HomeMy WebLinkAbout05660 - AIDS ASSISTANCE PROGRAM CDBG SUBRECIPIENT AGR SUBRECIPIENT AGREEMENT
THIS AGREEMENT (herein "Agreement"), is made and entered into this 26 day of February,
200 8, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and charter
city, and the AIDS Assistance Program , (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 "Acf), 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 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 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 2004 — 2005 Fiscal Year shall provide to City a financial
statement prepared by a recognized accounting firm approved by or satisfactory to City s Finance Director
completed within the most recent twelve (12) months showing the Provider's financial records to be kept
in accordance with generally accepted accounting standards. The report shall include a general ledger
balance sheet which identifies revenue sources and expenses in sufficient detail to demonstrate contract
compliance and be balanced to bank statements. Any organization receiving or due to receive less than
$20,000,00 in the current fiscal year from the City shall provide a copy of the organization's most recent
charitable trust report to the Attorney General, or other financial information satisfactory to City's Finance
Director. The financial information provided for in this paragraph shall be furnished not later than January
31"of.the current fiscal year. r,
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 NINETEEN THOUSAND—NINE HUNDRED DOLLARS($19,900.00) (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 6 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 CircularA-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:
Walter Reed, 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 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 wonting hours. Said records shall be maintained for such time as 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.
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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;
(t) 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;
(t) The restrictions prohibiting use of funds for the benefit of a religious
organization or activity as set forth in 24 CFR 570200 O;
(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);
(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
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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 seq.);
(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 subrecipienfs
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 Providers performance under this Agreement. Provider shall also carry
Workers' Compensation Insurance in accordance with State Workers' Compensation laws_ Such
insurance shall be kept in effect during the term of this Agreement and shall not be cancelable without
thirty (30) days' prior written notice of the proposed cancellation to City. A certificate evidencing the
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
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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 Contractors
performance under this Agreement, except for such loss as may be caused by Citys 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.
TO 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 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
WITH COPY TO:
City of Palm Springs
3200 East Tahquitz Canyon Way
Palm Springs, CA 92262-6959
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Attn: City Attorney
TO PROVIDER:
Walter Reed Executive director
AIDS Assistance Program
P_O. Box 4182 T
Palm Springs, CA 92263
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
7T: a municipal corporation
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C' Clerk C�d^t City Manager
APPRO EDfO,Fp� APPROVED BY CITY COUNCIL
By: 31h
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City Attorney
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,
Assist Secretary, Treasure ssistaanntt Treasurer, or Chief I /nciccial fficer).
By. � J° B : i�l/l
Notarized Signature of Chairman of Board, tar- gd igriature Secretary,Asst Secretary,
President or any Vice President Tr asuref,Asst Treasurer or Chief Financial Officer
Name: jd� ) D�M Name:
Title: k.��l�,e"x]�` Title: /�
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personally known ^7 / ,- //,sZ Dc personally known
to me(or proved to me on the basis of satisfactory evidence)to to me(or proved to me on the basis of satisfactory evidence)to
be the person(z)whose name(s}Is/are subscribed to the within be the person(s)whose names) islare subscribed to the within
Instrument and acknowledged to me that he/she0ar executed instrument and acknowledged to me that he/she/they executed
the same in hisiherAheir authorized capacity(ies} and that by the same in hislher4t� authorized capao[Mies), and that by
hisrher/their signature(5y on the instrument the peson(s}, or the his/hekheir signature(s)on the instrument the person(a),or the
entity upon behalf of which the person(s) acted, executed the entity upon behalf of which the person(s) acted, executed the
instrument Instrument.
WITNESS my hand andofficial seal. WITNESS my hand a official seal-
Notary Notary
Signature: Signature-
Notary Seal: Notary Seal:
KAREN 9.WAON
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CITY OF PALM SPRINGS
EXHIBIT A
Scope of services
Proiect/Activity Title: Proiect Number
AIDS Assistance Program (AAP)/ 0004
Back-To-Work Program
Name/Address of Provider.
AIDS Assistance Program (AAP)
PO Box 4182, 1276 N Palm Canyon, Ste#108
Palm Springs, CA 92263-4182
Objectives/Activities
The intent of this program is to provide supportive assistance to low income persons living with HIV/AIDS
to transition back into the community as a productive and contributing member either in a work/school
capacity or even as a valued volunteer at agencies throughout the valley. This will be accomplished
through an intensive three to four day `Back-To-Work' training to educate, inform and empower clients
with information which will enable and support the disabled community in pursuing and ultimately
returning to part/full-time work or returning to school for training in a new profession or just finding the
courage to try_
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 rovidin any additional information re uested.
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 keening rocess.
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: Advedise market and publicize the orogram 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 two hundred and thirty-nine (239) Palm
S rin s residents from very low income individuals affected by HIV/AIDS.
TARGET
DATE ACTIVITY#1
On-Going Two hundred and thirty-nine (239) Palm Springs residents will participate in the Back-To-
Work seminars. Maintain records of names, addresses, demographics and service dates
for all assistance.
Objective 5: Maintain records for all CDBG activities related to this program.
TARGET
DATE ACTIVITY#1
On-Going Document and maintain all records related to this program, including those required, in
accordance with HUD Regulations, in a stable and secure location.
ACTIVITY#2
Monthly Submit quarterly reports—referenced Exhibit E.
Objective 6: Manage/monitor program activities_
TARGET
DATE ACTIVITY#1
On-Going Perform monitoring activities necessary to ensure that the program is being conducted in
compliance with the CDBG policies, federal regulations, and local statues, including
Davis-Bacon Act, Copeland Act, and Non-discrimination/EEO requirements.
Objective 7: Provide food voucher distribution activities to person living with HIV/AIDS 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
07/15/05 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 8
Budget Summary
Proiect/Activity Title; Project Number
AIDS Assistance Program (AAP)/Food Vouchers 0004
Name/Address of Provider.
AIDS Assistance Program (AAP)
PO Box 4182, 1276 N Palm Canyon, Ste#108
Palm Springs, CA 92263-4182
BUDGET SUMMARY
COSTCATEGORY CDBG OTHER TOTAL
SHARE SOURCES COST
1 Personnel - 0 - $102,200.00 $102,200.00
2 Consultant/Contract Services - 0 - $7,150.00 $7,150.00
3 Travel _ 0 - - 0 - - 0
4 Space Rental/Maintenance - 0 - $11,700.00 $11,700,00
5 Consumable Supplies - 0 - $12,200.00 $12,200.00
6 Rental, Lease or Purchase of - 0 - - 0 - - 0 -
E ui ment
7 Insurance - 0 - $2,500.00 $2,500.00
8 Other $19,900.00 $15,100,00 $35,000.00
Wrkshp[Fm $83.27 x239
Food Voucher Program 0 - $475,000.00 $475,000,00
- 0 - $4,800,00 $4,800.00
Utilities(Tele hone
119,900.00 $630,650.00 $650,550.0o
TOTALS
If costs are to be shared by other sources of funding, including CDBG funds from other
jurisdictions, identify the source of funding, grantor/lending agency, and Cost category
information.
Other funding sources include Fundraising activities conducted by AAP's Angel Donor Program,
Ryan White Title I, R.D. & Joan Dale Hubbard Foundation, Broadway Cares Equity Fights AIDS
and Desert Regional Medical Center Auxiliary, all totaling $313,311.
The Subrecipient shall receive monthly reimbursements in accordance with the aforementioned
cost categories and line items. The program will pay S83.27 for each of the 239 participants.
Payments, approved by the Subrecipient and based upon the actual number of income eligible
participants within the prior period, shall be reimbursed. Services are to be performed over the
twelve-month period of this 2004—05 Program Year—July 1, 2004 through June 30,2005.
CITY OF PALM SPRINGS
EXHIBIT C
insurance Inventory
Pre ect/AActiviU Title: Project Number:
AIDS Assistance Program (AAP)/ Food Vouchers 0004
Name/Address of Provider: Date:
AIDS Assistance Program (AAP)
PO Box 4182, 1276 N Palm Canyon, Ste#108
Palm Springs, CA 92263-4182
INSURANCE INVENTORY
LIABILITY INSURANCE POLICY
Name of Provider's Insurance Company Travelers Property Casualty
Effective Dates of Policy 04/19/07 to 04/19/09
Claims Made Policy / / Per Occurrence Policy
Limits of Liability 2M General Aggregate
Deductibles:
Per Occurrence NONE
Annual Aggregate
Additional Insured Endorsement (Certificate Holder) ❑ Yes O No
Original Certificate of Insurance Attached 0 Yes Ef No
WORKER'S COMPENSATION POLICY
Name of Provider's Insurance Company State Insurance Fund
Effective Dates 10/01/07 to 10/01/08
Limits of Liability $1M
Underlying Coverage Limits Unlimited
Original Certificate of Insurance Attached 0 Yes d No
(MMIQQ
ACORD CERTIFICATE OF LIABILITY INSURANCE AID ID DA04/11 oe
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
CaSSW00d Insurance Agency,Ltd. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
Five Hal;Cmooil Executive Park ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clifton Park NY 12065-5694
Fh022e:S18-373-8700 Fax:516-373-8799 INSURERS AFFORDING COVERAGE NAIC4
INSURED INSURERA Travelers Insurance Co
INSURER B
Aids Assistance Program INSURER ..
P-O. Box 4182 INGURERD
Palm Springs CA 92262
NSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THB INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING
ANY REQUIREMENT TERM OR CONDITION OF MY CONTRACT OR OTHER DOCUMENT WITI I RESPECT TO WHICI I TI IIS CCRTIF=,MAY BE ISSUED OR
MAYPERIAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO NJ THFTEPMS EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES AGGREGATE LIMIT'S SHOWN MAY HOVE BEEN REDUCED BY PAID CLAIMS
LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE IMMMDIYY) DATE(MMJDONY) — LIMITS
GENERAL LIABILITY EACH OCCURRENCE 51,000,000
A 7t X tu
COMMERCIAL GENERAL LIABILITY 660619X4243 04/39/07 04/19/09 PREMISES(Eeoccurence) S ]-00,000
CLAIMS MADE OCCUR mED EXP(My onuporsoil S 51000
PERSONAL A AI]V INJURY a1,000,000
GENERAL AGGREGATE $2,000,000
GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG T2,000,000
POLICY JECCTT LOC
AUTOMOBILE LIA8ILTTY COMBINED SINGLE LIMIT 51,000,000
A ANY AUTO 660619X4243 04/19/07 04/19/09 (Ea accident)
,--. ALL OWNED AUTOS
BODILY INJURY �
SCIHEDULED AUTOS (Per person)
X HIRED AUTOS
BODILY INJURY S
X NONOWNED ANDS
(Par cwdo,q
PROPERTY DAMAGE $
PROPERTY
*REMWION
AUTO ONLY-EAACCOENT 5
MY OTHER THAN EAACC $
AUTO ONLY AGG $
LIABILITY EACI I OCCURRENCE $
CLAIMS MADE AGGREGATE $
F
5
E S
WDRKERS COMPENSATION AND u
TORT LIMITS ER
EMPLOYERS LIABILITY
ANY P1101'NETORIRMTNER/CXLCNIVE EL EACH ACCIDENT S
OFFICERIMEMEER EXCLUD7M CL ❑ISEASE-EAEMPLOYEE il
Ityes descOtle Wdor
SPECIAL PROVISIONS edjgw EL DISEASE•POLICY LIMIT 5
OTHER
A Property Section 660619X4243 04/19/07 04/19/09
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
*10 day notice of cancellation will be mailed for non-payment Of premium.
.Additional Insured: The City of Palm Springs its officials, employees and
agents are named as an additional isnured, as respects a specific contact-
This insurance is primary and non-contributory. Should any of the aobe
described policies be cancled before the expiraiton dated thereof, the
CERTIFICATE HOLDER CANCELLATION
cl:TYRA:L SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURERWILL ENDCAVORTO MAIL 30* DAYSWRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
The City of Palm Springs IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER US AGENTS OR
3200 East Tahguitz Canyon Way REPRESENTATNES.
Palm Springs CA 92262 AU RBPRE$EIJ{A r
Zek
ACORD 25(2001108) (/�f��J �/,/(/J•O ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORO 25(2001/08)
or 10 days fox non-payment.
CERTHOLDER COPY
SK
STATE P.O. BOX 420807, SAN PRANCISCO,CA 94142-0807
COMPENSATION
I N5UFtANCE
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 05-08-2008 GROUP:
POLICY NUMBER: 1423846-2007
CERTIFICATE ID: 4
CERTIFICATE EXPIRES: 10-01-2008
10-01-2007/10-01-2008
CITY OF PALM SPRINGS SK
DEPT OF BUILDING & SAFETY
PO BOX 2743
PALM SPRINGS CA 92263-2743
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 noL subject to cancellation by the Fund except upon 30 days advance written notice Lo 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 J\the
terms,
exclusions, and conditions, of such policy.
L/ �J
tTIORIZED REPRESENTATI PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT X2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE OS-08-2008 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
AIDS ASSISTANCE PROGRAM (NON PROFIT SK
CORPORATION)
PO BOX 4192
PALM SPRINGS CA 92253
(OMC,CN)
IREV.2-0e1 PRINTED : 05-08-2008
CITY OF PALM SPRINGS
EXHIBIT D
Beneficiary Qualification Statement
Prolect/Actiyity Title: Project Number:
AIDS Assistance Program (AAP)/Food Vouchers 0004
Name/Address of Provider. Date:
AIDS Assistance Program (AAP)
PO Box 4182, 1276 N Palm Canyon, Ste#108
Palm Springs, CA 92263-4182
BENEFICIARY QUALIFICATION STATEMENT
This statement must be Completed and signed by each person or head of household (legal guardian) receiving benefits form the
described projecuactivity. Please answer each of the following questions.
1. How many persons are In your household?
For this question a household is a group of related or unrelated persons occupying the same house with at least one member
being the head of the household. Renters,roomers,or borders cannot be included as household members.
2. Circle your combined gross annual income(Riversid"an Bernardino,CA—01128104)
MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD:
INCOME 1 2 3 4 5 6 7 8
LEVEL
VERY LOW
INCOME $19,000 $21,700 $24,450 $27,150 $29,300 $31.500 $33,650 $35,850
Below 50%
LOW INCOME $30,400 $34,750 $39,100 $43,450 $46,900 $5,400 $55,850 $57,350
51 —80%
MODERATE
INCOME $45,500 $52.100 $58,650 $65,150 S70.350 $75,550 $80,a00 S86,000
120%
3. What mcelethnicity 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
0 Black/African American q Asian AND White
13 Asian ❑ Slack/Afrloan American AND White
❑ American Indian or Alaskan Native ❑ American Indian]Alaske Native AND Black/African American
❑ Native Hawaiian or Other Pacific Islander ❑ Other:
HISPANIC/LATINO ETFINICITY 0 Yes ❑ No If yes,check one: ❑ MexicanlChicano
❑ Puerto Rican
• Cuban
Cl Other.
4, Are you female Head of Household? q YES ❑ NO
5. Do you have a disability? ❑ YES ❑ NO If YES,please describe:
ACKNOWLEDGEMENT AND DISCLAIMER
I CERTIFY UNDER PENALTY OF PERJURY THAT INCOME AND HOUSHOLD STATEMENTS MADE ON THIS FORM ARE TRUE.
NAME; DATE:
ADDRESS: PHONE NO:
SIGNATURE:
The information you provide on this form is confidential and is only utilized for Community Development Block Gran( (CDBG)program purposes,q
Federally-fundod program,govemmenlal roporting purposes to monitor compliance.
CITY OF PALM SPRINGS
EXHIBIT E
Quarterly Program Progress Report
Project/Activity Title: Project Number,
AIDS Assistance Program (AAP)/ Food Vouchers 0004
Name/Address of Provider: Date:
AIDS Assistance Program (AAP)
PO Box 4182, 1276 N Palm Canyon, Ste#108
Palm Springs, CA 92263-4182
PROGRAM PROGRESS REPORT Period
DIRECT BENEFIT REPORT
♦ Number of First-Time Program Beneficiaries Serviced:
#of Households #of Persons
0-50%below 51-80%below 120% below
♦ Number of First-Time Female I-leaded 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
ACCOMPLISHMENT NARRATIVE
LEVERAGING RESOURCES NARRATIVE
Signed Title Date
CITY OF PALM SPRINGS
EXHIBIT IF �T
Request for Reimbursement
Project/Activity Title. Project Number-
AIDS Assistance Program (AAP)/ Food Vouchers 0004
Name/Address of Provider, Date,
AIDS Assistance Program (AAP)
PO Box 4182, 1276 N Palm Canyon, Ste 4108
Palm Springs, CA 92263-4182
App roved Current Prior Total Grant
bascription Grant Reimbursement Reimbursement YTS Balance
Amount Period Period(s) Raimbersement (overt Under)
Workshop Scholarship- $19 900
$83.27 x 239 attendees
TOTAL
I CERTIFY THAT, (a) the City of PALM SPRINGS, as grantee of the CDBG, has not previously been billed for the
costs covered by this invoice, (b) funds have not been received from the Federal Government or expended for such
costs under the terms of the Agreement or grant pursuant to FMC-74-4 & 24 CFR Part 58;(c) this agency is in full
compliance with all applicable provisions under the terms of the Contractor grant; and (d) this agency is in full
compliance with all applicable tax laws and hereby affix original signatures
PREPARED BY: APPROVED BY:
Name, Title, Date Name, Title, Date
City of PALM SPRINGS Use Only
Audited by Examined by: Approved by:
If necessary, additional sheet(s) must be attached detailing cost breakdowns, and verified by original signatures.
CITY OF PALM SPRINGS
EXHIBIT G
Employment Restrictions
I. 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-5;40 USC 327 and 40 USC 276e)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$2,000.00 for
constmctlon, renovation or repair work financed in whole or in part with assistance provided under this contract, shall comply
with Federal requirements adopted by the CITY pertaining to such contracts and with the applicable requirements of the
regulations of the Department of labor, under 29 CFR Parts 1 3 5 and 7 governing the payment of wages and ratio of
apprentices and trainees to journeyworkers; provided that if wage rates higher than those required under the regulations are
imposed by state and local law, nothing hereunder is intended to relieve the PROVIDER of its obligation, if any, to require
payment of the higher wage. The PROVIDER shall cause or require to be inserted in full,in all such contracts subject to such
regulations,provisions meeting the requirements of this paragraph
2. "Section 3 Clause"
a. Compliance
Compliance with the provisions of Section 3,the regulations set forth in 24 CFR 135,and all applicable rules and orders
issued hereunder prior to the execution of this contract, shall be a condition of the Federal financial assistance provided
under this Contract and binding upon the CITY, the PROVIDER and any of the PROVIDER'S subrecipients and
subcontractors. Failure to fulfill these requirements shall subject the CITY,the PROVIDER and any of the PROVIDER'$
subrocipients 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
1908, as amended, 12 U.S.0 1701. Section 3 requires that to the greatest extent feasible opportunities for training
and employment be given to low- and very low-income residents of the project area and contracts for work in
connection with the project be awarded to business concerns that provide economic Opportunities for low-and Very
low-income persons residing in the metropolitan area in which the project is located."
The PROVIDER further agrees to ensure that opportunities for training and employment arising in connection with a housing
rehabilitation (including reduction and abatement of lead-based paint hazards), housing construction, or other public
construction project are given to low-and very low-income persons residing within the metropolitan area in which the CDBG-
funded project is located;where feasible, priority should be given to low-and very low-income persons within the service area
of the project or the neighborhood in which the project is located, and to law-and very low-income participants in other HUD
programs; and award contracts for work undertaken in Connection with a housing rehabilitation (including reduction and
abatement of lead-based paint hazards), housing construction, or other public construction project are given to business
concerns that provide economic opportunities for low-and very low-income persons residing within the metropolitan area in
which the CDBG-funded project is located, where feasible, priority should be given to business concerns which provide
economic opportunities to low-and very low-income residents within the service area or the neighborhood in which the 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. Notifcalinns
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.