HomeMy WebLinkAbout05536 - OPERATION SAFE HOUSE INC CDBG SUBRECIPIENT SUBREGIPIENT AGREEMENT
THIS AGREEMENT (herein "Agreement"), is made and entered into this U�day Of. ! ,
200 by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporati and
chart r city, and the Operation Safe House, Inc- , (herein"Provider").
WHEREAS, the City has entered into various funding agreements with the United States
Department of Housing and Urban Development ("HUD"), which agreements provide funds ("CDBG
Funds") to the City under the Federal Housing and Community Development Act of 1974 (42 U.S.C.
Section 5301 et sec.), as amender from time to time (the "Act"), and the regulations promulgated
thereunder(24 C.F.R. Section 570 et sec. ("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 Rom. 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 5'of the current fiscal year.
o,,,EC—�iIi L B d D
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 THIRTY-TWO THOUSAND DOLLARS ($32,000.00) (the "Contract
Sum") in accordance with the Budget attached hereto in Exhibit B and incorporated herein by this
reference; and as herein provided. The budget cost categories set out in Exhibit B are general
guidelines and if mutually agreed by both parties, may be amended administratively by no more than
10%, without the requirement of a formal amendment to this Agreement, but in no event shall such
adjustments increase the Contract Sum. The Provider shall submit to the City monthly statements on
reimbursable expenditures pursuant to the attached Budget along with pertinent supporting
documentation. The City shall promptly review the monthly expenditure statements and, upon
approval, reimburse the Provider its authorized operating costs.
2.2 Payroll Records. In cases where the contract sum will reimburse payroll
expenses as part of operations, the Provider will establish a system of maintaining accurate payroll
records which will track daily hours charged to the project by the Provider's respective employees, as
set forth in OMB Circular A-122 Attachment B.6.
2.3 Draw Downs. Failure by Provider to request reimbursement or encumbrance
of at least 25% of the total grant by the 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:
Kathlyn McAdara, Executive Director _
32 Contract Officer. The Contract Officer shall be such person as may be
designated by the chief administrative officer of City.
3.3 Prohibition Against Subcontractinq 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
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may be required by the regulations of the Housing and Community Development Act, but in no case
for less than three years after the close of the program.
4.2 The Provider certifies it shall adhere to and comply with the following as they
may be applicable:
(a) Submit to City through its Community and Economic Development
Department monthly reports on program status;
(b) Section 109 of the Housing and Community Development Act of 1974,
as amended and the regulations issued pursuant thereto;
(c) Section 3 of the Housing and Urban Development Act of 1968, as
amended;
(d) Executive Order 11246, as amended by Executive Orders 11375 and
12086, and implementing regulations at 41 CFR Chapter 60;
(e) Executive Order 11063, as amended by Executive Order 12259, and
implementing regulations at 24 CFR Part 107;
(f) Section 504 of the Rehabilitation Act of 1973 (P.L. 93-112), as
amended, and implementing regulations;
(g) The Age Discrimination Act of 1975 (P.L. 94135, as amended, and
implementing regulations;
(h) The relocation requirements of Title 11 and the acquisition requirements
of Tide III of the Uniform Relocation Assistance and Real Property
Acquisition at 24 CFR Part 42;
(1) The restrictions prohibiting use of funds for the benefit of a religious
organization or activity as set forth in 24 CFR 570.200 0);
(j) The labor standard requirements as set forth in 24 CFR Part 570,
Subpart K and HUD regulations issued to implement and
requirements;
(k) The Program Income requirements as set forth in 24 C.F.R.
570.504(c) and 570.503(b)(8);
(I) 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 etse�c.);
(s) Maintain property inventory system to numerically identify HUD
purchased property and document its acquisition date as is set forth
in OMB Circular A-110 Attachment N Property Management
Standard 6d; and
(t) Reversion of asset. Upon the Expiration of the agreement, the
subrecipient shall transfer to the City any CDBG funds on hand at the
time of expiration and any accounts receivable attributable to the use
of CDBG funds. Additionally, any real property under the
subrecipient's control that was acquired or improved in whole or in part
with CDBG funds (including CDBG funds provided to the subrecipient
in the form of a loan) in excess of$25,000 is either:
(i) Used to meet one of the national objectives in Section
570.208 (formerly Section 570.901) until five years after
expiration of the agreement, or for such longer period of time
as determined to be appropriate by the City; or
(ii) Not used in accordance with paragraph (s)(i) above, in which
event the subrecipient shall pay to the City an amount equal
to the current market value of the property less any portion of
the value attributable to expenditures of non-CDBG funds for
the acquisition of, or improvement to, the property. The
payment is program income to the City. (No payment is
required after the period of time specified in paragraph (s) of
this section.)
(u) Such other City, County, State, or Federal laws, rules, and regulations,
executive orders or similar requirements which might be applicable.
4.3 The City shall have the right to periodically monitor the program operations of
the Provider under this Agreement.
5.0 INSURANCE AND INDEMNIFICATION.
5.1 Insurance. The Provider shall procure and maintain, at its cost, and submit
concurrently with its execution of this Agreement, public liability and property damage insurance
against claims for injuries against persons or damages to property resulting from Provider's acts or
omissions arising out of or related to Provider's performance under this Agreement. Provider shall also
carry Workers'Compensation Insurance in accordance with State Workers' Compensation laws. Such
insurance shall be kept in effect during the term of this Agreement and shall not be cancelable without
thirty (30) days' prior written notice of the proposed cancellation to City. A certificate evidencing the
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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 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 Tenn. Either party may terminate this
Agreement at any time, with or without cause, upon thirty (30) days' written notice to the other party.
Upon receipt of the notice of termination the Provider shall immediately cease all services hereunder
except as may be specifically approved by the Contract Officer. Provider shall be entitled to
compensation for all services rendered prior to receipt of the notice of termination and City shall be
entitled to reimbursement for any services which have been paid for but not rendered.
7.0 MISCELLANEOUS PROVISIONS.
7.1 Notice. Any notice, demand, request, document, consent, approval, or
communication either party desires or is required to give to the other party shall be in writing and either
served personally or sent by prepaid, first-class mail to the address set forth below, or such other
addresses as may from time to time be designated by mail.
TO CITY:
City of Palm Springs
3200 East Tahquitz Canyon Way
Palm Springs, CA 92262-6959
Attn: City Manager
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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:
Operation Safe House, Inc.
9685 Haves St,
Riverside, CA 92503
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
lATTTTTEEST: corpor i n
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'i Clerk cB/Q S[z b D --eVlCity Manager
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APPRO TO RM: APPROVED BY CITY COUNCIL
By: ✓I Ia �� � 1� ' ��'
City Attorne
PROVIDER, Check one: —Individual —Partnership Corporation
(Corporations require two notarized signatures: One signature m be from the Chairman of
Board, President, or any Vice President. The second signat}t m st be from the Secretary,
Assistant Secretary, Treasurer, A istant Treasurer, or Chief runt q'ffi r).
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By: L By: �r4
Notarized Sj ature of Chairman of Board, N tarized Signature Secretary,eKst Secretary,
Presi ent or any Vice President Treasurer,Asst Treasurer or Chief Financial Officer
Name:/�4:2n6 j�4& 4,,lojw Name: G6F-,^T foaE { Ce�r
Title: Fxsca--me,?F_ Title: ireas-:r�1^
State of state of CA 1,t
Countyof Kh.?1FFiSiCK,ass County of 4?fK :e5r� _ss
On .d17114r,- ll.y7£7 �berpre me, On 'j�a,o,7S- it.pS=1-k. o`Z'=' before me,
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to me(or proved to me on the basis of satisfactory evidence) to me(or proved to me on the basis of satisfactory evidence)
to be the personjorwhose name(2risls7re'subscribed to the to be the person(a)gvhose nane(Wisbwrrsubscribed to the
within instrument and acknowledged to me that.beshelther within instrument and acknowledged to me that he/she/theq
executed the same in Wherabeir authorized capacity(ies), executed the same in hislkerfthei^ authorized capacity(ioe),
and that by K/her/tW signatureWon the instrument the and that by hlslgeNlheir signature(sron the instrument the
personW,, or the entity upon behalf of Which the person(ar person(aj, or the entity upon behalf of which the person(er
acted,executed the instrument, acted,executed the instrument,
WITNESS my hand and official seal. WITNESS my hand and official seal.
Notary Notary 1.
Signature: Signature: �— --nQ
Notary Seal: Notary Seal:
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CITY OF PALM SPRINGS
EXHIBIT A
Scope of Services
Project/Activity Title: Project Number
Operation Safe House, Inc/SafeHouse of the Desert 0001
Name/Address of Provider:
Operation Safe House, Inc.
42-600 Cook St, Ste 201-A 9685 Hayes St
Palm Desert, CA 92211 Riverside, CA 92503
Objectives/Activities
The intent of this program is to provide temporary housing and crisis counseling services for young adults
runaways or homeless, or at high-risk of homeless. This will be accomplished through the construction of
new emergency shelter for youth (ages 12-18) for one hundred and fifty (150) 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
(i.e . 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 qualifies at least_ an-_approximately one hundred and fifty (150)
residents.
TARGET
DATE ACTIVITY#1
On-Going Provide direct client services and advocacy to help this targeted population. 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 92
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: On-site preparation shall include block wall/chain-link fence demolition, and
prubbinglgrading 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
Objective 8: Provide an evaluation within fifteen (15) calendar days of the program completion or final
reimbursement
TARGET
DATE ACTIVITY#1
07/15/02 Provide an evaluation and final report on all programmatic and financial activities.
General Administration
Provide the management oversight and leadership to address specific operational tasks in meeting the
established performance levels, as well as perform supportive activities (i.e., clerical, monitoring, etc.)
CITY OF PALM SPRINGS
EXHIBIT B
Budget Summary
Project/Activity Title: Project Number:
Operation Safe House, Inc/SafeHouse of the Desert 0001
Name/Address of Provider:
Operation Safe House, Inc.
42-600 Cook St, Ste 201-A 9685 Hayes St
Palm Desert, CA 92211 Riverside, CA 92503
BUDGET SUMMARY _
COSTCATEGORY CDBG OTHER TOTAL
SHARE SOURCES COST
1 Personnel $ $ $
2 Consultant/Contract Services $ $ $
3 Travel $ $ $
4 Space Rental $ $ $
5 Consumable Supplies $ $ $
6 Rental, Lease or Purchase of $ $ $
Equipment
7 Insurance $ $ $
8 Other $32,000. $45,000 $77,000
On-Site Improvements
$32,000. $45,000. $77,000.
TOTALS
*If costs are to be shared by other sources of funding, including CDBG funds from other
jurisdictions, identify the source of funding, grantor/lending agency, and cost category information.
Other funding sources primarily are grant-writing and fundraising activities conducted by
Operation Safe House which includes City of Palm Desert's CDBG for$50,000.
Payments, approved by the Subrecipient, shall be paid by the 30th day of each month, provided
that the payment application has been submitted to the City on or before the first working day of
the month
Services are to be performed over the twelve-month period of this 2004-05 Program Year—July 1,
2004 through June 30, 2005
CITY OF PALM SPRINGS
EXHIBIT C
Insurance Inventory
Prolert/ActiyitV Title: Project Number.
Operation Safe House, Inc/SafeHouse of the Desert 0001
Name/Address of Provider: Date:
Operation Safe House, Inc.
42-600 Cook St, Ste 201-A 9685 Hayes St
Palm Desert, CA 92211 Riverside, CA 92503
INSURANCE INVENTORY
LIABILITY INSURANCE POLICY
Name of Provider's Insurance Company Nonprofits' Insurance Alliance
Effective Dates of Policy 07/01/04 to 07/01/05 & 07/01/05 to 07/01/06
Claims Made Policy ! / Per Occurrence Policy
Limits of Liability General Aggregate` 2 000 000
Deductibles:
Per Occurrence
Annual Aggregate
Additional Insured Endorsement (Certificate Holder) o Yes ❑ No
Original Certificate of Insurance Attached ❑ Yes z No
WORKER'S COMPENSATION POLICY
Name of Provider's Insurance Company State Compensation Insurance Fund
Effective Dates 01/01/04 to 01/01/05 & 01/01/05 to 01/01/06
Limits of Liability $1,000,000 Per Occurrence
Underlying Coverage Limits
Original Certificate of Insurance Attached ❑ Yes ® No
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Pmicy NUM6ER: 2007-07722-NPO COMMERCIAL GENERAL LIABILITY
CG 20 26 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ fT CARf=FtiLLY-
ADDITIONAO INSURED - DESIGNATED
PERSON OR ORGANIZATION
This gndorsement modifies insurance provided under the folloWmg:
COMMERCIAL GENERAL I-KRILTY COVERAGE PART
SCHEDULE
Namo Of Additional Insured Penantsi Oro onizatlon s
Any person or organization that you are requirad to add as an additional insured on this policy, under
a written contract or agreement currently an effect, or becoming effective during the term of this policy,
and for which a certificate of insurance naming such person or organization as additional insured has
been issued, but only with respect to their liability arising out of their requirements for certain perform-
ance placed upon you, as a nonprofit organization, in consideration for funding or financial contribu-
tions you receive from them.The additional insured status will not be afforded with respect to liability
arising out of or related to your activities as a real estate manager for that perscin or organization.
Information r wired to complete this Schedule if not shown above will be shown in the Declaralions.
Section 11 - Who Is An Insured is amended to in-
elude as an addWariat insured the person(s)or organi-
zation(s) shown in the Schedule,but only with respect
to liability for "bodily injury', "property damage" or
"personal and advertising injury' caused, in Whole or
in part,by your acts or omisslona or the acts or omis-
sions of those acting on your behalf-.
A. In the peAormance or your ongoing operations;or
a. In connection with your premises owned by or
rented to you.
0020200704 0ISO Properties,Inc .2004 Page I of t A
SECTION tY—COMMERCIAL GENERAL LU1614ITY b. To sue us on this Coverage Par', unless all of
CONDIT{DNS its,terms have been fully complied with.
1. Bankruptcy A person or organization may sue us fo recover on
Bankruptcy or insolvency of the insured or of the an agreed settlement or on a rnal Judgment
Insured'a estate will not relieve us of our obliga- against an insured obtained after an actual trial:
lions under this Coverage Part, but we will not be liable for damages that are not
payable under the terms of this Coverage Part or
2, Duties In The Event Of Occurrence.offense,• that are in excess of the applicable limit of insur-
Claim Or Suit ante An agreed settlement means a settlement
a, You must see to it that we are notified as soon and release of liability signed by us, the Insured
as practicable of an"orcurrence" or an offense and the claimant or the claimant's legal represco-
which may result in a claim.To the extent pos- tative.
sible,notice should include: 0. Other Insurance
(1) How, when and when,the 'occurrence' or If other valid and collectible insurance is awaiiabla
offense took place; to the Insured for a loss we cover under Cover
(2) The names and addresses of any injured ages A or B or this Coverage Part,our obligations
persons and witnesses,and are limited as follows:
(3) The nature and location of any injury or a. p6maryln3urance
damage arising out of the "occur nsce' or This Insurance is primary except when b-below
offense. applies. If this insurance is primary, our oblga-
b, If a claim is made or 'suit is brought against Lions are not affected unless any of the other
any insured,you must: insurance is also Primary. Then, we will strafe
(1) Immediately record the specifics of the with all that other Insurance by the method de-
claim or"suit"and the date received;and scribed in c. below,
(2) Notify us as soon as practicable_ It. Excess Insurance
You must sea to It that wa receive written no- Thls insurance is excess over
tice of the claim or"suit" as soon as practice- (1) Any of the other insurance, whether pd-
ble. Mary, excess, contingent or on any other
c. You and any ether involved insured must brisa-
(1) Immediately sand us copies of any de- (al That is Fire, Extended Coverage,
mands, notices, summonses or legal pa- Builders Risk, Installation Risk or similar
pars received re connection with the claim coverage for"your work";
or"suit"; (b) That is Fire insurance for premI
(2) Auftrize us to obtain records and other rented to you or teinporanly occupied by
reformation;
you with permission of the owner;
(3) Cooperate with us in the investigation or (e) That Is insurance purchased by you to
settlement of the claim or defense against cover your liability as a tenant for"prop-
the'suk':and erty damage" to premises ranted to you
or temporarily occupied by you with
(4) Assist us, upon our repuest, In the en- permission of the owner,or
forcement of any right against any person or
organization. which may be Fable to the in- (d) If floe loss arises out of the maintenance
sured because of injury or damage to which or use of aircraft,'autos"or watercraft to
this insurance may also apply. the extent not subject to Exclusion V. or
Section I Coverage A — Bodily Injury
d. No insured will, except at that insurad'm awn And property Damage Liability.
cast, voluntarily make a payment, assume any
obligation, or incur any expense, other than for (2) Any other primary insurance available to
first aid,without our consent. you covering liability for damages Arising
out of the promises or operations for which
3_ tvgal Action Against Us you have been added as an additional In-
No person or organization has a right under this sured by attachment of an endorsement.
Coverage Parb
a. To join us as a party or otherwise bring us into
a%uif'asking for damages from an insured;of
CG 00 01 Or 98 Copyright, Insurance Unrkes Office,Inc„ 1097 Page 9 of 13 0
when this insurance Is excess, we will have no 8. Representations
duty under Coverages A or B to defend the In- By accepfirtg this policy,you agree:
sured against any'suit'if any other meurer has
a duty to defend the insured against that'sult7. a. The statements In the Declarations are aceu-
If no other insurer defends,we will undertake to rate and complete;
do so, but we will be entitled to the insurer's b. Those statements are based upon representa-
rights against all those other insurers, lions you made to us;and
When this insurance is excess over other in- c. We have Issued this policy in reliance upon
surance, we will pay only our chars or the your representations. _
amount of the loss, if any, That exceeds the 7, Separation Of Insureds
sum of-
(1) The total amount that all such other insur- Except with respect to the Limits of Insurance,and
ante would pay for the IOSs in the absence any rights or duties specifically assigned in this
of this insurance;and Coverage Fart to the first Named Insured,this in-
surance applies.
(2) The total of aA deductible and self-Insured a. As if each Named Insured were the only
amounts under all that other insurance, Named Insured;and
We will share the remaining loss, it any, with b. Separately to each insured against whom claim
any other Insurance that is not described in this is made or"suit"Is brought.
Excess Insurance provision and was not
bought specifically to apply in excess of the 3. Transfer Of Rights Of Recovery Against Others
Limits of insurance shown in the Declarations To Ns
of this Coverage Part. If the woured has rights to recover all or part of any
c. Method Of Sharing payment we have made under this Coverage Part,
If all of the other insurance permits contribution those rights are transferred to us. The insured
by equal Shares, we will fallow this method must do nothing after loss to Impair them. At our
request, the insured will bring "sue"
also. Under this approach each insurer contr those rights transfer
utes equal amounts until it has paid its applica-
ble limit of insurance or none of the less re 9. When We Do Not Rrnew
mains,whichever curves first. IF we decide not to renew this Coverage Part, we
If any of the other insurnnra does not permit will mail or deliver to the first Named Insured
contribution by equal sharis,we will contribute shown in the Declarations written nonce of the
by Ilmns. Under this method, each insurer's nonrenewal not less than 3D days before the expi-
share is based on the ratio of its applicable limit ration date,
of insurance to the total applimnle limits of in- IF r*dce is mailed,proof of moiling will be sufficsnt
surance of as insurers. proof of notice.
5. Premium Audit SECTION V--DEFINITIONS
a. We will compute as premiums [or this Cover- 1. "Advertisement" means a notice that is broadcast
age Part in accordance with our rules and or published to the general putillc or specific mar-
ratm- ket sagments about your goods, products or ser-
h. Premium shown in this Coverage Part as ad- vices for the purpose of attracting custorners or
vance premium is a deposit premium only. At supporters,
the dose of each audit period we will compute Z 'Auto'means a land motor vehicle, trailer a seml-
the earned premium for that period. Audit pre- trailer designed for travel on public roads, Including
mlums are due and payable on notice to the any attached machinery or equipment. But 'auto'
first Named Insured- if the sum of the advance does not w0ude,'mobile equipment".
and audit premiums paid for the policy period is 3 •Bddity Injury means bodily Injury. Sidrness or
earned
grealef than the premium,we will return disease sustained by a person, including death re-
the excess to the First Named Insured. suiting from any of these at any time.
c. The first Named Insured must keep records of 4. 'Coverage territory'means:
the information we need for premium Computa-
tion, and send us copies at such times as we a- The United States of America (Including its
may request. territories and possessions), Puerto Rico and
Canada;
Page 10 of 13 Copyright,Insurance Services C icc,Ina, 1997 CG 80 01 07 98 L7
CERTHOLDER COPY SK
STATE PO, BOX 420807, SAN FRANCISCOACA 94142-0807
CI 5 116sufgA MC
FUND CERTIFICATE of WORKERS' COMPENSATION INSURANCE
ISSUE DATE' 07-15-2001 41401)P: 000i
POLICY ryi.08S1*,, ODD061Y-2D07
CERTIFICATE Ih gb
CIRTIFICATE EXPIRES 01-01-2009
Dt-Dt-ZOD�Jo1-ot-loos
CITY OF PALM SPRINGS SK
21p0 E TA110t11T2 CANYON WAY
PALM SPRINGS CA 92262-69" ,
This is lu "rWy that we Move Isswd a Valid Workers! Compensation Ihawarice policy in a form Approved by the j
California Irtoxivice Commissioner w the ernnlarar narfled below for Ins policy parlod indiooTad
This Policy is not s0h)ept 10 cancoliation by the fund alteoot upon 20 ears advance wrinen mdoe to " emWaYar,
We Will also give You 30 days advance notice shoald firs policy be caneanaq prior to lit norm* expirstiom.
Thid CenrllWre of insurance is not a„ InaKanee pPGer, and dues not amend, axtend or alter the ceverege afforded
wit„ res We dK�to listed
hichrf� car[fieXa of insurance
ng o�be Iscatmmdoor condition
iff may contract
the other
ur lc document
afforded by the policy dasarihad hiror% It subject to all the larms, exclusrons, and conditivrrs, of such policy.
/
t:JJZEP REPRESENTATI PRESIOEhft '
EMPLOYER'S LIASILITT LIMIT INCWOING NF'ENSE COSTS: S1,000.000 PER OCCURRENCE.
EIDORSEMEHT 00015 IM71TLJ0 AOOITIOMAL Ilr6lIREO EMPLOYER EFFECTIVE 2DO7-07-16 IS
ATTA41LD TO AND FOM>•S A PART OF TNIS POLICY. NAME OF ADDITIONAL I16UME0:
CITY OF PALM SPRINGS 1
ENDORSMWNT I20M ENT3TLE0 CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2006 IS
ATTACMD TO AND FORKS A FART OF THIS PULWY.
ptOORSEIIMT 112576 IWITLED WAIVIR OF SL16RORAYIpM EFFECTIVE 2007-07-16 IS
ATTACW0 TO AND FORMS A PART OF THIS POLICY. IMMD PARTY NAME:
CITY OF PAL* SPRINGS ,
EMPLOYER
OPERATION SAFE HOUSE SK
VMS MAYES ST
RIVERSIDE CA 92302
PRINTED 0781BSYW7
IeeV,a-oB! ii
CITY OF PALM SPRINGS
EXHIBIT D
Beneficiary Qualification Statement
Project/Activity Title: Project Number:
Operation Safe House, Inc/SafeHouse of the Desert 0001
Name/Address of Provider: Date
Operation Safe House, Inc.
42-600 Cook St, Ste 201-A 9685 Hayes St
Palm Desert, CA 92211 Riverside, CA 92503
BENEFICIARY QUALIFICATION STATEMENT
This statement must be completed and signed by each person or head of household (legal guardian) receiving benefits farm the
described projectlactivity. 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 grass annual income(Riverside-San 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 $35850
Below 50%
LOW INCOME S30,400 $34,750 $39,100 S43,450 S46,900 S5,400 $53,850 $57,350
51 —80%
MODERATE
INCOME $45.600 $52,100 $58,650 $65,150 $70.350 $76,550 $80.800 $86.000
120%
3. What race/ethnicity do you identify yourself as; please note that this self-identification is voluntary in accordance with
equal opportunity laws?
❑ White ❑ American Indian or Alaska Native AND White
❑ Black/African American ❑ Asian AND White
❑ Asian ❑ Black/African American AND White
❑ Amoncan Indian or Alaskan Native ❑ American Indian/Alaska Native AND Blaek/Afriean American
❑ Native Hawaiian or Other Pacific Islander ❑ Other:
HISPANIC/LATINO ETHNICITY ❑ Yes ❑ No If yes,check one: ❑ Mexican/Chicano
❑ Puerto Rican
0 Cuban
0 Other,
4. Please check, ves or 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 this form is for Community Development Black Grant(CDBG)program purposes only and will be kepi confidential
CITY OF PALM SPRINGS
EXHIBIT E
Program Progress Report
Project/Activity Project/Activity Title: Protect Number,
Operation Safe House, Inc/SafeHouse of the Desert 0001
Name/Address of Provider: Date:
Operation Safe House, Inc,
42-600 Cook St, Ste 201-A 9685 Hayes St
Palm Desert, CA 92211 Riverside, CA 92503
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 Headed Households
♦ Counts by Race/Ethnicity:
White, not Hispanic Origin Black, not Hispanic Origin
Hispanic American Indian/Alaskan Native
Asian Pacific Islander Multi-ethnic
ACCOMPLISHMENT NARRATIVE
LEVERAGING RESOURCES NARRATIVE
Signed Title Date
CITY OF PALM SPRINGS
EXHIBIT F
Request for Reimbursement
Project/Activity Title: Proiect Number:
Operation Safe House, Inc/SafeHouse of the Desert 0001
Name/Address of Provider Date:
Operation Safe House, Inc.
42-500 Cook St, Ste 201-A 9685 Hayes St
Palm Desert, CA 92211 Riverside, CA 92503
A roved Current Prior Total Grant
PP
Doscriptlon Grant Reimbursement Reimbursement YTD balance
Amount Period Period(s) Reimbursement (Over/Under)
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
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-5;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 52,000.00 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 Campbance
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
subreelpients and subcontractors, their successors and assigns, to those sanctions specified by the Agreement through
which Federal assistance is provided. The PROVIDER certifies and agrees that no contractual or other disability exists
which would prevent Compliance with these requirements.
The PROVIDER further agrees to Comply with these 'Section 3" requirements and to include the following language in all
subcontracts executed under this Agreement.
"The work to be performed under this Contract is a project assisted under a program providing direct Federal financial
assistance from HUD and is subject to the requirements of Section 3 of the Housing and Urban Development Act of
1968, as amended, 12 U.S.0 1701 Section 3 requires that to the greatest extent feasible opportunities for training
and employment be given to low- and very low-income residents of the project area and contracts for work in
connection with the project be awarded to business concerns that provide economic opportunities for low-and very
low-income persons residing in the metropolitan area in which the project is located."
The PROVIDER further agrees to ensure that opportunities for training and employment arising in connection with a housing
rehabilitation (including reduction and abatement of lead-based paint hazards), housing construction, or other public
construction project are given to low-and very low-income persons residing within the metropolitan area in which the CDBG-
funded project is located;where feasible, priority should be given to low-and very low-income persons within the service area
of the project or the neighborhood in which the project is located, and to low- and very low-income participants in other HUD
programs, and award contracts for work undertaken in connection with a housing rehabilitation (including reduction and
abatement of lead-based paint hazards), housing construction, or other public construction project are given to business
concerns that provide economic opportunities for low- and very low-income persons residing within the metropolitan area in
which the CDBG-funded project is located where feasible, priority should be given to business concerns which provide
economic opportunities to low-and very low-income residents within the service area or the neighborhood in which the 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. Notifications
The PROVIDER agrees to send to each labor organization or representative of workers with which it has a collective
bargaining agreement or other contract or understanding, if any, a notice advising said labor organization or workers
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.