0003 Energy Conservation Improvements Name/Address of Provider: Stroke Recovery Center 2800 E Alejo Rd Palm Springs, CA 92262-6253 06iecti_v_es/Activities The intent of this program is to provide programming, services and therapies for stroke survivors. This will be accomplished through the continued renovation of their facility that will upgrade of the building's HVAC (Heating Ventilation and Air Conditioning) systems and evaporative cooler by increasing their energy-efficiencies. These improvements will replace aged and non-efficient equipment with more energy-saving equipment which will reduce operational expenses enabling those savings to be redirect to program and service operations. The Stroke Recovery Center covers the entire Coachella Valley, serving 193 clients of which 57 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 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 fifty-seven (57) very-low income to moderate- income Palm Springs residents. 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: Upgrade and improve the building's HVAC systems and evaporative cooler for greater energy-efficiency in accordance with an 'open 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 07/15/07 Provide an evaluation and final report an 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 Prolect/Activity Title: Project Number: Stroke Recovery Center/ 0003 Energy Conservation Improvements Name/Address of Provider: Stroke Recovery Center 2800 E Alejo Rd Palm Springs, CA 92262-6253 BUDGET SUMMARY 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 $50,000. $ - 0 - $50,000. A/C Contractor Contract $ - 0 - $ - 0 - $ - 0 - TOTALS $50,000. $ - 0 - $50,000. 'If costs are to be shared by other sources of funding, including CbBG funds from other jurisdictions, identify the source of funding, grantor/lending agency, and cost category information. The Subrecipient shall submit Request for Reimbursement in accordance with the aforementioned cost categories. In no quarter shall the Subrecipient submit for reimbursement more than % of the total annual budget. Payments, approved by the Subrecipient, shall be paid by the 3& 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 2006-07 Program Year — July 1, 2006 through June 30, 2007. CITY OF PALM SPRINGS EXHIBIT C Insurance Inventory Proiect/Activity Title. Project Number: Stroke Recovery Center! 0003 Energy Conservation Improvements Name/Address of Provider: Stroke Recovery Center 2800 E Alejo Rd Palm Springs, CA 92262-6253 INSURANCE INVENTORY LIABILITY INSURANCE POLICY Name of Provider's Insurance NTAC Effective Dates of Policy 02/01/07 - 02/01-08 Claims Made Policy / / Per Occurrence Policy Limits of Liability $3 000,000 General Aggregate Deductibles: Per Occurrence 51.000.000.00 Annual Aggregate 1 000 000.00 Additional Insured Endorsement (Certificate Holder) m Yes ❑ No Original Certificate of Insurance Attached ❑ Yes m No WORKER'S COMPENSATION POLICY Name of Provider's Insurance Company State Fund Effective Dates 01/01/07 - 01/01/08 Limits of Liability 1, 000 , 000 Underlying Coverage Limits Original Certificate of Insurance Attached efYes o No rcn, cr QVV1 6 •GO 1-11 1'' 'Lnm Cllr 1RC 11Y.70✓J apL'1 Yfr�Q V .7OCJOYJCO r . v.Je�e1.� i ".8492 . 2STROREC ACORIX CERTIFICATE OF LIABILITY INSURANCE 0=7120077Y�' PROdN:eR THIS cERnFICATI1 18 ISSUED As A MATTER OF INFORMATION �eaart Ertlpire Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR SerVICee, Inc. LIC NUFO9643 ALTER THE COVCRAGE AFFORDED BY THE POUCIES BELOW. 77-W Country Club Dr,11401 palm beserl,CA 92211 10_ 3 I: . `vo INSURERS AFFORDING COveR,Aca NAIC 0 mN,RP 1NwnenA: NIAC 36984 Stroke Recovery Center INwmEn B; State Fund 36076 2800 E.A*o Road INM1RMN C Philadelphia Insurance 23560 Palm Springs,CA 92262 INSURER D NSURER A COVFAAGEe THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED A60VE 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 IN3URAN6e AFFOM19D BY THE POLIcAS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,s%CLUSIONS AND CONDITIONS OF SUCH POLICIES.A00111EOATE LIMITS SHOWN MAY HAVE BEEN REDUCED SY PAID CLAIMS. KM TYPE OP INSURANCE POUCT NUMBBR "DCAUMIA17w LIMrn1 A aP1iVIALUARILTTY 2007067GUNPO 02101/07 02/01/08 s10000 ITLAIMS IFVALGaNKWIJAMLnY,� ®o�R Meo DTP el+. s10 PERSONAL\A3VIN UR/ 41.000.000 GENLnAL AaaREOATr s2,Qy0,0Q0 eENL AGGREGATE UMIT APPLIYS PIER FR=G l-COM4F AOa SLOW 20 POLICI' IOC A AVMMOIUUABRm 200706766NPO 02/M1/07 02/ l= cCMBNwwNw.cuvr X my To (aswdl ) 81,000,000 ALLOWNEOAUTOB tODIL�INJURY S fOHGDUI,aT)AUTpS X e11PL➢AIROa O ININAY �( NON-o'"n AVNo Mr ! 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LCERTIFICA ER CANCELLATION aNauLD ANr oP me uava DsfaAme roueRs as CANCELLED e[PaNaTHII axrwATNR+ Insured'sCopy D►TM THEREOF,THarMwQInBUMWaLLaNONAVORTOMAIL 1.1fl m"wlaTrm NMICi TO THE etRTIFICATE NOLDEII nM1eD TGTn!uFr,BUT EAIwRe ro DD aG sNALL INPGSE No oBL10AWm OR LIABIUTY OF ANY ONO UPON THE INSURER,IT*AoaNT$Ow n NTATNaR A TTAa ACOFID25(200710E)1 of 2 4810070MM100692 / 2frO 0 ACORD CORPORATION 1906 L/ 02-27-2A07 14:33 FTRf1KF RFcnIJFRY fFNTFR 7An-tPsRRPF. Poe=v Juiv u0 Ceur a . ei rri rrt jjCb LmI trir IML 1N7Cb JbO 4 `y l TO S3258026 P . 02 1.C-�-"ff•nl No, 2 iu Oer(MM[PW Y) OG/08/2007 I.Prad� b Paeay wwww- �er'G &pire Insurance Services, In G"a'"1�66S LIC #0509643 Policy 40;$6684 77-564 Country Club Dr., #401 Poky F*W:200705 6MIG Palm1Deaert, CA92211 cumppTdyo.r ❑adWrwwa T2140 oa. 4700 Lm Ap mkiierd Ewmm:❑brdwmad m urraa pm rwdmn m Lbraa 4.In" tamch w0gN Stroke Recovery Center a❑DwuClIble s 2800 R. 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Palm Bprinpa, GA 972ET wUxz4 In bM We wow rimu6med muawma c mpanv wd by Wrrturc W*m do w maw n�.mmPam a Ak endor, rar�r.rwv+..>•wNw.naapy! T-r herr, (�/�!] J am `jQ0 .. tiara SJgrd: g242U2G0Cl7 06-08-2©07 14:30 STROKE RECOVERY CENTER 760325GO26 PRGE2 ril rR ueatr, tilrlmC 1Nbbb Jbb 4 ('dy 10 bJ3251d026 P .03 General Liability SpQcial Endorsement 1 &eNaNaalnem Ha, 7,Iknhs L1eM(NAMPdYT) 06/C16/2007 for tho City of Palm Sorilly"; i.Prednear s.Pollq InWThnakdlh DTI AC Desert Empire insurance Services, Iae. .NAtc it 36684 77— 64 Count Palroy)'b: 2=06766NPO 77-564 Country Club Dr„ #401 popaypwod: 01 07 to 02/01/08 Palm Desert,CA 922" CmwWtTdnw i�w��. T.NN,b (760) 360-4700 Loss Ae)usknog Evea",Q Induded in Lends ❑b,Add;lbn to Umbe 4.Insusd r090 W" Stroke Recovery Center 6.Q Cadmllbts 7 2800 E. Alejo I%ad ❑Sdr-kMewiNotes" un Palm Springs, CA 92262 s win art Awe"*di � •ryk..sl..n..rw...a.wwvnxrCpwahw+Msl.,pe�ncy.tawnsrn.a xr4M w,d.r N.,nnhre apr.rn.^r Lod o.ed"M n tarp Mate kl.Cily dMWn dpMyr unlN{ d,sNsa Mta❑NI badl emom bw Ills lekannp Seem wo"WMands lm-w wchydrmawwv"mvpd [al'NnawnhYa4hwa. GMN.N IJtlNlly m.orw pwow" !to Dray Notice of Cancellation X cmpahckaGonmemLi0ft for non—payment of premium. Co Fo m m X ctiattlss/Orarrdna $w 00, . . , tt Wm.:wr.. l.r.nMw.+r+n..r.wM+owuw to Ye+rruarn pAdW u,s Nliauwl.A I ndlorium•Co"Hwid wlnauarc.hp..d Cpaasom °°°'OW OW,'° 'aao Nh.spwWav c4nVagm In WW dK~d ala MWEIM dwpb and WfttWrhbq ary xwanSlarM ddsl W In Mee PAr n which Ids mdnamam Y Aftd d alhdurdFe'+hsrhow(kthsnsartrlawa,krsteedaS Wvwr. iz aMapamannow�de:addbrwlnur a�nna�nr.orl she dsMwsdaa iiskhw.MwsWr,MlhbtMl�adamgs+awlhanhoawrtNnp Aam tlw q,ewrSehsahw,np parWmrtr ky«on aagW arwenwhe/ Inswid. 17.Cartrrlw.NrN�tinkL xrahl�hu r pdnwa Wkft M.Ryu 4 WW bW V ba mskAwbd by M Gry«Pelm SWsM am Owl poledan lrr fJlya rhwh+MWsfre�4,Uen. id. Crr,wrsilmh NMNd.WM hasp.a to des hnmsb d the Clly«Prm apvl,p Nis bwww""W be aanaiaW,w mk"hsduesd n mwwpr«a.+a.o.,xwrhklytad)ampna..ssr, yraRgracekasdddaywylhassrrephwlaahsGtydRsmSPseMvlSadx hkowS!CkyaePmbnsp AMrr.rassawh.a..390E-TshgAftCanyahWay.PaledSpMpaCAVA54 Each!as stand rater mdhw naSisl skr a nerd a eeShr,akar«e,dr<le�y dlala Low.aondNaa,apnslhra or axcluRBna d ohs p>tkr b tW en Los�.do- rhhbttisaaachad is.clryospunsw w"m It ❑ Cityorfpalm Spybw l Tina. Earls Ip,kLtyps AWN),nausea I m t h.w 3200 t .Ta"ulz Canyon Wily 'u""n bend w ae,ow nrnkerl ae Orly lend by my 3wome nbrdn do On ftkn3pringa6 CA 02262 Tek*m' (7601 3617ao nrkSipMA:,�l�(Zoar * TOTRL PRGE.03 ** 06-08-2007 14:30 STROKE RECOVERY CENTER 7603258026 PRGE3 Client#,6492 2STROREC ACORD.. CERTIFICATE OF LIABILITY INSURANCE ;;o5,2oo5Y ' PRODUCER THIS CERTIFICATE IS ISSUFD AS A MATTER OF INFORMATION Desert Empire Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Services, Inc. LIC#OP09E43 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 77.564 Country Club Drive Palm Desert,CA 92211 INSURERS AFFORDING COVERAGE NAIL# IxsuRED INSURERA NIAC 36684 Stroke Recovery Center INsURER a Tower Select Insurance Company 2800 E-Alejo Road INSURER C Urn Springs,CA 92262 INSURER D _ INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY RE0.1JIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BYT11E POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN N1AY HAVE BEEN REDUCED BY PAID CLAIMS. ER VdUCYEITECTIVE POUCYE.XPIRATION LIMITS LTR NCR TYPE OF INSURANCE POLICI'NIIMBfR MATF. MMDaYY DATE MM IVY A GENERAL unBILnY 20086766NPO 02101168 02101109 EACH OCCURRENCE Et 000 000 X COMMERCIAL GENERAL LIABILITY PRRMAGE51peoGED ,100000 CLAINIS MADE OCCUR MED EXP(Any VC4 P"") 510000 PERSONAE 6 ADV INJURY $1000000 GENERAL AGGREGATE $2 00D 000 GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMWOP ADD %2 O00 000 POLICY 7IEC P90.T LOL A AUTOMOBILE LIABILITY 20086766NPO 02101JOS 02/011t19 COMBINED SINGLE LILIR X ANYAUTO (En amdenq 51,000,000 ALL OWNED AUTOS RGCILV wURY SCHEOULEDAUT05 I(Prr Pnron) S X HIRED AUTOS BODILY INJURY X NON OWNED AUTOS (Pclnwkcn.) S PRDPERTI'DANVGE (Pe�acciennp CARADELIAEILITT AUTO OVLY-GA ACCIDENT 5 ANY-UTQ OTHER THAN EA ACC AUYO ONLY. AGG S A PESGJUMBRELLA LIABILRY 200806756UMBNPO 02/01/08 02101109 EACH OCCURRENCE 52000000 OCCUR 7CLAIMS MADE AGGREGATES S DEOIICTIBLERETENTION S 10000 S S RORKERS COMPENSATION AND TSIWD7080102400 01101108 01101/09 X we sTATU.I OTHH. EMPLOYERSEUBIUTY EL.EACH ACCIDENT 51000000 ANY PROPRIETORIPARTNERIEXECUDVE 0MFCCRIEIEMBER EXCLUDED? E.L.DISEASE—EA EMPLOYEE A'000,000 if,,O'PwbRW'O:f sP"CIALPROVISIONS biow EL DISEASE•POLICY LIMIT I 51,006,000 OTHER DESCRIPTION OF OPERATIOxs I LDCAYIDNS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS Certificate Holder is named as Additional Insured to include Primary and Non"contributory wording. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION The City of Palm Springs,ifs DAYS THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL ln" DAYSWRRTEH officials,employees and agents NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 50 SHALL P.Q.BOX 2743 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR Palm Springs,CA 922E2 REPRESENTATIVES. AUTHDRI2ED 7,RCSCNTATIVE ACOR02512001lO811 Of2 #S1260191M126018 2TEAD 0 ACORD CORPORATION 1988 POLICY NUMBER. 20086766NPO COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the fallowing: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name OF Additional Insured Person(s) Or Organization(a)! Locations Of Covered Operations City of Palm Springs P.O. Sox 2743 Palm Springs, CA 92262 Attn: City Clerk Information required to complete this Schedule, if not shown above will be shown in the Declarations. A. Section II — Who Is An Insured is amended to H. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply' with respect to liability for"bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. Your acts or omissions, or 'l. All work, including materials, parts or equip- ment furnished in connection with such work, 2, The acts or omissions of those acting on your on the project(other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desig- covered operations has been completed;or nated above. 2. That portlon of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. CG 20 10 07 04 O ISO Properties, Inc,2004 Page 1 of 1 ❑ r)r,v(MM UJ 1"ice Y4• _1.rd_„L'` live, t' i %al',"I `a,liE l2� 11/04/2008 I, I � „a[rL,���....--.�.�-�^���-�^f '+ i'rl1[•y 11I1u11�;,1 ur Desert Empire Insurance Svcs, Inc. c,llnar NLjC LIC v`OF09643 !Al`:Ir 36684 77-564 Country Club Drive Pul.CIS�LI,11,1 200806776NPO Palm Springs, CA92262 c, rrl_ I _. Jr._ ER 92262 — 02/01,/2009 rM1pre 111. (760) 360-4700 L.[as Atl sh•m!F..p�nn� �ll.r ,I'CJILIni L, ❑ 1 :.,Jlnr n;o(Irn'-. i n U VIA rla I Stroke Recovery Center ❑,[.,I ',:,,I cu l{Ltcn;¢rn of • 2800 E. Alejo Road Palm Springs, CA 92262 - - App'wdbk.r 1, pa �L.L � .nr To,q;e lrr .n jnr - l - yu r1•�pr a n1 r11 1 n n . ,,n nr v.cgp• nnngl nrpg` U;'1 ,e ,n L�r . I LrY � tl GC,I cral L1 ilnll•,y 'I, n-,. . ,m1r• w r x W� CA141111 Jr OL.l'.I 111 I.rr 11 111 i u i'e\: J,,(', I rih111DJ e untls In 1rn l nnrlsand,5 ° I-I IrSl.S'C,iL•1.[iILr15 •.u�..v '1 C.11 n•. '.Intl[^:n" rrq u'1 .r ii ..ui rI I-rnl I-.Np 1,..u.r ILI .,�UIrr �ulu.I T,I(pr' I d�Vo['vr.I+,;undGCu9lap�:J M.atrr[1� $1,000,000 S2,000 ACC i : I,1r,,r,:I:111,,;•,.,11n,,,•Iv1,I1r, $1,000,000 $2,000,000 j ,III'1 ,1 r --i _ Iu,r1r, C'n ar,,r,u1.1 I 3 ( In :'I1 11121.,113 1 'I r'. Inter uu n '•;1.d;pu: untl qol'+�rhsl.,gnlry ly .Ifly IPWI 111*1WI. S"1 III 11,L pI to wl'I¢I: T,Is- cn J,sewn, IS w1 , I: ,I.,[I 1..}L o 11,L,.J I u,'r a IL rglC I,Is aLyl e'Jd RI lu WI ; f 1, ACghtlonol lnsure[I The Gil/otPa,l'^1 I!.rlG;nnp l=f•:urctl•-'atlll rt u.n[I to lcl1U111",,nd G'.M1`l1; ;Ir III•I.11"1• 'n'. ;nl: II:I'JII IICS C''1'1Inu5L5 of whnlSouvU1'❑nslnq frJM:IIV UPI r(I:I[ Is arlrl t;U,dol l-II L,J:,y„•t,r I,;t I r 01:ur' I!n V, 1 13. Con[I I Itnd.I n.n ilLiµu'I r,,I11911lmpn=ury;.11nlu.puc[lo.I', urn p•1n.r.nl,u,l I I 'y1hc ,J IS 1Wlli,r l,)II,.rr,, Iwl•I I JI I lot L.Irl MI 11 .! 1 • 1: ri111C4`Il:f1v,n+'Jo{Icu '1LI l` •. Ir v;l fu Inc lnti!n,la bl UIL:: , ul IS,n"ti,,•°as Ihrs II '-1ol'.,; .I leg1 nU:7L b111n c111a' r,1 Illde°,11a1ry r L(lu ceu In I .4N,:r:ig: iY IIPILr UNULIII JI{r,IIAi11hy(JU)rl:,y"'ll,I,), vfIIIUIIII(dj,,IJ(I'.C.C'.IIJF•''f1,11 1,1 lll,'rtv`n giiu,r.0 the rll_i r. Pdl"I tiDII/11,',;J(ulrp5tr•( jp E iulrC.e (.II I I I I'-J I I gI,rluq AUn RAM'11 Jger+'1dOc Ia111urL V"I P I'II l,pp+yL'.,,..y':+!r; y Cry, r n.lnlrnl I'r 1t'L,UVIII iI,I wl 041:111nII IJL h1IJ rb w.u.,• 11-11 nl x'+I,;J)L,01,pl it n,Innu:. .I'1'111v;I I,u:r l ri u,ar s,ad,hrn�L"tl lr-,✓,h_y P,p11,11 aa• i1.�-p'::f'"..:). �lo7�ofv1^_—^_-.,__.r.-.�- , - r.._..r,� r Ir_i . . ..: ,. -, ..---.-. r —_ -...--��_. _- o. City Jcpn trnun;;GwcaG, ~t 1,3 ALILIlnnmd Repl es_nt.I,l`.a 7U nnr•r,Agora,❑U id,Lt,jr L 1' CIIY t)i Palftr Sill 111gS I - -Van Tanner- - - - - (I••m1;1,jI npl rrl !'maul+h.Y'vl.,, �200�.I afl Cf l:'i2 i.L'.I i�Joll Way I,Lrf pury,u k:ual[h[I eho`.I. n I:,1 -- _, 1I,u1,JfIG; 2U1)t1drty 1.11.1 br Il`. ,Iyl r U r, le,_In lu•,r !r 1lJ rllh, I ,rpny iq lh sa l ' m_II Psll*15crincs, CA 92252 /% ( irrw--tom- - - --- — .,I:r I (769.)_.360-G700- --- L,L Ihr1.1: -1110Z,/2008 .,........._..—A J.:.1",• ^.4ry ----��� ..a' t i ._.rrnr,urn III M I2 s;ur u.lb:(Fnmvoc,YY -a, lo.,, IS Pol,cyln!(r ),{,On 11/04/2008 C ru�r NYAC 36684 i 1,cal., >-n 41 Desert Empire Insurance Svcs, Inc. 11 200806776NP0 LIC #OF09643 �y Gc:..I r 02/01/2008 - 02/01/2009 Cmo1 ly., .,aal ,.1v 77-,564 Cvuntrp Club Drive a,. rl,,ra r.;rr, l [x Irl.ALd(.d,r.1.nllm j;[,1 P Jii,or,to l rr.r•. ---�II1 1 a.Yll>-nesex_t�.CA g�9ti�Zy�-�hn-�, O__ ---- -- -- -------.--_.. .. I Stroke Recovery Center �❑ J.0 1. In.dr•:1 iu.1 rltlLll (If I 2800 E. eLlejv Road Palm Springs, CA 92262 Ir..;n,vrP'•arl.• 13 AppllcaAla ih, INI,e lr•uuun.uv a• h•...... µgm. a•,•n• , r,-,I r I',,pf rnd,r III I agn•F,...nlr i rn l r nn 1, i i l 11 •1 x' ri y nl l Il Sp rny:.l rd,.... I'h,.ck.c ru:rc D e, ..........l,' ..... au,,, ;yr�prr cl�n '+b�me .vrpnr;Cla a1'a r` S�p'P rp.r.:.vn,.If Y -- ,f City Ayrcunuur.IWc mtn it u'",:1:;�'r r't' __ .—.�. 11n' l rr•ds rl I—. —'I__._ _ I `: 011ie,Pr r alrlor7- f�. .1. Il,)cwneng� - .1,.�q_y_I,rg•,;v I CSL: . ..w .. r' ° ' 1 S1,000,000 • t1 nill,.,l,l"ros i 1 —" 1o.ct.,rrrr: unEc,wmcr..-�•Wrr::.�n,atr�� 'or clol,cs II ,.u1do � pursuam to lnrs m:.w rr,«•(-lndre.:::run u•h•phon.�) clld+ryrd,Iv110iI v; U,_ ,J1vgn.,n1 J_I.;)ud ,Intl Irulwlll,,ld1^11,1 p airy 10..:v1`m„p ll :!nlanl,,rl III JIV pd,Gy lu WN,h Itbs urwrsemgrl: is ath Cl,Cq ,l,,.rr` r; 1h;11 .ILII It ll.l lb,:ue 1, I In dy duo a os l.Jllu:..; 1, 1 9� AtItfirro1111111+., Ltl Ihrl:It >n101$Onrl7e due'It•nlli•1„I;' :ln:rlrt, P mgarrtl Lolla61illyand i `vr „i If l 111 ',I , n If lInIOCIC; If l'IP1Erg:;,dv.I�nls.cv.r Z, Ig llot till: aP¢,il(A',andinn, 1'I y I;-:rl„1u 1.., y',I,:n L d c•L' .;ILn n rin,:d P 11 Conlrlhu:iun Not Required. c1l of Fne Il"Il th. p CIl{'I I•,rl,n lu 4rt:le p�1S,.4v I C 13 C.0,ICplla(Ign NwTce Will,jetrpi CI to lho lnk:rvys Or Itur City OF Palm $prmu;:tn18 urqurpnrp Sim'`r Jl pt;p,;nl;W r:;11 I,r 1r1 Ppwi..Iy µ•d,,;p,l Ir1 p cn.cingr•o,111•11I i uAarpt altc•Ihu ty(30 I;I aprior ddniten•io:IM by IeCOIJI-:d rirllve v'las:cen g den lu ihu CIt,,or Pnlu.Sp'ndb atldgssod J:; ','U..• Cl,)I tJ;•rn 'Orr•b;, All, iH,•P,::,1.ayC'?["7= "r:61,bICCf:Iya, WO, "6P• $„n,:;LCAT1d 2b �1 -„•� )t a;,,'1,Cr'Jr•nx U nail luny l';R V.n Sl 111 yr h,pl,I tQ 1,LvI J'h,r•v Cx4:P:I :r I,,,1 it!,, p•pry I C)"Jill4nv JIM pglr:y lU`.vl rc]I I 14. C1fy❑cputtrlLnt 6wacZ!U .L 'ur.,d r:w L fau,.pr'A;,I n' _1J 1a r.du(cr City of Palm Springs { Van Tanner 2200 E.T2r-qu;`z Canyon Way = "' _ . (prurLn:p:..nar 1c1 '.'-1"1:rut I hack .),lip), lj io 91nj thu eY)pvu nlbl r. I�y,,ncu,:u11l p,.rly dr;I,%'11y 1,In IIU I,.I U(Gan.IU So PatniSprinos, CA 92262 4 �11,,r:rlec.c. Iac"nyu,rf • ;.n'' r� 1 7601 - .360_47-U------- ,,I .d 11/04/2999 I I CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement Proiect/Activity Title: Proiect Number: Stroke Recovery Center/ 0003 Energy Conservation Improvements Name/Address of Provider: Stroke Recovery Center 2800 E Alejo Rd Palm Springs, CA 92262-6253 BENEFICIARY QUALIFICATION STATEMENT This statement must be completed and signed by each person or head of household (legal guardian) receiving benefits form the described project/activity. Please answer each of the following questions. 1. How many persons are in your household? For this question a household is a group of related or unrelated persons occupying the same house with at least one member being the head of the household. Renters roomers,or border$Cannot be included as household members. 2. Circle your combined gross annual income(Riverside-San Bernardino-Ontario,CA MSA—03108106) MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD, INCOME 3 4 5 6 7 8 LEVEL VERY LOW INCOME $20,150 $23,000 $25,900 $28,750 $31,050 $33,350 $35,650 $37,350 Sclow 50 LOW INCOME $32,200 $36.800 $41.400 $46,000 $49.700 $53.350 $57 050 $60,700 51 —80% MODERATE INCOME $48,300 $55,200 $62,100 S69,000 $74,500 $80,000 $85,000 $91,100 120 3. What race/ethnicity do you identify yourself as; Please note that this self-identification is voluntary in accordance with equal opportunity laws9 ❑ 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 ❑ Yes ❑ No If yes,check one: ❑ Mexican/Chicano ❑ Puerto Rican ❑ Cuban ❑ Other: 4. Please check,for no If you are a female Head of Household? ❑ YES ❑ NO 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 Information you provide on chic farm Is contldentlal and Is only utlllzed for Community Oevelopment 81oc1(Granl(CDBG)program purposes a Federally-funded program governmental reporting purposes to monitor compliance CITY OF PALM SPRINGS EXHIBIT E -- Semi-Annual Program Progress Report ProiecUActivity Title: Proiect Number: Stroke Recovery Center 1 0003 Energy Conservation Improvements Name/Address of Provider: Stroke Recovery Center 2800 E Alejo Rd Palm Springs, CA 92262-6253 PROGRAM PROGRESS REPORT Period: DIRECT BENEFIT REPORT • Number of First-Time Program Beneficiaries Serviced: #of Households A or Persons 0-50%below 51-50%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 W Black/AfriCen 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 ACCOMPLISHMENT NARRATIVE LEVERAGING RESOURCES NARRATIVE Signed Title Dale CITY OF PALM SPRINGS EXHIBIT F Request for Reimbursement Proiect/Activity Title: Project Number: Stroke Recovery Center/ 0003 Energy Conservation Improvements Name/Address of Provider-- Stroke Recovery Center 2800 E Alejo Rd Palm Springs, CA 92262-6253 BENEFICIARY QUALIFICATION STATEMENT APp roV4& 'Current Prior Total Grant Description Grant Reimbursement Reimbursement YTD Balance Amount Period Period(s) Reimbursement (Over/Under) 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 mvoicc, (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 afrix 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.C. 276a-276a-6;40 USC 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 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 law-Income persons residing within the metropolitan arcs in which the CDeG- 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 law-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. The PROVIDER certifies and agrees that no contractual or other legal incapacity exists which would prevent compliance with these requirements. b. Ngtrj a ions 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 past copies of the notice in conspicuous places available to employees and applicants for employment or training